Can physiological stimulation prior to ileostomy closure reduce postoperative ileus? A prospective multicenter pilot study.

BACKGROUND: The aim of this study was to assess the impact of ileostomy closure following preoperative physiological stimulation (PPS) on postoperative ileus (POI) in patients with loop ileostomy after low anterior resection for rectal cancer. METHODS: Patients who underwent ileostomy closure between January 2017 and February 2020 in two tertiary referral centers were prospectively included. PPS stimulation was compared to standard treatment. Stimulation was carried out daily during the 15 days prior to ileostomy closure by the patient's self-instillation of 200 ml of fecal contents from the ileostomy bag via the efferent loop, using a rectal catheter. Standard treatment (ST) consisted of observation. Outcomes measures were POI, morbidity, stimulation feasibility, and predictors to ileus. RESULTS: A total of 58 patients were included [42 males and 16 females, median age 67 (43-85) years]. PPS was used in 24 patients, who completed the entire stimulation process, and ST in 34 patients. No differences in preoperative factors were found between the two groups. POI was significantly lower in the PPS group (4.2%) vs the ST group (32.4%); p < 0.01, OR: 0.05 (CI 95% 0.01-0.65). The PPS group had a shorter time to restoration of bowel function (1 day vs 3 days) p = 0.02 and a shorter time to tolerance of liquids (1 day vs 2 days), p = 0.04. Age (p = 0.01), open approach at index surgery, p = 0.03, adjuvant capecitabine (p = 0.01). and previous abdominal surgeries (p = 0.02) were associated with POI in the multivariate analysis. C-reactive-protein values on the 3rd (p = 0.02) and 5th (p < 0.01) postoperative day were also associated with POI. CONCLUSIONS: PPS for patients who underwent ileostomy closure after low anterior resection for rectal cancer is feasible and might reduce POI.

Absence of allelic imbalance involving EMSY, CAPN5, and PAK1 genes in papillary thyroid carcinoma.

Papillary thyroid cancer (PTC) accounts for 80% of all thyroid malignancies, and genetic alterations associated to its etiology remain largely unknown. Chromosomal band 11q13 seems to be one of the most frequently amplified regions in human cancer, providing several candidate genes that need detailed characterization. The aim of our study was to investigate the existence of allelic imbalance at EMSY, CAPN5, and PAK1, as candidate genes within 11q13.5-q14 region using a single nucleotide polymorphism-based analysis. We selected a panel of 9 polymorphisms that were analyzed in 41 thyroid carcinoma samples, their contralateral non-pathological tissue and 178 controls from the general population. We did not detect allelic imbalance at these loci in our series. However, we observed a difference in the EMSY-haplotype distribution among PTC patients when compared to controls (odds ratio=2.00; p=0.02). We conclude that 11q13.5-q14 is not imbalanced in PTC, but there is evidence suggesting that EMSY might be of relevance in PTC etiology.

[Effect of endothelin-1 on tumor arteries in patients with colorectal cancer]. / Efecto de la endotelina-1 sobre las arterias tumorales de pacientes con neoplasia colorrectal.

Endothelin-1 is an endothelium-derived vasoconstrictor peptide whose plasma levels are increased in patients with colorectal cancer, and which may be involved in tumor blood flow regulation. To study whether response to this peptide is altered in tumor arteries, mesenteric arteries supplying blood flow to colorectal tumors, and mesenteric arteries far from said tumors were obtained from 13 patients undergoing colectomy; mesenteric arteries were also obtained from patients with diverticulitis (n = 4) or inflammatory bowel disease (n = 3). Arteries were prepared for isometric tension recording in an organ bath, and in this preparation it was found that endothelin-1 induced contraction in all three types of arteries, but that sensitivity to this peptide was greater in arteries supplying blood flow to the tumor than in arteries far from the tumor or arteries from patients without cancer. These results suggest that endothelin-1 may regulate blood flow to colorectal tumors by inducing a greater contraction in tumor-supplying arteries than in non-tumor arteries.

Pancreatic cancer. Management.

Pancreatic cancer still represents a serious medical concern for which no adequate solution has thus far been found. Surgery is the only appropriate therapy, but has a survival rate of around 30-35% at three years, with an operative mortality below 3% and an operative morbidity approaching 10% of radically resected patients, all of which applies to surgery performed by expert teams in highly experienced sites.