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1.
Curr Issues Mol Biol ; 46(2): 1208-1218, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-38392195

RESUMEN

Gastric cancer (GC) persists as the fourth most prevalent cause of global cancer-related mortality, presenting a challenge due to the scarcity of available therapeutic strategies. Precision medicine is crucial not only in the treatment but also in the management of GC. We performed gene panel sequencing with Oncomine focus assay comprising 52 cancer-associated genes and MSI analysis in 100 case-matched gastric cancer cases. A comprehensive analysis of clinical and genetic characteristics was conducted on these genetic results and clinicopathological findings. Upon comparison of clinicopathological characteristics, significant differences between early gastric cancer (EGC) and advanced gastric cancer (AGC) were observed in tumor location (p = 0.003), Lauren classification (p = 0.015), T stage (p = 0.000), and N stage (p = 0.015). The six most frequently mutated genes were PIK3CA (29%, 10/35), ERBB2 (17%, 6/35), KRAS (14%, 5/35), ALK (6%, 2/35), ESR1 (6%, 2/35), and FGFR3 (6%, 2/35). Regarding genetic variation, there was a tendency for the N stage to be higher in GC patients with mutated genes (p = 0.014). The frequency of mutations in GC patients was statistically significantly higher in AGC (n = 24) compared to EGC (n = 11) (odds ratio, 2.792; 95% confidence interval, 1.113 to 7.007; p = 0.026). Six of the ten GC patients carrying mutated genes and exhibiting MSI were classified into intestinal-type and undifferentiated GC, with the location of the tumor being in the lower-third. Among these patients, five harbored mutated PIK3CA, while the remaining patient had a mutation in ALK. Conclusions: AGC patients more frequently exhibited alterations of PIK3CA, KRAS, and ERBB2 as somatic oncogenic drivers, and displayed a higher prevalence of cumulative genetic events, including increased rates of PIK3CA mutations, enhanced detection of immunotherapy biomarkers, and mutations of the ESR1 gene.

2.
BMC Cancer ; 24(1): 397, 2024 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-38553680

RESUMEN

BACKGROUND: High-risk stage III colon cancer has a considerably poorer prognosis than stage II and low-risk stage III colon cancers. Nevertheless, most guidelines recommend similar adjuvant treatment approaches for all these stages despite the dearth of research focusing on high-risk stage III colon cancer and the potential for improved prognosis with intensive adjuvant treatment. Given the the proven efficacy of triplet chemotherapy in metastatic colorectal cancer treatment, the goal of this study is to evaluate the oncologic efficacy and safety of mFOLFIRINOX in comparison to those of the current standard of care, mFOLFOX 6, as an adjuvant treatment for patients diagnosed with high-risk stage III colon cancer after radical resection. METHODS: This multicenter, randomized (1:1), open-label, phase II trial will assess and compare the effectiveness and toxicity of mFOLFIRINOX and mFOLFOX 6 in patients with high-risk stage III colon cancer after radical resection. The goal of the trial is to enroll 312 eligible patients, from 11 institutes, aged between 20 and 70 years, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, or between 70 and 75 with an ECOG performance status of 0. Patients will be randomized into two arms - Arm A, the experimental arm, and Arm B, the reference arm - and will receive 12 cycles of mFOLFIRINOX and mFOLFOX 6 every 2 weeks, respectively. The primary endpoint of this study is the 3-year disease-free survival, and secondary endpoints include the 3-year overall survival and treatment toxicity. DISCUSSION: The Frost trial would help determine the oncologic efficacy and safety of adjuvant triplet chemotherapy for high-risk stage III colon cancers and ultimately improve prognoses. TRIAL REGISTRATION: ClinicalTrials.gov NCT05179889, registered on 17 December 2021.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias del Colon , Adulto , Anciano , Humanos , Persona de Mediana Edad , Adulto Joven , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Quimioterapia Adyuvante , Ensayos Clínicos Fase II como Asunto , Neoplasias del Colon/patología , Supervivencia sin Enfermedad , Estudios Multicéntricos como Asunto , Supervivencia sin Progresión , Ensayos Clínicos Controlados Aleatorios como Asunto , Fluorouracilo/uso terapéutico
3.
Dig Dis Sci ; 69(9): 3305-3317, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39090444

RESUMEN

BACKGROUND: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is an attractive target for the treatment of various malignancies; however, its therapeutic potential is limited because of the frequent occurrence of tumor cell resistance. In this study, we determined whether TRAIL resistance acquired by repeated administration could be overcome by HDAC inhibition in human colorectal cancer cells. METHODS: TRAIL-resistant HCT116 human colorectal cancer cells (HCT116-TR) were generated by repeated treatment with 10 and 25 ng/mL TRAIL twice weekly for 28 days. RESULTS: The resulting TRAIL-resistant cells were noncross-resistant to other chemotherapeutic agents. The levels of histone acetylation-related proteins, such as ac-histone H4 and HDAC1, were altered in HCT116-TR cells compared with the parental HCT116 cell line. The combined treatment with TRAIL and HDAC inhibitors significantly increased apoptosis in HCT116-TR cells and indicated a synergistic effect. The mechanism by which HDAC inhibition sensitizes HCT116-TR cells to TRAIL is dependent on the intrinsic pathway. In addition, we found that HDAC inhibition enhanced the sensitivity of cells to TRAIL through mitogen-activated protein kinases/CCAAT/enhancer-binding protein homologs of protein-dependent upregulation of death receptor 5. CONCLUSION: These results suggest that histone acetylation is responsible for acquired TRAIL resistance after repeated exposure and acquired resistance to TRAIL may be overcome by combination therapies with HDAC inhibitors.


Asunto(s)
Apoptosis , Neoplasias Colorrectales , Resistencia a Antineoplásicos , Sinergismo Farmacológico , Inhibidores de Histona Desacetilasas , Histonas , Ligando Inductor de Apoptosis Relacionado con TNF , Humanos , Ligando Inductor de Apoptosis Relacionado con TNF/metabolismo , Ligando Inductor de Apoptosis Relacionado con TNF/farmacología , Inhibidores de Histona Desacetilasas/farmacología , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/metabolismo , Neoplasias Colorrectales/patología , Acetilación , Resistencia a Antineoplásicos/efectos de los fármacos , Células HCT116 , Histonas/metabolismo , Apoptosis/efectos de los fármacos
4.
BMC Cancer ; 23(1): 1059, 2023 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-37923987

RESUMEN

BACKGROUND: Preoperative (chemo)radiotherapy has been widely used as an effective treatment for locally advanced rectal cancer (LARC), leading to a significant reduction in pelvic recurrence rates. Because early administration of intensive chemotherapy for LARC has more advantages than adjuvant chemotherapy, total neoadjuvant therapy (TNT) has been introduced and evaluated to determine whether it can improve tumor response or treatment outcomes. This study aims to investigate whether short-course radiotherapy (SCRT) followed by intensive chemotherapy improves oncologic outcomes compared with traditional preoperative long-course chemoradiotherapy (CRT). METHODS: A multicenter randomized phase II trial involving 364 patients with LARC (cT3-4, cN+, or presence of extramural vascular invasion) will be conducted. Patients will be randomly assigned to the experimental or control arm at a ratio of 1:1. Participants in the experimental arm will receive SCRT (25 Gy in 5 fractions, daily) followed by four cycles of FOLFOX (oxaliplatin, 5-fluorouracil, and folinic acid) as a neoadjuvant treatment, and those in the control arm will receive conventional radiotherapy (45-50.4 Gy in 25-28 fractions, 5 times a week) concurrently with capecitabine or 5-fluorouracil. As a mandatory surgical procedure, total mesorectal excision will be performed 2-5 weeks from the last cycle of chemotherapy in the experimental arm and 6-8 weeks after the last day of radiotherapy in the control arm. The primary endpoint is 3-year disease-free survival, and the secondary endpoints are tumor response, overall survival, toxicities, quality of life, and cost-effectiveness. DISCUSSION: This is the first Korean randomized controlled study comparing SCRT-based TNT with traditional preoperative LC-CRT for LARC. The involvement of experienced colorectal surgeons ensures high-quality surgical resection. SCRT followed by FOLFOX chemotherapy is expected to improve disease-free survival compared with CRT, with potential advantages in tumor response, quality of life, and cost-effectiveness. TRIAL REGISTRATION: This trial is registered at Clinical Research Information under the identifier Service KCT0004874 on April 02, 2020, and at Clinicaltrial.gov under the identifier NCT05673772 on January 06, 2023.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto , Humanos , Terapia Neoadyuvante/métodos , Calidad de Vida , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Fluorouracilo/uso terapéutico , Neoplasias del Recto/radioterapia , Neoplasias del Recto/tratamiento farmacológico , Quimioradioterapia/métodos , Estadificación de Neoplasias
5.
BMC Cancer ; 22(1): 940, 2022 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-36045334

RESUMEN

In human colorectal cancer (CRC), TP53 is one of the most important driver genes. Immunohistochemistry (IHC) has been used most often to assess the variational status of TP53. Recently, next-generation sequencing (NGS) of the TP53 gene has increased. However, to our knowledge, a comparison between TP53 status evaluated by IHC and NGS has not been studied. Therefore, the primary aim of this study was to compare the clinical effect of TP53 status evaluated by IHC and NGS in patients with CRC. The secondary aim was to investigate the correlation between expression of p53 by IHC and variational status of TP53 by NGS. We performed immunohistochemical staining of p53 and sequencing of TP53 by NGS in 204 human samples of CRC. We then analyzed the correlation between variational status of TP53 and p53 expression, along with their prognostic impact in CRC patients. There was significant correlation between p53 expression and TP53 variation, TP53 variation and higher N stage, and positive p53 expression and higher N stage. Positive IHC expression of p53 was significantly associated with overall survival (OS) of CRC patients by univariate analysis and was revealed as an independent prognostic factor by multivariate analysis. Additionally, the nonsense/frameshift p53 expression pattern showed a significantly better prognosis than the wild type and missense p53 expression patterns. However, the variational status of TP53 was not significant in OS of CRC patients. These results suggest that IHC expression of p53 protein correlates with variation status of TP53 and expression of p53 protein rather than variation status of TP53 has more significant impact on the OS of CRC patients.


Asunto(s)
Neoplasias Colorrectales , Genes p53 , Neoplasias Colorrectales/genética , Humanos , Inmunohistoquímica , Mutación , Pronóstico , Proteína p53 Supresora de Tumor/genética , Proteína p53 Supresora de Tumor/metabolismo
6.
Int J Colorectal Dis ; 37(1): 141-151, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34595585

RESUMEN

PURPOSE: The presence of tumor deposits (TDs) in colorectal cancer is associated with a poor prognosis. In patients with the concomitant presence of both TDs and lymph nodes (LNs), there is no staging option except for the number of positive LNs alone. Therefore, to determine the prognostic value of TDs in patients with stage III colorectal cancer, meta-analyses of survival outcomes of patients with TDs were performed comparing different subgroups based on the lymph node status. METHODS: PubMed, EMBASE, and the Cochrane Library were searched. Data were pooled, and overall effect size was calculated using random-effect models. Outcome measures were 5-year overall survival (OS) and 5-year disease-free survival (DFS). RESULTS: We included in the analysis 18 nonrandomized studies and 1 prospective study that examined 90,455 patients. N1c patients (TD + LN-) had worse 5-year DFS than TDs-negative stage III patients (TD-LN +) with a RR of 1.30 (95% CI 1.06-1.61, I2 = 47%). In subgroup analysis, N1c patients had worse 5-year DFS (RR = 1.60, 95% CI = 1.25-2.05, I2 = 40%) compared with TDs-negative N1 patients (TD-N1) whereas N1c patients had better 5-year OS (RR = 0.72, 95% CI = 0.62-0.83, I2 = 0%) and 5-year DFS (RR = 0.75, 95% CI = 0.57-0.99, I2 = 0%) compared with TDs-negative N2 patients (TD-N2). CONCLUSIONS: These results may suggest that current nodal staging for colorectal cancer needs modification. The presence of TDs may have more adverse oncologic outcomes than TDs-negative N1 patients. More studies are warranted to further verify these results.


Asunto(s)
Neoplasias Colorrectales , Extensión Extranodal , Neoplasias Colorrectales/patología , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Estadificación de Neoplasias , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos
7.
Surg Endosc ; 36(5): 3122-3135, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-34169371

RESUMEN

BACKGROUND: Transanal total mesorectal excision (TaTME) appears to have favorable surgical and pathological outcomes. However, the evidence on survival outcomes remains unclear. We performed a meta-analysis to compare long-term oncologic outcomes of TaTME with transabdominal TME for rectal cancer. METHODS: PubMed, EMBASE, and the Cochrane Library were searched. Data were pooled, and overall effect size was calculated using random-effects models. Outcome measures were overall survival (OS), disease-free survival (DFS), and local and distant recurrence. RESULTS: We included 11 nonrandomized studies that examined 2,143 patients for the meta-analysis. There were no significant differences between the two groups in OS, DFS, and local and distant recurrence with a RR of 0.65 (95% CI 0.39-1.09, I2 = 0%), 0.79 (95% CI 0.57-1.10, I2 = 0%), 1.14 (95% CI 0.44-2.91, I2 = 66%), and 0.75 (95% CI 0.40-1.41, I2 = 0%), respectively. CONCLUSION: In terms of long-term oncologic outcomes, TaTME may be an alternative to transabdominal TME in patients with rectal cancer. Well-designed randomized trials are warranted to further verify these results.


Asunto(s)
Laparoscopía , Neoplasias del Recto , Cirugía Endoscópica Transanal , Humanos , Laparoscopía/métodos , Complicaciones Posoperatorias/cirugía , Neoplasias del Recto/patología , Recto/cirugía , Cirugía Endoscópica Transanal/métodos , Resultado del Tratamiento
8.
Ann Surg Oncol ; 26(5): 1366-1375, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30805809

RESUMEN

BACKGROUND: Previous studies comparing the oncologic outcomes of primary tumor-sidedness for patients with colon cancer have reported a worse prognosis for those with right-sided tumors. However, most of these studies evaluated patients with metastatic disease. METHODS: PubMed, EMBASE, and the Cochrane Library were searched for studies that assessed the effects of primary tumor-sidedness on survival outcomes for patients with stages 1, 2, and 3 colon cancer. The hazard ratio (HR) for primary tumor location was estimated for overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS). RESULTS: The inclusion criteria were met by 37 studies involving 581,542 patients. The patients with a right-sided tumor had better CSS (HR, 0.67; 95% confidence interval [CI], 0.56-0.80; p < 0.0001) among those with stage 1 cancer as well as better OS (HR, 0.89; 95% CI 0.86-0.92; I2 = 19%) and CSS (HR, 0.78; 95% CI 0.70-0.86; I2 = 78%) among those with stage 2 cancer. In contrast, among the patients with stage 3 cancer, those with a right-sided tumor had worse OS (HR, 1.12; 95% CI 1.04-1.20; p = 0.002), CSS (HR, 1.05; 95% CI 1.01-1.10; p = 0.02), and DFS (HR, 1.32; 95% CI 1.07-1.63; p = 0.008). CONCLUSIONS: Primary tumor location may be a prognostic factor for patients with non-metastatic colon cancer. The prognosis for patients with right-sided tumor may be better for those with stage 1 or 2 cancer, but worse for those with stage 3 cancer.


Asunto(s)
Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Neoplasias del Colon/mortalidad , Neoplasias del Colon/patología , Estudios de Seguimiento , Humanos , Estadificación de Neoplasias , Tasa de Supervivencia
9.
Ann Surg Oncol ; 24(11): 3289-3299, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28608118

RESUMEN

BACKGROUND: Anastomotic leakage (AL) is a major complication of surgery for colorectal cancer (CRC), and is associated with increased morbidity and mortality; However, there are conflicting results on the impact of AL on long-term oncologic outcomes. OBJECTIVE: The aim of this meta-analysis was to assess the oncologic outcomes of AL following restorative surgery for CRC. METHODS: Multiple comprehensive databases, including PubMed, EMBASE, and The Cochrane Library, were searched for studies that assessed the oncologic effects of AL following surgery for CRC. The included studies evaluated local and distant recurrence, overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Outcome data were pooled, and overall effect size was calculated using random effects models. RESULTS: Thirty-four nonrandomized studies including 78,434 patients met the inclusion criteria. The results show that AL was associated with increased local recurrence (relative risk [RR] 1.90, 95% confidence interval [CI] 1.48-2.44, I 2 = 78%) and reduced OS (RR 1.36, 95% CI 1.24-1.50, I 2 = 74%), CSS (RR 1.41, 95% CI 1.19-1.68, I 2 = 56%), and DFS (RR 1.40, 95% CI 1.20-1.63, I 2 = 86%). AL had no significant effect on distant recurrence (RR 1.20, 95% CI 0.94-1.53, I 2 = 61%). CONCLUSIONS: AL after restorative surgery for CRC is associated with increased local recurrence and reduced long-term survival, including OS, CSS, and DFS.


Asunto(s)
Fuga Anastomótica/etiología , Fuga Anastomótica/mortalidad , Neoplasias Colorrectales/cirugía , Cirugía Colorrectal/efectos adversos , Humanos , Pronóstico , Tasa de Supervivencia
10.
Dig Dis Sci ; 61(4): 1060-8, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26660905

RESUMEN

BACKGROUND: Renin-angiotensin system is involved in the pathophysiology of colonic inflammation. However, there are a few reports about modulation of natriuretic peptide system. AIMS: This study investigates whether a local atrial natriuretic peptide (ANP) system exists in rat colon and whether ANP plays a role in the regulation of colonic motility in experimental colitis rat model. METHODS: Experimental colitis was induced by an intake of 5 % dextran sulfate sodium (DSS) dissolved in tap water for 7 days. After rats were killed, plasma hormone concentrations and mRNAs for natriuretic peptide system were measured. Functional analysis of colonic motility in response to ANP was performed using taenia coli. RESULTS: DSS-treated colon showed an increased necrosis with massive infiltration of inflammatory cells. The colonic natriuretic peptide receptor-A mRNA level and particulate guanylyl cyclase activity in response to ANP from colonic tissue membranes were higher, and the mRNA levels of ANP and natriuretic peptide receptor-B were lower in DSS-treated rats than in control rats. ANP decreased the frequency of basal motility in a dose-dependent manner but did not change the amplitude. The inhibitory responses of frequency of basal motility to ANP and 8-bromo-cGMP were enhanced in DSS-treated rat colon. CONCLUSION: In conclusion, augmentation of inhibitory effect on basal motility by ANP in experimental colitis may be due an increased expression of colonic natriuretic peptide receptor-A mRNA. These data suggest that local natriuretic peptide system is partly involved in the pathophysiology of experimental colitis.


Asunto(s)
Factor Natriurético Atrial/sangre , Colitis/metabolismo , Colon/fisiopatología , Renina/sangre , Animales , Peso Corporal , Colitis/inducido químicamente , Colitis/fisiopatología , Sulfato de Dextran , Modelos Animales de Enfermedad , Motilidad Gastrointestinal , Guanilato Ciclasa/metabolismo , Masculino , Ratas Sprague-Dawley , Receptores del Factor Natriurético Atrial/metabolismo , Sistema Renina-Angiotensina
11.
Ann Surg Treat Res ; 106(2): 93-105, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38318094

RESUMEN

Purpose: Patients with obstructive colorectal cancer managed by emergency surgery show high morbidity, mortality, and stoma formation rates. Decompression modalities, including the self-expandable metallic stent (SEMS) and tube drainage (TD), have been used to improve surgical outcomes. However, there have been limited studies comparing the 2 modalities. We performed a meta-analysis on short- and long-term outcomes between SEMS and TD. Methods: PubMed, EMBASE, Cochrane Library, and Google Scholar were searched. Data were pooled, and the overall effect size was calculated using random effect models. Outcome measures were perioperative short-term and 3-year survival outcomes. Results: We included 20 nonrandomized studies that examined 2,047 patients in the meta-analysis. The meta-analysis showed SEMS had better short-term outcomes in clinical success rate, decompression-related complications, laparoscopic surgery rate, stoma formation rate, and postoperative complication rate with a relative risk (RR) of 0.36 (95% confidence interval [CI], 0.24-0.54; I2 = 20%), 0.32 (95% CI, 0.20-0.50; I2 = 0%), 0.47 (95% CI, 0.34-0.66; I2 = 87%), 0.34 (95% CI, 0.24-0.49; I2 = 52%), and 0.70 (95% CI, 0.54-0.89, I2 = 28%), respectively. However, there was no significant difference between the 2 groups in 3-year overall survival (RR, 0.99; 95% CI, 0.77-1.27; I2 = 0%). Conclusion: Although the long-term oncologic impact of SEMS is still unclear compared with TD, the results of this meta-analysis may suggest that SEMS insertion can be performed more successfully and safely and may have benefits for short-term perioperative outcomes compared with TD. Further studies are warranted to provide more definitive survival results.

12.
Abdom Radiol (NY) ; 49(8): 2659-2671, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39009896

RESUMEN

PURPOSE: To compare high flip angle (FA) hepatobiliary-phase (hHBP) imaging with variable time intervals to conventional HBP (cHBP) to assess the impact of increased FA on image quality in shortened HBP imaging. METHODS: Data from 218 patients, divided into normal liver group (n = 184) and decompensated liver group (n = 34), who underwent liver magnetic resonance imaging (MRI) including 10-min, 15-min, 20-min hHBP, and cHBP were analyzed. Signal-to-noise ratio (SNR), contrast-ratio (CR), contrast-to-noise ratio (CNR), signal intensity ratios (SIRs), and relative enhancement (RE) of the liver were calculated for quantitative analysis. Sharpness, noise, and artifacts of the image, contrast media visibility, overall image quality, and lesion conspicuity were evaluated by two abdominal radiologists. RESULTS: Quantitative analysis showed that SNR, RE, SIR for liver/muscle, liver/spleen, and CR of all hHBP images demonstrated a significantly higher value compared to cHBP images in the normal liver group (p < 0.001). These values were also superior in the normal liver group compared to the decompensated liver group (p < 0.01). In qualitative analysis, both normal and decompensated liver groups exhibited significantly superior image sharpness in all hHBP images compared to cHBP images and the overall image quality of the 15-min and 20-min hHBP did not show significant difference compared to cHBP. All values tended to be better in the normal liver group than the decompensated liver group with statistical significance except for lesion conspicuity (p < 0.01). CONCLUSION: High-FA HBP has proven to be a valuable image acquisition method, potentially shortening liver MR imaging time while maintaining acceptable image quality.


Asunto(s)
Medios de Contraste , Hepatopatías , Imagen por Resonancia Magnética , Relación Señal-Ruido , Humanos , Femenino , Masculino , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Hepatopatías/diagnóstico por imagen , Anciano , Adulto , Hígado/diagnóstico por imagen , Estudios Retrospectivos , Anciano de 80 o más Años , Aumento de la Imagen/métodos , Artefactos , Interpretación de Imagen Asistida por Computador/métodos
13.
Medicine (Baltimore) ; 103(27): e38791, 2024 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-38968511

RESUMEN

RATIONALE: Adenomatous polyposis (AP) is a genetic disorder characterized by the occurrence of numerous adenomatous polyps in the colon and rectum and can be classified into classical AP and attenuated AP (AAP). AAP is diagnosed when the number of observed adenomas is between 10 and 99. The detection of AAP is significantly increasing mainly due to the improvement of the imaging technique and application of the screening program for colorectal cancer detection. Currently, the germline variations of the APC and MUTYH genes are reported as the main cause of classical AP. However, the underlying genetic basis of AAP is not well understood. In this study, we report 2 cases of AAP with MSH6 variations. PATIENT CONCERNS: Both patients visited the hospital after multiple polyps were detected during colonoscopies conducted as part of their health checkups. DIAGNOSES: The 2 patients were diagnosed with AAP through colonoscopic examination at our hospital. INTERVENTIONS: The 2 received genetic consultation; and, for follow-up purposes, both patients agreed to be tested for an underlying genetic condition through next generation sequencing. And germline MSH6 variations were detected in both AAP patients. OUTCOMES: There was no recurrence for both patients for 3 years follow-up. LESSONS: Minor portion of AAP can cause by genetic mutation in MSH6, and further research is needed.


Asunto(s)
Poliposis Adenomatosa del Colon , Proteínas de Unión al ADN , Humanos , Masculino , Poliposis Adenomatosa del Colon/genética , Poliposis Adenomatosa del Colon/diagnóstico , Persona de Mediana Edad , Femenino , Proteínas de Unión al ADN/genética , Adulto , Colonoscopía , Mutación de Línea Germinal
14.
Cancers (Basel) ; 16(20)2024 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-39456590

RESUMEN

BACKGROUND/OBJECTIVES: This study evaluated the impact of fluorescence lymph node mapping (FLNM) using indocyanine green (ICG) on the diagnostic accuracy of preoperative computed tomography (CT) in right-sided colon cancer. METHODS: A total of 218 patients who underwent laparoscopic right hemicolectomy with D3 lymph node dissection (LND) were analyzed: 86 patients in the FLNM group and 132 in the conventional surgery group. The FLNM technique allowed for enhanced intraoperative visualization of lymph node (LN) and more precise dissection, improving the identification of metastatic LNs. The diagnostic value of preoperative CT staging was assessed in both the FLNM and control groups by calculating the apparent prevalence, true prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value, positive likelihood ratio (PLR), negative likelihood ratio, false positive and false negative proportions, and accuracy. RESULTS: FLNM increased the accuracy of CT staging for detecting D3 LN metastasis in advanced cancer cases, with a higher PPV, PLR, and accuracy. In the FLNM group, the false-positive rate was significantly reduced, and the specificity was higher compared to the control group. Multivariate analysis identified FLNM as an independent factor associated with improved D3 LN metastasis detection. These findings suggest that incorporating FLNM into surgical procedures enhances the diagnostic value of preoperative CT by improving the precision of LND, particularly in patients with advanced colon cancer. CONCLUSIONS: The use of FLNM for D3 LND enhances the diagnostic accuracy of cN staging in right-sided colon cancer by improving surgical precision.

15.
Ann Coloproctol ; 40(2): 89-113, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38712437

RESUMEN

Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients' values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.

16.
Ann Coloproctol ; 39(3): 267-274, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35350092

RESUMEN

PURPOSE: Renin-angiotensin system (RAS) is involved in the pathophysiology of colonic inflammation. The aim of this study was to investigate whether small angiotensins (Angs) peptides play a role in the regulation of colonic motility and their roles are modulated in colitis. METHODS: Experimental colitis was induced by an intake of 5% dextran sulfate sodium (DSS) dissolved in tap water for 7 days in Sprague-Dawley rats. After sacrifice, plasma hormone concentrations and messenger RNAs (mRNAs) for RAS were measured. Functional analysis of colonic motility in response to Angs peptides was performed using Taenia coli. RESULTS: DSS-treated colon showed an increased necrosis with massive infiltration of inflammatory cells. The mRNA level of colonic angiotensin II receptor type 2 (AT2R) in DSS-treated rats was higher than that in control rats whereas the mRNA levels of angiotensin II converting enzyme (ACE), ACE2, AT1R, AT4R, and Mars receptor were not different from those in control rats. Ang III, Ang IV, and Ang-(1-9) (1, 3 µM) increased the frequency of basal colonic motility. Ang-(1-7) did not cause any significant changes in frequency and amplitude of basal motility. The order of potency for an increased frequency of basal motility seems to be Ang II>>Ang IV>Ang III=Ang-(1-9). The increased frequency of basal motility by Ang-(1-9) but not Ang IV was significantly enhanced in DSS-treated rat colon. CONCLUSION: In conclusion, these data suggest that small Angs peptides are partly involved in the pathophysiological regulation of colonic motility in experimental colitis.

17.
Trials ; 24(1): 152, 2023 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-36855158

RESUMEN

BACKGROUND: Minimally invasive surgery has become popular as a surgical approach for colorectal cancer because it has fewer complications related to the abdominal incision and perioperative complications. However, the incidence of incisional hernias in laparoscopic surgery has been reported to be similar to that in open surgery. We developed a new method, the non-muscle-cutting periumbilical transverse incision, for a small incision in laparoscopic colon cancer surgery. This study aims to evaluate the effectiveness of the non-muscle-cutting periumbilical transverse incision in comparison with the midline incision in reducing the incidence of an incisional hernia in patients undergoing laparoscopic colon cancer surgery. METHODS: This is an open-label, multi-centre, parallel, superiority, and randomised trial. Altogether, 174 patients will be allocated in a 1:1 ratio to either the midline incision or the non-muscle-cutting periumbilical transverse incision group, after stratifying by the location of the tumour (right- or left-sided). The primary outcome of this study is the incidence of incisional hernias (both symptomatic and radiologic hernias) at 12 months after surgery. The secondary outcomes include operative outcomes, 30-day postoperative complications, pathological results, and patient-reported outcomes (short form-12 health survey questionnaire and body image questionnaire). Both primary (intention-to-treat) and secondary (as-treated principles) analyses will be performed for all outcomes. The statistical significance level was set at p < 0.05 (two-sided testing). DISCUSSION: This trial may show that the non-muscle-cutting periumbilical transverse incision will reduce the incidence of incisional hernias compared to the midline incision. TRIAL REGISTRATION: Clinical Research Information Service (CRiS) of Republic of Korea, KCT0006082 . Registered on April 12, 2021.


Asunto(s)
Neoplasias del Colon , Hernia Incisional , Humanos , Hernia Incisional/epidemiología , Hernia Incisional/etiología , Hernia Incisional/prevención & control , Neoplasias del Colon/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Imagen Corporal , Encuestas Epidemiológicas , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Multicéntricos como Asunto
18.
Trials ; 24(1): 311, 2023 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-37149610

RESUMEN

BACKGROUND: Incisional hernia following abdominal surgery is a frequent complication of midline laparotomy. This complication is strongly associated with the technique and material used for suture. While a monofilament absorbable suture is recommended to prevent incisional hernia, it can lead to suture loosening or surgical-knot breakage. Although barbed sutures can be an alternative suture material in abdominal fascial closure, evidence for its safety and effectiveness is lacking. Therefore, we designed a prospective randomized trial to evaluate the safety and efficacy of absorbable barbed sutures for midline fascia closure in minimally invasive surgery for colorectal and gastric cancers in comparison with conventional absorbable monofilament sutures. METHODS: A total of 312 patients who underwent minimally invasive surgery for colorectal and gastric cancers will be randomly allocated to either the absorbable barbed or monofilament suture group for abdominal fascia closure in a 1:1 ratio. The primary outcome is incisional hernia rate within 3 years after surgery, as verified by physical examination and computed tomography. Postoperative complications, including surgical site infection, postoperative pain, and quality of life, will be compared between two groups as secondary outcomes. The investigator will examine the patients until discharge and at 6, 12, 18, 24, and 36 months postoperatively. DISCUSSION: This is the first randomized controlled trial to compare absorbable barbed sutures with monofilament sutures for midline fascia closure in minimally invasive surgery. If absorbable barbed sutures demonstrate superior results to those of monofilament sutures, this type of suture material may be recommended as an alternative option for abdominal fascia closure. TRIAL REGISTRATION: KCT0007069. Registered on January 30, 2023.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Neoplasias Colorrectales , Hernia Incisional , Neoplasias Gástricas , Humanos , Hernia Incisional/etiología , Hernia Incisional/prevención & control , Calidad de Vida , Estudios Prospectivos , Neoplasias Gástricas/cirugía , Técnicas de Sutura/efectos adversos , Técnicas de Cierre de Herida Abdominal/efectos adversos , Fascia , Procedimientos Quirúrgicos Mínimamente Invasivos , Suturas/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto
19.
Cancers (Basel) ; 15(20)2023 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-37894294

RESUMEN

BACKGROUND: The distinction between D3 lymph nodes and actual lymphatic pathways in primary tumors can be difficult during surgery, making it challenging to confirm the completeness of D3 lymph node dissection. Fluorescence lymph node mapping (FLNM) is a promising method for lymph node visualization. PURPOSE: This study aimed to assess whether FLNM enhances the effectiveness of D3 lymph node dissection in patients with right-sided colon cancer. METHODS: Endoscopic submucosal indocyanine green injection were performed on the distal margin of the colon cancer. In an FLNM group, the lymphatic drainage pathway and distribution of D3 lymph nodes were explored. Pathological evaluations were conducted for the fluorescent D3 and non-fluorescent D3 lymph nodes. RESULTS: The FLNM group showed a significantly higher number of harvested lymph nodes in the D3 area. In stage III patients, the proportion of D3 lymph node metastasis was significantly higher in the FLNM group. The harvested D3 lymph node count showed a proportional correlation with a metastatic lymph node count of up to 15. CONCLUSION: FLNM could be considered a promising new strategy to potentially increase harvested D3 lymph node counts in colon cancer surgery.

20.
World J Clin Cases ; 10(25): 8939-8944, 2022 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-36157670

RESUMEN

BACKGROUND: Post-polypectomy electrocoagulation syndrome (PPES) can occur after colonoscopic polypectomy and is usually treated conservatively with a positive prognosis. Nevertheless, there can be cases with complications developing. CASE SUMMARY: A 58-year-old woman, who had no previous medical history, visited the Emergency Department of another hospital with symptoms of abdominal pain and fever, 1 d after multiple colonoscopic polypectomies. An abdominopelvic computed tomography (CT) scan demonstrated colo-colonic intussusception, and she was transferred to our hospital to consider an operation. CT showed colo-colonic intussusception with PPES and no evidence of obstruction. The physical examination showed localized mild tenderness on the right sided abdomen. The patient fasted and was admitted for treatment with intravenous antibiotics (piperacillin/tazobactam 4.5 g each 8 h, ornidazole 500 mg each 12 h). After admission, the symptoms got better and a follow-up CT scan demonstrated resolution of the PPES and intussusception. The patient was discharged on hospital day 9. CONCLUSION: Colo-colic intussusception can occur with PPES, and it can be properly treated conservatively.

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