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Wozniak S, Tabola R, Grabowski K. Colon micro- and macrooesofagisation in interposed pedicled colonic right half segments for esophagus reconstruction. Medicine (Baltimore) 2023; 102:e35486. [PMID: 37933035 PMCID: PMC10627643 DOI: 10.1097/md.0000000000035486] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/13/2023] [Indexed: 11/08/2023] Open
Abstract
Treatment of esophageal burns may require surgical transplantation (interposition) of the colon or stomach. The interposed parts change their function and morphology. To investigate the macro- and microchanges in the transplanted colonic segment we analyzed in long-term follow-up (up to 29 years) the group of 21 patients in a retrospective study who underwent surgical interposition of pedicled colonic right half segments for esophageal burns. The data were analyzed statistically with the software package Statistica 13 (StatSoft Polska, Cracow). All calculations were performed with a significant level of P = .05. We evaluated the macro- and microanatomy of the grafts using radiology, endoscopy and histology. The adaptation of the transplanted tube was excellent. The diameter of the colonic tube was normal (35-60 mm) in 60% of females and 100% of males. Typical macrooesophagisation was found in all patients, while microoesophagisation involved inflammation, which gradually resolved over a period of about 5 years to be replaced by edema without fibrosis. Only in few patients persistent reflux was present, leading to erosions or ulcerations. All symptoms subsided after conservative treatment. We concluded macrooesophagization developed gradually after surgery, and was fully developed after 15 to 20 years. Microoesophagization appeared soon after interposition, and was obvious after 5 years. No metaplasia or dysplasia were observed (except in 1 patient), and the number of goblet cell remained constant.
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Affiliation(s)
- Slawomir Wozniak
- Department of Anatomy, Medical University in Wroclaw, Wroclaw, Poland
| | - Renata Tabola
- Department of Thoracic Surgery, Medical University in Wroclaw, Lower Silesian Centre of Oncology, Pulmonology and Hematology, Wroclaw, Poland
| | - Krzysztof Grabowski
- Department of Surgery Teaching, Medical University in Wroclaw, Wroclaw, Poland
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Augoff K, Hryniewicz-Jankowska A, Tabola R, Stach K. MMP9: A Tough Target for Targeted Therapy for Cancer. Cancers (Basel) 2022; 14:cancers14071847. [PMID: 35406619 PMCID: PMC8998077 DOI: 10.3390/cancers14071847] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 02/01/2023] Open
Abstract
Having the capability to proteolyze diverse structural and signaling proteins, matrix metalloproteinase 9 (MMP9), one of the best-studied secretory endopeptidases, has been identified as a crucial mediator of processes closely associated with tumorigenesis, such as the extracellular matrix reorganization, epithelial to mesenchymal transition, cell migration, new blood vessel formation, and immune response. In this review, we present the current state of knowledge on MMP9 and its role in cancer growth in the context of cell adhesion/migration, cancer-related inflammation, and tumor microenvironment formation. We also summarize recent achievements in the development of selective MMP9 inhibitors and the limitations of using them as anticancer drugs.
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Affiliation(s)
- Katarzyna Augoff
- Department of Surgical Education, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Department of Chemistry and Immunochemistry, Wroclaw Medical University, 50-367 Wroclaw, Poland;
- Correspondence:
| | | | - Renata Tabola
- Department of Thoracic Surgery, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Kamilla Stach
- Department of Chemistry and Immunochemistry, Wroclaw Medical University, 50-367 Wroclaw, Poland;
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Abstract
The invasive nature of many cancer cells involves the formation of F-actin-based, lipid-raft-enriched membrane protrusions known as invadopodia or, more broadly, invadosomes. Invadopodia are specialized adhesive structures arising from ventral cell surface within cell-extracellular matrix (ECM) contacts and concentrate high proteolytic activities that allow cells to overcome the dense scaffold of local microenvironment, comprising a natural barrier to cell spreading. This degradative activity distinguishes invadopodia from other adhesive structures like focal adhesions, lamellipodia or filopodia, and is believed to drive cancer progression.
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Affiliation(s)
- Katarzyna Augoff
- Department of Surgical Education, Wroclaw Medical University, Wroclaw, Poland
| | | | - Renata Tabola
- Second Department and Clinic of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
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Forkasiewicz A, Dorociak M, Stach K, Szelachowski P, Tabola R, Augoff K. The usefulness of lactate dehydrogenase measurements in current oncological practice. Cell Mol Biol Lett 2020; 25:35. [PMID: 32528540 PMCID: PMC7285607 DOI: 10.1186/s11658-020-00228-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/21/2020] [Indexed: 12/28/2022] Open
Abstract
One of the hallmarks of cancer cells is increased energy requirements associated with the higher rate of cellular proliferative activity. Metabolic changes in rapidly dividing cancer cells are closely associated with increased uptake of glucose and abnormal activity of lactate dehydrogenase (LDH), which regulates the processing of glucose to lactic acid. As serum LDH levels were found to be commonly increased in cancer patients and correlated with poor clinical outcome and resistance to therapy, the determination of LDH has become a standard supportive tool in diagnosing cancers or monitoring the effects of cancer treatment. The aim of this review is to summarize the current knowledge about methods and the practical utility for measuring both the total LDH and LDH isoenzymatic activities in the diagnosis, prognosis and prediction of cancer diseases.
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Affiliation(s)
- Agata Forkasiewicz
- Department of Surgical Education, Wroclaw Medical University, ul. Sklodowskiej-Curie 66, 50-369 Wroclaw, Poland
| | - Maja Dorociak
- Department of Surgical Education, Wroclaw Medical University, ul. Sklodowskiej-Curie 66, 50-369 Wroclaw, Poland
| | - Kamilla Stach
- Department of Biochemistry, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Szelachowski
- Department of Surgical Education, Wroclaw Medical University, ul. Sklodowskiej-Curie 66, 50-369 Wroclaw, Poland
| | - Renata Tabola
- Second Department and Clinic of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Augoff
- Department of Surgical Education, Wroclaw Medical University, ul. Sklodowskiej-Curie 66, 50-369 Wroclaw, Poland
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Zaremba-Czogalla M, Hryniewicz-Jankowska A, Tabola R, Nienartowicz M, Stach K, Wierzbicki J, Cirocchi R, Ziolkowski P, Tabaczar S, Augoff K. Corrigendum to 'A novel regulatory function of CDKN1A/p21 in TNFα-induced matrix metalloproteinase 9-dependent migration and invasion of triple-negative breast cancer cells' cellular signalling, volume 47, July 2018, Pages 27-36. Cell Signal 2018; 53:413. [PMID: 30446180 DOI: 10.1016/j.cellsig.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Renata Tabola
- Department of Biochemistry, Medical University of Wroclaw, Poland
| | - Miroslaw Nienartowicz
- Department of Minimally Invasive Surgery and Proctology, Wroclaw Medical University, Wroclaw, Poland
| | - Kamilla Stach
- Department of General and Oncological Surgery, University of Perugia, Italy
| | | | - Roberto Cirocchi
- Department of Gastrointestinal and General Surgery, Medical University of Wroclaw, Poland
| | - Piotr Ziolkowski
- Laboratory of Cytobiochemistry, Biotechnology Faculty, University of Wroclaw, Poland
| | - Sabina Tabaczar
- Department of Biochemistry, Medical University of Wroclaw, Poland
| | - Katarzyna Augoff
- Department of Minimally Invasive Surgery and Proctology, Wroclaw Medical University, Wroclaw, Poland.
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Ruscelli P, Renzi C, Polistena A, Sanguinetti A, Avenia N, Popivanov G, Cirocchi R, Lancia M, Gioia S, Tabola R. Clinical signs of retroperitoneal abscess from colonic perforation: Two case reports and literature review. Medicine (Baltimore) 2018; 97:e13176. [PMID: 30407351 PMCID: PMC6250550 DOI: 10.1097/md.0000000000013176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Retroperitoneal colonic perforation is a rare cause of retroperitoneal abscess. It presents, more frequently in frail elderly patients, with heterogeneous signs and symptoms which hamper the clinical diagnosis. Subcutaneous emphysema with pneumomediastinum and iliopsoas muscle abscess are unusual signs. Colonic retroperitoneal perforation may be consequent to diverticulitis or locally advanced colon cancer. Due to the anatomy of the retroperitoneal space and different physiopathology, diverticular perforation may present with air and pus collection; on the other hand perforated colon cancer may cause groin mass and psoas abscess. We reported 2 cases of colonic retroperitoneal perforation from diverticulitis and locally advanced colon cancer, respectively. Aim of this report is to improve differential diagnosis based on clinical signs. PATIENTS' CONCERNS A 71-year-old man presented with pain in his left side, fatigue, fever, nausea, massive subcutaneous emphysema of the neck, and Blumberg sign in the left iliac fossa. A 67-year-old man presented with abdominal pain, sub-occlusion, left groin mass, left groin, and lower limb pain during walking, negative Blumberg sign. DIAGNOSIS In the first patient the computerized tomography revealed pneumoperitoneum, gas in the mesosigma, pneumomediastinum, wall thickening of the descending colon, and retroperitoneal collection from diverticular perforation. In the second patient abdominal CT scan found thickening of the sigmoid colon adherent to the iliopsoas and fluid collection. INTERVENTIONS In the first patient, a left hemicolectomy extending to the transverse colon, followed by a toilette and debridement of the retroperitoneum were performed. In the second patient, tumor of descending colon perforated in the retroperitoneum with iliopsoas abscess was treated with left hemicolectomy and a drainage of the abscess. OUTCOMES The first patient underwent right colectomy with ileostomy in the 7 postoperative day for large bowel necrosis. He died of sepsis 2 days after. The second patient had regular postoperative and he is still alive. LESSONS The spread of retroperitoneal abscess in complicated colonic diverticulitis is different from that in advanced colonic cancer. The former can present with a subcutaneous emphysema, the latter with a groin mass. Hence a thorough clinical examination and radiological studies are needed to diagnose these conditions.
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Affiliation(s)
- Paolo Ruscelli
- Emergency Surgery Unit, Torrette Hospital, Faculty of Medicine and Surgery, Polytechnic University of Marche, Ancona
| | | | - Andrea Polistena
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | | | - Nicola Avenia
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | - Georgi Popivanov
- Military Medical Academy-Sofia, Department of Surgery, Sofia, Bulgaria
| | | | - Massimo Lancia
- Azienda Ospedaliera Santa Maria Terni, Legal Medicine, University of Perugia, Terni, Italy
| | - Sara Gioia
- Azienda Ospedaliera Santa Maria Terni, Legal Medicine, University of Perugia, Terni, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Medical University, Wroclaw. Poland
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Popivanov G, Tabakov M, Mantese G, Cirocchi R, Piccinini I, D'Andrea V, Covarelli P, Boselli C, Barberini F, Tabola R, Pietro U, Cavaliere D. Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review. Transl Gastroenterol Hepatol 2018; 3:71. [PMID: 30363779 DOI: 10.21037/tgh.2018.09.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 02/25/2018] [Accepted: 09/04/2018] [Indexed: 01/10/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumours in the digestive tract. The duodenal GIST (dGIST) is the rarest subtype, representing only 4-5% of all GIST, but up to 21% of the resected ones. The diagnostic and therapeutic management of dGIST may be difficult due to the rarity of this tumor, its anatomical location, and the clinical behavior that often mimic a variety of conditions; moreover, there is lack of consent for their treatment. This study has evaluated the scientific literature to provide consensus on the diagnosis of dGIST and to outline possible options for surgical treatment. Methods An extensive research has been carried out on the electronic databases MEDLINE, Scopus, EMBASE and Cochrane to identify all clinical trials that report an event or case series of dGIST. Results Eighty-six studies that met the inclusion criteria were identified with five hundred forty-nine patients with dGIST: twenty-seven patients were treated with pancreatoduodenectomy and ninety-six with only local resection (segmental/wedge resections); in four hundred twenty-six patients it is not possible identify the type of treatment performed (pancreatoduodenectomy or segmental/wedge resections). Conclusions dGISTs are a very rare subset of GISTs. They may be asymptomatic or may involve symptoms of upper GI bleeding and abdominal pain at presentation. Because of the misleading clinical presentation the differential diagnosis may be difficult. Tumours smaller than 2 cm have a low biological aggressiveness and can be followed annually by endoscopic ultrasound. The biggest ones should undergo radical surgical resection (R0). In dGIST there is no uniformly adopted surgical strategy because of the low incidence, lack of experience, and the complex anatomy of the duodenum. Therefore, individually tailored surgical approach is recommended. R0 resection with 1-2 cm clear margin is required. Lymph node dissection is not recommended due to the low incidence of lymphatic metastases. Tumor rupture should be avoided.
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Affiliation(s)
- Georgi Popivanov
- Military Medical Academy, Clinic of Endoscopic, Endocrine surgery and Coloproctology, Sofia, Bulgaria
| | - Mihail Tabakov
- University Hospital Sv. Ivan Rilski, Surgical Clinic, Sofia, Bulgaria
| | - George Mantese
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Irene Piccinini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Vito D'Andrea
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Piero Covarelli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Carlo Boselli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Francesco Barberini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Ursi Pietro
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Davide Cavaliere
- General Surgery and Surgical Oncology, Morgagni-Pierantoni Hospital, Forlì, Italy
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Ruscelli P, Popivanov G, Tabola R, Polistena A, Sanguinetti A, Avenia N, Renzi C, Cirocchi R, Ursi P, Fingerhut A. Modified Paul-Mikulicz jejunostomy in frail geriatric patients undergoing emergency small bowel resection. MINERVA CHIR 2018; 74:121-125. [PMID: 29795063 DOI: 10.23736/s0026-4733.18.07714-3] [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: 11/08/2022]
Abstract
BACKGROUND Proximal or extended bowel resections are sometimes necessary during emergency surgery of the small bowel and call for creating a high small bowel stomy as a part of damage control surgery. Secondary restoration of intestinal continuity in the frail geriatric patient, further weakened by subsequent severe malabsorption may be prohibitive. METHODS Six patients underwent emergency small bowel resection for proximal jejunal disease (83.3% high-grade adhesive SBO and 16.7% jejunal diverticulitis complicated with perforation). With the intention to avoid end jejunostomy and the need for repeat laparotomy for bowel continuity restoration we modified the classic Paul-Mikulicz jejunostomy. RESULTS The postoperative course was uneventful in four patients whose general condition improved considerably. At six-month follow-up, neither patients required parenteral nutrition. CONCLUSIONS This modified stoma can have the advantage of allowing a partial passage of the enteric contents, reducing the degree of malabsorption, and rendering jejunostomy reversal easy to perform later.
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Affiliation(s)
- Paolo Ruscelli
- Unit of Emergency Surgery, Torrette Hospital, Faculty of Medicine and Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Georgi Popivanov
- Military Medical Academy-Sofia, Clinic of Endoscopic, Endocrine Surgery and Coloproctology, Sofia, Bulgaria
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Andrea Polistena
- Unit of General Surgery and Surgical Specialties, University of Perugia, Terni, Italy
| | | | - Nicola Avenia
- Unit of General Surgery and Surgical Specialties, University of Perugia, Terni, Italy
| | - Claudio Renzi
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy
| | - Roberto Cirocchi
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy -
| | - Pietro Ursi
- Department of General Surgery and Surgical Specialties, Sapienza University, Rome, Italy
| | - Abe Fingerhut
- Section for Surgical Research, Medical University of Graz, Graz, Austria
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Abstract
The purpose of this retrospective study is to show that transcervical diverticulectomy (TD) in treatment of Zenker diverticulum (ZD) can still be a first choice procedure in selected patients and in experienced hands its safety might be compared to the minimally invasive endoscopic diverticulostomy.The study cohort consisted of 44 patients (18 male, 26 female) operated for (ZD). All the patients underwent open diverticulectomy. The decision to choose open surgical repair depended on surgical risk, age of the patient, size of the diverticular septum (the distance between the top of the diverticulum and its bottom on barium study), and patient's preference.Mean age of patients was 64.6 ± 11.9 years; range: 26 to 88 years. A total of 36.4% out of them finished 70 years. Postoperative mortality was nil. Two major complications (4.5%) requiring surgical intervention occurred: leak and hematoma.Data were analyzed by t test for independent samples using Statistica 12.5 software. P value <0.05 was considered statistically significant.Surgical treatment of patients with ZD should be individualized. Large Zenker diverticula with the septum longer than 6 cm should preferably be resected through an open approach because it is not possible to remove the septum completely during one-step endoscopic procedure and diverticulostomy creates a weak and large common cavity in the esophagus. Surgical repair is effective for all sizes of diverticula, but its most serious complications such as leakage or laryngeal nerve injury should be considered, especially in elderly patients with comorbidities. However, age alone should not be the main criterion if choosing the treatment option.
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Affiliation(s)
- Renata Tabola
- Department of Gastrointestinal and General Surgery, Medical University of Wroclaw, Wroclaw, Poland
| | - Andrzej Lewandowski
- Department of Gastrointestinal and General Surgery, Medical University of Wroclaw, Wroclaw, Poland
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Perugia, Italy
| | - Katarzyna Augoff
- Department of Gastrointestinal and General Surgery, Medical University of Wroclaw, Wroclaw, Poland
| | | | | | - Krzysztof Grabowski
- Department of Gastrointestinal and General Surgery, Medical University of Wroclaw, Wroclaw, Poland
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Grassi V, Tabola R, Basile E, De Sol A, Polistena A, Sanguinetti A, Avenia N, Popivanov G, Burattini MF, Cirocchi R, Ursi P. Sigmoid diverticulitis in elderly patients: a rare cause of right iliac fossa pain. MINERVA CHIR 2018; 73:444-447. [PMID: 29600833 DOI: 10.23736/s0026-4733.18.07722-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Veronica Grassi
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Emanuela Basile
- Department and Clinic of Gastrointestinal and General Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Angelo De Sol
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | - Andrea Polistena
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | | | - Nicola Avenia
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | - Georgi Popivanov
- Military Medical Academy-Sofia, Clinic of Endoscopic, Endocrine, Surgery and Coloproctology, Sofia, Bulgaria
| | - Maria F Burattini
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy
| | - Roberto Cirocchi
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy -
| | - Pietro Ursi
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
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11
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Cirocchi R, Cesare Campanile F, Di Saverio S, Popivanov G, Carlini L, Pironi D, Tabola R, Vettoretto N. Laparoscopic versus open colectomy for obstructing right colon cancer: A systematic review and meta-analysis. J Visc Surg 2017; 154:387-399. [PMID: 29113714 DOI: 10.1016/j.jviscsurg.2017.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hemicolectomy is the treatment of choice for intestinal obstruction from right colon cancer. This review compares the laparoscopic vs open access in hemicolectomy for patients with right colon cancer. METHODS A systematic review and meta-analysis of clinical studies published after January 2017 was performed according to the Prisma guidelines. The study has been recorded on the Prospero register (CRD42016044108). RESULTS Five studies were included for review. Only one anastomotic leak was reported in conventional open anastomosis group (1.9%) and none of the studies included in the meta-analysis reported re-operations during the first 30 postoperative days. The 30-day postoperative mortality did not differ between the two groups. The length of incision, blood loss, early mobilization after surgery, the 30-day postoperative overall complication rate and hospital length of stay were significantly shorter in the laparoscopic group. The difference in the duration of procedure was statistically significant in favor of the open group. The number of dissected lymph nodes, the overall survival at 5 years and time to flatus were described only in one study, without any significant difference. Finally, none of the trials reported any information concerning differences in the costs between the two techniques. CONCLUSIONS The better outcomes described in this study achieved with laparoscopy, must be interpreted with caution because of the small number of patients involved, the selection and publication bias and the low level of evidence of the analysed trials. Indeed, the advantages of a minimally invasive approach, which have been demonstrated by the present meta-analysis, should encourage the use of laparoscopy also in emergency setting.
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Affiliation(s)
- R Cirocchi
- Department of general and oncologic surgery, university of Perugia, 1, via Tristano di Joannuccio, 05100 Terni, Italy.
| | | | - S Di Saverio
- Emergency surgery and trauma surgery unit, Maggiore hospital trauma center, Bologna, Italy
| | | | - L Carlini
- Department of legal medicine, university of Perugia, Terni, Italy
| | - D Pironi
- Department of surgical sciences, Sapienza university of Rome, Rome, Italy
| | - R Tabola
- Department of gastrointestinal and general surgery, medical university of Wrocław, Wrocław, Poland
| | - N Vettoretto
- Laparoscopic surgery unit, department of surgery, M Mellini hospital, Chiari, Italy
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12
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Tabola R, Zaremba-Czogalla M, Baczynska D, Cirocchi R, Stach K, Grabowski K, Augoff K. Fibroblast activating protein-α expression in squamous cell carcinoma of the esophagus in primary and irradiated tumors: the use of archival FFPE material for molecular techniques. Eur J Histochem 2017; 61:2793. [PMID: 28735527 PMCID: PMC5484010 DOI: 10.4081/ejh.2017.2793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/23/2017] [Accepted: 05/26/2017] [Indexed: 01/19/2023] Open
Abstract
There are numerous reports suggesting that fibroblast activating protein-α (FAP-α) plays an important role in invasion of various tumor types. We studied the expression pattern of FAP-α in esophageal squamous cell carcinoma (ESCC) patients who had not been treated primarily and those who had received neoadjuvant radiochemotherapy. Our goal was to establish whether readily available tissue specimens fixed in formalin and stored in paraffin blocks for years might still be a source of FAP-α RNA for PCR analysis. The study included 20 patients divided into two groups, 10 patients in each group. We evaluated the expression of FAP- α by PCR techniques in fresh frozen and in paraffin-embedded tissues, and compared it to the expression in non-cancer tissues. To detect the protein expression level of FAP-α in paraffin-embedded tissues we used chromogenic immunohistochemical (IHC) staining. Data were analyzed by t-test or the nonparametric Wilcoxon matched pair test using Statistica 12.5 software. We observed an increased level of the FAP-α gene and protein expression in cancer tissues when compared with their corresponding normal tissues. However, statistically significant differences were found only in the group of patients untreated before surgery. RNA extracted from paraffin-embedded tissue sections had very low quality, especially in the context of degradation. FAP-α remains a highly altered participant of a complex microenvironment in esophageal squamous cell carcinoma, and its role in cell signaling requires further study. In this paper, we conclude that the use of a regular RT-PCR method for diagnostic purposes, which we have presented in an earlier paper, can be as good as qRT-PCR. Also, immunohistochemistry proved to be very useful and the only reliable method that can be used on longterm stored formalin-fixed, paraffin-embedded tissues.
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Affiliation(s)
- Renata Tabola
- Medical University of Wroclaw, Department of Gastrointestinal and General Surgery.
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13
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Cirocchi R, Kelly MD, Griffiths EA, Tabola R, Sartelli M, Carlini L, Ghersi S, Di Saverio S. A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system. Surgeon 2017; 15:379-387. [PMID: 28619547 DOI: 10.1016/j.surge.2017.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The incidence of duodenal perforation after ERCP ranges from 0.09% to 1.67% and mortality up to 8%. METHODS This systematic review was registered in Prospective Register of Systematic Reviews, PROSPERO. Stapfer classification of ERCP-related duodenal perforations was used. RESULTS The systematic search yielded 259 articles. Most frequent post-ERCP perforation was Stapfer type II (58.4%), type I second most frequent perforation (17.8%) followed by Stapfer type III in 13.2% and type IV in 10.6%. Rate of NOM was lowest in Stapfer type I perforations (13%), moderate in type III lesions (58.1%) and high in other types of perforations (84.2% in type II and 84.6% in IV). In patients underwent early surgical treatment (<24 h from ERCP) the most frequent operation was simple duodenal suture with or without omentopexy (93.7%). In patients undergoing late surgical treatment (>24 h from ERCP) interventions performed were more complex. In type I lesions post-operative mortality rate was higher in patients underwent late operation (>24 h). In type I lesions, failure of NOM occurred in 42.8% of patients. In type II failure of NOM occurred in 28.9% of patients and in type III there was failure of NOM in only 11.1%, none in type IV. Postoperative mortality after NOM failure was 75% in type I, 22.5% in type II and none died after surgical treatment for failure of NOM in type III perforations. CONCLUSIONS This systematic review showed that in patients with Stapfer type I lesions, early surgical treatment gives better results, however the opposite seems true in Stapfer III and IV lesions.
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Affiliation(s)
- Roberto Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, Terni, Italy.
| | | | - Ewen A Griffiths
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland.
| | - Renata Tabola
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2WB, United Kingdom.
| | | | - Luigi Carlini
- Section of Legal Medicine, University of Perugia, Terni, Italy.
| | - Stefania Ghersi
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy.
| | - Salomone Di Saverio
- Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna, Italy.
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Boselli C, Cirocchi R, Gemini A, Grassi V, Avenia S, Polistena A, Sanguinetti A, Burattini MF, Pironi D, Santoro A, Tabola R, Avenia N. Surgery for colorectal cancer in elderly: a comparative analysis of risk factor in elective and urgency surgery. Aging Clin Exp Res 2017; 29:65-71. [PMID: 27837462 DOI: 10.1007/s40520-016-0642-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Colon cancer therapy is primarily surgical. Advanced age does not represent a contraindication to surgery. We analyse the results of surgery in ultra 75 patients undergoing surgery for colorectal cancer by examining the correlation between the comorbidity and any post-operative complications. MATERIALS AND METHODS We surgically treated 66 patients for colorectal cancer, aged over 75. The examined subjects were compromised for various reasons. We have evaluated the different influences of risk factors in elective and urgency operation. DISCUSSION Several studies have shown that age alone is not a significant prognostic factor in survival after colonic surgery. The assessment of general conditions in elderly patients, as demonstrated by the literature, is a fundamental moment in the management of colorectal cancer. CONCLUSIONS The surgical choice should be made case by case (custom-made), not based on age only.
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Affiliation(s)
- Carlo Boselli
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy.
| | - Alessandro Gemini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Veronica Grassi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Stefano Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Andrea Polistena
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Alessandro Sanguinetti
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Maria Federica Burattini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 32400161, Rome, Italy
| | - Alberto Santoro
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 32400161, Rome, Italy
| | - Renata Tabola
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland
| | - Nicola Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
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Tabola R, Cirocchi R, Fingerhut A, Arezzo A, Randolph J, Grassi V, Binda GA, D'Andrea V, Abraha I, Popivanov G, Di Saverio S, Zbar A. A systematic analysis of controlled clinical trials using the NiTi CAR™ compression ring in colorectal anastomoses. Tech Coloproctol 2017; 21:177-184. [PMID: 28132113 DOI: 10.1007/s10151-017-1583-2] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/09/2017] [Indexed: 02/08/2023]
Abstract
Anastomotic leak following colorectal surgery can be a devastating adverse event. The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction which potentially contribute to early anastomotic dehiscence or late anastomotic stricture. A systematic review was performed examining available data on controlled randomized and non-randomized trials assessing the NiTi compression anastomosis ring-(NiTi CAR™) (NiTi Solutions, Netanyah Israel) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. A protocol for this meta-analysis has been registered on PROSPERO (CRD42016050934). The initial search yielded 45 potentially relevant articles. After screening titles and abstracts for relevance and assessment for eligibility, 39 of these articles were eventually excluded leaving 6 studies for analysis in the review. Regarding the primary outcome measure, the overall anastomotic leak rate was 2.2% (5/230) in the compression anastomosis group compared with 3% (10/335) in the conventional anastomosis group; this difference was not statistically significant (RR 0.75, 95% CI 0.25-2.24; participants = 565; studies = 6; I 2 = 0%). There were no statistically significant differences between compression and conventional anastomoses in any of the secondary outcomes. This review was unable to demonstrate any statistically significant differences in favor of the compression anastomosis technique over conventional manual or stapled mechanical anastomoses.
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Affiliation(s)
- R Tabola
- Department of General and Gastrointestinal Surgery, Medical University of Wrocław, Wrocław, Poland
| | - R Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
| | - A Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - A Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - J Randolph
- Tift College of Education, Mercer University, Atlanta, GA, USA
| | - V Grassi
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - G A Binda
- Colorectal Surgery Unit, Galliera Hospital, Genoa, Italy
| | - V D'Andrea
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - I Abraha
- Department of Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - G Popivanov
- Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria
| | - S Di Saverio
- General (Colorectal), Emergency and Trauma Surgery Service, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health Services, Bologna, Italy
| | - A Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel.,Department of Anatomy, University of Otago, Dunedin, New Zealand
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Tabola R, Mantese G, Cirocchi R, Gemini A, Grassi V, Boselli C, Avenia S, Sanguinetti A, Avenia N, Sroczynski M, Wierzbicki J. Postoperative mortality and morbidity in older patients undergoing emergency right hemicolectomy for colon cancer. Aging Clin Exp Res 2016; 29:121-126. [PMID: 27830519 DOI: 10.1007/s40520-016-0643-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Even with the advances in surgical technique and perioperative care, morbidity and mortality after colorectal cancer surgery remain considerable, and patients (pt) who present as an emergency have an even higher mortality and morbidity rate. METHODS A total of 35 pt with caecum or ascending colon cancer between January 2007 and June 2015, three departments in Italy and in Poland, were included in the study. The intention of surgery in all cases was curative resection with ileo-colic anastomosis. Comparative statistical analysis was performed. RESULTS Acute bowel obstruction was the major complication of CRC that led to an emergency hemicolectomy. Postoperative mortality and morbidity rates were in total 12.5 and 28.1%, respectively. All the deaths happened in Poland. Of the pt, 42.8% had morbidity in Poland and 16.6% in Italy. Out of the pt, 25% presenting with perforation: 25% died, 25% had wound dehiscence, 12.5% had pulmonary oedema, and 12.5% had an intra-abdominal abscess. The mean age of the pt with complications in Poland and in Italy was 79.3 and 72.0 years, respectively. CONCLUSION We observed that particularly lethal combination is older age, perforation with peritonitis and advanced stage of the cancer.
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Affiliation(s)
- Renata Tabola
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, ul. Curie-Sklodowskiej 66, 50-369, Wrocław, Poland
| | - George Mantese
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, ul. Curie-Sklodowskiej 66, 50-369, Wrocław, Poland
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte 1, 06134, Perugia, Italy.
| | - Alessandro Gemini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte 1, 06134, Perugia, Italy
| | - Veronica Grassi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte 1, 06134, Perugia, Italy
| | - Carlo Boselli
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte 1, 06134, Perugia, Italy
| | - Stefano Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Alessandro Sanguinetti
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Nicola Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Maciej Sroczynski
- Department of Minimally Invasive Surgery and Proctology, Medical University of Wroclaw, ul. Borowska 213, 50-556, Wrocław, Poland
| | - Jaroslaw Wierzbicki
- Department of Minimally Invasive Surgery and Proctology, Medical University of Wroclaw, ul. Borowska 213, 50-556, Wrocław, Poland
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Tabola R, Augoff K, Lewandowski A, Ziolkowski P, Szelachowski P, Grabowski K. Esophageal anastomosis - how the granulation phase of wound healing improves the incidence of anastomotic leakage. Oncol Lett 2016; 12:2038-2044. [PMID: 27602135 DOI: 10.3892/ol.2016.4873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 01/31/2016] [Accepted: 06/02/2016] [Indexed: 12/22/2022] Open
Abstract
A two-stage esophagectomy with an interval for reconstruction of the esophagus creates an opportunity for the esophageal stump to recover from vessel injury and allows the formation of granulation tissue rich in proangiogenic factors, including transforming growth factor β (TGF-β) and vascular endothelial growth factor A (VEGF-A), which may have an impact on anastomosis healing. The present study comprised 25 patients (27 in total, 2 succumbed to complications following surgery) who underwent two-stage esophagectomy for squamous cell carcinoma in the Department of Gastrointestinal and General Surgery, Wrocław Medical University (Wrocław, Poland) between January 2007 and December 2012. Immunohistochemical staining for VEGF-A and TGF-β was performed to evaluate esophageal wall specimens at the time of esophagostomy construction and prior to anastomosis, in which the cervical esophagus was connected with the colon or ileum. At the time of reconstructive surgery, a significant increase in microvessel density was observed in all esophageal specimens (P<0.03). Significant differences were also identified in the immunohistochemical staining intensity of TGF-β and VEGF-A in the epithelium of all esophageal specimens between biopsies obtained from normal esophageal tissues at the time of esophagectomy and during reconstructive surgery. Delayed anastomosis construction provides an advantage for the esophageal stump to accumulate proangiogenic growth factors, which overlap with the subsequent proliferative stage of the anastomosed tissue and thus supports its recovery, creating an optimal environment for the healing of any fistulas.
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Affiliation(s)
- Renata Tabola
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, 50-369 Wrocław, Poland
| | - Katarzyna Augoff
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, 50-369 Wrocław, Poland
| | - Andrzej Lewandowski
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, 50-369 Wrocław, Poland
| | - Piotr Ziolkowski
- Department of Pathomorphology, Wrocław Medical University, 50-369 Wrocław, Poland
| | - Piotr Szelachowski
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, 50-369 Wrocław, Poland
| | - Krzysztof Grabowski
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, 50-369 Wrocław, Poland
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Cirocchi R, Grassi V, Cavaliere D, Renzi C, Tabola R, Poli G, Avenia S, Farinella E, Arezzo A, Vettoretto N, D'Andrea V, Binda GA, Fingerhut A. New Trends in Acute Management of Colonic Diverticular Bleeding: A Systematic Review. Medicine (Baltimore) 2015; 94:e1710. [PMID: 26554768 PMCID: PMC4915869 DOI: 10.1097/md.0000000000001710] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Colonic diverticular disease is the most common cause of lower gastrointestinal bleeding. In the past, this condition was usually managed with urgent colectomy. Recently, the development of endoscopy and interventional radiology has led to a change in the management of colonic diverticular bleeding.The aim of this systematic review is to define the best treatment for colonic diverticular bleeding.A systematic bibliographic research was performed on the online databases for studies (randomized controlled trials [RCTs], observational trials, case series, and case reports) published between 2005 and 2014, concerning patients admitted with a diagnosis of diverticular bleeding according to the PRISMA methodology.The outcomes of interest were: diagnosis of diverticulosis as source of bleeding; incidence of self-limiting diverticular bleeding; management of non self-limiting bleeding (endoscopy, angiography, surgery); and recurrent diverticular bleeding.Fourteen studies were retrieved for analysis. No RCTs were found. Eleven non-randomized clinical controlled trials (NRCCTs) were included in this systematic review. In all studies, the definitive diagnosis of diverticular bleeding was always made by urgent colonoscopy. The colonic diverticular bleeding stopped spontaneously in over 80% of the patients, but a re-bleeding was not rare. Recently, interventional endoscopy and angiography became the first-line approach, thus relegating emergency colectomy to patients presenting with hemodynamic instability or as a second-line treatment after failure or complications of hemostasis with less invasive treatments.Colonoscopy is effective to diagnose diverticular bleeding. Nowadays, interventional endoscopy and angiographic treatment have gained a leading role and colectomy should only be entertained in case of failure of the former.
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Affiliation(s)
- Roberto Cirocchi
- From the Department of Digestive Surgery and Liver Unit, St Maria Hospital, Terni, Italy (RC, VG); Surgical Oncology, Forlì Hospital, Forlì, Italy (DC); Department of General and Oncologic Surgery, University of Perugia, St Maria Hospital, Perugia, Italy (CR); Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland (RT); Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy (GP); Department of Endocrine Surgery, University of Perugia, Perugia, Italy (SA); Department of Digestive Surgery, ULB-Hopital Erasme, Brussels, Belgium (EF); Department of Surgical Sciences, University of Torino, Torino, Italy (AA); Department of Surgery, Montichiari, Ospedali Civili Brescia, Italy (NV); Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy (VD); Department of Colorectal Surgery, Galliera Hospital, Genoa, Italy (GAB); and Surgical Research Unit, Medical University of Graz, Austria and First Department of Surgery, Hippokration Hospital, University of Athens Medical School, Athens, Greece (AF)
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Augoff K, Hryniewicz-Jankowska A, Tabola R, Czapla L, Szelachowski P, Wierzbicki J, Grabowski K, Sikorski AF. Upregulated expression and activation of membrane‑associated proteases in esophageal squamous cell carcinoma. Oncol Rep 2014; 31:2820-6. [PMID: 24789592 DOI: 10.3892/or.2014.3162] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/02/2014] [Indexed: 11/06/2022] Open
Abstract
To better understand the role of membrane-associated proteolytic systems in the development of esophageal cancer, we studied the expression of two serine proteases, fibroblast activation protein-α (FAP-α) and dipeptidyl peptidase IV (DPPIV) and three metalloproteinases, matrix metalloproteinase (MMP)-2, MMP-9 and MT1-MMP in 24 primary esophageal squamous cell carcinoma (ESCC) tissues and paired non-cancer tissues. Using reverse-transcription PCR, western blotting and zymography, we showed that both serine proteases and all three metalloproteinases were highly altered in ESCC. A positive correlation between the expression of FAP-α and DPPIV and the activity of both gelatinases was found. This may indicate that these proteolytic systems are tightly linked to each other and collectively are involved in the process of ECM degradation that facilitates cancer cell invasion and metastasis.
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Affiliation(s)
- Katarzyna Augoff
- Department of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | | | - Renata Tabola
- Department of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Leszek Czapla
- Department of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Szelachowski
- Department of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Jaroslaw Wierzbicki
- Department of Minimally Invasive Surgery and Proctology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Grabowski
- Department of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksander F Sikorski
- Laboratory of Cytobiochemistry, Biotechnology Faculty, University of Wroclaw, Wroclaw, Poland
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Abstract
BACKGROUND The optimal therapeutic schedule in patients with achalasia is still under discussion. The aim of this study was to review our institution's experience with myotomy and dilation in patients with achalasia. MATERIAL AND METHODS Clinical data were available for 59 patients who had ever had myotomy (n=38), dilation (n=21), or both procedures (n=8) between 2000 and 2007. Patients were followed prospectively with objective (a barium esophagogram) and subjective (a simple survey that scored dysphagia and overall patient satisfaction with the procedure) diagnostic tools. In the group of patients after pneumatic dilatations, frequency of interventions was higher (1, 2) than in the myotomy group (0, 2) at 2-year follow-up. Patients after myotomy with recurrence of dysphagia were treated with dilations. RESULTS Mean time of dysphagia occurrence was similar in both groups (10 months). The statistically significant differences in treatment outcomes in both groups were in favor of myotomy during 2-year follow-up. CONCLUSIONS The data indicates that both methods of treatment might be useful in dysphagia control, but better results are obtained after myotomy. Repeat interventions are more frequent after endoscopic dilation. One method of treatment does not exclude the other. A short period of symptom relief after myotomy may suggest the myotomy was incomplete.
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Augoff K, Hryniewicz-Jankowska A, Tabola R, Czapla L, Szelachowski P, Grabowski K, Sikorski AF. Abstract 5056: Up-regulated expression and activation of invadopodia-associated proteases in esophageal squamous cell carcinoma (ESCC). Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-5056] [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: 11/16/2022]
Abstract
Abstract
To invade adjacent tissues, cancer cells form special membrane protrusions with high proteolytic activity, named invadopodia. To better understand the role of invadopodia-associated proteolytic systems in the growth of esophageal cancer, we studied the expression of two serine proteases, FAP-alpha and DPPIV, and three metalloproteinases, MMP-2, MMP-9 and MT1-MMP, in a primary ESCC. The enzyme profile was evaluated in relation to the synthesis of cortactin as an important control factor in invadopodia formation and function. The expression and activity of proteases and cortactin in cancer tissues paired with non-cancer tissues were analyzed by RT-PCR, WB and zymography. Tissue samples were obtained from 24 patients who were undergoing surgical resection for esophageal carcinoma. All the tumors had been classified as ESCC and diagnosed as T3 or T4, N1-N3, and M0-M1 according to the TNM classification. The non-cancer tissue samples were taken from the distal area (5-10 cm from the macroscopic changes) and confirmed in histological examinations to be R0. We found an average 3-fold increase in DPPIV expression and an average five-fold higher level of FAP-alpha expression in ESCC over the control tissues. Up-regulation of DPPIV positively correlates with the FAP-alpha expression ratio. FAP-alpha transcripts and DPPIV mRNAs were observed in all the analyzed cancer and non-cancer tissue samples. We found a much higher level of the active MT1-MMP form in cancers relative to paired non-cancer tissues. The correlation between the level of MT1-MMP active form and MMP-2 activity observed in this study shows a tight connection between the two enzymes. We observed enhanced synthesis and activation of both MMP-2 and MMP-9 in cancer tissues. The cancer to normal ratios of the two active gelatinases correlated positively with the expression levels of both serine proteases. We examined the levels of CTTN in the cancer and non-cancer tissues of esophagus in order to find out if CTTN expression is associated with the expression and/or activity of invadopodia proteases. The increased level of CTTN was identified in 35% of ESCC tissues but the differences between groups were not statistically significant. No significant correlation was found between CTTN expression level and any other factors evaluated in our study.
In conclusion, we showed that invadopodia-associated proteases, including FAP-alpha, DPPIV, MT1-MMP, MMP-2 and MMP-9, are significantly up-regulated in ESCC and that it might contribute to a more aggressive esophageal cancer. The presence of FAP-alpha in the cancer-free surgical margin suggests that alterations in the stromal environment may extend much father into surrounding tumor tissues than is usually considered.
Citation Format: Katarzyna Augoff, Anita Hryniewicz-Jankowska, Renata Tabola, Leszek Czapla, Piotr Szelachowski, Krzysztof Grabowski, Aleksander F. Sikorski. Up-regulated expression and activation of invadopodia-associated proteases in esophageal squamous cell carcinoma (ESCC). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5056. doi:10.1158/1538-7445.AM2013-5056
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Augoff K, Grabowski K, Rabczynski J, Kolondra A, Tabola R, Sikorski AF. Expression of decorin in esophageal cancer in relation to the expression of three isoforms of transforming growth factor-beta (TGF-beta1, -beta2, and -beta3) and matrix metalloproteinase-2 activity. Cancer Invest 2009; 27:443-52. [PMID: 19212830 DOI: 10.1080/07357900802527221] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To determine the role of the reactive stroma in cancer progression, we investigated decorin (DCN) and transforming growth factor-beta (TGF-beta expression, and matrix metalloproteinase-2 (MMP-2) activity in the tumorous esophagus. We found statistically insignificantly decreased levels of DCN expression in the pathological tissues. No obvious alterations in TGF-beta expression were noticed. The highly significant increase in MMP-2 activity in cancers did not result in elevated levels of TGF-beta dimers. Therefore, the system of TGF-beta liberation from its complex with DCN by activated MMP-2 does not seem to contribute to esophageal cancerogenesis, although this hypothesis should be reevaluated with a larger study group.
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Affiliation(s)
- K Augoff
- Department of Gastrointestinal and General Surgery, University of Wroclaw, Poland.
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Augoff K, Rabczynski J, Tabola R, Czapla L, Ratajczak K, Grabowski K. Immunohistochemical study of decorin expression in polyps and carcinomas of the colon. Med Sci Monit 2008; 14:CR530-CR535. [PMID: 18830193] [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: 05/26/2023] Open
Abstract
BACKGROUND Recent studies showed that a small leucine-rich proteoglycan, decorin, may suppress tumor progression as a natural anticancer agent negatively controlling cellular growth. It was hypothesized that physiological expression of decorin may be associated with cellular senescence of the colorectal mucosa and that its down-regulation, promoting an increase in cellular proliferation, could participate in the progression of adenoma to adenocarcinoma. Therefore the expression of decorin in hyperplastic and neoplastic polyps of the colorectum was examined and compared with normal colonic mucosa and colon cancer tissues. MATERIAL/METHODS Tissue samples were obtained from 41 patients with different types of colonic polyps (6 hyperplastic adenomas, 34 neoplastic adenomas, and 1 adenomatous polyp with focal carcinoma) and 12 patients with colon cancer. Seven samples of normal colon tissue were used as controls. Paraffin-embedded samples were used for immunohistochemical study. RESULTS Normal and hyperplastic tissues and the majority of tubular adenomas showed strong expression of decorin in the stroma. Adenomas with a villous component showed moderate and very low decorin immunoreactivity. The decrease in decorin reactivity in tubulo-villous adenomas was significant as compared with other polyps and controls. Weak decorin immunoreactivity in stroma adjacent to clusters of cancerous cells was also found in most cases of common types of adenocarcinoma, but not in adenocarcinoma mucinosum. CONCLUSIONS The expression of decorin may be involved in the differentiation of colonic polyps and reduced expression of decorin may abrogate the defensive potential of stromal tissue and promote the development of common types of colon carcinoma.
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Affiliation(s)
- Katarzyna Augoff
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, Wrocław, Poland
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Augoff K, Ratajczak K, Gosk J, Tabola R, Rutowski R. Gelatinase A activity in Dupuytren's disease. J Hand Surg Am 2006; 31:1635-9. [PMID: 17145384 DOI: 10.1016/j.jhsa.2006.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 08/14/2006] [Accepted: 08/15/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE Dupuytren's contracture is a fibroproliferative disorder of the hand characterized by an abnormal myofibroblast and fibroblast proliferation and extracellular matrix deposition leading to retraction and deformation of the palm. Recent studies have shown that molecules of extracellular matrix may coordinate morphogenesis, cell differentiation, and most importantly, fibrogenesis in tissue. Gelatinase A (MMP-2) is a member of the matrix metalloproteinase family of proteolytic enzymes that contribute to remodeling the extracellular matrix by degrading its components. The aim of this study was to determine the level of MMP-2 activation in the palmar fascia of patients with Dupuytren's contracture with reference to the clinical stages of disease progression and recurrence of the contracture after surgery. METHODS The level of relative MMP-2 activation, expressed by the active to latent MMP-2 ratio, was investigated with use of zymography and computerized densitometry in 16 normal and 71 pathologic tissues characterizing different clinical stages of the disease progression. RESULTS We found that the level of MMP-2 activation was significantly elevated in the palmar fascias with Dupuytren's contracture compared with normal tissues. We did not find statistically significant differences between groups with different stages of the disease progression. We also did not find a relation between a high level of MMP-2 activation and the recurrence in the area of surgically treated Dupuytren's contracture. CONCLUSIONS The differences in MMP-2 activation between contractured and normal fascia suggest a participation of this enzyme in the promotion of Dupuytren's disease. We did not find a relationship, however, between the level of MMP-2 activation and the secondary contracture.
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Affiliation(s)
- Katarzyna Augoff
- Department of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland.
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