Peter M. Neary

Treatment of locally advanced rectal cancer remains one of the most challenging in colorectal surgery. It has had an evolving landscape over the past three decades. This review describes the introduction of total neoadjuvant therapy—a term aimed to describe an approach where both systemic chemotherapy and chemoradiation are administered in the preoperative setting. This novel strategy has come to the fore with the strength of well-documented results of recent trials. Its implementation has begun globally, but long-term outcomes and data analysis to identify optimal schedules are eagerly awaited. Received: 20 September 2022 Accepted: 05 December 2022 Article published online: 02 February 2023 © 2023. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Treatment of locally advanced rectal cancer remains a challenge in colorectal surgery. It has had an evolving landscape over the past three decades. Implementation of total neoadjuvant therapy (TNT) as a novel approach to management has begun globally but long-term outcomes and data analysis to identify optimal schedules are eagerly awaited. We report a case of locally advanced rectal cancer management in a young male with a complete pathological response to TNT.

A 37-year-old male healthcare worker presented to the medical assessment unit complaining of a 3-month history of lethargy, weight loss, night sweats and intermittent abdominal discomfort. On examination there was some dullness to percussion at the right lung base and decreased breath sounds. He had mild generalised tenderness in his abdomen. Blood tests were normal. Chest x-ray and CT of the thorax showed small bilateral pleural effusions with no other abnormality. CT of the abdomen and pelvis however, showed ascites with extensive thickening of the peritoneum and marked induration of the mesentery and omentum. Mantoux test was positive. Laparoscopy was undertaken to outrule intra-abdominal malignancy and confirmed the diagnosis of tuberculosis. Peritoneal wall biopsies were taken from which Mycobacterium was isolated confirming peritoneal tuberculosis. He was started on rifampicin, isoniazid, pyrazinamide and ethambutol and completed a 6-month course without further complications.

Thyroid drains following thyroid surgery are routinely used despite minimal supportive evidence. Our aim in this study is to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-determined fluid accumulation at 24 hours.

Aim. This study determined the usefulness of an interactive, individualized online patient pathway to patients undergoing elective operation for nonmalignant disease. Methods. An exploratory double-blind, prospective randomized controlled trial was established involving consecutive patients undergoing minimally invasive radioguided parathyroidectomy (MIRP). A total of 64 patients were randomly assigned to either a standard or an enhanced Web site (interactive with detailed, personalized timeline). Each patient completed validated Hospital Anxiety and Depression Scale questionnaires preoperatively and pain assessments and questionnaires concerning Web site usefulness postoperatively. Results . All patients found their Web site useful, although patient satisfaction was significantly higher with the enhanced Web site in regard to overall impression as well as ease, organization, usefulness, and specificity of information. There were no significant differences in mean anxiety or pain scores, in analgesia requirements, or adequacy of informed consent. Conclusion. Providing education and information through a tailored Web server is viewed positively by patients.

Taurolidine consists of two taurinamide rings derived from the naturally occurring amino acid taurine. It has been utilized to prevent adhesions, as an antimicrobial, and as an anti-inflammatory agent. More recently, it has been found to exert antineoplastic activity. We reviewed the literature regarding taurolidine and its role in cancer treatment. Taurolidine induces cancer cell death through a variety of mechanisms. Even now, all the antineoplastic pathways it employs are not completely elucidated. It has been shown to enhance apoptosis, inhibit angiogenesis, reduce tumor adherence, downregulate proinflammatory cytokine release, and stimulate anticancer immune regulation following surgical trauma. Apoptosis is activated through both a mitochondrial cytochrome-c-dependent mechanism and an extrinsic direct pathway. A lot of in vitro and animal data support taurolidine’s tumoricidal action. Taurolidine has been used as an antimicrobial agent in the clinical setting since the 1970s and thus far appears nontoxic. The nontoxic nature of taurolidine makes it a favorable option compared with current chemotherapeutic regimens. Few published clinical studies exist evaluating the role of taurolidine as a chemotherapeutic agent. The literature lacks a gold-standard level 1 randomized clinical trial to evaluate taurolidine’s potential antineoplastic benefits. However, these trials are currently underway. Such randomized control studies are vital to clarify the role of taurolidine in modern cancer treatment.