Medullary colon carcinoma with microsatellite instability: case report / Carcinoma medular do cólon com instabilidade de microssatélites: relato de caso

Colorectal cancer is the third most common neoplasm and the second most lethal worldwide. The most common histological type is adenocarcinoma, characterized by its glandular pattern. Medullary colon carcinoma is a rare histological variant of colorectal cancer, characterized by a predominantly solid architecture, poorly di?erentiated or undifferentiated morphology, often associated with an anomalous immunophenotype and microsatellite instability. The present study reports a case in an academic service of general surgery of a 74-year-old patient who presented with a tumor of the ascending colon, histologically with an exuberant lymphocytic in?ltrate, suggestive of large cell lymphoma, but which was revealed by subsequent immunohistochemistry to be medullary carcinoma of the colon with microsatellite instability.

O câncer colorretal é a terceira neoplasia mais comum e a segunda mais letal no mundo. O adenocarcinoma é o tipo histológico mais comum, caracterizado pelo seu padrão glandular. O carcinoma medular do cólon é uma variante histológica rara do câncer colorretal, caracterizada por uma arquitetura predominantemente sólida, morfologia pouco diferenciada ou indiferenciada, frequentemente associada a um imunofenótipo anômalo e instabilidade de microssatélites. O presente estudo relata um caso em um serviço acadêmico de cirurgia geral de um paciente de 74 anos que apresentou tumor de cólon ascendente, histologicamente com infiltrado linfocitário exuberante, sugestivo de linfoma de grandes células, mas que foi revelado através de exame subsequente imunohistoquímico como carcinoma medular do cólon com instabilidade de microssatélites.

Analysis of influencing factors of postoperative infection in patients with colon cancer and construction of nomogram model / 中国医师进修杂志

Objective:To analyze the risk factors of postoperative infection in patients with colon cancer, and construct a nomogram model.Methods:The clinical data of 220 patients with colon cancer in Anhui Cancer Hospital from May 2019 to June 2022 were retrospectively analyzed. Among them, 55 patients developed postoperative infection (infection group), and 165 patients did not develop postoperative infection (non-infection group). The receiver operating characteristic (ROC) curve was used to analyze the efficacy of each index in predicting postoperative infection in patients with colon cancer. Multivariate Logistic regression analysis was used to analyze the independent risk factors of postoperative infection in patients with colon cancer. R language 3.5.2 software was used to construct a nomogram model for predicting postoperative infection in patients with colon cancer, and it was verified and evaluated.Results:There were no significant differences in gender composition, body mass index, tumor stage, intraoperative blood transfusion, hypertension, smoking history, alcohol consumption history, tumor diameter and hemoglobin between the two groups ( P>0.05); the age, diabetes mellitus ratio, operation time and exhaust time in the infection group were significantly higher than those in the non-infection group: (49.60 ± 4.40) years old vs. (47.20 ± 4.12) years old, 63.64% (35/55) vs. 30.30% (50/165), (197.80 ± 12.55) min vs. (192.23 ± 12.05) min and (3.42 ± 1.18) d vs. (2.60 ± 0.80) d, the albumin was significantly lower than that in the non-infected group: (28.29 ± 3.02) g/L vs. (32.80 ± 3.21) g/L, and there were statistical differences ( P<0.01). ROC curve analysis result showed that the area under the curve of age, operation time, exhaust time and albumin for predicting postoperative infection in patients with colon cancer were 0.672, 0.610, 0.706 and 0.846, and the optimal cut-off values were 49 years old, 184 min, 3 d and 30 g/L, respectively. Multivariate Logistic regression analysis result showed that age (>49 years old), diabetes mellitus, operation time (>184 min), exhaust time (>3 d) and albumin (≤30 g/L) were independent risk factors of postoperative infection in patients with colon cancer ( OR = 2.131, 1.758, 1.449, 1.841 and 2.325; 95% CI 1.269 to 2.696, 1.354 to 3.059, 1.201 to 1.965, 1.018 to 2.365 and 1.582 to 3.051; P<0.01). A nomogram model was constructed with age, diabetes mellitus, operation time, exhaust time, and albumin as predictors for predicting postoperative infection in patients with colon cancer. The correction curve of the nomogram model for predicting postoperative infection in patients with colon cancer was close to the ideal curve (C-index = 0.764, 95% CI 0.657 to 0.834); decision curve analysis result showed that the nomogram model provided clinical net benefit when the risk threshold was > 0.07; and the clinical net benefit of the model was higher than that of age, diabetes mellitus, operation time, exhaust time and albumin. Conclusions:The age (>49 years old), diabetes mellitus, operation time (>184 min), exhaust time (>3 d) and albumin (≤30 g/L) are the independent risk factors of postoperative infection in patients with colon cancer, and the nomogram model based on the above variables could predict postoperative infection.

Study on preoperative bedside ultrasonography-assessed perioperative reflux and aspiration risk in surgical colon cancer patients with incomplete intestinal obstruction / 肿瘤研究与临床

Objective:To investigate the correlation between preoperative incomplete intestinal obstruction and the risk of perioperative reflux and aspiration assessed by preoperative bedside ultrasonography in patients with colon cancer.Methods:A prospective case series study was conducted. A total of 300 patients with colon cancer who underwent elective surgery from March 2020 to January 2022 in the First Hospital of Shanxi Medical University were prospectively selected for the study. According to whether there was incomplete intestinal obstruction before operation, the patients were divided into obstruction group and non-obstruction group. All patients underwent preoperative ultrasound examination of the gastric antrum, measuring the cross-sectional area of the gastric antrum in the right lateral position, and calculating the gastric volume and unit body mass gastric volume (GV/W), which were all expressed as M ( Q1, Q3). The differences in cross-sectional area of the gastric antrum, gastric volume and GV/W in the right lateral position between the two groups were compared, as well as the risk of reflux and aspiration (the risk of reflux and aspiration was extremely low at GV/W<0.8 ml/kg, the risk was low at GV/W 0.8-1.5 ml/kg, and the risk was high at GV/W >1.5 ml/kg). Multivariate logistic regression was used to analyze the influencing factors of high risk of reflux and aspiration. Results:Of 300 patients, 7 patients were excluded because of blurred images on ultrasonography, and a total of 293 patients were finally included. The age [ M ( Q1, Q3)] of obstruction group (146 cases) was 58.0 years old (55.0 years old, 67.0 years old), including 80 males and 66 females; the age of non-obstruction group (147 cases) was 55.0 years old (53.5 years old, 64.0 years old), including 64 males and 83 females. The age and body mass index (BMI) of the patients in the obstructin group were higher than those in the non-obstruction group, and the differences were statistically significant (both P < 0.05), and there were no significant differences in gender, duration of dietary abstinence, comorbid hypertension, comorbid diabetes mellitus, smoking status, sedentariness, and alcoholism between the two groups (all P > 0.05). Compared with the non-obstruction group, patients in the obstruction group had a higher cross-sectional area of the gastric antrum [5.83 cm 2 (5.25 cm 2, 6.70 cm 2) vs. 5.13 cm 2 (4.43 cm 2, 5.79 cm 2), P < 0.001], gastric volume [43.00 ml (37.07 ml, 52.74 ml) vs. 32.78 ml (25.52 ml, 39.85 ml), P < 0.001] and GV/W [0.70 ml/kg (0.65 ml/kg, 0.82 ml/kg) vs. 0.55 ml/kg (0.46 ml/kg, 0.62 ml/kg), P < 0.001] in the right lateral position. The proportion of patients at high risk of reflux and aspiration in the obstruction group was higher than that in the non-obstruction group [22.6% (33/146) vs. 12.2% (18/147), χ2 = 4.59, P = 0.032]. Multivariate logistic regression analysis showed that combination of incomplete intestinal obstruction (combined vs. uncombined, OR = 2.145, 95% CI: 1.096-4.198, P = 0.026), and males (females vs. males, OR = 0.415, 95% CI: 0.199-0.867, P = 0.019) were the independent risk factors for a high risk of perioperative reflux and aspiration assessed by preoperative bedside ultrasonography. Conclusions:Colon cancer patients combined with incomplete intestinal obstruction have significantly larger preoperative cross-sectional area of the gastric antrum, gastric volume and GV/W in the right lateral position, and have gastric retention, which may contribute to a higher risk of perioperative reflux and aspiration.

Multivariate Prognostic Models for Patients with Stages I and Ii Colon Carcinoma: a Strobe-Compliant Retrospective Cohort Study

ABSTRACT Background: Colorectal cancer is the most frequent gastrointestinal malignancy worldwide. The value of adjuvant treatment is controversial in Stages I and II. Objective: The aim of this study was to construct post-operative prognostic models applicable to patients with stages I-II colon carcinoma (CC). Methods: This is a retrospective cohort study of patients with Stage I-II CC treated over a 25-year period. Exposure was defined as clinical, histopathological, and immunohistochemical factors (including CDX2 and MUC2 expression). Patients were randomly allocated to either a "modeling set" or a "validation set". Factors associated with recurrence, disease-free survival (DFS), and overall survival (OS) were defined in the "modeling set". Their performances were tested in the "validation set". Results: From a total of 556 recruited patients, 339 (61%) were allocated to the "modeling set" and 217 (39%) to the "validation set". Three models explaining recurrence, DFS, and OS were described. Tumor location in the left colon (Hazards ratio [HR] = 1.57; 95% Confidence interval [CI] 0.99-2.48), lymphocyte (HR = 0.46; 96% CI 0.27-0.88) and monocyte (HR = 0.99; 95% CI 0.99-1) counts, neutrophil/platelet ratio (HR = 1.3; 95% CI 0.74-2.3, and HR = 2.3; 95% CI 1.3-4.1; for second and third category, respectively), albumin/monocyte ratio (HR = 0.43; 95% CI 0.21-0.87), and microscopic residual disease after surgery (HR = 8.7; 95% CI 3.1-24) were independently associated with OS. T classification and expression of CDX2 and/or MUC2 were not independently associated with recurrence or prognosis. Conclusion: These models are simple and readily available, and distinguish the risk and prognosis in patients with CC stages I and II; these models require cheaper processes than the use of more sophisticated molecular biology techniques. They may guide either the need for adjuvant therapy versus post-operative surveillance only, as well as aid in the design of clinical trials.

Fulminant endogenous panophthalmitis caused by Clostridium septicum infection / Panoftalmite endógena fulminante por infecção por Clostridium septicum

ABSTRACT We report an unusual case of fulminant endogenous Clostridium septicum panophthalmitis. A 74-year-old male patient presented with sudden amaurosis in the right eye, which in a few hours, evolved into an orbital cellulitis, endophthalmitis, anterior segment ischemia, and secondary perforation of the eye. A complete diagnostic study, which included cranial and orbital contrast-enhanced computed tomography scan, contrast-enhanced magnetic resonance imaging, blood cultures, and complete blood work, were performed. No causal agent was identified. Clostridium septicum infection caused fulminant gaseous panophthalmitis. Despite broad-spectrum antibiotic treatment, evisceration of the eyeball was necessary. The extension study showed a colon adenocarcinoma as the origin of the infection. Clostridium septicum panophthalmitis is a rare but aggressive orbital infection. This infection warrants the identification of a neoplastic process in the gastrointestinal tract in many cases not previously described.

RESUMO Este é o relato de um caso incomum de panoftalmite endógena fulminante por Clostridium septicum. Um paciente do sexo masculino, 74 anos, apresentou amaurose súbita no olho direito, que em poucas horas evoluiu para celulite orbitária, endoftalmite, isquemia do segmento anterior e perfuração secundária do olho. Foi realizado um estudo diagnóstico completo, que incluiu uma tomografia computadorizada com contraste cranial e orbital, um exame de ressonância magnética, hemocultura e hemograma completo. Nenhum agente causal foi identificado. A infecção por Clostridium septicum causou uma panoftalmite gasosa fulminante. Apesar do tratamento com antibióticos de amplo espectro, foi necessário eviscerar o globo ocular. O estudo de seguimento mostrou um adenocarcinoma de cólon como a origem da infecção. A panoftalmite por Clostridium septicum é um tipo raro, mas muito agressivo de infecção orbitária. Essa infecção deve sugerir a busca por um processo neoplásico no trato gastrointestinal, em muitos casos não diagnosticado anteriormente.

Application and challenge of microsatellite instability detection in colorectal cancer / 中华消化外科杂志

Colorectal cancer (CRC) is one of the most common gastrointestinal cancers. The incidence and mortality of CRC are still rising in China. It is of great importance to explore the molecular mechanisms of the development and progression of CRC. Microsatellites are short tandem repeats that are distributed throughout the genome. Detection of microsatellite instability (MSI) is of great value in the diagnosis and treatment of CRC. MSI detection is an important method for Lynch syndrome screening. For patients with stage Ⅱ CRC, MSI status is an influencing factor for post-operative recurrence and an important reference for adjuvant therapy. For patients with stage Ⅳ CRC, MSI status is an important indicator for screening potential patients suitable for treatment of immune checkpoint inhibitors. However, there are still problems concerning the application of MSI. The detection methods of MSI have not been fully unified. The requirement of MSI detection in CRC patients are universal but not precise. MSI is not a valid predictor for the prognosis of CRC patients, and it could not effectively predict the efficacy of chemotherapy and immunotherapy. Moreover, with the application of other molecular markers, such as programmed death-1, programmed death-ligand 1, tumor mutation burden and immunoscore, the value of MSI in CRC is being challenged and remains to be unveiled with more studies. The authors investigate the problems in MSI detection and application, in order to provide reference for clinical practice.

Analysis of the application of nano-carbon lymphatic tracer technology in laparoscopic radical resection of colon cancer based on propensity matching / 中国医师进修杂志

Objective:To analyze the application effect of nano-carbon lymphatic tracer technology in laparoscopic colon cancer (CC) radical resection based on propensity matching.Methods:Retrospective case-control study was performed in this study. From January 2016 to April 2021, 714 cases of CC patients who underwent laparoscopic CC radical resection in Kunshan Second People′s Hospital were divided into groups according to whether or not the nano-carbon lymphatic tracing technique was applied. Seventy-eight cases in group A were applied with nano-carbon lymphatic tracing technique, while 636 cases in group B were not applied with nano-carbon lymphatic tracing technique. The initial data were matched 1∶3 by the propensity score matching method, and finally group A (73 cases) and group B (219 cases) were obtained. The detection of lymph nodes in the two groups after propensity score matching was compared.Results:By comparing the baseline data of the two groups after propensity score matching, it was found that there were no significant differences in gender, height, weight, body mass index, tumor T stage, tumor N stage, tumor TNM stage, preoperative chemotherapy, or tumor location ( P>0.05). The total number of lymph nodes in group A was higher than that in group B: (22.24 ± 7.08) pieces vs. (19.03 ± 6.29) pieces, and the difference was statistically significant ( t = 3.66, P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis in group A were not significantly different from those in group B ( P>0.05). Tumor T stage T 3, tumor N stage N 0, tumor TNM stage Ⅱ, and preoperative chemotherapy, the total number of lymph nodes in group A was higher than that in group B: 23 (6, 60) pieces vs. 19 (4, 54) pieces , 20 (3, 62) pieces vs. 18 (3, 75) pieces, 23 (6, 59) pieces vs. 20 (7, 54) pieces, 22 (5, 45) pieces vs. 14 (4, 46) pieces, and the difference was statistically significant ( Z = 2.43, 2.70, 2.64 and 3.32; P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis of tumor N stage N 2 in group A were lower than those in group B: 4 (4, 9) pieces vs. 6 (4, 25) pieces , 16 (10, 42) pieces vs. 32 (19, 100) pieces, and the difference between groups was statistically significant ( Z = -2.53 and -2.87, P<0.05). Followed up to April 2022, among the 292 patients, 5 were lost to follow-up, the 3-year disease-free survival rates of 72 patients in group A and 215 patients in group B were 83.33% (60/72) and 91.16% (196/215) respectively, there was no significant difference between two groups ( P>0.05). Conclusions:The number of lymph nodes detected in laparoscopic CC radical resection increases after the application of nano-carbon lymphatic tracing technology.

Expression and Significance of L-Selectin and its Ligand Podocalyxin in Development and Progression of Colon Cancer / 胃肠病学

Background:Early diagnosis and treatment can effectively improve the prognosis of colon cancer.Simple,effective and sensitive screening indicators are of great significance for identification of early cancer and precancerous lesions.L-selectin is a cell adhesion molecule,and podocalyxin(PODXL)is its ligand,both of them play key roles in the development of cancer.Aims:To investigate the expression and significance of L-selectin and its ligand PODXL in colon cancer.Methods:A total of 120 cases of pathological specimens(40 hyperplastic polyp,40 colon adenoma,and 40 colon cancer)from Nov.2020 to Nov.2022 at the Frist People's Hospital of Hangzhou Lin'an District and the First Affiliated Hospital of Zhejiang Chinese Medical University were collected,and 20 cases of normal intestinal mucosal tissue were served as controls.qRT-PCR and immunohistochemistry were used to detect the mRNA and protein expressions of L-selectin and PODXL,respectively.Western blotting was used to determine the expressions of L-selectin and PODXL,and their relations with different clinicopathological parameters of colon cancer were analyzed.In addition,60 serum specimens of colon cancer were collected.ELISA was used to detect serum concentrations of L-selectin and PODXL.Results:Expressions of L-selectin and PODXL mRNA and protein in colon adenoma group were significantly higher than those in normal controls and hyperplastic polyp group(P<0.05),and mRNA and protein expressions of L-selectin and PODXL in colon cancer group were significantly higher than those in normal controls,hyperplastic polyp group and colon adenoma group(P<0.05).Significant differences in protein expressions of L-selectin and PODXL were found in different pathological types,lymph node metastasis,Dukes staging in colon cancer(P<0.05).Expression of L-selectin was positive correlated with expression of PODXL in colon cancer(r=0.855,P<0.001).Serum concentrations of L-selectin and PODXL were significantly lower in the initial group than in the relapse group(P<0.05),and serum concentrations of L-selection and PODXL was significantly lower in the non-metastatic group than in the metastatic group(P<0.05).Serum concentrations of L-selectin and PODXL at 3 months after surgery was significantly lower than 3 days after surgery and before surgery(P<0.05).Conclusions:L-selectin and PODXL may be involved in the development and progression of colon cancer.They are carcinogenic proteins,and their detection could provide reference value for the prevention and early diagnosis of colon cancer,and through early screening of lesion could improve the prognosis of colon cancer to a certain extent.

Effect of anesthesia factor on recovery of postoperative gastrointestinal function in patients undergoing laparoscopic radical resection for colorectal cancer: dexmedetomidine-based anesthesia / 中华麻醉学杂志

Objective:To investigate the effect of dexmedetomidine-based anesthesia on gastrointestinal function in the patients undergoing laparoscopic radical resection for colorectal cancer.Methods:One hundred patients, aged 40-70 yr, with body mass index of 18-29 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ to Ⅲ, scheduled for elective laparoscopic radical resection for colorectal cancer, were divided into 2 groups ( n=50 each) using a random number table method: dexmedetomidine group (group D) and control group (group C). In group D, dexmedetomidine was intravenously infused as a bolus of 0.5 μg/kg at 10 min before anesthesia induction, followed by a continuous infusion of 0.5 μg·kg - 1·h - 1 until the end of surgery. In group C, the equal volume of normal saline was administered at the same time points. Patient-controlled intravenous analgesia was performed with hydromorphone, flurbiprofen, and metoclopramide after operation. Oxycodone was taken orally for rescue analgesia when visual analog scale score> 3. Serum intestinal fatty acid-binding protein concentrations were determined using an enzyme-linked immunosorbent assay at 10 min before anesthesia induction (T 1), 10 min after establishing pneumoperitoneum (T 2), immediately after tumor resection (T 3), 30 min before the end of surgery (T 4), and 1 h after the end of surgery (T 5). Gastrointestinal function was assessed using the I-FEED scoring system at 1-6 days after surgery.The intraoperative consumption of propofol and remifentanil, time to first flatus, first defecation and first oral intake and duration of hospital stay after surgery, and requirement for rescue analgesia within 3 days after surgery were recorded. Results:Compared with group C, the serum intestinal fatty acid-binding protein concentrations were significantly decreased at T 3-T 5, the I-FEED scores were decreased on postoperative days 3-5, the intraoperative consumption of propofol and remifentanil was decreased, and the time to first flatus, first defecation and first oral intake and duration of hospital stay were shortened ( P<0.05), and no significant difference was found in the rate of rescue analgesia in group D ( P>0.05). Conclusions:Dexmedetomidine-based anesthesia can promote the recovery of postoperative gastrointestinal function in the patients undergoing laparoscopic radical resection for colorectal cancer.

Value of MRI histogram in predicting survival of patients undergoing surgical treatment of colorectal cancer / 中华消化外科杂志

Objective:To investigate the value of multi-stage dynamic contrast enhanced MRI (DCE-MRI) histogram in predicting survival of patients undergoing surgical treatment of colorectal cancer (CRC).Methods:The retrospective cohort study was conducted. The clinico-pathological data of 81 patients with CRC who were admitted to the Jiuquan City People′s Hospital from January 2018 to February 2019 were collected. There were 47 males and 34 females, aged (62±6)years. All patients underwent routine MRI and DCE-MRI examination to extract relevant imaging parameters. Observation indicators: (1) treatment, imaging examination and follow-up; (2) imaging factors influencing postoperative disease-free survival of patients with CRC. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Univariate and multivariate analyses were conducted using the COX proportional risk model. Pearson correlation test was used to analyze and exclude factors with correlation in univariate analysis, and the multi-variate analysis was conducted on the rest of factors. The Kaplan-Meier method was used to calculate survival rates, and Log-Rank test was used for survival analysis. Results:(1) Treatment, imaging examination and follow-up. All 81 patients underwent preoperative MRI plain scan, enhanced imaging, and diffusion weighted imaging. After complete examination, all patients underwent radical resection of CRC and received postoperative chemotherapy using the FOLFOX regimen. All 81 patients were followed up for 42(range, 11-61)months after surgery. The 1-, 3-, 5-year overall survival rate of 81 patients after surgery was 98.8%, 96.3%, 93.8%, respectively. During the follow-up period, 56 of the 81 patients survived from disease-free and 25 patients had disease progressed. (2) Imaging factors influencing postoperative disease-free survival of patients with CRC. Results of multivariate analysis showed that the kurtosis value and skewness value of positive enhancement integral (PEI) were independent imaging factors influencing postoperative disease-free survival of patients of CRC ( odds ratio=1.840, 1.243, 95% confidence interval as 1.403-2.412, 1.020-1.516, P<0.05). Taking the median values of kurtosis value and skewness value of PEI as 4.864 and 5.042 for further analysis. The postoperative 5-year disease-free survival rate of patients with kurtosis value of PEI <4.864 and ≥4.864 was 89.7% and 10.3%, showing a significant difference between them ( χ2=31.265, P<0.05). The postoperative 5-year disease-free survival rate of patients with skewness value of PEI<5.042 and ≥5.042 was 63.4% and 36.6%, showing a significant difference between them ( χ2=8.164, P<0.05). Conclusions:The kurtosis value and skewness value of PEI in DCE-MRI are independent imaging factors influencing postoperative disease-free survival of patients of CRC. The DCE-MRI histogram can effectively evaluate the postoperative prognosis of patients of CRC.

Clinical characteristics of early-onset colorectal cancer / 中华消化外科杂志

Objective:To investigate the clinicopathological characteristics of early-onset colorectal cancer.Methods:The retrospective and descriptive study was conducted. The clincopatholo-gical data of 59 206 patients with colorectal cancer in the Surveillance, Epidemiology, and End Results Program of the United States of America From January 1,2010 to December 31,2019 were collected. There were 33 213 males, 25 993 males, aged (50±7)years. Observation indicators: (1) demographic and oncological characteristics of colorectal cancer patients; (2) comparison of clinico-pathological characteristics between early-onset and late-onset colorectal cancer. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison among groups was conducted using the Kruskal-Wallis H test. Count data were described as absolute numbers, and comparison among groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the non-parameter H test. Patients with early-onset colorectal cancer were segmented by age, and missing data for categorical variables is set as unknown. Results:(1) Demographic and oncological characteristics of colorectal cancer patients. Of 59 206 patients, there were 23 104 cases with early-onset colorectal cancer and 36 102 cases with late-onset colorectal cancer, and cases aged 13-29 years, cases aged 30-34 years, cases aged 35-39 years, cases aged 40-44 years, cases aged 45-49 years, cases aged 55-59 years were 1 041, 1 740, 3 288, 6 050, 10 985, 15 303,20 799, respectively. (2) Comparison of clinicopathological charac-teristics between early-onset and late-onset colorectal cancer. ① There were significant differences in gender, tumor location, degree of tumor differentiation, tumor histological type, tumor TNM staging, tumor T staging, tumor N staging, tumor M staging, preoperative carcinoembryonic antigen (CEA), perineural invasion, cancer nodule, tumor diameter between patients with early-onset and late-onset colorectal cancer ( P<0.01). Results of further analysis showed that cases with tumor located in ileocecal region, ascending colon, colon liver region, transverse colon were 2 329, 2 139, 579, 1 303 in the 6 350 patients with early-onset right colon cancer. The above indicators were 4 563, 3 945, 902, 1 951 in the 11 361 patients with late-onset right colon cancer. There was a significant difference in the above indicators between the two groups of patients ( χ2=114.27, P<0.01). Cases with tumor located in splenic region of the colon, descending colon, sigmoid colon, rectum sigmoid junction were 553, 1 354, 6 404, 2 431 in the 10 742 patients with early-onset left colon cancer. The above indicators were 865, 1 798, 9 668, 3 610 in the 15 941 patients with late-onset left colon cancer. There was a significant difference in the above indicators between the two groups of patients ( χ2=35.60, P<0.01). ②Of 23 104 patients with early-onset colorectal cancer, cases aged 13-29 years, cases aged 30-34 years, cases aged 35-39 years, cases aged 40-44 years, cases aged 45-49 years were 1 041, 1 740, 3 288, 6 050, 10 985, respectively. There were significant differences in gender, degree of tumor differentiation, tumor histological type, tumor TNM staging, tumor T staging, tumor N staging, pre-operative CEA, perineural invasion, cancer nodule, tumor diameter among patients of different age groups ( P<0.01). Results of further analysis showed that cases with tumor located in ileocecal region, ascending colon, colon liver region, and transverse colon were 91, 117, 45, 69 in the 6 350 early-onset right colorectal cancer patients aged 13-29 years. The above indicators were 165, 136, 47, 115, 304, 313, 93,201, 614, 535, 151, 330, 1 155, 1 038, 243, 588 in early-onset right colorectal cancer patients aged 30-34, 35-39, 40-44, 45-49 years, respectively. There was a significant difference in the above indicators among the five groups of patients ( H=36.63, P<0.01). Cases with tumor located in splenic region of the colon, descending colon, sigmoid colon, rectum sigmoid junction were 32, 83, 260, 95 in the 10 742 early-onset left colorectal cancer patients aged 13-29 years. The above indica-tors were 53, 112, 452, 171, 95, 230, 867, 342, 149, 337, 1 702, 665, 224, 592, 3 123, 1 158 in the 10 742 early-onset left colorectal cancer patients aged 30-34, 35-39, 40-44, 45-49 years, respectively. There was a significant difference in the above indicators among the five groups of patients ( H=47.84, P<0.01). Conclusions:Compared with late-onset colorectal cancer, early-onset colorectal cancer are more likely to occur in the left colon and rectum, with poorly differentiated and undifferentiated tumors, histological type of mucinous adenocarcinoma, TNM staging of stage Ⅲ and Ⅳ, higher proportion of nerve infiltration and cancer nodules, and larger tumor diameter. There are significant differences in clinicopathological characteristics of tumors among patients with early-onset colorectal cancer of different age groups.

Effect of the distance of the circumferential resection margin on postoperative recurrence after laparoscopic radical resection of colon cancer / 中国医师进修杂志

Objective:To investigate the effect of the distance of the circumferential resection margin (CRM) on postoperative recurrence after laparoscopic radical resection of colon cancer.Methods:The clinical data of 83 patients who underwent laparoscopic radical resection of colon cancer in Yiwu Central Hospital from January 2020 to January 2022 were retrospectively included. They were divided into recurrent group (16 cases) and non-recurrent group (67 cases) according to the recurrence within 1 year after operation. The clinical data, postoperative CRM distance and laboratory indicators of the two groups were collected to analyze the influence of CRM distance on postoperative recurrence after laparoscopic radical resection of colon cancer.Results:The proportion of patients treated with postoperative chemotherapy, and postoperative CRM distance in the recurrent group were lower than those in the non-recurrent group: 9/16 vs. 83.58 % (56/67), (0.85 ± 0.23) mm vs. (1.64 ± 0.76) mm. The levels of CEA and CA19-9 at admission were higher than those in the non-recurrent group: (156.74 ± 11.58) μg/L vs. (149.96 ± 10.26) μg/L, (15.63 ± 2.77) kU/L vs. (14.04 ± 2.35) kU/L, and the differences were statistically significant ( P<0.05). Point binary correlation analysis showed that there was a negative correlation between CRM distance and postoperative recurrence after laparoscopic radical resection of colon cancer ( r = - 0.412, P<0.01). Multivariate Logistic regression analysis showed that the long distance of CRM was the protective factor of recurrence after laparoscopic radical resection of colon cancer ( OR<1, P<0.05). The results of the receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of the CRM distance to predict the recurrence after laparoscopic radical resection of colon cancer was 0.833>0.7, and the predictive value was good. When the optimal threshold was 1.080 mm, the ideal sensitivity and specificity could be obtained 87.50% and 81.00%. Conclusions:The shorter the CRM distance after laparoscopic radical resection of colon cancer, the higher the risk of recurrence. The CRM distance can be used as a predictor of recurrence after laparoscopic radical resection of colon cancer.

The prognostic significance of CEA in patients with simultaneous liver and/or lung metastasis of colon cancer and the establishment of a nomogram: a study based on the SEER database / 中国医师杂志

Objective:To explore the prognostic significance of preoperative carcinoembryonic antigen (CEA) in patients with stage Ⅳ colon cancer with simultaneous liver and/or lung metastasis, and establish a predictive model.Methods:Using the SEER database, 5 149 patients diagnosed with colon cancer from 2010 to 2015 were collected based on inclusion and exclusion criteria. They were divided into a CEA positive group and a CEA negative group based on their preoperative CEA status. Based on the different CEA status and metastatic sites, we plotted different survival curves and analyzed the differences using the Log rank method. We used the Cox proportional risk model to analyze the risk factors affecting the prognosis of patients with simultaneous liver and/or lung metastasis in colon cancer, and constructed a column chart based on the results. The area under the receiver operating characteristic (ROC) curve of different variable models was calculated and the model discrimination wasevaluated. By using x-tile software, the optimal cutoff value for individual total scores was selected and risk levels were classified to predict patient prognosis.Results:CEA positive colon cancer patients with liver and/or lung metastasis had a poor prognosis, with a 5-year survival rate of 13.4%. Cox proportional risk analysis showed that CEA positive patients had an increased risk of death compared to negative patients after adjusting for other factors ( HR=1.64). After incorporating the CEA+ X, X (independent risk factors other than CEA), and AJCC T+ N models, the areas under the ROC curve were 0.712, 0.706, and 0.59, respectively. According to the prediction score given in the column chart, the x-tilie selected for the best cutoff score was 262.5, which can be divided into high-risk and low-risk populations. The Log rank test was P<0.05. Conclusions:The preoperative CEA level has important predictive value for the prognosis of stage IV colon cancer patients with simultaneous liver and/or lung metastasis. The survival prediction model and column chart for colorectal cancer patients with liver and/or lung metastasis established based on the Cox proportional risk model are of great significance for patient prognosis evaluation and are conducive to the selection of personalized treatment plans.

Effect of ultrasound-guided lumbar quadratus muscle block on the analgesic effect during and after colon cancer surgery in elderly patients / 中国医师杂志

Objective:To investigate the effect of ultrasound-guided lumbar quadratus muscle plane block combined with general anesthesia on the analgesic effect during and after laparoscopic colon cancer radical surgery in elderly patients.Methods:A prospective study was conducted on 61 elderly patients who underwent radical colon cancer surgery at the Changsha Central Hospital Affiliated to South China University from May 2022 to February 2023, with American Society of Anesthesiologist (ASA) grades Ⅱ to Ⅲ. They were randomly divided into SA and GA groups using a random number table method, with 31 patients in the SA group and 30 patients in the GA group. The SA group received ultrasound-guided plane block of the upper lumbar quadratus muscle in the arcuate ligament combined with general anesthesia, while the GA group received simple general anesthesia. Record the mean artery pressure (MAP) and heart rate (HR) of two groups of patients at the time of entering the operating room (T 0), 5 minutes before skin incision (T 1), at skin incision (T 2), 30 minutes after surgery (T 3), at surgery end (T 4), and during anesthesia resuscitation and extubation (T 5); The Visual Analogue Scale (VAS) of two groups of patients at T 5, upon returning to the ward (T 6), 6 hours (T 7), 12 hours (T 8), 24 hours (T 9), and 48 hours (T 10) after surgery were recorded; The dosage of sufentanil, remifentanil, and propofol used during surgery, anesthesia recovery time, total number of analgesic pump presses within 48 hours after surgery, Lovett muscle strength score, early postoperative recovery, and adverse reactions within 48 hours after surgery were also recorded. Resultsl:The MAP and HR of the SA group were lower than those of the GA group at T 1-5 (all P<0.05); The VAS score of the SA group was lower than that of the GA group at T 5-10 (all P<0.05); The intraoperative dosage of propofol, remifentanil, and sufentanil in the SA group was lower than that in the GA group (all P<0.05); The anesthesia recovery time and first time out of bed in the SA group were earlier than those in the GA group (all P<0.05); The total number of times the analgesic pump was pressed within 48 hours after surgery was less than that of the GA group ( P<0.05); The incidence of nausea and vomiting within 48 hours after surgery in the SA group was lower than that in the GA group ( P<0.05). There was no statistically significant difference in postoperative Lovett muscle strength score, hospital stay, and dizziness incidence between the two groups of patients (all P>0.05). Conclusions:Ultrasound-guided lumbar quadratus muscle plane block on the arcuate ligament can significantly reduce the dosage of intraoperative general anesthesia drugs and postoperative analgesics in elderly patients undergoing laparoscopic colon cancer surgery, reduce postoperative pain scores, effectively alleviate postoperative pain, and thus advance the patient′s first time out of bed activity, reduce postoperative complications, and promote rapid recovery.

Clinical application of modified grading system for GSRS scores in assessing long-term postoperative gastrointestinal dysfunction in colon cancer patients / 国际外科学杂志

Objective:To explore the practical application and clinical significance of modified grading system for Gastrointestinal Symptom Rating Scale (GSRS) scores in evaluating long-term postoperative gastrointestinal dysfunction (PGID) in patients after colon cancer surgery.Methods:A retrospective analysis was conducted on the case data of 122 patients who underwent right hemicolectomy for colorectal cancer at Beijing Friendship Hospital, Capital Medical University from September 2021 to September 2022. Among these patients, 69 were males (56.6%), and 53 were females (43.4%). The median age was 66.5 years, and the body mass index was (24.4±3.3) kg/m 2. The main observe indiator was GSRS scores of patients. The measurement data of normal distribution were represented as mean±standard deviation( ± s), and intergroup comparisons were conducted using ANOVA. The measurement data of non-normal distribution were expressed as the median (interquartile distance) [ M( Q1, Q3)], the Kruskal-Wallis H test was employed. Unordered count data comparisons were performed using the χ2 test, while comparisons for ordered count data between groups were conducted using the Kruskal-Wallis H test. GSRS scores were represented using density plots, and the scores were categorized into five symptom groups, presented using radar charts to illustrate the distribution of each symptom group. Results:Among the 122 patients, the most common long-term PGID syndromes was dyspepsia, followed by abdominal pain, diarrhea, and constipation. GSRS score data in the study population exhibited a nearly trimodal trend. Based on the overall data trend, the GSRS scale was refined, with cut-off values of 20 and 30, categorizing patients with right-sided colon cancer into low-risk, moderate-risk, and high-risk groups for quantifying the severity of long-term PGID. In terms of gender distribution, the differences among the three groups was statistically significant ( P=0.031), suggesting that males may be more susceptible to long-term PGID. However, there were no significant differences among the three groups concerning age, tumor location, surgical approach, anastomotic technique, lymph node dissection, pathological staging, adjuvant chemotherapy, and other factors. Conclusions:The modified grading system for GSRS scores aligns with the distribution characteristics of postoperative gastrointestinal function in colorectal cancer patients. It can quantify the risk of long-term PGID, allowing for a graded management approach to improve the postoperative quality of life for patients.

The impact of nutritional status on postoperative complications in elderly patients with right-sided colon cancer / 国际外科学杂志

Objective:To explore the correlation between preoperative nutritional status and postoperative complications in elderly patients with right-sided colon cancer.Methods:A prospective registry database of 1, 196 patients undergoing curative surgery for right-sided colon cancer was collected from 52 top-tier hospitals nationwide between September 2021 and June 2022. The cohort included 627 males and 569 females, with an age range of 64(53, 71) years. Among these, 136 patients developed complications, while 1, 060 did not. Patients were divided into two groups based on age: the elderly group(≥65 years, n=571) and the middle-aged group(<65 years, n=625). Preoperative nutritional assessment indicators, clinical pathological data, and the incidence of complications within 30 days post-surgery were collected. For normally distributed quantitative data, mean ± standard deviation( ± s) was used, and the t-test was applied for intergroup comparisons. Non-normally distributed quantitative data were represented as M( Q1, Q3) and analyzed using the Wilcoxon rank-sum test; categorical data were compared using the chi-square test or Fisher′s exact test. In the analysis of risk factors for postoperative complications in elderly patients, univariate analysis was first conducted on all potential risk factors, followed by the inclusion of statistically significant variables from univariate regression into a multivariate logistic regression model. Results:The overall incidence of postoperative complications was 11.37%(136/1 196), with common complications includin wound infection(2.26%), intestinal obstruction (2.26%), anastomotic leakage(1.42%), deep vein thrombosis(1.42%), and chylous leakage(1.42%). In the elderly group, the proportion of patients with preoperative nutritional risk who developed complications was significantly higher than those without complications(66.20% vs. 53.40%, P=0.043). In the multivariate analysis, body mass index( OR=1.058, 95% CI: 1.005-1.117, P=0.031) and nutritional risk( OR=1.803, 95% CI: 1.066-3.126, P=0.031) were identified as independent risk factors for postoperative complications in elderly patients. Conclusions:There is a correlation between preoperative nutritional status and the occurrence of postoperative complications in elderly colon cancer patients, particularly with respect to body mass index and nutritional risk. These findings underscore the importance of preoperative nutritional assessment and intervention in elderly patients to reduce the risk of postoperative complications.

Pólipos adenomatosos en familiares de primer grado de pacientes con cáncer del colon

Introducción: El cáncer colorectal constituye en la actualidad la segunda neoplasia maligna más frecuente. La mayoría son esporádicos, otra pequeña proporción corresponde a formas hereditarias. Sin embargo, se estima que en un 15 % a 20 % de casos pueden existir un componente hereditario asociado. Los familiares de primer grado de pacientes con cáncer colorrectal, constituyen un universo de mayor riesgo que la población general de padecer esta enfermedad, por lo que se recomienda el cribado en estos individuos. Objetivo: Determinar la frecuencia de pólipos adenomatosos en individuos con familiares de primer grado diagnosticados con cáncer de colon. Métodos: Se realizó un estudio descriptivo, de corte transversal, que incluyó a 126 adultos con familiares de primer grado de consanguinidad con cáncer de colon, a los que se les realizó colonoscopia en el Instituto de Gastroenterología entre diciembre de 2019 y diciembre 2021. Se describen las características de los pólipos adenomatosos encontrados. Resultados: La media para la edad fue de 55,9 ± 10,6, predominaron las mujeres. Se encontraron pólipos adenomatosos; 27 eran sésiles y 12 pediculados; en 26 (66,7 %), el tamaño era menor de 10 mm. La mayoría de los pólipos, fueron del tipo tubular. Se observó diversidad en cuanto a la localización de las lesiones, sin que existiera un predominio en ningún segmento anatómico. Conclusiones: Lesiones precursoras del cáncer colorrectal, como los pólipos adenomatosos, son frecuentes en individuos asintomáticos con familiares de primer grado de consanguinidad que padecieron esta neoplasia maligna.

Introduction : Colorectal cancer is currently the second most frequent neoplasm. Most of them are sporadic, another small proportion corresponds to hereditary forms. However, it is estimated that in 15-20% of cases there may be an associated hereditary component. First-degree relatives of patients with colorectal cancer constitute a universe with a higher risk of developing this disease than that of the general population, so screening is recommended in these individuals. Objective : To determine the frequency of adenomatous polyps in individuals with first-degree relatives diagnosed with colon cancer. Methods : A descriptive, cross-sectional study was carried out, including 126 adult relatives with first-degree blood relatives with colon cancer, who underwent colonoscopy at the Institute of Gastroenterology between December 2019 and December 2021. The characteristics of the adenomatous polyps found are described. Results : The mean for age was 55.9 ± 10.6, women predominated: 94 (74.6 %). Thirty-nine (30.9 %) adenomatous polyps were found; 27 (69.2 %) were sessile and 12 (30.7 %) pedunculated; in 26 (66.7 %) the size was less than 10 mm. The majority, 37 (94.8 %), were of the tubular type. Diversity was observed as to the location of the lesions, with no predominance in any anatomical segment. Conclusions : Precursor lesions of colorectal cancer, such as adenomatous polyps, are common in asymptomatic individuals with first-degree relatives who have had this malignancy.

Caracterización del cáncer de colon en pacientes operados en el servicio de Coloproctología de Camagüey

Introducción: Dentro de las enfermedades neoplásicas el cáncer de colon ocupa sin dudas un lugar preponderante, por ser altamente frecuente. Por ello se hace necesario caracterizar los pacientes con cáncer de colon y contar con un registro real de la incidencia de este problema de salud. Objetivo: Caracterizar el cáncer de colon en pacientes operados en el servicio de Coloproctología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey, en el período comprendido desde septiembre de 2018 hasta septiembre de 2022. Métodos: Se realizó un estudio descriptivo, longitudinal prospectivo con el objetivo de caracterizar el cáncer de colon en pacientes operados en el servicio de Coloproctología en el período comprendido desde septiembre de 2018 hasta septiembre de 2022. El universo lo conformaron todos los pacientes que acudieron a consulta en ese período, la muestra a criterio de los autores la integraron 217 pacientes adultos, con diagnóstico de cáncer de colon operados. La fuente primaria de la investigación estuvo dada por la historia clínica. Resultados: El cáncer de colon se presentó con mayor frecuencia en el grupo etáreo de 60-79 años en ambos sexos, predominó el sexo masculino. El síndrome general fue la sintomatología más frecuente. El diagnóstico se realizó mediante el examen clínico y endoscópico. El adenocarcinoma moderadamente diferenciado tuvo mayor recurrencia. La localización topográfica predominante fue en el colon derecho y la hemicolectomía derecha la técnica quirúrgica más utilizada. Las complicaciones quirúrgicas tuvieron una baja incidencia. Conclusiones: El cáncer de colon presentó una mayor frecuencia en el grupo de etáreo de 60-79 años en ambos sexos. El adenocarcinoma moderadamente diferenciado se presentó en mayor frecuencia. Las complicaciones quirúrgicas fueron infrecuentes con una proporción de uno de cada 10 pacientes.

Introduction: Within neoplastic diseases, colon cancer undoubtedly occupies a preponderant place, because it is highly frequent. For this reason, it is necessary to characterize patients with colon cancer and have a real record of the incidence of this health problem. Objective: To characterize colon cancer in patients operated in the Coloproctology service of the Manuel Ascunce Domenech University Hospital in Camagüey, in the period from September 2018 to September 2022. Methods: A prospective longitudinal descriptive study was carried out with the objective of characterizing colon cancer in patients operated in the Coloproctology service of the Manuel Ascunce Domenech University Hospital, in the period from September 2018 to September 2022. The universe was made up of all the patients who attended the consultation in that period, the sample was to the authors' criteria included 217 adult patients with a diagnosis of colon cancer who underwent surgery. The primary source of the investigation was given by the clinical history. Results: Colon cancer occurred more frequently in the age group of 60-79 years in both sexes, the male sex predominating. The general syndrome was the most frequent symptoms. The diagnosis was made by clinical and endoscopic examination. Moderately differentiated adenocarcinoma had a higher recurrence. The predominant topographic location was in the right colon, and right hemicolectomy was the most widely used surgical technique. Surgical complications had a low incidence. Conclusions: Colon cancer presented a higher frequency in the age group of 60-79 years in both sexes. Moderately differentiated adenocarcinoma occurred more frequently. Right hemicolectomy was the most used surgical technique. Surgical complications were in frequent with a proportion of one in 10 patients.

The expression and clinical significance of microRNA-574-3p in colon cancer / 中国医师杂志

Objective:To study the expression and clinical significance of microRNA-574-3p (miR-574-3p) in colon cancer.Methods:A total of 106 colon cancer patients who were admitted to the First Hospital of Qinhuangdao and Shijiazhuang Hospital of Traditional Chinese Medicine from June 2012 to June 2015 were selected as the research objects. Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression level of miR-574-3p in colon cancer tissues and normal adjacent tissues. The relationship between the expression of miR-574-3p and the clinicopathological characteristics and prognosis of patients with colon cancer was analyzed. Immunohistochemical staining was used to detect the relationship between the expression of miR-574-3p and the expression of CyclinA2 or E-cadherin.Results:Compared with normal tissues adjacent to cancer, the expression level of miR-574-3p in 106 cases of colon cancer was significantly lower ( P<0.01). The decreased expression of miR-574-3p was related to tumor diameter, Dukes stage, histological grade and lymph node metastasis (all P<0.05), but not to age and tumor location (all P>0.05). The patients with low expression of miR-574-3p, high Dukes stage and histological grade, and lymph node metastasis had poor survival (all P<0.05). The 5-year overall survival rate of patients with decreased miR-574-3p expression in cancer tissue was significantly lower than that of patients without decreased miR-574-3p expression ( P=0.007 6). Compared with patients with no decreased miR-574-3p expression, patients with decreased miR-574-3p expression had higher CyclinA2 protein integrated optical density (IOD) value and lower E-cadherin protein IOD value in colon cancer tissues (all P<0.05). Conclusions:The decreased expression of miR-574-3p is related to the poor prognosis of colon cancer patients, which may affect tumor recurrence and metastasis by regulating the expression of CyclinA2 and E-cadherin proteins.

Relationship between abnormal imaging findings of adipose tissue around primary colon cancer and prognosis / 中华放射学杂志

Objective:To explore the relationship between the abnormal adipose tissue around the primary tumor of colon cancer and the prognosis.Methods:From January 2015 to December 2017, 448 patients with colon cancer in Peking University Cancer Hospital were retrospectively and consecutively collected. The scores were assigned to the severity, horizontal and vertical ranges of peritumoral adipose tissue (PAT) abnormalities, and the cumulative scores were calculated to establish the PAT grades from 1 to 3. We defined a score of 0 or 1 as PAT grade 1, a score of 2 as PAT grade 2, a score of 3 as PAT grade 3. The patients were followed up, and the overall survival (OS) and metastasis-free survival (MFS) were recorded. The Kaplan-Meier curve, log-rank test and Cox regression analysis were used to evaluate its impact on prognosis, and the hazard ratio (HR) and 95% confidence interval (CI) were calculated.Results:Among the 448 patients, patients with PAT grade 1, 2, and 3 accounted for 70.1% (314/448), 18.1% (81/448), and 11.8% (53/448), respectively. The Kaplan-Meier survival curve showed that patients with PAT grade 1 had the best OS, patients with grade 3 had the worst OS, and patients with grade 2 were in between, and the difference was statistically significant (χ 2=27.38, P<0.001). There were statistically significant differences between the grades in pairs ( P<0.05). There was no significant difference in MFS between different PAT grades (χ 2=2.85, P=0.240). The results of Cox regression analysis showed that PAT grade was an independent factor affecting the OS. Compared with PAT grade 1, the risk of death in patients with PAT grade 2 and 3 was significantly increased (HR 2.563, 95%CI 1.181-5.561; HR 2.269, 95%CI 1.005-5.121; P=0.034). PAT grade was not an independent factor of MFS ( P=0.253). Conclusion:The PAT grade established based on the degree and scope of abnormal PAT in colon cancer is an independent factor for poor prognosis of colon cancer.