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Baraibar I, García A, Salvà F, Ros J, Saoudi N, Comas R, Castillo G, Sanchis M, García-Álvarez A, Hernando J, Capdevila J, Castells MR, Martí M, Landolfi S, Espín E, Navalpotro B, Guevara J, Dopazo C, Nuciforo P, Vivancos A, Tabernero J, Élez E. Impact of the COVID-19 pandemic in the early-onset colorectal cancer. Transl Oncol 2023; 32:101668. [PMID: 37031602 PMCID: PMC10073589 DOI: 10.1016/j.tranon.2023.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
The COVID19 pandemic has affected the spectrum of cancer care worldwide. Early onset colorectal cancer (EOCRC) is defined as diagnosis below the age of 50. Patients with EOCRC faced multiple challenges during the COVID19 pandemic and in some institutions it jeopardized cancer diagnosis and care delivery. Our study aims to identify the clinicopathological features and outcomes of patients with EOCRC in our Centre during the first wave of the pandemic in comparison with the same period in 2019 and 2021. Patients with EOCRC visited for the first time at Vall d'Hebron University Hospital in Spain from the 1st March to 31st August of 2019, 2020 and 2021 were included in the analysis. 177 patients with EOCRC were visited for the first time between 2019 and 2021, of which 90 patients met the inclusion criteria (2019: 30 patients, 2020: 29 patients, 2021: 31 patients). Neither differences in frequency nor in stage at diagnosis or at first visit during the given periods were observed. Of note, indication of systemic therapy in the adjuvant or metastatic setting was not altered. Days to treatment initiation and enrollment in clinical trials in this subpopulation was not affected due to the COVID-19 outbreak.
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Affiliation(s)
- Iosune Baraibar
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain.
| | - Ariadna García
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Francesc Salvà
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Javier Ros
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Nadia Saoudi
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Raquel Comas
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Gloria Castillo
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Mireia Sanchis
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Alejandro García-Álvarez
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Jorge Hernando
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Jaume Capdevila
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Marta R Castells
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Marc Martí
- Department of General Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Stefania Landolfi
- Department of Pathological Anatomy, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Eloy Espín
- Department of General Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Begoña Navalpotro
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Jorge Guevara
- Department of Gastroenterology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Cristina Dopazo
- Department of General Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Paolo Nuciforo
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Ana Vivancos
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Elena Élez
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
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Hidalgo-Pujol M, Biondo S, Die Trill J, Vigorita V, Paniagua Garcia-Señorans M, Pascual Migueláñez I, Prieto-La Noire F, Timoteo A, Cornejo L, Martín Parra JI, Fidalgo García M, Solís-Peña A, Cirera de Tudela A, Rodriguez González A, Sánchez-Guillen L, Bustamante Recuenco C, Pérez-Alonso C, Hurtado Caballero E, Pascual M, García Septiem J, Mora López L, Cervera-Aldama J, Guadalajara H, Espín E, Kreisler E. Upfront surgery versus self-expanding metallic stent as bridge to surgery in left-sided colonic cancer obstruction: A multicenter observational study. Surgery 2022; 172:74-82. [PMID: 35168815 DOI: 10.1016/j.surg.2021.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oncological outcomes of self-expanding metallic stent used as a bridge to surgery in potential curative patients with left-sided colonic cancer obstruction remain unclear. The aim of this study was to investigate perioperative and mid-term oncological outcomes of 2 of the currently most commonly performed treatments in left-sided colonic cancer obstruction. METHODS This is a retrospective multicenter study including patients with left-sided colonic cancer obstruction treated with curative intent between 2013 and 2017. The presence of metastasis at diagnosis was an exclusion criterion. The primary outcome was to evaluate the noninferiority, in terms of overall survival, of bridge to surgery strategy compared with emergency colonic resection. The secondary outcomes were perioperative morbimortality, disease free survival, local recurrence, and distant recurrence. RESULTS A total of 564 patients were included, 320 in the emergency colonic resection group and 244 in the bridge to surgery group. Twenty-seven patients of the bridge-to-surgery group needed urgent operation. Postoperative morbidity rates were statistically higher in the emergency colonic resection group (odds ratio [95% confidence interval] 0.37 [0.24-0.55], P < .001). There was no difference in 90-day mortality between groups (odds ratio [95% confidence interval] 0.85 [0.36-1.99], P = .702). The median follow-up was 3.80 years (2.29-4.92). The results show the noninferiority of bridge to surgery versus emergency colonic resection in terms of overall survival (hazard ratio [95% confidence interval) 0.78 [0.56-1.07], P = .127). There were no differences in disease free survival, distant recurrence, and local recurrence rates between bridge to surgery and emergency colonic resection groups. CONCLUSION Self-expanding metallic stent as bridge to surgery might not lead to a negative impact on the long-term prognosis of the tumor compared with emergency colonic resection in expert hands and selected patients.
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Affiliation(s)
- Marta Hidalgo-Pujol
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain.
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Javier Die Trill
- Department of General and Digestive Surgery, Coloproctology Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - Vincenzo Vigorita
- Division of Coloproctology, Department of General and Digestive Surgery, University Hospital Complex of Vigo, Vigo, Spain; General Surgery Research Group, SERGAS-UVIGO, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Marta Paniagua Garcia-Señorans
- Division of Coloproctology, Department of General and Digestive Surgery, University Hospital Complex of Vigo, Vigo, Spain; General Surgery Research Group, SERGAS-UVIGO, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | | | | | - Ander Timoteo
- Department of General and Digestive Surgery, Doctor Josep Trueta University Hospital, Girona, Spain
| | - Lidia Cornejo
- General and digestive surgery research group. Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - José Ignacio Martín Parra
- Division of Coloproctology, Department of General and Digestive Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - María Fidalgo García
- Department of General and Digestive Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Alejandro Solís-Peña
- Department of General and Digestive Surgery, Coloproctology Unit, Vall d'Hebron University Hospital, Autonomic University of Barcelona, Barcelona, Spain
| | - Arturo Cirera de Tudela
- Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Araceli Rodriguez González
- Department of General and Digestive Surgery, Emergency Surgery Unit, Donostia University Hospital, San Sebastián, Spain
| | - Luís Sánchez-Guillen
- Department of General and Digestive Surgery, Coloproctology Unit, Elche University Hospital, Alicante, Spain
| | - Carlos Bustamante Recuenco
- Department of General and Digestive Surgery, Nuestra Señora del Prado Hospital, Talavera de la Reina, Toledo, Spain
| | - Carla Pérez-Alonso
- Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
| | - Elena Hurtado Caballero
- Department of General and Digestive Surgery, Coloproctology Unit, Gregorio Marañón University Hospital, Madrid, Spain
| | - Marta Pascual
- Department of General and Digestive Surgery, Coloproctology Unit, Hospital del Mar, Barcelona, Spain
| | - Javier García Septiem
- Department of General and Digestive Surgery, La Princesa University Hospital, Madrid, Spain
| | - Laura Mora López
- Department of General and Digestive Surgery, Parc Taulí University Hospital, Sabadell, Spain
| | - Jorge Cervera-Aldama
- Coloproctology Unit. General and Digestive Surgery Department. Cruces University Hospital. Barakaldo, Bizkaia, Spain
| | - Héctor Guadalajara
- Department of General and Digestive Surgery, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Eloy Espín
- Department of General and Digestive Surgery, Coloproctology Unit, Vall d'Hebron University Hospital, Autonomic University of Barcelona, Barcelona, Spain
| | - Esther Kreisler
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
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Monfort-Ferré D, Caro A, Menacho M, Martí M, Espina B, Boronat-Toscano A, Nuñez-Roa C, Seco J, Bautista M, Espín E, Megía A, Vendrell J, Fernández-Veledo S, Serena C. The Gut Microbiota Metabolite Succinate Promotes Adipose Tissue Browning in Crohn's Disease. J Crohns Colitis 2022; 16:1571-1583. [PMID: 35554517 PMCID: PMC9624294 DOI: 10.1093/ecco-jcc/jjac069] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/17/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease [CD] is associated with complex microbe-host interactions, involving changes in microbial communities, and gut barrier defects, leading to the translocation of microorganisms to surrounding adipose tissue [AT]. We evaluated the presence of beige AT depots in CD and questioned whether succinate and/or bacterial translocation promotes white-to-beige transition in adipocytes. METHODS Visceral [VAT] and subcutaneous [SAT] AT biopsies, serum and plasma were obtained from patients with active [n = 21] or inactive [n = 12] CD, and from healthy controls [n = 15]. Adipose-derived stem cells [ASCs] and AT macrophages [ATMs] were isolated from VAT biopsies. RESULTS Plasma succinate levels were significantly higher in patients with active CD than in controls and were intermediate in those with inactive disease. Plasma succinate correlated with the inflammatory marker high-sensitivity C-reactive protein. Expression of the succinate receptor SUCNR1 was higher in VAT, ASCs and ATMs from the active CD group than from the inactive or control groups. Succinate treatment of ASCs elevated the expression of several beige AT markers from controls and from patients with inactive disease, including uncoupling protein-1 [UCP1]. Notably, beige AT markers were prominent in ASCs from patients with active CD. Secretome profiling revealed that ASCs from patients with active disease secrete beige AT-related proteins, and co-culture assays showed that bacteria also trigger the white-to-beige switch of ASCs from patients with CD. Finally, AT depots from patients with CD exhibited a conversion from white to beige AT together with high UCP1 expression, which was corroborated by in situ thermal imaging analysis. CONCLUSIONS Succinate and bacteria trigger white-to-beige AT transition in CD. Understanding the role of beige AT in CD might aid in the development of therapeutic or diagnostic interventions.
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Affiliation(s)
- Diandra Monfort-Ferré
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Aleidis Caro
- Colorectal Surgery Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Marc Martí
- Colorectal Surgery Unit, General Surgery Service, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Beatriz Espina
- Colorectal Surgery Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Albert Boronat-Toscano
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Cati Nuñez-Roa
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Seco
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Michelle Bautista
- Digestive Unit, Hospital Universitari Joan XXIII, 43007, Tarragona, Spain
| | - Eloy Espín
- Colorectal Surgery Unit, General Surgery Service, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ana Megía
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Vendrell
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain,Universitat Rovira i Virgili, Tarragona, Spain
| | - Sonia Fernández-Veledo
- Corresponding authors: Sonia Fernández-Veledo, PhD, Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain. ;
| | - Carolina Serena
- Carolina Serena, PhD, Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain. ;
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Barreiro-de Acosta M, Marín-Jimenez I, Rodríguez-Lago I, Guarner F, Espín E, Ferrer Bradley I, Gutiérrez A, Beltrán B, Chaparro M, Gisbert JP, Nos P. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on pouchitis in ulcerative colitis. Part 2: Treatment. Gastroenterol Hepatol 2020; 43:649-658. [PMID: 32600917 DOI: 10.1016/j.gastrohep.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
Pouchitis treatment is a complex entity that requires a close medical and surgical relationship. The elective treatment for acute pouchitis is antibiotics. After a first episode of pouchitis it is recommended prophylaxis therapy with a probiotic mix, nevertheless it is not clear the use of this formulation for preventing a first episode of pouchitis after surgery. First-line treatment for chronic pouchitis is an antibiotic combination. The next step in treatment should be oral budesonide. Selected cases of severe, chronic refractory pouchitis may benefit from biologic agents, and anti-TNF α should be recommended as the first option, leaving the new biologicals for multi-refractory patients. Permanent ileostomy may be an option in severe refractory cases to medical treatment.
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Affiliation(s)
- Manuel Barreiro-de Acosta
- Unidad EII, Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, España.
| | - Ignacio Marín-Jimenez
- Servicio de Aparato Digestivo, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Iago Rodríguez-Lago
- Unidad de EII, Servicio de Aparato Digestivo, Hospital de Galdakao, Galdakao, España; Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, España
| | - Francisco Guarner
- Grupo de Fisiología y Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - Eloy Espín
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Ana Gutiérrez
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, España
| | - Belén Beltrán
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, España; Unidad de EII, Servicio de Medicina Digestiva, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, España; Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Madrid, España
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, España; Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Madrid, España
| | - Pilar Nos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, España; Unidad de EII, Servicio de Medicina Digestiva, Hospital Universitario y Politécnico La Fe, Valencia, España
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Barreiro-de Acosta M, Gutierrez A, Rodríguez-Lago I, Espín E, Ferrer Bradley I, Marín-Jimenez I, Beltrán B, Chaparro M, Gisbert JP, Nos P. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on pouchitis in ulcerative colitis. Part 1: Epidemiology, diagnosis and prognosis. Gastroenterol Hepatol 2019; 42:568-578. [PMID: 31606162 DOI: 10.1016/j.gastrohep.2019.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/17/2019] [Accepted: 08/18/2019] [Indexed: 12/13/2022]
Abstract
Pouchitis is a common complication in ulcerative colitis patients after total proctocolectomy. This is an unspecific inflammation of the ileo-anal pouch, the aetiology of which is not fully known. This inflammation induces the onset of symptoms such as urgency, diarrhoea, rectal bleeding and abdominal pain. Many patients suffering from pouchitis have a lower quality of life. In addition to symptoms, an endoscopy with biopsies is mandatory in order to establish a definite diagnosis. The recommended index to assess its activity is the Pouchitis Disease Activity Index (PDAI), but its modified version (PDAIm) can be used in clinical practice. In accordance with the duration of symptoms, pouchitis can be classified as acute (<4 weeks) or chronic (>4 weeks), and, regarding its course, pouchitis can be infrequent (<4 episodes per year), recurrent (>4 episodes per year) or continuous.
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Affiliation(s)
- Manuel Barreiro-de Acosta
- Unidad EII, Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - Ana Gutierrez
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, España
| | - Iago Rodríguez-Lago
- Unidad de EII, Servicio de Aparato Digestivo, Hospital de Galdakao, Galdakao, Vizcaya, España; Instituto de Investigación Sanitaria Biocruces Bizkaia, Bilbao, España
| | - Eloy Espín
- Unidad de Cirugía Colorectal, Servicio de Cirugía General, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España
| | | | - Ignacio Marín-Jimenez
- Servicio de Aparato Digestivo. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Belén Beltrán
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, España; Unidad de EII, Servicio de Medicina Digestiva, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, España; Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Madrid, España
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, España; Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Madrid, España
| | - Pilar Nos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, España; Unidad de EII, Servicio de Medicina Digestiva, Hospital Universitario y Politécnico La Fe, Valencia, España
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Casellas F, Navarro E, Amil P, Barber C, Marín L, Guardiola J, Espín E, Sainz E, Aldeguer X, Gallego M, Murciano F, García-Planella E, Martín-de-Carpi J, Mendive JM, González-Mestre A. Development and validation of the QUECOMIICAT questionnaire: a tool to assess disease-related knowledge in patients with inflammatory bowel disease. Rev Esp Enferm Dig 2019; 111:586-592. [PMID: 31317762 DOI: 10.17235/reed.2019.6298/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION adequate knowledge of inflammatory bowel disease (IBD) is essential for a successful patient-centered management of IBD. OBJECTIVE due to the scarcity of up-to-date tools for measuring IBD literacy, this single-center, prospective study aimed to develop and validate a new questionnaire to assess IBD-related knowledge. MATERIAL AND METHODS the study included patients followed up at the Crohn-Colitis Care Unit (UACC) at the Hospital Vall d'Hebron (Barcelona, Spain). Patients admitted to the UACC for the first time were subsequently enrolled into a standard IBD educational program. A pilot questionnaire was developed and validated in 92 IBD patients by determining the internal consistency reliability (Cronbach's α test), feasibility, construct validity (correlation with the Crohn's and Colitis Knowledge [CCKNOW] questionnaire and a knowledge visual analog scale [VAS]) and sensitivity (score change before and after a standard IBD educational program). The questionnaire, named "Qüestionari Coneixements Malaltia Inflamatòria Intestinal Catalunya" (IBD-knowledge questionnaire Catalonia) (QUECOMIICAT) was written in Spanish and had 25 items addressing six dimensions: general concepts, clinic, treatment, surgery, habits and social context. RESULTS the median (interquartile range) completion time was 15 (10-20) minutes and the floor and ceiling effects were 1.1% and 2.1%, respectively. The Cronbach's α coefficient was α = 0.75. QUECOMIICAT significantly correlated with the VAS (rho = 0.34, p < 0.01) and CCKNOW questionnaires (rho = 0.74, p < 0.01). Patient knowledge significantly increased 24 hours after attending a standard IBD educational program and remained statistically significant one month later (Pearson's test-retest correlation coefficient r = 0.81, p < 0.001). CONCLUSION in conclusion, the QUECOMIICAT questionnaire is a new up-to-date tool to assess IBD-related knowledge with good feasibility and validation results for use in the routine clinical practice.
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Affiliation(s)
| | - Ester Navarro
- Unitat Atenció Crohn-Colitis, Hospital Universitari Vall d'Hebrón
| | - Paloma Amil
- Programa Pacient Expert Catalunya®. Programa de pr, Direcció General de Planificació en Salut. Departament de Salut, Generalitat de Catalunya, Spain
| | - Claudia Barber
- Unitat Atenció Crohn-Colitis. , Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Marín
- Hospital Universitari Germans Trias i Pujol. Badalona, Spain
| | - Jordi Guardiola
- Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Spain
| | - Eloy Espín
- Unitat d'Atenció Crohn-Colitis, Hospital Universitari Vall d'Hebron. Barcelona, Spain
| | - Empar Sainz
- Hospital Universitari Arnau de Vilanova. Lleida, Spain
| | | | - Marta Gallego
- Hospital Clínic i Provincial de Barcelona. Barcelona, Spain
| | | | | | | | - Juan Manuel Mendive
- CAP la Mina. SAP Litoral. Gerència d'Atenció Primària de Barcelona. Barcelona, Spain
| | - Assumpció González-Mestre
- Programa Pacient Expert Catalunya®. Programa de pr, Direcció General de Planificació en Salut. Departament de Salut, Generalitat de Catalunya, Spain
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7
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Marinello F, Kraft M, Ridaura N, Vallribera F, Espín E. Tratamiento de la fístula anal mediante clip con el dispositivo OTSC ® : resultados a corto plazo. Cir Esp 2018. [DOI: 10.1016/j.ciresp.2018.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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8
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de la Portilla F, Builes S, García-Novoa A, Espín E, Kreisler E, Enríquez-Navascues JM, Biondo S, Codina A. Analysis of Quality Indicators for Colorectal Cancer Surgery in Units Accredited by the Spanish Association of Coloproctology. Cir Esp 2018; 96:226-233. [PMID: 29606350 DOI: 10.1016/j.ciresp.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/29/2018] [Accepted: 02/03/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Currently, there is growing interest in analyzing the results from surgical units and the implementation of quality standards in order to identify good healthcare practices. Due to this fact, the Spanish Association of Coloproctology (AECP) has developed a unit accreditation program that contemplates basic standards. The aim of this article is to evaluate and analyze the specific quality indicators for the surgical treatment of colorectal cancer, established by the program. Data were collected from colorectal units during the accreditation process. METHODS We analyzed prospectively collected data from elective colorectal surgeries at 18 Spanish coloproctology units during the period 2013-2017. Three main and four secondary quality indicators were considered. Colon and rectal surgeries were analyzed independently; furthermore, results were compared according to surgical approach. RESULTS A total of 3090 patients were included in the analysis. The global anastomotic leak rate was 7.8% (6.6% colon vs 10.6% rectum), while the surgical site infection rate was 12.6% (11.4% colon vs 14.8% rectum). Overall 30-day mortality was 2.3%, and anastomotic leak-related mortality was 10.2%. There were higher surgical site infection and mortality rates in the patients operated by open approach, however there was no difference in the anastomotic leak rate when compared with minimally invasive approaches. CONCLUSIONS The evaluation of these results has determined optimal quality indices for the units accredited in the treatment of colorectal cancer. Furthermore, it allows us to establish realistic references in our country, thereby providing a better understanding and comparison of outcomes.
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Affiliation(s)
- Fernando de la Portilla
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Virgen del Rocío/IBiS/CSIC/Universidad de Sevilla, Sevilla, España.
| | - Sergio Builes
- Servicio de Cirugía General y Aparato Digestivo, Hospital Juaneda Miramar, Palma de Mallorca, España
| | - Alejandra García-Novoa
- Servicio de Cirugía General y Aparato Digestivo, Hospital Do Salnés, Villagarcía, Pontevedra, España
| | - Eloy Espín
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital Vall d'Hebron, Barcelona, España
| | - Esther Kreisler
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital Bellvitge, Barcelona, España
| | - José María Enríquez-Navascues
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital Donostia, San Sebastián, España
| | - Sebastiano Biondo
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital Bellvitge, Barcelona, España
| | - Antonio Codina
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital Josep Trueta, Girona, España
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9
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Landi F, Espín E, Rodrigues V, Vallribera F, Martinez A, Charpy C, Brunetti F, Azoulay D, de'Angelis N. Pathologic response grade after long-course neoadjuvant chemoradiation does not influence morbidity in locally advanced mid-low rectal cancer resected by laparoscopy. Int J Colorectal Dis 2017; 32:255-264. [PMID: 27757541 DOI: 10.1007/s00384-016-2685-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with locally advanced rectal cancer and pathologic complete response to neoadjuvant chemoradiation therapy have lower rates of recurrence compared to those who do not. However, the influences of the pathologic response on surgical complications and survival remain unclear. This study aimed to investigate the influence of neoadjuvant therapy for rectal cancer on postoperative morbidity and long-term survival. METHODS This was a comparative study of consecutive patients who underwent laparoscopic total mesorectal excision for rectal cancer in two European tertiary hospitals between 2004 and 2014. Patients with and without pathologic complete responses were compared in terms of postoperative morbidity, mortality, and survival. RESULTS Fifty patients with complete response (ypT0N0) were compared with 141 patients who exhibited non-complete response. No group differences were observed in the postoperative mortality or morbidity rates. The median follow-up time was 57 months (range 1-121). Over this period, 11 (5.8 %) patients, all of whom were in the non-complete response group, exhibited local recurrence. The 5-year overall survival and disease-free survival were significantly better in the complete response group, 92.5 vs. 75.3 % (p = 0.004) and 89 vs. 73.4 % (p = 0.002), respectively. CONCLUSIONS Postoperative complication rate after laparoscopic total mesorectal excision is not associated with the pathologic response grade to neoadjuvant chemoradiation therapy.
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Affiliation(s)
- Filippo Landi
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France. .,Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain. .,Universidad Autonoma de Barcelona UAB, Barcelona, Spain.
| | - Eloy Espín
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Universidad Autonoma de Barcelona UAB, Barcelona, Spain
| | - Victor Rodrigues
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Universidad Autonoma de Barcelona UAB, Barcelona, Spain
| | - Francesc Vallribera
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Universidad Autonoma de Barcelona UAB, Barcelona, Spain
| | - Aleix Martinez
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Cecile Charpy
- Department of Pathology. Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, Creteil, France
| | - Francesco Brunetti
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Daniel Azoulay
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Nicola de'Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
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10
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Manchon-Walsh P, Aliste L, Espinàs J, Prades J, Guarga A, Balart J, Biondo S, Castells A, Sanjuan X, Tabernero J, Borras J, Biondo S, Cambray M, Castells A, Codina A, Espín E, Musulen E, Pozuelo A, Saigi E, Sala J, Salas A, Salazar R, Sanjuán X, Tabernero J, Targarona E. Improving survival and local control in rectal cancer in Catalonia (Spain) in the context of centralisation: A full cycle audit assessment. Eur J Surg Oncol 2016; 42:1873-1880. [DOI: 10.1016/j.ejso.2016.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/29/2016] [Accepted: 08/04/2016] [Indexed: 01/27/2023] Open
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11
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Ortiz H, Codina A, Ciga MÁ, Biondo S, Enríquez-Navascués JM, Espín E, García-Granero E, Roig JV. Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery in the Spanish Rectal Cancer Project. Cir Esp 2016; 94:442-52. [PMID: 27491271 DOI: 10.1016/j.ciresp.2016.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 05/26/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED INTRODUCCIóN: The purpose of this prospective multicentre multilevel study was to investigate the influence of hospital caseload on long-term outcomes following standardization of rectal cancer surgery in the Rectal Cancer Project of the Spanish Society of Surgeons. METHODS Data relating to 2910 consecutive patients with rectal cancer treated for cure between March 2006 and March 2010 were recorded in a prospective database. Hospitals were classified according to number of patients treated per year as low-volume, intermediate-volume, or high volume hospitals (12-23, 24-35, or ≥36 procedures per year). RESULTS After a median follow-up of 5 years, cumulative rates of local recurrence, metastatic recurrence and overall survival were 6.6 (CI95% 5.6-7.6), 20.3 (CI95% 18.8-21.9) and 73.0 (CI95% 74.7 - 71.3) respectively. In the multilevel regression analysis overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients (HR 0,727 [CI95% 0,556-0,951]; P=.02). The risk of local recurrence and metastases were not related to the caseload. Moreover, there was a statistically significant variation in overall survival (median hazard ratio [MHR] 1.184 [CI95% 1.071-1,333]), local recurrence (MHR 1.308 [CI95% 1.010-1.668]) and metastases (MHR 1.300 [CI95% 1.181; 1.476]) between all hospitals. CONCLUSIONS Overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients. However, local recurrence was not influenced by caseload.
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Affiliation(s)
- Héctor Ortiz
- Departamento Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España.
| | - Antonio Codina
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Josep Trueta, Girona, España
| | - Miguel Á Ciga
- Unidad de Coloproctología, Departamento de Cirugía, Complejo Hospitalario de Navarra, Pamplona, España
| | - Sebastiano Biondo
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario de Bellvitge, Barcelona, España
| | - José M Enríquez-Navascués
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Donostia, Donostia, España
| | - Eloy Espín
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Vall D'Hebron, Barcelona, España
| | - Eduardo García-Granero
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario La Fe, Valencia, España
| | - José V Roig
- Unidad de Coloproctología. Hospital Nisa 9 de Octubre, Valencia, España
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12
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Landi F, Vallribera F, Rivera JP, Bertoli P, Armengol M, Espín E. Morbidity after laparoscopic and open rectal cancer surgery: a comparative analysis of morbidity in octogenarians and younger patients. Colorectal Dis 2016; 18:459-67. [PMID: 26408287 DOI: 10.1111/codi.13136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/10/2015] [Indexed: 12/25/2022]
Abstract
AIM Although the oncological adequacy of laparoscopic rectal resection (LR) appears equivalent to open resection (OR), its benefit is controversial in the elderly. The aim of this study was to investigate the influence of LR on morbidity and mortality in octogenarians. METHOD This was a retrospective analysis of all patients who underwent rectal surgery for cancer between 2003 and 2013 in a teaching hospital. The primary aim of the study was to assess the influence of surgical approach on mortality and morbidity of rectal resection in patients ≥ 80 years old. Regression analysis was performed to control the effect of covariables on the clinical outcome. RESULTS Of 408 patients 203 were in the LR group and 205 in the OR group including 303 (74.3%) less than 80 years and 105 (25.7%) over 80 years. The mortality was lower in the LR group compared with the OR group for patients under 80 years (0% vs 4.6%; P = 0.049) and no different in the over 80 group (11.5% vs 9.4%; P = 0.859). In younger patients, the OR group showed longer hospital stay (9 vs 7 days; P < 0.001) and more complications (44.1% vs 29.8%; P = 0.042). Medical complications were more frequent in LR group than OR group octogenarians (40.4% vs 20.8%; P = 0.009) as well as grade C anastomotic leakage (13.8 vs 10.7; P = 0.041). CONCLUSION LR for rectal cancer showed clinical advantages in patients under 80 years and was as safe as OR in patients over 80 years, although the advantages of laparoscopic surgery were lost in the elderly group due to a higher rate of medical complications. OR may be an option in elderly patients with important comorbidities.
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Affiliation(s)
- F Landi
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - F Vallribera
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - J P Rivera
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - P Bertoli
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - M Armengol
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - E Espín
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,Universidad Autonoma de Barcelona, Barcelona, Spain
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13
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Ortiz H, Biondo S, Codina A, Ciga MÁ, Enríquez-Navascués J, Espín E, García-Granero E, Roig JV. [Hospital variation in anastomotic leakage after rectal cancer surgery in the Spanish Association of Surgeons project: The contribution of hospital volume]. Cir Esp 2016; 94:213-20. [PMID: 26875478 DOI: 10.1016/j.ciresp.2015.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 11/13/2015] [Accepted: 11/22/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This multicentre observational study aimed to determine the anastomotic leak rate in the hospitals included in the Rectal Cancer Project of the Spanish Society of Surgeons and examine whether hospital volume may contribute to any variation between hospitals. METHODS Hospital variation was quantified using a multilevel approach on prospective data derived from the multicentre database of all adenocarcinomas of the rectum operated by an anterior resection at 84 surgical departments from 2006 to 2013. The following variables were included in the analysis; demographics, American Society of Anaesthesiologists classification, use of defunctioning stoma, tumour location and stage, administration of neoadjuvant treatment, and annual volume of elective surgical procedures. RESULTS A total of 7231 consecutive patients were included. The rate of anastomotic leak was 10.0%. Stratified by annual surgical volume hospitals varied from 9.9 to 11.3%. In multilevel regression analysis, the risk of anastomotic leak increased in male patients, in patients with tumours located below 12 cm from the anal verge, and advanced tumour stages. However, a defunctioning stoma seemed to prevent this complication. Hospital surgical volume was not associated with anastomotic leak (OR: 0.852, [0.487-1.518]; P=.577). Furthermore, there was a statistically significant variation in anastomotic leak between all departments (MOR: 1.475; [1.321-1.681]; P<0.001). CONCLUSION Anastomotic leak varies significantly among hospitals included in the project and this difference cannot be attributed to the annual surgical volume.
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Affiliation(s)
- Héctor Ortiz
- Departamento Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España.
| | - Sebastiano Biondo
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario de Bellvitge, Barcelona, España
| | - Antonio Codina
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Josep Trueta, Gerona, España
| | - Miguel Á Ciga
- Unidad de Coloproctología, Departamento de Cirugía, Complejo Hospitalario de Navarra, Pamplona, España
| | - José Enríquez-Navascués
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Donostia, San Sebastián, España
| | - Eloy Espín
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Eduardo García-Granero
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario La Fe, Valencia, España
| | - José Vicente Roig
- Unidad de Coloproctología, Hospital Nisa 9 de Octubre, Valencia, España
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14
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Ortiz H, Biondo S, Codina A, Ciga MÁ, Enríquez-Navascués JM, Espín E, García-Granero E, Roig JV. Variabilidad interhospitalaria de la mortalidad postoperatoria en el proyecto del cáncer de recto de la Asociación Española de Cirujanos. La influencia del volumen quirúrgico. Cir Esp 2016; 94:22-30. [DOI: 10.1016/j.ciresp.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/31/2015] [Accepted: 09/07/2015] [Indexed: 10/22/2022]
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15
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Arqués O, Chicote I, Puig I, Tenbaum SP, Argilés G, Dienstmann R, Fernández N, Caratù G, Matito J, Silberschmidt D, Rodon J, Landolfi S, Prat A, Espín E, Charco R, Nuciforo P, Vivancos A, Shao W, Tabernero J, Palmer HG. Tankyrase Inhibition Blocks Wnt/β-Catenin Pathway and Reverts Resistance to PI3K and AKT Inhibitors in the Treatment of Colorectal Cancer. Clin Cancer Res 2015. [PMID: 26224873 DOI: 10.1158/1078-0432.ccr-14-3081] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Oncogenic mutations in the KRAS/PI3K/AKT pathway are one of the most frequent alterations in cancer. Although PI3K or AKT inhibitors show promising results in clinical trials, drug resistance frequently emerges. We previously revealed Wnt/β-catenin signaling hyperactivation as responsible for such resistance in colorectal cancer. Here we investigate Wnt-mediated resistance in patients treated with PI3K or AKT inhibitors in clinical trials and evaluate the efficacy of a new Wnt/tankyrase inhibitor, NVP-TNKS656, to overcome such resistance. EXPERIMENTAL DESIGN Colorectal cancer patient-derived sphere cultures and mouse tumor xenografts were treated with NVP-TNKS656, in combination with PI3K or AKT inhibitors.We analyzed progression-free survival of patients treated with different PI3K/AKT/mTOR inhibitors in correlation with Wnt/β-catenin pathway activation, oncogenic mutations, clinicopathological traits, and gene expression patterns in 40 colorectal cancer baseline tumors. RESULTS Combination with NVP-TNKS656 promoted apoptosis in PI3K or AKT inhibitor-resistant cells with high nuclear β-catenin content. High FOXO3A activity conferred sensitivity to NVP-TNKS656 treatment. Thirteen of 40 patients presented high nuclear β-catenin content and progressed earlier upon PI3K/AKT/mTOR inhibition. Nuclear β-catenin levels predicted drug response, whereas clinicopathologic traits, gene expression profiles, or frequent mutations (KRAS, TP53, or PIK3CA) did not. CONCLUSIONS High nuclear β-catenin content independently predicts resistance to PI3K and AKT inhibitors. Combined treatment with a Wnt/tankyrase inhibitor reduces nuclear β-catenin, reverts such resistance, and represses tumor growth. FOXO3A content and activity predicts response to Wnt/β-catenin inhibition and together with β-catenin may be predictive biomarkers of drug response providing a rationale to stratify colorectal cancer patients to be treated with PI3K/AKT/mTOR and Wnt/β-catenin inhibitors.
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Affiliation(s)
- Oriol Arqués
- Stem Cells and Cancer Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Irene Chicote
- Stem Cells and Cancer Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Isabel Puig
- Stem Cells and Cancer Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Stephan P Tenbaum
- Stem Cells and Cancer Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Guillem Argilés
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain. Gastrointestinal and Endocrine Tumors Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Rodrigo Dienstmann
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain. Gastrointestinal and Endocrine Tumors Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain. Sage Bionetworks, Fred Hutchinson Cancer Research Centre, Seattle, Washington
| | - Natalia Fernández
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain. Gastrointestinal and Endocrine Tumors Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Ginevra Caratù
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Judit Matito
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Jordi Rodon
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain. Early Clinical Drug Development Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Stefania Landolfi
- Department of Pathology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aleix Prat
- Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Eloy Espín
- General Surgery Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ramón Charco
- Department of HBP Surgery and Transplantation, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Wenlin Shao
- Stem Cells and Cancer Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain. Gastrointestinal and Endocrine Tumors Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Héctor G Palmer
- Stem Cells and Cancer Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
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Aguilar G, Albiol S, Alcaide J, Alonso M, Alonso V, Andreu M, Aparicio J, de la Vega FA, Arrivi A, Ayuso JR, Bohn U, Bouzas R, Cano JM, Castañón C, Castells A, Cerdà P, Cerezo L, Conill C, Cuatrecasas M, Pozo MND, Delgado JI, Enriquez-Navascues JM, Escudero P, Espín E, l RE, Falcó E, Farré J, Feliu J, Fernández-Martos C, Ferrer AI, Gallego R, Galvez E, de Albéniz XG, Olmo DG, García-Carbonero R, Dorronsoro MG, Martín CG, Moreno SG, Hernández A, Iraola A, Jímenez E, Jiménez MC, Jurado I, Leno R, León A, Martín E, Martín M, Maurel J, Méndez JC, Méndez R, Palma P, Pardo F, Pereira F, Pérez-Altozano J, Pérez E, Rodríguez J, Ruiz-Casado AI, Sabater L, Sarría L, Segura A, Sevilla I, Tobeña M, Torres E, Viudez A, Zanui M, Zorrilla M. Guidelines for diagnosis, staging and treatment of metastatic colorectal cancer by Grupo Español Multidisciplinar en Cancer Digestivo (GEMCAD). Colorectal Cancer 2015. [DOI: 10.2217/crc.15.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Advances in the care of patients with metastatic colorectal cancer arise from well-designed clinical trials. In the present document we address specific challenges in the design of clinical trials for metastatic colorectal cancer regarding staging and standard of care according to prognosis, as well as some relevant methodological issues.
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Affiliation(s)
| | - Santiago Albiol
- Department of Medical Oncology, Hospital del Espíritu Santo, Barcelona, Spain
| | - Julia Alcaide
- Department of Medical Oncology, Hospital Costa del Sol, Marbella, Spain
| | - Martina Alonso
- Department of Medical Oncology, Hospital San Pedro, de Logroño, Spain
| | - Vicente Alonso
- Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Jorge Aparicio
- Department of Medical Oncology, Hospital La Fe, Valencia, Spain
| | | | - Antonio Arrivi
- Department of Medical Oncology, Clinica Rotger, Palma de Mallorca, Spain
| | - Juan Ramón Ayuso
- Department of Radiology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Uriel Bohn
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Rosa Bouzas
- Department of Radiology, Hospital Universitario de Vigo, Vigo, Spain
| | - Juana Maria Cano
- Department of Medical Oncology, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Carmen Castañón
- Department of Medical Oncology, Complejo Asistencial de León, León, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Paula Cerdà
- Department of Medical Oncology, Instituto Oncológico Teknon, Barcelona, Spain
| | - Laura Cerezo
- Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid, Spain
| | - Carles Conill
- Department of Radiation Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | | | - Jose Ignacio Delgado
- Department of Medical Oncology, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | | | - Pilar Escudero
- Department of Medical Oncology, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Eloy Espín
- Department of Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael Estevan l
- Department of Surgery, Instituto Valenciano de Oncología, Valencia, Spain
| | - Esther Falcó
- Department of Medical Oncology, Hospital Son Llatzer, Palma de Mallorca, Spain
| | - José Farré
- Department of Surgery, Hospital Quirón, Torrevieja, Spain
| | - Jaime Feliu
- Department of Medical Oncology, Hospital La Paz, Madrid, Spain
| | | | - Ana Isabel Ferrer
- Department of Medical Oncology, Hospital Obispo Polanco, Teruel, Spain
| | - Rosa Gallego
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Elisa Galvez
- Department of Medical Oncology, Hospital General Universitario de Elda, Alicante, Spain
| | | | | | | | | | - Carlos Gómez Martín
- Department of Medical Oncology, Hospital Universitario 12 de octubre, Madrid, Spain
| | | | - Ana Hernández
- Department of Radiation Oncology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Amparo Iraola
- Department of Medical Oncology, Hospital Verge dels Lliris, Alcoi, Spain
| | - Esther Jímenez
- Department of Radiation Oncology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Ismael Jurado
- Department of Pathology, Hospital Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Rubén Leno
- Department of Medical Oncology, Hospital Virgen del Puerto, Plasencia, Spain
| | - Ana León
- Department of Medical Oncology, Fundación Jiménez Díaz, Madrid, Spain
| | - Elena Martín
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Marta Martín
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Madrid, Spain
| | - Joan Maurel
- Department of Medical Oncology, Hospital Clinic Barcelona, C. Villarroel 170, 08030 Barcelona, Spain
| | | | - Ramiro Méndez
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Palma
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Fernando Pardo
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Elisabet Pérez
- Department of Medical Oncology, Hospital Costa del Sol, Marbella, Spain
| | - Javier Rodríguez
- Department of Medical Oncology, Hospital Costa del Sol, Marbella & Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Luis Sabater
- Department of Surgery, Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis Sarría
- Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Angel Segura
- Department of Medical Oncology, Hospital La Fe, Valencia, Spain
| | - Isabel Sevilla
- Department of Medical Oncology, Hospital Clínico de Málaga, Málaga, Spain
| | - Maria Tobeña
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Madrid, Spain
| | - Esperanza Torres
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio Viudez
- Department of Medical Oncology, Complejo Universitario de Navarra, Pamplona, Spain
| | - Montserrat Zanui
- Department of Medical Oncology, Hospital de Mataró, Barcelona, Spain
| | - Miriam Zorrilla
- Department of Medical Oncology, Hospital San Pedro, de Logroño, Spain
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Espín E, Ciga MA, Pera M, Ortiz H. Oncological outcome following anastomotic leak in rectal surgery. Br J Surg 2015; 102:416-22. [PMID: 25619499 DOI: 10.1002/bjs.9748] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/13/2014] [Accepted: 11/14/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The influence of anastomotic leak on local recurrence and survival remains debated in rectal cancer. METHODS This was a multicentre observational study using data from the Spanish Rectal Cancer Project database. Demographics, American Society of Anesthesiologists classification, tumour location, stage, use of defunctioning stoma, administration of neoadjuvant and adjuvant treatment, invasion of circumferential resection margin, quality of mesorectal excision and anastomotic leakage were recorded. Anastomotic leak was defined as an anastomotic event requiring surgical intervention or interventional radiology, including pelvic abscesses without radiological evidence of leakage and early rectovaginal fistulas. Variables associated with oncological outcome were assessed by multivariable Cox regression analysis. RESULTS A total of 1181 consecutive patients were included. Rates of anastomotic leak and 30-day postoperative mortality were 9·4 and 2·4 per cent respectively. Data from 1153 patients were analysed after a median follow-up of 5 years. Cumulative rates of local recurrence, overall recurrence, overall survival and cancer-specific survival were 4·9, 19·4, 77·5 and 84·7 per cent respectively. In the multivariable regression analysis, anastomotic leakage was not associated with local recurrence (hazard ratio (HR) 0·80, 95 per cent c.i. 0·28 to 2·26; P = 0·669), overall recurrence (HR 1·14, 0·70 to 1·85; P = 0·606), overall survival (HR 1·10, 0·73 to 1·65; P = 0·648) or cancer-specific survival (HR 1·23, 0·75 to 2·02; P = 0·421). CONCLUSION Anastomotic leak after low anterior resection did not affect oncological outcomes in these patients.
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Affiliation(s)
- E Espín
- Colorectal Unit, Department of Surgery, Hospital Universitari Vall d'Hebron, Barcelona
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18
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Reina A, Errasti J, Espín E. Melanoma anorrectal. Revisión de conjunto. Cir Esp 2014; 92:510-6. [DOI: 10.1016/j.ciresp.2013.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/08/2013] [Accepted: 07/11/2013] [Indexed: 12/12/2022]
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19
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Mañas MJ, Espín E, López-Cano M, Vallribera F, Armengol-Carrasco M. Multivisceral Resection for Locally Advanced Rectal Cancer: Prognostic Factors Influencing Outcome. Scand J Surg 2014; 104:154-60. [PMID: 25260784 DOI: 10.1177/1457496914552341] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 08/19/2014] [Indexed: 12/16/2022]
Abstract
AIMS To assess outcome in patients with locally advanced rectal cancer undergoing multivisceral resection. METHODS Retrospective study of 30 consecutive patients (mean age 67.8 years) with primary locally advanced rectal cancer undergoing en bloc multivisceral resection of the organs involved with curative intent between 1998 and 2010. Overall survival, local and distal recurrence, and disease-free survival were analyzed by the Kaplan-Meier method. Risk factors for clinical outcome were obtained using a Cox multivariate model. RESULTS Postoperative complications occurred in 76.7% of patients and the in-hospital mortality rate was 10%. The median follow-up was 28.8 months. A total of 19 patients died at follow-up. Of the 11 patients who were alive, 7 were free of disease. In the multivariate analysis, lymph node involvement, stage II, and lymph vascular invasion were significantly associated with survival, and stage III showed a strong trend towards significance. Suture dehiscence (peritonitis and intra-abdominal abscess) showed a significant trend towards a higher local recurrence. Lymph vascular invasion was associated with a higher distant recurrence. CONCLUSION Lymph node involvement was associated with worse survival, whereas stage II and absence of lymph vascular invasion were associated with a better survival. Lymph vascular invasion was associated with a higher distant recurrence.
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Affiliation(s)
- M J Mañas
- Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - E Espín
- Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - M López-Cano
- Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - F Vallribera
- Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - M Armengol-Carrasco
- Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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20
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Espín E, Sánchez García JL, Vallribera F. Ultralow anterior resection with mechanical anastomosis in the treatment of distal third rectal cancer. Cir Esp 2014; 92 Suppl 1:4-12. [PMID: 24842686 DOI: 10.1016/s0009-739x(14)70003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Tumors of the lower third of the rectum are a challenge for the surgeon. Among the various techniques of surgical treatment of these lesions, radical surgery and ultra low anterior anastomosis is one of the therapeutic options. This technique is a defy both in the evaluation of the potential patient as in the surgical technique. Such evaluation and treatment processes must be audited in order to keep proper quality indices both in the oncological as in their functional results. This is only possible when both the multidisciplinary and surgical teams have an adequate and ongoing specialized training and a satisfactory volume of patients treated. Details of this technique, its indications and results are reported in this paper.
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Affiliation(s)
- Eloy Espín
- Unidad de Colon y Recto, Servicio de Cirugía General, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - José Luis Sánchez García
- Unidad de Colon y Recto, Servicio de Cirugía General, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Francesc Vallribera
- Unidad de Colon y Recto, Servicio de Cirugía General, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
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21
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Calvet X, Panés J, Alfaro N, Hinojosa J, Sicilia B, Gallego M, Pérez I, Lázaro y de Mercado P, Gomollón F, Aldeguera X, Alós R, Andreu M, Barreiro M, Bermejo F, Casis B, Domenech E, Espín E, Esteve M, García-Sánchez V, López-Sanromán A, Martínez-Montiel P, Luis Mendoza J, Gisbert JP, Vera M, Dosal A, Sánchez E, Marín L, Sanromán L, Pinilla P, Murciano F, Torrejón A, Ramón García J, Ortega M, Roldán J. Delphi consensus statement: Quality Indicators for Inflammatory Bowel Disease Comprehensive Care Units. J Crohns Colitis 2014; 8:240-51. [PMID: 24295646 DOI: 10.1016/j.crohns.2013.10.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/21/2013] [Accepted: 10/29/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS While it is commonly accepted that Inflammatory bowel disease (IBD) Comprehensive Care Units (ICCUs) facilitate the delivery of quality care to Crohn's disease and ulcerative colitis patients, it remains unclear how an ICCU should be defined or evaluated. The aim of the present study was to develop a comprehensive set of Quality Indicators (QIs) of structure, process, and outcomes for defining and evaluating an ICCU. METHODS A Delphi consensus-based approach with a standardized three-step process was used to identify a core set of QIs. The process included an exhaustive search using complementary approaches to identify potential QIs, and two Delphi voting rounds to select the QIs defining the core requirements for an ICCU. RESULTS The consensus selected a core set of 56 QIs (12 structure, 20 process and 24 outcome). Structure and process QIs highlighted the need for multidisciplinary management and continuity of care. The minimal IBD team should include an IBD nurse, gastroenterologists, radiologists, surgeons, endoscopists and stoma management specialists. ICCUs should be able to provide both outpatient and inpatient care and admission should not break the continuity of care. Outcome QIs focused on the adequate prophylaxis of disease complication and drug adverse events, the need to monitor appropriateness of treatment and the need to reinforce patient autonomy by providing adequate information and facilitating the patients' participation in their own care. CONCLUSIONS The present Delphi consensus identified a set of core QIs that may be useful for evaluating and certifying ICCUs.
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Affiliation(s)
- Xavier Calvet
- Servei de Malaties Digestives, Hospital de Sabadell, Institut Universitari Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain
| | - Julián Panés
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain; Hospital Clínic, Barcelona, Spain.
| | - Noelia Alfaro
- Técnicas Avanzadas de Investigación en Servicios de Salud (TAISS), Spain
| | | | - Beatriz Sicilia
- Servicio de Gastroenterología, Hospital Universitario de Burgos, Spain
| | | | - Ildefonso Pérez
- Asociación de pacients de Crohn y Colitis Ulcerosa (ACCU), Spain
| | | | - Fernando Gomollón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain; Servicio de Aparato Digestivo, Hospital Clínico "Lozano Blesa" de Zaragoza, Spain
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Puig I, Chicote I, Tenbaum SP, Arqués O, Herance JR, Gispert JD, Jimenez J, Landolfi S, Caci K, Allende H, Mendizabal L, Moreno D, Charco R, Espín E, Prat A, Elez ME, Argilés G, Vivancos A, Tabernero J, Rojas S, Palmer HG. A personalized preclinical model to evaluate the metastatic potential of patient-derived colon cancer initiating cells. Clin Cancer Res 2013; 19:6787-801. [PMID: 24170545 DOI: 10.1158/1078-0432.ccr-12-1740] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Within the aim of advancing precision oncology, we have generated a collection of patient-derived xenografts (PDX) characterized at the molecular level, and a preclinical model of colon cancer metastasis to evaluate drug-response and tumor progression. EXPERIMENTAL DESIGN We derived cells from 32 primary colorectal carcinomas and eight liver metastases and generated PDX annotated for their clinical data, gene expression, mutational, and histopathological traits. Six models were injected orthotopically into the cecum wall of NOD-SCID mice in order to evaluate metastasis. Three of them were treated with chemotherapy (oxaliplatin) and three with API2 to target AKT activity. Tumor growth and metastasis progression were analyzed by positron emission tomography (PET). RESULTS Patient-derived cells generated tumor xenografts that recapitulated the same histopathological and genetic features as the original patients' carcinomas. We show an 87.5% tumor take rate that is one of the highest described for implanted cells derived from colorectal cancer patients. Cecal injection generated primary carcinomas and distant metastases. Oxaliplatin treatment prevented metastasis and API2 reduced tumor growth as evaluated by PET. CONCLUSIONS Our improved protocol for cancer cell engraftment has allowed us to build a rapidly expanding collection of colorectal PDX, annotated for their clinical data, gene expression, mutational, and histopathological statuses. We have also established a mouse model for metastatic colon cancer with patient-derived cells in order to monitor tumor growth, metastasis evolution, and response to treatment by PET. Our PDX models could become the best preclinical approach through which to validate new biomarkers or investigate the metastatic potential and drug-response of individual patients.
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Affiliation(s)
- Isabel Puig
- Authors' Affiliations: Translational Program, Stem Cells and Cancer Laboratory; Molecular Oncology Group; Genomics Cancer Group; and Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO); Parc de Recerca Biomèdica de Barcelona (PRBB), Centre d'Imatge Molecular (CRC) Corporació Sanitària; Departments of Pathology, Medical Oncology, and HBP Surgery and Transplantation, Vall d'Hebron University Hospital, Universidad Autónoma de Barcelona; and General Surgery Service, Vall d'Hebron University Hospital, Barcelona, Spain
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Dávalos V, Súarez-López L, Castaño J, Messent A, Abasolo I, Fernandez Y, Guerra-Moreno A, Espín E, Armengol M, Musulen E, Ariza A, Sayós J, Arango D, Schwartz S. Human SMC2 protein, a core subunit of human condensin complex, is a novel transcriptional target of the WNT signaling pathway and a new therapeutic target. J Biol Chem 2012; 287:43472-81. [PMID: 23095742 DOI: 10.1074/jbc.m112.428466] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Human SMC2 is part of the condensin complex, which is responsible for tightly packaging replicated genomic DNA prior to segregation into daughter cells. Engagement of the WNT signaling pathway is known to have a mitogenic effect on cells, but relatively little is known about WNT interaction with mitotic structural organizer proteins. In this work, we described the novel transcriptional regulation of SMC2 protein by direct binding of the β-catenin·TCF4 transcription factor to the SMC2 promoter. Furthermore, we identified the precise region in the SMC2 promoter that is required for β-catenin-mediated promoter activation. Finally, we explored the functional significance of down-regulating SMC2 protein in vivo. Treatment of WNT-activated intestinal tumor cells with SMC2 siRNA significantly reduced cell proliferation in nude mice, compared with untreated controls (p = 0.02). Therefore, we propose that WNT signaling can directly activate SMC2 transcription as a key player in the mitotic cell division machinery. Furthermore, SMC2 represents a new target for oncological therapeutic intervention.
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Affiliation(s)
- Verónica Dávalos
- Drug Delivery and Targeting Group, Molecular Biology and Biochemistry Research Centre for Nanomedicine (CIBBIM-Nanomedicine), Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona 08035 Spain
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24
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López-Cano M, Lozoya-Trujillo R, Quiroga S, Sánchez JL, Vallribera F, Martí M, Jiménez LM, Armengol-Carrasco M, Espín E. Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial. Hernia 2012; 16:661-7. [PMID: 22782367 DOI: 10.1007/s10029-012-0952-z] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 06/22/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE Prevention of parastomal hernia represents an important aim when a permanent stoma is necessary. The objective of this work is to assess whether implantation of a prophylactic prosthetic mesh during laparoscopic abdominoperineal resection contributed to reduce the incidence of parastomal hernia. METHODS Rectal cancer patients undergoing elective laparoscopic abdominoperineal resection with permanent colostomy were randomized to placement of a large-pore lightweight mesh in the intraperitoneal/onlay position by the laparoscopic approach (study group) or to the control group (no mesh). Parastomal hernia was defined radiologically by a CT scan performed after 12 months of surgery. The usefulness of subcutaneous fat thickness measured by CT to discriminate patients at risk of parastomal hernia was assessed by ROC curve analysis. RESULTS Thirty-six patients were randomized, 19 to the mesh group and 17 to the control group. Parastomal hernia was detected in 50 % of patients in the mesh group and in 93.8 % of patients in the control group (P = 0.008). The AUC for thickness of the subcutaneous abdominal was 0.819 (P = 0.004) and the optimal threshold 23 mm. Subcutaneous fat thickness ≥23 mm was a significant predictor of parastomal hernia (odds ratio 15.7, P = 0.010), whereas insertion of a mesh was a protective factor (odds ratio 0.06, P = 0.031). CONCLUSIONS Use of prophylactic large-pore lightweight mesh in the intraperitoneal/onlay position by a purely laparoscopic approach reduced the incidence of parastomal hernia formation. Subcutaneous fat thickness ≥23 mm measured by CT was an independent predictor of parastomal hernia.
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Affiliation(s)
- M López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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25
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Biondo S, Trenti L, Espín E, Frago R, Vallribera F, Jiménez LM, Gálvez A, Sánchez JL, Kreisler E. Complicaciones y mortalidad postoperatorias tras anastomosis coloanal en dos tiempos según técnica de Turnbull-Cutait. Cir Esp 2012; 90:248-53. [DOI: 10.1016/j.ciresp.2011.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022]
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Mazzolini R, Dopeso H, Mateo-Lozano S, Chang W, Rodrigues P, Bazzocco S, Alazzouzi H, Landolfi S, Hernández-Losa J, Andretta E, Alhopuro P, Espín E, Armengol M, Tabernero J, Ramón y Cajal S, Kloor M, Gebert J, Mariadason JM, Schwartz S, Aaltonen LA, Mooseker MS, Arango D. Brush border myosin Ia has tumor suppressor activity in the intestine. Proc Natl Acad Sci U S A 2012; 109:1530-5. [PMID: 22307608 PMCID: PMC3277176 DOI: 10.1073/pnas.1108411109] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The loss of the epithelial architecture and cell polarity/differentiation is known to be important during the tumorigenic process. Here we demonstrate that the brush border protein Myosin Ia (MYO1A) is important for polarization and differentiation of colon cancer cells and is frequently inactivated in colorectal tumors by genetic and epigenetic mechanisms. MYO1A frame-shift mutations were observed in 32% (37 of 116) of the colorectal tumors with microsatellite instability analyzed, and evidence of promoter methylation was observed in a significant proportion of colon cancer cell lines and primary colorectal tumors. The loss of polarization/differentiation resulting from MYO1A inactivation is associated with higher tumor growth in soft agar and in a xenograft model. In addition, the progression of genetically and carcinogen-initiated intestinal tumors was significantly accelerated in Myo1a knockout mice compared with Myo1a wild-type animals. Moreover, MYO1A tumor expression was found to be an independent prognostic factor for colorectal cancer patients. Patients with low MYO1A tumor protein levels had significantly shorter disease-free and overall survival compared with patients with high tumoral MYO1A (logrank test P = 0.004 and P = 0.009, respectively). The median time-to-disease recurrence in patients with low MYO1A was 1 y, compared with >9 y in the group of patients with high MYO1A. These results identify MYO1A as a unique tumor-suppressor gene in colorectal cancer and demonstrate that the loss of structural brush border proteins involved in cell polarity are important for tumor development.
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Affiliation(s)
- Rocco Mazzolini
- Group of Molecular Oncology, and
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, 50018 Zaragoza, Spain
| | - Higinio Dopeso
- Group of Molecular Oncology, and
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, 50018 Zaragoza, Spain
| | - Silvia Mateo-Lozano
- Group of Molecular Oncology, and
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, 50018 Zaragoza, Spain
| | - Wakam Chang
- Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, 06520-8103 CT
| | - Paulo Rodrigues
- Group of Molecular Oncology, and
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, 50018 Zaragoza, Spain
| | | | | | | | | | - Elena Andretta
- Group of Molecular Oncology, and
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, 50018 Zaragoza, Spain
| | - Pia Alhopuro
- Department of Medical Genetics, Genome-Scale Biology Research Program, Biomedicum Helsinki, University of Helsinki, 00014 Helsinki, Finland
| | | | | | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | | | - Matthias Kloor
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; and
| | - Johannes Gebert
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; and
| | - John M. Mariadason
- Ludwig Institute for Cancer Research, Melbourne Centre for Clinical Sciences, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Simo Schwartz
- Group of Drug Delivery and Targeting, Centro de Investigaciones en Bioquímica y Biología Molecular-Nanomedicine, Vall d'Hebron University Hospital Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, 50018 Zaragoza, Spain
| | - Lauri A. Aaltonen
- Department of Medical Genetics, Genome-Scale Biology Research Program, Biomedicum Helsinki, University of Helsinki, 00014 Helsinki, Finland
| | - Mark S. Mooseker
- Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, 06520-8103 CT
| | - Diego Arango
- Group of Molecular Oncology, and
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, 50018 Zaragoza, Spain
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Casal JE, Biondo S, Espín E. Report from Spanish Society: report from the Asociación Española de Coloproctología. Colorectal Dis 2011; 13:606. [PMID: 21435148 DOI: 10.1111/j.1463-1318.2011.02592.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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López-Cano M, Mañas MJ, Hermosilla E, Espín E. Multivisceral resection for colon cancer: analysis of prognostic factors. Dig Surg 2010; 27:238-45. [PMID: 20571272 DOI: 10.1159/000276974] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 12/31/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS To assess outcome of multivisceral resection in colon cancer patients and to identify predictors of survival. METHODS One hundred and thirteen consecutive patients with primary locally advanced colon cancer infiltrating adjacent organs undergoing multivisceral resection between 1998 and 2007 were reviewed. Overall survival and disease-free survival were analyzed by the Kaplan-Meier method. The relative risk for clinical outcome was obtained using a Cox multivariate model. RESULTS The median follow-up was 74.9 months. Fifty-two patients had sigmoid tumors and 48 involvement of the small intestine. Complications occurred in 54 patients. The diagnosis was conventional adenocarcinoma in 94 patients. R0 resection was achieved in 96 patients (85%). Eighty-three patients received postoperative adjuvant therapy. The operative mortality was 7.1% (8 patients). Sixty-seven patients died at follow-up. Of the 46 patients who were alive, 38 were free of disease. In 73 patients with pT4a disease, 42 patients died (57.5%) and of the 31 survivors, recurrence was documented in 6. Hematochezia and adjuvant chemotherapy were independent factors of favorable outcome and grade G3 and tumor stage III-IV of poor survival. CONCLUSION Hematochezia and adjuvant chemotherapy were associated with a better survival, and poorly differentiated tumors and stage IV disease with a poor survival.
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Affiliation(s)
- Manuel López-Cano
- Colorectal Unit, Department of Surgery, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
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Casal JE, Espín E, Biondo S. Report from Spanish society: report from the Asociación Española de Coloproctología. Colorectal Dis 2010; 12:496-7. [PMID: 20184632 DOI: 10.1111/j.1463-1318.2010.02248.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Dopeso H, Mateo-Lozano S, Elez E, Landolfi S, Ramos Pascual FJ, Hernández-Losa J, Mazzolini R, Rodrigues P, Bazzocco S, Carreras MJ, Espín E, Armengol M, Wilson AJ, Mariadason JM, Ramon Y Cajal S, Tabernero J, Schwartz S, Arango D. Aprataxin tumor levels predict response of colorectal cancer patients to irinotecan-based treatment. Clin Cancer Res 2010; 16:2375-82. [PMID: 20371676 DOI: 10.1158/1078-0432.ccr-09-3275] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Irinotecan (CPT11) treatment significantly improves the survival of colorectal cancer patients and is routinely used for the treatment of these patients, alone or in combination with other agents. However, only 20% to 30% of patients show an objective response to irinotecan, and there is great need for new molecular markers capable of identifying the subset of patients who are unlikely to respond. EXPERIMENTAL DESIGN Here we used microarray analysis of a panel of 30 colorectal cancer cell lines and immunohistochemistry to identify and validate a new biomarker of response to irinotecan. RESULTS A good correlation was observed between irinotecan sensitivity and the expression of aprataxin (APTX), a histidine triad domain superfamily protein involved in DNA repair. Moreover, using an isogenic in vitro system deficient in APTX, we show that aprataxin directly regulates the cellular sensitivity to camptothecin, suggesting that it could be used to predict patient response to irinotecan. We constructed a tissue microarray containing duplicate tumor samples from 135 patients that received irinotecan for the treatment of advanced colorectal cancer. Immunohistochemical assessment of the tumor levels of aprataxin showed a significant association with treatment response and patient survival. Patients with low aprataxin had longer progression-free (9.2 versus 5.5 months; P = 0.03) and overall survival (36.7 versus 19.0 months; P = 0.008) than patients with high tumor aprataxin. No associations were found between coding APTX variants and aprataxin levels or camptothecin sensitivity. CONCLUSIONS These results show that aprataxin tumor levels can be used to identify patients with low probability of response to irinotecan-based therapy who are ideal candidates to receive treatment with alternative agents in an attempt to improve patient survival.
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Affiliation(s)
- Higinio Dopeso
- Group of Molecular Oncology, Molecular Biology and Biochemistry Research Center, CIBBIM-Nanomedicine, Vall d'Hebron University Hospital, Barcelona, Spain
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Lozano FS, Arcelus JI, Ramos JL, Alós R, Espín E, Rico P, Ros E. [Risk of venous thromboembolic disease in general surgery]. Cir Esp 2009; 85 Suppl 1:45-50. [PMID: 19589410 DOI: 10.1016/s0009-739x(09)71628-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite preventive efforts, venous thromboembolic disease (VTED) is still a major problem for surgeons due to its frequency and the morbidity, mortality and enormous resource consumption caused by this entity. However, the most important feature of VTED is that it is one of the most easily preventable complications and causes of death. To take appropriate prophylactic decisions (indication, method, initiation, duration, etc.), familiarity with the epidemiology of VTED in general surgery and some of its most significant populations (oncologic, laparoscopic, bariatric, ambulatory and short-stay) is essential. These factors must also be known to determine the distinct risk factors in these settings with a view to stratifying preoperative risk.
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Affiliation(s)
- Francisco S Lozano
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario, Salamanca, España.
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Codina-Cazador A, Espín E, Biondo S, Luján J, de Miguel M, Alós R, García-Granero E, Echeverría-Balda A, Ortiz H. Proceso docente auditado del tratamiento del cáncer de recto en España: resultados del primer año. Cir Esp 2007; 82:209-13. [DOI: 10.1016/s0009-739x(07)71708-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Davalos V, Dopeso H, Castaño J, Wilson AJ, Vilardell F, Romero-Gimenez J, Espín E, Armengol M, Capella G, Mariadason JM, Aaltonen LA, Schwartz S, Arango D. EPHB4 and survival of colorectal cancer patients. Cancer Res 2006; 66:8943-8. [PMID: 16982731 DOI: 10.1158/0008-5472.can-05-4640] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The family of receptor tyrosine kinases EPH and their Ephrin ligands regulate cell proliferation, migration, and attachment. An important role in colorectal carcinogenesis is emerging for some of its members. In this study, we evaluate the role of EPHB4 in colorectal cancer and its value as a prognostic marker. EPHB4 levels were assessed by immunohistochemical staining of tissue microarrays of 137 colorectal tumors and aberrant hypermethylation of the EPHB4 promoter was investigated using methylation-specific PCR. We found that EPHB4 expression is frequently reduced or lost in colorectal tumors. Patients with low EPHB4 tumor levels had significantly shorter survival than patients in the high EPHB4 group (median survival, 1.8 and >9 years, respectively; P < 0.01, log-rank test), and this finding was validated using an independent set of 125 tumor samples. In addition, we show that EPHB4 promoter hypermethylation is a common mechanism of EPHB4 inactivation. Moreover, reintroduction of EPHB4 resulted in a significant reduction in the clonogenic potential of EPHB4-deficient cells, whereas abrogation of EPHB4 in cells with high levels of this receptor lead to a significant increase in clonogenicity. In summary, we identified EPHB4 as a useful prognostic marker for colorectal cancer. In addition, we provide mechanistic evidence showing that promoter methylation regulates EPHB4 transcription and functional evidence that EPHB4 can regulate the long-term clonogenic potential of colorectal tumor cells, revealing EPHB4 as a potential new tumor suppressor gene in colorectal cancer.
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Affiliation(s)
- Veronica Davalos
- Molecular Oncology Program, Institut Catala d'Oncologia, Barcelona, Spain
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Davalos V, Dopeso H, Velho S, Ferreira AM, Cirnes L, Díaz-Chico N, Bilbao C, Ramírez R, Rodríguez G, Falcón O, León L, Niessen RC, Keller G, Dallenbach-Hellweg G, Espín E, Armengol M, Plaja A, Perucho M, Imai K, Yamamoto H, Gebert JF, Díaz-Chico JC, Hofstra RM, Woerner SM, Seruca R, Schwartz S, Arango D. High EPHB2 mutation rate in gastric but not endometrial tumors with microsatellite instability. Oncogene 2006; 26:308-11. [PMID: 16819508 DOI: 10.1038/sj.onc.1209780] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The EPH/EFN family of receptor tyrosine kinases regulates cell adhesion and migration and has an important role in controlling cell positioning in the normal intestinal epithelium. Inactivation of EPHB2 has recently been shown to accelerate tumorigenesis in the colon and rectum, and we have previously demonstrated frequent frameshift mutations (41%) in an A9 coding microsatellite repeat in exon 17 of EPHB2 in colorectal tumors with microsatellite instability (MSI). In this study, we extended these analyses to extracolonic MSI cancers, and found frameshift EPHB2 mutations in 39% (25/64) of gastric tumors and 14% (8/56) of endometrial tumors. Regression analysis of these EPHB2 mutation data on the basis of our previously proposed statistical model identified EPHB2 as a selective target of frameshift mutations in MSI gastric cancers but not in MSI endometrial carcinomas. These results suggest a functional role for EPHB2 in gastric tumor progression, and emphasize the differences between the tumorigenic processes in MSI gastrointestinal and endometrial cancer.
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Affiliation(s)
- V Davalos
- Molecular Oncology Program, Molecular Oncology and Aging Group, Vall d'Hebron Hospital Research Institute, Passeig Vall d'Hebron, Barcelona, Spain
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Vilar E, Balmaña J, Espín E. BRAF mutations in colorectal carcinoma suggest two entities of microsatellite-unstable tumors. Cancer 2006; 106:2528-9; author reply 2529. [PMID: 16628650 DOI: 10.1002/cncr.21902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Domingo E, Laiho P, Ollikainen M, Pinto M, Wang L, French AJ, Westra J, Frebourg T, Espín E, Armengol M, Hamelin R, Yamamoto H, Hofstra RMW, Seruca R, Lindblom A, Peltomäki P, Thibodeau SN, Aaltonen LA, Schwartz S. BRAF screening as a low-cost effective strategy for simplifying HNPCC genetic testing. J Med Genet 2005; 41:664-8. [PMID: 15342696 PMCID: PMC1735885 DOI: 10.1136/jmg.2004.020651] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND According to the international criteria for hereditary non-polyposis colorectal cancer (HNPCC) diagnostics, cancer patients with a family history or early onset of colorectal tumours showing high microsatellite instability (MSI-H) should receive genetic counselling and be offered testing for germline mutations in DNA repair genes, mainly MLH1 and MSH2. Recently, an oncogenic V600E hotspot mutation within BRAF, a kinase encoding gene from the RAS/RAF/MAPK pathway, has been found to be associated with sporadic MSI-H colon cancer, but its association with HNPCC remains to be further clarified. METHODS BRAF-V600E mutations were analysed by automatic sequencing in colorectal cancers from 206 sporadic cases with MSI-H and 111 HNPCC cases with known germline mutations in MLH1 and MSH2. In addition, 45 HNPCC cases showing abnormal immunostaining for MSH2 were also analysed. RESULTS The BRAF-V600E hotspot mutation was found in 40% (82/206) of the sporadic MSI-H tumours analysed but in none of the 111 tested HNPCC tumours or in the 45 cases showing abnormal MSH2 immunostaining. CONCLUSIONS Detection of the V600E mutation in a colorectal MSI-H tumour argues against the presence of a germline mutation in either the MLH1 or MSH2 gene. Therefore, screening of these mismatch repair (MMR) genes can be avoided in cases positive for V600E if no other significant evidence, such as fulfilment of the strict Amsterdam criteria, suggests MMR associated HNPCC. In this context, mutation analysis of the BRAF hotspot is a reliable, fast, and low cost strategy which simplifies genetic testing for HNPCC.
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Affiliation(s)
- E Domingo
- Centre d'Investigacions en Bioquímica i Biologia Molecular (CIBBIM), Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain
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Espín E, Armengol M. Radioterapia en el cáncer de recto. Estado actual. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Borruel N, Carol M, Casellas F, Antolín M, de Lara F, Espín E, Naval J, Guarner F, Malagelada JR. Increased mucosal tumour necrosis factor alpha production in Crohn's disease can be downregulated ex vivo by probiotic bacteria. Gut 2002; 51:659-64. [PMID: 12377803 PMCID: PMC1773447 DOI: 10.1136/gut.51.5.659] [Citation(s) in RCA: 251] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Tumour necrosis factor alpha (TNF-alpha) plays a key role in the pathogenesis of intestinal inflammation in Crohn's disease. The effect of bacteria on TNF-alpha release by intestinal mucosa was investigated. METHODS Ileal specimens were obtained at surgery from 10 patients with Crohn's disease (ileal stricture) and five disease controls undergoing right hemicolectomy (caecal cancer). Mucosal explants from each specimen were cultured for 24 hours with either non-pathogenic Escherichia coli, Lactobacillus casei DN-114001, L bulgaricus LB10, or L crispatus (each study contained blank wells with no bacteria). Tissue and bacterial viability was confirmed by lactate dehydrogenase (LDH) release and culture. Concentrations of TNF-alpha were measured in supernatants and the phenotype of the intestinal lymphocytes was analysed by flow cytometry. RESULTS Coculture of mucosa with bacteria did not modify LDH release. Release of TNF-alpha by inflamed Crohn's disease mucosa was significantly reduced by coculture with L casei or L bulgaricus; changes induced by L crispatus or E coli were not significant. The effect of L casei and L bulgaricus was not prevented by protease inhibitors. Coculture with L casei and L bulgaricus reduced the number of CD4 cells as well as TNF-alpha expression among intraepithelial lymphocytes from Crohn's disease mucosa. None of the bacteria induced changes in non-inflamed mucosa. CONCLUSIONS Probiotics interact with immunocompetent cells using the mucosal interface and modulate locally the production of proinflammatory cytokines.
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Affiliation(s)
- N Borruel
- Digestive System Research Unit, Hospitals Vall d'Hebron, Autonomous University, Barcelona, Spain
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Menoyo A, Alazzouzi H, Espín E, Armengol M, Yamamoto H, Schwartz S. Somatic mutations in the DNA damage-response genes ATR and CHK1 in sporadic stomach tumors with microsatellite instability. Cancer Res 2001; 61:7727-30. [PMID: 11691784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Maintenance of genomic stability depends on the appropriate cellular responses to DNA damage and the integrity of the DNA repair systems. We analyzed stomach tumors with microsatellite instability (MSI) for frameshift mutations in several potential targets of the mutator phenotype involved in DNA damage-response pathways, such as the ataxia telangiectasia mutated protein-related protein (ATR)-CHK1-Cdc25c pathway, and DNA repair. High frequency of mutations was found within ATR [5 (21%) of 23], MED1 [10 (43%) of 23], hMSH3 [13 (56%) of 23], and hMSH6 [10 (43%) of 23] genes. Also, a low frequency of mutations within the CHK1 gene was detected in 9% (2 of 23) of tumors. No mutations of hMLH3, ATM, BRCA1, or NBS1 genes were detected. These results confirm ATR, MED1, and CHK1 as targets of the mutator pathway in stomach tumorigenesis, and also suggest a potential role of MED1 increasing, together with hMSH3 and hMSH6, the genomic instability in the mutator pathway as a secondary mutator. Furthermore, these results suggest that the inhibition of the ATR-CHK1 DNA damage-response pathway might be involved in the tumorigenesis of gastric cancer with microsatellite instability.
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Affiliation(s)
- A Menoyo
- Molecular Pathology Program, Centre d'Investigacions en Bioquímica i Biologia Molecular, Barcelona 08035, Spain
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Affiliation(s)
- J Ponseti
- Unidad Funcional de la Miastenia. Hospital General Universitario Vall d'Hebron. Barcelona
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Sánchez JL, Espín E, Fort JM, de Lara F, de Torres I, Armengol M. [Sarcoma in the diverticulum of Meckel]. Rev Esp Enferm Dig 1997; 89:334-5. [PMID: 9221027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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