Early-stage colon cancer with high MALAT1 expression is associated with the 5-Fluorouracil resistance and future metastasis.

BACKGROUND: This study aimed to investigate the role of long noncoding RNA (LncRNA) expression profiles to predict relapse and 5-FU response in patients with stage I/II colon cancer (CC). METHODS AND RESULTS: The expression level of 15 LncRNA was analyzed in stage I/II colon tumors of 126 CC patients. To confirm the findings in-vitro, 5FU-resistant HT29 cells were generated by subjecting HT-29 cells to the increasing concentrations of 5FU for 6 months. The 5FU resistance was observed in WST-1 and Annexin V analyses. The colony formation and wound healing assays were assessed to determine the metastatic properties of the cells. Expression levels of LncRNAs and mRNA of EMT-related genes were determined by RT-PCR. The role of LncRNA on metastasis and 5FU sensitivity were confirmed in pcDNA3.0-PTENP1 and si-MALAT1 expressed 5FU-resistant HT29 cell lineages. RESULTS: High MALAT1 (p = 0.0002) and low PTENP1 (p = 0.0044) expressions were significantly associated with 5-FU resistance and tumor relapse in stage I/II CC. The invasiveness and colony-forming characteristics of 5-FU-resistant cell lineages were higher as compared to the parent HT-29. Moreover, the expression of MALAT1 (p = 0.0009) was increased while the expression of PTENP1 (p = 0.0158) decreased in 5FU-resistant-HT-29 cells. Si-MALAT1 treatment increased cell sensitivity to 5FU, whereas it decreased invasive behaviors of 5 FU-resistant-HT-29 cells. CONCLUSION: MALAT1 may be a biomarker in predicting recurrence in early-stage CC. Our findings suggest that a cell-based therapy to target MALAT1 could be established for these patients to prevent metastasis and 5-FU resistance.

Can heat shock protein 32 be used for the early diagnosis of acute mesenteric ischemia?

OBJECTIVE: Acute mesenteric ischemia is a challenging and fatal disease. The aim of this study was to detect the heat shock protein 32 (HSP32) response in intestinal tissue and systemic blood to intestinal ischemia and ischemia/reperfusion to define a tool for the early diagnosis of acute mesenteric ischemia. MATERIAL AND METHODS: Thirty female Wistar albino rats were equally divided into 3 groups. Group 1 rats underwent simple laparotomy and closure (control). In Group 2 rats, 1-hour intestinal ischemia followed by 5-hour reperfusion was performed, and Group 3 rats were subjected to 6-hour intestinal ischemia. The experiment was repeated with a 24-hour waiting period. At the end of the waiting period, blood was withdrawn from the tail veins of the rats and the rats were sacrificed via cardiac puncture. Re-laparotomy was subsequently performed and intestinal tissue and luminal samples were obtained for biochemical and pathological investigations. The HSP32 levels of intestinal tissues, luminal contents and blood levels were compared among the groups. RESULTS: At the end of the 24-hour waiting period, the median tissue HSP32 levels were 0.43 (0-6.6) ng/mL for Group 1, 9.51 (2.5-49.9) ng/mL for Group 2 and 43.13 (6.3-121.3) ng/mL for Group 3 (p=0.001). The median blood HSP32 levels were 0.11 (0.1-1.4) ng/mL for Group 1, 0.42 (0.1-0.7) ng/mL for Group 2, and 0.25 (0.1-1.2) ng/mL for Group 3 (p=0.047). The HSP levels in the luminal contents were undetectable. CONCLUSION: Both ischemia and ischemia/reperfusion significantly raised intestinal tissue HSP32 levels in comparison with the control group. However, this change was not reflected in the circulating blood or luminal contents.

MicroRNA expression patterns of tumors in early-onset colorectal cancer patients.

BACKGROUND: The expression of microRNAs (miRNAs) may differ in tumors from patients with different ethnic origins and ages. The aims of the present study were to clarify the appropriate alterations of miRNA expression associated with the early stages of carcinogenesis in early-onset Turkish colorectal cancer (CRC) patients and to define specific biomarkers that could be used as new diagnostic and prognostic markers for this population. MATERIALS AND METHODS: The expression profiles of 38 different miRNAs associated with CRC were evaluated using miRNA polymerase chain reaction arrays in tumors and surgical margin tissue samples from 40 sporadic early-onset Turkish CRC patients. The relationships between the miRNA expression profiles and the characteristics of the tumors and patients were evaluated. RESULTS: The expression of miR-106a was found to be upregulated, and miR-143 and miR-125b levels were found to be downregulated in tumor tissues compared with the normal tissues. The high expression level of miR-106a (2.93-fold; P = 0.031) and low expression level of miR-125b (2.42-fold; P = 0.063) were observed in tumors with lymph node metastases compared with the normal colorectal mucosa samples. However, the deregulation of these miRNAs was not significantly associated with survival (log-rank P > 0.05). CONCLUSIONS: The present results implied that miR-106a and the miR-125b were associated with the formation and invasion of colorectal tumors. Thus, these miRNAs might be used as significant prognostic factors and indicators of early-stage CRC. Further studies and validations are required; these miRNAs may provide novel molecular targets for CRC treatment.

Microscopic Growth Pattern of Metastatic Colorectal Carcinomas, Morphological Findings of the Non-Neoplastic Liver, and Their Relationship With Prognosis and Survival.

Introduction. Various clinicopathological, radiological, and molecular parameters are predictive of prognosis in patients with colorectal carcinoma and distant organ metastases continue to have a significant place among them. Recent studies reveal that not only the presence of metastases but also the histopathological growth pattern of the metastatic tumor significantly affects prognosis. This study aimed to investigate the prognostic significance of the histopathological growth patterns of metastatic tumors, the morphological findings in the peritumoral non-neoplastic liver, and its relationship with survival in patients who have metastatic colorectal carcinoma. Materials and Method. Hematoxylin and eosin-stained slides of the tumors were re-examined in terms of histopathological diagnosis, growth pattern, presence and degree of peritumoral lymphocytic infiltration, steatosis, cholestasis, and peritumoral ductular reaction in the non-neoplastic liver. Results. In terms of histopathological growth patterns, 24 (47%) tumors showed replacement, 19 (37%) showed desmoplastic and 8 (16%) showed pushing growth pattern. In terms of total survival, there was a significant difference (P = .011) between desmoplastic and replacement growth patterns, and the survival period was shorter in patients with replacement growth patterns. Conclusion. Recent studies show that histopathological growth patterns in metastatic liver tumors may be a promising prognostic and predictive parameter. It is important to include this parameter in the pathology reports as it does not require additional equipment for evaluation in routine pathology practice, does not bring additional costs, or takes a long time to evaluate. This feature can be evaluated standardly by every pathologist.

Microsatellite instability status affects gene expression profiles in early onset colorectal cancer patients.

BACKGROUND: The association between microsatellite instability (MSI) status and gene expression profiles in the early onset sporadic colorectal cancer (CRC) has not been clearly established. The aim of this study was to identify the altered gene expression patterns depending on the MSI status of early onset CRC and determine specific biomarkers that could provide novel therapeutic molecular targets in the Turkish population. MATERIALS AND METHODS: MSI markers (BAT25, BAT26, D2S123, D5S346, and D17S250) were investigated in tumors from 36 early onset sporadic CRC patients in whom gene expression profiles were analyzed previously. The relationship between the gene expression profiles depending on MSI status was evaluated. RESULTS: A total of 15 tumors (16.66%) were identified as having MSI and 21 tumors (58.33%) were identified as having microsatellite stability (MSS). CK20 and MAP3K8 upregulation, observed in MSS tumors, was significantly associated with lymph node metastasis, recurrence, and/or distant metastasis and a short median survival (P < 0.05). REG1A upregulation is also correlated with recurrence and/or distant metastasis and a short median survival in patients with MSI tumors (P < 0.05). CONCLUSIONS: High expression levels of CK20 and MAP3K8 in MSS tumors and REG1A in MSI tumors correlated with a poor prognosis in CRC patients. Further studies and validations are required; these genes may provide novel therapeutic molecular targets for the development of anticancer drugs related to MSI status for early onset CRC treatment.

DPYD c.1905 + 1G>A Promotes Fluoropyrimidine-Induced Anemia, a Prognostic Factor in Disease-Free Survival, in Colorectal Cancer.

Background and Aim: In 10-30% of colorectal cancer (CRC) patients, toxic reactions occur after fluoropyrimidine-based chemotherapy. A dihydropyridine dehydrogenase (DPYD) gene variant, c.1905 + 1G>A, leads to intolerance to fluoropyrimidines. Due to the low frequency of this variant in many populations, the prevalence of fluoropyrimidine-induced hematologic side effects in CRC patients with the c.1905 + 1G>A variant is unclear. In this study, we investigated the prevalence of the DPYD c.1905 + 1 variants in a Turkish CRC cohort and the potential effects of these variants on fluoropyrimidine-induced hematologic side effects. Materials and Methods: The DPYD c.1905 + 1 variant was genotyped using polymerase chain reaction-restriction fragment length polymorphism analysis and confirmed by Sanger sequencing in peripheral blood samples of 100 CRC patients who received fluoropyrimidine-based chemotherapy and 60 healthy volunteers. The association of c.1905 + 1 variants with susceptibility to hematologic side effects was evaluated. Results: The DPYD c.1905 + 1G>A variant was more common in the CRC group than in the healthy control group (p = 0.001). The presence of the c.1905 + 1G>A variant was associated with thrombocytopenia (p = 0.039) and anemia (p = 0.035). CRC patients with fluoropyrimidine-induced anemia had shorter disease-free survival than CRC patients without fluoropyrimidine-induced anemia (p = 0.0009). Conclusions: Before administering fluoropyrimidine-based chemotherapy, genetic screening for the DPYD c.1905 + 1G>A variant should be performed with the aim of preventing anemia and anemia-induced complications in CRC patients.

Fall of another myth for colon cancer: Duration of symptoms does not differ between right- or left-sided colon cancers.

BACKGROUND/AIMS: Patients with colorectal cancer continue to present with relatively advanced tumors that are associated with poor oncological outcomes. The aim of the present study was to assess the association between localization, symptom duration, and tumor stage. MATERIALS AND METHODS: A prospective, multicenter cohort study was conducted on patients newly diagnosed with a histologically proven colorectal adenocarcinoma. Standardized questionnaire-interviews were performed. Data were collected on principal presenting symptoms, duration of symptoms (time to first presentation to a doctor and time to diagnosis) and treatment, diagnostic procedures, tumor site, and stage of the tumor (tumor, node, and metastasis (TNM)). RESULTS: A total of 1795 patients with colorectal cancer were interviewed (mean age: 60.76±13.50 years, male patients: 1057, patients aged >50 years: 1444, colon/rectal cancer: 899/850, right side/left side: 383/1250, stage 0-1-2/stage 3-4: 746/923). No statistically significant correlations were found between duration of symptoms and either tumor site or stage. Principal presenting symptoms were significantly associated with left colon cancer. Patients who had "anemia," "change in bowel habits," "anal pruritus or discharge," "weight loss," and "tumor in right colon" had a significantly longer symptom time. CONCLUSION: Symptom duration is not associated with localization, nor is the tumor stage. Diagnosis of colorectal cancer at an earlier stage may be best achieved by screening of the population.

Does single, low-dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double-blind, randomized clinical trial.

Preoperative single, high-dose methylprednisolone administration improves postoperative outcomes after colonic surgery. Several randomized studies, including major surgeries, assessed various high-dose steroid regimens; however, evidence about the effect of administration of lower doses on postoperative outcomes in colorectal surgery is not available. The aim of the present study is to determine whether the administration of a single, low dose of dexamethasone before surgery would confer an outcome advantage after colorectal surgery. Thirty patients undergoing colorectal surgery were included in this randomized, double-blind study. Patients received 8 mg dexamethasone or serum physiologic preoperatively. Levels of Interleukin-6 and C-reactive protein, pain scores, postoperative nausea and vomiting, mobilization, complications, hospital stay, and readmissions were compared. Age, sex, indications, and operations were similar in both groups (P > 0.05). C-reactive protein and Interleukin-6 levels increased significantly postoperatively in each group (P < 0.05), but there were no differences between groups when compared (P > 0.05). There were also no significant differences between pain scores, bowel functions, mobilization, hospital stay, complication rates, and readmission rates between the two groups (P > 0.05). Preoperative 8 mg dexamethasone administration has no significant effect on reducing postoperative inflammatory response and also does not improve outcomes of colorectal surgery.

Comparison of protracted infusion 5-fluorouracil and capecitabine in adjuvant chemoradiotherapy for rectal cancer.

BACKGROUND/AIMS: 5-Fluorouracil-based chemoradiotherapy is the most widely used treatment modality in the adjuvant treatment of rectal cancer. Capecitabine represents a valuable alternative to 5-Fluorouracil in this situation. METHODOLOGY: Patients with stage II and stage III rectal adenocarcinoma, who were included in this analysis, received adjuvant chemoradiotherapy consisting of external-beam radiotherapy (50.4-54Gy) either with 5-Fluorouracil at a median dose of 300 mg/m2/day by protracted venous infusion for 5 days a week, or capecitabine at a median dose of 1650 mg/m2/day for 5 days a week after surgery. The data concerning the toxicity and the efficacy of the treatments were compared in patients treated with 5-Fluorouracil- and capecitabine-based chemoradiotherapy. RESULTS: Forty-three patients received 5-Fluorouracil, and 24 patients received capecitabine during adjuvant radiotherapy. Although there were no differences between the groups in terms of toxicity rates, distant metastasis-free survival, disease-free survival, and overall survival rates; a trend for improved loco-regional recurrence-free survival rate was observed in the capecitabine arm (p = 0.063). CONCLUSIONS: Capecitabine is at least as effective as 5-Fluorouracil in the postoperative treatment of rectal adenocarcinoma. Considering the trend for improved loco-regional recurrence-free survival rate in the capecitabine arm, it seems that the drug exerts better synergy with radiotherapy in this situation.

P53 expression in synchronous colorectal cancer.

OBJECTIVE: We reviewed cases of primary colorectal adenocarcinoma to document synchronous colon and rectum adenocarcinoma (SCRC). METHODS: In a retrospective setting, 764 cases underwent surgical resection for primary colorectal adenocarcinoma and referred to the Department of Surgical Pathology, Uludag University, Medical Faculty for diagnoses between 1997 and 2006, were reviewed. Tumor site, depth of invasion, coexistence of adenoma, distance between these multiple primary tumors, degree of p53 expression, and p53 expression pattern indicating polyclonal or monoclonal origins were noted in order to establish a possible effect on prognosis. RESULTS: There were 28 cases with SCRC of colon and rectum. Nine cases were female, 19 cases were male (female to male ratio was 1:2). Most of the cases were within the 5th and the 6th decades. There were statistically significant relationships between p53 expression and differentiation status (p=0.001), and invasion depth (p=0.03). Forty of 62 colorectal carcinomas showed immunohistochemical positivity for p53. Six cases showed a discordant pattern of p53 mutation among individual lesions indicating polyclonal origin. CONCLUSION: Synchronous colon and rectum adenocarcinoma is not rare. The incidence is 3.6% in our series. We believe that further studies with larger series are needed for p53 to prove useful in predicting prognosis of SCRCs and assessing the polyclonal origin of SCRC at a genetic level.

Colorectal cancer surgery in octogenarians.

OBJECTIVE: The incidence of colorectal cancer becomes higher among octogenarians as the life expectancy increases. Whether advanced age is a risk factor for colorectal surgery is a matter of debate. In the present study, the clinical results of octogenarians who underwent colorectal cancer surgery are discussed to find an answer to this question. MATERIAL AND METHODS: Data of 63 octogenarians who were operated in a tertiary colorectal surgery department between January 1, 2010 and December 31, 2013 were reviewed retrospectively. Demographic data and preoperative, peroperative, and postoperative parameters were evaluated. RESULTS: Overall, 57.2% of the patients were men. The median age was 81 (80-89) years. Cancer was located at the right colon in 17.5%, left colon in 50.8%, and rectum in 31.7%. Eleven patients underwent emergency surgery (17.5%). The most common surgical procedure was low anterior resection in elective (22.2%) and Hartmann's procedure in the emergency setting (9.5%). Stoma creation was more frequent among patients undergoing emergency procedures (42% vs. 6.8%; p=0.0018). Histopathological diagnosis was adenocarcinoma in 90.5% of the patients, and 34.9% of the patients had stage IIIB disease. Surgical morbidity was significantly higher among patients who underwent rectal resection (66% vs. 10.2%; p=0.0124). Medical morbidity was observed in 10 (15.9%) patients. Preoperative blood transfusion was a risk factor for morbidity (83.4% vs. 29.8%; p=0.0170). Length of total hospital stay was 14 (3-39) days. Surgical (p=0.0004) and medical (p=0.0288) morbidity prolonged the length of total hospital stay. The overall mortality rate was 1.6%. CONCLUSION: Colorectal surgery may be safely performed in octogenarians with acceptable morbidity and mortality in specialized centers.

Hand-assisted Laparoscopy: Expensive but Considerable Step Between Laparoscopic and Open Colectomy.

PURPOSE: Hand-assisted laparoscopic colectomy (HALC) and laparoscopic-assisted colectomy (LAC) have been shown to have comparable short-term outcomes while there are limited data regarding costs. The aim of our study was to compare the short-term outcomes and costs of HALC and LAC. MATERIALS AND METHODS: In total, 46 patients who underwent HALC or LAC for benign or malignant disease between January 2011 and December 2014 at our institution were included in the study. Patients were randomized into HALC or LAC group. Patients' demographics and characteristics, operative details, short-term outcomes, and costs were evaluated. RESULTS: There were 25 patients in LAC group and 21 patients in HALC group. Patient's demographics and characteristics and short-term outcomes were comparable between the LAC and HALC groups. Conversion rate was significantly lower in the HALC group (4.7% vs. 28%, P=0.03) while surgical costs ($1706.83±203.70 vs. $1304.93±305.67, P=0.038) and total costs ($2427.18±254.27 vs. $2044.03±215.22, P=0.021) were significantly higher in HALC group. CONCLUSIONS: HALC is associated with increased surgical and total hospital costs, and decreased rate of conversion. Although it is more expensive, HALC may be helpful by providing a step between LAC and open surgery before considering conversion.

Coexistence of MACC1 and NM23-H1 dysregulation and tumor budding promise early prognostic evidence for recurrence risk of early-stage colon cancer.

The tumor-node-metastasis (TNM) classification, the presence of a mucinous component, and signet ring cells are well-known criteria for identifying patients at a high risk for recurrence and determining the therapeutic approach for early-stage colon cancer (eCC). Nevertheless, recurrence can unexpectedly occur in some eCC cases after surgical resection. The aims of the present study were to evaluate the relation of dysregulated MACC1, c-MET, and NM23-H1 expression with the histopathological features of tumors in recurrence formation in eCC cases. A total of 100 sporadic eCC patients without poor prognosis factors were evaluated in this study. The relationship between the altered expression of MACC1, c-MET, and NM23-H1 and pathological microenvironmental features, including the presence of tumor budding and desmoplasia, were assessed. The primary outcomes, including 5-year overall survival (OS) and disease-free survival (DFS), were also measured. Compared with nonrecurrent patients, the expression level of MACC1 was 8.27-fold higher, and NM23-H1 was 11.36-fold lower in patients with recurrence during the 5-year follow-up (p = 0.0345 and p = 0.0301, respectively). In addition, the coexistence of high MACC1 and low NM23-H1 expression and tumor budding was associated with short OS (p < 0.001). We suggest that the combination of reduced NM23-H1, induced MACC1, and the presence of tumor budding are promising biomarkers for the prediction of recurrence and may aid the stratification of patients with stage II colon cancer for adjuvant chemotherapy.

Factors affecting the mortality risk in elderly patients undergoing surgery.

BACKGROUND: Factors affecting the mortality in elderly patients vary among different studies. This study investigates the influence of the patient-related factors, especially the effect of the diseased organ system on the mortality risk in the elderly. METHODS: Records of 942 operated patients aged 70 years and over were retrospectively examined. Age, sex, site of the diseased organ system, type of admission, benign/malign nature, American Society for Anesthesiologists (ASA) score, main surgical diagnosis, method of surgical therapy and concomitant diseases were examined for their influence on the mortality. RESULTS: There were 501 men and 441 women. Mean age was 75.5 years. Most of the patients had colorectal pathologies. Emergency surgery was carried out in 313 patients. Mortality rate was 11.8%. Cardiogenic shock was the leading cause of mortality. There was a strong linear correlation between ASA score and mortality. Logistic regression analysis concluded that higher (> or =3) ASA scores, operations under emergent conditions and diseases of the colorectal and upper gastrointestinal systems were significantly associated with higher mortality rates. CONCLUSION: When combined with ASA score and type of admission, site of the diseased organ system may be a good indicator of mortality in the elderly patients undergoing surgery.

Microbiological aspects of Fournier's gangrene.

BACKGROUND: Fournier's gangrene (FG) is a devastating disease that is characterized by necrotizing fasciitis of the perineal, genital, or perianal region. Broad-spectrum antibiotics are the key component of its treatment. However, there is paucity of data regarding the optimal empirical antibiotherapy for FG. MATERIALS AND METHODS: Data from patients who underwent surgery for FG between January 2007 and December 2012 were retrieved from a prospectively collected departmental FG database. Demographics, clinical characteristics, causative pathogens and drug susceptibility/resistance were evaluated. RESULTS: Fifty patients with a median age of 58.5 (22-83) years were included. The perianal origin (58%) was most commonly affected. A positive growth was found in specimen cultures of 48 (96%) patients. The median number of bacterial strains that grew in the cultures was 3 (0-10). Amikacin was the antibiotic with the highest frequency of sensitivity (74%), while the highest resistance was observed against ampicillin-sulbactam (64%). Escherichia coli was the most common microorganism (72%). Acinetobacter baumannii and Klebsiella pneumonia were significantly more common in patients who required mechanical ventilation. The mortality rate was 26%. An Uludag Fournier's Gangrene Severity Index (UFGSI) score of >9.5 and ventilatory support requirement were factors associated with an increased rate of mortality. Acinetobacter baumannii was the only microorganism which was associated with an increased mortality rate. CONCLUSION: Causative pathogens in FG appeared to be shifting; thus, empirical antibiotic treatment for this disease should be modified. We recommend 3rd-generation cephalosporin, metronidazole and amikacin for empirical therapy.

Laparoscopic findings of peritoneal dialysis catheter malfunction and management outcomes.

OBJECTIVE: Peritoneal dialysis catheter malfunction is a common complication forcing conversion to hemodialysis. The purpose of this study was to evaluate laparoscopic findings of catheter malfunction and to establish a relationship between those findings and the outcomes of procedures performed. DESIGN: Retrospective study. SETTING: A tertiary referral center. PATIENTS: 40 consecutive patients with stage 5 chronic kidney disease underwent 46 laparoscopic correction procedures for the treatment of peritoneal dialysis catheter malfunction between November 1994 and August 2004. MAIN OUTCOME MEASURES: Laparoscopic findings of catheter malfunction, procedures performed, catheter survival, and recurrent cases were evaluated. RESULTS: There were 28 tip migrations in 40 patients; 16 were without adhesions and 10 were associated with omental adhesions. Reposition and adhesiolysis were the most frequent procedures performed. Malfunction recurred in 12 patients and 5 of them underwent 6 secondary laparoscopic procedures. Estimated mean catheter survival was 19.9 +/-3.32 months (%95 confidence interval 13.43 - 26.46). CONCLUSIONS: The most frequent laparoscopic finding was catheter tip migration, with or without adhesions. Laparoscopic repositioning and adhesiolysis without omentectomy are simple and effective procedures that can prolong catheter survival, even in recurrent malfunctions.

Criteria to consider when assessing the mortality risk in geriatric surgery.

As the population ages, surgery is performed more frequently on geriatric patients for both elective and emergency situations. Four hundred sixty-nine patients > or = 70 years of age who underwent operations were retrospectively reviewed. Sex, American Society of Anesthesiologists (ASA) score, type of admission, main surgical diagnosis, benign or malignant nature, site of disease, concomitant disease, preoperative ASA grade, and death were assessed. The ratio of the elderly against all those who were operated on in our department during the same period was 5.9%. The mortality rate was 8.5% for men and 9.4% for women. According to ASA scoring, mortality rates were 0%, 8.8%, 29.8%, 36.8%, and 66.6%, respectively (P < 0.05). The mortality rate was 2.5% for elective and 49.2% for emergency procedures (P < 0.0001). The mortality rate was 9.7% for benign and 7.2% for malignancy. Hepatopancreatic biliary conditions were most common (39.6%), followed by colorectal (19.4%), hernia (18.8%), upper gastrointestinal (15.3%), and endocrine disease (6.9%). The highest mortality rate was for diseases of the upper gastrointestinal system (30.5%; P < 0.001). The incidence of associated disease was 13.1% in patients who died (P < 0.005). Overall mortality rate in this study was 8.9%. In emergency surgery, the presence of associated disease, an ASA score of III-V, and upper gastrointestinal surgery affected the risk of postoperative death in elderly patients.

A rare tumor located in the anorectal junction: sarcomatoid carcinoma.

Sarcomatoid carcinoma is a very rare tumor. Though it has been more than a century since sarcomatoid carcinoma was first described by Wirchow, many unresolved points remain. Histogenesis and nomenclature are controversial. A proper management has not been defined. Patients suffering from this aggressive tumor have a very poor prognosis. However, in this paper a case with a disease-free survival of more than five years is reported.

Gender does not affect the prognosis of Fournier's gangrene: a case-matched study.

BACKGROUND: Female gender is accepted as a poor prognostic factor for Fournier's gangrene (FG). However, there is a paucity of data in the literature regarding this matter. This case-matched study was designed to investigate the impact of gender on outcomes of FG. METHODS: Study patient data were retrieved from 120-patient, prospectively maintained database. Thirty-two female patients with FG were case-matched to 32 male patients based on symptom duration (days), FG severity index score, patient age, etiology, and presence of diabetes mellitus (DM) terms. Outcomes of FG were compared between the 2 groups. RESULTS: Median age was 57 years (range: 22-80 years), and 35 (54.7%) patients had DM. Patients underwent average of 3 debridement procedures (range: 1-9 debridements), and 15 (23.4%) received diverting stoma. Overall mortality rate was 28.1% (18 of 64 patients). Female gender was associated with widespread disease (p=0.009), increased need for consecutive debridements (p=0.005), prolonged length of intensive care unit stay (p=0.035), and increased requirement for split-thickness skin graft reconstruction (p=0.040). However, mortality rates were comparable between genders (p=0.264). CONCLUSION: FG is often more extensive in females and seems to be associated with anatomical features of female pelvis. However, female gender is not a factor affecting prognosis of patients with FG.

Analysis of prognostic and immunohistochemical factors in gastrointestinal stromal tumors with malignant potential.

The aim of this study was to analyze 37 patients with malignant primary gastrointestinal stromal tumors and to compare the findings and their therapeutic implications with those previously reported. The medical records of 37 patients who were diagnosed and operated on between January 1996 and December 2002 were retrospectively reviewed. The patients' age, tumor size, type of surgery, histologic type, mitotic counts, presence of necrosis, Ki-67 proliferative index, National Institutes of Health 2001 consensus classification, immunohistochemical staining, and recurrence were examined to analyze factors affecting survival. Overall actuarial survival for all patients was 46%. When analyzed by type of resection, the complete resection group (R0 resection) had a mean overall survival of 48.2 +/- 6.18 months compared with the patients with incomplete resection (R1-R2) who survived a mean of 10.8 +/- 3.2 months (P=0.00). Univariate analysis showed development of recurrence (P=0.00), tumor size of 8 cm or greater (P=0.05), Ki-67 proliferative index greater than 0.82 (P=0.0448), desmin staining (P=0.0076), age younger than 49 years (P=0.0009), and incomplete resection (P=0.00) to be significantly correlated with a poor survival. In multivariate analysis, desmin staining (P=0.031), tumor size (P=0.033), age (P=0.01), recurrence (P=0.038), and R0 resection (P=0.02) were significant independent prognostic factors. We recommend that more careful preoperative and more frequent postoperative follow-up examinations be performed for patients with large tumors, age of younger than 49 years, and Ki-67 proliferative index greater than 0.82.