Search

Introduction Low anterior resections (LAR) of rectum with sphincter salvage have become increasingly popular in the management of low and mid rectal cancers as their oncological safety and potential to improve quality of life have been established. The advent of neoadjuvant therapy and circular stapling devices has improved sphincter salvage rates in rectal cancer. Anastomotic dehiscence is a potential complication of LAR and can lead to significant postoperative morbidity and mortality. The present meta-analysis addresses the potential role of protective diversion ileostomy in LAR to lessen the anastomosis leak rates and reoperation rates. Methods A literature search was performed in Pubmed for the randomized controlled trials (RCTs) that compared the role of protective ileostomy with no-ileostomy in low anterior resection of the rectum, published prior to October 2016. Review manager (Cochrane Collaboration's software) version RevMan 5.2 was used for analysis. The effect size for dichotomous and continuous data was displayed as relative risk (RR) and weighted mean difference (WMD) respectively with their corresponding 95% confidence intervals. A fixed effect or random effects model was used to pool the data according to the result of a statistical heterogeneity test. Heterogeneity between studies was evaluated using the Cochran Q statistic and the I2 test, with p < 0.05 indicating significant heterogeneity. Results There were five RCTs available for the analysis. A total of 768 patients were included in the meta-analysis - 390 underwent protective diversion ileostomy at the time of LAR in rectal cancer while 378 patients did not. The fashioning of ileostomy significantly decreased the anastomosis leak rates (RR 0.33, 95% CI 0.21-0.51, p value <0.000) and reoperation rates (RR 0.26, 95% CI 0.15-0.45, p value <0.000). Conclusion The present metaanalysis supports the beneficial role of protective diversion ileostomy in LAR in rectal cancer as it decreases the anastomotic leak rates by one third and reoperation rates by one fourth. [ABSTRACT FROM AUTHOR]

Introduction: Local treatment of metastatic cystosarcoma phyllodes is classically viewed with skepticism because it does not provide survival benefit. When these advanced tumors ulcerate, they reduce quality of life dramatically because of associated pain, infection, malodor, massive discharge, and bleeding., Case Presentations: Two patients with metastatic cystosarcoma phyllodes presented to our hospital with recurrent disease featuring foul-smelling, ulcerated chest wall masses that caused physical pain and social exclusion. The first patient underwent radical chest wall resection with pedicled lattisimus dorsi flap reconstruction. The second patient underwent wide local excision with split-thickness skin grafting. There was significant improvement in the quality of life for these patients after the operations., Discussion: Though both patients finally succumbed to progressive metastatic disease, palliative resection allowed them to have good social and family support to the end. Palliative surgery plays an important role in alleviating suffering of patients with metastatic fungating cystosarcoma phyllodes and has the potential to improve their quality of life significantly.