Early detection of colorectal neoplasia: application of a blood-based serological protein test on subjects undergoing population-based screening.

BACKGROUND: Blood-based biomarkers used for colorectal cancer screening need to be developed and validated in appropriate screening populations. We aimed to develop a cancer-associated protein biomarker test for the detection of colorectal cancer in a screening population. METHODS: Participants from the Danish Colorectal Cancer Screening Program were recruited. Blood samples were collected prior to colonoscopy. The cohort was divided into training and validation sets. We present the results of model development using the training set. Age, sex, and the serological proteins CEA, hsCRP, TIMP-1, Pepsinogen-2, HE4, CyFra21-1, Galectin-3, ferritin and B2M were used to develop a signature test to discriminate between participants with colorectal cancer versus all other findings at colonoscopy. RESULTS: The training set included 4048 FIT-positive participants of whom 242 had a colorectal cancer. The final model for discriminating colorectal cancer versus all other findings at colonoscopy had an AUC of 0.70 (95% CI: 0.66-0.74) and included age, sex, CEA, hsCRP, HE4 and ferritin. CONCLUSION: The performance of the biomarker signature in this FIT-positive screening population did not reflect the positive performance of biomarker signatures seen in symptomatic populations. Additional biomarkers are needed if the serological biomarkers are to be used as a frontline screening test.

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis.

AIMS: The study aimed to assess the diagnostic value of serial monitoring of biochemical inflammatory markers (C-reactive protein (CRP) and white blood cell (WBC) count) in the postoperative diagnosis of anastomotic leakage or ureteral injury after bowel resection for deep infiltrating endometriosis. METHODS: This is a review of prospectively collected data from 217 patients who underwent laparoscopic bowel resection for endometriosis from January 2009 to April 2015. Patients with an anastomotic leakage or ureteral injury were identified and classified. RESULTS: The frequency of anastomotic leakage requiring reoperation was 8.3%. The frequency of ureteral injury was 4.6%. Median time to diagnosis was 6 days for anastomotic leakage and 8 days for ureteral injury. The daily mean values of serum CRP were significantly higher in patients with a surgical complication starting at the second postoperative day (POD 2, p = 0.004). WBC was significantly higher (p < 0.05) on POD 2 and 3 in patients with a surgical complication. A decrease in CRP from POD 1 to 3 predicted an uncomplicated course in 92.1% of the cases. CONCLUSION: A decrease in CRP from POD 1 to 3 was an indicator of uncomplicated subsequent postoperative course. The test is recommended when early discharge after rectal resection for deep infiltrating endometriosis is considered.

Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing laparoscopic and open approaches.

BACKGROUND: Iatrogenic ureteral injury is a rare complication in colorectal surgery. We aimed to investigate the risk of ureteral injury among patients with colorectal cancer operated on with curative intent in Denmark with laparoscopic and open technique. METHOD: The study was based on the Danish National Colorectal Cancer database (DCCG) and included patients treated with intended curative resection for colorectal cancer between 2005 and 2011. From the DCCG database, we extracted data on intraoperative urinary tract injuries. To identify urinary tract injuries not recognized at the time of surgery but within 30 days after surgery, we cross-linked data with the National Patient Registry. All ureteral injuries were confirmed by medical record review. Data were analyzed separately for colon and rectal cancer. RESULTS: A total of 18,474 patients had a resection for colorectal cancer. Eighty-two ureteral injuries were related to colorectal surgery. The rate of ureteral injuries in the entire cohort was 0.44 %, with 37 (0.59 %) injuries in the laparoscopic group (n = 6,291) and 45 (0.37 %) injuries in the open group (n = 12,183), (P = 0.03). No difference in ureteral injury was found in relation to surgical approach in colon cancer patients. In rectum cancer patients (n = 5,959), the laparoscopic approach was used in 1,899 patients, and 19 (1.00 %) had ureteral injuries, whereas 17 (0.42 %) of 4,060 patients who underwent an open resection had a ureteral injury. In multivariate analysis adjusted for age, gender, ASA score, BMI, tumor stage, preoperative chemo-radiation, calendar year, and specialty of the surgeon, the laparoscopic approach was associated with an increased risk of ureteral injury, OR = 2.67; 95 % CI 1.26-5.65. CONCLUSION: In this nationwide study laparoscopic surgery for rectal cancer with curative intent was associated with a significantly increased risk of iatrogenic ureteral injury compared to open surgery.

Long-term follow-up of laparoscopic repair of parastomal hernia using a bilayer mesh with a slit.

BACKGROUND: Open surgery for parastomal hernia has been associated with high morbidity and recurrence rates exceeding 50%. Laparoscopic mesh repair is a promising alternative. Published series on laparoscopic mesh repair of parastomal hernia, however, are few with relative short follow-up. METHODS: Seventy-two consecutive patients with 48 paracolostomy and 24 paraileostomy hernias were studied prospectively. Using a two-layer mesh with polypropylene on the parietal side and nonadhesive PTFE toward the viscera, a slit with a central keyhole was cut in the mesh modified after Hofstetter. Covering the fascial defect, the slit was closed laterally. Of the 70 patients discharged alive, 66 were followed for 6 months to 11 years (median=3 years). Four patients were lost for follow-up. RESULTS: Lysis of adhesions to the anterior abdominal wall, necessary in 68 patients (94%), was frequently a cumbersome and time-consuming task. In nine patients it was the apparent cause of inadvertent full-thickness enterotomy and seromuscular lesion in three and six patients, respectively. Three procedures (4%) were converted to open surgery. Postoperative complications were observed in 16 patients (22%), nine of whom required repeat surgery (13%). Two patients (3%) died. The median hospital stay was 3 days. Late mesh-related complications were observed in five patients (7%) after 5-34 months. Three patients developed abscess that required mesh removal in two patients, including one patient with a small bowel fistula. In two patients the mesh was removed because of small-bowel obstruction and stenosis of the colon at the level of the mesh, respectively. Parastomal hernia recurred in two patients 1 month and 52 months after surgery (recurrence rate=3%, 95% confidence interval=1-10). CONCLUSIONS: Laparoscopic repair of parastomal hernia using bilayer mesh with a slit is associated with a risk of substantial postoperative morbidity, including late mesh-related complications, but a recurrence rate of less than 10%.

[Toothpick perforation in the ventricle].

A 60-year-old male was admitted with acute abdominal pain and fever. Computed tomography (CT) of the abdomen revealed free air. Diagnostic laparoscopy showed a toothpick perforating the ventricle, and the toothpick was removed successfully. This condition is severe with a reported mortality of 9.6%. A practical guideline based on 136 cases was presented in 2014. Endoscopy was found to be superior to CT in identifying toothpicks as well as offering therapeutic intervention, rendering endoscopy the first choice in diagnostic and treatment. Subsequently CT or ultrasound is recommended in the unresolved patient.

[Traumatic duodenal perforation in a 16 month-old girl]. / Perforation af duodenum efter banalt traume hos en 16 måneder gammel pige.

Duodenal injury following a blunt abdominal trauma is a rare condition. It poses a diagnostic challenge since symptoms are often subtle in the beginning and the trauma may initially remain undisclosed. We present a case of a 16 month-old girl, who was admitted to hospital due to critical illness after a tumble the day before. An explorative laparotomy revealed a perforation of the duodenum. This case demonstrates the importance of thoroughly evaluating anamnesis information and emphasises the need of considering a variety of potential diagnoses when assessing the critically ill child.

[Breast cancer metastasis to the colon]. / Cancer mammae med metastase til colon.

A 69-year-old woman was admitted with diarrhoea, anaemia and elevated C-reactive protein. She was diagnosed with metastases of a carcinoma to the colon; the immunohistochemical profile made lobular breast cancer the most likely primary tumour. But despite thorough examination, such tumour was never found. Twenty-two years earlier, the patient underwent surgery for a benign breast tumour. The benign diagnosis was confirmed in new slides from the then removed tissue. Metastases from breast cancer to the colon are rare, and a primary tumour is usually found. In this case report, however, no primary tumour was found.

[Study of the quality of colonoscopies]. / Koloskopier--en kvalitetsundersøgelse.

INTRODUCTION: The quality of colonoscopy in Denmark has been questioned over the last few years. In order to explore any differences between international standards and local department performance a prospective study of the quality of colonoscopies was made. MATERIALS AND METHODS: Over 5 months 342 consecutive colonoscopies were examined at Randers Hospital, surgical department K. Success rate, patient characteristics, time usage, endoscopic procedures, charge and usage of x-ray were monitored. RESULTS: Patient characteristics were comparable with other studies. The rate of success for cecal intubation was 93% of all colonoscopies. Mean time for cecal intubation was 12 minutes and 17 seconds for experienced doctors while the group of trainees used 17 minutes and 54 seconds. Experienced doctors performed 80% of all colonoscopies. X-ray was used in 5 colonoscopies. CONCLUSION: The usage of time and the rate of success in cecal intubation reach the quality standards of comparable international studies. In addition, usage of x-ray seems irrelevant in achieving cecal intubation. The distribution of colonoscopies between experienced doctors and trainees lowers opportunities for education of trainees.