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Sun Y, Liu D, Zhang X, Su P, Li X, Li Z, Gai Y, Li J, Yang Z, Ding Y, Zhu J, Tan X. Regulation of Hippo/YAP axis in colon cancer progression by the deubiquitinase JOSD1. Cell Death Discov 2024; 10:365. [PMID: 39143074 PMCID: PMC11325045 DOI: 10.1038/s41420-024-02136-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/27/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
Colon cancer is a prevalent malignancy, while recent studies revealed the dys-regulation of Hippo signaling as the important driver for colon cancer progression. Several studies have indicated that post-translational modifications on YAP play crucial roles in both Hippo signaling activity and cancer progression. This raises a puzzling question about why YAP/TAZ, an auto-inhibitory pathway, is frequently over-activated in colon cancer, despite the suppressive cascade of Hippo signaling remaining operational. The protein stability of YAP is subject to a tiny balance between ubiquitination and deubiquitination processes. Through correlation analysis of DUBs (deubiquitinases) expression and Hippo target gene signature in colon cancer samples, we found JOSD1 as a critical deubiquitinase for Hippo signaling and colon cancer progression. JOSD1 could facilitate colon cancer progression and in colon cancer, inhibition of JOSD1 via shRNA has been demonstrated to impede tumorigenesis. Furthermore, molecular mechanism studies have elucidated that JOSD1 enhances the formation of the Hippo/YAP transcriptome by impeding K48-linked polyubiquitination on YAP. ChIP assays have shown that YAP binds to JOSD1's promoter region, promoting its gene transcription. These results suggest that JOSD1 is involved in both activating and being targeted by the Hippo signaling pathway in colon cancer. Consequently, a positive regulatory loop between JOSD1 and Hippo signaling has been identified, underscoring their interdependence during colon cancer progression. Thus, targeting JOSD1 may represent a promising therapeutic approach for managing colon cancer.
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Affiliation(s)
- Yanan Sun
- Department of General Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, Shandong Province, P.R. China
| | - Dongyi Liu
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, Shandong Province, P.R. China
| | - Xiaobo Zhang
- Department of General surgery, Shengjing Hospital of China Medical University, Shenyang, 110000, Liaoning Province, P.R. China
| | - Peng Su
- Department of Pathology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, P.R. China
| | - Xin Li
- Xinxiang Key Laboratory of Tumor Migration and Invasion Precision Medicine, School of Medical Technology, Xinxiang Medical University, Xinxiang, 453003, Henan Province, P.R. China
| | - Zhongbo Li
- Xinxiang Key Laboratory of Tumor Migration and Invasion Precision Medicine, School of Medical Technology, Xinxiang Medical University, Xinxiang, 453003, Henan Province, P.R. China
| | - Yingwen Gai
- Department of General surgery, Shengjing Hospital of China Medical University, Shenyang, 110000, Liaoning Province, P.R. China
| | - Jingying Li
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, 110000, Liaoning Province, P.R. China
| | - Zhiyong Yang
- Deartment of Cardiology, Shengjing Hospital of China Medical University, Shenyang, 110000, Liaoning Province, P.R. China
| | - Yinlu Ding
- Department of General Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, Shandong Province, P.R. China.
| | - Jian Zhu
- Department of General surgery, Shengjing Hospital of China Medical University, Shenyang, 110000, Liaoning Province, P.R. China.
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, Shandong Province, P.R. China.
| | - Xiaodong Tan
- Department of General surgery, Shengjing Hospital of China Medical University, Shenyang, 110000, Liaoning Province, P.R. China.
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2
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Parasido E, Ribeiro P, Chingle RM, Rohwetter T, Gupta N, Avetian G, Bladelli E, Pierobon M, Chen Y, Tang Q, Schnermann M, Rodriguez O, Robbins D, Burke TR, Albanese C, Ihemelandu C. Enhancing precision in colorectal cancer surgery: development of an LGR5-targeting RSPO1 peptide mimetic as a contrast agent for intraoperative fluorescence molecular imaging. Cell Cycle 2024:1-12. [PMID: 38984667 DOI: 10.1080/15384101.2024.2364578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/09/2024] [Indexed: 07/11/2024] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. In the United States alone, CRC was responsible for approximately 52,550 deaths in 2023, with an estimated 153,020 new cases. CRC presents with synchronous peritoneal spread in 5-10% of patients, and up to 20-50% of patients with recurrent disease will develop metachronous colorectal cancer peritoneal metastatic (CRC-PM) disease. Eradication of the tumor, tumor margins and microscopic residual disease is paramount, as microscopic residual disease is associated with local recurrences, with 5-year survival rates of less than 35%. The success of resection and reduction of residual disease depends on the accuracy with which cancer cells and normal tissue can be intra-operatively distinguished. Fluorescence Molecular Imaging (IFMI) and tumor-targeted contrast agents represent a promising approach for intraoperative detection and surgical intervention. Proper target selection, the development of scalable imaging agents and enhanced real-time tumor and tumor microenvironment imaging are critical to enabling enhanced surgical resection. LGR5 (leucine-rich repeat-containing G-protein-coupled receptor 5), a colonic crypt stem cell marker and the receptor for the R-spondins (RSPO) in the Wnt signaling pathway, is also expressed on colorectal cancer stem cells (CSC) and on CRC tumors and metastases, suggesting it could be a useful target for imaging of CRC. However, there are numerous diverging reports on the role of LGR5 in CRC therapy and outcomes. Herein, we report on the synthesis and validation of a 37 amino acid RSPO1-mimetic peptide, termed RC18, that was specifically designed to access the R-spondin binding site of LGR5 to potentially be used for interoperative imaging of CRC-PM. The receptor-binding capabilities of the RC18 indicate that direct interactions with LGR5 neither significantly increased LGR5 signaling nor blocked RSPO1 binding and signal transduction, suggesting that the RSPO1-mimetic is functionally inert, making it an attractive contrast agent for intraoperative CRC-PM imaging.
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Affiliation(s)
- Erika Parasido
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Patricia Ribeiro
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Ramesh M Chingle
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Thomas Rohwetter
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Nikita Gupta
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - George Avetian
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Elisa Bladelli
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Fairfax, VA, USA
| | - Mariaelena Pierobon
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Fairfax, VA, USA
| | - Yu Chen
- College of Photonic and Electronic Engineering, Fujian Normal University, Fuzhou, Fujian, P. R. China
| | - Qinggong Tang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Martin Schnermann
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Olga Rodriguez
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
- Center for Translational Research, Georgetown University Medical Center, Washington, DC, USA
| | - David Robbins
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Terrence R Burke
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Chris Albanese
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
- Center for Translational Research, Georgetown University Medical Center, Washington, DC, USA
- Department of Radiology, Georgetown University Medical Center, Washington, DC, USA
| | - Chukwuemeka Ihemelandu
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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3
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Aleksiev V, Yavorov B, Stoev H, Dimov R, Kostov G, Vazhev Z. The role of extended resection in locally recurrent colorectal cancer with invasion of the aortoiliac bifurcation: a rare clinical case. Folia Med (Plovdiv) 2024; 66:123-127. [PMID: 38426474 DOI: 10.3897/folmed.66.e107127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/11/2023] [Indexed: 03/02/2024] Open
Abstract
Colorectal carcinoma (CRC) is the third most common cancer and the fourth deadliest. Despite recent advances in screening methods and preoperative imaging techniques, the threat of colorectal cancer remains at an all-time high. Moreover, even after curative treatment, disease recurrence occurs in up to 40% of all cases. However, half of patients with recurrent disease do not register any distant metastases. Therefore, much effort should be expended in identifying and evaluating these patients, as many of them are suitable candidates for en bloc resections with perioperative chemoradiation. In fact, it has recently been found that overall survival benefits greatly from extended resections, provided that free margins are achieved intraoperatively. In this case report, we will present a case of locally advanced recurrent colorectal cancer invading the aortoiliac axis and our approach to achieving a R0 resection.
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Affiliation(s)
| | | | - Hristo Stoev
- Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Rosen Dimov
- Medical University of Plovdiv, Plovdiv, Bulgaria
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4
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Grüter AAJ, Vlug MS, Spaanderman IT, Bins AD, Buffart TE, Tuynman JB. Challenging case of deficient mismatch repair right-sided locally advanced adenocarcinoma of the ascending colon with duodenal involvement: A case report including step-by-step video of operation. Int J Surg Case Rep 2024; 114:109137. [PMID: 38091709 PMCID: PMC10758974 DOI: 10.1016/j.ijscr.2023.109137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Irresectable colon cancer presents a complex clinical challenge. Neoadjuvant immunotherapy has shown potential in improving resectability. Additionally, advancements in surgical techniques, including complete mesocolic excision (CME) with central vascular ligation (CVL), have contributed to better outcomes for right-sided colon cancer. This case report aims to demonstrate the successful laparoscopic resection of initial appearing irresectable colon cancer with suspected duodenal involvement. CASE PRESENTATION A 70-year-old female presented with an irresectable mismatch repair deficient (dMMR) adenocarcinoma of the ascending colon with suspected duodenal ingrowth. Neoadjuvant treatment with pembrolizumab and ataluren resulted in a significant response, allowing for surgical resection. A laparoscopic right hemicolectomy with CME, including CVL, intracorporeal anastomosis and extraction through a Pfannenstiel incision, was performed. Additionally, the serosal layer of the duodenum was shaved after observing the absence of intraluminal invasion. Postoperatively, transient gastroparesis occurred, but overall outcomes were favourable. CLINICAL DISCUSSION This case emphasizes the potential of immunotherapy in improving resectability for irresectable dMMR colon cancer with suspected involvement of surrounding organs. The combination of neoadjuvant therapy and advanced surgical techniques, such as CME with CVL, shows promise in achieving favourable clinical outcomes. However, further studies are needed to validate the effectiveness and safety of this combined approach in a larger cohort of patients. CONCLUSION The successful laparoscopic resection of initially irresectable dMMR colon cancer with duodenal involvement, following neoadjuvant immunotherapy, demonstrated promising outcomes. This case advocates for further exploration of neoadjuvant treatments' efficacy, coupled with advanced surgical techniques, in managing locally advanced right-sided colon cancer.
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Affiliation(s)
- Alexander A J Grüter
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, the Netherlands.
| | - Malaika S Vlug
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Ide T Spaanderman
- Amsterdam UMC, Department of Medical Oncology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Adriaan D Bins
- Amsterdam UMC, Department of Medical Oncology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Tineke E Buffart
- Amsterdam UMC, Department of Medical Oncology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Jurriaan B Tuynman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands
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5
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Suwatthanarak T, Tanjak P, Suwatthanarak T, Acharayothin O, Thanormjit K, Chaiboonchoe A, Tawantanakorn T, Phalanusitthepha C, Trakarnsanga A, Methasate A, Pithukpakorn M, Okamoto R, Chinswangwatanakul V. Exploring extracellular matrix and prostaglandin pathway alterations across varying resection margin distances of right-sided colonic adenocarcinoma. BMC Cancer 2023; 23:1202. [PMID: 38062443 PMCID: PMC10702019 DOI: 10.1186/s12885-023-11595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Surgical resection followed by indicated adjuvant therapy offers potential curative treatment in colonic adenocarcinoma. Beyond the well-established seed and soil theory of colon cancer progression, the 'normal-appearing' tissues near the tumor are not genuinely normal and remain as remnants in patients following surgery. Our objective was to elucidate the alteration of gene expression and pathways across various distances of resection margins in right-sided colonic adenocarcinoma. METHODS Twenty-seven fresh samples of primary cancer and 56 matched non-tumor tissues adjacent to the tumor (NAT) were collected from patients with resectable right-sided colon cancer. NAT were systematically obtained at varying distances (1, 5, and 10 cm) on both proximal and distal sides. Comprehensive gene expression analysis was performed using 770-gene PanCancer Progression Panel, delineating distinctive pathways and functional predictions for each region. RESULTS Distinctive gene signatures and pathways exhibited by normal-appearing tissues were discovered at varying distances from cancer. Notably, SFRP2, PTGDS, COL1A1, IL1B, THBS2, PTGIS, COL1A2, NPR1, and BGN were upregulated, while ENPEP, MMP1, and NRCAM were downregulated significantly in 1-cm tissue compared to farther distances. Substantial alterations in the extracellular matrix (ECM) and prostaglandin/thromboxane synthesis were significantly evident at the 1-cm distance. Functional analysis indicated enhanced cell viability and survival, alongside reduced cellular death and apoptosis. CONCLUSIONS Different distances exerted a significant impact on gene alteration within the normal-looking mucosa surrounding primary cancer, influenced by various mechanisms. These findings may highlight potential therapeutic targets related to the ECM and prostaglandin/thromboxane pathways for treatment strategies.
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Grants
- R016241047 Foundation for Cancer Care, Siriraj Hospital, Thailand
- R016241047 Foundation for Cancer Care, Siriraj Hospital, Thailand
- R016241047 Foundation for Cancer Care, Siriraj Hospital, Thailand
- R016241047 Foundation for Cancer Care, Siriraj Hospital, Thailand
- R016241047 Foundation for Cancer Care, Siriraj Hospital, Thailand
- 63-117 Health Systems Research Institute (HSRI) of Thailand
- 63-117 Health Systems Research Institute (HSRI) of Thailand
- 63-117 Health Systems Research Institute (HSRI) of Thailand
- 63-117 Health Systems Research Institute (HSRI) of Thailand
- 63-117 Health Systems Research Institute (HSRI) of Thailand
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Affiliation(s)
- Tharathorn Suwatthanarak
- Graduate School of Medical and Dental Sciences, Joint Degree Doctoral Program in Medical Sciences between Tokyo Medical and Dental University, Tokyo, Japan
- Mahidol University, Bangkok, Thailand
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th Floor, Syamindra Building, 2, Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Pariyada Tanjak
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th Floor, Syamindra Building, 2, Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
- Siriraj Cancer Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thanawat Suwatthanarak
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th Floor, Syamindra Building, 2, Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
- Siriraj Cancer Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Onchira Acharayothin
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th Floor, Syamindra Building, 2, Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Kullanist Thanormjit
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th Floor, Syamindra Building, 2, Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
- Siriraj Cancer Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amphun Chaiboonchoe
- Siriraj Center of Research Excellence for Systems Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thikhamporn Tawantanakorn
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th Floor, Syamindra Building, 2, Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Chainarong Phalanusitthepha
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th Floor, Syamindra Building, 2, Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Atthaphorn Trakarnsanga
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th Floor, Syamindra Building, 2, Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Asada Methasate
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th Floor, Syamindra Building, 2, Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Manop Pithukpakorn
- Division of Medical Genetics, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Genomics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ryuichi Okamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Vitoon Chinswangwatanakul
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th Floor, Syamindra Building, 2, Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand.
- Siriraj Cancer Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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6
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Lynch A, Arean-Sanz R, Ore AS, Cataldo G, Crowell K, Fabrizio A, Cataldo TE, Messaris E. Impact of neoadjuvant chemotherapy for locally advanced colon cancer on postoperative complications. Langenbecks Arch Surg 2023; 408:365. [PMID: 37726584 DOI: 10.1007/s00423-023-03094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Although not considered standard therapy, neoadjuvant chemotherapy (NAC) is an encouraging alternative for selected patients with locally advanced colon cancer (LAC). The aim of this study was to compare 30-day postoperative outcomes between patients undergoing upfront surgery and those undergoing NAC for LAC. METHODS Using the ACS-NSQIP data from 2016 to 2020, 11,498 patients with LAC were divided into those who underwent upfront colectomy (96.2%) and those who received NAC (3.8%). The primary outcome was a composite outcome encompassing 30-day major postoperative complications. Propensity score matched (PSM) analysis and multivariable logistic regression were performed. RESULTS After PSM analysis, there was no statistically significant difference in the development of a major complication. NAC was not significantly associated with the primary outcome. Risk factors for postoperative complications were T4 stage, older age, male sex, black race, smoking, dependent status, severe COPD, hypoalbuminemia, and preoperative transfusion. Laparoscopic and robotic surgery was protective. CONCLUSION NAC did not increase the odds of developing a major complication.
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Affiliation(s)
- Andrew Lynch
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rodrigo Arean-Sanz
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ana Sofia Ore
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giulio Cataldo
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kristen Crowell
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas E Cataldo
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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7
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Mohseni N, Ghaniee Zarich M, Afshar S, Hosseini M. Identification of Novel Biomarkers for Response to Preoperative Chemoradiation in Locally Advanced Rectal Cancer with Genetic Algorithm-Based Gene Selection. J Gastrointest Cancer 2023; 54:937-950. [PMID: 36534304 DOI: 10.1007/s12029-022-00873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The conventional treatment for patients with locally advanced colorectal tumors is preoperative chemo-radiotherapy (PCRT) preceding surgery. This treatment strategy has some long-term side effects, and some patients do not respond to it. Therefore, an evaluation of biomarkers that may help predict patients' response to PCRT is essential. METHODS We took advantage of genetic algorithm to search the space of possible combinations of features to choose subsets of genes that would yield convenient performance in differentiating PCRT responders from non-responders using a logistic regression model as our classifier. RESULTS We developed two gene signatures; first, to achieve the maximum prediction accuracy, the algorithm yielded 39 genes, and then, aiming to reduce the feature numbers as much as possible (while maintaining acceptable performance), a 5-gene signature was chosen. The performance of the two gene signatures was (accuracy = 0.97 and 0.81, sensitivity = 0.96 and 0.83, and specificity = 86 and 0.77) using a logistic regression classifier. Through analyzing bias and variance decomposition of the model error, we further investigated the involved genes by discovering and validating another 28-gene signature which possibly points towards two different sub-systems involved in the response of the patients to treatment. CONCLUSIONS Using genetic algorithm as our gene selection method, we have identified two groups of genes that can differentiate PCRT responders from non-responders in patients of the studied dataset with considerable performance. IMPACT After passing standard requirements, our gene signatures may be applicable as a robust and effective PCRT response prediction tool for colorectal cancer patients in clinical settings and may also help future studies aiming to further investigate involved pathways gain a clearer picture for the course of their research.
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Affiliation(s)
- Nima Mohseni
- Department of Biology, Faculty of Science, Lund University, Skåne, Sweden
| | | | - Saeid Afshar
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
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8
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Li X, Lu Y, Wen P, Yuan Y, Xiao Z, Shi H, Feng E. Matrine restrains the development of colorectal cancer through regulating the AGRN/Wnt/β-catenin pathway. ENVIRONMENTAL TOXICOLOGY 2023; 38:809-819. [PMID: 36620879 DOI: 10.1002/tox.23730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/15/2022] [Accepted: 12/25/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Colorectal cancer is a common malignant digestive tract tumor. This study aimed to explore the biological role and potential underlying mechanism of matrine in colorectal cancer. METHODS The mRNA expression of AGRN was measured using RT-qPCR. Cell proliferation, migration, invasion and apoptosis were determined using CCK-8, EdU, transwell assays and flow cytometry, respectively. Xenograft tumor experiment was performed to explore the action of matrine and AGRN on tumor growth in colorectal cancer in vivo. Immunohistochemistry (IHC) assay was applied for AGRN, β-catenin, and c-Myc expression in the tumor tissues from mice. RESULTS Matrine dramatically repressed cell growth and reduced the level of AGRN in colorectal cancer cells. AGRN expression was boosted colorectal cancer tissues and cells. AGRN downregulation depressed cell proliferation, migration, invasion, and enhanced cell apoptosis in colorectal cancer cells. Moreover, matrine showed the anti-tumor effects on colorectal cancer cells via regulating AGRN expression. AGRN knockdown could inactivate the Wnt/β-catenin pathway in colorectal cancer cells. We found that AGRN downregulation exhibited the inhibition action in the progression of colorectal cancer by modulating the Wnt/β-catenin pathway. In addition, matrine could inhibit the activation of the Wnt/β-catenin pathway through regulating AGRN in colorectal cancer cells. Furthermore, xenograft tumor experiment revealed that matrine treatment or AGRN knockdown repressed the development of colorectal cancer via the Wnt/β-catenin pathway in vivo. CONCLUSION Matrine retarded colorectal cancer development by modulating AGRN to inactivate the Wnt/β-catenin pathway.
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Affiliation(s)
- Xianzhe Li
- Department of General Surgery, Nanshi Hospital, Nanyang, China
| | - Ye Lu
- Department of radiation oncology, The Fifth People's Hospital of Huai'an, Huai'an, China
| | - Penghao Wen
- Department of Medical Oncology, Nanshi Hospital, Nanyang, China
| | - Yan Yuan
- Department of Radiotherapy, Nanshi Hospital, Nanyang, China
| | - Zhenghong Xiao
- Department of Medical Oncology, Nanshi Hospital, Nanyang, China
| | - Hengwei Shi
- Department of General Surgery, Nanshi Hospital, Nanyang, China
| | - Eryan Feng
- Department of Neurosurgery, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an Second People's Hospital, Huai'an, China
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9
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Ishiyama Y, Hirano Y, Tanaka H, Yonezawa H, Sasaki M, Fujii T, Okazaki N, Ishii T, Deguchi K. Does Pathological T-Factor Affect Long-term Prognosis of Locally Advanced Colorectal Cancer Treated With Laparoscopic Multivisceral Resection? CANCER DIAGNOSIS & PROGNOSIS 2023; 3:236-243. [PMID: 36875298 PMCID: PMC9949537 DOI: 10.21873/cdp.10207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/02/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND/AIM Locally advanced colorectal cancer (LACC) has poor long-term outcomes. Our hypothesis was that the pathological tumor depth would affect postoperative outcomes in patients who underwent multivisceral resection with clear margins (R0). The aim of this study was to analyze short- and long-term outcomes in patients who underwent multivisceral resection for LACC, comparing between T3 and T4 stages. PATIENTS AND METHODS This was a propensity score-matched, retrospective study. All 8,764 consecutive patients who underwent surgery for colorectal cancer between April 2007 and January 2021 at the Saitama Medical University International Medical Center were screened; 572 underwent multivisceral resection for LACC. We compared the T3 and T4 groups to evaluate outcomes. RESULTS The 5-year disease-free survival (DFS) rates did not significantly differ between the two groups (hazard ratio=1.344, 95% confidence interval=0.638-2.907, p=0.33). The 5-year overall survival (OS) rates were significantly worse for the T4 group than for the T3 group (hazard ratio=3.162, 95% confidence interval=1.077-11.44), p=0.037). To determine the association between American Society of Anesthesiologists (ASA) score, transfusion, pathological T and OS, we performed univariate and multivariate analyses. ASA, transfusion, and pathological T-stage were associated with worse OS in univariate analysis (T4 vs. T3, respectively). CONCLUSION Our study showed that postoperative complications and DFS of the T4 group were similar to those of the T3 group of locally advanced colorectal cancer treated with laparoscopic multivisceral resection. However, OS was worse in the T4 group compared with the T3 group. Multivariate risk factors for poor OS were ASA>2, transfusion, and T4 stage.
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Affiliation(s)
- Yasuhiro Ishiyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yasumitu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hiroto Tanaka
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hiroki Yonezawa
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Megumi Sasaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takatugu Fujii
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Naoto Okazaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Toshimasa Ishii
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Katsuya Deguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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10
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Zaman S, Bhattacharya P, Mohamedahmed AYY, Cheung FY, Rakhimova K, Di Saverio S, Peravali R, Akingboye A. Outcomes following open versus laparoscopic multi-visceral resection for locally advanced colorectal cancer: A systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:98. [PMID: 36811741 DOI: 10.1007/s00423-023-02835-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This meta-analysis aims to compare morbidity, mortality, oncological safety, and survival outcomes after laparoscopic multi-visceral resection (MVR) of the locally advanced primary colorectal cancer (CRC) compared with open surgery. MATERIALS AND METHODS A systematic search of multiple electronic data sources was conducted, and all studies comparing laparoscopic and open surgery in patients with locally advanced CRC undergoing MVR were selected. The primary endpoints were peri-operative morbidity and mortality. Secondary endpoints were R0 and R1 resection, local and distant disease recurrence, disease-free survival (DFS), and overall survival (OS) rates. RevMan 5.3 was used for data analysis. RESULTS Ten comparative observational studies reporting a total of 936 patients undergoing laparoscopic MVR (n = 452) and open surgery (n = 484) were identified. Primary outcome analysis demonstrated a significantly longer operative time in laparoscopic surgery compared with open operations (P = 0.008). However, intra-operative blood loss (P<0.00001) and wound infection (P = 0.05) favoured laparoscopy. Anastomotic leak rate (P = 0.91), intra-abdominal abscess formation (P = 0.40), and mortality rates (P = 0.87) were comparable between the two groups. Moreover the total number of harvested lymph nodes, R0/R1 resections, local/distant disease recurrence, DFS, and OS rates were also comparable between the groups. CONCLUSION Although inherent limitations exist with observational studies, the available evidence demonstrates that laparoscopic MVR in locally advanced CRC seems to be a feasible and oncologically safe surgical option in carefully selected cohorts.
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Affiliation(s)
- Shafquat Zaman
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Pratik Bhattacharya
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | | | - Fang Yi Cheung
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Kamila Rakhimova
- Institute of Cancer and Genomic Science, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Salomone Di Saverio
- Department of General Surgery, ASUR Marche, Hospital of San Benedetto del Tronto (AP), AV5, San Benedetto del Tronto, Italy
| | - Rajeev Peravali
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Akinfemi Akingboye
- Department of General Surgery, The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, UK
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11
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Han JH, Lee BC, Noh BG, Park JK, Choi JB, Park YM, Jung HJ, Jo HJ. En-bloc resection including SMV and duodenum in patient of locally advanced colon cancer. J Surg Case Rep 2023; 2023:rjac610. [PMID: 36628062 PMCID: PMC9825237 DOI: 10.1093/jscr/rjac610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/11/2022] [Indexed: 01/09/2023] Open
Abstract
Tumor could directly invade or is adherent to other organs, but superior mesentery vein (SMV) and duodenum invasion are very rare. A 62-year-old woman was diagnosed with abdominal pain for several months. Multiple erythematous brownish skin patches and palpable mass were found at epigastric area. Computed tomography imaging showed focal wall thickening at the transverse colon that invaded to the rectus muscle and anterior abdominal wall. On exploration, we identified tumor invaded or was adherent to the duodenum and superior mesenteric vein and performed en-bloc resection. After surgery, the patient received chemotherapy and was followed up without any recurrence for 16 months. Adhesion and invasion of tumor to surrounding organs can be unexpectedly found during surgery. In our case, we found duodenum and SMV invasion and achieved R0 resection by SMV and duodenum resection, which could improve the patient's prognosis.
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Affiliation(s)
- Jeong Hee Han
- Department of Surgery, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 49241, Korea
| | - Byoung Chul Lee
- Correspondence address. Department of Surgery, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: 82-51-240-7238; Fax: 82-51-247-1365; E-mail:
| | - Byeong Gwan Noh
- Department of Surgery, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 49241, Korea
| | - Jae Kyun Park
- Department of Surgery, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 49241, Korea
| | - Jung Bum Choi
- Department of Surgery, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 49241, Korea
| | - Young Mok Park
- Department of Surgery, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 49241, Korea
| | - Hyuk Jae Jung
- Department of Surgery, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 49241, Korea
| | - Hong Jae Jo
- Department of Surgery, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 49241, Korea
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12
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Ishiyama Y, Tachimori Y, Harada T, Mochizuki I, Tomizawa Y, Ito S, Oneyama M, Amiki M, Hara Y, Narita K, Goto M, Sekikawa K, Hirano Y. Oncologic outcomes after laparoscopic versus open multivisceral resection for local advanced colorectal cancer: A meta-analysis. Asian J Surg 2023; 46:6-12. [PMID: 35568616 DOI: 10.1016/j.asjsur.2022.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
Laparoscopic (lap) colectomies for advanced colorectal cancer (CRC) often require resection of other organs. We systematically reviewed currently available literature on lap multi-visceral resection for CRC, with regard to short- and long-term oncological outcomes, and compared them with open procedures. We performed a systematic literature search in MEDLINE, EMBASE, Google Scholar and PubMed from inception to November 30, 2020. The aim of this study was to synthesize short-term and oncological outcomes associated with laparoscopic versus open surgery. Pooled proportions and risk ratios (RRs) were calculated using an inverse variance method. We included six observational cohort studies published between 2012 and 2020 (lap procedures: n = 262; open procedures: n = 273). Collectively, they indicated that postoperative complications were significantly more common after open surgeries than lap surgeries (RR: 0.53; 95% confidence interval [CI]: 0.39-0.72; P < 0.00001), but the two approaches did not significantly differ in positive resection margins (RR: 0.75; 95% CI: 0.38-1.50; P = 0.42), local recurrence (RR: 0.66; 95% CI: 0.28-1.62; P = 0.37), or (based on two evaluable studies) 5-year OS (RR: 0.70; 95% CI: 0.46-1.04; P = 0.08) or 5-year DFS (RR: 0.86; 95% CI: 0.67-1.11) for T4b disease. In conclusion, laparoscopic and open multi-visceral resections for advanced CRC have comparable oncologic outcomes. Although a randomized study would be ideal for further research, no such studies are currently available.
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Affiliation(s)
- Yasuhiro Ishiyama
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan; Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
| | - Yuji Tachimori
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | | | | | - Yuki Tomizawa
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Shingo Ito
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Masaki Oneyama
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Manabu Amiki
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yoshiaki Hara
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Kazuhiro Narita
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Manabu Goto
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Koji Sekikawa
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yasumitu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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13
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Pedrazzani C, Turri G, Marrelli D, Kim HJ, Park EJ, Spolverato G, Foppa C, Spinelli A, Pucciarelli S, Baik SH, Choi GS. Prediction of Metachronous Peritoneal Metastases After Radical Surgery for Colon Cancer: A Scoring System Obtained from an International Multicenter Cohort. Ann Surg Oncol 2022; 29:7896-7906. [PMID: 35789302 PMCID: PMC9550705 DOI: 10.1245/s10434-022-12097-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/12/2022] [Indexed: 01/01/2023]
Abstract
Background Since novel strategies for prevention and treatment of metachronous peritoneal metastases (mPM) are under study, it appears crucial to identify their risk factors. Our aim is to establish the incidence of mPM after surgery for colon cancer (CC) and to build a statistical model to predict the risk of recurrence. Patients and Methods Retrospective analysis of consecutive pT3–4 CC operated at five referral centers (2014–2018). Patients who developed mPM were compared with patients who were PM-free at follow-up. A scoring system was built on the basis of a logistic regression model. Results Of the 1423 included patients, 74 (5.2%) developed mPM. Patients in the PM group presented higher preoperative carcinoembryonic antigen (CEA) [median (IQR): 4.5 (2.5–13.0) vs. 2.7 (1.5–5.9), P = 0.001] and CA 19-9 [median (IQR): 17.7 (12.0–37.0) vs. 10.8 (5.0–21.0), P = 0.001], advanced disease (pT4a 42.6% vs. 13.5%; pT4b 16.2% vs. 3.2%; P < 0.001), and negative pathological characteristics. Multivariate logistic regression identified CA 19-9, pT stage, pN stage, extent of lymphadenectomy, and lymphovascular invasion as significant predictors, and individual risk scores were calculated for each patient. The risk of recurrence increased remarkably with score values, and the model demonstrated a high negative predictive value (98.8%) and accuracy (83.9%) for scores below five. Conclusions Besides confirming incidence and risk factors for mPM, our study developed a useful clinical tool for prediction of mPM risk. After external validation, this scoring system may guide personalized decision-making for patients with locally advanced CC. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-022-12097-9.
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Affiliation(s)
- Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Verona University Hospital, University of Verona, Verona, Italy.
| | - Giulia Turri
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Verona University Hospital, University of Verona, Verona, Italy
| | - Daniele Marrelli
- Department of Surgery, Policlinico le Scotte, University of Siena, Siena, Italy
| | - Hye Jin Kim
- Colorectal Cancer Centre, Kyungpook National University Medical Centre, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Eun Jung Park
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gaya Spolverato
- General Surgery 3, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Caterina Foppa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Seung Hyuk Baik
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyu Seog Choi
- Colorectal Cancer Centre, Kyungpook National University Medical Centre, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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14
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Bess SN, Greening GJ, Rajaram N, Muldoon TJ. Macrophage-targeted anti-CCL2 immunotherapy enhances tumor sensitivity to 5-fluorouracil in a Balb/c-CT26 murine colon carcinoma model measured using diffuse reflectance spectroscopy. BMC Immunol 2022; 23:20. [PMID: 35461243 PMCID: PMC9035255 DOI: 10.1186/s12865-022-00493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Immunotherapy in colorectal cancer (CRC) regulates specific immune checkpoints and, when used in combination with chemotherapy, can improve patient prognosis. One specific immune checkpoint is the recruitment of circulating monocytes that differentiate into tumor-associated macrophages (TAMs) and promote tumor angiogenesis. Changes in vascularization can be non-invasively assessed via diffuse reflectance spectroscopy using hemoglobin concentrations and oxygenation in a localized tumor volume. In this study, we examine whether blockade of monocyte recruitment via CCL2 (macrophage chemoattractant protein-1) leads to enhanced sensitivity of 5-fluorouracil (5-FU) in a CT26-Balb/c mouse model of CRC. It was hypothesized that the blockade of TAMs will alter tumor perfusion, increasing chemotherapy response. A subcutaneous tumor model using Balb/c mice injected with CT26 colon carcinoma cells received either a saline or isotype control, anti-CCL2, 5-FU, or a combination of anti-CCL2 and 5-FU.
Results Findings show that 12 days post-treatment, monocyte recruitment was significantly reduced by approximately 61% in the combination group. This shows that the addition of anti-CCL2 to 5-FU slowed the fold-change (change from the original measurement to the final measurement) in tumor volume from Day 0 to Day 12 (~ 5 fold). Modest improvements in oxygen saturation (~ 30%) were observed in the combination group. Conclusion The findings in this work suggest that the blockade of CCL2 is sufficient in the reduction of TAMs that are recruited into the tumor microenvironment and has the ability to modestly alter tumor perfusion during early-tumor response to treatment even though the overall benefit is relatively modest. Supplementary Information The online version contains supplementary material available at 10.1186/s12865-022-00493-5.
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15
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Popp J, Weinberg DS, Enns E, Nyman JA, Beck JR, Kuntz KM. Reevaluating the Evidence for Intensive Postoperative Extracolonic Surveillance for Nonmetastatic Colorectal Cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:36-46. [PMID: 35031098 PMCID: PMC9186065 DOI: 10.1016/j.jval.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 07/19/2021] [Accepted: 07/31/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The FACS, GILDA, and COLOFOL trials have cast doubt on the value of intensive extracolonic surveillance for resected nonmetastatic colorectal cancer and by extension metastasectomy. We reexamined this pessimistic interpretation. We evaluate an alternative explanation: insufficient power to detect a realistically sized survival benefit that may be clinically meaningful. METHODS A microsimulation model of postdiagnosis colorectal cancer was constructed assuming an empirically plausible efficacy for metastasectomy and thus surveillance. The model was used to predict the large-sample mortality reduction expected for each trial and the implied statistical power. A potential recurrence imbalance in the FACS trial was investigated. Goodness of fit between model predictions and trial results were evaluated. Downstream life expectancy was estimated and power calculations performed for future trials evaluating surveillance and metastasectomy. RESULTS For all 3 trials, the model predicted a mortality reduction of ≤5% and power of <10%. The FACS recurrence imbalance likely led to a large relative bias (>2.5) in the hazard ratio for overall survival favoring control. After adjustment, both COLOFOL and FACS results were consistent with model predictions (P>.5). A 2.6 (95% credible interval 0.5-5.1) and 3.6 (95% credible interval 0.8-7.0) month increase in life expectancy is predicted comparing intensive extracolonic surveillance-routine computed tomography scans and carcinoembryonic antigen assays-with 1 computed tomography scan at 12 months or no surveillance, respectively. An adequately sized surveillance trial is not feasible. A metastasectomy trial should randomize at least 200 to 300 patients. CONCLUSIONS Recent trial results do not warrant de novo skepticism of metastasectomy nor targeted extracolonic surveillance. Given the potential for clinically meaningful life-expectancy gain and significant uncertainty, a trial of metastasectomy is needed.
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Affiliation(s)
- Jonah Popp
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA.
| | - David S Weinberg
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Eva Enns
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - John A Nyman
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - J Robert Beck
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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16
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Pérez Lara FJ, Hebrero Jimenez ML, Moya Donoso FJ, Hernández Gonzalez JM, Pitarch Martinez M, Prieto-Puga Arjona T. Review of incomplete macroscopic resections (R2) in rectal cancer: Treatment, prognosis and future perspectives. World J Gastrointest Oncol 2021; 13:1062-1072. [PMID: 34616512 PMCID: PMC8465452 DOI: 10.4251/wjgo.v13.i9.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/28/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the most prevalent tumours, but with improved treatment and early detection, its prognosis has greatly improved in recent years. However, when the tumour is locally advanced at diagnosis or if there is local recurrence, it is more difficult to perform a complete tumour resection, and there may be a residual macroscopic tumour. In this paper, we review the literature on residual macroscopic tumour resections, concerning both locally advanced primary tumours and recurrences, evaluating the main problems encountered, the treatments applied, the prognosis and future perspectives in this field.
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17
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Pei JP, Zhang CD, Fu X, Ba Y, Yue S, Zhao ZM, Dai DQ. A Novel TNM Classification for Colorectal Cancers based on the Metro-ticket Paradigm. J Cancer 2021; 12:3299-3306. [PMID: 33976739 PMCID: PMC8100802 DOI: 10.7150/jca.55097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/09/2021] [Indexed: 01/24/2023] Open
Abstract
Background: Several revisions of the TNM classifications for colorectal cancer (CRC) have acknowledged that the oncological outcomes of stage IIB/IIC CRC are worse than those of stage IIIA. We aimed to develop a novel TNM (nTNM) classification based on the metro-ticket paradigm. Methods: We identified eligible CRC patients from the Surveillance, Epidemiology, and End Results database. The nTNM was developed using distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages, and was compared with the AJCC TNM classification. The areas under the curves (AUCs), calibration curves, and Akaike's information criterion (AIC) were used to evaluate the predictive performances of the two classifications. Clinical benefits were further estimated by decision curve analyses. The validation cohort was applied to validate these findings. Results: A total of 58,192 CRC patients (40,736 training cohort, 17,456 validation cohort) were finally included. In the training cohort, 18,476 patients (45.4%) experienced upstaging and 15,907 patients (39.0%) experienced downstaging in the nTNM classification compared with the TNM classification. Taking the prognosis of stage I as the reference, survival decreased with increasing nTNM stage. The nTNM classification showed better discrimination (AUC, 0.678 vs. 0.667, P<0.001), model-fitting (AIC, 236,525 vs. 237,741), and clinical benefits than the TNM classification. Similar results were found in the validation cohort. Conclusions: The nTNM classification for CRC has better predictive performances and superior accuracy for predicting prognosis compared with the TNM classification. The nTNM classification should therefore be considered in future revisions of the TNM classification.
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Affiliation(s)
- Jun-Peng Pei
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Chun-Dong Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China.,Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Xiang Fu
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Yong Ba
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Shuai Yue
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Zhe-Ming Zhao
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Dong-Qiu Dai
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China.,Cancer Center, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
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18
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Tong X, Zhuang Z, Wang X, Yang X, Bai L, Su L, Wei P, Su X. ACBP suppresses the proliferation, migration, and invasion of colorectal cancer via targeting Wnt/beta-catenin signaling pathway. Biomed Pharmacother 2021; 137:111209. [PMID: 33581651 DOI: 10.1016/j.biopha.2020.111209] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/14/2020] [Accepted: 12/26/2020] [Indexed: 01/24/2023] Open
Abstract
Anticancer bioactive peptide (ACBP), a novel bioactive peptide isolated from spleens of goats immunized with tumor extracts in our lab, can inhibit the proliferation of CRC in vitro and vivo. However, it remains unclear how the proliferation of CRC is inhibited by ACBP at the molecular level. Here, we provide evidences showing that ACBP significantly inhibits the expression of Wnt/β-catenin related genes (cyclin D1, met and c-myc) through pharmacotranscriptomic and qRT-PCR analysis in CRCs. Active β-catenin, a key protein within Wnt pathway, was compromised remarkably by ACBP in three CRCs, including HCT116, RKO and HT29. Thus nuclear accumulation of active β-catenin was retarded and finally lead to the decreased expression of oncogenes cyclin D1, met, and c-myc. In addition, we proved that active β-catenin reduction was mainly due to the inhibition of phospho-LRP6 and stimulation of phospho-β-catenin by ACBP. Based on the detection of Met and C-Myc in CRC tumor tissue without prior radiotherapy or chemotherapy, our results demonstrated that ACBP can act as a promising anticancer agent for CRC by targeting Wnt/β-catenin pathway, especially active β-catenin.
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Affiliation(s)
- Xin Tong
- Clinical Medical Research Center of the Affiliated Hospital, Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, 1 Tong Dao Street, Hohhot 010050, Inner Mongolia, China; NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Tian Tan Xi Li, Beijing 100050, China
| | - Zhuochen Zhuang
- NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Tian Tan Xi Li, Beijing 100050, China
| | - Xianjue Wang
- Clinical Medical Research Center of the Affiliated Hospital, Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, 1 Tong Dao Street, Hohhot 010050, Inner Mongolia, China
| | - Xiaoyu Yang
- Clinical Medical Research Center of the Affiliated Hospital, Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, 1 Tong Dao Street, Hohhot 010050, Inner Mongolia, China
| | - Liping Bai
- NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Tian Tan Xi Li, Beijing 100050, China
| | - Liya Su
- Clinical Medical Research Center of the Affiliated Hospital, Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, 1 Tong Dao Street, Hohhot 010050, Inner Mongolia, China.
| | - Ping Wei
- Department of Medical Immunology, Basic Medical College, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian 271000, China.
| | - Xiulan Su
- Clinical Medical Research Center of the Affiliated Hospital, Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, 1 Tong Dao Street, Hohhot 010050, Inner Mongolia, China.
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19
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Agas RAF, Co LBA, Sogono PG, Jacinto JCKM, Yu KKL, Jacomina LE, Bacorro WR, Sy Ortin TT. Assessing the Effect of Radiotherapy in Addition to Surgery in Colon Adenocarcinomas: a Systematic Review and Meta-analysis of Contemporary Evidence. J Gastrointest Cancer 2021; 51:445-460. [PMID: 31463890 DOI: 10.1007/s12029-019-00300-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE This study aims to review the contemporary evidence investigating radiotherapy (RT) in addition to surgery for colon adenocarcinomas. METHODS We searched the following databases: PubMed, Science Direct, Scopus, ASCOpubs, the Cochrane Library, and Google Scholar. Studies (since January 2005) comparing outcomes of high-risk colon adenocarcinomas who underwent RT in addition to surgery versus no RT were eligible. Pooling of outcomes from published results or from analysis of survival curves was done. Subgroup analysis was conducted to determine if the efficacy of RT varies with RT timing. RESULTS Eight studies were included (five retrospective cohorts, three population-based studies). Pooled analysis from retrospective cohorts showed a reduction in 5-year LR (OR 0.41; 95% CI 0.21-0.79; p = 0.007) in the RT group. A benefit in 3-year (OR 1.81; 95% CI 1.15-2.87; p = 0.01) and 5-year (OR 2.10; 95% CI 1.21-3.63; p = 0.008) DFS and in 3-year (OR 2.55; 95% CI 1.43-4.54; p = 0.001) and 5-year (OR 2.00; 95% CI 1.17-3.41; p = 0.01) OS was seen in the RT group. The OS benefit was demonstrated in the subgroup analysis of neoadjuvant RT, but not with adjuvant RT. The improvement in OS with neoadjuvant RT was supported by a population-based study from NCDB, while results from two population-based studies investigating adjuvant RT were conflicting. CONCLUSION Taking into account the limitations of the studies, our review of evidence suggests a possible role of RT in improving oncologic outcomes of select colon adenocarcinomas. Prospective studies are needed to definitively assess the value of RT for colon cancer.
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Affiliation(s)
- Ryan Anthony F Agas
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, España Boulevard, 1008, Manila, Philippines.
| | - Lester Bryan A Co
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, España Boulevard, 1008, Manila, Philippines
| | - Paolo G Sogono
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, España Boulevard, 1008, Manila, Philippines
| | - J C Kennetth M Jacinto
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, España Boulevard, 1008, Manila, Philippines
| | - Kelvin Ken L Yu
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, España Boulevard, 1008, Manila, Philippines
| | - Luisa E Jacomina
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, España Boulevard, 1008, Manila, Philippines
| | - Warren R Bacorro
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, España Boulevard, 1008, Manila, Philippines
| | - Teresa T Sy Ortin
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, España Boulevard, 1008, Manila, Philippines
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20
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Cortes-Guiral D, Glehen O. Expanding Uses of HIPEC for Locally Advanced Colorectal Cancer: A European Perspective. Clin Colon Rectal Surg 2020; 33:253-257. [PMID: 32968360 DOI: 10.1055/s-0040-1713742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Locally advanced colorectal cancer is a challenge for surgeons and medical oncologist; 10 to 20% colorectal cancer debut as locally advanced disease, with tumors extending through the colon wall with perforation and/or invasion of adjacent organs or structures. Those locally advanced tumors have a worse prognostic at any stage due not only to systemic dissemination but also in a high percentage of patients, to locoregional recurrence, in fact, peritoneal carcinomatosis of colorectal origin is so predictable that we can assess the risk for each patient according to some histopathological and clinical features: small peritoneal nodules resected in the first surgery (70% probability), ovarian metastases (60%), perforated tumor onset or intraoperative tumor rupture (50%), positive cytology (40%), and pT4/mucinous pT3 up to 40%. Prophylactic or adjuvant hyperthermic intraperitoneal chemotherapy seems to be a promising strategy for patients with advanced colorectal cancer to prevent the development of peritoneal recurrence and improve prognosis of this group of patients.
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Affiliation(s)
- Delia Cortes-Guiral
- General Surgery Department, Principe de Asturias University Hospital, Carretera de Alcala s/n, Alcalá de Henares, Madrid, Spain
| | - Olivier Glehen
- General Surgery Department (Surgical Oncology), Centre Hospitalier Lyon Sud (Hospices Civils de Lyon), Lyon, France
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21
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Mackowsky M, Toussaint A, Clarke K, Hudacko R. Metachronous Mesorectal Recurrence after Colectomy for Ascending Colon Cancer. Case Rep Oncol 2020; 13:643-648. [PMID: 32774249 PMCID: PMC7383195 DOI: 10.1159/000506734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 12/03/2022] Open
Abstract
Background An isolated metachronous recurrence in the mesorectum from a primary ascending colon cancer is a rare finding that has not been previously reported. This may represent a form of retroperitoneal spread, sometimes referred to as “drop metastasis,” which is an uncommon mechanism for metachronous recurrence. Case Presentation A 38-year-old male presented to the Emergency Department in January of 2018 with profound anemia. A colonoscopy revealed innumerable colonic polyps. He reported having multiple family members diagnosed with colon cancer and was subsequently diagnosed with familial adenomatous polyposis with rectal sparing. Total abdominal colectomy with ileorectal anastomosis was performed, revealing a T3N1a adenocarcinoma of the ascending colon. The patient subsequently underwent 12 cycles of adjuvant FOLFOX. Surveillance imaging in late 2019 revealed a suspicious mass in the superior perirectal soft tissue without any other sites of potential disease. Completion proctectomy was performed in January 2020, 2 years after the initial resection. Pathology revealed a mesorectal tumor deposit located 1.5 cm distal to the ileorectal anastomosis. No evidence of mucosal involvement or nodal metastasis was identified. Conclusion Isolated mesorectal recurrence is a rare and previously unreported clinical finding following resection of an ascending colon cancer with an ileorectal anastomosis. This likely represents a form of retroperitoneal spread.
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Affiliation(s)
- Matthew Mackowsky
- Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Ashley Toussaint
- Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Kevin Clarke
- Department of Surgery, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Rachel Hudacko
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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22
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Abstract
There have been significant developments in the management of advanced and recurrent colorectal cancer in recent decades. 70% of primary colorectal tumours arise in the colon and for patients with stage I-III disease, the standard of care is surgical resection followed by adjuvant therapy where appropriate. Locoregional recurrence (LR) occurs in 4-11.5% of patients following treatment of primary colon cancer with curative intent, and can be categorised as peri-anastomotic, mesenteric/paracolic (nodal), retroperitoneal and peritoneal. Of these, peritoneal recurrence is usually recognised as the most challenging type of recurrence to manage. Patients with isolated peri-anastomotic or limited nodal recurrence in the mesentery or retroperitoneum may be curable by radical salvage surgery, which often requires en bloc multi-visceral resection, while patients with low volume peritoneal metastases may be candidates for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ensuring complete resection along embryonic mesocolic planes or en bloc resection of contiguously involved structures are best strategies to reduce the likelihood of local recurrence through a R1 resection margin. The role of complete mesocolic excision (CME) with high vascular ligation has been demonstrated to increase nodal yield and improve overall survival although this is more contentious. In patients with T4a disease and serosal surface involvement, peritoneal recurrence represents the greatest threat. Efforts for early diagnosis of peritoneal recurrence in these patients or prophylactic treatment, while intuitive have not demonstrated the survival benefit that would be expected. Other than locoregional recurrence (LR), systemic recurrence may occur in up to 50% of patients who have undergone curative resection for colorectal cancer. In keeping with portal venous outflow, the most common site of systemic recurrence is the liver. Although previously thought to be a fatal condition, liver resection is now the standard of care where liver metastases can be completely resected with clear margins plus leaving an adequate liver remnant with intact vascular inflow, outflow and biliary drainage. This can usually be achieved in 26-45% of patients presenting with liver metastases. Liver surgeons at the forefront of liver resection have also developed techniques to induce liver hypertrophy so as to improve likelihood of resectability. Even where patients have non-resectable disease, ablative techniques have become increasingly common. Naturally, none of these would be possible without the advent of improved chemotherapeutic and biological options in the field of medical oncology. Pulmonary metastasectomy with curative intent may be possible in a small number (10%) of patients with lung metastases, which is associated with an overall survival of up to 40%. Unlike liver metastases, proportionally less patients with pulmonary metastases will be resectable. For these patients, several ablative options are available. For all patients with recurrent colon cancer, patient selection for radical salvage surgery and decisions surrounding treatment strategy (including use of systemic therapy or ablative procedures) should take place in a multidisciplinary team setting.
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Affiliation(s)
- Kilian G M Brown
- SOuRCe (Surgical Outcomes Research Centre), Royal Prince Alfred Hospital, Sydney, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Cherry E Koh
- SOuRCe (Surgical Outcomes Research Centre), Royal Prince Alfred Hospital, Sydney, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, Discipline of Surgery, University of Sydney, Australia
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23
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Mukai T, Nagasaki T, Akiyoshi T, Fukunaga Y, Yamaguchi T, Konishi T, Nagayama S, Ueno M. Laparoscopic multivisceral resection for locally advanced colon cancer: a single-center analysis of short- and long-term outcomes. Surg Today 2020; 50:1024-1031. [PMID: 32152770 DOI: 10.1007/s00595-020-01986-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/28/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE We evaluated the technical and oncological safety of laparoscopic multivisceral resection (MVR) in selected patients with locally advanced colon cancer (LACC). METHODS We compared the clinical backgrounds, and short- and long-term outcomes of patients who underwent laparoscopic vs. those who underwent open MVR for LACC en bloc at our hospital. RESULTS Between January, 2004 and December, 2015, 140 patients underwent MVR of the primary tumor en bloc via laparoscopic surgery (laparoscopic group; LG, n = 69) or open surgery (open group; OG, n = 71). Laparoscopic surgery was selected mainly for tumors that invaded the bladder and abdominal wall. The LG patients had smaller tumors (60 vs. 80 mm, p < 0.001), less blood loss (30 vs. 181 g, p < 0.001), and shorter hospital stays (12 vs. 19 days, p < 0.001) than the OG patients. Open conversion was required for two patients. Postoperative complications and R0 resection were comparable between the groups. Local recurrence occurred in two LG patients and two OG patients. The 5-year cancer-specific survival, disease-free survival, and local disease-free survival of patients with pT4b disease were not significantly different between the LG and OG groups (90.3% vs. 75.2%, 71.2% vs. 67.6%, and 97.1% vs. 94.2%). CONCLUSION Although the LG included patients with lower risk, the short- and long-term outcomes were equivalent to those of the OG, which included patients with higher risk.
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Affiliation(s)
- Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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24
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Application of Irreversible Electroporation Ablation as Adjunctive Treatment for Margin Enhancement: Safety and Efficacy. J Surg Res 2020; 246:260-268. [DOI: 10.1016/j.jss.2019.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/21/2019] [Accepted: 06/05/2019] [Indexed: 02/08/2023]
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25
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Khalili M, Daniels L, Gleeson EM, Grandhi N, Thandoni A, Burg F, Holleran L, Morano WF, Bowne WB. Pancreaticoduodenectomy outcomes for locally advanced right colon cancers: A systematic review. Surgery 2019; 166:223-229. [PMID: 31182232 DOI: 10.1016/j.surg.2019.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/08/2019] [Accepted: 04/24/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) with right hemicolectomy (RH) to treat locally advanced right colon cancer (LARCC) has been rarely reported in the literature. Herein, we characterize clinicopathologic factors and evaluate outcomes of en bloc PD and RH for LARCC. METHODS A systematic review of the literature was conducted on PubMed using MeSH terms ("pancreaticoduodenectomy" or "pancreas/surgery" or "duodenum/surgery" or "colectomy") and ("colonic neoplasms"). Data was extracted from patients who underwent en bloc PD and RH for LARCC. Factors investigated included patient demographics, surgical and pathologic parameters, postoperative complications, disease recurrence, and survival. RESULTS Our search yielded 27 articles (106 patients), including 1 case from our institution. Most patients were male (62.1%), median age 58 years (range 34-83). Surgical procedures performed included en bloc RH with PD (n = 91, 85.8%) and en bloc RH with pylorus-preserving PD (n = 15, 14.2%). Among reported, 95.5% of patients (n = 63), underwent R0 resection. One or more complications were reported in 33 patients (52.4%). Median survival was 168 months. Survival after resection was 75.9% at 2 years and 66.3% at 5 years. Overall survival was greater in patients with no lymph node involvement (IIC versus IIIC, hazard ratio 8.4, P = .003). Five-year survival for patients was 84.9% in patients with stage IIC versus 46.4% in patients with stage IIIC. There were 3 postoperative mortalities. CONCLUSION This data demonstrates that en bloc PD and RH is rarely performed yet can be a potentially safe treatment option in patients with LARCC. Lymph node involvement was the only independent prognostic factor.
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Affiliation(s)
- Marian Khalili
- Department of Surgery, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA
| | - Lynsey Daniels
- Department of Surgery, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA
| | - Elizabeth M Gleeson
- Department of Surgery, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA
| | - Nikhil Grandhi
- Department of Surgery, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA
| | - Aditya Thandoni
- Department of Surgery, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA
| | - Franklin Burg
- Department of Surgery, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA
| | - Lauren Holleran
- Department of Surgery, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA
| | - William F Morano
- Department of Surgery, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA
| | - Wilbur B Bowne
- Department of Surgery, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA.
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26
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Ramphal W, Boeding JRE, Schreinemakers JMJ, Gobardhan PD, Rutten HJT, Crolla RMPH. Colonoscopy Surveillance After Colorectal Cancer: the Optimal Interval for Follow-Up. J Gastrointest Cancer 2019; 51:469-477. [PMID: 31155695 DOI: 10.1007/s12029-019-00254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Patients who have undergone curative surgery for colorectal cancer are at risk of developing a metachronous colorectal tumour or anastomotic recurrence. The aim of this study was to determine the incidence of recurrent colorectal cancer in a cohort of patients who participated in a colonoscopy surveillance programme. METHODS This single-centre retrospective observational cohort study included patients who underwent curative surgery for colorectal cancer between 2005 and 2015. All reports of postoperative colonoscopies were retrieved to calculate the incidence rates of recurrence and metachronous colorectal cancer. RESULTS Of 2420 patients, 1644 (67.9%) underwent at least one postoperative colonoscopy and 776 (32.1%) did not. In 1087 patients, colonoscopy was performed in the first 18 months after surgery, which detected 34 (3.1%) instances of metachronous colorectal tumours or anastomotic recurrence. Thirty-three additional patients were also diagnosed with recurrent colorectal cancer, but the tumours were detected by other diagnostic modalities or detected perioperatively, rather than by colonoscopy. CONCLUSIONS Patients with a history of colorectal cancer have an increased risk for a second colorectal tumour. Therefore, we recommend a colonoscopic surveillance programme with the first colonoscopy performed 1 year after curative surgery, which is in accordance with national guidelines.
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Affiliation(s)
- Winesh Ramphal
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK, Breda, The Netherlands.
| | - Jeske R E Boeding
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK, Breda, The Netherlands
| | | | - Paul D Gobardhan
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Rogier M P H Crolla
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK, Breda, The Netherlands
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27
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Ramphal W, Boeding JR, van Iwaarden M, Schreinemakers JM, Rutten HJ, Crolla RM, Gobardhan PD. Serum carcinoembryonic antigen to predict recurrence in the follow-up of patients with colorectal cancer. Int J Biol Markers 2019; 34:60-68. [DOI: 10.1177/1724600818820679] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Serum carcinoembryonic (CEA) antigen is used as a diagnostic screening tool during follow-up in colorectal cancer patients. However, it remains unclear whether preoperative serum CEA is a reliable marker in the follow-up to predict recurrence. The aim of the study is to determine the value of elevated pre- and postoperative serum carcinoembryonic antigen levels (CEA > 5 µg/L) as an independent prognostic factor for locoregional and distant recurrence in patients who underwent curative surgery for colorectal cancer. Methods: This single center retrospective observational cohort study includes patients who underwent curative surgery for colorectal cancer between 2005 and 2015 and had pre- and postoperative serum CEA measurements. Five-year disease-free survival and multivariate Cox regression analyses were performed to adjust for confounding factors. Results: Preoperative serum CEA level was measured in 2093 patients with colorectal cancer. No significant association was found between an elevated preoperative serum CEA and locoregional recurrence (adjusted hazard ratio (HR) 1.29 (95% confidence interval (CI) 0.91, 1.84; P=0.26)). However, a significant association was found between an elevated preoperative serum CEA and systemic recurrence (adjusted HR 1.58 (95% CI 1.25, 2.00; P<0.01)]. The five-year disease-free survival was lower in patients with elevated preoperative serum CEA levels ( P<0.01). Postoperative serum CEA level was the most sensitive for hepatic metastases during follow-up (73.3%). Conclusions: The preoperative serum CEA level is an independent prognostic factor for systemic metastasis after curative surgery for colorectal cancer in patients with stage I–III disease. The level is the most sensitive for hepatic metastasis compared to metastasis to other anatomic sites.
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Affiliation(s)
- Winesh Ramphal
- Department of Surgery Amphia Hospital Breda, the Netherlands
| | | | | | | | - Harm J.T. Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
- GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
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28
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Liu ZH, Wang N, Wang FQ, Dong Q, Ding J. Oncological outcomes of laparoscopic versus open surgery in pT4 colon cancers: A systematic review and meta-analysis. Int J Surg 2018; 56:221-233. [PMID: 29940259 DOI: 10.1016/j.ijsu.2018.06.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/01/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Widespread adoption of minimally invasive surgery for colon cancer has achieved improved short-term benefits and better long-term oncological outcomes compared with open surgery. However, it is still controversial whether laparoscopic surgery is suitable for patients with stage T4 colon cancer. The aim of this meta-analysis was to compare short- and long-term oncological outcomes associated with laparoscopic and conventional open surgery for pT4 colon cancer. METHODS Published studies from 2003 to 2018 comparing oncological outcomes following laparoscopic and open surgery for pT4 colon cancer were systematically searched. Data on conversion rate, R0 resection rate, number of harvested lymph nodes, morbidity and mortality, and overall survival (OS) and disease-free survival (DFS) were subjected to meta-analysis using fixed-effect and random-effect models. RESULTS Twelve observational studies met the inclusion criteria with a total of 2396 cases (1250 laparoscopic and 1146 open). There was no significant difference in R0 resection rate [relative risk (RR) = 1.007; 95% confidence interval (CI) = 0.935-1.085; P = 0.850], number of harvested lymph nodes (MD = 0.004; 95% CI = -0.139 to 0.148; P = 0.951), mortality (RR = 0.509; 95% CI = 0.176-1.470; P = 0.212), and 3-year OS (RR = 1.056; 95% CI = 0.939-1.188; P = 0.360), 5-year OS (RR = 1.003; 95% CI = 0.883-1.139; P = 0.966), 3-year DFS (RR = 1.032; 95% CI = 0.903-1.179; P = 0.642), and 5-year DFS (RR = 0.995; 95% CI = 0.868-1.140; P = 0.973) between the groups. The rate of conversion from laparoscopic to open procedures was 10.7% (95% CI = 0.090-0.124). There was a significant difference in incidence of complications within 30 postoperative days between laparoscopic and open surgery (RR = 0.703; 95% CI = 0.564-0.876; P = 0.002). CONCLUSION Laparoscopic surgery is safe and feasible in pT4 colon cancer, oncological outcomes are similar, and more importantly, there are fewer postoperative complications compared with open surgery.
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Affiliation(s)
- Zhen-Hua Liu
- Medical College of Guizhou University, Guiyang 550025, China; Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Ning Wang
- Department of Pharmacy, Guizhou Orthopaedic Hospital, Guiyang 550002, China
| | - Fei-Qing Wang
- Department of Clinical Laboratory, First Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang 550001, China
| | - Qi Dong
- Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Jie Ding
- Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China.
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29
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An Optimal Orthotopic Mouse Model for Human Colorectal Cancer Primary Tumor Growth and Spontaneous Metastasis. Dis Colon Rectum 2018; 61:698-705. [PMID: 29722728 DOI: 10.1097/dcr.0000000000001096] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colorectal cancer is a leading cause of cancer-related death. Small animal models allow for the study of different metastatic patterns, but an optimal model for metastatic colorectal cancer has not been established. OBJECTIVE The purpose of this study was to determine which orthotopic model most accurately emulates the patterns of primary tumor growth and spontaneous liver and lung metastases seen in patients with colorectal cancer. DESIGN Using luciferase-tagged HT-29 cells coinoculated with lymph node stromal analog HK cells, 3 tumor cell delivery models were compared: intrarectal injection, intracecal injection, and acid enema followed by cancer cell instillation. Tumor growth was monitored weekly by bioluminescent imaging, and mice were sacrificed based on primary tumor size or signs of systemic decline. Liver and lungs were evaluated for metastases via bioluminescent imaging and histology. SETTINGS The study was conducted at a single university center. MAIN OUTCOME MEASURES Primary tumor and metastasis bioluminescent imaging were measured. RESULTS Intrarectal injection had the lowest mortality at 4.0% (1/25) compared with the intracecal group at 17.4% (4/23) and the acid enema followed by cancer cell instillation group at 15.0% (3/20).The primary tumors in intrarectal mice had the highest average bioluminescence (3.78 × 10 ± 4.94 × 10 photons) compared with the mice in the intracecal (9.52 × 10 ± 1.92 × 10 photons; p = 0.012) and acid enema followed by cancer cell instillation groups (6.23 × 10 ± 1.23 × 10 photons; p = 0.0016). A total of 100% of intrarectal and intracecal mice but only 35% of mice in the acid enema followed by cancer cell instillation group had positive bioluminescent imaging before necropsy. Sixty percent of intrarectal mice had liver metastases, and 56% had lung metastases. In the intracecal group, 39% of mice had liver metastases, and 35% had lung metastases. Only 2 acid enema followed by cancer cell instillation mice developed metastases. LIMITATIONS Tumor injections were performed by multiple investigators. Distant metastases were confirmed, but local lymph node status was not evaluated. CONCLUSIONS Intrarectal injection is the safest, most reproducible, and successful orthotopic mouse model for human colorectal cancer primary tumor growth and spontaneous metastasis.
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30
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Abstract
BACKGROUND Locally advanced colon cancer invading surrounding organs or structures is challenging to surgeons and oncologists. Multivisceral resections with tumor removal en bloc with invaded tissues provide the best chance for cure. OBJECTIVE We aimed to assess the management and outcomes after multivisceral resections in patients with clinically infiltrative, locally advanced primary colon cancer. DESIGN This is a descriptive retrospective cohort study. SETTINGS A total of 121 consecutive patients with locally advanced primary colon cancer underwent en bloc multivisceral resections at a tertiary referral unit for colorectal cancer between 2007 and 2014. MAIN OUTCOME MEASURES Patient demographics, surgical details, histopathological findings, and outcomes were analyzed through registry data and reviews of patient files. RESULTS An R0 resection was achieved in 112 patients (92.6%), and an R1 resection was achieved in 9 patients (7.4%). Actual tumor cell infiltration in resected tissues was found in 77 patients (63.6%), and inflammation was found in 44 patients (36.4%). The estimated 5-year overall survival was 60.8% and 86.9%. Survival was significantly better after R0 than after R1 resections. After a median follow-up of 28 months, recurrent disease was diagnosed in 25 patients (20.7%). Female sex, low tumor stage, and adjuvant chemotherapy, but not tumor infiltration per se, were independently associated with better overall survival in a multivariate analysis. LIMITATIONS The main limitations of the study are the retrospective design and the fact that all patients were operated on at 1 institution by a small number of surgeons. CONCLUSIONS Patients with locally advanced colon cancer can be cured with an R0 resection. All involved surrounding tissues should be removed en bloc with the primary tumor. See Video Abstract at http://links.lww.com/DCR/A548.
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31
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Littlechild J, Junejo M, Simons AM, Curran F, Subar D. Emergency resection surgery for colorectal cancer: Patterns of recurrent disease and survival. World J Gastrointest Pathophysiol 2018; 9:8-17. [PMID: 29487762 PMCID: PMC5823701 DOI: 10.4291/wjgp.v9.i1.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 11/25/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate prognostic pathological factors associated with early metachronous disease and adverse long-term survival in these patients.
METHODS Clinical and histological features were analysed retrospectively over an eight-year period for prognostic impact on recurrent disease and overall survival in patients undergoing curative resection of a primary colorectal cancer.
RESULTS A total of 266 patients underwent curative surgery during the study period. The median age of the study cohort was 68 year (range 26 to 91) with a follow-up of 7.9 years (range 4.6 to 12.6). Resection was undertaken electively in 225 (84.6%) patients and emergency resection in 35 (13.2%). Data on timing of surgery was missing in 6 patients. Recurrence was noted in 67 (25.2%) during the study period and was predominantly early within 3 years (82.1%) and involved hepatic metastasis in 73.1%. Emergency resection (OR = 3.60, P = 0.001), T4 stage (OR = 4.33, P < 0.001) and lymphovascular invasion (LVI) (OR = 2.37, P = 0.032) were associated with higher risk of recurrent disease. Emergency resection, T4 disease and a high lymph node ratio (LNR) were strong independent predictors of adverse long-term survival.
CONCLUSION Emergency surgery is associated with adverse disease free and long-term survival. T4 disease, LVI and LNR provide strong independent predictive value of long-term outcome and can inform surveillance strategies to improve outcomes.
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Affiliation(s)
- Joe Littlechild
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Muneer Junejo
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Anne-Marie Simons
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Finlay Curran
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Darren Subar
- Hepatobiliary Surgery Unit, Royal Blackburn Hospital, Blackburn BB2 3HH, United Kingdom
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Alcántara-Quispe C, Xavier JM, Atallah S, Romagnolo LGC, Melani AGF, Jorge E, Muller RL, Machado RD, Faria EF. Laparoscopic left ureteral substitution using the cecal appendix after en-bloc rectosigmoidectomy: a case report and video demonstration. Tech Coloproctol 2017; 21:817-818. [PMID: 28993947 DOI: 10.1007/s10151-017-1694-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- C Alcántara-Quispe
- Department of Urology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
| | - J M Xavier
- Department of Urology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - S Atallah
- Center for Colon and Rectal Surgery, Florida Hospital, Winter Park, FL, USA
| | - L G C Romagnolo
- Department of Coloproctology, Cancer Hospital of Barretos, Barretos, São Paulo, Brazil
| | - A G F Melani
- Department of Coloproctology, Américas Medical City, Rio de Janeiro, Brazil
| | - E Jorge
- Department of Urology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - R L Muller
- Department of Urology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - R D Machado
- Department of Urology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - E F Faria
- Department of Urology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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En Bloc Pancreaticoduodenectomy for Locally Advanced Right Colon Cancers. Int J Surg Oncol 2017; 2017:5179686. [PMID: 28751989 PMCID: PMC5511679 DOI: 10.1155/2017/5179686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/04/2017] [Indexed: 12/02/2022] Open
Abstract
Locally advanced right colon cancer may invade adjacent tissue and organs. Direct invasion of the duodenum and pancreas necessitates an en bloc resection. Previously, this challenging procedure was associated with high morbidity and mortality; however, today, this procedure can be done more safely in experienced centers. The aim of this study is to report our experience on en bloc right colectomy with pancreaticoduodenectomy for locally advanced right colon cancers. Between 2000 and 2012, 5 patients underwent en bloc multivisceral resection. No major morbidities or perioperative mortalities were observed. Median disease-free survival time was 24.5 months and median overall survival time was 42.1 (range: 4.5–70.4) months in our series. One patient lived 70 months after multivisceral resection and underwent cytoreductive surgery and total pelvic exenteration during the follow-up period. In locally advanced right colon tumors, all adhesions should be considered as malign invasion and separation should not be done. The reasonable option for this patient is to perform en bloc pancreaticoduodenectomy and right colectomy. This procedure may result in long-term survival with acceptable morbidity and mortality rates. Multidisciplinary teamwork and multimodality treatment alternatives may improve the results.
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Successful Resection of Isolated Para-Aortic Lymph Node Recurrence from Advanced Sigmoid Colon Cancer following 156 Courses of FOLFIRI Regimen. Case Rep Surg 2016; 2016:4548798. [PMID: 27648336 PMCID: PMC5014983 DOI: 10.1155/2016/4548798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/28/2016] [Accepted: 08/03/2016] [Indexed: 01/11/2023] Open
Abstract
Isolated para-aortic lymph node (PLN) recurrence from colorectal cancer (CRC) is rare, with no currently validated treatments. Few reports have described the successful resection of isolated PLN involvement from CRC following chemotherapy. We report the case of a 63-year-old man who underwent sigmoidectomy for sigmoid colon cancer at our hospital. Pathological examination demonstrated advanced sigmoid colon cancer with metastatic involvement in both of the tested PLNs. Palliative chemotherapy was initiated four weeks after surgical resection, with administration of the FOLFIRI regimen. Four years after the operation, computed tomography (CT) revealed an enlarged PLN below the left renal vein. As PLN enlarged to 15 mm in the minor axis on a CT scan in 2014 after receiving a total of 156 courses of the FOLFIRI regimen, we considered the enlarged PLN to represent an isolated metastasis. Accordingly, lymph node resection was performed with microscopically negative margins. The patient maintained a good quality of life without any side effects throughout the whole course of his treatment and remains disease-free at 24 months without chemotherapy after resection of the isolated PLN. Curative resection following chemotherapy may improve survival of carefully selected advanced CRC patients with locoregional recurrence, such as isolated PLN involvement.
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Chu QD, Zhou M, Medeiros KL, Peddi P, Kavanaugh M, Wu XC. Poor survival in stage IIB/C (T4N0) compared to stage IIIA (T1-2 N1, T1N2a) colon cancer persists even after adjusting for adequate lymph nodes retrieved and receipt of adjuvant chemotherapy. BMC Cancer 2016; 16:460. [PMID: 27412163 PMCID: PMC4944507 DOI: 10.1186/s12885-016-2446-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/24/2016] [Indexed: 12/15/2022] Open
Abstract
Background A survival paradox between Stage IIB/C and Stage IIIA colon cancers exists. It is unclear how adequate lymph nodes dissection (LN) and post-surgery chemotherapy contribute to the survival paradox. We intended to assess the impact of these two factors on the survival paradox. Results We evaluated 34,999 patients diagnosed with stage IIIA or stage IIB/C colon cancer in 2003–2012 from the National Cancer Data Base. The 5-year overall survival (OS) was 73.5 % for stage IIIA and 51.1 % for stage IIB/C (P < 0.0001). The 5-year OS was 84.1 % for stage IIIA with post-surgery chemotherapy, 70.8 % for stage IIB/C with ≥ 12 LNs retrieved with chemotherapy, 53.9 % for stage IIB/C < 12 LNs with chemotherapy, 49.5 % for stage IIIA without chemotherapy, 43.7 % for stage IIB/C ≥ 12 LNs retrieved without chemotherapy, to 27.7 % for stage IIB/C < 12 LNs without chemotherapy. Even among stage IIB/C who had optimal treatment (≥12 LNs retrieved, received chemotherapy), OS remains lower than stage IIIA with chemotherapy. After adjusting LN dissection and chemotherapy in addition to the adjustment of other clinical factors, the survival paradox was reduced from HR = 1.76 (95 % CI: 1.68–1.85) to HR 1.51 (95 % CI: 1.44–1.59). Conclusions LN dissection and post-surgery chemotherapy partially explained the survival paradox. More research is warranted to identify other factors that contribute to this paradox. Future iteration of TNM staging system should take this into consideration.
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Affiliation(s)
- Quyen D Chu
- Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, 71130, USA.,Feist-Weiller Cancer Center, Shreveport, Louisiana, 71130, USA
| | - Meijiao Zhou
- Louisiana Tumor Registry and Epidemiology, New Orleans, Louisiana, 71102, USA.,School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, 71102, USA
| | - Kaelen L Medeiros
- Louisiana Tumor Registry and Epidemiology, New Orleans, Louisiana, 71102, USA.,School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, 71102, USA
| | - Prakash Peddi
- Department of Medicine, Division of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, 71130, USA. .,Feist-Weiller Cancer Center, Shreveport, Louisiana, 71130, USA.
| | - Mindie Kavanaugh
- Department of Medicine, Division of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, 71130, USA.,Feist-Weiller Cancer Center, Shreveport, Louisiana, 71130, USA
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry and Epidemiology, New Orleans, Louisiana, 71102, USA.,School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, 71102, USA
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36
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Natsume S, Shimizu Y, Sano T, Senda Y, Ito S, Komori K, Abe T, Yanagisawa A, Yamao K. Long-term survival case of a recurrent colon cancer owing to successful resection of a tumor at hepaticojejunostomy: report of a case. Surg Case Rep 2016; 1:26. [PMID: 26943394 PMCID: PMC4747950 DOI: 10.1186/s40792-015-0016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/09/2015] [Indexed: 11/11/2022] Open
Abstract
With advances in surgical procedures and perioperative management, hepato-biliary-pancreatic surgery, including hepatectomy and pancreaticoduodenectomy, has been employed for recurrent colon cancer. However, no report has described a case of major hepatectomy with the combined resection of hepaticojejunostomy following pancreaticoduodenectomy for locoregionally recurrent colon cancer. Here, such a case is reported. The patient, a 37-year-old woman, had undergone pancreaticoduodenectomy for lymph node recurrence along the extrahepatic bile duct from cecal cancer. Thirteen months later, a biliary stricture was found at the hepaticojejunostomy site and right hepatectomy was performed. The resected specimen showed a papillary tumor at the hepaticojejunostomy. Based on its histological features, the pathogenesis of this tumor was considered to be intramural recurrence via lymphatic vessels. Although she underwent resection of a lymph node recurrence at her mesentery 12 months later, she has remained well thereafter, without any sign of further recurrence during 5 years of follow-up after hepatectomy.
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Affiliation(s)
- Seiji Natsume
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Japan.
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Japan.
| | - Tsuyoshi Sano
- Department of Gastroenterological Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, Japan.
| | - Yoshiki Senda
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Japan.
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Japan.
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Japan.
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Japan.
| | - Akio Yanagisawa
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, 465 Kajiimachi, Hirokoji-noboru, Kawaramachi-dori, Kamikyo-ku, Kyoto, Japan.
| | - Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Japan.
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37
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Anticancer bioactive peptides suppress human colorectal tumor cell growth and induce apoptosis via modulating the PARP-p53-Mcl-1 signaling pathway. Acta Pharmacol Sin 2015; 36:1514-9. [PMID: 26592508 DOI: 10.1038/aps.2015.80] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/12/2015] [Indexed: 02/06/2023] Open
Abstract
AIM We have reported novel anticancer bioactive peptides (ACBPs) that show tumor-suppressive activities in human gastric cancer, leukemia, nasopharyngeal cancer, and gallbladder cancer. In this study, we investigated the effects of ACBPs on human colorectal cancer and the underlying mechanisms. METHODS Cell growth and apoptosis of human colorectal tumor cell line HCT116 were measured using cell proliferation assay and flow cytometry, respectively. The expression levels of PARP, p53 and Mcl1A were assessed with Western blotting and immunohistochemistry. For evaluation of the in vivo antitumor activity of ACBPs, HCT116 xenograft nude mice were treated with ACBPs (35 μg/mL, ip) for 10 days. RESULTS Treatment of HCT116 cells with ACBPs (35 μg/mL) for 4-6 days significantly inhibited the cell growth. Furthermore, treatment of HCT116 cells with ACBPs (35 μg/mL) for 6-12 h significantly enhanced UV-induced apoptosis, increased the expression of PARP and p53, and decreased the expression of Mcl-1. Administration of ACBPs did not change the body weight of HCT116 xenograft nude mice, but decreased the tumor growth by approximately 43%, and increased the expression of PARP and p53, and decreased the expression of Mcl-1 in xenograft mouse tumor tissues. CONCLUSION Administration of ACBPs inhibits human colorectal tumor cell growth and induces apoptosis in vitro and in vivo through modulating the PARP-p53-Mcl-1 signaling pathway.
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38
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Elnahas A, Sunil S, Jackson TD, Okrainec A, Quereshy FA. Laparoscopic versus open surgery for T4 colon cancer: evaluation of margin status. Surg Endosc 2015; 30:1491-6. [PMID: 26123344 DOI: 10.1007/s00464-015-4360-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 06/18/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic resection has been considered a relative contraindication for T4 colonic and rectal lesions due to concern over inadequate margins. The objective of this study was to compare planned laparoscopic and open resections of T4 lesions with respect to the positive margin rate. METHODS Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program participant use file to perform a retrospective cohort analysis. The study population consisted of patients that underwent a colorectal resection for a primary T4 lesion during 2011 and 2012. A multiple logistic regression analysis was conducted to determine the adjusted odds ratio (OR) of positive margins based on surgical approach. An inverse probability of treatment weighting (IPTW) analysis was used to account for confounding by indication. A sensitivity analysis including only "as-treated" cases was also performed. RESULTS The sub-selected population consisted of 455 and 406 patients in the laparoscopic and open group, respectively. In the original cohort, demographic variables were similar. The open group had a higher incidence of comorbidities, metastatic disease, and emergency cases. Laparoscopic surgery was found to be no different than open surgery with respect to positive margin status (OR 1.10, p = 0.54). After IPTW adjustment, surgical approach remained a nonsignificant predictor of positive margins (OR 1.18, p = 0.31). The "as-treated" analysis also showed that surgical approach had no significant effect on the positive margin rate (OR 1.24, p = 0.24). CONCLUSIONS Using this large national surgical database, select patients with T4 lesions who underwent planned laparoscopic colorectal resections did not have a significantly higher positive margin rate compared with patients with open operations. Further research is needed to identify the role of laparoscopy in managing T4b lesions before any consensus can be reached regarding its application in locally advanced colon cancer.
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Affiliation(s)
- Ahmad Elnahas
- Department of Surgery, Toronto Western Hospital - University Health Network, University of Toronto, 399 Bathurst Street, Room 8MP - 320, Toronto, ON, M5T 2S8, Canada
| | - Supreet Sunil
- Department of Surgery, Toronto Western Hospital - University Health Network, University of Toronto, 399 Bathurst Street, Room 8MP - 320, Toronto, ON, M5T 2S8, Canada
| | - Timothy D Jackson
- Department of Surgery, Toronto Western Hospital - University Health Network, University of Toronto, 399 Bathurst Street, Room 8MP - 320, Toronto, ON, M5T 2S8, Canada
| | - Allan Okrainec
- Department of Surgery, Toronto Western Hospital - University Health Network, University of Toronto, 399 Bathurst Street, Room 8MP - 320, Toronto, ON, M5T 2S8, Canada
| | - Fayez A Quereshy
- Department of Surgery, Toronto Western Hospital - University Health Network, University of Toronto, 399 Bathurst Street, Room 8MP - 320, Toronto, ON, M5T 2S8, Canada. .,Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
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39
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Schumacher A, Babikir OM, Abboud A, Theodorakis S. A rare presentation of locally re-recurrent colon cancer involving the iliac bone and a review of the literature. BMJ Case Rep 2014; 2014:bcr-2014-203547. [PMID: 25355743 DOI: 10.1136/bcr-2014-203547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Colorectal cancer is a leading cause of cancer death in the USA. While locally advanced rectal cancer involving bone has been described extensively, colon cancer locally involving bone has only been described, to our knowledge, in a single case report. In this case report, we describe the presentation and treatment of locally advanced re-recurrent colon cancer involving the iliac bone. We also discuss the available literature on treatment for recurrent and re-recurrent colorectal cancer.
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Affiliation(s)
- Andrew Schumacher
- Department of Medicine, Weiss Memorial Hospital, Chicago, Illinois, USA
| | | | - Amer Abboud
- Department of Pathology, Weiss Memorial Hospital, Chicago, Illinois, USA
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40
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Right hemicolectomy plus pancreaticoduodenectomy vs partial duodenectomy in treatment of locally advanced right colon cancer invading pancreas and/or only duodenum. Surg Oncol 2014; 23:92-8. [DOI: 10.1016/j.suronc.2014.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/29/2014] [Accepted: 03/17/2014] [Indexed: 12/28/2022]
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Abstract
BACKGROUND Approximately 10% of patients with colorectal cancer have locally advanced disease with peritoneal involvement (T4a) or invasion of adjacent organs (T4b) at the time of diagnosis. Of patients who undergo resection with curative intent, between 7 and 33% develop isolated locoregional recurrences. R0 surgical excision is potentially curative. METHODS We reviewed the literature relating to multivisceral resection for T4 or recurrent colorectal cancer. RESULTS Comprehensive staging to identify the local and systemic extent of disease is essential to determine resectability and patient suitability for a curative approach. PET scans and pelvic MRI (rectal) staging and a coordinated multispecialty input to neoadjuvant treatment, multivisceral surgical resection, reconstruction and adjuvant chemotherapy are essential. Intraoperative radiotherapy and hyperthermic intraperitoneal chemotherapy may have a role in selected patients. R0 resection can achieve 5-year local control rates for primary locally advanced and recurrent colorectal cancer of up to 89 and 38%, respectively, and overall 5-year survival up to 66 and 25%, respectively. CONCLUSION An aggressive surgical strategy as part of a multimodal strategy in the treatment of locally advanced or recurrent colorectal cancer in the absence of incurable metastatic disease affords the best prospect for long-term survival in selected patients.
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Affiliation(s)
- J O Larkin
- Surgical Professorial Unit, St. Vincent's University Hospital and UCD School of Medicine and Medical Sciences, Dublin, Ireland
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