Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long-term survival.

AIM: The applicability of laparoscopic D3 oncological resection for splenic flexure cancer (SFC) surgery has not been fully explored due to technical difficulties and variations in surgical procedure. The aim of this work is to describe the feasibility of performing laparoscopic D3 resection in SFC and its impact on long-term survival. METHOD: A retrospective study on 47 out of 52 consecutive patients who underwent elective laparoscopic colectomy for SFC from December 2006 until December 2019 at Korea University Anam Hospital was performed. Data on patients' demographic and clinical features, surgical procedures, intraoperative and postoperative complications, pathological features and follow-up were collected. Categorical data are expressed as frequencies (n) and percentages (%). Continuous data are expressed as mean ± standard deviation and median (range). The Kaplan-Meier test was used to determine the overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS). RESULTS: The median age of patients was 67.0 years (range 27-87 years) and 72.3% were men. Ten (21.3%) patients presented with an obstructing tumour and underwent an elective laparoscopic colectomy, while 68.1% of patients presented with Stage II and III disease. The conversion rate was 4.3% and the morbidity rate was 31.9%. There was one postoperative death secondary to splenic infarction and anastomotic leak leading to multi-organ failure. Four deaths occurred due to disease progression during a median follow-up of 63.8 months. The rate of recurrence was 20%, the 5-year OS was 89.6% and the 5-year PFS was 72.9%. After R0 resection, the 5-year OS was 91.5% and the 5-year DFS was 74.5%. CONCLUSION: Laparoscopic D3 colectomy for SFC is feasible, with an acceptable morbidity and long-term oncological outcome when performed by highly skilled laparoscopic colorectal surgeons with knowledge of the complex anatomy around the splenic flexure. Further randomized trials should be performed to determine the advantage of laparoscopic D3 colectomy over conventional colectomy for SFC.

Operative and Survival Outcomes of Robotic-Assisted Surgery for Colorectal Cancer in Elderly and Very Elderly Patients: A Study in a Tertiary Hospital in South Korea.

MATERIALS AND METHODS: Data of all patients ≥75 years who underwent a robotic-assisted curative resection in Korea University Anam Hospital, Seoul, South Korea, between January 2007 and January 2021 were extracted from a prospectively maintained colorectal cancer database. Patients were subdivided into the three groups according to the age: youngest-old (YO: 75-80 years), middle-old (MO: 81-85), and oldest-old (OO: ≥86 years). Intraoperative findings, postoperative, and oncological outcomes were compared between the groups. RESULTS: Seventy-six consecutive patients (female 52.6%) were included; mean age was 80 years (SD 0.33); mean body mass index (BMI), 23.8 20.9 kg/m2 (SD 3.58); mean total operative time, 279 min (SD 80.93); mean blood loss, 186 ml (SD 204.03); mean postoperative length of stay, 14 days (SD 12.03). Major complications were seen in 2.1% of patients. The 30-day mortality rate was 0%. Average number of lymph node harvested was 20.9 (SD 12.33). Postoperative complications were not statistically different between the groups. Mean follow-up time for cancer-specific survival (CSS) was 99.28 months for the YO, 72.11 months for MO, and 31.25 months for OO groups (p = 0.045). The CSS rates at 5 years were 27.0%, 21.0%, and 0%, respectively. Recurrence risk was 10.50 times higher in the OO group than the others (adjusted HR, 95% CI 1.868-59.047, p = 0.008). In the multivariable analysis, TNM stage was not a risk factor for CSS in all groups. The number of the harvested nodes was a protective factor for recurrence (HR of 0.932, 95% CI 0.875-0.992, p = 0.027) and CSS (HR of 0.928, 95% CI 0.861-0.999, p = 0.047) in elderly patients. CONCLUSION: Robotic surgery is highly feasible in elderly and very elderly colorectal cancer patients, providing a favorable operative safety profile and an acceptable cancer-specific survival outcome.

Serum miRNA profile as a potential tool for non-invasive gastric cancer diagnosis in Mexican patients.

INTRODUCTION: Gastric cancer (GC) is the third leading cause of cancer death and a major public health-care problem worldwide. At present, methods for plasma detection of cancer are limited. MicroRNAs (miRNAs) have recently been proposed as genetic regulators, which are deregulated in different types of cancer. The miRNAs are stable in serum/plasma and can be detected. Circulating miRNAs in plasma have been proposed as potential diagnostic biomarkers in GC. MATERIALS AND METHODS: After reviewing the relevant literature, the expression levels of seven miRNAs (miR-16, miR-21, miR-25, miR-26a, miR-92, miR-218, miR-223, and miR-451) were assessed by quantitative reverse transcription polymerase chain reaction using TaqMan microRNA Assays (Applied Biosystems) in plasma samples from GC patients (n = 80) and healthy controls (n = 80). RESULTS: Our results demonstrated that the expression levels of miR-21 and miR-25 were significantly upregulated in GC patients compared to healthy controls with a Fold Change of 11.551 and 60.129, respectively, while miR-223 showed downregulation in GC patients compared to healthy controls with a Fold Change of -247.281. The absolute value of Fold Change > 2 was consider significant, p < 0.05. CONCLUSIONS: Our results indicated that miR-21, miR-25, and miR-223 in plasma samples can be served as a potential noninvasive tool in detection of GC.

INTRODUCCIÓN: El cáncer gástrico (CG) es la tercera causa de muerte por cáncer y un importante problema de salud pública. Actualmente, los métodos para la detección de CG en plasma son limitados. Recientemente se han propuesto los microARNs (miARN) como reguladores genéticos en diferentes tipos de cáncer. Los miARN son estables en plasma, lo que permite una fácil detección, pudiendo usarse como biomarcadores en CG. MATERIALES Y MÉTODOS: Los niveles de expresión de siete miARN seleccionados (miR-16, miR-21, miR-25, miR-26a, miR-92, miR218, miR-223, miR-451) fueron evaluados mediante qRT-PCR mediante análisis con microARN TaqMan (Applied Biosystems) en muestras de plasma de pacientes con CG (n = 80) y controles sanos (n = 80). RESULTADOS: Se observo que los niveles de expresión de miR-21 y miR-25 estaban significativamente regulados al alza en los pacientes con CG en comparación con los controles con un Fold Change de 11.551 y 60.129 respectivamente, mientras que miR-223 mostró una regulación negativa con un cambio de -247,281. El valor absoluto de Fold Change >2 se consideró estadísticamente significativo, P <0,05. CONCLUSIONES: Nuestros resultados indicaron que miR 21, miR 25 y miR-223 en plasma pueden servir como una potencial herramienta no invasiva en la detección de CG.