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Fadlallah H, El Masri J, Fakhereddine H, Youssef J, Chemaly C, Doughan S, Abou-Kheir W. Colorectal cancer: Recent advances in management and treatment. World J Clin Oncol 2024; 15:1136-1156. [PMID: 39351451 PMCID: PMC11438855 DOI: 10.5306/wjco.v15.i9.1136] [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: 12/27/2023] [Revised: 06/11/2024] [Accepted: 07/29/2024] [Indexed: 08/29/2024] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide, and the second most common cause of cancer-related death. In 2020, the estimated number of deaths due to CRC was approximately 930000, accounting for 10% of all cancer deaths worldwide. Accordingly, there is a vast amount of ongoing research aiming to find new and improved treatment modalities for CRC that can potentially increase survival and decrease overall morbidity and mortality. Current management strategies for CRC include surgical procedures for resectable cases, and radiotherapy, chemotherapy, and immunotherapy, in addition to their combination, for non-resectable tumors. Despite these options, CRC remains incurable in 50% of cases. Nonetheless, significant improvements in research techniques have allowed for treatment approaches for CRC to be frequently updated, leading to the availability of new drugs and therapeutic strategies. This review summarizes the most recent therapeutic approaches for CRC, with special emphasis on new strategies that are currently being studied and have great potential to improve the prognosis and lifespan of patients with CRC.
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Affiliation(s)
- Hiba Fadlallah
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Jad El Masri
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Hiam Fakhereddine
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Joe Youssef
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Chrystelle Chemaly
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Samer Doughan
- Department of Surgery, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Wassim Abou-Kheir
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
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Ding H, Xu B, Wang Y, Xu B, Qiu W, Zhang W, Wang Y, Li G. Sigmoid colon cancer presenting as a large abdominal mass accompanied by abscess and rupture: a case report and literature review. Ann Med Surg (Lond) 2024; 86:5604-5610. [PMID: 39238955 PMCID: PMC11374294 DOI: 10.1097/ms9.0000000000002425] [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: 06/04/2024] [Accepted: 07/25/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction and Importance Colon cancer presenting as a large abdominal mass accompanied by abscess and rupture is rare and prone to be misdiagnosed and delayed. In addition, the treatment plan is not clear when combined with abdominal wall metastasis. Case Presentation A 79-year-old woman presented with a large abdominal mass accompanied by abscess and rupture. It was misdiagnosed as a soft tissue infection in a local hospital, and after a comprehensive examination, it was diagnosed as sigmoid colon cancer with abdominal wall metastasis and abscess formation. The patient underwent a one-stage surgery, including en bloc resection of the tumor and invaded abdominal wall, as well as autologous tissue abdominal wall reconstruction, with a good clinical prognosis. Clinical Discussion For the diagnosis of large abdominal masses, abdominal CT, and pus culture are more valuable than ultrasound. For colon cancer with abdominal wall metastasis, one-stage surgery to completely remove the tumor and full-thickness of the abdominal wall, and the use of autologous tissue abdominal wall reconstruction technology to repair defects is feasible. Conclusion This case highlights the importance of using colon cancer as one of the differential diagnoses for the diagnosis for large abdominal mass accompanied by abscess and rupture in elderly patients, as well as the possibility of one-stage surgical resection of the tumor and invasion of the abdominal wall and reconstruction of the abdominal wall with autologous tissue when there is abdominal wall metastasis.
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Affiliation(s)
- Haibo Ding
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Baiying Xu
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Yueming Wang
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Bin Xu
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Wei Qiu
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Wenzhong Zhang
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Yongbing Wang
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Gang Li
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
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de'Angelis N, Schena CA, Espin-Basany E, Piccoli M, Alfieri S, Aisoni F, Coccolini F, Frontali A, Kraft M, Lakkis Z, Le Roy B, Luzzi AP, Milone M, Pattacini GC, Pellino G, Petri R, Piozzi GN, Quero G, Ris F, Winter DC, Khan J. Robotic versus laparoscopic right colectomy for nonmetastatic pT4 colon cancer: A European multicentre propensity score-matched analysis. Colorectal Dis 2024; 26:1569-1583. [PMID: 38978153 DOI: 10.1111/codi.17089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 07/10/2024]
Abstract
AIM Minimally invasive surgery has been increasingly adopted for locally advanced colon cancer. However, evidence comparing robotic (RRC) versus laparoscopic right colectomy (LRC) for nonmetastatic pT4 cancers is lacking. METHODS This was a multicentre propensity score-matched (PSM) study of a cohort of consecutive patients with pT4 right colon cancer treated with RRC or LRC. The two surgical approaches were compared in terms of R0, number of lymph nodes harvested, intra- and postoperative complication rates, overall (OS), and disease-free survival (DFS). RESULTS Among a total of 200 patients, 39 RRC were compared with 78 PS-matched LRC patients. The R0 rate was similar between RRC and LRC (92.3% vs. 96.2%, respectively; p = 0.399), as was the odds of retrieving 12 or more lymph nodes (97.4% vs. 96.2%; p = 1). No significant difference was noted for the mean operating time (192.9 min vs. 198.3 min; p = 0.750). However, RRC was associated with fewer conversions to laparotomy (5.1% vs. 20.5%; p = 0.032), less blood loss (36.9 vs. 95.2 mL; p < 0.0001), fewer postoperative complications (17.9% vs. 41%; p = 0.013), a shorter time to flatus (2 vs. 2.8 days; p = 0.009), and a shorter hospital stay (6.4 vs. 9.5 days; p < 0.0001) compared with LRC. These results were confirmed even when converted procedures were excluded from the analysis. The 1-, 3- and 5-year OS (p = 0.757) and DFS (p = 0.321) did not significantly differ between RRC and LRC. CONCLUSION Adequate oncological outcomes are observed for RRC and LRC performed for pT4 right colon cancer. However, RRC is associated with lower conversion rates and improved short-term postoperative outcomes.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Robotic and Minimally Invasive Surgery, Department of Surgery, Ferrara University Hospital, Ferrara, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Carlo Alberto Schena
- Unit of Robotic and Minimally Invasive Surgery, Department of Surgery, Ferrara University Hospital, Ferrara, Italy
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eloy Espin-Basany
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Micaela Piccoli
- Unit of General, Emergency Surgery and New Technologies, Ospedale Civile Baggiovara, Azienda Ospedaliero Universitaria Di Modena, Modena, Italy
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Aisoni
- Unit of General Surgery, Department of Surgery, Ferrara University Hospital, Ferrara, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Alice Frontali
- Department of General Surgery, Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Miquel Kraft
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Bertrand Le Roy
- Department of Digestive and Oncologic Surgery, Hospital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | | | - Marco Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Gianmaria Casoni Pattacini
- Unit of General, Emergency Surgery and New Technologies, Ospedale Civile Baggiovara, Azienda Ospedaliero Universitaria Di Modena, Modena, Italy
| | - Gianluca Pellino
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Roberto Petri
- General Surgery Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Frederic Ris
- Division of Abdominal and Transplantation Surgery, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Des C Winter
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Jim Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- University of Portsmouth, Portsmouth, UK
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Khalil C, Khoury M, Higgins K, Enepekides D, Karam I, Husain ZA, Bayley A, Poon I, Truong T, Chan KKW, Smoragiewicz M, Fu R, Eskander A. Lymph node yield: Impact on oncologic outcomes in oral cavity cancer. Head Neck 2024; 46:1965-1974. [PMID: 38344842 DOI: 10.1002/hed.27656] [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: 07/19/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Lymph node metastases are associated with poor prognosis in oral cavity squamous cell carcinoma (OCSCC). In other cancers, clinical guidelines on the number of lymph nodes removed during primary surgery, lymph node yield (LNY), exist. Here, we evaluated the prognostic capacity of LNY on regional failure, locoregional recurrence, and disease-free survival (DFS) in patients with OCSCC treated by primary neck surgery. METHODS This retrospective cohort study took place at Sunnybrook Health Sciences Centre in Toronto, Canada and involved a chart review of all adult patients with treatment-naive OCSCC undergoing primary neck dissection. For each outcome, we first used the maximally selected rank statistics and an optimism-corrected concordance to identify an optimal threshold of LNY. We then used a multivariable Cox proportional hazards model to assess the association between high LNY (>threshold) and each outcome. RESULTS Among the 579 patients with OCSCC receiving primary neck dissection, 61.7% (n = 357) were male with a mean age of 62.9 years (standard deviation: 13.1) at cancer diagnosis. When adjusting for sociodemographic and clinical factors, LNY >15 was significantly associated with improved DFS (adjusted HR [aHR]: 0.73, 95% CI: 0.54-0.98), locoregional recurrence (aHR: 0.68, 95% CI: 0.49-0.95), and regional failure (aHR: 0.61, 95% CI: 0.39-0.93). CONCLUSIONS Our study findings suggested high LNY to be a strong independent predictor of various patient-level quality of surgical care metrics. The optimal LNY we found (15) was lower than the conventionally recommended (18), which calls for further research to establish validity in practice.
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Affiliation(s)
- Carlos Khalil
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Khoury
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Zain Ali Husain
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Andrew Bayley
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ian Poon
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Tra Truong
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martin Smoragiewicz
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rui Fu
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Meece MS, Davis JK, Ramsey WA, Galan DC, Castillo RP, Kutlu OC, Paluvoi NV. High Ligation of the Inferior Mesenteric Artery in Left-Sided Colon and Rectal Cancer Resection: Rates of Success and Outcomes. Am Surg 2024; 90:717-724. [PMID: 37878680 DOI: 10.1177/00031348231209531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND High ligation of the inferior mesenteric artery, defined as ligation before the takeoff of the left colic artery, is often described as the gold standard in low left-sided colon and rectal cancer surgery. The aim of this study is to quantify the rate of ligation at the described level at a single academic center. Additionally, we examined the relationship between level of ligation and cancer-related outcomes. METHODS This retrospective cohort study included patients ages 18 and over with low left-sided colon, rectal, and anal cancers undergoing surgical resection. Radiographic evidence of high ligation was defined as ligation of the inferior mesenteric artery before the takeoff of the left colic artery. Patients with and without radiographic evidence of high ligation on CT were compared. Secondary outcomes include lymph node yield and positivity, need for adjuvant therapy, and time from surgery to adjuvant therapy. RESULTS 169 patients (54% male) were included in the study. 61.5% of operative reports described high ligation of the IMA. There was radiographic evidence of high ligation in 55.6% of total patients and in 70.2% of patients where high ligation was intended. There was no significant difference in surgeon experience, surgical procedure, or surgical approach. There was no difference in lymph node yield, time to adjuvant chemotherapy, or recurrence rates. CONCLUSION This study demonstrates good technical success rate of high ligation of the inferior mesenteric artery but shows no difference in short-term patient-measured outcomes between high and low ligation (or successful and unsuccessful high ligation).
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Affiliation(s)
- Matthew S Meece
- DeWitt Daughtry Family Department of Surgery, School of Medicine, University of Miami Miller, Miami, FL, USA
- Jackson Memorial Hospital, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Jenna K Davis
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Walter A Ramsey
- DeWitt Daughtry Family Department of Surgery, School of Medicine, University of Miami Miller, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Daniela C Galan
- Jackson Memorial Hospital, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - R Patricia Castillo
- Jackson Memorial Hospital, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Onur C Kutlu
- DeWitt Daughtry Family Department of Surgery, School of Medicine, University of Miami Miller, Miami, FL, USA
- Jackson Memorial Hospital, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Nivedh V Paluvoi
- DeWitt Daughtry Family Department of Surgery, School of Medicine, University of Miami Miller, Miami, FL, USA
- Jackson Memorial Hospital, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
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Maes-Carballo M, Gómez-Fandiño Y, García-García M, Martín-Díaz M, De-Dios-de-Santiago D, Khan KS, Bueno-Cavanillas A. Colorectal cancer treatment guidelines and shared decision making quality and reporting assessment: Systematic review. PATIENT EDUCATION AND COUNSELING 2023; 115:107856. [PMID: 37451055 DOI: 10.1016/j.pec.2023.107856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Physicians must share decisions and choose personalised treatments regarding patients´ beliefs and values. OBJECTIVE To analyse the quality of the recommendations about shared decision making (SDM) in colorectal (CRC) and anal cancer treatment clinical practice guidelines (CPGs) and consensus statements (CSs). METHODS Guidelines were systematically reviewed following prospective registration (Prospero: CRD42021286146) without language restrictions searching 15 databases and 59 professional society websites from January 2010 to November 2021. A validated 31-item SDM quality assessment tool was employed to extract data in duplicate. RESULTS We identified 134 guidelines. Only 46/134 (34.3 %) mentioned SDM. Fifteen (11.1 %) made clear, precise and actionable recommendations, while 9/134 (6.7 %) indicated the strength of the SDM-related recommendations. CPGs underpinned by systematic reviews reported SDM more often than those based on consensus or reviews (35.9 % vs 32.0 %; p = 0.031). Guidelines that reported following quality tools (i.e., AGREE II) more commonly commented about SDM than when it was not reported (75.0 % vs 32.0 %; p = 0.003). CONCLUSION AND PRACTICE IMPLICATIONS Most of the CRC and anal treatment guidelines did not mention SDM and it was superficial. Guidelines based on systematic reviews and those using quality tools demonstrated better reporting of SDM. Recommendations about SDM in these guidelines merit urgent improvement.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; Hospital Público de Verín, Ourense, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Yolanda Gómez-Fandiño
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Ouyang Y, Zhu Y, Chen H, Li G, Hu X, Luo H, Li Z, Han S. Case Report: Long-term survival of a patient with advanced rectal cancer and multiple pelvic recurrences after seven surgeries. Front Oncol 2023; 13:1169616. [PMID: 37256170 PMCID: PMC10225707 DOI: 10.3389/fonc.2023.1169616] [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: 03/30/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023] Open
Abstract
Background Rectal cancer has a high risk of recurrence and metastasis, with median survival ranging from 24 months to 36 months. K-RAS mutation is a predictor of poor prognosis in rectal cancer. Advanced rectal cancer can be stopped in its tracks by pelvic exenteration. Case summary A 51-year-old woman was diagnosed with advanced rectal cancer (pT4bN2aM1b, stage IV) with the KRAS G12D mutation due to a change in bowel habits. The patient had experienced repeated recurrences of rectal cancer after initial radical resection, and the tumor had invaded the ovaries, sacrum, bladder, vagina and anus. Since the onset of the disease, the patient had undergone a total of seven surgeries and long-term FOLFIRI- or XELOX-based chemotherapy regimens, with the targeted agents bevacizumab and regorafenib. Fortunately, the patient was able to achieve intraoperative R0 resection in almost all surgical procedures and achieve tumor-free survival after pelvic exenteration. The patient has been alive for 86 months since her diagnosis. Conclusions Patients with advanced rectal cancer can achieve long-term survival through active multidisciplinary management and R0 surgery.
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Affiliation(s)
- Ye Ouyang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yilin Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haoyi Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guoquan Li
- Department of General Surgery, Guangdong Province Huizhou Sixth Hospital, Huizhou, China
| | - Xiongwei Hu
- Department of General Surgery, Guangdong Province Huizhou Sixth Hospital, Huizhou, China
| | - Hongyu Luo
- Department of General Surgery, Guangdong Province Huizhou Sixth Hospital, Huizhou, China
| | - Zhou Li
- Department of Gastrointestinal Surgery, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuai Han
- Department of Gastrointestinal Surgery, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Tidadini F, Trilling B, Quesada JL, Foote A, Sage PY, Bonne A, Arvieux C, Faucheron JL. Association between Enhanced Recovery After Surgery (ERAS) protocol, risk factors and 3-year survival after colorectal surgery for cancer in the elderly. Aging Clin Exp Res 2023; 35:167-175. [PMID: 36306111 DOI: 10.1007/s40520-022-02270-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/26/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION As life expectancy is currently growing, more elderly and fragile patients need colorectal resection for cancer. We sought to assess the link between enhanced rehabilitation after surgery (ERAS), risk factors and overall survival at 3 years, in patients aged 65 and over. METHODS Between 2005 and 2017, all patients undergoing colorectal resection for cancer were included. Overall survival at 3 years was compared for patients treated in following ERAS guidelines compared to conventional treatment (pre-ERAS). RESULTS 661 patients were included (ERAS, n = 325; pre-ERAS, n = 336). The 3-year overall survival rate was significantly better regardless of age for ERAS vs pre-ERAS patients (73.1% vs 64.4%; p = 0.016). With overall survival rates of 83.2% vs 73.8%, 65.4% vs 62.8% and 59.6% vs 40% for the age bands 65-74, 75-84 and ≥ 85 years. The analysis of survival at 3 years by a multivariate Cox model identified ERAS as a protective factor with a reduction in the risk of death of 30% (HR = 0.70 [0.50-0.94], p = 0017) independently of other identified risk factors: age bands, ASA score > 2, smoking, atrial fibrillation and abdominal surgery. This result is confirmed by an analysis of the propensity score (HR = 0.67 [0.47-0.97], p = 0.032). CONCLUSIONS Our study shows that ERAS is associated with better 3-year survival in patients undergoing colorectal resection for cancer, independent of risk factors. The practice of ERAS is effective and should be offered to patients aged 65 and over.
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Affiliation(s)
- Fatah Tidadini
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Alison Foote
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierre-Yves Sage
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Aline Bonne
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Jean-Luc Faucheron
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France. .,University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France.
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9
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Yao Z, Tian W, Huang M, Xu X, Zhao R. Effect of placing double-lumen irrigation-suction tube on closure of anastomotic defect following rectal cancer surgery. Surg Endosc 2023; 37:412-420. [PMID: 35984523 DOI: 10.1007/s00464-022-09523-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/31/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aimed to investigate the effect of placement of double-lumen irrigation-suction tubes (DLIST) on the closure of anastomotic defect (AD) after rectal cancer surgery. METHODS The study was carried out at two centers managed by one surgeon, both adopted the same treatments. Patients with postoperative AD after rectal cancer surgery from January 2011 to June 2020 were eligible and were divided into a passive drainage (PD) group and a DLIST group according to whether the PD, placed in the rectal cancer surgery, had been replaced with the DLIST. The effect of DLIST on the AL was evaluated. RESULT There distributed 76 patients in the DLIST group and 52 in the PD group. A higher closure rate was reported in the DLIST group (46 patients in DLIST group, for a closure rate of 60.5%, and 21 patients in PD group, for a closure rate of 40.4%. HR = 3.05; 95% CI: 1.79-5.19; P < 0.001). Both length of stay and costs of the treatment in the DLIST group were lower (54 days [interquartile range, IQR: 41-17] days vs. 112 days [IQR: 66-27] days, P = 0.005; and $18,721 [IQR: $14,982-4,960] vs. $40,840 [IQR: $20,932-50,529], P < 0.001). CONCLUSION Placement of DLIST might serve as an effective method for treating AD following rectal cancer surgery. In comparison with PD, it costs lower to apply DLIST in the treatment of AD and the length of stay is shorter.
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Affiliation(s)
- Zheng Yao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China. .,Department of Enterocutaneous Fistula Surgery, Jiangning Hospital, Hushan Road NO.169, Nanjing, Jiangsu, China.
| | - Weiliang Tian
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - Ming Huang
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Xin Xu
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China. .,Department of Enterocutaneous Fistula Surgery, Jiangning Hospital, Hushan Road NO.169, Nanjing, Jiangsu, China.
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10
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Abdou Hassan W, Muqresh MA, Omar M. The Potential Role of CD44 and CD133 in Colorectal Stem Cell Cancer. Cureus 2022; 14:e30509. [DOI: 10.7759/cureus.30509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
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11
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Effect of implementation of enhanced recovery after surgery (ERAS) protocol and risk factors on 3-year survival after colorectal surgery for cancer-a retrospective cohort of 1001 patients. Int J Colorectal Dis 2022; 37:1151-1159. [PMID: 35471611 DOI: 10.1007/s00384-022-04155-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Several recent studies have shown that the enhanced recovery after surgery (ERAS) protocol reduces morbidity and mortality and shortens the length of stay compared to conventional recovery strategy (pre-ERAS). The aim of this study was to evaluate the effect of the implementation of this protocol on 3-year overall survival and postoperative outcome in patients undergoing colorectal resection for cancer. METHODS This was a retrospective, single-center, comparative, and non-randomized study. Between January, 2005, and December, 2017, 1001 patients were included (ERAS, n = 497; pre-ERAS, n = 504). RESULTS The 3-year overall survival rate was significantly better for ERAS than for pre-ERAS patients (76.1 vs 69.2%; p = 0.017). The length of hospital stay (median 10 days vs 15; p = ≤ 0.001) and the 90-day readmission rate (15 vs 20%; p = 0.037) were significantly lower in the ERAS group. Three-year recurrence-free survival (p = 0.398) and 90-day complications (p = 0.560) were similar in the two groups. Analysis of 3-year survival by a multivariate Cox model identified ERAS as a protective factor with a 30% reduction in the risk of death: (HR = 0.70 [0.55-0.90]). CONCLUSION The implementation of the ERAS protocol was associated with an improvement in 3-year survival, a reduction of the length of hospital stay and the rate of readmission. ERAS is associated with better 3-year survival, independent of other commonly considered parameters. An ASA score > 2, smoking, a history of cancer, and atrial fibrillation are deleterious risk factors linked to earlier mortality.
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12
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Podda M, Pisanu A, Morello A, Segalini E, Jayant K, Gallo G, Sartelli M, Coccolini F, Catena F, Di Saverio S. Laparoscopic versus open colectomy for locally advanced T4 colonic cancer: meta-analysis of clinical and oncological outcomes. Br J Surg 2022; 109:319-331. [PMID: 35259211 DOI: 10.1093/bjs/znab464] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/11/2021] [Accepted: 12/17/2021] [Indexed: 09/11/2023]
Abstract
BACKGROUND The aim of this study was to review the early postoperative and oncological outcomes after laparoscopic colectomy for T4 cancer compared with open surgery. METHOD MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for any relevant clinical study comparing laparoscopic and open colectomy as treatment for T4 colonic cancer. The risk ratio (RR) with 95 per cent c.i. was calculated for dichotomous variables, and the mean difference (m.d.) with 95 per cent confidence interval for continuous variables. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was implemented for assessing quality of evidence (QoE). RESULTS Twenty-four observational studies (21 retrospective and 3 prospective cohort studies) were included, analysing a total of 18 123 patients: 9024 received laparoscopic colectomy and 9099 underwent open surgery. Laparoscopic colectomy was associated with lower rates of mortality (RR 0.48, 95 per cent c.i. 0.41 to 0.56; P < 0.001; I2 = 0 per cent, fixed-effect model; QoE moderate) and complications (RR 0.61, 0.49 to 0.76; P < 0.001; I2 = 20 per cent, random-effects model; QoE very low) compared with an open procedure. No differences in R0 resection rate (RR 1.01, 1.00 to 1.03; P = 0.12; I2 = 37 per cent, random-effects model; QoE very low) and recurrence rate (RR 0.98, 0.84 to 1.14; P = 0.81; I2 = 0 per cent, fixed-effect model; QoE very low) were found. CONCLUSION Laparoscopic colectomy for T4 colonic cancer is safe, and is associated with better clinical outcomes than open surgery and similar oncological outcomes.
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Affiliation(s)
- Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital 'D. Casula', Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Adolfo Pisanu
- Department of Emergency Surgery, Cagliari University Hospital 'D. Casula', Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Alessia Morello
- Department of Surgery, Maggiore Hospital, Crema, Italy
- Department of Surgery, San Matteo Hospital, University of Pavia, Pavia, Italy
| | | | - Kumar Jayant
- Department of Surgery, Chicago University Hospital, Chicago, Illinois, USA
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Massimo Sartelli
- Department of General and Emergency Surgery, Macerata General Hospital, Macerata, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- Department of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso General Hospital, San Benedetto del Tronto, Italy
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13
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Mahmoud NN. Colorectal Cancer. Surg Oncol Clin N Am 2022; 31:127-141. [DOI: 10.1016/j.soc.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Dauch J, Hamidi M, Arrington AK, O'Grady CL, Hsu CH, Joseph B, Riall TS, Khreiss M. The Impact of Frailty on Patients Undergoing Liver Resection for Colorectal Liver Metastasis. J Gastrointest Surg 2022; 26:608-614. [PMID: 34545542 DOI: 10.1007/s11605-021-05149-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/21/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study is to assess the impact of frailty on short-term outcomes after hepatectomy for colorectal liver metastasis (CRLM). METHODS Patients were identified using the National Surgical Quality Improvement Program (NSQIP). Patients were divided into 3 categories using the 5-item Modified Frailty Index (mFI). RESULTS There were 5230 patients included. 52%, 35%, and 13% had mFI scores of 0, 1, and ≥ 2 respectively. Patients with a ≥ 2 mFI score were more likely to experience minor complication (OR 1.34, 95% CI 1.06-1.69), major complication (OR 1.56, 95% CI 1.15-2.12), readmission (OR 1.55, 95% CI 1.12-2.14), unfavorable discharge (OR 2.48, 95% CI 1.62-3.80), 30-day mortality (OR 3.02, 95% CI 1.02-8.95), prolonged length of stay (OR 1.47, 95% CI 1.18-1.83), and bile leak (OR 1.51, 95% CI 1.02-2.24). CONCLUSION Frailty is associated with increased post-operative complications. The 5-item mFI can guide risk stratification, optimization, and counseling.
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Affiliation(s)
| | | | | | | | - Chiu-Hsieh Hsu
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Bellal Joseph
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Taylor S Riall
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mohammad Khreiss
- University of Arizona College of Medicine, Tucson, AZ, USA.
- Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, USA.
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15
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Livadaru C, Moscalu M, Ghitun FA, Huluta AR, Terinte C, Ferariu D, Lunca S, Dimofte GM. Postoperative Quality Assessment Score Can Select Patients with High Risk for Locoregional Recurrence in Colon Cancer. Diagnostics (Basel) 2022; 12:363. [PMID: 35204454 PMCID: PMC8871190 DOI: 10.3390/diagnostics12020363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Monitoring surgical quality has been shown to reduce locoregional recurrence (LRR). We previously showed that the arterial stump length (ASL) after complete mesocolic excision (CME) is a reproducible quality instrument and correlates with the lymph-node (LN) yield. We hypothesized that generating an LRR prediction score by integrating the ASL would predict the risk of LRR after suboptimal surgery. METHODS 502 patients with curative resections for stage I-III colon cancer were divided in two groups (CME vs. non-CME) and compared in terms of surgical data, ASL-derived parameters, pathological parameters, LRR and LRR-free survival. A prediction score was generated to stratify patients at high risk for LRR. RESULTS The ASL showed significantly higher values (50.77 mm ± 28.5 mm) with LRR vs. (45.59 mm ± 28.1 mm) without LRR (p < 0.001). Kaplan-Meier survival analysis showed a significant increase in LRR-free survival at 5.58 years when CME was performed (Group A: 81%), in contrast to non-CME surgery (Group B: 67.2%). CONCLUSIONS The prediction score placed 76.6% of patients with LRR in the high-risk category, with a strong predictive value. Patients with long vascular stumps and positive nodes could benefit from second surgery to complete the mesocolic excision.
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Affiliation(s)
- Cristian Livadaru
- Surgical Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- Radiology and Medical Imaging Department, St. Spiridon Emergency County Clinical Hospital, 700111 Iasi, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | | | - Cristina Terinte
- Department of Pathology, Regional Oncology Institute, 700483 Iasi, Romania
| | - Dan Ferariu
- Department of Pathology, Regional Oncology Institute, 700483 Iasi, Romania
| | - Sorinel Lunca
- Surgical Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, 700483 Iasi, Romania
| | - Gabriel Mihail Dimofte
- Surgical Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, 700483 Iasi, Romania
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16
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Kong JC, Lee J, Gosavi R, Ngan SY, Tillman MM, Bednarski BK, Heriot AG, Chang GJ, Warrier SK. Is neoadjuvant therapy an alternative strategy to immediate surgery in locally perforated colon cancer? Colorectal Dis 2021; 23:3162-3172. [PMID: 34379861 DOI: 10.1111/codi.15868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/16/2021] [Accepted: 08/01/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Perforations are a rare but serious complication of colorectal cancer. The current standard of treatment is emergent surgery followed by adjuvant chemotherapy. The concern with this approach is not only the uncertainty of achieving a R0 resection but also potential injury to adjacent vessels, nerves and ureters due to inflamed tissue planes. A subset of this patient population with a contained perforation who are clinically stable may have superior oncological outcomes with local sepsis control, neoadjuvant therapy followed by radical resection. The aim of this study is to report on the pre-operative safety profile for neoadjuvant therapy in the setting of an abscess from colon cancer perforation and the short-term oncological surgical quality outcomes. METHODS In this retrospective observational study, all consecutive perforated colon cancer receiving neoadjuvant therapy from Jan 2010 to Dec 2019 were included. RESULTS There were 21 patients that met the inclusion criteria. The most common symptom at presentation was abdominal pain (71.4%) and most common site of perforation was sigmoid colon (61.9%). Local sepsis control was achieved with a combination of radiological or surgical drainage, diverting ostomy and/or intravenous antibiotics. Thirteen patients had long-course chemoradiation and eight patients had neoadjuvant chemotherapy. Of these, 13 (61.9%) had tumour regression, with one patient having a pathological complete response. All patients achieved a R0 resection. CONCLUSIONS In a small subset of patients with colon cancer perforation, this study has demonstrated the potential safe usage of neoadjuvant therapy first before radical surgery to achieve a clear resection margin.
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Affiliation(s)
- Joseph C Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Colorectal Surgery, Alfred Health, Melbourne, Vic., Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Vic., Australia
| | - Jordan Lee
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Rathin Gosavi
- Department of Colorectal Surgery, Alfred Health, Melbourne, Vic., Australia
| | - Samuel Y Ngan
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Vic., Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Matthew M Tillman
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian K Bednarski
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Vic., Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - George J Chang
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Colorectal Surgery, Alfred Health, Melbourne, Vic., Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Vic., Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
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17
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Unruh KR, Bastawrous AL, Bernier GV, Flum DR, Kumar AS, Moonka R, Thirlby RC, Simianu VV. Evaluating the Regional Uptake of Minimally Invasive Colorectal Surgery: a Report from the Surgical Care Outcomes Assessment Program. J Gastrointest Surg 2021; 25:2387-2397. [PMID: 33206328 DOI: 10.1007/s11605-020-04875-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) for colorectal disease has well-known benefits, but many patients undergo open operations. When choosing an MIS approach, robotic technology may have benefits over traditional laparoscopy and is increasingly used. However, the broad adoption of MIS, and specifically robotics, across colorectal operations has not been well described. Our primary hypothesis is that rates of MIS in colorectal surgery are increasing, with different contributions of robotics to abdominal and pelvic colorectal operations. METHODS Rates of MIS colorectal operations are described using a prospective cohort of elective colorectal operations at hospitals in the Surgical Care Outcomes Assessment Program (SCOAP) from 2011 to 2018. The main outcome was proportion of cases approached using open, laparoscopic, and robotic surgery. Factors associated with increased use of MIS approaches were described. RESULTS Across 21,423 elective colorectal operations, rates for MIS (laparoscopic or robotic surgery) increased from 44% in 2011 to 75% in 2018 (p < 0.001). Approaches for abdominal operations (n = 12,493) changed from 2 to 11% robotic, 43 to 63% laparoscopic, and 56 to 26% open (p < 0.001). Approaches for pelvic operations (n = 8930) changed from 3 to 33% robotic, 40 to 42% laparoscopic, and 57 to 24% open(p < 0.001). These trends were similar for high-(100 + operations/year) and low-volume hospitals and surgeons. CONCLUSIONS At SCOAP hospitals, the majority of elective colorectal operations is now performed minimally invasively. The increase in the MIS approach is primarily driven by laparoscopy in abdominal procedures and robotics in pelvic procedures.
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Affiliation(s)
- Kenley R Unruh
- Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, C6-GS, Seattle, WA, 98101, USA
| | | | - Greta V Bernier
- Colon and Rectal Surgery Clinic, University of Washington Medicine-Valley Medical Center, Renton, WA, USA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Anjali S Kumar
- Department of Medical Education and Clinical Sciences, Washington State University, Spokane, WA, USA
| | - Ravi Moonka
- Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, C6-GS, Seattle, WA, 98101, USA
| | - Richard C Thirlby
- Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, C6-GS, Seattle, WA, 98101, USA
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, C6-GS, Seattle, WA, 98101, USA.
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18
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Chiorean EG, Nandakumar G, Fadelu T, Temin S, Alarcon-Rozas AE, Bejarano S, Croitoru AE, Grover S, Lohar PV, Odhiambo A, Park SH, Garcia ER, Teh C, Rose A, Zaki B, Chamberlin MD. Treatment of Patients With Late-Stage Colorectal Cancer: ASCO Resource-Stratified Guideline. JCO Glob Oncol 2021; 6:414-438. [PMID: 32150483 PMCID: PMC7124947 DOI: 10.1200/jgo.19.00367] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To provide expert guidance to clinicians and policymakers in resource-constrained settings on the management of patients with late-stage colorectal cancer. METHODS ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines, conducted a modified ADAPTE process, and used a formal consensus process with additional experts for two rounds of formal ratings. RESULTS Existing sets of guidelines from four guideline developers were identified and reviewed; adapted recommendations from five guidelines form the evidence base and provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% on all recommendations. RECOMMENDATIONS Common elements of symptom management include addressing clinically acute situations. Diagnosis should involve the primary tumor and, in some cases, endoscopy, and staging should involve digital rectal exam and/or imaging, depending on resources available. Most patients receive treatment with chemotherapy, where chemotherapy is available. If, after a period of chemotherapy, patients become candidates for surgical resection with curative intent of both primary tumor and liver or lung metastatic lesions on the basis of evaluation in multidisciplinary tumor boards, the guidelines recommend patients undergo surgery in centers of expertise if possible. On-treatment surveillance includes a combination of taking medical history, performing physical examinations, blood work, and imaging; specifics, including frequency, depend on resource-based setting. Additional information is available at www.asco.org/resource-stratified-guidelines.
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Affiliation(s)
- E Gabriela Chiorean
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Govind Nandakumar
- Columbia Asia Hospitals, Bangalore, India.,Weill Cornell Medical College, New York, NY
| | | | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | - Suyapa Bejarano
- Excelmedica, Liga Contra el Cancer Honduras, San Pedro Sulal, Honduras
| | | | | | | | - Andrew Odhiambo
- University of Nairobi, College of Health Sciences, Nairobi, Kenya
| | | | | | - Catherine Teh
- Philippine Association of HPB Surgeons/Makati Medical Center, Makati City, Philippines
| | - Azmina Rose
- Independent Colorectal Patient Representative, London, United Kingdom
| | - Bassem Zaki
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
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19
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Hidalgo Mora VM, Baquero Zamarra DR, Cendales MA, Figueroa Avendaño CE. Synovial sarcoma of the transverse colon metastatic to the chest wall after 3 years of follow-up. BMJ Case Rep 2021; 14:14/7/e239088. [PMID: 34215633 DOI: 10.1136/bcr-2020-239088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a fifth case of a transverse colon primary synovial sarcoma. A 31-year-old man with history of grade I obesity presented to an outpatient clinic reporting 6 months of intermittent colicky abdominal pain associated with haematochezia and rectal bleeding. Colonoscopy reported a partially obstructive intraluminal tumour lesion located in the transverse colon. There was no evidence of metastatic disease in the extension studies, so the patient was admitted to the hospital for a laparoscopic subtotal colectomy. Histopathology demonstrated intermediate-grade synovial sarcoma. At the third year of follow-up, the patient presented metastases on the chest wall, which required extensive resection and complementary oncological management.
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20
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Martínez Ortega P, Cienfuegos JA, Baixauli J, Sánchez Justicia C, Abengózar M, Pastor Idoate C, Hernández Lizoáin JL. Prognostic significance of lymph node count in high-risk node-negative colon carcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:609-614. [PMID: 32496119 DOI: 10.17235/reed.2020.6709/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND the prognostic value of the number of lymph nodes isolated (< 12 versus ≥ 12) in the surgical specimen continues to be controversial. In this study, the impact of isolating fewer or more than 12 lymph nodes in stage II colon cancer with a high-risk biologic phenotype was analyzed, such as the presence of perineural invasion. METHODS all cases of stage II disease (T3-4N0M0) with perineural invasion (PNI+) were retrospectively identified from a prospective database of patients undergoing surgery for colon cancer. The cohort was divided into two groups depending on the number of lymph nodes isolated (< 12 vs ≥ 12). Apart from clinical and surgical data, the patterns of recurrence, overall (OS) and disease-free survival (DFS) at five and ten years were analyzed. RESULTS sixty patients met the inclusion criteria, 31.7 % had < 12 lymph nodes isolated and 68.3 % had more than 12 isolated. There were no clinical or surgical differences between the two groups. OS at five and ten years was significantly lower in the patients with < 12 lymph nodes isolated (84.2 %, 62.7 % vs 94.6 % and 91.6 %, p = 0.01). DFS at five and ten years was 51 % vs 86.5 %, respectively (p = 0.005). CONCLUSION the number of lymph nodes isolated (with a cutoff of 12) in stage II colon cancer with PNI+ has prognostic value and should therefore be borne in mind when planning adjuvant chemotherapy.
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21
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Niu SQ, Li RZ, Yuan Y, Xie WH, Wang QX, Chang H, Lu ZH, Ding PR, Li LR, Wu XJ, Zeng ZF, Xiao WW, Gao YH. Neoadjuvant chemoradiotherapy in patients with unresectable locally advanced sigmoid colon cancer: clinical feasibility and outcome. Radiat Oncol 2021; 16:93. [PMID: 34030722 PMCID: PMC8147345 DOI: 10.1186/s13014-021-01823-4] [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: 02/01/2021] [Accepted: 05/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Patients with locally advanced sigmoid colon cancer (LASCC)
have limited treatment options and a dismal prognosis with poor quality of life. This retrospective study aimed to further evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by surgery as treatment for select patients with unresectable LASCC. Methods
We studied patients with unresectable LASCC who received NACRT between November 2010 and April 2019. The NACRT regimen consisted of intensity modulated radiotherapy (IMRT) of 50 Gy to the gross tumor and positive lymphoma node and 45 Gy to the clinical target volume. Capecitabine‑based chemotherapy was administered every 2 (mFOLFOX6) or 3 weeks (CAPEOX). Surgery was scheduled 6–8 weeks after radiotherapy. Results Seventy‑two patients were enrolled in this study. Patients had a regular follow-up (median, 41.1 months; range, 8.3–116.5 months). Seventy‑one patients completed NACRT, and sixty-five completed surgery. Resection with microscopically negative margins (R0 resection) was achieved in 64 patients (88.9%). Pathologic complete response was observed in 15 patients (23.1%), and multivisceral resection was necessary in 38 patients (58.3%). The cumulative probability of 3-year overall survival (OS) and progression-free survival (PFS) were 75.8 and 70.7%, respectively. Conclusions For patients with unresectable LASCC, neoadjuvant chemoradiotherapy is feasible, surgery can be performed safely and may result in increased survival and organ preservation rates.
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Affiliation(s)
- Shao-Qing Niu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, 510060, People's Republic of China.,Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Rong-Zhen Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, 510060, People's Republic of China
| | - Yan Yuan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, 510060, People's Republic of China
| | - Wei-Hao Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, 510060, People's Republic of China
| | - Qiao-Xuan Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, 510060, People's Republic of China
| | - Hui Chang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, 510060, People's Republic of China
| | - Zhen-Hai Lu
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Pei-Rong Ding
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Li-Ren Li
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xiao-Jun Wu
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Zhi-Fan Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, 510060, People's Republic of China
| | - Wei-Wei Xiao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, 510060, People's Republic of China.
| | - Yuan-Hong Gao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, 510060, People's Republic of China.
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22
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Wang X, Huang S, Lu X, Huang Y, Chi P. Incidence of and Risk Factors for Gastroepiploic Lymph Node Involvement in Patients with Cancer of the Transverse Colon Including the Hepatic Flexure. World J Surg 2021; 45:1514-1525. [PMID: 33475804 DOI: 10.1007/s00268-020-05933-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To define the incidence of gastroepiploic lymph node (GLN) metastasis in patients with cancer of the transverse colon, including the hepatic flexure, and to identify the preoperative predictors of GLN involvement in a large-volume center in China. METHODS This retrospective monocentric cross-sectional study respected the STROBE statement. Of 3208 consecutive patients who underwent colon cancer resection, a total of 371 patients with cancer of the transverse colon including the hepatic flexure who underwent complete mesocolic excision and GLN resection in our center were retrospectively reviewed between November 2010 and November 2017. Logistic regression was performed to identify predictors of GLN metastasis. Endoscopic obstruction was defined as a luminal obstruction of the colon severe enough to prevent the colonoscope from passing beyond the tumor regardless of the presenting symptoms. RESULTS The GLN involvement rate was 4.0 (2.0-6.1)%. Patients who had GLN involvement had a significantly higher rate of endoscopic obstruction (P = 0.030), higher rate of signet ring adenocarcinoma or lymphovascular invasion (P < 0.05), higher preoperative CEA level (P = 0.037), more advanced pN stage (P < 0.001) and more advanced M stage (P = 0.003) than the patients without GLN involvement. ROC curve analyses showed that the cutoff value for CEA was 17.0 ng/ml (46.7% sensitivity, 84.3% specificity, P = 0.037) for the prediction of GLN metastasis. Multivariate analysis showed that endoscopic obstruction, signet ring adenocarcinoma, a CEA level ≥17 ng/ml and M1 stage were independently correlated with the GLN metastasis. CONCLUSION The incidence rate of GLN metastasis was low. To the best of our knowledge, the present study was the first to evaluate the preoperative predictors of GLN metastasis. Combinations of predictive factors may be useful for stratifying patients at high risk of GLN metastasis.
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Affiliation(s)
- Xiaojie Wang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Shenghui Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Xingrong Lu
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Ying Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.
| | - Pan Chi
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
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Granero L, Cienfuegos JA, Baixauli J, Pastor C, Sánchez Justicia C, Valentí V, Rotellar F, Hernández Lizoáin JL. Predictive Risk Factors for Postoperative Complications and Its Impact on Survival in Laparoscopic Resection for Colon Cancer. Surg Laparosc Endosc Percutan Tech 2021; 31:558-564. [PMID: 33840737 DOI: 10.1097/sle.0000000000000936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic resection is the ideal treatment of colon cancer. The aim of the study was to analyze the predictive factors for postoperative complications and their impact on oncologic outcomes in laparoscopic resections in colon cancer. MATERIALS AND METHODS In all patients undergoing elective laparoscopic surgery the number and degree of severity of postoperative complications were recorded and classified according to Clavien-Dindo. A univariate analysis was made of the demographic, surgical, and oncologic variables of patients with and without complications. The statistically significant variables were then entered into a multivariate model. In both groups overall and disease-free survival were analyzed using Kaplan-Meier estimates. RESULTS Of 524 patients, 138 (26.3%) experienced some type of complication, 110 less severe (79.7%) and 28 (20.4%) severe. Twenty-nine conversions to open surgery occurred (5.5%) and hospital mortality was 0.2%.In the multivariate analysis, use of corticosteroids [odds ratio (OR): 3.619], oral anticoagulants (OR: 3.49), blood transfusions (OR: 4.30), and conversion to open surgery (OR: 3.93) were significantly associated with the development of complications. However, sigmoid resections were associated with fewer complications (OR: 0.45).Overall 5-year and 10-year survival in both groups, was 83.3%, 74.1%, 76.0%, and 67.1%, respectively (P=0.18). Disease-free survival at 5 and 10 years, excluding stage IV tumors, was 88.6% and 90.4%, respectively (P=0.881). CONCLUSIONS The use of corticosteroids, oral anticoagulants, blood transfusions, and conversion to open surgery are all independent predictive factors of postoperative complications. Sigmoid resections are associated with fewer complications. In laparoscopic resections of the colon, complications do not negatively affect long-term oncologic outcomes.
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Affiliation(s)
- Lucia Granero
- Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra
| | - Javier A Cienfuegos
- Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra
- Institute of Health Research of Navarra (IdisNA)
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Spain
| | - Jorge Baixauli
- Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra
| | - Carlos Pastor
- Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra
| | - Carlos Sánchez Justicia
- Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra
| | - Víctor Valentí
- Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra
- Institute of Health Research of Navarra (IdisNA)
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Spain
| | - Fernando Rotellar
- Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra
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Akgor U, Kuru O, Soyak B, Gunes AC, Uyanık E, Gultekin M, Ozgul N, Salman C. Adnexal masses in patients with colorectal cancer. J Gynecol Obstet Hum Reprod 2020; 50:101898. [PMID: 32827838 DOI: 10.1016/j.jogoh.2020.101898] [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: 06/06/2020] [Revised: 07/25/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the clinicopathological features and outcomes of patients undergone surgery for benign and metastatic adnexal masses during the surveillance of colorectal cancer (CRC). METHODS A single institute retrospective study involving 90 patients diagnosed with CRC that undergone surgery at Hacettepe University Hospital between 2000-2018. Clinicopathological and survival data was obtained from hospital records. RESULTS Elevated blood levels of CEA (HR, 1.23; 95 % CI: 1.03-1.24; p = 0.01), adnexal masses larger than 5 cm (HR, 3.296; 95 % CI: 1.527-7.076; p = 0.002), bilaterality of adnexal mass (HR, 2.200; 95 % CI: 2.464-11.969; p = 0.001) and high PCI score (HR, 0.150; 95 % CI: 0.044-0.479; p = 0.01) were found to be significantly associated with ovarian metastasis. There was a significant difference in overall survival (OS), with respect to complete and incomplete resection in adnexal surgery of ovarian metastasis (46.6 vs. 29.6 months; p = 0.004). The median survival time was 32.8 months for patients with ≤ 24 months interval time to adnexal metastasis surgery, and 48.5 months for patients with >24 months interval time to adnexal metastasis surgery (p = 0.001). CONCLUSION This study showed that numerous clinicopathological variables such as bilaterality and size of adnexal mass, serum blood levels of CEA and PCI score may have a significant impact on the prediction and management of ovarian masses diagnosed during CRC surveillance. Complete resection and interval time to adnexal surgery is significantly associated with OS.
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Affiliation(s)
- Utku Akgor
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Oguzhan Kuru
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Burcu Soyak
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Can Gunes
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Esra Uyanık
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Gultekin
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Ozgul
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Coskun Salman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Huang Y, Ge K, Fu G, Chu J, Wei W. Mucinous Histology Might Be an Indicator for Enhanced Survival Benefit of Chemotherapy in Stage II Colon Cancer. Front Med (Lausanne) 2020; 7:205. [PMID: 32582726 PMCID: PMC7290047 DOI: 10.3389/fmed.2020.00205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background: It was a difficult question to identify candidates who would benefit most from adjuvant chemotherapy in stage II colon cancer because of the paucity of relevant conclusive clinical trial results. We aimed to assess if mucinous adenocarcinoma (MUA) could be an indicator for the efficacy of adjuvant chemotherapy in stage II colon cancer. Methods:Using SEER*Stat software V.8.3.5, eligible patients were then recruited from the SEER database. A χ2 test was applied to compare the distribution of different categorical variables between nonmucinous adenocarcinoma (NMUA) and MUA groups. We then used the Kaplan–Meier method to analyze overall survival (OS) of different histological types in stage II colon cancer, and the log-rank test was then used to assess the OS differences. The Cox proportional regression risk models were also built in our analyses to eliminate potential crossed bias from other prognostic factors. Results:A total of 50,065 patients diagnosed with stage II colon cancer were recruited from the SEER database from 2004 to 2011; all the patients were divided into two groups, including NMUA (n = 44,785) and MUA (n = 5,280). The Cox analysis of the histological type indicated that the survival difference between MUA and NMUA failed to reach statistical significance in stage II colon cancer (P = 0.360). In NMUA, patients treated with adjuvant chemotherapy were independently associated with 37.2% decreased risk of overall mortality compared with those not [hazard ratio (HR) = 0.628, 95% confidence interval (CI) = 0.601-1.656, P < 0.001]; in MUA, the number increased to 41.5% (HR = 0.585, 95% CI = 0.515-0.665, P < 0.001). Conclusions:Our study showed that the survival difference between MUA and NMUA failed to reach statistical significance in stage II colon cancer. More importantly, our study had provided the first evidence that chemotherapy would offer higher survival improvement in MUA compared with NMUA in stage II colon cancer; mucinous histology might be an indicator for enhanced survival benefit of chemotherapy in stage II colon cancer.
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Affiliation(s)
- Yong Huang
- Department of General Surgery, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, China
| | - Kuanxue Ge
- Department of Gastroenterology, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, China
| | - Guangshun Fu
- Department of General Surgery, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, China
| | - Junfeng Chu
- Department of Radiotherapy, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, China
| | - Wei Wei
- Department of General Surgery, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, China
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Xin H, Wang C, Chi Y, Liu Z. MicroRNA-196b-5p promotes malignant progression of colorectal cancer by targeting ING5. Cancer Cell Int 2020; 20:119. [PMID: 32308564 PMCID: PMC7149860 DOI: 10.1186/s12935-020-01200-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/31/2020] [Indexed: 12/21/2022] Open
Abstract
Background miR-196b-5p expression is deregulated in many malignant tumors. Although miR-196b-5p has been implicated in the malignant transformation of colorectal cancer, its role in this specific type of cancer has not been fully explored. Thus, the present study was aimed to examine the cellular function of miR-196b-5p and its role in malignant biological behavior in colorectal cancer. Methods miR-196b-5p expression was measured in colorectal cancer tissues and cell lines using quantitative real-time PCR. Cell counting kit-8 (CCK-8) assay and Transwell assay were used to detect proliferation, migration, and invasion in cell lines, whereas flow cytometry was applied to study apoptosis. Western blot analysis was performed to measure the protein levels. Dual luciferase reporter assay was used to investigate the interaction between miR-196b-5p and ING5. Tumor formation was evaluated in mice. Results MiR-196b-5p was abundantly expressed in colorectal cancer tissues and cell lines, whereas ING5 was expressed at low levels. MiR-196b-5p was successfully overexpressed or knocked down in colorectal cancer cells. We found that miR-196b-5p overexpression significantly accelerated the proliferation, cell cycle, migration and invasion, while inhibited cell apoptosis in colorectal cancer cells. However, miR-196b-5p inhibitor showed the opposite effects. Moreover, ING5 overexpression or knockdown was successfully performed in colorectal cancer cells. ING5 overexpression suppressed proliferation, migration, invasion, the phosphorylation of PI3K, Akt as well as MEK, and promoted cell apoptosis, which could be reversed by ING5 knockdown. Additionally, ING5 was identified as a target of miR-196b-5p through bioinformatics analysis and a luciferase activity assay. Furthermore, ING5 knockdown could attenuate the decrease in proliferation, migration, invasion, and the protein levels of p-PI3K, p-Akt, and p-MEK, which were induced by miRNA-196b-5p inhibitor. Besides, miR-196b-5p knockdown inhibited tumor growth, whereas ING5 knockdown elevated it in vivo. Conclusions In conclusion, miR-196b-5p promotes cell proliferation, migration, invasion, and inhibits apoptosis in colorectal cancer by targeting ING5.
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Affiliation(s)
- He Xin
- Department of Radiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004 People's Republic of China
| | - Chuanzhuo Wang
- Department of Radiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004 People's Republic of China
| | - Yuan Chi
- Department of Radiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004 People's Republic of China
| | - Zhaoyu Liu
- Department of Radiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004 People's Republic of China
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Abstract
BACKGROUND Timing of surgery has been shown to affect outcomes in many forms of cancer, but definitive national data do not exist to determine the effect of time to surgery on survival in colon cancer. OBJECTIVE This study aimed to determine whether a delay in definitive surgery in colon cancer significantly affects survival. DATA SOURCES A retrospective cohort study using 2 independent population-based databases, The Surveillance, Epidemiology, and End Results Medicare-linked database and the National Cancer Database, was performed. STUDY SELECTION All patients had American Joint Committee on Cancer stage 1 through 3 colon cancer. Patients were more than 18 years of age in the National Cancer Database cohort and older than 66 years of age in the Medicare cohort. Patients had a minimum of 3 years of follow-up. MAIN OUTCOME MEASURES The main outcome was overall survival as a function of time between diagnosis and surgery in 4 intervals (1-2, 3-4, 5-6, >6 weeks). RESULTS The Medicare cohort demonstrated an adjusted 5-year survival of 8% to 14% higher in patients with a surgical delay between 3 and 6 weeks, with significantly lower hazard ratios in that interval. The National Cancer Database cohort demonstrated an adjusted 5-year survival of 9% to 16% higher in patients with surgery 3 to 6 weeks after diagnosis, with comparatively similar improvements in survival hazard. LIMITATIONS Because this was a retrospective study of administrative databases, with Medicare data limited to billing data, the causality of outcomes must be interpreted with caution. CONCLUSIONS The ideal timing of definitive resection in colon cancer is between 3 and 6 weeks after initial diagnosis. All efforts should be made for patients to obtain definitive surgery within this interval to achieve a modest but significant improvement in overall survival. See Video Abstract at http://links.lww.com/DCR/B76. ¿CUÁNDO DEBEN SOMETERSE LOS PACIENTES CON CÁNCER DE COLON A UNA RESECCIÓN DEFINITIVA?: Se ha demostrado que el momento de la cirugía afecta los resultados en muchas formas de cáncer, pero no existen datos nacionales definitivos para determinar el efecto del tiempo hasta la cirugía en la supervivencia en el cáncer de colon.Determinar si un retraso en la cirugía definitiva en el cáncer de colon afecta significativamente la supervivencia.Un estudio de cohorte retrospectivo que utiliza dos bases de datos independientes basadas en la población; Se realizó la base de datos vinculada a la vigilancia, la epidemiología y los resultados finales y la base de datos nacional del cáncer.Pacientes con cáncer de colon en estadíos 1 a 3 del Comité Estadounidense Conjunto sobre el Cáncer. Los pacientes tenían más de 18 años en la cohorte de la National Cancer Database y más de 66 años en la cohorte de Medicare. Los pacientes tuvieron un mínimo de 3 años de seguimiento.El resultado principal fue la supervivencia general en función del tiempo entre el diagnóstico y la cirugía en 4 intervalos (1-2, 3-4, 5-6, y mas de 6 semanas).La cohorte de Medicare demostró una supervivencia ajustada de 5 años de 8 a 14% más en pacientes con un retraso quirúrgico entre 3 a 6 semanas, con razones de riesgo significativamente más bajas en ese intervalo. La cohorte de la National Cancer Database demostró una supervivencia ajustada a 5 años de 9 a 16% más en pacientes con cirugía de 3 a 6 semanas después del diagnóstico, con mejoras comparativamente similares en el riesgo de supervivencia.Dado que este fue un estudio retrospectivo de bases de datos administrativas, con datos de Medicare limitados a datos de facturación, la causalidad de los resultados debe interpretarse con precaución.El momento ideal para la resección definitiva en el cáncer de colon es entre tres y seis semanas después del diagnóstico inicial. Se deben hacer todos los esfuerzos para que los pacientes obtengan una cirugía definitiva dentro de este intervalo para lograr una mejora modesta pero significativa en la supervivencia general. Consulte Video Resumen en http://links.lww.com/DCR/B76.
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Baguena G, Pellino G, Frasson M, Escrig J, Marinello F, Espí A, García-Granero A, Roselló S, Cervantes A, García-Granero E. Impact of perioperative transfusions and sepsis on long-term oncologic outcomes after curative colon cancer resection. A retrospective analysis of a prospective database. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:63-72. [PMID: 31918857 DOI: 10.1016/j.gastrohep.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/18/2019] [Accepted: 07/04/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Intra-abdominal septic complications (IASC) affect short-term outcomes after surgery for colon cancer. Blood transfusions have been associated with worse short-term results. The role of IASC and blood transfusions on long-term oncologic results is still debated. This study aims to assess the impact of these two variables on survival after curative colon cancer resection. PATIENTS AND METHODS Retrospective analysis of a prospectively maintained database of patients who underwent curative surgery for colon cancer at a university hospital, between 1993 and 2010. Cox regression was used to identify the role of IASC and transfusions (alone and combined) on local recurrence (LR), disease-free survival (DFS), and cancer-specific survival (CSS). RESULTS Out of the 1686 patients analyzed, 1277 fit in the inclusion criteria. Colorectal surgeons performed the procedure in 82.2% of the patients. Blood transfusions were administered to 25.8% of the patients. Thirty-day complication and mortality rates were 34.5% and 6.1%. IASC occurred in 9.9%. The mean follow-up was 66 months. The 5-year rates of LR, DFS, and CSS were 7%, 79.8%, and 85.1%. The year of surgery and pT (Hazard ratio 9.35, 95% CI 1.23-70.9, for T4) and pN (Hazard ratio 2.57, 95% CI 1.39-4.72, for N2) stages were independent risk factors for LR. The same variables, bowel obstruction and surgeries performed by surgeons not specialized in colorectal surgery, were also associated with worse DFS and CSS. IASC and blood transfusions were not associated with LR, DFS, and CSS, whether alone or combined. CONCLUSIONS IASC and transfusions were not associated with worse oncological outcomes after curative colon cancer surgery per se. Other factors were more important predictors of survival.
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Affiliation(s)
- Gloria Baguena
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain
| | - Gianluca Pellino
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain; Colorectal Surgery, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Matteo Frasson
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain.
| | | | - Franco Marinello
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain
| | - Alejandro Espí
- Department of General Surgery, Coloproctology Unit, Hospital Clínico Universitario, University of Valencia, Spain
| | - Alvaro García-Granero
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain; Department of Human Anatomy and Embryology, University of Valencia, Spain
| | - Susana Roselló
- Department of Haematology and Medical Oncology, Hospital Clínico Universitario, University of Valencia, Spain
| | - Andres Cervantes
- Department of Haematology and Medical Oncology, Hospital Clínico Universitario, University of Valencia, Spain
| | - Eduardo García-Granero
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain
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Emergency Surgery for Obstructive Colon Cancer in Elderly Patients: Results of a Multicentric Cohort of the French National Surgical Association. Dis Colon Rectum 2019; 62:941-951. [PMID: 31283592 DOI: 10.1097/dcr.0000000000001421] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although elderly patients constitute most of the patients undergoing surgery for obstructed colon cancer, available data in the literature are very limited. OBJECTIVE The purpose of this study was to assess the management and outcomes of elderly patients treated for obstructed colon cancer. DESIGN This was a multicenter, retrospective cohort study. SETTINGS Between 2000 and 2015, 2325 patients managed for an obstructed colon cancer in member centers of the French National Surgical Association were identified. Data were collected by each center on a voluntary basis after institutional approval. Bowel obstruction was defined clinically and confirmed by imaging. PATIENTS Three age groups were defined, including patients <75 years, 75 to 84 years, and ≥85 years. MAIN OUTCOME MEASURES Postoperative and oncologic results in elderly patients with an obstructed colon cancer were measured. Relative survival was calculated as the ratio of the overall survival with the survival that would have been expected based on the corresponding general population. INTERVENTIONS A total of 302 patients (13%) underwent colonic stent insertion, and 1992 (87%) underwent surgery as emergency procedure. RESULTS A total of 2294 patients were analyzed (<75 y, n = 1200 (52%); 75-84 y, n = 650 (28%); and ≥85 y, n = 444 (20%)). Elderly patients were more likely to be women (p < 0.0001), to have proximal colon cancer (p < 0.0001), and to have a higher incidence of comorbidities (p < 0.0001). The use of colonic stent or the type of surgery was identical regardless of age. In patients with resected colon cancer, elderly patients had less stage IV disease (p < 0.0001). The absence of tumor resection (p < 0.0001) and definitive stoma rate increased with age (p < 0.0001). Postoperative mortality and morbidity were significantly higher in elderly patients (p < 0.0001), but surgical morbidity was similar across age groups (p = 0.60). Postoperative morbidity was correlated to the 6-month mortality rate in elderly (p < 0.0001). Overall and disease-free survivals were significantly lower in more elderly patients (p < 0.0001) but relative survival was not (p = 0.09). LIMITATIONS It is quite difficult to know how to interpret these data as a whole, given the inherent bias in the study population, lack of ability to stratify by performance status, and long study period duration. CONCLUSIONS Elderly patients have high morbidity with lower survival in the highest age ranges of elderly subgroups. These data should be considered when deciding on an operative approach. See Video Abstract at http://links.lww.com/DCR/A964.
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Bednarski BK, Nickerson TP, You YN, Messick CA, Speer B, Gottumukkala V, Manandhar M, Weldon M, Dean EM, Qiao W, Wang X, Chang GJ. Randomized clinical trial of accelerated enhanced recovery after minimally invasive colorectal cancer surgery (RecoverMI trial). Br J Surg 2019; 106:1311-1318. [PMID: 31216065 DOI: 10.1002/bjs.11223] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) and enhanced recovery protocols (ERPs) have improved postoperative recovery and shortened length of hospital stay (LOS). Telemedicine technology has potential to improve outcomes and patient experience further. This study was designed to determine whether the combination of MIS, ERP and a structured telemedicine programme (TeleRecovery) could shorten total 30-day LOS by 50 per cent. METHODS This was a phase II prospective RCT at a large academic medical centre. Eligible patients aged 18-80 years undergoing minimally invasive colorectal resection using an ERP were randomized after surgery. The experimental arm (RecoverMI) included accelerated discharge on postoperative day (POD) 1 with or without evidence of bowel function and a televideoconference on POD 2. The control arm was standard postoperative care. The primary endpoint was total 30-day LOS (postoperative stay plus readmission/emergency department/observation days). Secondary endpoints included patient-reported outcomes measured by EQ-5D-5L™, Brief Pain Inventory (BPI) and a satisfaction questionnaire. RESULTS Thirty patients were randomized after robotic (21 patients) or laparoscopic (9) colectomy, including 14 patients in the RecoverMI arm. Median 30-day total LOS was 28·3 (i.q.r. 23·7-43·6) h in the RecoverMI arm and 51·5 (43·8-67·0) h in the control arm (P = 0·041). There were no differences in severe adverse events or EQ-5D-5L™ score between the study arms. The BPI revealed low pain scores regardless of treatment arm. Satisfaction was high in both arms. CONCLUSION In patients having surgery for colorectal neoplasms, the trimodal combination of MIS, ERP and TeleRecovery can reduce 30-day LOS while preserving patients' quality of life and satisfaction. Registration number: NCT02613728 ( https://clinicaltrials.gov).
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Affiliation(s)
- B K Bednarski
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - T P Nickerson
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Y N You
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - C A Messick
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - B Speer
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - V Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - M Manandhar
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - M Weldon
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - E M Dean
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - W Qiao
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - X Wang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G J Chang
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Li S, Liu Z, Fang XD, Wang XY, Fei BY. MicroRNA (miR)-597-5p Inhibits Colon Cancer Cell Migration and Invasion by Targeting FOS-Like Antigen 2 ( FOSL2). Front Oncol 2019; 9:495. [PMID: 31245295 PMCID: PMC6581747 DOI: 10.3389/fonc.2019.00495] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/24/2019] [Indexed: 12/18/2022] Open
Abstract
Our previous work had shown that FOS-like antigen 2 (FOSL2) is regulated by miR-143-5p in colorectal cancer (CRC). Given that it has been shown by others that FOSL2 is also a target of miR-597-5p in breast adenocarcinoma, the objective of the current work was to determine whether FOSL2 is regulated by miR-597-5p in CRC and the role of miR-597-5p in CRC. MiR-597-5p expression was determined in RNA obtained from 30 paired samples of colon cancer and tumor adjacent normal tissue, as well as in the LoVo (CRC cell line) and FHC (normal colonic epithelial cells) by quantitative real time polymerase chain reaction (qRT-PCR). MiR-597-5p expression was significantly downregulated in both CRC tissue and LoVo cells. Reporter assays using wild-type and miR-597-5p seed mutant FOSL2 confirmed that FOSL2 is a bona fide target of miR-597-5p. Modulating miR-597-5p expression levels in FHC and LoVo cells using antagomir and mimic, respectively, impacted expression of epithelial and mesenchymal cell markers as well as in vitro migration and invasion, without any effect on cell proliferation, showing that miR-597-5p functions as a suppressor of epithelial to mesenchymal transition. Restoration of FOSL2 expression rescued pro-metastatic functional properties of LoVo cells conforming that effect of miR-597-5p was being mediated by targeting FOSL2. Xenograft assays in athymic nude mice showed that miR-597-5p mimic did not reduce tumor incidence or growth in LoVo cells. However, using a hepatic metastasis model showed that miR-597-5p mimic can significantly prevent hepatic metastatic nodule formation as well as FOSL2 expression in these metastatic nodules. Importantly, FOSL2 mRNA and miR-597-5p expression was found to be inversely correlated in an independent cohort of 21 CRC patients Cumulatively our results show that miR-597-5p functions as a suppressor of metastatic progression in CRC by targeting FOSL2. Replenishment of miR-597-5p can be a potential therapeutic target where its expression along with FOSL2 can serve as potential diagnostic markers in CRC.
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Affiliation(s)
- Shuo Li
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhuo Liu
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xue-Dong Fang
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiu-Ying Wang
- Medical Record Department, China Japan Union Hospital of Jilin University, Changchun, China
| | - Bing-Yuan Fei
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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Abstract
BACKGROUND TNM stage has been identified as an independent variable for local recurrence and survival after colon cancer resection. It is still unclear whether peritoneal invasion (pT4a) is a risk factor for adverse oncologic outcome or whether these patients have better results compared with contiguous organs infiltration (pT4b), independent from nodal status (pN). OBJECTIVE The purpose of this study was to analyze whether peritoneal invasion is an independent risk factor for worse oncologic outcome after curative colon cancer resection. DESIGN This was a retrospective analysis with multivariate regression of a prospective database, according to Strengthening the Reporting of Observational Studies in Epidemiology Statement. SETTINGS The study was conducted in a specialized colorectal unit of a tertiary hospital. PATIENTS A consecutive series of pT3-pT4a-pT4b patients with colon cancer who underwent curative surgery (1993-2010) were included, and patients with metastasis were excluded. MAIN OUTCOME MEASURES A multivariate Cox regression analysis was performed to assess independent risk factors for 5-year local recurrence, peritoneal carcinomatosis-like recurrence, disease-free survival, and cancer-specific survival. RESULTS A total of 1010 patients were analyzed (79.3% pT3, 9.9% pT4a, and 10.8% pT4b). At diagnosis, 22.0% had obstructive symptoms, and 10.5% had bowel perforation. A total of 72.2% of the surgeries were elective, and in 15.6% en bloc resection of contiguous organs was performed. Median follow-up was 62 months (38-100 mo). For the whole group, 5-year actuarial rates were 8.8% for local recurrence, 2.5% for peritoneal carcinomatosis, 75.5% for disease-free survival, and 81.8% for cancer-specific survival. At multivariate analysis, pT4a stage was an independent risk factor for local recurrence (p = 0.002; HR = 3.1), peritoneal carcinomatosis (p = 0.02; HR = 4.9), worse disease-free survival (p = 0.002; HR = 1.9), and cancer-specific survival (p = 0.001; HR = 2.2). When considering only the 566 patients with ≥12 nodes identified, T stage was still associated with higher local recurrence (p = 0.04) and carcinomatosis rate (p = 0.04), as well as worse disease-free (p = 0.009) and cancer-specific survival (p = 0.014). LIMITATIONS This was a retrospective, single-center study. CONCLUSIONS pT4a stage is an independent risk factor for worse oncologic outcome after curative colon cancer resection compared with pT3 and pT4b stages. The current pT4a-pT4b classification should be reconsidered. Of note, even in pT4a patients, 5-year carcinomatosis rate does not exceed 6%. See Video Abstract at http://links.lww.com/DCR/A926.
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Mege D, Manceau G, Bridoux V, Voron T, Sabbagh C, Lakkis Z, Venara A, Ouaissi M, Denost Q, Kepenekian V, Sielezneff I, Karoui M. Surgical management of obstructive left colon cancer at a national level: Results of a multicentre study of the French Surgical Association in 1500 patients. J Visc Surg 2019; 156:197-208. [DOI: 10.1016/j.jviscsurg.2018.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Livadaru C, Morarasu S, Frunza TC, Ghitun FA, Paiu-Spiridon EF, Sava F, Terinte C, Ferariu D, Lunca S, Dimofte GM. Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision. World J Gastrointest Oncol 2019; 11:208-226. [PMID: 30918594 PMCID: PMC6425332 DOI: 10.4251/wjgo.v11.i3.208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/06/2018] [Accepted: 01/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Quality control in colon cancer surgery is an ongoing debate ever since standardization proved to be highly efficient in improving survival in rectal cancer. Complete mesocolic excision (CME) is widely acclaimed as the new gold-standard in colon cancer resections, thus it is imperative to establish quality criteria of CME in order to make it easily understood and verified by surgeons worldwide. One simple and reproducible tool could be the measurement of arterial stumps postoperatively and a straightforward way to test its reliability is to test it in a comparative study between CME and non-CME surgery.
AIM To validate arterial stump measurement as a surgical quality tool by comparing CME with conventional radical colectomies.
METHODS This was a retrospective study, carried out on a prospective database. We collected data from two groups of patients, divided according to standard CME with D2 central vascular ligation (group A) and non-standardized surgery (group B). The two groups were compared with regard to the arterial stump length after right- and left-sided colectomies for colon cancer. The actual stump lengths of the ileocolic artery (ICA) and inferior mesenteric artery (IMA) were compared with their theoretical best D2 position of predicted ligation levels (D2PLLs) for calculating the potential for improvement. Measurements on follow-up computed tomography scans were carried out by three observers. Pathological data were recorded (specimen length, lymph node yield) and correlated with stump length.
RESULTS We analysed 58 colectomies. The stump lengths (mean ± SD) in group A were 16.97 ± 4.77 mm for ICA and 31.70 ± 15.71 mm for IMA, whereas group B had 49.93 ± 20.29 mm for ICA and 67.24 ± 28.71 mm for IMA. Shorter lengths were obtained in group A, by a mean difference of 35.66 mm (χ2 = 27.38, P < 0.001), which was significant for all types of colectomies. Except for a 5.85 ± 4.71 mm difference for right colectomies, all the ligations from group A significantly reached their potential height (0.26 ± 12.18 mm from D2PLL; χ2 = 0.005, P = 0.944). Apart from three left colectomies, group B failed to reach D2PLL, by a mean difference of 32.14 ± 26.15 mm (χ2 = 21.77, P < 0.001). The calculated improvement potentials were significantly shorter in group A than in group B, by a mean of 31.88 mm (χ2= 22.13, P < 0.001). The large spread of results in group B showed that there is significant variability (P = 0.004) when compared to standard surgery. Significant correlations were found between stump length, specimen length and number of lymph nodes (P = 0.018 and P = 0.008 respectively). No statistical difference was found between observers’ measurements (P = 0.866).
CONCLUSION Arterial stump monitoring is a significant step in defining surgical quality, as longer stumps contain residual mesocolic tissue and correlate with major prognostic factors.
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Affiliation(s)
- Cristian Livadaru
- ”Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Stefan Morarasu
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Tudor Cristian Frunza
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Florina A Ghitun
- ”Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Elena Florina Paiu-Spiridon
- Department of Radiology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Florina Sava
- Department of Radiology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Cristina Terinte
- Department of Pathology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Dan Ferariu
- Department of Pathology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Sorinel Lunca
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Gabriel Mihail Dimofte
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
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Bagateliya ZA, Shabunin AV, Gugnin AV. [Standardization of surgical care for malignant colonic obstruction]. Khirurgiia (Mosk) 2019:53-59. [PMID: 30789609 DOI: 10.17116/hirurgia201901153] [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: 11/17/2022]
Abstract
AIM To standardize surgical care for malignant colonic obstruction. MATERIAL AND METHODS There were 572 patients with malignant colonic obstruction: 247 of them were hospitalized in 2011-2013 (I group); 325 - in 2014-2017 (group II). Forty-six patients underwent medication; 302 - acute resection; 141 - stoma construction; 83 - stent deployment. Elective surgery and radiation or chemotherapy was performed after 0.5-6 months in 110 patients of group II. Acute resection was more common in I group, elective resection - in group II. Early and long-term results including Kaplan-Meier 3-year overall survival were compared in both groups. RESULTS Complications occurred in 46.69% (group I) and 21% (group II). Postoperative mortality was significantly higher in group I compared with II group: 26.11 and 10.33%, respectively. Three-year overall survival was higher in group I compared with group II: 0.82 and 0.69, respectively. CONCLUSION Advisability of new two-stage surgical standard is confirmed for malignant colonic obstruction. Stoma formation and stenting may be a valid alternative in some patients with malignant colonic obstruction due to significantly lower postoperative mortality.
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Affiliation(s)
- Z A Bagateliya
- Chair of Surgery of the Russian Medical Academy of Continuing Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russia; Botkin Municipal Clinical Hospital, Moscow, Russia
| | - A V Shabunin
- Botkin Municipal Clinical Hospital, Moscow, Russia
| | - A V Gugnin
- Botkin Municipal Clinical Hospital, Moscow, Russia
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Leijssen LGJ, Dinaux AM, Amri R, Kunitake H, Bordeianou LG, Berger DL. The Impact of a Multivisceral Resection and Adjuvant Therapy in Locally Advanced Colon Cancer. J Gastrointest Surg 2019; 23:357-366. [PMID: 30284199 DOI: 10.1007/s11605-018-3962-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 08/31/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multivisceral resection for locally advanced colon cancer is mandatory to achieve complete tumor resection. We aimed to determine if local multivisceral resections (LMR) for pT4 and pT3 tumors impact perioperative and long-term oncological outcomes. METHODS All stage II or III colon cancer patients who had surgery between 2004 and 2014 were identified. We analyzed patients with non-multivisceral resections (NMR) for pT4 tumors vs. pT4-LMR. In addition, outcomes were compared to both NMR and LMR pT3 patients. RESULTS LMR was performed in 55 (29.7%) of all patients with pT4 tumors and in 48 (8.9%) of all patients with pT3 tumors. The most commonly involved areas of extension were the abdominal wall and the small intestine. Transverse colon cancer was correlated with LMR. Morbidity rates were comparable between NMR and LMR, with the exception of higher rates of blood transfusion and postoperative ileus. Over one third of all pT4-NMR patients developed recurrent disease, which was higher compared to all other groups. Subsequently, overall and disease-specific survival, as well as disease-free survival (DFS), was worse for pT4-NMR, even after adjustment for pTN-staging, adjuvant therapy, and R0 resection. Furthermore, when analyzing only curative resections, radial margin < 1 cm along with nodal disease was independent predictor for worse DFS. Long-term outcomes were comparable between pT4-LMR and pT3 patients. CONCLUSIONS Multivisceral resection for locally advanced colon cancer preserves long-term oncological outcomes without increased postoperative morbidity. Moreover, LMR in pT3 tumors does not contribute to postoperative morbidity. Our study underlines the feasibility and importance of performing LMR when locally advanced cancer is suspected.
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Affiliation(s)
- Lieve G J Leijssen
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne M Dinaux
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Amri
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hiroko Kunitake
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Costas-Chavarri A, Nandakumar G, Temin S, Lopes G, Cervantes A, Cruz Correa M, Engineer R, Hamashima C, Ho GF, Huitzil FD, Malekzadeh Moghani M, Sharara AI, Stern MC, Teh C, Vázquez Manjarrez SE, Verjee A, Yantiss R, Shah MA. Treatment of Patients With Early-Stage Colorectal Cancer: ASCO Resource-Stratified Guideline. J Glob Oncol 2019; 5:1-19. [PMID: 30802158 PMCID: PMC6426503 DOI: 10.1200/jgo.18.00214] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To provide resource-stratified, evidence-based recommendations on the treatment and follow-up of patients with early-stage colorectal cancer. METHODS ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus process with additional experts for one round of formal ratings. RESULTS Existing sets of guidelines from 12 guideline developers were identified and reviewed; adapted recommendations from six guidelines form the evidence base and provide evidence to inform the formal consensus process, which resulted in agreement of 75% or more on all recommendations. RECOMMENDATIONS For nonmaximal settings, the recommended treatments for colon cancer stages nonobstructing, I-IIA: in basic and limited, open resection; in enhanced, adequately trained surgeons and laparoscopic or minimally invasive surgery, unless contraindicated. Treatments for IIB-IIC: in basic and limited, open en bloc resection following standard oncologic principles, if not possible, transfer to higher-level facility; in emergency, limit to life-saving procedures; in enhanced, laparoscopic en bloc resection, if not possible, then open. Treatments for obstructing, IIB-IIC: in basic, resection and/or diversion; in limited or enhanced, emergency surgical resection. Treatment for IIB-IIC with left-sided: in enhanced, may place colonic stent. Treatment for T4N0/T3N0 high-risk features or stage II high-risk obstructing: in enhanced, may offer adjuvant chemotherapy. Treatment for rectal cancer cT1N0 and cT2n0: in basic, limited, or enhanced, total mesorectal excision principles. Treatment for cT3n0: in basic and limited, total mesorectal excision, if not, diversion. Treatment for high-risk patients who did not receive neoadjuvant chemotherapy: in basic, limited, or enhanced, may offer adjuvant therapy. Treatment for resectable cT3N0 rectal cancer: in enhanced, base neoadjuvant chemotherapy on preoperative factors. For post-treatment surveillance, a combination of medical history, physical examination, carcinoembryonic antigen testing, imaging, and endoscopy is performed. Frequency depends on setting. Maximal setting recommendations are in the guideline. Additional information can be found at www.asco.org/resource-stratified-guidelines . NOTICE It is the view of the American Society of Clinical Oncology that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guidelines are intended to complement but not replace local guidelines.
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Affiliation(s)
| | - Govind Nandakumar
- Columbia Asia Hospitals, Bangalore, India
- Weill Cornell Medical College, New York, NY
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Marcia Cruz Correa
- The University of Puerto Rico, San Juan, PR
- The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | | | | | - Fidel David Huitzil
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Mariana C Stern
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | | | - Azmina Verjee
- Homerton University Hospital National Health Service Foundation Trust, London, United Kingdom
- Bowel Disease Research Foundation, London, United Kingdom
| | - Rhonda Yantiss
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Manish A Shah
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY
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Bagateliya ZA. [The optimal terms of the second stage of treatment of patients with malignant colonic obstruction]. Khirurgiia (Mosk) 2018:76-81. [PMID: 30560849 DOI: 10.17116/hirurgia201812176] [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: 11/17/2022]
Abstract
AIM To determine the optimal terms of the second stage of treatment of patients with malignant colonic obstruction. MATERIAL AND METHODS There were 110 patients with colorectal cancer stage T3-4N0M0 (groups I-III, n=69) and T3-4N0-2M0-1 (group IV, n=41). Everybody has been previously treated for colonic obstruction 0,5-6 months ago: stoma in 62 cases, stenting - in 48 cases. Elective radical surgery and radiotherapy and/or chemotherapy were applied in 2 (I group, n=23), 3 (II, n=23), 4 (III, n=23) weeks or 4-6 months (IV, n=41) after colonic decompression. The optimal terms of radical surgery are determined depending on CT-data, histological examination. RESULTS Bowel wall thickness was significantly higher in I-II groups compared with III-IV groups: 3.7; 2.5; 1.9; 1.7, respectively (p≤0,5). The maximum number of tumor emboli was found in III-IV groups. Signs of focal colitis were absent in III-IV groups. CONCLUSION The expediency of the new surgical standard is confirmed. Bridging strategy (stenting and stoma) may be a valid alternative in some patients with malignant colonic obstruction due to reduced postoperative mortality. The optimal terms for resection in patients with local cancer is 4 weeks after colonic decompression, in locally advanced cancer - 4-6 months.
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Affiliation(s)
- Z A Bagateliya
- Chair of Surgery, Russian Medical Academy of Continuing Postgraduate Education of Healthcare Ministry of the Russia, Moscow, Russia; Botkin Municipal Clinical Hospital, Moscow, Russia
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Jiménez I, Pacha MÁ, Pares D, Esteve M, Troya J, Roca J, Canet J, Julián JF, Fernández-Llamazares J. Survival and quality of life after surgery for colorectal cancer in the elderly: a comparative study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 111:193-198. [PMID: 30545228 DOI: 10.17235/reed.2018.5807/2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND the aim of this study was to analyze the clinical results of the multidisciplinary management of elderly patients with colorectal cancer in a single center and to describe postoperative quality of life. METHODS a comparative study was designed to compare the results and quality of life of patients treated in our center for colon cancer, aged from 80 to 84 years (study group) compared to a control group (aged form 75 to 79 years of age). Morbidity, mortality, oncological results and quality of life were analyzed. RESULTS eighty-seven patients aged between 80 and 84 years of age (study group) were compared to a control group, which was formed by 91 patients aged from 75 to 79 years of age. There were no significant differences in technique and morbidity. Survival at 30 days, 90 days and at the end of follow-up (median 48 months) were similar in both groups. There were no differences in quality of life except for one item with regard to physical function (p = 0.0138). CONCLUSION similar clinical results and quality of life were achieved after treating elderly patients with colon cancer with a multidisciplinary management approach.
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Affiliation(s)
| | | | - David Pares
- Unidad de Cirugia Colorrectal, Hospital Germans Trias i Pujol. Universitat Autónoma de Barcelona, España
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Muthukrishnan S, Naganathbabu OL, Murugesan SD, Srinivasan UP, Amudhan A, Rajendran S. Krukenberg tumours from gastrointestinal cancers-analysis from a tertiary care centre in India. J Gastrointest Oncol 2018; 9:1164-1167. [PMID: 30603137 DOI: 10.21037/jgo.2018.07.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Krukenberg tumour (KT) is clinically defined as any ovarian metastatic carcinoma derived from a primary malignancy (usually from the gastrointestinal tract). Our aim was to analyse the incidence, demographic profile, clinical features, management and survival of patients with KTs from gastrointestinal tract malignancies at our centre. Methods This was a retrospective analysis data at our centre between Jan 2015 and Dec 2017. Results A total of 8 patients of KTs (2 from gastric and 6 from colorectal cancers) were observed with an incidence of 0.66% in gastric and 2.90% in colorectal cancers. The mean age of all the patients was 40 years (44 in gastric and 39 in colorectal group) and most of them (5 out of 8) occurred in premenopausal women. They were also most commonly bilateral (6 out of 8) and synchronous (6 out of 8). Surgical debulking was possible in 7 patients and all patients underwent systemic chemotherapy. Interestingly, 4 patients in the colorectal KT group with metastasis limited to ovary alone managed by surgical debulking and chemotherapy had a significantly higher 1-year survival compared to the others with peritoneal disease are alive at an average of 14.5 months. Conclusions The incidence of KTs from colorectal cancers is on the rise. KTs from colorectal cancers and KTs without peritoneal metastases have a better prognosis showing significantly higher 1-year survival rates following complete surgical resection and systemic chemotherapy.
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Affiliation(s)
- Srinivasan Muthukrishnan
- Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital & Madras Medical College, Chennai, India
| | | | - Satish Devakumar Murugesan
- Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital & Madras Medical College, Chennai, India
| | - Ulagendra Perumal Srinivasan
- Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital & Madras Medical College, Chennai, India
| | - Anbalagan Amudhan
- Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital & Madras Medical College, Chennai, India
| | - Shanmugasundaram Rajendran
- Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital & Madras Medical College, Chennai, India
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41
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A modified frailty index predicts adverse outcomes among patients with colon cancer undergoing surgical intervention. Am J Surg 2018; 216:1090-1094. [DOI: 10.1016/j.amjsurg.2018.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/25/2018] [Accepted: 07/02/2018] [Indexed: 12/20/2022]
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42
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Al-Busaidi IS, Bailey T, Dobbs B, Eglinton TW, Wakeman CJ, Frizelle FA. Complete resection of colorectal cancer with ovarian metastases combined with chemotherapy is associated with improved survival. ANZ J Surg 2018; 89:1091-1096. [PMID: 30485627 DOI: 10.1111/ans.14930] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/12/2018] [Accepted: 10/02/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ovarian metastases (OM) from colorectal cancer (CRC) are uncommon, and data about optimal management are lacking. The aim of this study was to examine the management and outcomes of patients with OM from CRC. METHODS A retrospective review of records of patients with a histopathological diagnosis of OM from CRC who were treated at Christchurch Hospital between 1 January 2000 and 31 December 2016. Data related to presentation, clinicopathological characteristics, treatment and outcomes were recorded. The primary outcomes were overall survival and disease-free survival. RESULTS Thirty-one patients were identified (median age 55 years, range 28-77), with a median follow-up of 23 months (range 3-84 months). Abdominal pain was the most common presenting symptom (22 patients). Synchronous OM occurred in 22 patients, 14 patients had bilateral ovarian involvement. Twenty-one patients received adjuvant chemotherapy. R0 resection was achieved in 14 patients. For all patients the 5-year disease-free and overall survival were 11% and 12%, respectively, while 5-year overall survival for R0 resections was 30%. Improved median survival was associated with negative colon resection margins (26.7 months versus 7.8 months, P = 0.03), R0 resection (30.5 months versus 23.5 months, P = 0.04), and use of adjuvant chemotherapy (28.8 months versus 8.2 months, P < 0.0001); however, on multivariate analysis adjuvant chemotherapy was the only independent factor associated with improved prognosis (P = 0.01). CONCLUSIONS OM from CRC are uncommon and carry a poor prognosis. Improved survival was associated with complete surgical resection of the primary tumour and metastatic disease in combination with systemic chemotherapy.
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Affiliation(s)
| | - Teresa Bailey
- Department of Anatomical Pathology, Christchurch Hospital, Christchurch, New Zealand
| | - Bruce Dobbs
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Tim W Eglinton
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Christopher J Wakeman
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Frank A Frizelle
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand
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Nascimento EFR, Ribeiro ML, Magro DO, Carvalho J, Kanno DT, Martinez CAR, Coy CSR. TISSUE EXPRESION OF THE GENES MUTYH AND OGG1 IN PATIENTS WITH SPORADIC COLORECTAL CANCER. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 30:98-102. [PMID: 29257843 PMCID: PMC5543786 DOI: 10.1590/0102-6720201700020005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/14/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND MTUYH and OGG1 genes have importance in the base excision repair systems of oxidized DNA bases. Modification of the tissue expression of these genes is related to the increased risk of developing colorectal cancer. AIM To evaluate the tissue expression of MUTYH and OGG1 comparing normal and neoplastic tissues of patients with sporadic colorectal cancer and to correlate it with clinical and histopathological variables. METHOD MUTYH and OGG1 tissue expression was quantified by RT-PCR in patients with colorectal cancer and the values were compared in normal and neoplastic tissues. MUTYH and OGG1 expression was measured and normalized to the constitutive 18S gene. The level of expression of both genes was correlated with the variables: age, gender, tumor location, size of the tumor, histological type, degree of cell differentiation, invasion depth in the intestinal wall, angiolymphatic infiltration, lymph node involvement and TNM staging. RESULTS Was found downregulation of both genes in neoplastic when compared to normal tissue. There was downregulation of the MUTYH in larger tumors and in patients with angiolymphatic invasion. Tumors with more advanced TNM stages (III and IV) presented downregulation of both genes when compared to those with earlier stages (I and II). CONCLUSION The MUTYH and OGG1 genes present downregulation in the more advanced stages of colorectal cancer.
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Affiliation(s)
- Enzo Fabrício Ribeiro Nascimento
- Faculty of Medical Sciences of the State University of Campinas (FCM-UNICAMP), Postgraduate Program in Surgery Sciences, Campinas, SP
| | - Marcelo Lima Ribeiro
- São Francisco University, Post-Graduation Program in Health Sciences, Bragança Paulista, SP
| | - Daniela Oliveira Magro
- Faculty of Medical Sciences of the State University of Campinas, Department of Surgery, Campinas, SP
| | - Juliana Carvalho
- State University of Campinas, Integrated Center for Women's Health Care, Campinas, SP, Brazil
| | - Danilo Toshio Kanno
- São Francisco University, Post-Graduation Program in Health Sciences, Bragança Paulista, SP
| | - Carlos Augusto Real Martinez
- São Francisco University, Post-Graduation Program in Health Sciences, Bragança Paulista, SP.,Faculty of Medical Sciences of the State University of Campinas, Department of Surgery, Campinas, SP
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Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli M, Agresta F, Allievi N, Bellanova G, Coccolini F, Coy C, Fugazzola P, Martinez CA, Montori G, Paolillo C, Penachim TJ, Pereira B, Reis T, Restivo A, Rezende-Neto J, Sartelli M, Valentino M, Abu-Zidan FM, Ashkenazi I, Bala M, Chiara O, De' Angelis N, Deidda S, De Simone B, Di Saverio S, Finotti E, Kenji I, Moore E, Wexner S, Biffl W, Coimbra R, Guttadauro A, Leppäniemi A, Maier R, Magnone S, Mefire AC, Peitzmann A, Sakakushev B, Sugrue M, Viale P, Weber D, Kashuk J, Fraga GP, Kluger I, Catena F, Ansaloni L. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg 2018; 13:36. [PMID: 30123315 PMCID: PMC6090779 DOI: 10.1186/s13017-018-0192-3] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/28/2018] [Indexed: 02/07/2023] Open
Abstract
ᅟ Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC). Methods The literature was extensively queried for focused publication until December 2017. Precise analysis and grading of the literature has been performed by a working group formed by a pool of experts: the statements and literature review were presented, discussed and voted at the Consensus Conference of the 4th Congress of the World Society of Emergency Surgery (WSES) held in Campinas in May 2017. Results CT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, self-expandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann’s procedure, whenever the characteristics of the patient and the surgeon are permissive. Right-sided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted. With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value. Clinical scenarios in the case of perforation might be dramatic, especially in case of free faecal peritonitis. The importance of an appropriate balance between life-saving surgical procedures and respect of oncologic caveats must be stressed. In selected cases, a damage control approach may be required. Medical treatments including appropriate fluid resuscitation, early antibiotic treatment and management of co-existing medical conditions according to international guidelines must be delivered to all patients at presentation. Conclusions The current guidelines offer an extensive overview of available evidence and a qualitative consensus regarding management of large bowel obstruction and perforation due to colorectal cancer.
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Affiliation(s)
- Michele Pisano
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | - Luigi Zorcolo
- 2Colorectal Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Cecilia Merli
- Unit of Emergency Medicine Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy
| | | | - Elia Poiasina
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | - Marco Ceresoli
- 5Department of General Surgery, School of Medicine, University of Milano, Milan, Italy
| | | | - Niccolò Allievi
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | | | - Federico Coccolini
- Unit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy
| | - Claudio Coy
- 9Colorectal Unit, Campinas State University, Campinas, SP Brazil
| | - Paola Fugazzola
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | | | | | - Ciro Paolillo
- Emergency Department Udine Healthcare and University Integrated Trust, Udine, Italy
| | | | - Bruno Pereira
- 14Department of Surgery, University of Campinas, Campinas, Brazil
| | - Tarcisio Reis
- Oncology Surgery and Intensive Care, Oswaldo Cruz Hospital, Recife, Brazil
| | - Angelo Restivo
- 2Colorectal Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Joao Rezende-Neto
- 16Department of Surgery Division of General Surgery, University of Toronto, Toronto, Canada
| | | | - Massimo Valentino
- 18Radiology Unit Emergency Department, S. Antonio Abate Hospital, Tolmezzo, UD Italy
| | - Fikri M Abu-Zidan
- 19Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Miklosh Bala
- 21Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | | | - Nicola De' Angelis
- 22Unit of Digestive Surgery, HPB Surgery and Liver Transplant Henri Mondor Hospital, Créteil, France
| | - Simona Deidda
- 2Colorectal Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Belinda De Simone
- Department of General and Emergency Surgery Cannes' Hospital Cannes, Cedex, Cannes, France
| | | | - Elena Finotti
- Department of General Surgery ULSS5 del Veneto, Adria, (RO) Italy
| | - Inaba Kenji
- 25Division of Trauma & Critical Care University of Southern California, Los Angeles, USA
| | - Ernest Moore
- 26Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, CO USA
| | - Steven Wexner
- Digestive Disease Center, Department of Colorectal Surgery Cleveland Clinic Florida, Tallahassee, USA
| | - Walter Biffl
- 28Acute Care Surgery The Queen's Medical Center, Honolulu, HI USA
| | - Raul Coimbra
- 29Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Sciences, San Diego, USA
| | - Angelo Guttadauro
- 5Department of General Surgery, School of Medicine, University of Milano, Milan, Italy
| | - Ari Leppäniemi
- Second Department of Surgery, Meilahti Hospital, Helsinki, Finland
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Stefano Magnone
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | - Alain Chicom Mefire
- 32Department of Surgery and Obs/Gyn, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Andrew Peitzmann
- 33Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Boris Sakakushev
- 34General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Michael Sugrue
- General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Dieter Weber
- 37Trauma and General Surgeon, Royal Perth Hospital, Perth, Australia
| | - Jeffry Kashuk
- 38Surgery and Critical Care Assuta Medical Centers, Tel Aviv, Israel
| | - Gustavo P Fraga
- 39Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Ioran Kluger
- 40Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Luca Ansaloni
- Unit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy
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Hagihara K, Takahashi H, Miyoshi N, Haraguchi N, Hata T, Matsuda C, Mizushima T, Yamamoto H, Doki Y, Mori M. Case of laparoscopic right hemicolectomy for ascending colon cancer after aortic graft replacement and revascularization of the superior mesenteric artery. Asian J Endosc Surg 2018; 11:266-269. [PMID: 29322641 DOI: 10.1111/ases.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/23/2017] [Indexed: 12/17/2022]
Abstract
A 67-year-old man who presented with a bloody stool was diagnosed with ascending colon cancer. He had previously experienced thoracic and abdominal aortic dissections, which were treated with thoracic and abdominal aortic grafts and superior mesenteric artery revascularization. We performed a laparoscopic right hemicolectomy with a D3 lymph node dissection. During the laparotomy, we identified the superior mesenteric artery and an enlarged anterior superior pancreaticoduodenal artery. Injury to the latter artery could lead to severe ischemia in multiple organs; therefore, it was crucial to identify the primary feeding artery and vascular anatomy before and during surgery. We chose the laparoscopic right hemicolectomy to avoid injuring the anterior superior pancreaticoduodenal artery and the intra-abdominal abscess. This case study was the first to describe a laparoscopic hemicolectomy after thoracic and abdominal aortic grafts and superior mesenteric artery revascularization.
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Affiliation(s)
- Kiyotaka Hagihara
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Naotsugu Haraguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taishi Hata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Chu Matsuda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hirofumi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Cienfuegos JA, Baixauli J, Martínez Ortega P, Valentí V, Martínez Regueira F, Martí-Cruchaga P, Zozaya G, Hernández Lizoain JL. Screening-detected colorectal cancers show better long-term survival compared with stage-matched symptomatic cancers. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:684-690. [PMID: 30032629 DOI: 10.17235/reed.2018.5509/2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE the aim of this study was to compare overall and disease-free survival among patients with colorectal cancer detected via a screening program as compared to those with symptomatic cancer. MATERIAL AND METHODS patients diagnosed via colonoscopy (screening group) and those with clinical symptoms (non-screening) were identified from 1995 to 2014. Demographic, clinical, surgical and pathologic variables were recorded. Stage I, II and III cancers were included. Overall and disease-free survival were calculated at five and ten years after tumor resection and survival was calculated by matching both groups for cancers at stage I, II and III. RESULTS two hundred and fifty patients were identified as a result of screening procedures and 1,330 patients presented with symptomatic cancers. There were no significant differences in the baseline characteristics between the two groups. Pathologic stage, degree of differentiation, perineural invasion and lymphovascular invasion were lower in the screening group (p < 0.01). Overall and disease-free survival at five and ten years were higher in the screening group (p < 0.01). However, when the subjects were matched for pathologic stage, significant differences were found between the two groups with regard to stage I and III tumors. Disease-free survival in stage III at five years (79.1 vs 61.7%; p < 0.001) and ten years (79.1% vs 58.5%; p < 0.001) were significantly higher in the screening group. CONCLUSIONS patients with stage I and III tumors that were diagnosed via a screening program have a higher overall and disease-free survival at five and ten years.
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Affiliation(s)
| | | | | | | | | | | | - Gabriel Zozaya
- Cirugía General y del Aparato Digestivo, Clínica Universidad de Navarra, España
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Lee L, Kelly J, Nassif GJ, deBeche-Adams TC, Albert MR, Monson JRT. Defining the learning curve for transanal total mesorectal excision for rectal adenocarcinoma. Surg Endosc 2018; 34:1534-1542. [PMID: 29998391 DOI: 10.1007/s00464-018-6360-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/06/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Early observational data suggest that this approach is safe and feasible, but it is technically challenging and the learning curve has not yet been determined. The objective of this study was to determine the number of cases required achieve proficiency in transanal total mesorectal excision (TA-TME) for rectal adenocarcinoma. METHODS All TA-TME cases performed from 03/2012-01/2017 at a single high-volume tertiary care institution for rectal adenocarcinoma were included. A cumulative summation (CUSUM) analysis was performed to determine the number of cases required to reach proficiency, defined as high-quality TME (complete or near-complete mesorectal envelope, negative distal (DRM), and circumferential resection (> 1 mm; CRM) margin). The acceptable and unacceptable rates of good quality TME were defined based on the incidence of high-quality TME in laparoscopic (unacceptable rate = 81.7%) and open (acceptable rate = 86.9%) arms of the ACOSOG Z6051 trial. RESULTS A total of 87 consecutive cases were included with mean tumor height 4.8 cm (SD 2.7) and 80% (70/87) received neoadjuvant chemoradiation. Post-operative morbidity occurred in 44% (38/87) of cases, including 21% (18/87) readmissions. Median length of stay was 4 days [IQR 3-8]. A good quality TME was performed in 95% (83/87) of cases including 98% (85/87) negative CRM, 99% (86/87) negative DRM, and 99% (86/87) complete or near-complete mesorectal envelope. CUSUM analysis reported that the good quality TME rate reaches an acceptable rate after 51 cases overall, and 45 cases if abdominoperineal resections are excluded. CONCLUSION TA-TME is a complex technique that requires a minimum of 45-51 cases to reach an acceptable incidence of high-quality TME and lower operative duration.
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Affiliation(s)
- Lawrence Lee
- Center for Colon and Rectal Surgery, Florida Hospital, 2415 N Orange Ave, suite 102, Orlando, FL, 32804, USA.
| | - Justin Kelly
- Center for Colon and Rectal Surgery, Florida Hospital, 2415 N Orange Ave, suite 102, Orlando, FL, 32804, USA
| | - George J Nassif
- Center for Colon and Rectal Surgery, Florida Hospital, 2415 N Orange Ave, suite 102, Orlando, FL, 32804, USA
| | - Teresa C deBeche-Adams
- Center for Colon and Rectal Surgery, Florida Hospital, 2415 N Orange Ave, suite 102, Orlando, FL, 32804, USA
| | - Matthew R Albert
- Center for Colon and Rectal Surgery, Florida Hospital, 2415 N Orange Ave, suite 102, Orlando, FL, 32804, USA
| | - John R T Monson
- Center for Colon and Rectal Surgery, Florida Hospital, 2415 N Orange Ave, suite 102, Orlando, FL, 32804, USA
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Achieving high quality standards in laparoscopic colon resection for cancer: A Delphi consensus-based position paper. Eur J Surg Oncol 2018; 44:469-483. [PMID: 29422252 DOI: 10.1016/j.ejso.2018.01.091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/08/2018] [Accepted: 01/16/2018] [Indexed: 12/21/2022] Open
Abstract
AIM To investigate the rate of laparoscopic colectomies for colon cancer using registries and population-based studies. To provide a position paper on mini-invasive (MIS) colon cancer surgery based on the opinion of experts leader in this field. METHODS A systematic review of the literature was conducted using PRISMA guidelines for the rate of laparoscopy in colon cancer. Moreover, Delphi methodology was used to reach consensus among 35 international experts in four study rounds. Consensus was defined as an agreement ≥75.0%. Domains of interest included nosology, essential technical/oncological requirements, outcomes and MIS training. RESULTS Forty-four studies from 42 articles were reviewed. Although it is still sub-optimal, the rate of MIS for colon cancer increased over the years and it is currently >50% in Korea, Netherlands, UK and Australia. The remaining European countries are un-investigated and presented lower rates with highest variations, ranging 7-35%. Using Delphi methodology, a laparoscopic colectomy was defined as a "colon resection performed using key-hole surgery independently from the type of anastomosis". The panel defined also the oncological requirements recognized essential for the procedure and agreed that when performed by experienced surgeons, it should be marked as best practice in guidelines, given the principles of oncologic surgery be respected (R0 procedure, vessel ligation and mesocolon integrity). CONCLUSION The rate of MIS colectomies for cancer in Europe should be further investigated. A panel of leaders in this field defined laparoscopic colectomy as a best practice procedure when performed by an experienced surgeon respecting the standards of surgical oncology.
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A pooled analysis of en bloc right hemicolectomy with pancreaticoduodenectomy for locally advanced right-sided colon cancer. Int J Colorectal Dis 2018; 33:819-822. [PMID: 29500486 DOI: 10.1007/s00384-018-2997-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the safety and efficacy of en bloc right hemicolectomy with pancreaticoduodenectomy (RHCPD) for locally advanced right-sided colon cancer (LARCC). METHOD A pooled data analysis was performed on individual patients identified from the literature and the authors' institutions. The short- and long-term outcomes were assessed. RESULTS Recruited in this study were 81 LARCC patients undergoing RHCPD, including 75 patients reported in the literature and 6 patients from our own institutions. R0 resection was achieved in 97.5% cases. Morbidity and the 30-day mortality rate were 53.8 and 3.7%, respectively. The median survival duration was 70.4 months, and the 1-, 3- and 5-year overall survival rates were 77.8, 64.6, and 55.2%, respectively. Multivariable analysis identified only lymph node metastasis (hazard ratio 3.474, 95% confidence interval 1.323-9.120; P = 0.011) as independent predictors of poor survival. CONCLUSION En bloc RHCPD for LARCC can be performed safely with a high proportion of R0 resection and a good postoperative survival outcome.
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50
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Şimşek T, Büyükgebiz O, Şahin D, Güneş A, Gürbüz Y. Using a Video-Laparoscope for Intraoperative Colonoscopy: An Experimental Study on Intraluminal Temperature Values and Tissue Damage. Surg Laparosc Endosc Percutan Tech 2018; 28:e78-e82. [PMID: 29746424 DOI: 10.1097/sle.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Laparoscopy systems possess remarkable heat production. Video-laparoscopy was used for colonoscopy intraoperatively in rabbits. Rod lens type laparoscopes 5 and 10 mm in diameter connected with 175 and 300-W xenon light sources were used in combination. Physiological parameters including blood pressure, pulse, oxygen saturations, and luminal temperatures were investigated during 20 minutes of colonoscopy. Thermal damage scores were obtained by histopathologic analysis of the intestinal wall. The changes were categorized as physiological and structural. Damage scores were not different when 175-W light source was used with 5- and 10-mm laparoscopes. Intraluminal heat values most increased with 300 W plus 10-mm laparoscope and caused significant increase in damage scores. Structural damage indicating tissue necrosis was not observed with any of the combination in all groups. Video-laparoscopy systems did not cause significant tissue damage when used at low and moderate levels of xenon light source in the rabbit bowel intraoperatively.
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Affiliation(s)
| | | | | | | | - Yeşim Gürbüz
- Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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