Women with chronic constipation have more bothersome urogenital symptoms.

BACKGROUND: The aim of our study was to characterize urogenital symptoms in women with and without constipation, and by severity of constipation. METHODS: This was a retrospective cohort study conducted at a pelvic floor disorder center in a tertiary healthcare facility from May 2007 through August 2019 and completed an intake questionnaire were included. We collected demographic, physical exam data and quality of life outcomes. The Urinary Distress Inventory (UDI-6) was used to assess urogenital symptoms. Women with constipation completed the Constipation Severity Instrument (CSI). We excluded women with a history of a bowel resection, inflammatory bowel disease, or pelvic organ prolapse symptoms. The cohort was then divided into two groups, constipated and non-constipated, and the prevalence and severity of urogenital-associated symptoms were compared. A secondary analysis was made among constipated subjects stratified by constipation severity based on CSI scores. RESULTS: During the study period, 875 women (59.5%) had chronic constipation. Women with chronic constipation were more likely to experience urogenital symptoms, such as dyspareunia, urinary hesitancy, and a sensation of incomplete bladder emptying (all p < 0.05). Moreover, on univariate analysis, women with high CSI scores (75 percentile or higher) were found to have higher UDI-6 scores, increased bladder splinting, pad use, urinary frequency and dyspareunia while on multivariate analysis higher UDI score, increased bladder splinting, urinary frequency and dyspareunia were significantly associated (p < 0.05). CONCLUSION: We found that the presence and severity of chronic constipation worsened the degree of bother from urogenital symptoms. Given that chronic constipation can modulate urogenital symptoms, our study suggests that pelvic floor specialists should assess the presence and severity of urogenital and bowel symptoms to provide comprehensive care.

Pathologic factors are more important than tumor location in long-term survival in colon cancer.

PURPOSE: Proximal and distal colon cancers differ in terms of epidemiology, clinical presentation, and pathologic features. The aim of our study was to evaluate the impact of right-sided (RC), transverse (TC), and left-sided (LC) colon cancer on morbidity rates and oncological outcomes. METHODS: A retrospective analysis of patients with resected colon cancer between 2004 and 2014 was conducted. Cox proportional hazard models were used to assess predictors of overall (OS), and disease-specific survival (DSS), as well as disease-free survival (DFS). RESULTS: A total of 1189 patients were included. RC patients (n = 618) were older, predominantly women, and had a higher comorbidity rate. LC (n = 454) was associated with symptomatic presentation and increased rates of laparoscopic surgery. Multivisceral resections were more frequently performed in TC tumors (n = 117). This group was admitted 1 day longer and had a higher complication rate (RC 35.6% vs. TC 43.6% vs. LC 31.1%, P0.032). Although the incidence of abscess/leak was similar between the groups, the necessity of readmission and subsequent reoperation for a leak was significantly higher in LC patients. Pathology revealed more poorly differentiated tumors and microsatellite instability in RC. Kaplan-Meier curves demonstrated worse 5-year OS for right-sided tumors (RC 73.0%; TC 76.2%. LC 80.8%, P0.023). However, after adjustment, no differences were found in OS, DSS, and DFS between tumor location. Only pathological features were independently correlated with prognosis, as were baseline characteristics for OS. CONCLUSION: Tumor location in colon cancer was not associated with survival or disease recurrence. Pathological differences beyond tumor stage were significantly more important.

The Influence of Screening on Outcomes of Clinically Locally Advanced Rectal Cancer.

BACKGROUND: Screening for colorectal cancer has resulted in declining incidence rates of both colon and rectal cancer and it may influence stage at presentation and improve survival. The aim of this study was to assess the impact of screening on patients diagnosed with locally advanced rectal cancer. METHODS: A retrospective analysis of a consecutive series of patients who underwent neoadjuvant therapy and had an R0-resection for clinical AJCC stage II or stage III disease. All patients received surgery at a single center between 2004 and 2015. Patients diagnosed through screening were compared to patients diagnosed through symptomatic presentation. RESULTS: Three hundred nine patients were included, of whom 43 (13.9%) were diagnosed through screening. Screened patients had more often a white ethnicity, while there were no other differences in baseline characteristics or median household income. Screened patients had a lower rate of disease recurrence in addition to a longer disease free survival and overall survival. CONCLUSIONS: Patients with locally advanced rectal cancer diagnosed through screening demonstrated more favorable short and long-term outcomes than patients diagnosed through symptoms. Findings of this study reinforce the need for screening programs in addition to the need for research regarding optimization of screening adherence.

The negative impact of understaging rectal cancer patients.

BACKGROUND: Neo-adjuvant chemoradiation followed by surgery and adjuvant therapy is standard treatment of clinical node positive rectal cancer. Understaging leads to delay in treatment with possible detrimental results. This study analyses effects of understaging stage III rectal cancer on long-term outcomes. METHODS: A consecutive series of patients, operated on in MGH between 2004 and 2015 was included. Outcomes of non-neoadjuvantly treated clinical stage I patients who turned out to have pathological stage III disease and neoadjuvantly treated clinical stage III patients were retrospectively reviewed. The latter group was subdivided into patients who had persistent nodal disease (ypN+) and patients without positive lymph nodes after neoadjuvant treatment (ypN0). RESULTS: Of the 204 included patients, 30 had unexpected nodal disease on pathology. Clinical stage I-patients had higher rates of local recurrence, and rectal cancer and overall mortality than ypN0-patients. CONCLUSION: Understaging stage III rectal cancer led to poorer oncologic outcomes, when compared to patients without positive lymph nodes on pathology after neoadjuvant. Future research should focus on identifying patients with treatment susceptible lymph node involvement.

Rectal Cancer in Patients Under 50 Years of Age.

BACKGROUND: General population screening for colorectal cancer starts at 50, and incidence rates of rectal cancer in patients over 50 years old are decreasing. However, incidence of rectal cancer under age 50 is increasing. This paper analyzes short-and long-term outcomes for rectal cancer patients under 50 years of age. METHODS: Retrospective analyses of consecutive patient cohort, who all received surgical treatment for primary rectal adenocarcinoma at a single institute were used in the study. Outcomes were stratified based on age under or over 50 at the time of surgery. RESULTS: A total of 582 patients was included, of whom 125 were younger than 50. ASA-score was higher for older patients, with no other significant differences in baseline characteristics. AJCC-staging, based on surgical pathology, differed significantly due to higher stage II-rate in the older group and higher stages III- and IV-rates in the younger group. Percentages of high-grade disease, small vessel-, and perineural invasion were higher for younger patients. Stage-for-stage oncologic survival analyses did not demonstrate a significant difference between younger and older patients. Additionally, an age under/over 50 did not have a significant effect in multivariable analyses for disease free-, and disease specific survival. CONCLUSIONS: Patients who present with rectal cancer under the age of 50 do not seem to have more aggressive disease, while they present with more advanced disease when compared to patients older than 50. Identifying young people at risk of developing rectal cancer and start screening earlier in a selective group might improve disease stage on presentation.

The Impact of Pathologic Complete Response in Patients with Neoadjuvantly Treated Locally Advanced Rectal Cancer-a Large Single-Center Experience.

Small cohort studies demonstrated better oncologic outcomes for patients with pathologic complete response (PathCR) after neoadjuvant treatment for locally advanced rectal cancer. This study reviews long-term outcomes of a large cohort of clinically stage II/III rectal cancer patients who received neoadjuvant chemoradiation and surgery. This is a retrospective analysis of a single-center cohort, including all clinical stage II/III rectal cancer patients who received neoadjuvant chemoradiation and surgery between 2004 and 2014 (n = 271). Cox regressions were done to assess the influence of PathCR on recurrence-free survival (RFS) and overall survival (OS), adjusting for postoperative chemotherapy, clinical AJCC staging, comorbidity, and age where appropriate. PathCR patients had significantly lower distant recurrence rates (4 vs. 15.8%; P = 0.028) and lower disease-specific mortality rates (0 vs. 8.1%; P = 0.052), compared to patients with residual disease. PathCR was associated with longer RFS (HR, 5.6 [95% CI 1.3-23.1] P = 0.018) and longer OS (HR, 3.4 [1.31-10.0] P = 0.014) compared to having pathological residual disease. This large single-center study shows that patients with PathCR have significant longer RFS and OS than patients with residual disease on pathology after neoadjuvant chemoradiation.

The prognostic value of lymph node ratio after neoadjuvant chemoradiation and rectal cancer surgery.

BACKGROUND: Neoadjuvant chemotherapy decreases total lymph nodes harvested and possibly affects lymph node staging after total mesorectal excision in patients with rectal cancer. OBJECTIVE: This study aimed to compare staging by lymph node ratio with staging by absolute number of positive lymph nodes. DESIGN: This study is a retrospective cohort review. SETTING: : A tertiary care referral center was the setting for this investigation. PATIENTS: A total of 281 consecutive patients who underwent neoadjuvant chemoradiation and total mesorectal excision after histologically confirmed rectal cancer between January 1, 1998 and December 31, 2008 were included in this study. MAIN OUTCOME MEASURES: Lymph node ratio is the number of positive lymph nodes divided by the total number of lymph nodes within one sample. Risk categories of low (0 to < 0.09); medium (0.09 to < 0.36); and high (≥ 0.36) for lymph node ratio were chosen by significance with the use of Cox proportional hazards models. These categories were then used in a reclassification table and compared with positive lymph node stage: low (0 positive nodes), medium (1-3 nodes), and high (> 3) by 5-year mortality rates. RESULTS: The majority (87%) of patients were concordant in risk assessment. Thirty patients were downstaged to lower risk lymph node ratio categories without showing actual lower mortality rates. Seven patients were upstaged to a high-risk lymph node ratio category with a supporting higher 5-year mortality rate. When limiting the analysis to those with fewer than 12 nodes, 136 (95%) patients were concordant in risk assessment; all 30 incorrectly downstaged patients were removed, but the 7 correctly upstaged patients remained. CONCLUSIONS: Patients who undergo neoadjuvant chemoradiation before rectal cancer surgery frequently have fewer than 12 lymph nodes harvested despite maintaining vigorous surgical standards. Lymph node ratios may provide excellent prognostic value and are possibly a better independent staging method than absolute positive lymph node counts when less than 12 lymph nodes are harvested after neoadjuvant treatment.