[Strategies to advance recovery (STAR) protocol implemented colorectal cancer patients during the COVID-19 pandemic]. / En época de COVID-19: ¿cómo las estrategias de recuperación avanzadas (STAR) pueden ayudar a dar soluciones a los pacientes oncológicos?

BACKGROUND: SARS-CoV-2 hampered the resolution of multiple diseases, including cancer. AIM: To show that a multidisciplinary program of Strategies to Advance Recovery (STAR) can be implemented in a public hospital in Chile, despite the global pandemic and state of a national catastrophe, to provide a solution to cancer patients. MATERIAL AND METHODS: A retrospective descriptive study, of patients requiring an elective resolution of a colorectal cancer. Patients met the inclusion criteria, established in the STAR program. A total of 24 perioperative interventions were performed in the protocol. Demographic variables, days of hospitalization, complications, mortality, and readmissions were described. RESULTS: The 24 interventions of the protocol were successfully implemented, although some partially. Sixteen patients aged 53 to 83 years (50% women) were operated. The median length of hospitalization was four days (range 2 to 9). Four complications were recorded, all were grade I or II according to the Clavien-Dindo classification. Two patients were readmitted. There were no reoperations or mortality. One patient was infected with coronavirus, diagnosed at the time of readmission. CONCLUSIONS: The STAR protocol reduces the length of hospital stay. In a pandemic context such as COVID-19 it becomes a useful resource and can be implemented in cancer patients, as herein reported.

[Homozygous germline mutation in MUTYH gene in familial adenomatous polyposis]. / Mutación homocigota en la línea germinal del gen MUTYH en una paciente chilena con poliposis adenomatosa familiar.

Recently, MUTYH mutations have been reported to predispose to the development of polyposis. However, polyposis caused by mutations in MUTYH has been characterized as an autosomal recessive hereditary disease, different from the autosomal dominant pattern observed in polyposis caused by APC mutations. We report a 41-year-old female consulting for anemia. Colonoscopy detected multiple sessile polyps and a cecal carcinoma. The patient was operated and in the surgical piece, the tumor invaded serosa and there was lymph node involvement. Approximately 100 polyps were found. The patient received 5-fluorouracil, as adjuvant therapy. The patient had a sister (of a total of 12 brothers) with a colorectal carcinoma. The genetic study identified a homozygous mutation of the MUTYH gene, called c.340T > C, that produces an amino acid change of tyrosine for histidine called p.Y114H. The sister with colorectal cancer was a heterozygous carrier of this mutation.

[A screening program for colorectal cancer in Chilean subjects aged fifty years or more]. / Programa de detección de neoplasias colorrectales en población mayor de 50 años.

BACKGROUND: Mortality from colorectal cancer (CCR) in Chile has nearly doubled over the past 15 years. International studies have shown that CCR screening programs based on fecal occult blood test (FOBT) reduce CCR mortality. AIM: To analyze the results from a CCR screening model in people over 50 years. MATERIAL AND METHODS: Between 2007 and 2009, a prospective multicenter study was performed in seven major Chilean cities. FOBT using an immunological method, was measured in asymptomatic subjects aged 50 years or more, without risk factors. In patients with a positive FOBT, with symptoms or with family risk factors, a colonoscopy was indicated. RESULTS: A total of 6348 subjects were assessed, FOBT was performed in 4938 of them, with a compliance of 77%. The result was positive in 9.6%. A total of 2359 colonoscopies were ordered, with an overall compliance of 50.1%. Of the 1184 colonoscopies performed, adenomas and high risk adenomas were found in 304 (26%) and 75 (6%) patients, respectively. Thirteen patients were diagnosed with stage I and IICCR. Three of these lesions were excised endoscopically and 10 surgically. The detection rate of polyps, high risk adenomas and cancer was 75, 12 and 2 per 1000 screened individuals, respectively. CONCLUSIONS: This program allowed the early detection of an important number of high risk colon lesions, and all patients with CCR were diagnosed at early stages.

En época de COVID-19: ¿cómo las estrategias de recuperación avanzadas (STAR) pueden ayudar a dar soluciones a los pacientes oncológicos? / Strategies to advance recovery (STAR) protocol implemented colorectal cancer patients during the COVID-19 pandemic

Background: SARS-CoV-2 hampered the resolution of multiple diseases, including cancer. Aim: To show that a multidisciplinary program of Strategies to Advance Recovery (STAR) can be implemented in a public hospital in Chile, despite the global pandemic and state of a national catastrophe, to provide a solution to cancer patients. Material and Methods: A retrospective descriptive study, of patients requiring an elective resolution of a colorectal cancer. Patients met the inclusion criteria, established in the STAR program. A total of 24 perioperative interventions were performed in the protocol. Demographic variables, days of hospitalization, complications, mortality, and readmissions were described. Results: The 24 interventions of the protocol were successfully implemented, although some partially. Sixteen patients aged 53 to 83 years (50% women) were operated. The median length of hospitalization was four days (range 2 to 9). Four complications were recorded, all were grade I or II according to the Clavien-Dindo classification. Two patients were readmitted. There were no reoperations or mortality. One patient was infected with coronavirus, diagnosed at the time of readmission. Conclusions: The STAR protocol reduces the length of hospital stay. In a pandemic context such as COVID-19 it becomes a useful resource and can be implemented in cancer patients, as herein reported.

Soluble ST2: a new and promising activity marker in ulcerative colitis.

AIM: To correlate circulating soluble ST2 (sST2) levels with the severity of ulcerative colitis (UC) and serum levels of pro-inflammatory cytokines, and to demonstrate the predictive power of sST2 levels for differentiation between active and inactive UC. METHODS: We recruited 153 patients: 82 with UC, 26 with Crohn's disease (CD) and 43 disease controls [non-inflammatory bowel disease (IBD)]. Subjects were excluded if they had diagnosis of asthma, autoimmune diseases or hypertension. The serum levels of sST2 and pro-inflammatory cytokines [pg/mL; median (25th-75th)] as well as clinical features, endoscopic and histological features, were subjected to analyses. The sST2 performance for discrimination between active and inactive UC, non-IBD and healthy controls (HC) was determined with regard to sensitivity and specificity, and Spearman's rank correlation coefficient (r). To validate the method, the area under the curve (AUC) of receiver-operator characteristic (ROC) was determined (AUC, 95% CI) and the total ST2 content of the colonic mucosa in UC patients was correlated with circulating levels of sST2. RESULTS: The serum sST2 value was significantly higher in patients with active [235.80 (90.65-367.90) pg/mL] rather than inactive UC [33.19 (20.04-65.32) pg/mL], based on clinical, endoscopic and histopathological characteristics, as well as compared with non-IBD and HC (P < 0.001). The median level of sST2 in CD patients was 54.17 (35.02-122.0) pg/mL, significantly higher than that of the HC group only (P < 0.01). The cutoff was set at 74.87 pg/mL to compare active with inactive UC in a multicenter cohort of patients. Values of sensitivity, specificity, and ability to correctly classify UC, according to activity, were 83.33%, 83.33% and 83.33%, respectively. The AUC of the ROC curve to assess the ability of this molecule to discriminate between active vs inactive UC was 0.92 (0.86-0.97, P < 0.0001). The serum levels of sST2 in patients with UC significantly correlated with endoscopic and histopathological scores (r = 0.76 and r = 0.67, P < 0.0001, respectively), and with the pro-inflammatory cytokine, tumor necrosis factor-α (r = 0.69 and r = 0.61, respectively, P < 0.0001). Interestingly, we found a direct correlation between total intestinal ST2 content and serum levels of sST2, adjusted to endoscopic activity score in patients with mild (r = 0.44, P = 0.004), moderate (r = 0.59, P = 0.002) and severe disease (r = 0.82, P = 0.002). Only patients with inactive UC showed no significant correlation (r = 0.45, P = 0.267). CONCLUSION: sST2 levels correlated with disease severity and inflammatory cytokines, are able to differentiate active from inactive UC and might have a role as a biomarker.

Mutación homocigota en la línea germinal del gen MUTYH en una paciente chilena con poliposis adenomatosa familiar / Homozygous germline mutation in MUTYH gene in familial adenomatous polyposis

Recently, MUTYH mutations have been reported to predispose to the development of polyposis. However, polyposis caused by mutations in MUTYH has been characterized as an autosomal recessive hereditary disease, different from the autosomal dominant pattern observed in polyposis caused by APC mutations. We report a 41-year-old female consulting for anemia. Colonoscopy detected multiple sessile polyps and a cecal carcinoma. The patient was operated and in the surgical piece, the tumor invaded serosa and there was lymph node involvement. Approximately 100 polyps were found. The patient received 5-fluorouracil, as adjuvant therapy. The patient had a sister (of a total of 12 brothers) with a colorectal carcinoma. The genetic study identified a homozygous mutation of the MUTYH gene, called c.340T > C, that produces an amino acid change of tyrosine for histidine called p.Y114H. The sister with colorectal cancer was a heterozygous carrier of this mutation.

Programa de detección de neoplasias colorrectales en población mayor de 50 años / A screening program for colorectal cancer in Chilean subjects aged fifty years or more

Background: Mortality from colorectal cancer (CCR) in Chile has nearly doubled over the past 15 years. International studies have shown that CCR screening programs based on fecal occult blood test (FOBT) reduce CCR mortality. Aim: To analyze the results from a CCR screening model in people over 50 years. Material and Methods: Between 2007 and 2009, a prospective multicenter study was performed in seven major Chilean cities. FOBT using an immunological method, was measured in asymptomatic subjects aged 50 years or more, without risk factors. In patients with a positive FOBT, with symptoms or with family risk factors, a colonoscopy was indicated. Results: A total of 6348 subjects were assessed, FOBT was performed in 4938 of them, with a compliance of 77%. The result was positive in 9.6%. A total of 2359 colonoscopies were ordered, with an overall compliance of 50.1%. Of the 1184 colonoscopies performed, adenomas and high risk adenomas were found in 304 (26%) and 75 (6%) patients, respectively. Thirteen patients were diagnosed with stage I and IICCR. Three of these lesions were excised endoscopically and 10 surgically. The detection rate of polyps, high risk adenomas and cancer was 75, 12 and 2 per 1000 screened individuals, respectively. Conclusions: This program allowed the early detection of an important number of high risk colon lesions, and all patients with CCR were diagnosed at early stages.