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Objective: To find out whether the biological marker, carbohydrate deficient transferrin (CDT), was helpful in the detection of alcoholic patients in a surgical unit. Design: Prospective open study. Setting: Teaching hospital, Denmark. Subjects: 286 men and 248 women admitted to the department of surgical gastroenterology between March and July 1996. Main outcome measures: Specific interview about drinking and correlation with CDT concentration. Results: 31 men (13%) and 10 women (3%) were alcoholic and at special risk of operation. The correlation between intake and CDT:transferrin ratio was 0.63 for men and 0.53 for women. The correlation between consumption and CDT was better, being 0.77 and 0.58, respectively. Younger women had the lowest correlation (0.33). Sensitivity of CDT for men and women was 100% and 80%, respectively; the specificity was 97% and 96%; the positive predictive value 82% and 44%; and the negative predictive value 97% and 99%. Conclusion: CDT is a valid marker of harmful alcohol intake among surgical patients, except among younger women. [ABSTRACT FROM AUTHOR]

Introduction: The optimal method for perineal reconstruction after extralevator abdominoperineal excision (elAPE) for low rectal cancer remains controversial. This study aimed to assess whether simultaneous perineal reconstruction and parastomal reinforcement with Strattice™ Reconstructive Tissue Matrix after elAPE could prevent hernia formation., Methods: In this prospective, multicentre, observational, non-comparative study of consecutive patients undergoing elAPE for low rectal cancer underwent simultaneous perineal reconstruction and colostomy site reinforcement with Strattice™ mesh. All patients underwent long course chemoradiotherapy prior to surgery and had excision of the coccyx. Patients were assessed for perineal wound healing at 7 day, 1, 3, 6 and 12 months, perineal and parastomal hernia defects on clinical and radiological assessment at 1 year following surgery., Results: 19 patients (median age = 67 years, median BMI = 26, M:F = 11:8) were entered the study. 10 (52.6%) patients underwent laparoscopic elAPE. The median length of post-operative stay was 9 days. Complete wound healing was observed for 8(42%) patients at 1 month, 12(63%) at 3 months, and 19(100%) patients at 12 months. Median time for radiological and clinical assessment for hernias was 12 months. No perineal hernia was detected in 17 patients following CT assessment. Dynamic MRI was undertaken in 11 patients at 12 months and all showed no evidence of perineal hernia. 3 (16%) patients had a parastomal hernia detected radiologically. No mesh was removed during the 12 months follow up period., Conclusion: Perineal and parastomal reconstruction with biological mesh is a feasible approach for parastomal and perineal hernia prevention after laparoscopic and open elAPE.

Introduction: The impact of cancer patient pathways (CPP) on long-term outcome after surgery for colorectal cancer has not been documented. This study aimed to investigate the effect of CPP on survival in patients who underwent surgery for colorectal cancer., Methods: This was a retrospective cohort study performed in a single centre on prospectively collected data from a national database, the Danish Colorectal Cancer Group. In total, we reviewed 309 consecutive patients (145 females) with a median age of 70 years (range: 30-92 years), who underwent surgery for colorectal cancer between 2007 and 2009., Results: A total of 148 patients who underwent elective surgery after the introduction of CPP on 1 April 2008 had a decrease in the median number of days from referral to endoscopy (from 8 to 6, p = 0.001, from referral to oncological treatment (from 46.5 to 32 days, p < 0.001) and from referral to surgery (from 28 to 22 days, p = 0.066), but this latest reduction was not significant. Overall survival (OS) was analysed using the Kaplan Meier method; and variables were compared with the log rank test. The 60-month OS was significantly improved from 61.1% in those who were operated before 1 April 2008 (n = 161) to 72.6% in the CPP group operated after 1 April (p = 0.026). Using the Cox regression model, we found that CPP was an independent factor associated with survival (p = 0.032, hazard ratio = 0.661, 95% confidence interval: 0.454-0.964)., Conclusion: Introduction of CCPs in a single centre was associated with a significant improvement of overall sur-vival, and using Cox regression we found that the CPP was an independent marker for survival. Larger studies are needed to clearly understand the effect of CPP.

Introduction: Pelvic sepsis after Hartmann's procedure for low rectal cancer is a frequent complication. It has been reported at a frequency of 12.2-17.2% and has even reached 33% when the transection level of the rectum is ≤ 2 cm from the anal verge. The aim of this study was to examine whether intersphincteric proctectomy reduces the frequency of pelvic sepsis in patients operated with an extended Hartmann's procedure for rectal cancer., Methods: Patients undergoing elective extended Hartmann's procedure with an intersphincteric proctectomy from 2010 until 2014 were reviewed retrospectively. Patient characteristics and post-operative complications were obtained and analysed., Results: A total of 50 patients were included in this analysis. Sixteen were female, the median age was 73 years, and the median BMI was 26 kg/m2. Furthermore, the American Society of Anesthesiologists (ASA) scores were as follows: ASA 1 (28%), ASA 2 (60%), and ASA 3 (12%); their tumour-node-metastasis (TNM) staging was TNM: ≤ T2 (30%), T3 (50%), and T4 (20%); and 26% had received neoadjuvant radiotherapy, whereas 40% had received chemotherapy. A total of three patients (6%) developed a post-operative pelvic sepsis. The median length of post-operative hospitalisation was 9.5 days. Overall mortality was 4% (n = 50). The most frequent surgical complication to intersphincteric proctectomy was perineal wound infection, occurring in 20%., Discussion: This study suggests a reduction in the frequency of pelvic sepsis when intersphincteric proctectomy is performed in patients who undergo extended Hartmann's procedure. The frequency is, however, larger than that reported herein when the rectal stump is left long. Intersphincteric proctectomy should therefore primarily be reserved for low cancers with short rectal stumps., Funding: not relevant., Trial Registration: not relevant.

Introduction: In colorectal surgery, the most feared complication is anastomotic leakage (AL), which is associated with a high morbidity and mortality. In this study, we focus on treatment of perianastomotic abscess following AL after low anterior resection (LAR) of rectal cancer. In the literature, conservative irrigation regimes are reported to perdure for months and some even years and to be associated with a poor stoma closure rate. In the present paper, we evaluated endoscopic vacuum treatment of the perianastomotic abscess., Material and Methods: Patients who had LAR due to rectal cancer with total mesorectal excision (TME) performed in Slagelse and Næstved Hospitals in the 2008-2012 (1st February) period were identified in the Danish Colorectal Cancer Group database. We included patients who had AL and who did not require emergency reoperation and were treated with endoscopic vacuum in the study period. Patients who initiated treatment more than one month after the leakage were excluded. All patients had primary ileostomy., Results: A total of 13 patients were included. All patients had successful closure of the perianastomotic abscess for a median of 18 (3-40) days in a median of eight (1-18) sessions. The median length of hospital stay was 25 (7-39) days. Mortality was zero, and the stoma closure rate was 12/13 (97%)., Conclusion: Our data support the positive findings previously reported by other studies. Endoscopic vacuum treatment seems to be a safe approach for selected patients in the treatment of perianastomotic abscess after LAR with TME of rectal cancer., Funding: not relevant., Trial Registration: not relevant.