Prevalence of synchronous colorectal neoplasms in surgically treated gastric cancer patients and significance of screening colonoscopy

Colonoscopy plays an important role in detecting colorectal neoplasms in patients with gastric neoplasms

BACKGROUND

Gastric cancer (GC) and colorectal cancer (CRC) are the fifth and third most common cancer worldwide, respectively. Nowadays, GC is reported to have a potential predictive value for CRC, especially for advanced CRC.

AIM

To evaluate the necessity of colonoscopy for gastric neoplasm (GN) patients.

METHODS

Four databases, including PubMed, EMBASE, the Cochrane Library, and Ovid, were used to perform the search strategy on May 2, 2023. The prevalence of colorectal neoplasms (CRN) and baseline characteristics were compared between the neoplasm group and the control group. Continuous variables are expressed as the mean difference and standard deviation. Relationships of categorical variables in the two groups are expressed as odds ratios (OR) and 95% confidence intervals (95%CIs). Subgroup analysis according to different kinds of GNs was conducted for more in-depth analysis. The results of this study are represented by forest plots. Publication bias was evaluated by a funnel plot. All data analyses were performed by STATA SE 16.0 software.

RESULTS

A total of 3018 patients with GNs and 3905 healthy controls (age and sex matched) were enrolled for analysis. After comparing the prevalence of CRNs between the two groups, CRNs were detected significantly more frequently in GN patients than in controls (OR = 1.69, 95%CI = 1.28 to 2.23, I2 = 85.12%, P = 0.00), especially in patients with GC (OR =1.80, 95%CI = 1.49 to 2.18, I2 = 25.55%, P < 0.1). Moreover, other risk factors including age (OR = 1.08, 95%CI = 1.00 to 1.17, I2 = 90.13%, P = 0.00) and male sex (OR = 2.31, 95%CI = 1.26 to 4.22, I2 = 87.35%, P = 0.00), were related to the prevalence of CRNs. For patients in the GN group, body mass index (BMI, OR = 0.88, 95%CI = 0.80 to 0.98, I2 = 0.00%, P = 0.92) and smoking (OR = 1.03, 95%CI = 1.01 to 1.05, I2 = 0.00%, P = 0.57) were protective and risk factors for CRNs, respectively.

CONCLUSION

Patients are recommended to undergo colonoscopy when diagnosed with GNs, especially GC patients with a low BMI and a history of smoking.

Laparoscopic Subtotal Gastrectomy and Sigmoidectomy Combined With Natural Orifice Specimen Extraction Surgery (NOSES) for Synchronous Gastric Cancer and Sigmoid Colon Cancer: A Case Report

Background

Gastric cancer and colon cancer are rarely seen in clinic, but there are still related reports. For gastric cancer and simultaneous colon cancer, surgical resection is the main treatment. Traditional surgery requires an incision from xiphoid process to pubic symphysis. With the progress of minimally invasive technology, laparoscopic surgery is also used in the treatment of gastric cancer, but also in the abdominal incision to remove specimens and in vitro anastomosis of digestive tract. Taking specimens through the natural cavity as a new surgical method can not only reduce the abdominal incision, but also reduce the occurrence of wound-related complications. Here, we report a patient with gastric cancer and colon cancer who was treated in our hospital.

Case Summary

We report a series of patients with gastric cancer and colon cancer. upper abdominal pain was treated in our hospital for 6 months. electronic gastroscopy showed large irregular ulcers on the lesser curvature of the gastric antrum and biopsy showed poorly differentiated adenocarcinoma of the gastric antrum. The enhanced CT of abdomen and pelvis showed irregular thickening of gastric antrum wall, irregular thickening of sigmoid colon wall and no obvious enlarged lymph nodes around. Further electronic enteroscopy showed that the sigmoid colon showed cauliflower protuberance, the intestinal cavity was slightly narrow, the intestinal wall was stiff, and the biopsy pathology showed moderately differentiated adenocarcinoma of the sigmoid colon. No obvious abnormality was found in serological tumor indexes. We diagnosed gastric cancer with sigmoid colon cancer and the patient received Laparoscopic subtotal gastrectomy and sigmoidectomy combined with natural orifice specimen extraction surgery. At present, 12 months after operation, no clear tumor recurrence was found in the metastasis.

Conclusion

We should improve the understanding of gastric cancer and sigmoid cancer and combine examination with pathology to avoid misdiagnosis as metastatic cancer. Laparoscopic subtotal gastrectomy should be performed for tumors with no serosa invasion, body mass index <30 and tumor diameter <6.5 cm. Sigmoidectomy combined with natural nostril sampling is feasible.

Difference in the prevalence of advanced colon adenoma between patients with gastric neoplasm and healthy people: A STROBE-compliant study

We compared the prevalence of adenoma and cancerous colon polyps in patients undergoing endoscopic removal or gastric surgery for gastric adenoma or gastric cancer and in healthy individuals.The medical records of 707 patients with gastric neoplasm and 798 age- and sex-matched healthy subjects were retrospectively analyzed between January 2010 and July 2018. The clinicopathological characteristics, prevalence of colorectal neoplasm diagnosed by colonoscopy, and risk factors for colorectal polyps were also investigated.When comparing the two groups, the prevalence of overall colorectal polyps and its distribution was not different between the two groups (54.0% vs.49.5%, P = .079), whereas, the number of colon polyps (1.20 ± 1.71 vs 0.99 ± 1.54, P = .015) and the maximal size (3.53 ± 6.14 vs 2.08 ± 2.88, P < .001) were significantly larger in the gastric neoplasm group. The prevalence of advanced colon adenoma was significantly higher in the gastric neoplasm group (10.7% vs 3.8%, P < .001). Risk factors such as elevated glucose levels and the presence of gastric neoplasm were related to the prevalence of all colon polyps. The presence of gastric neoplasm is an important risk factor for advanced colon polyps.Patients with gastric neoplasms had a significantly higher prevalence of advanced colon adenoma. Advanced colon adenoma is associated with the chain from benign adenomas through malignant altered adenomas to advanced colon cancer. Thus, patients with gastric neoplasm are regarded as a high-risk group for colorectal cancer and are recommended for screening colonoscopy at the time of diagnosis.

Cryptosporidium and colorectal cancer: a review of epidemiology and possible association

Cryptosporidiosis is an important protozoan disease with serious public health implications. The contribution of Cryptosporidium to colorectal cancer is still vaguely studied, but little evidence from experimental and epidemiological studies has suggested a possible association. This review discusses the epidemiology of cryptosporidiosis and colorectal cancer and attempts to unravel the possible link between the two diseases using epidemiological, pathological, molecular, and immunological evidence. The review stressed the need to undertake more studies in this relatively neglected field.

Positive H. pylori status predicts better prognosis of non-cardiac gastric cancer patients: results from cohort study and meta-analysis

BACKGROUND

Previous researches have associated Helicobacter pylori (H. pylori) with a prognosis of gastric cancer (GC), however, without a concert conclusion. This study aimed to study this issue further by a prospective cohort study and a meta-analysis.

METHODS

Histologically diagnosed gastric cancer (GC) patients were recruited into the primary prospective cohort study between January 2009 to December 2013. All the patients were followed-up periodically to record information on post-surgery therapy and overall survival status. The pre-surgery status of H. pylori was measured by enzyme-linked immunosorbent assay. A meta-analysis was conducted after retrieving related researches in the databases of PubMed and Embase up to April 2020. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were summarized to validate the relationship between H. pylori infection and the survival time of GC patients. I² statistics and Q test were used to assess the heterogeneity. Sensitivity analyses were performed using Galbraith's plot, leave-one-out analysis, subgroup analyses and meta-regression to explore the sources of heterogeneity and the stability of the summary results.

RESULTS

A total of 743 GC patients with radical tumorectomy were included prospectively and 516 (69.4%) were positive on H. pylori. H. pylori-positive patients tended to survive longer than -negative ones (HR 0.92, 95%CI: 0.74-1.15), though the tendency was not statistically significant. Cohort studies on the prognosis of GC were retrieved comprehensively by assessing the full-text and 59 published studies, together with the result of our study, were included in the further meta-analysis. The summarized results related the positive status of H. pylori to better overall survival (HR 0.81, 95%CI: 0.72-0.90) and disease-free survival (HR 0.83, 95%CI: 0.67-0.99). Results from subgroup analyses indicated that the pooled magnitude of this association was relatively lower in studies not referring to H. pylori in title and abstract.

CONCLUSIONS

In conclusion, gastric cancer patients with H. pylori have a better prognosis than patients of H. pylori negative. More stringent surveillance strategies may be necessary for patients with H. pylori negative at cancer diagnosis.

Genetic analyses supporting colorectal, gastric, and prostate cancer syndromes

Colorectal cancer (CRC), prostate cancer (PrC), and gastric cancer (GC) are common worldwide, and the incidence is to a certain extent dependent on genetics. We have recently shown that in families with more than one case of CRC, the risk of other malignancies is increased. We therefore suggested the presence of not yet described CRC syndromes. In this study, we have searched for genetic susceptibility loci for potential cancer syndromes involving CRC combined with PrC and/or GC. We have performed SNP (single-nucleotide polymorphism)-based linkage analyses in 45 families with CRC, PrC, and GC. In the regions with suggested linkage, we performed exome and association haplotype analyses. Five loci generated a high logarithm of odds (HLOD) score >2, suggestive of linkage, in chromosome bands 1q31-32, 1q24-25, 6q25-26, 18p11-q11, and Xp11. Exome analysis detected no potential pathogenic sequence variants. The haplotype association study showed that one of the top five haplotypes with the lowest P value in the chromosome band 6q25 interestingly was found in the family which contributed the most to the increased HLOD at that locus. This study supports a suggested hereditary cancer syndrome involving CRC and PrC and indicates a location at 6q25. The impact of this locus needs to be confirmed in additional studies.

Clinical importance of colonoscopy in patients with gastric neoplasm undergoing endoscopic submucosal dissection

AIM

To evaluate the usefulness of total colonoscopy (TCS) for patients undergoing gastric endoscopic submucosal dissection (ESD) and to assess risk factors for colorectal neoplasms.

METHODS

Of the 263 patients who underwent ESD at our department between May 2010 and December 2013, 172 patients undergoing TCS during a one-year period before and after ESD were targeted. After excluding patients with a history of surgery or endoscopic therapy for colorectal neoplasms, 158 patients were analyzed. Of the 868 asymptomatic patients who underwent TCS during the same period because of positive fecal immunochemical test (FIT) results, 158 patients with no history of either surgery or endoscopic therapy for colorectal neoplasms who were matched for age and sex served as the control group for comparison.

RESULTS

TCS revealed adenoma less than 10 mm in 53 patients (33.6%), advanced adenoma in 17 (10.8%), early colorectal cancer in 5 (3.2%), and advanced colorectal cancer in 4 (2.5%). When the presence or absence of adenoma less than 10 mm, advanced adenoma, and colorectal cancer and the number of adenomas were compared between patients undergoing ESD and FIT-positive patients, there were no statistically significant differences in any of the parameters assessed. The patients undergoing ESD appeared to have the same risk of colorectal neoplasms as the FIT-positive patients. Colorectal neoplasms were clearly more common in men than in women (P = 0.031). Advanced adenoma and cancer were significantly more frequent in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus (P = 0.019).

CONCLUSION

In patients undergoing gastric ESD, TCS appears to be important for detecting synchronous double neoplasms. Advanced adenoma and cancer were more common in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus. Caution is therefore especially warranted in patients with these risk factors.

Clinical impact of colonoscopy for patients with early gastric cancer treated by endoscopic submucosal dissection: A matched case-control study

BACKGROUND

Gastric cancer frequently occurs synchronously with colorectal cancer (CRC).

AIMS

The aim of the present study was to assess the value of colonoscopy in patients with primariy early gastric cancer (EGC) indicated for endoscopic submucosal dissection (ESD) and to identify predictors for the risk of high-risk adenomas.

METHODS

A total of 130 patients with EGC, who underwent both colonoscopy and gastric ESD, and 260 controls matched for age and sex, who underwent a colonoscopy as part of our institutional health check-up program. The prevalence of high-risk adenomas in EGC patients vs. controls was evaluated.

RESULTS

High-risk adenomas were found in 43 (33%) EGC patients and 37 (14%) controls (P<0.01). Multivariate analysis showed the presence of EGC was significantly associated with high-risk adenoma [odds ratio (OR) 2.8, 95% confidence interval (CI): 1.7-4.9]. Among EGC patients, high serum CEA level (OR 2.4, 95% CI: 1.2-5.0) was an independent predictor for high-risk adenoma.

CONCLUSIONS

Patients with EGC had a significant risk for colorectal cancer. When endoscopists detected an early gastric cancer indicated for ESD, colonoscopy should be considered for EGC patients with high serum CEA levels.

Diagnostic accuracy of 18F-FDG PET/CT for detecting synchronous advanced colorectal neoplasia in patients with gastric cancer

Preoperative screening for synchronous colorectal neoplasia (CRN) has been recommended in patients with gastric cancer because patients with gastric cancer are at increased risk for synchronous CRN. The aim of this study was to investigate the diagnostic accuracy of F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting synchronous advanced CRN in patients with gastric cancer.A total of 256 patients who underwent colonoscopy and F-FDG PET/CT for preoperative staging were enrolled in this study. The diagnosis of focal colonic F-FDG uptake on F-FDG PET/CT image was made based on histopathologic results from the colonoscopic biopsy. The F-FDG PET/CT result was considered as true positive for advanced CRN when focal F-FDG uptake matched colorectal carcinoma or adenoma with high-grade dysplasia in the same location on colonoscopy.Synchronous advanced CRN was detected in 21 of the 256 patients (4.7%). Sensitivity, specificity, and accuracy of F-FDG PET/CT were 76.2%, 96.2%, and 94.5%. The size of CRN with a true positive result was significantly larger than that with a false negative result.F-FDG PET/CT demonstrated high diagnostic accuracy for detecting synchronous advanced CRN in patients with gastric cancer. Colonoscopy is recommended as the next diagnostic step for further evaluation of a positive F-FDG PET/CT result in patients with gastric cancer.

Clinicopathologic features of gastric cancer with synchronous and metachronous colorectal cancer in Korea: are microsatellite instability and p53 overexpression useful markers for predicting colorectal cancer in gastric cancer patients?

BACKGROUND

A large-scale study was performed to identify the risk factors for developing synchronous and metachronous colorectal cancer (CRC) in gastric cancer (GC) patients, including microsatellite instability (MSI) and p53 overexpression.

METHODS

A total of 1041 GC patients who underwent endoscopic resection or surgery and underwent colonoscopy simultaneously or during surveillance for GC were consecutively enrolled. Clinicopathologic characteristics, MSI, and p53 overexpression were compared between the GC patients with and those without synchronous and metachronous CRC.

RESULTS

Of the 1041 patients, CRCs were detected in 67 (6.4 %) patients with GC. Forty-six (4.4 %) had synchronous CRC and 21 (2.0 %) had metachronous CRC. Univariate analysis indicated that age ≥63 years (P < 0.001), male sex (P = 0.005), and p53 overexpression (P = 0.040) were significantly associated with a higher incidence of CRC. However, body mass index, smoking, tumor location, tumor multiplicity, tumor histology, TNM stage, and MSI were not significantly associated with the incidence of CRC. Age ≥63 years (OR: 5.881; 95 % CI: 3.083-11.221; P < 0.001) and male sex (OR: 2.933; 95 % CI: 1.307-6.584; P = 0.009) were risk factors for CRC in GC patients according to multivariate analysis.

CONCLUSIONS

GC patients who are male and/or ≥63 years old are recommended to receive colonoscopy to detect CRC. MSI and p53 overexpression were not useful molecular markers for predicting CRC in GC.

Simultaneous total laparoscopic curative resection for synchronous gastric, cecal and rectal cancer: Report of a case

INTRODUCTION

Gastric cancer (GC) and colorectal cancer (CRC) are often diagnosed simultaneously. Recent technological advances in surgical techniques and devices have enabled the use of laparoscopic approaches for GC and CRC. Laparoscopic resection is expected to increase the number of cases of synchronous gastrointestinal (GI) cancers that meet the indication for laparoscopic surgery, owing to early detection of GI cancers and extended indications for laparoscopic surgery.

PRESENTATION OF CASE

We herein report a successful simultaneous total laparoscopic curative resection for synchronous early GC, early cecal cancer and advanced rectal cancer. The total time of the operation was 600min, and the estimated blood loss was 250ml. The patient was discharged on postoperative day (POD) 10 without postoperative complications.

CONCLUSION

Simultaneous total laparoscopic surgery is a minimally invasive, feasible treatment option for synchronous GI cancers.

Relationships of obesity and diabetes mellitus to other primary cancers in surgically treated gastric cancer patients

BACKGROUND

Other primary cancers (OPC) have been reported in gastric cancer (GC) patients. Recent studies have shown relationships of obesity and diabetes mellitus to cancer development in several organs. The purpose of this study was to investigate the relationships of obesity and diabetes mellitus (DM) to the prevalence of OPC in GC patients.

METHODS

We reviewed 435 GC patients who were treated surgically and followed their outcomes after surgery. Patients with body mass index (BMI) ≥ 25 kg/m(2) were defined as obese. Fasting plasma glucose (FPG) and HbA1c levels were examined before surgery.

RESULTS

OPC was observed in 109 GC patients (25.1%): 40 (9.2%) with synchronous OPC and 76 (18.2%) with metachronous OPC. The most common OPC was colorectal cancer (22.8%). OPC was frequently observed in patients with DM (p = 0.0022), and DM was an independent risk factor for the occurrence of OPC (odds ratio, 2.215; 95% confidence interval, 1.2007-4.0850; p = 0.011). Synchronous OPC was frequently observed in patients with obesity (p = 0.025), and obesity was an independent risk factor for the occurrence of synchronous OPC (odds ratio, 2.354; 95% confidence interval, 1.1246-4.9279; p = 0.023). Metachronous OPC was frequently observed in patients with DM (p = 0.0071), and DM was an independent risk factor for the occurrence of OPC (odds ratio, 2.680; 95% confidence interval, 1.0291-6.9780; p = 0.044).

CONCLUSION

There is a need to be aware of the possibility of OPC in GC patients with DM/obesity. They should undergo intensive screening for OPC before and after gastrectomy.