Call for New Staging System for Advanced Colorectal Cancer

Experts in treating colorectal cancer that has spread to distant sites say that the need for a better staging system for advanced disease is urgent. More specific staging could identify patients whose cancer could be cured with surgery.  For others, modern chemotherapy might make curative surgery possible.

In addition, a more precise staging system, with more categories, would provide better survival prognosis.

Currently all patients whose cancer has spread beyond their colon or rectum to distant sites (metastatic colorectal cancer) are lumped together in one group, classified as stage IV or Dukes D.  No difference is made for those who have liver tumors that could be surgically removed or those where chemotherapy might make surgical cure possible. Continue reading…

Posted by Kate Murphy on August 19th, 2008
Posted in: Research & Treatment News | No Comments »
Tags: metastatic colorectal cancer, staging, surgery

FDA Approves Entereg to Improve Post-Surgery Bowel Function

The FDA has approved Entereg® (alvimopan) to speed the restoration of normal bowel function after intestinal surgery.

However, the approval comes with a Risk Evaluation and Mitigation Strategy (REMS) to be sure that the benefits of using Entereg outweigh any potential risks.  Under the REMS, the drug can only be used only in hospitals for inpatients.  Hospitals that use it must be certified and materials developed for the health care professionals who administer it.  Its effectiveness must be regularly assessed. Continue reading…

Posted by Kate Murphy on May 28th, 2008
Posted in: Research & Treatment News | No Comments »
Tags: FDA, ileus, surgery

Chewing gum speeds recovery after laparoscopic colon surgery

Chewing gum a few times a day reduces the time it takes for bowel function to return after laproscopic colectomy, allowing patients to leave the hospital sooner. Patients who chewed a stick of gum four times a day had bowel activity return sooner and went home on average almost a day earlier than patients who were restricted to sips of water after surgery.

During surgery to treat colon cancer by removing all or part of the colon, rhythmic bowel activity stops, a condition known as *postoperative ileus*. Eating or drinking during this time can lead to bloating, abdominal pain, and vomiting. Until normal bowel motility returns, patients have been limited to ice chips or very small sips of clear liquids. They cannot leave the hospital until they can eat and drink normally and have had at least one bowel movement.

Surgeons at the University of Texas Southwestern Medical Center, Dallas; Western Pennsylvania Hospital, Pittsburgh; and Presbyterian Hospital, Dallas randomized 102 patients undergoing both traditional open colectomy and laparoscopic colectomy to chew a stick of gum four times a day or be in a control group that was not given gum. Their research was discussed at the American College of Surgeons 2005 Clinical Congress in San Francisco.

For those who had laparoscopic surgery, bowel function returned for gum chewers an average of 2.9 days after surgery compared to 3.5 days for the control group. They left the hospital 4.4 days post-surgery compared to 5.2 days for the group that did not chew gum.

However, there was no similar difference for patients who had open colectomy. Both gum chewers and the control group had bowel function return at 3.6 days. Gum chewers went home at 5.9 days compared to 5.3 days for controls.

Harry Papaconstantinou, MD, who led the study explained that

There are multiple stimuli that can affect the gut motility after surgery, and some of these are manipulation of the bowel during surgery, the type of anesthetic used, any inflammation that might be caused by the surgery, as well as alterations in the autonomic [peripheral] nervous system, the release of neurotransmitters [chemical substances that influence the transfer of nerve impulses to muscle] and gut hormones. When patients undergo colectomy, all of these factors can be significant stimuli that results in postoperative ileus.

He estimated that each day in the hospital costs an average of $500 to $750 and that the small cost of several packs of gum could have a major impact on medical costs after laparoscopic surgery.

Posted by Kate Murphy on October 23rd, 2005
Posted in: Research & Treatment News | 6 Comments »
Tags: side effects, surgery