This study showed a comparatively high incidence of minor postoperative complications (83%), but low reported severity of symptoms and a high overall satisfaction rate. Special attention should be paid to reduce these minor complications through more meticulous anesthetic technique.

ObjectiveTo determine the quality of surgical management offered to patients with colorectal cancer (CRC) as measured by adequacy of nodal resections and compare variations across the major hospitals in Jamaica.MethodData was obtained from the CRC Registry of patients diagnosed and treated surgically for CRC during the 3-year period commencing January 1, 2011. Variables analyzed included tumor site, stage and number of lymph nodes resected across hospitals.ResultsDuring the period under review 60% (349) of 586 patients had resections and formed the basis of this study. Of these 49% were treated at the UHWI, 27% from the KPH and STH, 15% from CRH and MRH and 8% from a private laboratory (DPS). Patient distribution was similar at UHWI compared to the others with mean age (61 vs 62) and with slightly more women having surgery (53% Vs 54%) (UHWI vs Others). For tumor grade, margin status, lymphovascular and depth of invasion (majority T3) there was no difference between UHWI and the other sites, although a smaller percentage of tumors treated at UHWI had Crohn's like reaction (p = 0.01). There was a larger proportion of sigmoid cancer at UHWI while the reverse trend was seen in cancers of the rectum (p = 0.027). The tumors treated at UHWI have a larger median number of regional nodes when compared to the other facilities (14 vs 10; p < 0.001) and also more likely to have positive nodes, as were women and younger patients. Comparison across facilities revealed that the proportion of tumors classed as well differentiated, circumferential margin involvement, and having lymphovascular invasion were higher for specimens processed at the private facility (p = 0.021, 0.035, 0.01 respectively). Histopathology reports of tumors treated at UHWI and DPS had median 14 and 18 nodes respectively while at NPH laboratory and CRH they were 9 and 10 respectively (p < 0.001), whilst those of the ascending, descending, sigmoid colon and rectum had median 15, 11, 13, 11 nodes respectively (p < 0.001).ConclusionsThis review demonstrates measurable differences in the surgery and histopathological reports for CRC patients treated across the island. Given adjuvant treatment and prognostic implications there is room for improvement.

This study showed a comparatively high incidence of minor postoperative complications (83%), but low reported severity of symptoms and a high overall satisfaction rate. Special attention should be paid to reduce these minor complications through more meticulous anesthetic technique.

Trauma remains a challenging burden on the often under-funded

Objective: To determine the clinicopathological features of patients with colorectal cancer (CRC) at the extremes of age and compare differences across the younger and older age groups.Method: Data was obtained from the CRC Registry for patients diagnosed during the 4-year period commencing January 1, 2011. Variables analyzed included clinical presentation, tumour site, stage, various histopathologic features and adequacy of nodal resection. Results:Of 900 cases entered into our database, 59 were age 40 and under and 119 were age 80 and over (7% and 13% respectively). These patients were referenced with patients diagnosed between age 50-70 years and they formed the basis of this study. Common clinical presentations across both groups were bleeding per rectum (26% vs 17%), change in bowel habits (both 31%) and abdominal pain (16% vs 14), with no statistical difference between groups (P = 0.556). Most tumours occurred in the rectum (27%) and the sigmoid colon (26%) with 72% of all tumours being moderately differentiated. Comparison across age groups revealed equivalent tumour distribution. However, younger patients had more signet ring histology (15% vs 4%; P = 0.035) while there was a trend towards older patients having perineural invasion (15% vs 7%; P = 0.088). All categories of patients had similar tumour (T) stage while significantly more nodes were examined for younger patients (P = 0.002). The number of positive nodes did not differ between the two extremes (P = 0.500). Conclusions:This review demonstrates that while there are a few measurable differences in CRC in patients at the extremes of age, most patients were overall similar in their clinical symptoms, tumour distribution and stage at diagnosis.