Predictive factors for distant recurrence of colorectal cancer in patients after curative resection for stage I-III colorectal cancer in Australia

Correlation between fasting time and bleeding, infection, and perforation after high-frequency electroresection of polyps under colonoscopy

BACKGROUND

Endoscopic mucosal resection (EMR) is a common method for treating colorectal polyps. The duration of fasting after the operation has been the focus of clinical attention. However, there is currently a lack of research on the correlation between fasting duration and the occurrence of bleeding, infection, and perforation.

AIM

To explore the relationship between fasting time and bleeding, infection, and perforation after colonoscopic electro-resection of polyps to provide guidance on fasting strategies for postoperative patients.

METHODS

In a cohort of 14857 colorectal polyp patients admitted to the Second People's Hospital of Luqiao District from 2000 to 2023, a case-control study design with matching propensity scores was used to evaluate the risk of bleeding and perforation after polypectomy in adults aged 40 years and older; 3505 patients with short-term postoperative fasting and 9669 patients with prolonged postoperative fasting met the study criteria. A total of 2560 patients in each group were matched for further analysis. The postoperative fasting time of the experimental group was 2 h, and the postoperative fasting time of the control group was 24 h. The liquid food was gradually replaced with semi-liquid food and ordinary food according to the size of the incision and the effect of the operation. The postoperative follow-up duration was 1 mo, and the incidence of postoperative bleeding, infection, and perforation in both groups was recorded.

RESULTS

In the short fasting group, the rates of bleeding, infection, and perforation were 0.64%, 0.07%, and 0.07%, respectively. In the long fasting group, the rates of bleeding, infection, and perforation were 0.40%, 0.04%, and 0.04%, respectively. There was no significant difference between the two groups in terms of the rates of bleeding, infection, and perforation.

CONCLUSION

Based on these results, it can be preliminarily concluded that the duration of postoperative fasting may not have a significant effect on the incidence of bleeding, infection, and perforation after colonoscopic high-frequency electroresection of polyps. For choosing fasting time, strategies can be developed according to the specific situation and actual needs of the patient. However, it is important to note that this is only a retrospective study and more clinical studies are needed to further validate our findings and explore other possible influencing factors.

Can sarcopenia predict survival in locally advanced rectal cancer patients?

BACKGROUND

There is mounting evidence that suggests sarcopenia can be used to predict survival outcomes in patients with colon cancer. However, the effect on locally advanced rectal cancer (LARC) is less clear. We sought to determine the association between sarcopenia on Overall Survival and Recurrence-free Survival (OS and RFS) in patients with LARC undergoing multimodal treatment.

METHODS

A retrospective study was undertaken of all pre-treatment stage 2-3 rectal cancer patients who underwent neo-adjuvant treatment and surgery with curative intent between January 2010 and September 2016 at Western Health. Sarcopenia was measured on pre-treatment staging scans at the third lumbar vertebrae and defined using cohort-derived, sex-specific thresholds. Primary outcomes were OS and RFS.

RESULTS

A total of 132 patients with LARC were analysed. Sarcopenia: Hazard ratio (HR) 3.71; 95% CI, 1.28-10.75, P = 0.016 was independently associated with worse Overall Survival following multivariate analysis. There was no significant relationship between sarcopenia and RFS: Time ratio (TR) 1.67; 95% CI 0.52-5.34, P = 0.386.

CONCLUSION

Sarcopenia was found to be an independent risk factor for worse overall survival, but not recurrence free survival, in patients with locally advanced rectal cancer undergoing neo-adjuvant chemo-radiotherapy and surgery with curative intent.

Anastomotic Leak in Colorectal Surgery: Predictive Factors and Survival

<br><b>Introduction:</b> Anastomotic leak (AL) is a serious complication following colorectal surgery.</br> <br><b>Aim:</b> The aim of this study was to identify factors associated with the development of AL and to analyze its impact on survival.</br> <br><b>Materials and methods:</b> All consecutive adult colorectal cancer resections performed between 2007 and 2020 with curative intent and anastomosis formation were included from a prospectively maintained database. The primary outcome measure was the rate of AL. The secondary outcome measure was 5-year overall survival (OS).</br> <br><b>Results:</b> There were 6837 eligible patients. The rate of AL was 2.2% and 4.0% in patients with colon and rectal cancer, respectively. AL was a significant independent predictor of reduced 5-year OS in patients who underwent curative surgery for rectal cancer (odds ratio 2.293, p = 0.009). Emergency surgery (p = 0.015), surgery at a public hospital (p = 0.002), and an open surgical approach (p = 0.021) were all associated with a significantly higher risk of AL in patients with colon cancer, with higher rates of AL noted in left colectomies as compared to right hemicolectomies (4.4% <i>vs.</i> 1.3%, p < 0.001). In rectal cancer patients, AL was associated with neoadjuvant chemoradiotherapy (p = 0.038) and male gender (p = 0.002). The anastomosis formation technique (hand-sewn <i>vs.</i> stapled) did not impact the rate of AL (p = 0.116 and p = 0.198 with colon and rectal cancer, respectively).</br> <br><b>Discussion:</b> Clinicians should be cognizant of the predictive factors for AL and should consider early intervention for at-risk patients.</br>.