Clinical Case Database / Category: Case Based Discussion

Elective surgery for colorectal cancer - Patient assessment and in-patient management

Publication details

Shahab Siddiqi BSc FRCS(Gen Surg), Irving Taylor FRCS
Foundation Years Journal, volume 2, issue 1, p.7 (123Doc Education, London, January 2008)

Abstract

A 60-year-old bus driver presented to the colorectal clinic with a 6 week history of bright red rectal bleeding and looser stools. There was no history of weight loss and past medical history included asthma, hypertension and hypercholesterolaemia. He takes medication for these and is a long term smoker. Clinical examination revealed a rectal mass and histological analysis confirmed an adenocarcinoma. Blood tests were unremarkable and staging investigations showed no metastatic disease. How would this man’s finess for surgery be assessed? How would he be managed as an inpatient?

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Authors

Shahab Siddiqi BSc FRCS(Gen Surg) (Corresponding author)

Specialist Registrar
Department of Colorectal Surgery
University College Hospital
235 Euston Road
London
NW1 2BU

Irving Taylor FRCS

Professor of Surgery and Vice-Dean
University College London

References

1. Cancer Research UK, 2007. Accessed in November 2007.
2. Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 2005;(1):CD004088.
3. Basse L, Hjort JD, Billesbolle P, Werner M, Kehlet H. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000; 232(1):51-57.
4. Andre T, de Gramont A. An overview of adjuvant systemic chemotherapy for colon cancer. Clin Colorectal Cancer 2004; 4 Suppl 1:S22-S28.
5. Noble EJ, Daniels IR. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection (Br J Surg 2007; 94: 689- 695). Br J Surg 2007; 94(10):1306.
6. Lichtenstein GR, Grandhi N, Schmalz M, Lottes SR, Forbes WP, Walker K et al. Clinical trial: sodium phosphate tablets are preferred and better tolerated by patients compared to polyethylene glycol solution plus bisacodyl tablets for bowel preparation. Aliment Pharmacol Ther 2007; 26(10):1361-1370.
7. Renaut AJ, Raniga S, Frizelle FA, Perry RE, Guilford L. A randomized controlled trial comparing the effiacy and acceptability of phospo-soda buffered saline (Fleet(R)) with sodium picosulphate/magnesium citrate (Picoprep(R)) in the preparation of patients for colonoscopy. Colorectal Dis 2007.
8. Basse L, Thorbol JE, Lossl K, Kehlet H. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 2004; 47(3):271-277.
9. Rehman HU, Mohammed K. Perioperative management of diabetic patients. Curr Surg 2003; 60(6):607-611.
10. Chawla LS, Moore G, Seneff MG. Incomplete reversal of enoxaparin toxicity by protamine: implications of renal insuffiiency, obesity, and low molecular weight heparin sulfate content. Obes Surg 2004; 14(5):695-698.
11. NICE guidance for Venous thromboembolism (surgical), 2007. Accessed in November 2007.
12. McFarland LV. Diarrhoea associated with antibiotic use. BMJ 2007; 335(7610):54-55.
13. Fujita S, Saito N, Yamada T, Takii Y, Kondo K, Ohue M et al. Randomized, multicenter trial of antibiotic prophylaxis in elective colorectal surgery: single dose vs 3 doses of a second-generation cephalosporin without metronidazole and oral antibiotics. Arch Surg 2007; 142(7):657-661.
14. ASCRS and WOCN Joint Position Statement on the Value of Preoperative Stoma Marking for Patients Undergoing Ostomy Surgery. Stoma Siting Procedure. ASCRS . 2003. Accessed in November 2007.
15. Rhodes A, Bennett ED. Early goal-directed therapy: an evidence-based review. Crit Care Med 2004; 32(11 Suppl):S448-S450.
16. Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database of Systematic Reviews 1, 2006. Accessed in November 2007.
17. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2007;(3):CD004929.
18. Tambyraja AL, Sengupta F, MacGregor AB, Bartolo DC, Fearon KC. Patterns and clinical outcomes associated with routine intravenous sodium and fluid administration after colorectal resection. World J Surg 2004; 28(10):1046-1051.
19. Basse L, Raskov HH, Hjort JD, Sonne E, Billesbolle P, Hendel HW et al. Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 2002; 89(4):446-453.
20. Christie IW, McCabe S. Major complications of epidural analgesia after surgery: results of a six-year survey. Anaesthesia 2007; 62(4):335-341.
21. Basse L, Werner M, Kehlet H. Is urinary drainage necessary during continuous epidural analgesia after colonic resection? Reg Anesth Pain Med 2000; 25(5):498-501.
22. Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 2007.
23. Colin JF. Driving after hernia surgery. Patients should be advised not to drive for 10 days. BMJ 2001; 322(7288):735-736.
24. Luchtefeld MA, Ross DS, Zander JD, Folse JR. Late development of metachronous colorectal cancer. Dis Colon Rectum 1987; 30(3):180-184.

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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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