Colorectal cancer and Crohn's colitis: clinical implications from 313 surgical patients.

BACKGROUND: The relation between Crohn's colitis (CC) and colorectal cancer is still controversial. Several case reports and retrospective studies have shown that patients with Crohn's disease (CD) have a 6- to 20-fold higher risk to develop CRC than does the normal population. The extent of disease (extensive colitis), presence of anal fistula, age > 40 years, strictures, and length of disease >10 years may be important determinants for increasing risk. Despite this evidence, other population-based studies have shown no increased risk of colon or rectal cancer. The aim of this study was to investigate retrospectively factors that may predict the development of cancer. METHODS: We searched the histopathologic database of the Digestive Surgery Unit at Careggi University Hospital for CC patients (January 1987 to September 2011) and identified 313 patients with CC who underwent surgery. RESULTS: There are 11 (3.5 %) of adenocarcinomas. Multivariate analysis showed disease duration (p = 0.001), age at CD diagnosis (p = 0.002), distal localization (p = 0.045), and penetrating disease (p = 0.041) to be risk factors. Multivariate analysis showed that 40 patients who had undergone previous immunosuppressive therapy had a significant risk of developing CRC (p = 0.026). CONCLUSIONS: Crohn's colitis patients who require surgery are at higher risk for developing CRC, particularly those whose disease duration is >10 years, have distal localization, age at diagnosis was <40 years, and have penetrating disease. Previous immunosuppressive therapy should be better investigated. We recommend surgery for any patient presenting with colonic strictures.

The role of cytoreductive surgery alone for the treatment of peritoneal carcinomatosis of colorectal origin. A retrospective analysis with regard to multimodal treatments.

BACKGROUND/AIMS: Patients with peritoneal carcinomatosis (PC) of colorectal origin have a poor prognosis (median survival of 6 months). Cytoreductive surgery (CS) with intra-peritoneal chemotherapy with or without hyperthermia (HIPEC or EPIC) allows encouraging survivals rates of 22-60 months to be obtained, with an acceptable mortality and morbidity. Nevertheless, the role of cytoreductive surgery alone is little explored in literature. The aim of this study was to better understand the role of CS alone in the treatment of PC of colorectal origin. METHODOLOGY: The outcome of 27 patients with PC of colorectal origin who underwent surgery with curative intent without combined treatments from 1996 to 2006, has been retrospectively analyzed. RESULTS: the median overall survival rate was 15 months; there was a significant statistical difference between patients who had CCR0-1 surgery (N=22) and those who had CCR2 or no resection (N=5) (15.8 vs. 9.6 months respectively, p=0.02). The mortality and the morbidity rates were 7.3% and 29%. CONCLUSIONS: This study suggests that CCR0-1 surgery alone as well as the extension of the disease are important variables influencing survival of patients with PC of colorectal origin. When a very aggressive procedure is needed to achieve a CCR0 resection, surgery should be considered rigorously because of the high risk of severe and potentially lethal complications even without chemohyperthermia. A prospective study should be realized to determine whether or not patients with PC could mostly benefit from combined treatments.

Ertapenem peritoneal fluid concentrations in adult surgical patients.

Ertapenem, a novel carbapenem, is approved for the treatment of mild to severe intra-abdominal infections (IAIs), although its in vivo concentrations in peritoneal fluid are unknown. The purpose of this study was to determine the peritoneal fluid concentration of ertapenem after a single 1 g intravenous dose. After informed consent, 21 patients (9 females and 12 males; mean+/-standard deviation (S.D.) age 50.2+/-17.7 years) requiring intra-abdominal surgery were enrolled. Plasma and peritoneal fluid samples were taken at fixed times during surgery. Drug concentrations were determined by high-performance liquid chromatography (HPLC) with ultraviolet detection. Mean+/-S.D. ertapenem peritoneal fluid concentrations were 64.3+/-23.4 mg/L at 1h and 31.3+/-26.5 mg/L at 3 h after administration. The mean tissue/plasma ratio ranged from 46.7% to 83.1%. The mean peritoneal fluid concentrations were well above the MIC(90) (minimum inhibitory concentration for 90% of the organisms) for susceptible bacteria found in IAIs, especially Escherichia coli, viridans streptococci, Enterobacteriaceae, Klebsiella spp. and Bacteroides fragilis, during the entire sampling time. These pharmacokinetic results support the assumption that ertapenem might be suitable for the treatment of IAIs.