![]() Some patients are exquisitely tender on rectal examination. The patient will be tender over an area of the colon, most commonly the descending colon. On examination, there is usually a disparity between the severity of the patient's symptoms and his or her physical condition, since they look well. The Rome II Criteria are excellent for standardization of therapeutic trials and the discipline that they brought to the field but their very rigidity brings artificial constraints that will have to be reconsidered in the future ( Camilleri 1998). Recently at a second conference in Rome on IBS, the Rome II Criteria evolved ( Box 8.7). ![]() Cancer phobia is another frequent observation in these patients. They frequently have a past history of appendicectomy for ‘chronic appendicitis’. IBS may have been the cause of pelvic pain in 60% women attending gynaecological clinics, having dilatation and curettage for dysmenorrhoea, 40% having elective hysterectomy, compared to 32% of age-matched controls ( Crowell et al 1994). IBS pain is asociated with nausea without vomiting, dyspepsia, urinary symptoms, especially dysuria, gynaecological symptoms, especially dysmenorrhoea, and headache IBS symptoms may begin after an attack of gastroenteritis ( Gwee et al 1999). However, the patient's appetite is rarely affected, and therefore a history of significant weight loss (i.e., more than 3.5 kg) is unusual and should raise suspicions of an alternative diagnosis. In about half the patients pain is aggravated by eating and relieved by defecation. ‘Meteorism’ is due to ‘air trapping’ in which segmental accumulation of gas occurs.Īlterations of bowel habit, diarrhoea or constipation occur in up to 90% of the patients. It varies from a dull ache to attacks of excruciating severity, lasting from minutes to several hours to all day, but it rarely prevents the patient from sleeping through the night. Limited resections for TC and SF cancers can be performed with the same clinical, oncological and survival outcomes as compared to more extended colectomies if an adequate size of the specimen for the achievement of at least 5 cm of health margin is associated to Central Vascular Ligation.Laurence M Blendis, in Handbook of Pain Management, 2003 Clinical featuresĪbdominal pain is predominantly periumbilical in children ( Milla et al 2001), whereas in adults it tends to occur over the surface markings of the colon with the commonest site in the left lower quadrant, less commonly the right or left upper quadrant over the hepatic or splenic flexures. Despite a shorter length of surgical specimen after limited resections, postoperative complications, lymph node yield, and survival were absolutely comparable in both types of surgical treatments. Arm B patients were treated either with more limited resections (resection of the TC and of the SF) or with extended colectomies (right- and left-sided, standard or enlarged, hemicolectomies), both associated with central vascular ligation. Overall 5-year survival rates were similar in arm A and B (82.3% and 73.05%, respectively P=0.29). Postoperative complications rate was extremely low and comparable in both arms (13.4 and 8.0 in arms A and B, respectively). Operative time was statistically longer in arm B. ![]() In arm A, resections were performed more frequently by mini-invasive approach as compared to arm B. Patients' population of the two arms was homogeneous as concerns demographic characteristics and stage of the disease. Central vascular ligation and the achievement of at least 5 cm of healthy margin were always performed in all procedures of both arms. Out of 1433 patients registered, 500 patients fulfilled all inclusion and exclusion criteria and were allocated in arm A (N.=425) or in arm B (N.=75). Based on tumor location, patients were enrolled in arm A (cancer of the ascending colon, right (hepatic) flexure, left and sigmoid colon) or arm B (cancer of the transverse colon and of the left (splenic) flexure). Several studies tried to investigate which is the optimal surgery for oncological and survival outcomes reporting extended colectomies as more effective than limited resections.Īll consecutive patients with diagnosis of colorectal cancer submitted to surgical resection with anastomosis between January 2005 and December 2016 at the Division of Surgical Oncology and Digestive Surgery, Department of Oncology, at the University of Turin, were included. Cancers of the transverse colon (TC) and of the splenic flexure (SF) are rather uncommon and their prognosis has been reported significantly poorer as compared to right- and left-sided colon cancers.
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