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Diseases of the Colon & Rectum Volume 57: 3 (2014)
abandoned immediately, as it perfectly mimics the most probable cause of pilonidal sinus disease − ie, shaving produces large numbers of cut hairs ready to pierce the natal cleft. This errant recommendation in the Practice Parameters should be corrected. REFERENCES 1. Steele SR, Perry WB, Mills S, Buie WD; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of pilonidal disease. Dis Colon Rectum. 2013;56:1021–1027. 2. Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S, Duesel W. Timeline of recurrence after primary and secondary pilonidal sinus surgery. Dis Colon Rectum. 2007;50: 1928–1934. 3. Gips M, Melki Y, Salem L, Weil R, Sulkes J. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum. 2008;51:1656–1662. 4. Rao MM, Zawislak W, Kennedy R, Gilliland R. A prospective randomised study comparing two treatment modalities for chronic pilonidal sinus with a 5-year follow-up. Int J Colorectal Dis. 2010;25:395–400. 5. Doll D. 5- and 10-year recurrence rate is the new gold standard in pilonidal sinus surgery benchmarking. Med Princ Pract. 2010;19:216–217. 6. Doll D, Matevossian E, Wietelmann K, Evers T, Kriner M, Petersen S. Family history of pilonidal sinus predisposes to earlier onset of disease and a 50% long-term recurrence rate. Dis Colon Rectum. 2009;52:1610–1615. 7. Petersen S, Wietelmann K, Evers T, Hüser N, Matevossian E, Doll D. Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum. 2009;52:131–134. 8. BUIE LA. Jeep Disease (Pilonidal Disease of Mechanized Warfare). Southern Medical Journal. 1944;37:103–109. 9. FAVRE R,DELACROIX P. [Apropos of 1,110 Cases of Pilonidal Disease of Coccy-Perineal Localization.]. Mem Acad Chir. 1964;90:669–676. 10. Doll D, Friederichs J, Dettmann H, Boulesteix AL, Duesel W, Petersen S. Time and rate of sinus formation in pilonidal sinus disease. Int J Colorectal Dis. 2008;23:359–364. 11. Sievert H, Evers T, Matevossian E, Hoenemann C, Hoffmann S, Doll D. The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients. Int J Colorectal Dis. 2013;28:1555–1562. 12. Doll D, Matevossian E, Hoenemann C, Hoffmann S. Incision and drainage preceding definite surgery achieves lower 20-year long-term recurrence rate in 583 primary pilonidal sinus surgery patients. J Dtsch Dermatol Ges. 2013;11:60–64. 13. Doll D, Novotny A, Rothe R, et al. Methylene Blue halves the long-term recurrence rate in acute pilonidal sinus disease. Int J Colorectal Dis. 2008;23:181–187. 14. Brückner B,Volmerig J. Zur Wirksamkeit von Sulmycin-Implantat bei der geschlossenen Behandlung des Sinus pilonidalis. Wehrmedizinische Monatsschrift. 1997;41:141–145.
15. Doll D, Evers T, Matevossian E, Hoffmann S, Krapohl BD, Bartsch DK. Does Gentamycin affect long term recurrence rate in pilonidal sinus surgery? European Surgery. Acta Chirurgica Astriaca. 2011;43:236–243. 16. Bunke HJ, Schultheis A, Meyer G, Düsel W. [Surgical revision of the pilonidal sinus with single shot antibiosis]. Chirurg. 1995;66:220–223. 17. Evers T, Doll D, Matevossian E, et al. [Trends in incidence and long-term recurrence rate of pilonidal sinus disease and analysis of associated influencing factors]. Zhonghua Wai Ke Za Zhi. 2011;49:799–803.
Dietrich Doll, M.D., Ph.D. Vechta, Germany
Comment on Time to Initiation of Postoperative Chemotherapy: An Outcome Measure for Patients Undergoing Laparoscopic Resection for Rectal Cancer
W
e were greatly impressed by Strouch’s article1 on using time to initiation of postoperative chemotherapy as an outcome measure for laparoscopic resection of rectal cancer. Instead of focusing on short-term or long-term outcomes, the authors devised an innovative measure that both reflects postoperative recovery and predicts overall survival. The potential benefits of early adjuvant chemotherapy in rectal cancer patients treated with laparoscopic surgery are noteworthy, and this article may open a new area for clinical researchers. Nevertheless, we noticed several limitations in this pioneering article. The study fails to mention the criteria used to select patients for laparoscopic surgery or to provide such preoperative patient information as tumor size, sign of ileus, and previous history of abdominal surgery.2,3 This information is crucial for deciding the type of operation, and the absence of those data could make the 2 groups of patients difficult to compare at all, let alone discern a clear difference in tumor location. Moreover, with respect to the timing of the postoperative chemotherapy, the study tries to reduce the surgeon’s influence by leaving the decision Financial Disclosure: None to declare. Correspondence: Ziqiang Wang, M.D., Department of Gastrointestinal Surgery, West China Hospital, Sichuan University Chengdu, Sichuan, China. E-mail: [email protected] Dis Colon Rectum 2014; 57: e33–e34 DOI: 10.1097/DCR.0000000000000073 © The ASCRS 2014
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to the medical oncologist alone. We believe cancer treatment should reflect an integrated strategy, and working separately does not fit the code of multidisciplinary management of patients.4 Establishing clear criteria for the application of adjuvant chemotherapy could be a better approach, as it would eliminate the potential for an overly aggressive or overly conservative medical oncologist to make an arbitrary decision. To verify the true benefit of laparoscopic rectal cancer surgery based on timing of postoperative chemotherapy, future prospective, randomized controlled trials are needed. References 1. Strouch MJ, Zhou G, Fleshman JW, et al. Time to initiation of postoperative chemotherapy: an outcome measure for patients undergoing laparoscopic resection for rectal cancer. Dis Colon Rectum. 2013;56):945–951.
LEtters to the Editor
2. van der Pas MH, Haglind E, Cuesta MA, et al.; COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210–218. 3. Yamamoto M, Okuda J, Tanaka K, et al. Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery. Dis Colon Rectum. 2013;56:336–342. 4. Beyond TME Collaborative. Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg. 2013;100:E1–E33.
Tinghan Yang, M.D. Yuanchuan Zhang, M.D. Xiangbing Deng, M.D. Ziqiang Wang, M.D. Sichuan, China
Diseases of the Colon & Rectum Volume 57: 3 (2014)
abandoned immediately, as it perfectly mimics the most probable cause of pilonidal sinus disease − ie, shaving produces large numbers of cut hairs ready to pierce the natal cleft. This errant recommendation in the Practice Parameters should be corrected. REFERENCES 1. Steele SR, Perry WB, Mills S, Buie WD; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of pilonidal disease. Dis Colon Rectum. 2013;56:1021–1027. 2. Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S, Duesel W. Timeline of recurrence after primary and secondary pilonidal sinus surgery. Dis Colon Rectum. 2007;50: 1928–1934. 3. Gips M, Melki Y, Salem L, Weil R, Sulkes J. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum. 2008;51:1656–1662. 4. Rao MM, Zawislak W, Kennedy R, Gilliland R. A prospective randomised study comparing two treatment modalities for chronic pilonidal sinus with a 5-year follow-up. Int J Colorectal Dis. 2010;25:395–400. 5. Doll D. 5- and 10-year recurrence rate is the new gold standard in pilonidal sinus surgery benchmarking. Med Princ Pract. 2010;19:216–217. 6. Doll D, Matevossian E, Wietelmann K, Evers T, Kriner M, Petersen S. Family history of pilonidal sinus predisposes to earlier onset of disease and a 50% long-term recurrence rate. Dis Colon Rectum. 2009;52:1610–1615. 7. Petersen S, Wietelmann K, Evers T, Hüser N, Matevossian E, Doll D. Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum. 2009;52:131–134. 8. BUIE LA. Jeep Disease (Pilonidal Disease of Mechanized Warfare). Southern Medical Journal. 1944;37:103–109. 9. FAVRE R,DELACROIX P. [Apropos of 1,110 Cases of Pilonidal Disease of Coccy-Perineal Localization.]. Mem Acad Chir. 1964;90:669–676. 10. Doll D, Friederichs J, Dettmann H, Boulesteix AL, Duesel W, Petersen S. Time and rate of sinus formation in pilonidal sinus disease. Int J Colorectal Dis. 2008;23:359–364. 11. Sievert H, Evers T, Matevossian E, Hoenemann C, Hoffmann S, Doll D. The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients. Int J Colorectal Dis. 2013;28:1555–1562. 12. Doll D, Matevossian E, Hoenemann C, Hoffmann S. Incision and drainage preceding definite surgery achieves lower 20-year long-term recurrence rate in 583 primary pilonidal sinus surgery patients. J Dtsch Dermatol Ges. 2013;11:60–64. 13. Doll D, Novotny A, Rothe R, et al. Methylene Blue halves the long-term recurrence rate in acute pilonidal sinus disease. Int J Colorectal Dis. 2008;23:181–187. 14. Brückner B,Volmerig J. Zur Wirksamkeit von Sulmycin-Implantat bei der geschlossenen Behandlung des Sinus pilonidalis. Wehrmedizinische Monatsschrift. 1997;41:141–145.
15. Doll D, Evers T, Matevossian E, Hoffmann S, Krapohl BD, Bartsch DK. Does Gentamycin affect long term recurrence rate in pilonidal sinus surgery? European Surgery. Acta Chirurgica Astriaca. 2011;43:236–243. 16. Bunke HJ, Schultheis A, Meyer G, Düsel W. [Surgical revision of the pilonidal sinus with single shot antibiosis]. Chirurg. 1995;66:220–223. 17. Evers T, Doll D, Matevossian E, et al. [Trends in incidence and long-term recurrence rate of pilonidal sinus disease and analysis of associated influencing factors]. Zhonghua Wai Ke Za Zhi. 2011;49:799–803.
Dietrich Doll, M.D., Ph.D. Vechta, Germany
Comment on Time to Initiation of Postoperative Chemotherapy: An Outcome Measure for Patients Undergoing Laparoscopic Resection for Rectal Cancer
W
e were greatly impressed by Strouch’s article1 on using time to initiation of postoperative chemotherapy as an outcome measure for laparoscopic resection of rectal cancer. Instead of focusing on short-term or long-term outcomes, the authors devised an innovative measure that both reflects postoperative recovery and predicts overall survival. The potential benefits of early adjuvant chemotherapy in rectal cancer patients treated with laparoscopic surgery are noteworthy, and this article may open a new area for clinical researchers. Nevertheless, we noticed several limitations in this pioneering article. The study fails to mention the criteria used to select patients for laparoscopic surgery or to provide such preoperative patient information as tumor size, sign of ileus, and previous history of abdominal surgery.2,3 This information is crucial for deciding the type of operation, and the absence of those data could make the 2 groups of patients difficult to compare at all, let alone discern a clear difference in tumor location. Moreover, with respect to the timing of the postoperative chemotherapy, the study tries to reduce the surgeon’s influence by leaving the decision Financial Disclosure: None to declare. Correspondence: Ziqiang Wang, M.D., Department of Gastrointestinal Surgery, West China Hospital, Sichuan University Chengdu, Sichuan, China. E-mail: [email protected] Dis Colon Rectum 2014; 57: e33–e34 DOI: 10.1097/DCR.0000000000000073 © The ASCRS 2014
e34
to the medical oncologist alone. We believe cancer treatment should reflect an integrated strategy, and working separately does not fit the code of multidisciplinary management of patients.4 Establishing clear criteria for the application of adjuvant chemotherapy could be a better approach, as it would eliminate the potential for an overly aggressive or overly conservative medical oncologist to make an arbitrary decision. To verify the true benefit of laparoscopic rectal cancer surgery based on timing of postoperative chemotherapy, future prospective, randomized controlled trials are needed. References 1. Strouch MJ, Zhou G, Fleshman JW, et al. Time to initiation of postoperative chemotherapy: an outcome measure for patients undergoing laparoscopic resection for rectal cancer. Dis Colon Rectum. 2013;56):945–951.
LEtters to the Editor
2. van der Pas MH, Haglind E, Cuesta MA, et al.; COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210–218. 3. Yamamoto M, Okuda J, Tanaka K, et al. Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery. Dis Colon Rectum. 2013;56:336–342. 4. Beyond TME Collaborative. Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg. 2013;100:E1–E33.
Tinghan Yang, M.D. Yuanchuan Zhang, M.D. Xiangbing Deng, M.D. Ziqiang Wang, M.D. Sichuan, China
