Clinico-epidemiologic criteria and predictors of survival of rectal cancer among Egyptians in Delta region

Assessment of Immunohistochemical Expression of CD44 and Osteopontin in Colorectal Carcinoma and colorectal adenoma.. [DOI: 10.21203/rs.3.rs-2574213/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background Colorectal cancer (CRC) is a foremost global health concern and remains one of the major causes of cancer-related morbidity and mortality. It is the third most common cancer in adults after lung cancer and breast cancer worldwide. The theory that cancer originates from a subpopulation of tumor cells, named cancer stem cells (CSC), they have important role of CSC in the initiation and maintenance of the tumor, as well as invasion, metastasis and therapeutic resistance. Among CSC markers, CD44 and OPN are two of the most investigated colorectal CSC markers and their proteins are introduced as the subpopulation with a greater tumorigenicity. This study aiming assessing the immunohistochemical expression of CD44 & OPN in colorectal adenomas & CRCs. And their relation between immunohistochemical expression of CD44 & OPN with tumor differentiation (grading), lympho-vascular invasion, perineural invasion, desmoplasia and TNM stage. Methods this is a retrospective descriptive study that included Sixty paraffin embedded blocks from the pathology laboratory, Suez Canal University Hospital. Paraffin blocks included (14 cases of colorectal carcinoma and 18 cases of colorectal adenoma). paraffin blocks reviewed for clinicopathological prognostic factors and stained by CD44 & OPN, monoclonal antibodies by immunohistochemical method. Results The CD44 protein was overexpressed in 80% of CRC, while was positive (44.4%) in adenoma this difference was statistically significant. Also, in this study the difference between the expression OPN in CRC and adenomas was statistically insignificant. Conclusions CD 44 is highly expressed in large number of CRC (80 of tumors). It is also significantly more expressed in CRC than in adenomas, suggesting a role of CD 44 in CRC tumorigenesis and progression of adenomas into carcinomas. Our study also associated CD 44 overexpression with both late TNM stage and lympho-vascular invasion.

The Impact of Narrow and Infiltrated Distal Margin After Proctectomy for Rectal Cancer on Patients' Outcomes: a Systematic Review and Meta-analysis

Rectal cancer is a common tumor within a difficult anatomic constraint. Total mesorectal excision with longitudinal and circumferential free margins is considered imperative for good prognosis. In this article, the authors systematically reviewed all published literature with specific Mesh terms until the end of year 2019. Thereafter, retrieved articles were assessed using the Newcastle-Ottawa Scale and meta-analysis was conducted comparing local recurrence among 1-cm, 5-mm, and narrow (< 1-mm)/infiltrated margins. Thirty-nine articles were included in the study. Macroscopic distal margin < 1 cm carried a higher incidence of recurrence for those who did not receive neoadjuvant radiation, without affecting neither estimated overall nor disease-free survival. Less than 5-mm margin after radiation therapy is accepted oncologically. Infiltrated margins and narrow margins (< 1 mm) microscopically are associated with higher incidence of local recurrence and shorter overall and disease-free survival. Surgeons should aim at 1-cm safety margin in radiotherapy-naïve patients and microscopic free margin > 1 mm for those who received neoadjuvant therapy. The cost/benefit of reoperation for patients with infiltrated margins is still inadequately studied.

Transanal Versus Laparoscopic Total Mesorectal Excision: A Comparative Prospective Clinical Trial from Two Centers

Purpose: Laparoscopic total mesorectal excision (LapTME) faced many obstacles in obese male with narrow pelvis and bulky mesorectum with increased risk of incomplete mesorectal excision and positive circumferential resection margin (CRM) and distal resection margin (DRM). Transanal total mesorectal excision (TaTME) is reported to result in a better quality total mesorectal excision (TME) specimen, lower incidence of CRM and DRM involvement, and higher rates of sphincter preservation. To date, there is still a debate about the feasibility and efficacy of transanal versus the laparoscopic approach for TME in middle and low rectal cancer. Materials and Methods: This is a prospective controlled clinical trial where 38 patients of middle or low rectal cancer from two tertiary centers were nonrandomly assigned to either TaTME or LapTME. Results: Eighteen patients were operated by TaTME versus 20 patients by LapTME. Mean body mass index was significantly higher in the TaTME group (30.74 ± 7.79) than in the LapTME group (25.99 ± 4.68) (P = .03). TaTME was associated with more transanal specimen extraction (55.5% versus 20%, P = .06). No significant differences were detected in CRM, DRM, peri- or postoperative complications, or conversion rates with more reported Clavien-Dindo grade III complications in the TaTME group (P = .29). Conclusions: TaTME facilitated rectal cancer surgery in obese patients and increased the chance of transanal specimen extraction with equivalent oncological outcomes to conventional LapTME. Further studies are recommended to build better evidence.