Background: Anastomotic leakage (AL) significantly impairs short-term outcomes. The impact on the long-term outcomes remains unclear. This study aimed to identify the risk factors for AL and the impact on long-term survival in patients with left-sided colorectal cancer.Methods: Nine-hundred patients with left-sided colorectal carcinoma who underwent sigmoid or rectal resection were enrolled in the study. Risk factors for AL after sigmoid or rectal resection were identified, and long-term outcomes of patients with and without AL were compared.Results: AL rates following sigmoid and rectal resection were 5.1% and 10.7%, respectively. Higher ASA score (III–IV; OR = 10.54,p= 0.007) was associated with AL in patients undergoing sigmoid surgery on multivariable analysis. Male sex (OR = 2.40,p= 0.004), CCI score > 5 (OR = 1.72,p= 0.025), and T3/T4 stage tumors (OR = 2.25,p= 0.017) were risk factors for AL after rectal resection on multivariable analysis. AL impaired disease-free and overall survival in patients undergoing sigmoid (p= 0.009 andp= 0.001) and rectal (p= 0.003 andp= 0.014) surgery.Conclusion: ASA score of III–IV is an independent risk factor for AL after sigmoid surgery, and male sex, higher CCI score, and advanced T stage are risk factors for AL after rectal surgery. AL impairs the long-term survival in patients undergoing left-sided colorectal surgery.

Purpose: To compare the results of laser hemorrhoidoplasty (LHP), excisional hemorrhoidectomy (EH), and sutured mucopexy (MP). Methods: A randomized, parallel-group, double-blinded, single-center prospective study. Patients: Symptomatic 2nd- or 3rd-degree hemorrhoids patients. Interventions: Computer randomization sequence, patient blinding, operating surgeon blinding, and surgeon-evaluator blinding. LHP was performed using a 1470 nm diode laser. Up to 250 J of energy delivered per 1 hemorrhoid. The procedure was performed circumferentially. MP ligations were placed in the area of visible hemorrhoidal tissue. Standard EH was performed up to the level of the hemorrhoidal pedicle. Follow-up at 1 and 6 weeks and 1 year. Outcome measures: Recurrence of symptoms requiring treatment, intensity, and duration of pain after the operation, patients’ quality of life, fecal incontinence, and patients’ evaluation of treatment. Results: A total of 121 patients. Groups were even preoperatively. LHP took 15 min (SD 5.6), MP took 16 min (SD 5.58), and EH took 29 min (SD 10.3). Recurrence requiring treatment rate was 0% after EH, 10% after LHP, and 22% after MP, p = 0.004. LHP and MP were less painful than EH, p < 0.001. Patients after LHP returned to regular activity after 15 days, after MP after 22 days, and after EH after 30 days, p < 0.001. SF-36 scores were better after EH. Symptoms of fecal incontinence improved in all the groups. Patients evaluate LHP better than EH and MP. Limitations: Single-center study. Conclusions: Laser hemorrhoidoplasty is a safe, minimally invasive option for hemorrhoids, more effective than MP and less effective than EH. Patients evaluate this technique better than the other two.

Postoperative ileus is common problem after colorectal surgery. A positive effect of coffee to bowel movement has been described. It is still unclear whether coffee decreases the risk of postoperative ileus. The purpose of this study was to determine whether consuming a 100-mL cup of coffee is effective in preventing or reducing postoperative ileus. This was a prospective, single-center, randomized controlled study. The study was conducted at a university teaching hospital. All of the patients who were scheduled for elective laparoscopic left-sided colectomy at our hospital after the detection of malignant disease in a preoperative biopsy between January 2013 and December 2014 entered the study. The patients were assigned randomly before surgery to receive coffee with caffeine (first group), coffee without caffeine (second group), or water (third group) after the procedure (100 mL 3 times daily). The primary end point was time to first bowel movement; secondary end points were time to first flatus and time to tolerance of solid food. A total of 105 patients were randomly assigned, 35 to each group. Fifteen patients were excluded. Patient demographic characteristics were similar in the groups. The time until the first bowel movement (measured in days) was significantly (p < 0.05) shorter in the decaffeinated coffee group (3.00 ± 1.50) versus the coffee with caffeine (3.75 ± 1.53) and water groups (4.14 ± 1.14). The time until tolerance of solid food was significantly shorter in decaffeinated group versus coffee with caffeine and water groups (1.85 versus 2.60 and 2.80; p < 0.05). Time until the first flatus (1.47 versus 1.57 and 1.77 for decaffeinated coffee versus coffee with caffeine and water; p > 0.05) did not show statistical significance. Postoperative hospital stay was similar in all 3 of the groups. This is a single-center study with a relatively small sample size. Coffee consumption after colectomy was safe and in the decaffeinated group associated with a reduced time to first bowel action. Caffeine is not a main ingredient affecting the length of postoperative ileus.

Introduction For more than the last 20 years, low anterior resection with total mesorectal excision (TME) is a gold standard for rectal cancer treatment. Oncological outcomes have improved significantly and now more and more reports of functional outcomes appear. Due to the close relationship between the rectum and pelvic nerves, bowel, bladder, and sexual function are frequently affected during TME. Methods A search for published data was performed using the MEDLINE database (from 1 January 2005 to 31 January 2015) to perform a systematic review of the studies that described anorectal, bladder, and sexual dysfunction following rectal cancer surgery. Methodological quality of the included studies was assessed using the MINORS criteria. Results Eighty-nine studies were eligible for analysis. Up to 76% of patients undergoing sphincter preserving surgery will have changes in bowel habits, the so-called “low anterior resection syndrome” (LARS). The duration of LARS varies between a few months and several years. Pre-operative radiotherapy, damage of anal sphincter and pelvic nerves, and height of the anastomosis are the risk factors for LARS. There is no evidence-based treatment available for LARS. Sexual function is more commonly affected after rectal surgery than after urinary function. The main cause of dysfunction is damage to pelvic nerves. Sexual and bladder functional outcomes in females are less well reported. Laparoscopic and robotic surgery allows better visualization of autonomic nerves and, therefore, more precise dissection and preservation. Conclusions It is important that rectal resection is standardized as much as possible, and that new functional outcome research use the same validated outcome questionnaires. This would allow for a high-quality meta-analysis.

Study aimed to assess long-term bowel function in patients who underwent low anterior resection for cancer five and more years ago. Patients who underwent low anterior resection for rectal cancer from 2010 to 2015 at National Cancer Institute were prospectively included in our study. They were interviewed using low anterior resection syndrome (LARS) score and Wexner questionnaire. We also assessed possible risk factors of postoperative bowel disorder. 150 patients were included in our study. Of them 125 (83.3%) were analysed. The median age at diagnosis was 62 years (40–79), and the average time of follow-up was 7.5 years (5–11). Overall, 58 (46.4%) patients had LARS, of them 33 (26.4%)—major LARS and 25 (20%)—minor LARS and 67 (53.6%) reported no LARS. Wexner score results were: normal in 43 (34.4%) patients, minor faecal incontinence—55 (44%), average faecal incontinence—18 (14.4%), complete faecal incontinence—9 (7.2%). 51 patients (40.8%) had tumour in the upper third rectum, 51 (40.8%)—in the middle and 23 (18.4%)—lower third. Preoperative (chemo)radiotherapy was the only significant risk factors for developing LARS in univariate analysis. Our study showed that only preoperative radiotherapy may be associated with more late problems in defecation after rectal cancer surgery.Trial registration: NCT03920202.