The impact of the gut microbiota on prognosis after surgery for colorectal cancer - a systematic review and meta-analysis.

The aim of this study was to conduct a systematic review of the association between gut microbiota and prognosis after colorectal cancer surgery. The review was conducted according to the PRISMA guidelines. A systematic literature search was conducted in PubMed, Embase, and Scopus. Studies examining the association between gut microbiota and survival after colorectal cancer surgery were identified. Secondary outcomes were association with cancer stage and immune infiltration of tumor. A total of 27 studies were included in the review. Fusobacterium nucleatum was the most frequently examined bacterium, and the meta-analysis showed that high level of F. nucleatum was significantly associated with decreased overall survival, hazard ratio of 1.63 (95% confidence interval 1.23-2.16) for unadjusted data, and hazard ratio of 1.47 (95% confidence interval 1.08-1.98) for adjusted data. Association between higher tumor stage and F. nucleatum was reported in ten studies, and two studies found an association with unfavorable tumor infiltration of immune cells. Three out of five studies examining Bacteroides fragilis found an association with decreased survival, advanced tumor stage, or unfavorable immune infiltration of tumor. High levels of F. nucleatum and possibly B. fragilis were associated with worse prognosis after surgery for colorectal cancer.

Validation of a register-based algorithm for recurrence in rectal cancer.

INTRODUCTION: Colorectal cancer is the third most common type of cancer worldwide. Recurrence is an important end-point in colorectal cancer research. This study aimed to validate a previously developed algorithm to determine recurrence after surgery for rectal cancer. METHODS: Information about a cohort of 500 patients with rectal cancer was retrieved from the Danish Civil Registration System, the Danish National Patient Register and the Danish National Pathology Register. Patients with an ICD-10 code for metastatic disease, chemotherapy or SNOMED code suggesting metastasis were identified as having recurrence. In a previous study, medical records of the same cohort had been reviewed to identify recurrence. Recurrence identified by the algorithm was compared with the previously retrieved information from the medical records using Kappa statistics. The sensitivity and specificity of the algorithm were determined. RESULTS: Of the 500 patients, 393 were included in the validation analysis. Kappa statistics showed good concordance with a Kappa value (95% confidence interval) of 0.80 (0.72-0.88). The sensitivity and specificity of the algorithm were 88% (77-95%) and 96% (93-98%), respectively. CONCLUSIONS: The study showed good concordance between the algorithm and medical record information. The algorithm makes it possible to perform large register-based studies of recurrence and disease-free survival in colorectal cancer patients without the need for evaluation of medical records. FUNDING: none. TRIAL REGISTRATION: not relevant.

Maternal use of fertility drugs and risk of cancer in children--a nationwide population-based cohort study in Denmark.

Large population-based studies are needed to examine the effect of maternal use of fertility drugs on the risk of cancer in children, while taking into account the effect of the underlying infertility. A cohort of 123,322 children born in Denmark between 1964 and 2006 to 68,255 women who had been evaluated for infertility was established. We used a case-cohort design and calculated hazard ratios (HRs) for cancer in childhood (0-19 years) and in young adulthood (20-29 years) associated with maternal use of six groups of fertility drugs (clomiphene, gonadotropins [i.e., human menopausal gonadotropins and follicle-stimulating hormone], gonadotropin-releasing hormone analogs, human chorionic gonadotropins, progesterone and other fertility drugs). We found no statistically significant association between maternal use of fertility drugs and risk for overall cancer in childhood or young adulthood. However, with regard to specific cancers in childhood, our results showed that maternal use of progesterone before childbirth markedly increased the risks of their offspring for acute lymphocytic leukemia (any use: HR, 4.95; 95% CI, 1.69-14.54; ≥ three cycles of use: HR, 9.96; 95% CI, 2.63-37.77) and for sympathetic nervous system tumors (any use: HR, 5.79; 95% CI, 1.23-27.24; ≥ three cycles of use: HR, 8.51; 95% CI, 1.72-42.19). These findings show that maternal use of progesterone may increase the risk for specific cancers in the offspring. Additional large epidemiological studies are urgently needed to confirm our finding.

Short convalescence and minimal pain after out-patient Bascom's pit-pick operation.

INTRODUCTION: Treatment of pilonidal sinuses with Bascom's pit-pick operation can easily be performed under local analgesia. We describe pain during and after the operation, time to return to work, time to healing and success rate. MATERIAL AND METHODS: The study comprised a cohort of 75 primary pit-pick (PP) operations performed at our department between August 2007 and December 2009. The median age was 30 years (range 15-64 years) and 57 (76%) were male. A total of 55 patients were interviewed daily by phone for one week with a view to registering their ability to return to work and their scoring of maximum pain on a numerical rating scale with a pain score ranging from 0 (no pain) to 10. RESULTS: The mean maximum pain during the first post-operative day was 2.2 (95% confidence interval (CI) 1.8-2.7) and at day four 1.0 (CI 0.7-1.3). Within 24 hours, 51% could return to work and the mean time was 3.2 (CI 1.8-4.5) days. Postoperative infection was related to the presence of secondary sinus (p = 0.03) and increasing number of midline sinus excisions (p = 0.02). Complete wound healing was achieved in 84% of the patients after a mean period of 3.5 (CI 3.1-3.9) weeks. Incomplete wound healing was significantly related to a small number of PPs (p < 0.05), increasing number of midline sinus excisions (p < 0.05) and no postoperative infection (p = 0.01). At one-year follow-up 80% were considered successfully treated. CONCLUSION: The majority of patients with simple pilonidal sinuses can be treated successfully with Bascom's PP procedure as out-patients. This regimen causes only mild postoperative pain and patients can resume work after a few days. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.