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1.
Gan To Kagaku Ryoho ; 48(3): 325-330, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33790150

RESUMEN

BACKGROUND: Tumor infiltration of CD3 and CD8-positive T cells has been reported as a good prognostic marker for patients with colorectal cancer(CRC). To clarify the significance of CD4 and FOXP3-positive T cells in CRC for prognosis of intratumoral infiltration. METHODS: CD3, CD8, CD4 and FOXP3-positive T cells were immunostained(IHC)from tissue specimens of 342 CRC patients who underwent curative resection to quantify the number of infiltrating cells in the tumor. Microsatellite instability(MSI)was also evaluated in 322 samples and the clinicopathological factors and survival were analyzed. RESULTS: Highly infiltrated groups of CD3, CD4 and FOXP3-positive T cells were associated with improved relapse-free survival(RFS). Highly infiltrated groups of CD8, CD4 and FOXP3-positive T cells were associated with improved disease- specific survival(DSS). Invasion depth, vascular infiltration, and CD4-positive T cell density were independent prognostic factors for DSS. CD4 and FOXP3-positive T cell infiltration was not associated with the high-frequency microsatellite instability group, in contrast to CD3 and CD8-positive T cell infiltration. CONCLUSIONS: Intratumoral CD4-positive T cell density and FOXP3-positive T cell densities were stronger prognostic indicators than other clinicopathological features. These results may facilitate the establishment of novel prognostic factors and therapeutic strategies for CRC.


Asunto(s)
Neoplasias Colorrectales , Linfocitos Infiltrantes de Tumor , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Factores de Transcripción Forkhead , Humanos , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Pronóstico
2.
Gan To Kagaku Ryoho ; 48(3): 391-393, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33790165

RESUMEN

There are few reports on laparoscopic stoma creation; we report here our experience with laparoscopic stoma creation. PATIENTS AND METHODS: Seven patients who underwent laparoscopic stoma creation between April 2019 and December 2019 were studied and their clinical outcome was evaluated retrospectively. Operation approach: We performed a colostomy in the transverse colon. At first, we insert a 12 mm first port into the site of stoma marking. And more, we insert three 5 mm ports on the opposite side of the first port. We remove the adhesions of the intestinal tract and create a colostomy. RESULT: We changed open method 2 cases out of 7 cases due to extensive adhesion. In laparoscopically, we had an operation time of 97 (42-130) minutes and a blood loss of 5(2-40) mL. We had no postoperative complications or stoma problems. CONCLUSION: Laparoscopic stoma creation was useful due to few postoperative complications and can be rapidly transferred to chemotherapy.


Asunto(s)
Neoplasias Colorrectales , Laparoscopía , Estomas Quirúrgicos , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/cirugía , Colostomía , Humanos , Ileostomía , Estudios Retrospectivos
3.
Gan To Kagaku Ryoho ; 48(3): 416-418, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33790173

RESUMEN

Conversion surgery for patients with initially unresectable colorectal liver metastases is increasingly being performed because of effective systemic chemotherapy. Additionally, many studies have reported the benefit of the liver-first approach for advanced liver metastasis. We report a case of an initially unresectable advanced colon cancer with multiple liver and lung metastases that was successfully treated with the liver-first approach following chemotherapy. The patient was a 36-year- old woman who was diagnosed with advanced rectal cancer, cT4aN2aM1b, cStage Ⅳb. After a temporary transverse colostomy, she was administered systemic chemotherapy for 9 months. The primary tumor and liver metastases showed partial response while the lung metastases showed complete response. Since it was considered that liver metastases were the main prognostic factors, we performed a right hemihepatectomy plus S3 partial hepatectomy, followed by laparoscopic high anterior resection. A partial pneumonectomy was also performed because of the regrowth of the lung metastases, and we succeeded in complete resection. The liver-first approach was a beneficial treatment option for this patient with unresectable colorectal liver metastases.


Asunto(s)
Neoplasias Colorrectales , Neoplasias Hepáticas , Neoplasias Pulmonares , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/cirugía , Femenino , Hepatectomía , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/cirugía
4.
BMC Surg ; 21(1): 190, 2021 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-33838677

RESUMEN

BACKGROUND: Fluorescence-guided visualization is a recently proposed technology in colorectal surgery. Possible uses include evaluating perfusion, navigating lymph nodes and searching for hepatic metastases and peritoneal spread. Despite the absence of high-level evidence, this technique has gained considerable popularity among colorectal surgeons due to its significant reliability, safety, ease of use and relatively low cost. However, the actual use of this technique in daily clinical practice has not been reported to date. METHODS: This survey was conducted on April 2020 among 44 centers dealing with colorectal diseases and participating in the Italian ColoRectal Anastomotic Leakage (iCral) study group. Surgeons were approximately equally divided based on geographical criteria from multiple Italian regions, with a large proportion based in public (89.1%) and nonacademic (75.7%) centers. They were invited to answer an online survey to snapshot their current behaviors regarding the use of fluorescence-guided visualization in colorectal surgery. Questions regarding technological availability, indications and techniques, personal approaches and feelings were collected in a 23-item questionnaire. RESULTS: Questionnaire replies were received from 37 institutions and partially answered by 8, as this latter group of centers do not implement fluorescence technology (21.6%). Out of the remaining 29 centers (78,4%), fluorescence is utilized in all laparoscopic colorectal resections by 72.4% of surgeons and only for selected cases by the remaining 27.6%, while 62.1% of respondents do not use fluorescence in open surgery (unless the perfusion is macroscopically uncertain with the naked eye, in which case 41.4% of them do). The survey also suggests that there is no agreement on dilution, dosing and timing, as many different practices are adopted based on personal judgment. Only approximately half of the surgeons reported a reduced leak rate with fluorescence perfusion assessment, but 65.5% of them strongly believe that this technique will become a minimum requirement for colorectal surgery in the future. CONCLUSION: The survey confirms that fluorescence is becoming a widely used technique in colorectal surgery. However, both the indications and methods still vary considerably; furthermore, the surgeons' perceptions of the results are insufficient to consider this technology essential. This survey emphasizes the need for further research to reach recommendations based on solid scientific evidence.


Asunto(s)
Neoplasias Colorrectales , Cirugía Colorrectal , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/cirugía , Cirugía Colorrectal/métodos , Humanos , Verde de Indocianina , Italia , Imagen Óptica
5.
Z Gastroenterol ; 59(4): 321-325, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33845498

RESUMEN

BACKGROUND: Although the problem of whether to perform a biopsy before endoscopic treatment for colorectal laterally spreading tumor (LST) troubles clinicians, about 50 % of lesions still undergo a preceding biopsy. We aimed to explore factors affecting the non-lifting sign in LST and examine the influence of "biopsy-related factors", such as the number of biopsy specimens and the interval after biopsy on non-lifting sign in cases with a history of biopsy. METHODS: Clinical data of 159 LSTs regarding age, gender, history of biopsy, tumor location, tumor size, the depth of submucosal invasion, tumor configuration, histologic type, location with respect to the fold, and result of non-lifting sign testing were investigated retrospectively. For patients with a history of biopsy, the period after biopsy and the number of biopsy specimens also were analyzed. RESULTS: Among 159 cases of LST, 112 were positive and 47 were negative for lifting signs. Biopsy history (p = 0.008), tumor size (p = 0.010), and location with respect to the fold (p = 0.022) were identified as factors affecting the non-lifting sign in multivariate analyses. In 75 LST cases with a history of biopsy, only the number of biopsies (p = 0.003) was identified as a factor affecting the non-lifting sign in multivariate analyses. CONCLUSIONS: For LST, lesions with larger size, being across the fold, and biopsy history were predictive factors for non-lifting signs. Reducing the number of biopsies would reduce the occurrence of non-lifting signs when biopsy is necessary. The impact of the interval after the biopsy on the non-lifting sign will require further study.


Asunto(s)
Biopsia/métodos , Colonoscopía/métodos , Neoplasias Colorrectales/patología , Mucosa Intestinal/patología , Biopsia/efectos adversos , Neoplasias Colorrectales/cirugía , Humanos , Mucosa Intestinal/cirugía , Estudios Retrospectivos
6.
Anticancer Res ; 41(4): 2117-2122, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813422

RESUMEN

BACKGROUND/AIM: Stanniocalcin2 (STC2) is associated with proliferation, invasion, and metastasis in various cancers. We examined the clinical significance of STC2 mRNA expression in patients with colorectal cancer (CRC). PATIENTS AND METHODS: Relative expression levels of STC2 mRNA in CRC tissues and corresponding normal mucosa obtained from 202 patients were measured using quantitative real-time reverse transcriptase-polymerase chain reaction. RESULTS: Expression of STC2 mRNA was higher in the cancer tissue than in the adjacent normal mucosa. STC2 mRNA expression in cancer tissues was associated with tumour size, liver metastasis, venous invasion, and lymph node metastasis. High expression of STC2 mRNA was significantly associated with poorer postoperative survival (p=0.0003). Multivariate analysis showed that high expression of STC2 mRNA was an independent predictor of postoperative survival. CONCLUSION: High expression of STC2 mRNA in CRC tissue may be a useful prognostic marker in patients with CRC.


Asunto(s)
Adenocarcinoma/diagnóstico , Biomarcadores de Tumor/genética , Neoplasias Colorrectales/diagnóstico , Glicoproteínas/genética , Péptidos y Proteínas de Señalización Intercelular/genética , Adenocarcinoma/genética , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Anciano , Biomarcadores de Tumor/metabolismo , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/cirugía , Femenino , Regulación Neoplásica de la Expresión Génica , Glicoproteínas/metabolismo , Humanos , Péptidos y Proteínas de Señalización Intercelular/metabolismo , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Pronóstico , ARN Mensajero/genética , ARN Mensajero/metabolismo , Reacción en Cadena en Tiempo Real de la Polimerasa , Análisis de Supervivencia , Resultado del Tratamiento
7.
BMC Surg ; 21(1): 188, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33836701

RESUMEN

BACKGROUND: Expansion of the indication for liver resection and new regimens for systemic chemotherapy have improved postoperative outcomes for synchronous colorectal liver metastases (CRLM). However, such cases can still have a high recurrence rate, even after curative resection. Therefore, there is a need for postoperative adjuvant chemotherapy (POAC) after liver resection in patients with CRLM. There are few studies of the efficacy of POAC with an oxaliplatin-based regimen after simultaneous resection for colorectal cancer and CRLM with curative intent. The goal of the study was to compare POAC with oxaliplatin-based and fluoropyrimidine regimens using propensity score (PS) matching analysis. METHODS: The subjects were 94 patients who received POAC after simultaneous resection for colorectal cancer and synchronous CRLM, and were enrolled retrospectively. The patients were placed in a L-OHP (+) group (POAC with an oxaliplatin-based regimen, n = 47) and a L-OHP (-) group (POAC with a fluoropyrimidine regimen, n = 47). Recurrence-free (RFS), cancer-specific (CSS), unresectable recurrence-free (URRFS), remnant liver recurrence-free (RLRFS), and extrahepatic recurrence-free (EHRFS) survival were analyzed. RESULTS: Before PS matching, the L-OHP (+) and (-) groups had no significant differences in RFS, CSS, URRFS, RLRFS, and EHRFS. Univariate analysis indicated significant differences in age, preoperative serum CEA (≤ 30.0 ng/mL/ > 30.0 ng/mL), differentiation of primary tumor (differentiated/undifferentiated), T classification (T1-3/T4), number of hepatic lesions and maximum diameter of the hepatic lesion between the L-OHP (+) and (-) groups. After PS matching using these confounders, RFS was significantly better among patients in the L-OHP (+) group compared with the L-OHP (-) group (HR 0.40, 95% CI 0.17-0.96, p = 0.04). In addition, there was a trend towards better RLRFS among patients in the L-OHP (+) group compared with the L-OHP (-) group (HR 0.42, 95% CI 0.17-1.02, p = 0.055). However, there were no significant differences in CSS, URRFS and EHRFS between the L-OHP (+) and (-) groups. CONCLUSIONS: PS matching analysis demonstrated the efficacy of POAC with an oxaliplatin-based regimen in RFS and RLRFS.


Asunto(s)
Neoplasias Colorrectales , Neoplasias Hepáticas , Oxaliplatino , Quimioterapia Adyuvante , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/cirugía , Hepatectomía , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Oxaliplatino/uso terapéutico , Cuidados Posoperatorios , Puntaje de Propensión , Estudios Retrospectivos , Resultado del Tratamiento
8.
Medicine (Baltimore) ; 100(15): e25022, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847612

RESUMEN

ABSTRACT: Previous studies showed that microRNA (miR)-449a may function as a tumor suppressor. However, the expression pattern and value of circulating miR-449a in colorectal cancer (CRC) remain unclear. Therefore, the purpose of this study was to measure circulating miR-449a level of CRC patients and evaluate its value for predicting prognosis.Plasma samples of 343 consecutive CRC patients and 162 healthy controls were obtained. Circulating miR-449a levels were measured by using real-time quantitative reverse transcription polymerase chain reactions. All enrolled patients were followed up in a regular interval after surgery. The clinical data and survival outcome of all 343 patients were collected. The correlation between circulating miR-449a level and survival outcomes was analyzed by univariate and multivariate analysis.Circulating miR-449a level in CRC patients was significantly decreased (P < .05) comparing with healthy controls. Low miR-449a was significantly associated with CEA and CA19-9 level (both P < .05). Furthermore, patients with a decreased miR-449a level had a lower 5-years overall survival (OS) rate than those with a high miR-449a (67.4% vs 76.9%, P = .03). Low circulating miR-449a level also been demonstrated as an independent risk factor for CRC in multivariate COX analysis (HR, 2.56; 95%CI: 1.15-8.63; P < .05).Circulating miR-449a was significantly decreased in CRC patients and closely related to poor prognosis, suggesting that miR-449a might can be used as a useful diagnostic and prognostic marker for CRC.


Asunto(s)
Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/mortalidad , MicroARNs/sangre , Factores de Edad , Anciano , Biomarcadores de Tumor , Antígeno Carcinoembrionario/sangre , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Factores de Riesgo , Factores Sexuales , Carga Tumoral
9.
World J Surg Oncol ; 19(1): 120, 2021 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-33858443

RESUMEN

BACKGROUND: The Chinese Society of Clinical Oncology guidelines 2018 and the recent update of that (version 2020) recommends accurate examination before major treatment for decision(s) in cases of colon cancer. Also, the difficulty in the identification of the lesion during colectomy may lead to resection of a wrong segment of the colon or a more extensive resection than planned. Accurate pre-colectomy local staging of colon cancer is required to make decisions for treatment of colon cancer. The objective of the study was to evaluate the diagnostic performance of the computed tomography colonography (CTC) for pre-colectomy tumor location and tumor, node, and metastasis (TNM) staging of colon cancer. METHODS: Data of preoperative colonoscopies, CTC, surgeries, and surgical pathology of a total of 269 patients diagnosed with colon cancer by colonoscopy and biopsy and underwent pre-colectomy location and TNM staging by CTC were collected and analyzed. The consistency between the radiological and the surgery/surgical-pathological for location and TN stages of colon tumor were estimated with the weighted kappa or kappa coefficient (κ) at 95% confidence interval (CI). RESULTS: CTC detected 261 (93%) and colonoscopy detected 201 (72%) correct locations of tumors. Sensitivity and accuracy of CTC for detection of location of colon tumors were 100% and 92.58% (κ = 0.89; 95% Cl: 0.83-0.95). 72.48% sensitivity, 90.64% specificity, and 83.57% accuracy were reported for CTC in differentiation of tumors confined to the colon wall (T1/T2) from advanced tumors (T3/T4) (κ = 0.69, 95% Cl: 0.51-0.75). 81.01% sensitivity, 89.11% specificity, and 83.93% accuracy of CTC was reported for differentiation of tumors between low-intermediate risk and high risk (κ = 0.68, 95% Cl: 0.53-0.75). 69.31% sensitivity, 66.15% specificity, and 67.14% accuracy of CTC were reported for N staging of tumors (κ = 0.41, 95% Cl: 0.59-0.69). CONCLUSIONS: CTC has high diagnostic parameters for pre-colectomy location and T staging of colon tumors except patients of colon cancer who received neoadjuvant chemotherapy. LEVEL OF EVIDENCE: III. TECHNICAL EFFICACY STAGE: 2.


Asunto(s)
Colectomía/métodos , Neoplasias del Colon/cirugía , Colonografía Tomográfica Computarizada , Neoplasias Colorrectales/cirugía , Adulto , Anciano , Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/patología , Colonoscopía , Neoplasias Colorrectales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Tomografía
10.
BMC Gastroenterol ; 21(1): 185, 2021 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-33879095

RESUMEN

BACKGROUND: Since December 2019, China has experienced a public health emergency from the coronavirus disease, which has become a pandemic and is impacting the care of cancer patients worldwide. This study evaluated the impact of the pandemic on colorectal cancer (CRC) patients at our center and aimed to share the lessons we learned with clinics currently experiencing this impact. METHODS: We retrospectively collected data on CRC patients admitted between January 1, 2020 and May 3, 2020; the control group comprised patients admitted between January 1, 2019 and May 3, 2019. RESULTS: During the pandemic, outpatient volumes decreased significantly, especially those of nonlocal and elderly patients, whereas the number of patients who received chemotherapy and surgery remained the same. During the pandemic, 710 CRC patients underwent curative resection. The proportion of patients who received laparoscopic surgeries was 49.4%, significantly higher than the 39.5% during the same period in 2019. The proportion of major complication during the pandemic was not significantly different from that of the control group. The mean hospital stay was significantly longer than that of the control group. CONCLUSIONS: CRC patients confirmed to be infection-free can receive routine treatment. Using online medical counseling and appropriate identification, treatment and follow-up can be effectively maintained. Adjuvant and palliative chemotherapy should not be discontinued. Endoscopic polypectomy, elective, palliative, and multidisciplinary surgeries can be postponed, while curative surgery should proceed as usual. For elderly CRC patients, endoscopic surgery and neoadjuvant radiotherapy are recommended.


Asunto(s)
/epidemiología , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/terapia , Anciano , China/epidemiología , Humanos , Pandemias , Estudios Retrospectivos
11.
Nat Commun ; 12(1): 2281, 2021 04 16.
Artículo en Inglés | MEDLINE | ID: mdl-33863879

RESUMEN

Interleukin (IL)-11 is a member of the IL-6 family of cytokines and is involved in multiple cellular responses, including tumor development. However, the origin and functions of IL-11-producing (IL-11+) cells are not fully understood. To characterize IL-11+ cells in vivo, we generate Il11 reporter mice. IL-11+ cells appear in the colon in murine tumor and acute colitis models. Il11ra1 or Il11 deletion attenuates the development of colitis-associated colorectal cancer. IL-11+ cells express fibroblast markers and genes associated with cell proliferation and tissue repair. IL-11 induces the activation of colonic fibroblasts and epithelial cells through phosphorylation of STAT3. Human cancer database analysis reveals that the expression of genes enriched in IL-11+ fibroblasts is elevated in human colorectal cancer and correlated with reduced recurrence-free survival. IL-11+ fibroblasts activate both tumor cells and fibroblasts via secretion of IL-11, thereby constituting a feed-forward loop between tumor cells and fibroblasts in the tumor microenvironment.


Asunto(s)
Adenoma/inmunología , Colitis/patología , Neoplasias Colorrectales/inmunología , Fibroblastos/inmunología , Interleucina-11/metabolismo , Recurrencia Local de Neoplasia/epidemiología , Adenoma/genética , Adenoma/mortalidad , Adenoma/cirugía , Anciano , Anciano de 80 o más Años , Animales , Línea Celular Tumoral , Colitis/inducido químicamente , Colitis/inmunología , Colon/citología , Colon/inmunología , Colon/patología , Colon/cirugía , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/cirugía , Sulfato de Dextran/administración & dosificación , Sulfato de Dextran/toxicidad , Modelos Animales de Enfermedad , Supervivencia sin Enfermedad , Femenino , Fibroblastos/metabolismo , Regulación Neoplásica de la Expresión Génica/inmunología , Técnicas de Silenciamiento del Gen , Genes Reporteros , Proteínas Fluorescentes Verdes/genética , Humanos , Interleucina-11/genética , Subunidad alfa del Receptor de Interleucina-11/genética , Subunidad alfa del Receptor de Interleucina-11/metabolismo , Mucosa Intestinal/citología , Mucosa Intestinal/inmunología , Mucosa Intestinal/patología , Estimación de Kaplan-Meier , Masculino , Ratones , Ratones Noqueados , Ratones Transgénicos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/inmunología , Organoides , Cultivo Primario de Células , Estudios Retrospectivos , Transcriptoma/inmunología , Microambiente Tumoral/inmunología
12.
Bratisl Lek Listy ; 122(4): 293-296, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33729824

RESUMEN

INTRODUCTION: During the COVID-19 pandemic, both the channelling of manpower into the COVID-19 services and efforts to limit viral spreading of the disease have led to rescheduling and prioritizing oncological cases that are considered as cases of emergency and any postponement of the cases can lead to health problems. In this study, we aimed to show that the surgical treatment of COVID-19 (-) colorectal cancer patients can be performed in a hospital which was declared as a pandemic hospital. METHOD: In our study, we included patients who underwent surgery for colorectal cancer in the general surgery clinic between the dates 03.20.2020 and 05.20.2020, when the hospital was declared COVID-19 pandemic hospital. Emergency colorectal cancer surgeries such as ileus and perforation were excluded from the study. RESULTS: While in the status of pandemic hospital, 80 COVID-19 (+) and 563 COVID-19 (+) suspicious patients were treated. Between 10 March 2020 and 15 May 2020, 12 colorectal cancer patients were operated in the General Surgery Clinic of BAIBU Faculty of Medicine, as well. CONCLUSION: We think that with our study we have shown that during the COVID-19 pandemic, the surgical treatment can be performed for patients with colorectal cancer by eliminating COVID-19 suspicions (Tab. 1, Ref. 14).


Asunto(s)
Neoplasias Colorrectales , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/cirugía , Hospitales , Humanos , Pandemias
14.
Medicine (Baltimore) ; 100(11): e25205, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33726015

RESUMEN

ABSTRACT: One-stage resections of primary colorectal cancer and liver metastases have been reported to be feasible and safe. Minimally invasive approaches have become more common for both colorectal and hepatic surgeries. This study aimed to investigate outcomes of these combined surgical procedures among different approaches.We retrospectively analyzed patients diagnosed as having primary colorectal cancer with synchronous liver metastases and who underwent 1-stage primary resection and hepatectomy with curative intent in our hospital. According to the surgical approach for the primary tumor and hepatic lesions, namely open laparotomy (Op) or laparoscopic approach (Lap), patients were classified into Op-Op, Lap-Op (laparoscopic colorectal resection plus open hepatectomy), and Lap-Lap groups, respectively. Clinicopathological factors were reviewed, and short- and long-term outcomes were compared among the groups.The Op-Op, Lap-Op, and Lap-Lap groups comprised 36, 18, and 17 patients, respectively. The superior/posterior hepatic segments were more frequently resected via an open approach. There was no laparoscopic major hepatectomy. The median volume of intraoperative blood loss was smaller in the Lap-Lap and Lap-Op groups (290 and 270 mL) than in the Op-Op group (575 mL, P = .008). The hospital stay after surgery was shorter in the Lap-Lap and Lap-Op groups (median: 17 days and 15 days, vs 19 days for the Op-Op group, P = .033). The postoperative complication rates and survivals were similar among the groups.Application of laparoscopy to 1-stage resections of primary colorectal cancer and liver metastases may offer advantages of enhanced recovery from surgical treatment, given appropriate patient selection.


Asunto(s)
Neoplasias Colorrectales/cirugía , Hepatectomía/métodos , Laparoscopía/métodos , Neoplasias Hepáticas/cirugía , Neoplasias Primarias Múltiples/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Colectomía/métodos , Terapia Combinada , Estudios de Factibilidad , Femenino , Humanos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Tempo Operativo , Proctectomía/métodos , Estudios Retrospectivos , Resultado del Tratamiento
15.
Anticancer Res ; 41(3): 1593-1598, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33788754

RESUMEN

BACKGROUND/AIM: We previously showed that an elevated postoperative serum C-reactive protein (CRP) level has a negative impact on long-term survival outcomes, regardless of the occurrence of infectious complications in colorectal cancer. However, the cause of postoperative inflammation could not be properly evaluated, because patient background factors, such as the surgical approach (open/laparoscopic), were not unified. PATIENTS AND METHODS: A total of 277 patients who underwent laparoscopic surgery for stage II/III colorectal cancer were enrolled. RESULTS: The high-CRP group had lower relapse-free and overall survival rates in comparison to the low-CRP group. A high postoperative serum CRP level was significantly associated with a larger tumor diameter and longer operation time, and tended to be associated with a higher T stage and larger amount of bleeding. CONCLUSION: Larger tumor volume, longer operation time and larger amount of bleeding were associated with the promotion of postoperative inflammation, which worsened long-term survival outcomes in colorectal cancer.


Asunto(s)
Infecciones Bacterianas/sangre , Proteína C-Reactiva/análisis , Neoplasias Colorrectales/cirugía , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/sangre , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/mortalidad , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias/mortalidad , Adulto Joven
16.
BMC Cancer ; 21(1): 284, 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33726686

RESUMEN

BACKGROUND: Circular RNAs (circRNAs) feature prominently in tumor progression. However, the biological function and molecular mechanism of circ_0003266 in colorectal cancer (CRC) require further investigation. METHODS: Circ_0003266 expression in 46 pairs CRC tissues / adjacent tissues, and CRC cell lines was detected by quantitative real-time polymerase chain reaction (qRT-PCR); after circ_0003266 was overexpressed or knocked down in CRC cells, cell proliferation, apoptosis, migration, and invasion were evaluated by the cell counting kit-8 (CCK-8), flow cytometry, and Transwell assays, respectively; the interaction among circ_0003266, miR-503-5p, and programmed cell death 4 (PDCD4) was confirmed using bioinformatics analysis and dual-luciferase reporter assay; PDCD4 protein expression in CRC cells was quantified using Western blot. RESULTS: Circ_0003266 was significantly lowly expressed in CRC tissues and cell lines. Circ_0003266 overexpression markedly repressed CRC cell proliferation, migration, and invasion, and accelerated the cell apoptosis, but its overexpression promoted the malignant phenotypes of CRC cells. PDCD4 was a direct target of miR-503-5p and circ_0003266 promoted PDCD4 expression by competitively sponging miR-503-5p. CONCLUSION: Circ_0003266 suppresses the CRC progression via sponging miR-503-5p and regulating PDCD4 expressions, which suggests that circ_0003266 may serve as a novel target for the treatment of CRC.


Asunto(s)
Proteínas Reguladoras de la Apoptosis/genética , Neoplasias Colorrectales/genética , Regulación Neoplásica de la Expresión Génica/genética , MicroARNs/metabolismo , ARN Circular/metabolismo , Proteínas de Unión al ARN/genética , Adulto , Línea Celular Tumoral , Neoplasias Colorrectales/cirugía , Progresión de la Enfermedad , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Técnicas de Silenciamiento del Gen , Humanos , Masculino , MicroARNs/agonistas , MicroARNs/antagonistas & inhibidores , Persona de Mediana Edad , ARN Circular/genética , Adulto Joven
17.
BMC Cancer ; 21(1): 282, 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33726687

RESUMEN

BACKGROUND: Mismatch repair (MMR)/microsatellite instability (MSI) and tumor mutational burden (TMB) are independent biomarkers that complement each other for predicting immune checkpoint inhibitors (ICIs) efficacy. Here we aim to establish a strategy that integrates MSI and TMB determination for colorectal cancer (CRC) in one single assay. METHODS: Surgical or biopsy specimens retrospectively collected from CRC patients were subjected to NGS analysis. Immunohistochemistry (IHC) and polymerase chain reaction (PCR) were also used to determine MMR/MSI for those having enough tissues. The NGS-MSI method was validated against IHC and PCR. The MSI-high (MSI-H) or microsatellite stable (MSS) groups were further stratified based on tumor mutational burden, followed by validation using the The Cancer Genome Atlas (TCGA) CRC dataset. Immune microenvironment was evaluated for each subgroup be profiling the expression of immune signatures. RESULTS: Tissues from 430 CRC patients were analyzed using a 381-gene NGS panel. Alterations in KRAS, NRAS, BRAF, and HER2 occurred at a significantly higher incidence among MSI-H tumors than in MSS patients (83.6% vs. 58.4%, p = 0.0003). A subset comprising 98 tumors were tested for MSI/MMR using all three techniques, where NGS proved to be 99.0 and 93.9% concordant with PCR and IHC, respectively. Four of the 7 IHC-PCR discordant cases had low TMB (1.1-8.1 muts/Mb) and were confirmed to have been misdiagnosed by IHC. Intriguingly, 4 of the 66 MSS tumors (as determined by NGS) were defined as TMB-high (TMB-H) using a cut-off of 29 mut/Mb. Likewise, 15 of the 456 MSS tumors in the TCGA CRC cohort were also TMB-H with a cut-off of 9 muts/Mb. Expression of immune signatures across subgroups (MSS-TMB-H, MSI-H-TMB-H, and MSS-TMB-L) confirmed that the microenvironment of the MSS-TMB-H tumors was similar to that of the MSI-H-TMB-H tumors, but significantly more immune-responsive than that of the MSS-TMB-L tumors, indicating that MSI combined with TMB may be more precise than MSI alone for immune microenvironment prediction. CONCLUSION: This study demonstrated that NGS panel-based method is both robust and tissue-efficient for comprehensive molecular diagnosis of CRC. It also underscores the importance of combining MSI and TMB information for discerning patients with different microenvironment.


Asunto(s)
Biomarcadores de Tumor/genética , Neoplasias Colorrectales/diagnóstico , Inestabilidad de Microsatélites , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Colon/patología , Colon/cirugía , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Análisis Mutacional de ADN , Femenino , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Masculino , Persona de Mediana Edad , Mutación , Estadificación de Neoplasias , Recto/patología , Recto/cirugía , Estudios Retrospectivos , Microambiente Tumoral/genética , Adulto Joven
19.
Medicine (Baltimore) ; 100(7): e24609, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607795

RESUMEN

ABSTRACT: Elderly colorectal cancer (CRC) patients tend to avoid standard treatment, especially curative surgical resection, because of concerns about surgical complications or underlying diseases. This study is intended to compare clinical characteristics and prognosis between patients who had undergone surgical resection and received supportive care, and to evaluate the usefulness of surgical treatment in elderly patients.A total of 114 patients aged ≥80 years who were diagnosed with CRC were analyzed retrospectively. Of these patients, 73 patients underwent surgical resection for malignancy and 41 patients received supportive care. Clinicopathological factors and overall survival (OS) rates were compared.The surgical resection group had better Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists (ASA) physical status, and a lower stage than did the supportive-care group. The 3-year OS rate of the surgical group was significantly higher than that of the supportive-care group (60.7% vs 9.1%, P < .001). In extremely elderly patients (age ≥85 years), the surgical group showed a better 3-year OS rate than did the supportive-care group (73.9% vs 6.3%, P < .001), although Eastern Cooperative Oncology Group performance status and ASA physical status were not different. The post-operative mortality rate was 2.7%. In the analysis of risk factors related to survival, surgical resection was a good prognostic factor.Surgical treatment in elderly CRC patients showed a survival benefit, even in the extremely elderly patients. Surgical resection for CRC in elderly patients can be considered to improve survival.


Asunto(s)
Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/terapia , Tratamiento Conservador , Anciano de 80 o más Años , Neoplasias Colorrectales/mortalidad , Femenino , Humanos , Masculino , Pronóstico , República de Corea , Estudios Retrospectivos , Análisis de Supervivencia
20.
In Vivo ; 35(2): 1299-1305, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33622934

RESUMEN

BACKGROUND/AIM: A notable re-allocation of healthcare resources and specific clinical and organizational measures have been required to prevent COVID-19 infection among hospitalized patients and healthcare workers. PATIENTS AND METHODS: From March 9th to May 9th 2020 we performed colorectal cancer elective surgery on 25 patients: a pre-hospital screening was carried out in order to avoid hospitalization of patients suspected of COVID-19 infection. RESULTS: All patients (median age=76 years; range=37-88 years) were considered suitable for admission after telephone triage; the median interval between primary diagnosis and hospital admission was 23.1 days (range=1-55 days). The median hospitalization was 7.8 days (range=4-18 days). One COVID-19-associated death was reported. CONCLUSION: Our experience demonstrates that safe colorectal cancer elective surgery can be performed during the pandemic COVID-19. Further consensus and guidelines to prevent diffusion of pandemic diseases among hospitalized patients and healthcare workers still need to be implemented.


Asunto(s)
/prevención & control , Neoplasias Colorrectales/cirugía , Procedimientos Quirúrgicos Electivos/métodos , /aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , /virología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Oncología Médica/métodos , Persona de Mediana Edad , Pandemias , /fisiología
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