Patients whose colorectal cancer (CRC) is detected during a screening colonoscopy are likely to survive longer than those who wait until they have symptoms before having the test, according to a study.

The study looked at 312 patients in 10 gastroenterology practices in Germany, all aged 55 or older, who were diagnosed with CRC in 2003-2005. Of those, 60 patients were diagnosed during a screening colonoscopy, meaning they had no symptoms and/or only a negative faecal occult blood test (FOBT). The other 252 patients had their cancers detected during a diagnostic colonoscopy,
following a positive FOBT and/or symptoms including abdominal pain, iron deficiency anaemia, weight loss, changes in bowel habits, or rectal bleeding. None of the patients had had a previous colonoscopy, and all received endoscopic follow-up care. The patients were followed for as long as 10 years after diagnosis.

Patients whose cancer was detected during screening colonoscopy lived 20.2 months longer, on average, than those who had the test after noticing symptoms or having a positive FOBT (diagnostic colonoscopy). The latter group tended to have more advanced stage tumors; as expected, those whose cancer was in a more advanced stage had shorter survival times. About 55 percent of the patients with diagnostic colonoscopy, and about 77 percent of the screening
colonoscopy patients, survived beyond the time period of the study.

According to the lead author, Kilian Friedrich, MD,

Patients undergoing colorectal operations who participated in an enhanced recovery program left the hospital  sooner and had significantly lower  hospital costs than patients who had the traditional approach to their care, according to a new study, which also found further postoperative improvements after adding an infection prevention protocol. 

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Surgical robots allow doctors to improve recovery time and minimise scarring.  A study into the safety of surgical robots has linked the machines’ use to at least 144 deaths and more than 1,000 injuries over a 14-year period in the US.
The events included broken instruments falling into patients’ bodies, electrical sparks causing tissue burns and system errors making surgery take longer than planned. The report notes that the figures represent a small proportion of the total number of robotic procedures.

But it calls for fresh safety measures. ‘Despite widespread adoption of robotic systems for minimally invasive surgery, a non-negligible number of technical difficulties and complications are still being experienced during procedures,’ the study states. ‘Adoption of advanced techniques in design and operation of robotic surgical systems may reduce these preventable incidents in the future.’

Robotic surgery can reduce the risk of infections and help patients heal more quickly.
The work was carried out by researchers at the University of Illinois at Urbana-Champaign, the Massachusetts Institute of Technology and Chicago’s Rush University Medical Center.

Their paper says 144 deaths, 1,391 injuries and 8,061 device malfunctions were recorded out of a total of more than 1.7 million robotic procedures carried out between January 2000 and December 2013. This was based on reports submitted by hospitals, patients, device manufacturers and others to the US Food and Drug Administration, and the study notes that the true number could be higher.

Surgeons face the risk of broken parts causing injury or lengthening procedures
Its authors say the number of injuries and deaths per procedure has remained relatively constant since 2007. But due to the fact that the use of robotic systems is increasing ‘exponentially’, they add, this means that the number of accidents is increasing every year.

They highlight that when problems do occur, people are several times more likely to die if the surgery involves their heart, lungs, head and/or neck rather than gynaecological and urological procedures.

They acknowledge that the data does not pinpoint why, but suggest it is because the former are more complex types of operations for which robots are less commonly used, so there is less experience and expertise available.
The researchers did not, however, compare accident rates with similar operations in which robots were not used. Their study has not been peer reviewed.

Surgical robotic devices are typically expensive – costing millions of pounds – but offer advantages.
They can allow surgeons to use smaller instruments, letting them make smaller and more nimble cuts. That can mean patients recover faster, with less risk of infection and the promise of smaller scars.
In addition, the development of remote surgery means that doctors do not always need to be in the same room as their patients, allowing specialists who are in demand to treat more people.

The report acknowledges that the ‘vast majority of procedures’ involving robots were successful BBC

A simple screening tool predicts sepsis early in trauma patients and reduces mortality, according to a new study.