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1.
World J Surg Oncol ; 19(1): 9, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33430884

RESUMO

BACKGROUND: Very few studies have been conducted on the treatment strategy for enlarged paraaortic lymph nodes (PALNs) incidentally detected during surgery. The purpose of this study was to investigate the benefit of lymph node dissection in patients with incidentally detected enlarged PALNs. METHODS: We retrospectively reviewed patients with left colon and rectal cancer who underwent surgical resection with PALN dissection between January 2010 and December 2018. The predictive factors for pathologic PALN metastasis (PALNM) were analyzed, and survival analyses were conducted to identify prognostic factors. RESULTS: Among 263 patients included, 19 (7.2%) showed pathologic PALNM and 5 (26.33%) had enlarged PALNs incidentally detected during surgery. These 5 patients accounted for 2.2% of 227 patients who had no evidence of PALNM on preoperative radiologic examination. Radiologic PALNM (odds ratio [OR] 12.737, 95% confidence interval [CI] 3.472-46.723) and radiologic distant metastasis other than PALNM (OR = 4.090, 95% CI 1.011-16.539) were independent predictive factors for pathologic PALNM. Pathologic T4 stage (hazard ratio [HR] 2.196, 95% CI 1.063-4.538) and R2 resection (HR 4.643, 95% CI 2.046-10.534) were independent prognostic factors for overall survival (OS). In patients undergoing R0 resection, pathologic PALNM was not associated with 5-year OS (90% vs. 82.2%, p = 0.896). CONCLUSION: Dissection of enlarged PALNs incidentally detected during colorectal surgery may benefit patients with favorable survival outcomes.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33318029

RESUMO

BACKGROUND: Evidence for aspirin's chemopreventative properties on colorectal cancer (CRC) is substantial, but its mechanism of action is not well-understood. We combined a proteomic approach with Mendelian randomization (MR) to identify possible new aspirin targets that decrease CRC risk. METHODS: Human colorectal adenoma cells (RG/C2) were treated with aspirin (24 hours) and a stable isotope labeling with amino acids in cell culture (SILAC) based proteomics approach identified altered protein expression. Protein quantitative trait loci (pQTLs) from INTERVAL (N = 3,301) and expression QTLs (eQTLs) from the eQTLGen Consortium (N = 31,684) were used as genetic proxies for protein and mRNA expression levels. Two-sample MR of mRNA/protein expression on CRC risk was performed using eQTL/pQTL data combined with CRC genetic summary data from the Colon Cancer Family Registry (CCFR), Colorectal Transdisciplinary (CORECT), Genetics and Epidemiology of Colorectal Cancer (GECCO) consortia and UK Biobank (55,168 cases and 65,160 controls). RESULTS: Altered expression was detected for 125/5886 proteins. Of these, aspirin decreased MCM6, RRM2, and ARFIP2 expression, and MR analysis showed that a standard deviation increase in mRNA/protein expression was associated with increased CRC risk (OR: 1.08, 95% CI, 1.03-1.13; OR: 3.33, 95% CI, 2.46-4.50; and OR: 1.15, 95% CI, 1.02-1.29, respectively). CONCLUSIONS: MCM6 and RRM2 are involved in DNA repair whereby reduced expression may lead to increased DNA aberrations and ultimately cancer cell death, whereas ARFIP2 is involved in actin cytoskeletal regulation, indicating a possible role in aspirin's reduction of metastasis. IMPACT: Our approach has shown how laboratory experiments and population-based approaches can combine to identify aspirin-targeted proteins possibly affecting CRC risk.

3.
Gastroenterology ; 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33058866

RESUMO

BACKGROUND AND AIMS: Susceptibility genes and the underlying mechanisms for the majority of risk loci identified by genome-wide association studies (GWAS) for colorectal cancer (CRC) risk remain largely unknown. We conducted a transcriptome-wide association study (TWAS) to identify putative susceptibility genes. METHODS: Gene-expression prediction models were built using transcriptome and genetic data from the 284 normal transverse colon tissues of European descendants from the Genotype-Tissue Expression (GTEx), and model performance was evaluated using data from The Cancer Genome Atlas (n = 355). We applied the gene-expression prediction models and GWAS data to evaluate associations of genetically predicted gene-expression with CRC risk in 58,131 CRC cases and 67,347 controls of European ancestry. Dual-luciferase reporter assays and knockdown experiments in CRC cells and tumor xenografts were conducted. RESULTS: We identified 25 genes associated with CRC risk at a Bonferroni-corrected threshold of P < 9.1 × 10-6, including genes in 4 novel loci, PYGL (14q22.1), RPL28 (19q13.42), CAPN12 (19q13.2), MYH7B (20q11.22), and MAP1L3CA (20q11.22). In 9 known GWAS-identified loci, we uncovered 9 genes that have not been reported previously, whereas 4 genes remained statistically significant after adjusting for the lead risk variant of the locus. Through colocalization analysis in GWAS loci, we additionally identified 12 putative susceptibility genes that were supported by TWAS analysis at P < .01. We showed that risk allele of the lead risk variant rs1741640 affected the promoter activity of CABLES2. Knockdown experiments confirmed that CABLES2 plays a vital role in colorectal carcinogenesis. CONCLUSIONS: Our study reveals new putative susceptibility genes and provides new insight into the biological mechanisms underlying CRC development.

4.
Ann Surg Treat Res ; 99(3): 171-179, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32908849

RESUMO

Purpose: A variety of clinical features of anastomotic leak occur during the surgical treatment of rectal cancer. However, little information regarding management of leakage is available and treatment guidelines have not been validated. The aim of this study was to evaluate the validity of currently proposed expert opinions on the management of anastomotic leak, after low anterior resection for rectal cancer. Methods: A retrospective analysis was conducted for 1,786 patients who underwent sphincter-preserving surgery for rectal cancer between 2005 and 2015. Clinical outcomes including anastomotic leak-associated mortality and permanent stoma were analyzed. Results: The overall incidence of anastomotic leak was 6.8% (122 of 1,786), including 6.1% (30 of 493 patients) with diverting stoma and 7.1% (92 of 1,293 patients) without diverting stoma (P = 0.505). A majority of patients without diversion were treated with diverting stoma (76 of 88 patients [86.4%]); 1 mortality (0.8%) was observed in this group. Treatments in the diversion group mainly included conservative treatment, local drainage, and/or transanal repair (26 of 30 patients [86.7%]). The anastomotic failure rates were 20.7% (19 of 92 patients) in the no diversion group and 53.3% (16 of 30 patients) in the diversion group. In the multivariate analysis, preoperative chemoradiotherapy (P < 0.001) and delayed diagnosis of anastomotic leak (P = 0.036) were independent risk factors for permanent stoma. Conclusion: Management of anastomotic leak should be tailored to individual patients. When anastomotic leak occurred, preoperative chemoradiotherapy and delayed diagnosis seemed to be associated with permanent stoma.

5.
Ann Coloproctol ; 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32972101

RESUMO

Purpose: This study aimed to evaluate the relationship between high-output stomas (HOSs), postoperative ileus (POI), and readmission after rectal cancer surgery with diverting ileostomy. Methods: We included 302 patients with rectal cancer who underwent restorative resection with diverting ileostomy between January 2011 and December 2015. HOSs were defined as stomas with ≥2000 mL/day output. We analyzed predictive factors for readmission of these patients. Results: Forty-eight (15.9%) patients had HOSs during the hospital stay, and 41 (13.6%) patients experienced POI. HOSs were strongly associated with POI (45.8 vs. 7.5%, p<0.001). The all-cause readmission rate was 16.9%, with 19 (6.3%) and 20 (6.6%) patients experiencing ileus and acute kidney injury, respectively. HOSs (27.1 vs. 15.0%, p=0.040) and POI (34.1 vs. 14.2%, p=0.002) were associated with all-cause readmission, and POI was associated with readmission with ileus (17.1 vs. 4.6%, p=0.007). POI was an independent risk factor for all-cause readmission (adjusted odds ratio [OR]=2.640; 95% confidence interval [CI] 1.162-6.001; p=0.020) and readmission with ileus (adjusted OR=3.869; 95% CI 1.387- 10.792; p=0.010). Conclusions: POI was associated with readmission, particularly for subsequent ileus, in patients with diverting ileostomy. We should make efforts to reduce POI, such as strong control of HOSs, to prevent readmission.

6.
Cancers (Basel) ; 12(8)2020 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-32824392

RESUMO

We aimed to assess the survival benefits of primary tumor resection (PTR) followed by chemotherapy in patients with asymptomatic stage IV colorectal cancer with asymptomatic, synchronous, unresectable metastases compared to those of upfront chemotherapy alone. This was an open-label, prospective, randomized controlled trial (ClnicalTrials.gov Identifier: NCT01978249). From May 2013 to April 2016, 48 patients (PTR, n = 26; upfront chemotherapy, n = 22) diagnosed with asymptomatic colorectal cancer with unresectable metastases in 12 tertiary hospitals were randomized (1:1). The primary endpoint was two-year overall survival. The secondary endpoints were primary tumor-related complications, PTR-related complications, and rate of conversion to resectable status. The two-year cancer-specific survival was significantly higher in the PTR group than in the upfront chemotherapy group (72.3% vs. 47.1%; p = 0.049). However, the two-year overall survival rate was not significantly different between the PTR and upfront chemotherapy groups (69.5% vs. 44.8%, p = 0.058). The primary tumor-related complication rate was 22.7%. The PTR-related complication rate was 19.2%, with a major complication rate of 3.8%. The rates of conversion to resectable status were 15.3% and 18.2% in the PTR and upfront chemotherapy groups. While PTR followed by chemotherapy resulted in better two-year cancer-specific survival than upfront chemotherapy, the improvement in the two-year overall survival was not significant.

7.
Trials ; 21(1): 628, 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641081

RESUMO

BACKGROUND: Current guidelines recommend the prescription of immune-enriched oral nutritional supplements for malnourished patients before major gastrointestinal surgery. However, the benefit of preoperative immunonutrition is still controversial. This randomized controlled trial aims to evaluate the effect of preoperative immunonutrition on the outcomes of surgery for colon cancer. METHODS/DESIGN: Patients with primary colon cancer will be included as study participants after screening. They will be randomly assigned (in a ratio of 1:1) to receive preoperative immunonutrition added to the normal diet (experimental arm) or consume normal diet alone (control arm). Patients in the experimental arm will receive oral supplementation (400 mL/day) with arginine and ω-3 fatty acids for 7 days before elective surgery. The primary endpoint is the rate of infectious complications, while the secondary endpoints are postoperative complication rate, change in body weight, length of hospital stay, and nature of fecal microbiome. The authors hypothesize that the rate of infectious complications would be 13% in the experimental arm and 30% in the control arm. With a two-sided alpha of 0.05 and a power of 0.8, the sample size is calculated as 176 patients (88 per arm). DISCUSSION: Although there have been many studies demonstrating significant benefits of preoperative immunonutrition, these were limited by a small sample size and potential publication bias. Despite the recommendation of immunonutrition before surgery in nutritional guidelines, its role in reduction of rate of infectious complications is still controversial. This trial is expected to provide evidence for the benefits of administration of preoperative immunonutrition in patients with colon cancer. TRIAL REGISTRATION: Clinical Research Information Service KCT0003770 . Registered on 15 April 2019.

8.
Cancer Sci ; 111(9): 3268-3278, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32533590

RESUMO

Fibroblast growth factor receptor 4 (FGFR4) is known to induce cancer cell proliferation, invasion, and antiapoptosis through activation of RAS/RAF/ERK and PI3K/AKT pathways, which are also known as major molecular bases of colon cancer carcinogenesis related with epidermal growth factor receptor (EGFR) signaling. However, the interaction between FGFR4 and EGFR signaling in regard to colon cancer progression is unclear. Here, we investigated a potential cross-talk between FGFR4 and EGFR, and the effect of anti-EGFR therapy in colon cancer treatment. To explore the biological roles of FGFR4 in cancer progression, RNA sequencing was carried out using FGFR4 transfected colon cell lines. Gene ontology data showed the upregulation of genes related to EGFR signaling, and we identified that FGFR4 overexpression secretes EGFR ligands such as amphiregulin (AREG) with consequent activation of EGFR and ErbB3. This result was also shown in in vivo study and the cooperative interaction between EGFR and FGFR4 promoted tumor growth. In addition, FGFR4 overexpression reduced cetuximab-induced cytotoxicity and the combination of FGFR4 inhibitor (BLU9931) and cetuximab showed profound antitumor effect compared to cetuximab alone. Clinically, we found the positive correlation between FGFR4 and AREG expression in tumor tissue, but not in normal tissue, from colon cancer patients and these expressions were significantly correlated with poor overall survival in patients treated with cetuximab. Therefore, our results provide the novel mechanism of FGFR4 in connection with EGFR activation and the combination of FGFR4 inhibitor and cetuximab could be a promising therapeutic option to achieve the optimal response to anti-EGFR therapy in colon cancer.


Assuntos
Anfirregulina/genética , Neoplasias do Colo/genética , Neoplasias do Colo/metabolismo , Inibidores de Proteínas Quinases/farmacologia , Receptor Tipo 4 de Fator de Crescimento de Fibroblastos/metabolismo , Linhagem Celular Tumoral , Cetuximab/farmacologia , Neoplasias do Colo/patologia , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/metabolismo , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Fosfatidilinositol 3-Quinases/metabolismo , Fosforilação , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais
9.
Ann Surg Treat Res ; 98(3): 139-145, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32158734

RESUMO

Purpose: Radical lymph node dissection for right-sided colon cancer is technically challenging. No clear guideline is available for surgical resection of clinical stage I right-sided colon cancer. This study was designed to review the pathologic stage of clinical stage I right-sided colon cancer and determine the relevant extent of surgical resection. Methods: Patients were treated for clinical stage I right-sided colon cancers (cecal, ascending, hepatic flexure, and proximal transverse colon) between July 2006 and December 2014 at a tertiary teaching hospital. Open surgery was not included because laparoscopic surgery is an initial major procedure in the institution. Results: During the study period, 80 patients diagnosed with clinical stage I right-sided colon cancer were classified into 2 groups according to the pathology: stage 0/I and II/III. Tumor sizes were larger in the stage II/III group (P = 0.003). The stage II/III group had higher rates of vascular (P = 0.023) and lymphatic invasion (P = 0.023) and lower rates of well differentiation (P = 0.022). During follow-up, 1 case of local and 4 cases of systemic recurrences were found. Multivariate analysis to confirm odds ratios affecting change from clinical stage I to pathological stage II/III showed that tumor size (P = 0.010) and the number of retrieved lymph nodes (P = 0.046) were risk factors. Conclusion: For right-sided colon cancer, even with clinical stage I included, radical lymph node dissection should be performed for exact staging with sufficient number of lymph nodes. This will help determine appropriate adjuvant treatment, especially in large tumor sizes.

10.
Medicine (Baltimore) ; 99(7): e19258, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049866

RESUMO

Primary tumor resection (PTR) for unresectable metastatic colorectal cancer (mCRC) patients has been documented to be associated with postoperative hyper-neovascularization and enhanced growth of metastases, which may be prevented by bevacizumab. This study aimed to investigate the survival outcome of PTR in patients who received palliative bevacizumab-containing chemotherapy (BCT).From January 2006 to December 2018, medical records of 240 mCRC patients who received palliative BCT at a single tertiary colorectal cancer center were retrospectively reviewed. Patients were classified into three groups: PTR-a (PTR before BCT, n = 60), PTR-b (PTR during BCT, n = 17), and BCT-only group (n = 163). Resectable mCRCs or recurrent diseases were excluded, and the end-point was overall survival (OS) rate.Three groups had similar age, cell differentiation, location of the primary tumor, and the number of metastatic organs. More than two-thirds of patients who received PTR experienced disease-progressions (PD) during their postoperative chemotherapy-free time (PTR-a vs PTR-b; 66.7% vs 76.5%, P = .170), but OS was not inferior to the BCT-only group (PTR-a vs BCT-only; HR 0.477 [95% CI 0.302-0.754], P = .002/PTR-b vs BCT-only; HR 0.77 [95% CI 0.406-1.462], P = .425). The postoperative chemotherapy-free time was similar between PTR-a and PTR-b (median 32.0 [14-98] days vs 41.0 [18-71] days, P = .142), but non-obstructive indications (perforation, bleeding, pain) were the more frequent in the PTR-b than PTR-a. Young age, the number of BCT, and PTR-a were the independent factors for OS.The efficacy of the PTR for unresectable mCRC has been controversial, but this study demonstrated that PTR should be considered for the unresectable mCRC patients regardless before and during BCT.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Bevacizumab/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Cuidados Paliativos , República da Coreia/epidemiologia , Estudos Retrospectivos
11.
Pathol Res Pract ; 216(3): 152834, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32001055

RESUMO

PURPOSE: The clinical importance of tissue CEA levels for predicting tumor response to preoperative chemoradiotherapy (CRT) for rectal cancer has not been studied. METHODS: Serum CEA levels and tissue CEA expressions for 117 patients who underwent preoperative CRT for rectal cancer, were prospectively collected and analyzed at a tertiary university hospital RESULTS: The median follow-up time was 49 months (range, 3-61 months), and the 5-year disease-free survival (DFS) rate was 68.3 %. In multivariate analysis, serum CEA (log-transformed value) [odds ratio (OR) = 0.741, 95 % confidence interval (CI) 1.588-40.422, P =  0.021], tissue CEA/GAPDH ratio (OR = 3.673, 95 % CI 1.316-12.081, P =  0.019), and tumor circumferentiality (OR = 2.960, 955 CI, 1.101-8.999, P =  0.040) were the independent predictors for good tumor response to CRT. Serum CEA level was significant prognostic factor for DFS (P =  0.004) in multivariate analysis. However, tissue CEA was not associated with DFS. CONCLUSIONS: Both serum and tissue CEA were significant factors for predicting good tumor response following preoperative CRT. However, tissue CEA was not associated with the oncologic outcome. The possibility of radiologic resistance of high CEA tumors is expected to be investigated through further studies.


Assuntos
Biomarcadores Tumorais/análise , Antígeno Carcinoembrionário/análise , Radioterapia/métodos , Neoplasias Retais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia Adjuvante/métodos , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Valor Preditivo dos Testes , Neoplasias Retais/patologia , Resultado do Tratamento
12.
Am J Surg ; 220(4): 993-998, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32057413

RESUMO

BACKGROUND: This study aimed to evaluate the association between nutritional risk screening (NRS) score and administration of adjuvant chemotherapy for stage III colon cancer. METHODS: A total of 404 patients with stage III colon cancer who underwent curative resection between January 2012 and December 2015 were included. Patients with a preoperative high nutritional risk score (NRS ≥4) were compared with those with an NRS <4. Predictive factors for omission of adjuvant chemotherapy, and prognostic factors for overall survival (OS) were analyzed. RESULTS: Eighty (19.8%) patients had a high nutritional risk (NRS ≥4). An NRS score ≥4 was associated with higher risk of omission of adjuvant chemotherapy (26.3% vs. 13.6%, p = 0.006), which was significant after adjusting for covariables (odds ratio = 1.862, p = 0.047). Multivariable survival analysis showed that omission of adjuvant chemotherapy was an independent poor prognostic factor for OS (hazard ratio = 4.060, p < 0.001). CONCLUSIONS: An NRS score ≥4 was associated with omission of adjuvant chemotherapy in stage III colon cancer, which resulted in poor OS.


Assuntos
Neoplasias do Colo/terapia , Detecção Precoce de Câncer/métodos , Estadiamento de Neoplasias , Avaliação Nutricional , Idoso , Quimioterapia Adjuvante , Neoplasias do Colo/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos
13.
Ann Surg Treat Res ; 97(4): 184-193, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31620392

RESUMO

Purpose: The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends on various factors. The present study was intended to investigate the oncologic outcome according to the time of resection of metastatic lesions. Methods: Data from patients who underwent treatment with curative intent for primary CRC and synchronous LM between 2004 and 2009 from 9 university hospitals in Korea were collected retrospectively. One hundred forty-three patients underwent simultaneous resection for primary CRC and synchronous LM (simultaneous surgery group), and 65 patients were treated by 2-stage operation (staged surgery group). Results: The mean follow-up length was 41.2 ± 24.6 months. In the extent of resection for hepatic metastasis, major hepatectomy was more frequently performed in staged surgery group (33.8% vs. 8.4%, P < 0.001). The rate of severe complications of Clavien-Dindo classification grade III or more was not significantly different between the 2 groups. The 3-year overall survival (OS) rate was 85.0% in staged surgery group and 69.4% in simultaneous surgery group (P = 0.013), and the 3-year recurrence-free survival (RFS) rate was 46.4% in staged surgery group and 30.2% in simultaneous surgery group (P = 0.143). In subgroup analysis based on the location of primary CRC, the benefit of staged surgery for OS and RFS was clearly shown in rectal cancer (P = 0.021 and P = 0.015). Conclusion: Based on our results, staged surgery with or without neoadjuvant chemotherapy should be considered for resectable synchronous LM from CRC, especially in rectal cancer, as a safe and fairly promising option.

14.
ANZ J Surg ; 89(9): E373-E378, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31452333

RESUMO

BACKGROUND: The optimal extent of lymph node dissection in patients with descending colon cancer is still debatable. We designed this study to evaluate the distribution of lymph node metastasis and the appropriate extent of lymph node dissection in descending colon cancer patients. METHODS: We retrospectively reviewed the medical records of 118 descending colon cancer patients without distant metastasis, who underwent curative resection between January 2004 and December 2014. The distribution of lymph node metastasis was evaluated, and prognostic factors were analysed. RESULTS: The median follow-up period was 52 months (range 1-125 months). Twenty-six (22.0%) patients underwent high ligation of the inferior mesenteric artery (IMA), whereas 92 (78.0%) patients underwent ligation of the left colic artery, saving the IMA. Lymph nodes at the origin of the IMA showed no metastasis in any of the 26 patients who underwent high ligation of the IMA. After propensity score matching, 3-year disease-free survival (80.4% versus 92.9%, P = 0.471) and 5-year overall survival (81.8% versus 90.9%, P = 0.875) were not significantly different according to the type of IMA ligation. CONCLUSION: In patients with descending colon cancer, there was no lymph node metastasis at the origin of the IMA, and ligation of the IMA showed no prognostic benefit.


Assuntos
Colo Descendente/patologia , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Excisão de Linfonodo , Metástase Linfática , Idoso , Neoplasias do Colo/mortalidade , Feminino , Seguimentos , Humanos , Laparoscopia , Ligadura , Masculino , Artéria Mesentérica Inferior/cirurgia , Pessoa de Meia-Idade , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida
15.
Int J Colorectal Dis ; 34(8): 1483-1490, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31292725

RESUMO

PURPOSE: Previous studies have reported paradoxical survival prognoses for some node-negative and node-positive colon cancer patients. However, current guidelines recommend adjuvant chemotherapy (CT) only for node-positive patients. This study investigated the efficacy of adjuvant CT for patients who underwent radical surgery for colon cancer with solitary lymph node (LN) metastasis. METHODS: This study included 281 patients treated between 2004 and 2015. Patients were classified into no-CT (n = 39) and CT (n = 242) groups, and the survival outcomes and recurrence-related follow-up data were analyzed. RESULTS: The groups exhibited similarities in tumor sidedness, tumor differentiation, and pathologic stage. However, the age, ASA class, and preoperative CEA level were relatively lower in the CT group. Although the CT group had a higher 5-year overall survival (OS) rate than the no-CT group (88.4% vs. 65.3%, p < 0.001), the groups did not differ in terms of 5-year disease-free survival (DFS) (CT, 84.1% vs. no-CT, 83.3%, p = 0.490). A multivariate analysis identified adjuvant CT as an independent factor for OS but not for DFS. A highly examined LN count (≥ 12) was associated with improved DFS improvement. However, D3 LN dissection was not associated with DFS or OS. For DFS, intermediate/apical positive LNs received a high hazard ratio relative to pericolic/epicolic LNs (2.080, 95% confidence interval: 0.979-4.416), but this was not significant (p = 0.057). CONCLUSIONS: Adjuvant chemotherapy did not provide clear advantages for colon cancer with solitary LN metastasis. Further large studies that analyze several prognostic factors are needed to establish tailored adjuvant CT administration guidelines.


Assuntos
Neoplasias do Colo/tratamento farmacológico , Metástase Linfática/patologia , Idoso , Quimioterapia Adjuvante , Neoplasias do Colo/diagnóstico por imagem , Intervalo Livre de Doença , Feminino , Humanos , Metástase Linfática/diagnóstico por imagem , Masculino , Análise Multivariada , Recidiva Local de Neoplasia/patologia , Prognóstico , Terapia de Salvação , Análise de Sobrevida , Tomografia Computadorizada por Raios X
16.
Ann Coloproctol ; 35(3): 137-143, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31288502

RESUMO

PURPOSE: The aim of this study was to assess oncological outcomes of postoperative radiotherapy plus chemotherapy (CRT) versus chemotherapy alone (CTx) in stage II or III upper rectal cancer patients who underwent curative surgery. METHODS: We retrospectively reviewed 263 consecutive patients with pathologic stage II or III upper rectal cancer who underwent primary curative resection with postoperative CRT or CTx from January 2008 to December 2014 at Chonnam National University Hwasun Hospital. Multivariate and propensity score matching analyses were used to reduce selection bias. RESULTS: Median follow-up was 48.1 months for the entire cohort and 53.5 months for the matched cohort. In subgroup analysis of the propensity score matched cohort, the 3-year local recurrence-free survival was 94.1% (95% confidence interval [CI], 87.8%-100%) in the CRT group and 90.1% (95% CI, 82.8%-97.9%) in the CTx group (P = 0.370). No significant difference in disease-free survival was observed according to treatment type. On multivariate analysis, circumferential resection margin involvement (hazard ratio [HR], 2.386; 95% CI, 1.190-7.599; P = 0.032), N stage (HR, 6.262; 95% CI, 1.843-21.278, P = 0.003), and T stage (HR, 5.896, 95% CI, 1.298-6.780, P = 0.021) were identified as independent risk factors for local recurrence of tumors of the upper rectum. CONCLUSION: Omission of radiotherapy in an adjuvant treatment setting may not jeopardize oncologic outcomes in stages II and III upper rectal cancer.

17.
J Invest Surg ; : 1-6, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31074296

RESUMO

PURPOSE: The colon originates from the midgut and hindgut, with subsequent differentiation into the right and left colon. The embryology, clinical symptoms, incidence, molecular pathways, and oncologic outcomes differ between right and left colorectal cancers. However, the differences have not been fully accepted. AIM OF THE STUDY: This study compared short- and long-term outcomes between right and left colon cancers. MATERIALS AND METHODS: This study included 966 patients who underwent laparoscopic resection with radical lymph node dissection for stage I, II, and III colon cancers between 2009 and 2014 at a tertiary teaching hospital. We excluded cases with fewer than 12 retrieved lymph nodes, emergency operations, synchronous or multiple cancers, and those located in the transverse colon and rectum. RESULTS: The right colon group included 343 (35.5%) patients and the left colon group 623. Female patients had a high incidence of right colon cancer (p < 0.001). Right colon cancer had longer operative times (p = 0.012), and more bleeding during the operation (p = 0.001). The size of the tumor was larger (p < 0.001) and more lymph nodes were harvested (p < 0.001) on the right side. Vascular (p = 0.006) and lymphatic (p = 0.004) invasion was greater in the right colon, but left colon cancer showed greater neural invasion (p = 0.008). Cancers on the right side also had a tendency to be poorly differentiated (p < 0.001). The groups did not differ in disease-free, overall, and cancer-specific survival rates for stage. CONCLUSION: Although the oncologic outcomes show no significant differences, colon cancer has characteristic, perioperative, and histopathologic differences according to its embryologic origin.

18.
Ann Coloproctol ; 35(2): 72-82, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31113172

RESUMO

PURPOSE: Treatment after failure of circumferential resection margin (CRM) conversion after preoperative chemoradiotherapy (pCRT) for locally advanced rectal cancer (LARC) has not been evaluated well. We conducted a single-center, retrospective analysis to fill this information gap. METHODS: From 2008 to 2016, we included 112 patients who had predictive CRM involvement on baseline magnetic resonance imaging (MRI) and who underwent surgery following pCRT for LARC. Baseline and posttreatment radiologic and clinical factors were analyzed. RESULTS: Of 493 patients with LARC, 112 had CRM involvement by baseline MRI (mrCRM). In 40 patients (35.7%), mrCRM involvement was converted as negative posttreatment CRM (ymrCRM-). Multivariate analysis showed the risk factors for persistent CRM involvement (ymrCRM+) after pCRT were extramural venous invasion (mrEMVI+) (P = 0.030) and lower tumor location (P = 0.007). In addition, persistent CRM involvement after pCRT was an independent risk factor for predicting pathologic CRM involvement. The Cox proportional hazard model showed baseline positive mrEMVI remained significant for disease-free survival (DFS) (P < 0.001). On posttreatment MRI, abdominoperineal resection (P = 0.031), intersphincteric resection (P = 0.006), and persistent CRM involvement (P = 0.001) remained significant for local recurrence-free survival. With regard to DFS, persistent CRM involvement (P = 0.048) and positive EMVI on posttreatment MRI (ymrEMVI) (P = 0.014) were significant. In the patient subgroup with persistent CRM involvement, 5-year DFS in patients with mrEMVI and ymrEMVI was 29.8% and 21.2%, respectively. CONCLUSION: Patients who fail to convert to negative CRM have extremely poor oncologic outcomes. Lower tumor height and negative mrEMVI status were good responders to ymrCRM conversion. Our results suggest that these patients require a more intensive treatment modality.

19.
Asian J Surg ; 42(8): 823-831, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30956039

RESUMO

BACKGROUND: Among rectal cancer patients, some of good responders after neoadjuvant chemoradiotherapy (nCRT) are considered for non-operative treatments to avoid postoperative morbidities and permanent stoma. However, oncologic feasibility of non-operative treatment has not been fully understood. METHODS: From 2008 to 2017, we retrospectively reviewed patient's records who had lower or mid rectal cancer and diagnosed to clinical complete response by magnetic resonance imaging after nCRT. Clinical differences and oncologic outcomes were compared among Radical surgery (RS), Local excision (LE) and Wait-and-see (WS) group. RESULTS: Number of 129, 25, 15 patients included to RS, LE, WS groups. Local recurrence was frequent type of recurrence in both of LE and WS group (RS; 31.3%, LE; 80%, WS; 66.7%), and many patients in WS group omitted salvage treatment (RS; 75%, LE; 100%, WS; 33.3%). 5-years local-recurrence/disease-free survival rate (LRFS, DFS) between RS and LE were similar between each group, but WS showed significantly inferior outcomes than that of RS (LRFS; p = 0.001, DFS; p = 0.001). In multivariate analysis, WS protocol (OR; 7.163, 95% CI; 1.995-25.715) and cT4 stage (OR; 8.206, 95% CI; 1.596-42.198) were independent factors for LRFS. CONCLUSIONS: Wait-and-see group showed high rate of rejection of salvage treatments for recurrence, and poor oncologic outcomes. However, recent low-level evidences reported favorable outcome of WS protocol when salvage treatment was followed after recurrence. It seems that the application of WS protocol should be postponed until the results of randomized-controlled trials are available. Local excision seems to be good alternative option to radical surgery when salvage treatment is followed.


Assuntos
Quimiorradioterapia Adjuvante , Terapia Neoadjuvante , Neoplasias Retais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório , Estudos de Viabilidade , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Retais/diagnóstico por imagem , Estudos Retrospectivos , Terapia de Salvação , Resultado do Tratamento
20.
Ann Surg Treat Res ; 96(3): 116-122, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30838183

RESUMO

Purpose: The predictive role of obesity on pathologic complete response (pCR) after neoadjuvant chemoradiation (nCRT) in rectal cancer remains controversial. This study aimed to evaluate the association between obesity and pathologic response in patients with rectal cancer following nCRT. Methods: A total of 320 patients with primary rectal cancer who underwent curative resection after nCRT between January 2010 and September 2014 were enrolled in this study. Obesity was defined as body mass index of ≥25 kg/m2. Clinicopathologic characteristics were analyzed to identify independent predictive factors for pCR. Results: Among the included patients, 23.4% (n = 75) were obese, and 14.7% (n = 47) showed pCR. Baseline characteristics were generally similar between obese and nonobese patients, except that women (P = 0.001) and cT2 tumors (P = 0.001) were more common in the obese group. Multivariate logistic regression analysis revealed that obesity (odds ratio [OR] = 2.051; 95% confidence interval [CI], 1.009-4.168), cT2 (OR, 3.614; 95% CI, 1.166-11.202), and pretreatment carcinoembryonic antigen <5 ng/mL (OR, 2.921; 95% CI, 1.365-6.253) were independent predictors for pCR. Obesity was not associated with disease-free survival or local recurrence-free survival. Conclusion: Obesity was an independent predictive factor for pCR following nCRT in rectal cancer, but was not associated with recurrence. Further studies are needed to clarify the association between obesity and prognosis of rectal cancer after nCRT.

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