levoleucovorin and Urinary-Bladder-Fistula

The aim of the present study was to compare the influence of preoperative chemoradiotherapy (CRT) with postoperative CRT on the incidence and types of postoperative complications in rectal cancer patients who underwent sphincter-saving resection.. We reviewed 285 patients who received preoperative CRT and 418 patients who received postoperative CRT between January 2000 and December 2006.. There was no between-group difference in age, gender, or cancer stage. In the pre-CRT group, the mean level of anastomosis from the anal verge was lower (3.5 +/- 1.4 cm vs. 4.3 +/- 1.7 cm, p < 0.001) and the rate of T4 lesion and temporary diverting ileostomy was higher than in the post-CRT group. Delayed anastomotic leakage and rectovaginal fistulae developed more frequently in the pre-CRT group than in the post-CRT group (3.9% vs. 1.2%, p = 0.020, 6.5% vs. 1.3%, p = 0.027, respectively). Small bowel obstruction (arising from radiation enteritis) requiring surgical intervention was more frequent in the post-CRT group (0% in the pre-CRT group vs. 1.4% in the post-CRT group, p = 0.042). Multivariate analysis identified preoperative CRT as an independent risk factor for fistulous complications (delayed anastomotic leakage, rectovaginal fistula, rectovesical fistula), and postoperative CRT as a risk factor for obstructive complications (anastomotic stricture, small bowel obstruction). The stoma-free rates were significantly lower in the pre-CRT group than in the post-CRT group (5-year stoma-free rates: 92.8% vs. 97.0%, p = 0.008).. The overall postoperative complication rates were similar between the pre-CRT and the Post-CRT groups. However, the pattern of postoperative complications seen after sphincter- saving resection differed with reference to the timing of CRT.

Topics: Adenocarcinoma; Adult; Aged; Anal Canal; Anastomosis, Surgical; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Deoxycytidine; Drug Administration Schedule; Enteritis; Female; Fluorouracil; Humans; Ileostomy; Intestinal Obstruction; Korea; Leucovorin; Male; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy; Postoperative Complications; Preoperative Care; Radiotherapy Dosage; Rectal Fistula; Rectal Neoplasms; Rectovaginal Fistula; Rectum; Urinary Bladder Fistula; Young Adult

The increase in longevity among patients with cystic fibrosis has brought to light comorbidities associated with the disease that are less acutely fatal than its pulmonary manifestations. Modern retrospective analysis has demonstrated an increased risk of gastrointestinal malignancy in patients with cystic fibrosis, with a marked elevation in malignancy rates among patients in their 20s and 30s. Here we report a case of colonic adenocarcinoma presenting as pneumaturia in a 13-year-old patient with cystic fibrosis.

Topics: Adenocarcinoma; Adolescent; Air; Anastomosis, Surgical; Antineoplastic Combined Chemotherapy Protocols; Cecal Neoplasms; Colectomy; Combined Modality Therapy; Cystic Fibrosis; Fluorouracil; Humans; Intestinal Fistula; Leucovorin; Male; Organoplatinum Compounds; Oxaliplatin; Ultrasonography; Urinary Bladder Fistula; Urine