Significance of the CONUT Score in the Prognosis of Colorectal Cancer Patients.

INTRODUCTION/OBJECTIVE: Nutritional status is related to the prognosis of colorectal cancer (CRC) patients. The CONUT (The Controlling Nutritional Status) score is a recent nutritional marker. This study aimed to examine the association of preoperative CONUT score with overall survival (OS) and disease-free survival (DFS), while the secondary aim was to assess the importance of preoperative nutritional status for the development of postoperative complications. Methods: The total number of CRC patients included in the study was 111. All patients underwent laboratory analyses within a week before surgery. Medical data were collected from archived data at the Zvezdara University Medical Centre. The CONUT score was analyzed in relation to the OS and DFS. Results: Using the Kaplan-Meier survival curve and Log-rank test, a statistically significant difference in OS and DFS between groups of patients with different CONUT scores was observed. Patients with higher CONUT scores have a longer duration of hospitalization after surgery, a longer total length of stay, and a more severe degree of postoperative complications. CONCLUSION: The CONUT score is related to short-term treatment outcomes, such as the length of intrahospital treatment and frequency and severity of postoperative complications, but also to long-term prognostic parameters. Early nutritional screening may be of prognostic significance.

IL-23/IL-17 Axis in Chronic Hepatitis C and Non-Alcoholic Steatohepatitis-New Insight into Immunohepatotoxicity of Different Chronic Liver Diseases.

Considering the relevance of the research of pathogenesis of different liver diseases, we investigated the possible activity of the IL-23/IL-17 axis on the immunohepatotoxicity of two etiologically different chronic liver diseases. A total of 36 chronic hepatitis C (CHC) patients, 16 with (CHC-SF) and 20 without significant fibrosis (CHC-NSF), 19 patients with non-alcoholic steatohepatitis (NASH), and 20 healthy controls (CG) were recruited. Anthropometric, biochemical, and immunological cytokines (IL-6, IL-10, IL-17 and IL-23) tests were performed in accordance with standard procedure. Our analysis revealed that a higher concentration of plasma IL-23 was associated with NASH (p = 0.005), and a higher concentration of plasma IL-17A but a lower concentration of plasma IL-10 was associated with CHC in comparison with CG. A lower concentration of plasma IL-10 was specific for CHC-NSF, while a higher concentration of plasma IL-17A was specific for CHC-SF in comparison with CG. CHC-NSF and CHC-SF groups were distinguished from NASH according to a lower concentration of plasma IL-17A. Liver tissue levels of IL-17A and IL-23 in CHC-NSF were significantly lower in comparison with NASH, regardless of the same stage of the liver fibrosis, whereas only IL-17A tissue levels showed a difference between the CHC-NSF and CHC-SF groups, namely, a lower concentration in CHC-NSF in comparison with CHC-SF. In CHC-SF and NASH liver tissue, IL17-A and IL-23 were significantly higher in comparison with plasma. Diagnostic accuracy analysis showed significance only in the concentration of plasma cytokines. Plasma IL-6, IL-17A and IL-23 could be possible markers that could differentiate CHC patients from controls. Plasma IL-23 could be considered a possible biomarker of CHC-NSF patients in comparison with controls, while plasma IL-6 and IL-17-A could be biomarkers of CHC-SF patients in comparison with controls. The most sophisticated difference was between the CHC-SF and CHC-NSF groups in the plasma levels of IL-10, which could make this cytokine a useful biomarker of liver fibrosis.

Prognostic Value of Combined Hematological/Biochemical Indexes and Tumor Clinicopathologic Features in Colorectal Cancer Patients-A Pilot Single Center Study.

Colorectal cancer (CRC) is a significant public health problem. There is increasing evidence that the host's immune response and nutritional status play a role in the development and progression of cancer. The aim of our study was to examine the prognostic value of clinical markers/indexes of inflammation, nutritional and pathohistological status in relation to overall survival and disease free-survival in CRC. The total number of CRC patients included in the study was 111 and they underwent laboratory analyses within a week before surgery. Detailed pathohistological analysis and laboratory parameters were part of the standard hospital pre-operative procedure. Medical data were collected from archived hospital data. Data on the exact date of death were obtained by inspecting the death registers for the territory of the Republic of Serbia. All parameters were analyzed in relation to the overall survival and survival period without disease relapse. The follow-up median was 42 (24-48) months. The patients with the III, IV and V degrees of the Clavien-Dindo classification had 2.609 (HR: 2.609; 95% CI: 1.437-4.737; p = 0.002) times higher risk of death. The modified Glasgow prognostic score (mGPS) 2 and higher lymph node ratio carried a 2.188 (HR: 2.188; 95% CI: 1.413-3.387; p < 0.001) and 6.862 (HR: 6.862; 95% CI: 1.635-28.808; p = 0.009) times higher risk of death in the postoperative period, respectively; the risk was 3.089 times higher (HR: 3.089; 95% CI: 1.447-6.593; p = 0.004) in patients with verified tumor deposits. The patients with tumor deposits had 1.888 (HR: 1.888; 95% CI: 1024-3481; p = 0.042) and 3.049 (HR: 3.049; 95% CI: 1.206-7.706; p = 0.018) times higher risk of disease recurrence, respectively. The emphasized peritumoral lymphocyte response reduced the risk of recurrence by 61% (HR: 0.391; 95% CI: 0.196-0.780; p = 0.005). Standard perioperative laboratory and pathohistological parameters, which do not present any additional cost for the health system, may provide information on the CRC patient outcome and lay the groundwork for a larger prospective examination.

Current Surgical Concepts and Future Perspectives in the Treatment of Borderline Resectable and Potentially Resectable Locally Advanced Pancreatic Cancer.

Pancreatic ductal adenocarcinoma (PDAC) represents an aggressive tumor with a low five-year survival rate of less than 10%. Only 20% of patients are estimated to be eligible for upfront curative resection at the time of presentation. The larger group of borderline resectable (BRPC) and locally advanced pancreatic cancers (LAPC) had much poorer outcomes in the past. Although there are improvements for the multimodal therapy of PDAC, surgery remains the single hope for a cure. Combined with adjuvant and/ or neoadjuvant treatment, pancreatic surgery can enhance five-year survival by up to 20%. However, pancreatic resection is widely associated with a high risk of complications and is regarded as one of the most complex surgical procedures. TRIANGLE operation should be added to pancreatic surgery armamentarium as a key procedure, with the potential to increase the number of harvested lymph nodes, reduce the complications rate, and better radical treatment efficacy for BRPC and LAPC be converted to resectability after neoadjuvant treatment (NAT). More and more aggressive pancreatectomy has become justified in the context of NAT. Further technical standardization and optimal neoadjuvant strategy are mandatory for the global dissemination of aggressive pancreatectomies. This review summarizes the surgical treatment for BRPC and potentially resectable LAPC based on the current literature, focusing on the "TRIANGLE "concept of pancreatic surgery.

Significance of Biomarkers in Early Diagnosis of Abdominal Sepsis.

INTRODUCTION/OBJECTIVE: Peritonitis is one of the most important sources of abdominal sepsis. Since intra-abdominal infection leads to the activation of the inflammatory response, this suggested that some of these mediators could be used as markers of the severity of newly formed sepsis, but primarily to identify or rule out new-onset sepsis. The aim of this study was to evaluate the sensitivity and specificity of serum markers of inflammation: C-reactive protein, procalcitonin and serum amyloid A in the serum of patients with diffuse secondary peritonitis. Methods: The prospective cohort study was conducted at the Clinic for Emergency Surgery of the Clinical Center of Serbia in Belgrade. The study group consisted of 100 patients aged 18 to 70 years, with signs of acute abdomen due to diffuse secondary peritonitis. Results: CRP and PCT are so far among the most valuable preoperative markers for distinguishing sepsis from SIRS. On the first postoperative day the analysis of the relationship between sensitivity and specificity at the different breakpoints used indicates a greater diagnostic accuracy and greater sensitivity of SAA compared to CRP and PCT. In the remaining postoperative period in our study, the ROC curve mostly coincided with the diagonal line, so CRP, PCT, and SAA had little diagnostic accuracy. CONCLUSION: The results of our study suggest that finding a specific marker for the diagnosis of abdominal sepsis, a marker that would differentiate between SIRS and sepsis, pre- and postoperatively, would be very useful.

Fatty acid in colorectal cancer in adult and aged patients of both sexes.

PURPOSE: Colorectal cancer represents the second most common type of cancer in Serbia. Alteration of lipid metabolism begins early, and can represent a central hallmark in cancer evolution. Fatty acids have various important functions as building components of cell membranes, as signaling molecules in immune responses and also manage the general cancer signaling network. The purpose of this study was to investigate the difference of various fatty acids content between colorectal cancer and adjacent healthy intestinal tissue in adult and aged patients of both sexes. METHODS: 52 subjects participated in this study. Healthy colon mucosa and tumor tissue samples were obtained from patients previously diagnosed with colorectal carcinoma. Simplified method of Berstad et al was used for direct transesterification of total lipids in tumor and healthy mucosa tissue samples and separations of the methyl esters was carried out using a gas chromatograph equipped with a split/splitless injector and a flame ionization detector. RESULTS: 18 0, 18 1 n7, 20 3, 20 4, 20 5, 22 4, 22 5 22 6, SFA, PUFA, n6, n3 and AA/EPA were significantly higher in tumor tissue. On the other hand, 18 1 n9, 18 2, 18 3 n3, MUFA, n6/n3 were significantly higher in healthy tissue. CONCLUSIONS: Saturation index (SI) could be a valuable tool to delineate robust immune response and worse prognosis in patients with colorectal cancer. Our study demonstrated significant differences in fatty acid profiles between tumor tissue and healthy mucosa. Parameters, such as gender, age, stage and mucinous component didn't influence altered fatty acid content.

Is Colorectal Cancer Stage Affected by COVID-19 Pandemic?

Background: Causing healthcare systems overload, COVID-19 pandemic has a huge influence on patients with colorectal cancer. The aim of our study was to assess the potential impact of COVID-19 on the stage of colorectal cancer. Methods: In our retrospective study, two groups of patients operated for colorectal cancer were analyzed at the Clinic for Surgery "Nikola Spasic", Zvezdara University Medical Center. The study group consisted of 49 patients operated in the period from March 15, 2020 to April 2021, during COVID-19 pandemic. The control group consisted of 152 patients, who were operated on in the period from January 1, 2019. to December 31, 2019. Results: There were no difference in surgical approach, prevalence of stoma, percentages of postoperative complications and rates of hospital readmission between both groups. T4b tumor stage was statistically significant more common in the study group (12.2% vs 3.3%, p=0.027). Locally advanced tumors, stage IIC, were statistically significantly more common in the group of patients operated on during the COVID-19 pandemic (10.2% vs 1.3%, p=0.01). Conclusion: Higher number of locally advanced tumors in study group could probably be caused by the impact of the COVID-19 pandemic on healthcare system.

Colorectal cancer and trace elements alteration.

BACKGROUND: Trace elements have important influence on body function primarily because of the vital role they have in many physiological processes. Their alterations have been found in many disorders, including cancer. It has been well known for decades that disturbances in elemental concentration may lead to cell damaging, DNA injuries and imbalance in oxidative burden. Our study tried to determine the difference of trace elements concentrations between colorectal adenocarcinoma and adjacent healthy intestinal tissue. METHODS: 59 subjects participated in this study. Healthy colon mucosa samples and colon tumor tissue samples were obtained from patients previously diagnosed with colon carcinoma by standard diagnostic procedures. Analysis of the elements was performed by inductively coupled plasma mass spectrometry (ICP-MS). RESULTS: The results showed that Na, K, Mg, Ca, Cu, Zn, Se, Mn, Cd, Cr and Hg significantly differ between malignant tissue of colorectal cancer (CRC) and adjacent healthy bowel tissue. We have, also, found that Cu/Zn tissue ratio was significantly higher in CRC compared to a healthy tissue and that patients with higher CRC stages had also significantly higher ratio. CONCLUSIONS: Since this is the first such study in Balkan region, we assume that results of our study could be a good indicator of elemental alterations in colorectal cancer of Balkan population, due to similarity in lifestyle, dietary intake, pollution and exposure to toxic elements.