Current status of quality measurement in colon and rectal surgery.

There is increasing pressure from the public and insurance payors for transparency and accountability in ensuring the quality of health care. In response to this, hospitals are now mandated to participate in quality improvement initiatives, and to report on their performance. This article describes three programs related to the measurement of quality that impact colon and rectal surgery: the Surgical Care Improvement Project, the National Surgical Quality Improvement Program, and the Surgical Care and Outcomes Assessment Program.

Sporadic colorectal polyps and mismatch repair proteins.

BACKGROUND: Colorectal cancers often arise from benign polyps. Adenomatous polyps and serrated polyps progress step by step to adenocarcinoma and change into malignant cancers. Genetic and epigenetic changes have correlation with specific stages of polyp-adenocarcinoma progression and colorectal cancer histopathological changes. AIMS: In this study we used immunohistochemistry (IHC) staining in sporadic colorectal polyps to assay functional status of MLH1, MSH2, MSH6, and PMS2 proteins, to track genetic/epigenetic roles of this issue in our patients. MATERIALS AND METHODS: In this cross-sectional study we assessed all patients who were admitted with sporadic colorectal polyps and underwent polypectomy in endoscopy department during 2004-2008. RESULT: IHC results were abnormal in 6.8% cases for MLH1, in 4.5% cases for MSH2, in 3% for MSH6, and in 4.8% for PMS2. In all cases with abnormal PMS2, MLH1 was also reported as abnormal. Same results were reported for abnormal MSH2, which is accompanied with abnormal MSH6 in all cases (P values < 0.001). There is no significant difference between IHC staining results, gender, dysplasia grade, adenomatous type, and invasion. On the other hand, there was significant difference between IHC staining results, polyp location, and mean age of patients. The same significant difference was between adenomatous polyps and serrated adenoma polyps by MLH1 and PMS2 (P values < 0.05). CONCLUSION: According to our findings, maybe MMR dysfunction is the cause of sporadic colorectal polyps in younger age and its increasing risk of dysplasia progression and malignancy progression is only in serrated adenoma. Sporadic polyps in left colon had a higher risk to progress to malignancies, and abnormal IHC staining for MLH1 and PMS2 in serrated polyps is much more than in other adenomatous polyps.

Prevalence of colorectal cancer in relatives of Iranian patients diagnosed with colorectal cancer.

BACKGROUND: A high rate of colorectal cancer occurrence is established in individuals with a positive family history of this type of cancer. OBJECTIVES: The aim of this study was to investigate the prevalence of colorectal cancer in first degree and second degree relatives of colorectal cancer patients. METHODS: Family medical histories of 489 first degree relatives of colorectal cancer patients were obtained by a questionnaire. 249 average risk patients with no family history of colorectal cancer were included as control patients. RESULTS: In our study from a total of 489 case patients, 153 (31.3%) had at least one close relative affected by colon cancer. Case-control analysis showed an odd ratio of 3.1 (95% CI, 2.07 to 6.27) for one and 5.7 (CI, 2.39 to 13.56) for two affected relatives. Cases with a positive family history had a 3.006 times greater risk in developing colorectal cancer if a first degree relative was affected comparing with a 4.9 times greater risk if a second degree family member was diagnosed with colorectal cancer. Our study indicated a higher risk for developing colorectal cancer in male family relatives 50 years and older. Rectal area was found the most tumor side affected in case and control patients. CONCLUSION: First-degree relatives of patients with colorectal cancer had an increased risk of developing this type of cancer. The risk was greater when diagnosis was in male, elderly patients and other first-degree relatives were affected.

Colonoscopy screening results in at risk Iranian population.

OBJECTIVES: To investigate the prevalence of colorectal adenomas and other advanced lesions in first degree relatives of Iranian patients diagnosed with colorectal cancer by colonoscopy and pathologic evaluation. METHODS: Iranian colorectal cancer patients (probands) were identified through pathologic reports of the regional cancer registry. First degree relatives (siblings, parents and offspring) of probands were evaluated for the existence of polyps and precancerous lesions via colonoscopy screening. Control patients were chosen among average risk population with no family history of colorectal cancer who agreed to colonoscopy screening. RESULTS: A total of 184 subjects underwent colonoscopy screening from April 2007 to March 2009. From 90 cases among families of probands, 70 (77.8%) had a normal colonoscopy result, 18 (20%) demonstrated polyps and 2 (2.2%) were diagnosed with colorectal cancer. Colonoscopy screening in 94 average risk control patients discovered polyps in 4 (4.3%) cases and the other 90 (95.7%) patients had normal total colonoscopy results. Mean age of cases with advanced lesions was 48.4∓10.2 and 41.5∓18.4 in control patients with polyps. The incidence of polyps was significantly higher in males, and in family case patients compared to controls. CONCLUSIONS: Based on colonoscopy screening, the prevalence of colorectal adenoma and precancerous lesions in first degree relatives of patients diagnosed with colorectal cancer is significantly higher than in the average risk population.

Colorectal stenting for management of acute malignant bowel obstruction in advanced colorectal cancer in Iran.

INTRODUCTION: Enteral stenting is used increasingly as a palliative treatment of gastrointestinal malignant or non-malignant obstructions. This aim of this study was to evaluate the role of endoscopic stent implantation for palliation of acute colorectal cancer obstruction in critical patients. METHODS: This study was performed prospectively with 8 patients suffering clinical manifestations of acute bowel obstruction with severe co-morbid diseases that caused them to be inoperable. They were treated by semi-elective stent insertion after primary resuscitation. Gentle dilation of stricture with balloon or buginage was performed under fluoroscopy and colonoscopy in gastrointestinal ward without complete preparation. Then an uncovered self-expanding metal stent was inserted over guide wire in the location of the tumor. RESULTS: Endoscopic stent implantation could be successfully performed in six patients. In early days after stent insertion; general condition of patients gradually improved, and symptoms of acute obstruction was relieved. In two of the cases stent was inserted with difficulty due to very tortuous and complex strictures. Complications of stenting in this study were very rare. Displacement of stent after successful insertion was not seen. Of our studied patients, two died after 2 months, one after 4 months and three of them after 7-8 months. The cause of death in these patients was advanced metastatic lesion in liver, lung, bone and severe underlying disease such as heart failure. CONCLUSION: Endoscopic stent implantation seems to be an effective and safe palliative approach for management of emergency conditions of acute colonic obstruction in inoperable patients with advanced colorectal cancer.