Sarcopaenia, obesity, sarcopaenic obesity and outcomes following hepatic resection for colorectal liver metastases: a systematic review and meta-analysis.

BACKGROUND: Obesity is a risk factor for the development of colorectal cancer. Limited evidence exists about outcomes for obese patients undergoing hepatic resection for colorectal liver metastases (CRLM). Sarcopaenia is characterised by a decline in muscle function and muscle mass. It is associated with poorer outcomes for patients on chemotherapy, but there are limited data for sarcopaenic patients undergoing hepatic resection for CRLM. METHODS: Pubmed, Embase, Cochrane Central, Web of Science, SCOPUS, and CINAHL databases were searched for articles which were selected in accordance with PRISMA guidelines. Primary outcomes were overall survival (OS) and disease-free survival (DFS). A random effects meta-analysis was conducted. RESULTS: Thirteen studies were included incorporating 2936 patients. No significant difference was found between obese and non-obese patients in OS (HR 0.81, CI 0.47-1.39, p = 0.44) or DFS (HR 1.0, CI 0.99-1.01, p = 0.98). Sarcopaenia was associated with worse OS (HR 1.65, CI 1.10-2.48, p = 0.01), and increased major post operative complications (OR 1.91, CI 1.16-3.14, p = 0.01). Only one study examined outcomes for sarcopaenic obese patients. CONCLUSION: Limited evidence exists describing the impact of obesity and sarcopenia on outcomes following hepatic resection for CRLM. Obese patients do not have worse oncological outcomes, whereas sarcopaenia is associated with poorer long-term survival.

Colorectal microbiota after removal of colorectal cancer.

The colonic microbiome has been implicated in the pathogenesis of colorectal cancer (CRC) and intestinal microbiome alterations are not confined to the tumour. Since data on whether the microbiome normalises or remains altered after resection of CRC are conflicting, we studied the colonic microbiota of patients after resection of CRC. We profiled the microbiota using 16S rRNA gene amplicon sequencing in colonic biopsies from patients after resection of CRC (n = 63) in comparison with controls (n = 52), subjects with newly diagnosed CRC (n = 93) and polyps (i = 28). The colonic microbiota after surgical resection remained significantly different from that of controls in 65% of patients. Genus-level profiling and beta-diversity confirmed two distinct groups of patients after resection of CRC: one with an abnormal microbiota similar to that of patients with newly diagnosed CRC and another similar to non-CRC controls. Consumption levels of several dietary ingredients and cardiovascular drugs co-varied with differences in microbiota composition suggesting lifestyle factors may modulate differential microbiome trajectories after surgical resection. This study supports investigation of the colonic microbiota as a marker of risk for development of CRC.

Impaction of swallowed dentures in the sigmoid colon requiring sigmoid colectomy.

INTRODUCTION: Foreign body (FB) ingestion results in perforation in 1% of cases and is associated with significant morbidity and rarely mortality. Clinical presentation is variable and can present a diagnostic challenge. We report our experience and management of a patient with a delayed presentation of a sigmoid colon foreign body as a result of ingestion of a dental plate. PRESENTATION OF CASE: A 67 year old female attended the colorectal outpatient clinic following an incidental finding of a sigmoid mass on computed tomography (CT) abdomen. Further investigation identified a dental plate impacted in a thickened sigmoid colon. On further questioning the patient recalled losing her dentures three years previously. At surgery the dental plate had partially eroded through the sigmoid colon into the pelvic side wall. A sigmoid colectomy and hand sewn end-to-end colo-colic anastomosis was performed. DISCUSSION: Localised perforation following ingestion of a foreign body may result in significant morbidity. Extra luminal migration and local inflammatory response resulted in the formation of a walled off collection. Delayed complications of perforation include abscess and fistula formation. CONCLUSION: Clinicians need to exhibit a high index of suspicion when treating edentulous patients and alcohol and drug abusers who present with an acute abdomen or a sub-acute presentation with associated atypical imaging and endoscopic findings. The decision regarding intervention and management strategy in cases of perforation by foreign body depends on chronicity of the case, extent of localised or diffuse peritonitis, and size of the lesion or area of bowel involved.