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Background: The management of lateral pelvic lymphadenopathy in low rectal cancer poses an oncological and technical challenge. Interpretation of the literature is confounded by different approaches to management in the East and West, and a lack of randomized data from which to draw accurate conclusions regarding the optimal approach. Recent collaboration between Eastern and Western centres has increased the standardization of care. Despite this, significant differences in international guidelines remain. The aim of this review was to appraise the available literature and propose a management algorithm., Methods: A literature review of all relevant studies was performed to summarize the historical evidence, as well as establish the significance of clinically positive lateral pelvic sidewall nodes, and the role of neoadjuvant chemoradiotherapy and lateral pelvic node dissection. A management algorithm was developed based on this review of the literature., Results: The management of pelvic sidewall lymphadenopathy in rectal cancer is non-standardized, with geographical differences. The mechanism of lateral lymphatic spread is well defined; the risk increases with lower tumour height and advanced T category. Existing data indicate that acceptable disease-free and overall survival can be achieved by neoadjuvant chemoradiotherapy with selective lateral pelvic node dissection., Conclusion: Suspicious lateral pelvic sidewall nodes, particularly in the internal iliac chain, should be considered as resectable locoregional disease, and surgery offered for enlarged nodes that do not respond to neoadjuvant chemoradiotherapy., (© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.)

Background: The growth pattern of colorectal cancer is seldom investigated. This cohort study aimed to explore tumour growth rate in colorectal cancers managed non-surgically or deemed not resectable, and to determine its implication for prognosis., Methods: Consecutive patients with colonic or rectal adenocarcinoma were identified through the colorectal multidisciplinary team database at Leeds Teaching Hospitals NHS Trust over a 2-year interval. Patients who received no treatment (surgery, stenting, colonic defunctioning procedures, chemotherapy, radiotherapy) and who underwent CT twice more than 5 weeks apart were included. Multidetector CT/three-dimensional image analysis was performed independently by three experienced radiologists., Results: Of 804 patients reviewed, 43 colorectal cancers were included in the final analysis. Median age at first CT was 80 (73-85) years and the median interval between scans was 150 (i.q.r. 72-471) days. An increase in T category was demonstrated in 31 of 43 tumours, with a median doubling time of 211 (112-404) days. The median percentage increase in tumour volume was 34·1 (13·3-53·9) per cent per 62 days. The all-cause 3-year mortality rate was 81 per cent (35 of 43) with a median survival time of 1·1 (0·4-2·2) years after the initial diagnostic scan. In those obstructed, the relative risk of death from subsequent perforation was 1·26 (95 per cent c.i. 1·07 to 1·49; P = 0·005)., Conclusion: This study documented a median doubling time of 211 days, with a concerning suggestion of tumour progression, which has implications for the current management standard., (© 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society.)

Imaging of rectal cancer has an increasingly pivotal role in the diagnosis, staging, and treatment stratification of patients with the disease. This is particularly true for advanced rectal cancers where magnetic resonance imaging (MRI) findings provide essential information that can change treatment. In this review we describe the rationale for the current imaging standards in advanced rectal cancer for both morphological and functional imaging on the baseline staging and reassessment studies. In addition the clinical implications and future methods by which radiologists may improve these are outlined relative to TNM8., (Copyright © 2019 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Purpose: Chronic pain following inguinal hernia repair is a complex problem. Mesh fixation with sutures may be a contributing factor to this pain. The aim of this study was to compare the incidence of chronic pain and limitation of activities of daily living following inguinal hernia repair using a sutured mesh to a self-adhesive mesh, 6 months and 1 year following surgery., Methods: All consecutive patients presenting to NHS Fife for open hernia repair between January 2009 and January 2010 were included in our analysis. A prospective survey of postoperative pain and activities of daily living was conducted at 6 months and 1 year following hernia repair. Chronic pain was assessed using the SF-36 questionnaire. The primary end points for analysis were incidence of chronic pain and limitation of activities of daily living., Results: Overall, 132 of 215 patients completed the questionnaire, 69 in the sutured group and 63 in the self-adhesive mesh group. The need for analgesics was similar during the first 24 h after surgery. Wound infections were detected in one patient in the Lichtenstein group and two in the second group. The incidence of chronic pain was 21 and 7.9% at 6 months and 18.8 and 6.3% at 1 year (p < 0.05). Moderate and vigorous activities were found to be limited some to all of the time in nine patients (60%) in the suture fixation group and in one patient in the self-adhesive group (20%, p < 0.02)., Conclusions: Open inguinal hernia repair with a self-adhesive mesh may lead to less chronic pain and less restriction of activities of daily living than a sutured mesh fixation.

The adenomatous polyposis coli gene (Apc) is mutated in most colorectal cancers. The multifunctional character of the Apc protein in the regulation of beta-catenin-mediated gene transcription and cytoskeletal proteins has been well described. An important question is how this protein affects the behaviour of cells within a tumour and how its mutational status influences the prognosis for these tumours. Here we provide an overview of the functions of Apc and examine how this information can be used in the prognosis and development of directed therapy in colorectal cancer.