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1.
BMC Cancer ; 24(1): 740, 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38886672

RESUMO

OBJECTIVE: Using the preoperative pan-immune-inflammation value (PIV) and the monocyte to high-density lipoprotein ratio (MHR) to reflect inflammation, immunity, and cholesterol metabolism, we aim to develop and visualize a novel nomogram model for predicting the survival outcomes in patients with colorectal cancer (CRC). METHODS: A total of 172 patients with CRC who underwent radical resection were retrospectively analyzed. Survival analysis was conducted after patients were grouped according to the optimal cut-off values of PIV and MHR. Univariate and multivariate analyses were performed using Cox proportional hazards regression to screen the independent prognostic factors. Based on these factors, a nomogram was constructed and validated. RESULTS: The PIV was significantly associated with tumor location (P < 0.001), tumor maximum diameter (P = 0.008), and T stage (P = 0.019). The MHR was closely related to gender (P = 0.016), tumor maximum diameter (P = 0.002), and T stage (P = 0.038). Multivariate analysis results showed that PIV (Hazard Ratio (HR) = 2.476, 95% Confidence Interval (CI) = 1.410-4.348, P = 0.002), MHR (HR = 3.803, 95%CI = 1.609-8.989, P = 0.002), CEA (HR = 1.977, 95%CI = 1.121-3.485, P = 0.019), and TNM stage (HR = 1.759, 95%CI = 1.010-3.063, P = 0.046) were independent prognostic indicators for overall survival (OS). A nomogram incorporating these variables was developed, demonstrating robust predictive accuracy for OS. The area under the curve (AUC) values of the predictive model for 1-, 2-, and 3- year are 0.791,0.768,0.811, respectively. The calibration curves for the probability of survival at 1-, 2-, and 3- year presented a high degree of credibility. Furthermore, Decision curve analysis (DCA) for the probability of survival at 1-, 2-, and 3- year demonstrate the significant clinical utility in predicting survival outcomes. CONCLUSION: Preoperative PIV and MHR are independent risk factors for CRC prognosis. The novel developed nomogram demonstrates a robust predictive ability, offering substantial utility in facilitating the clinical decision-making process.


Assuntos
Neoplasias Colorretais , Lipoproteínas HDL , Monócitos , Nomogramas , Humanos , Masculino , Feminino , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/sangue , Neoplasias Colorretais/patologia , Neoplasias Colorretais/imunologia , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Lipoproteínas HDL/sangue , Prognóstico , Inflamação/sangue , Período Pré-Operatório , Estadiamento de Neoplasias , Adulto , Modelos de Riscos Proporcionais
2.
BMC Cancer ; 24(1): 741, 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38890682

RESUMO

BACKGROUND: Sarcopenia is characterized by reduced skeletal muscle volume and is a condition that is prevalent among elderly patients and associated with poor prognosis as a comorbidity in malignancies. Given the aging population over 80 years old in Japan, an understanding of malignancies, including colorectal cancer (CRC), complicated by sarcopenia is increasingly important. Therefore, the focus of this study is on a novel and practical diagnostic approach of assessment of psoas major muscle volume (PV) using 3-dimensional computed tomography (3D-CT) in diagnosis of sarcopenia in patients with CRC. METHODS: The subjects were 150 patients aged ≥ 80 years with CRC who underwent primary tumor resection at Juntendo University Hospital between 2004 and 2017. 3D-CT measurement of PV and conventional CT measurement of the psoas major muscle cross-sectional area (PA) were used to identify sarcopenia (group S) and non-sarcopenia (group nS) cases. Clinicopathological characteristics, operative results, postoperative complications, and prognosis were compared between these groups. RESULTS: The S:nS ratios were 15:135 for the PV method and 52:98 for the PA method. There was a strong positive correlation (r = 0.66, p < 0.01) between PVI (psoas major muscle volume index) and PAI (psoas major muscle cross-sectional area index), which were calculated by dividing PV or PA by the square of height. Surgical results and postoperative complications did not differ significantly in the S and nS groups defined using each method. Overall survival was worse in group S compared to group nS identified by PV (p < 0.01), but not significantly different in groups S and nS identified by PA (p = 0.77). A Cox proportional hazards model for OS identified group S by PV as an independent predictor of a poor prognosis (p < 0.05), whereas group S by PA was not a predictor of prognosis (p = 0.60). CONCLUSIONS: The PV method for identifying sarcopenia in elderly patients with CRC is more practical and sensitive for prediction of a poor prognosis compared to the conventional method.


Assuntos
Neoplasias Colorretais , Imageamento Tridimensional , Músculos Psoas , Sarcopenia , Tomografia Computadorizada por Raios X , Humanos , Sarcopenia/diagnóstico por imagem , Sarcopenia/patologia , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/patologia , Masculino , Feminino , Neoplasias Colorretais/patologia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/diagnóstico por imagem , Idoso de 80 Anos ou mais , Tomografia Computadorizada por Raios X/métodos , Imageamento Tridimensional/métodos , Prognóstico , Tamanho do Órgão , Japão/epidemiologia , Estudos Retrospectivos
3.
BMC Surg ; 24(1): 180, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38867218

RESUMO

AIM: Surgery had a significant impact on 25-hydroxyvitamin D (25-(OH)D) levels. Uncertainty still existed regarding the effects of peri-operative 25(OH)D deficiency on colorectal cancer (CRC) patients' prognosis. The purpose of the present study was to explore the potential association between the peri-operative 25(OH)D deficiency and the survival outcome of CRC. METHODS: Seven electronic databases [including PubMed, EMBASE, Web of Science, The Cochrane Library, OvidMEDLINE(R), China National Knowledge Infrastructure (CNKI) and Wangfang data] were searched without language limitations. The primary outcomes were overall survival and all-cause mortality. Secondary outcomes were the incidence of 25(OH)D deficiency and risk variables for low 25(OH)D level in the peri-operative period. RESULTS: 14 eligible studies were obtained with 9324 patients for meta-analysis. In the peri-operative period, the pooled incidence of blood 25(OH)D deficiency was 59.61% (95% CI: 45.74-73.48). The incidence of blood 25(OH)D deficiency post-operatively (66.60%) was higher than that pre-operatively (52.65%, 95% CI: 32.94-72.36). Male (RR = 1.09, 95% CI: 1.03-1.16), rectum tumor (RR = 1.23, 95% CI: 1.03-1.47), spring and winter sampling (RR = 1.24, 95% CI: 1.02-1.49) were the risk factors for the 25(OH)D deficiency. The association between the low 25(OH)D post-operatively and short-term overall survival (HR = 0.43, 95% CI: 0.24-0.77) was most prominent, while a low 25(OH)D pre-operatively (HR = 0.47, 95% CI: 0.31-0.70) was more significantly associated with long-term all-cause mortality than that after surgery. CONCLUSION: Peri-operative 25(OH)D impacted the CRC patients' prognosis. Due to possible confounding effects of systemic inflammatory response (SIR), simultaneous measurement of vitamin D and SIR is essential for colorectal survival.


Assuntos
Neoplasias Colorretais , Deficiência de Vitamina D , Vitamina D , Humanos , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Vitamina D/sangue , Período Perioperatório , Prognóstico , Taxa de Sobrevida/tendências , Fatores de Risco , Incidência
4.
Minerva Anestesiol ; 90(6): 509-519, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38869264

RESUMO

BACKGROUND: The current study was designed to evaluate the role of prophylactic melatonin administration in reducing delirium occurrence in elderly patients undergoing colorectal cancer surgeries. METHODS: One hundred patients of both genders undergoing elective colorectal cancer surgeries under general anesthesia were randomly allocated into two equal groups. A treatment group of patients (Melatonin group) received five mg of melatonin the night before surgery, twelve hours before the scheduled surgery time, and an additional five mg of melatonin two hours before surgery. The control group of patients received placebo tablets at the same time points. Delirium score, sedation score, pain score, hemodynamics, oxygen saturation, and blood requirements were recorded. RESULTS: Twenty-eight patients (56%) in the control group versus 18 (36%) in the melatonin group developed delirium (P=0.045), OR=2.26, 95% CI: 1.013-5.05. Five patients (18%) in the control group versus six (33%) in the melatonin group developed delirium on discharge from the recovery room (P=0.749), OR=1.22, 95% CI: 0.34-4.31, while 23 patients (82%) in the control group versus 12 (66%) in the melatonin group developed delirium six hours postoperative (P=0.021), OR=1.705, 95% CI: 1.02-2.81 with higher nursing delirium screening score in the control group 2 (1, 4) versus 1 (0, 2) in the melatonin group (P=0.002), 95% CI: 1.77-2.71. CONCLUSIONS: The prophylactic administration of melatonin may decrease the incidence of postoperative delirium in elderly patients undergoing colorectal surgeries under general anesthesia.


Assuntos
Delírio , Melatonina , Complicações Pós-Operatórias , Humanos , Melatonina/uso terapêutico , Masculino , Feminino , Idoso , Complicações Pós-Operatórias/prevenção & controle , Delírio/prevenção & controle , Método Duplo-Cego , Neoplasias Colorretais/cirurgia , Idoso de 80 Anos ou mais , Delírio do Despertar/prevenção & controle
5.
Cir Cir ; 92(3): 314-323, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38862107

RESUMO

OBJECTIVE: The objective of this study was to investigate the clinical effect of overlap anastomosis and functional end-to-end anastomosis (FEEA) in laparoscopic radical resection of colorectal cancer (CRC). METHODS: The clinical data of 180 patients who underwent laparoscopic radical resection of CRC and side-to-side anastomosis were retrospectively collected; the patients were divided into the Overlap group and FEEA group, according to the anastomosis method that was used to treat them. RESULTS: The Overlap group had a shorter operation time, anastomosis time, post-operative hospital stay, post-operative feeding time, and post-operative exhaust time than the FEEA group (p < 0.05). The total incidence of post-operative complications was 14.4% (13/90) in the FEEA group and 0.7% (6/90) in the Overlap group, and there was no significant difference between the two groups (p > 0.05). CONCLUSIONS: Overlapping anastomosis can shorten the operation time and accelerate the recovery of intestinal function without increasing the incidence of post-operative complications, and it will not affect the quality of life and survival of patients in the short term after surgery.


OBJETIVO: Investigar el efecto clínico de la anastomosis superpuesta y de la anastomosis funcional de extremo a extremo (AFEE) en la resección radical laparoscópica del cáncer colorrectal (CCR). MÉTODO: Se recolectaron retrospectivamente los datos clínicos de 180 pacientes sometidos a resección radical laparoscópica de CCR y anastomosis de lado a lado. Los pacientes se dividieron en grupo de anastomosis superpuesta y grupo AFEE, según el método de anastomosis que se utilizó para tratarlos. RESULTADOS: El grupo de anastomosis superpuesta tuvo un tiempo de operación, un tiempo de anastomosis, una estancia hospitalaria posoperatoria, un tiempo de alimentación posoperatorio y un tiempo de escape posoperatorio más cortos que el grupo AFEE (p < 0.05). La incidencia total de complicaciones posoperatorias fue del 14.4% (13/90) en el grupo AFEE y del 0.7% (6/90) en el grupo de anastomosis superpuesta, y no hubo diferencias significativas entre los dos grupos (p > 0.05). CONCLUSIONES: La anastomosis superpuesta puede acortar el tiempo operatorio y acelerar la recuperación de la función intestinal sin aumentar la incidencia de complicaciones posoperatorias, y sin afectar la calidad de vida y la supervivencia de los pacientes a corto plazo después de la cirugía.


Assuntos
Anastomose Cirúrgica , Colo , Neoplasias Colorretais , Laparoscopia , Duração da Cirurgia , Complicações Pós-Operatórias , Humanos , Anastomose Cirúrgica/métodos , Laparoscopia/métodos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Neoplasias Colorretais/cirurgia , Colo/cirurgia , Idoso , Resultado do Tratamento , Tempo de Internação/estatística & dados numéricos , Colectomia/métodos , Adulto
6.
BMC Geriatr ; 24(1): 509, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38862916

RESUMO

BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) is a common and serious complication in older patients. This study investigates the impact of neuromuscular block on the MINS incidence and other cardiovascular complications in the early postoperative stage of older patients undergoing laparoscopic colorectal cancer resection. METHODS: 70 older patients who underwent laparoscopic colorectal cancer resection were separated into the deep neuromuscular block group and moderate neuromuscular block group for 35 cases in each group (n = 1:1). The deep neuromuscular block group maintained train of four (TOF) = 0, post-tetanic count (PTC) 1-2, and the moderate neuromuscular block group maintained TOF = 1-2 during the operation. Sugammadex sodium was used at 2 mg/kg or 4 mg/kg for muscle relaxation antagonism at the end of surgery. The MINS incidence was the primary outcome and compared with Fisher's exact test. About the secondary outcomes, the postoperative pain was analyzed with Man-Whitney U test, the postoperative nausea and vomiting (PONV) and the incidence of cardiovascular complications were analyzed with Chi-square test, intraoperative mean artery pressure (MAP) and cardiac output (CO) ratio to baseline, length of stay and dosage of anesthetics were compared by two independent samples t-test. RESULTS: MINS was not observed in both groups. The highest incidence of postoperative cardiovascular complications was lower limbs deep vein thrombosis (14.3% in deep neuromuscular block group and 8.6% in moderate neuromuscular group). The numeric rating scale (NRS) score in the deep neuromuscular block group was lower than the moderate neuromuscular block group 72 h after surgery (0(1,2) vs 0(1,2), P = 0.018). The operation time in the deep neuromuscular block group was longer (356.7(107.6) vs 294.8 (80.0), min, P = 0.008), the dosage of propofol and remifentanil was less (3.4 (0.7) vs 3.8 (1.0), mg·kg-1·h-1, P = 0.043; 0.2 (0.06) vs 0.3 (0.07), µg·kg-1·min-1, P < 0.001), and the length of hospital stay was shorter than the moderate neuromuscular block group (18.4 (4.9) vs 22.0 (8.3), day, P = 0.028). The differences of other outcomes were not statistically significant. CONCLUSIONS: Maintaining different degrees of the neuromuscular block under TOF guidance did not change the MINS incidence within 7 days after surgery in older patients who underwent laparoscopic colorectal cancer resection. TRIAL REGISTRATION: The present study was registered in the Chinese Clinical Trial Registry (10/02/2021, ChiCTR2100043323).


Assuntos
Neoplasias Colorretais , Laparoscopia , Bloqueio Neuromuscular , Complicações Pós-Operatórias , Humanos , Masculino , Feminino , Idoso , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Neoplasias Colorretais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Bloqueio Neuromuscular/métodos , Bloqueio Neuromuscular/efeitos adversos , Incidência , Idoso de 80 Anos ou mais , Traumatismos Cardíacos/epidemiologia , Traumatismos Cardíacos/etiologia
7.
World J Surg Oncol ; 22(1): 154, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38862958

RESUMO

BACKGROUND: Few studies have explored the impact of preoperative frailty on infectious complications in patients with a diagnosis of colorectal cancer (CRC). Therefore, this study aimed to investigate the effect of preoperative frailty on postoperative infectious complications and prognosis in patients with CRC using propensity score matching (PSM). METHODS: This prospective single-centre observational cohort study included 245 patients who underwent CRC surgery at the Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University between August 2021 to May 2023. Patients were categorised into two groups: frail and non-frail. They were matched for confounders and 1:1 closest matching was performed using PSM. Rates of infectious complications, intensive care unit (ICU) admission, 30-day mortality, and 90-day mortality, as well as postoperative length of hospital stay, total length of hospital stay, and hospital costs, were compared between the two groups. Binary logistic regression using data following PSM to explore independent factors for relevant outcome measures. RESULTS: After PSM, each confounding factor was evenly distributed between groups, and 75 pairs of patients were successfully matched. The incidence of intra-abdominal infectious complications was significantly higher in the frail group than in the non-frail group (10.7% vs. 1.3%, P < 0.05). There were no significant differences in ICU admission rate, postoperative length of hospital stay, total length of hospital stay, hospital costs, 30-day mortality rate, or 90-day mortality rate between the two groups (P > 0.05). Our logistic regression analysis result showed that preoperative frailty (OR = 12.014; 95% CI: 1.334-108.197; P = 0.027) was an independent factor for intra-abdominal infection. CONCLUSIONS: The presence of preoperative frailty elevated the risk of postoperative intra-abdominal infectious complications in patients undergoing CRC surgery. Therefore, medical staff should assess preoperative frailty in patients with CRC early and provide targeted prehabilitation interventions.


Assuntos
Neoplasias Colorretais , Fragilidade , Complicações Pós-Operatórias , Pontuação de Propensão , Humanos , Masculino , Feminino , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Neoplasias Colorretais/mortalidade , Estudos Prospectivos , Prognóstico , Idoso , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pessoa de Meia-Idade , Fragilidade/complicações , Fragilidade/epidemiologia , Seguimentos , Tempo de Internação/estatística & dados numéricos , Fatores de Risco , Taxa de Sobrevida , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Incidência
9.
Elife ; 122024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38829205

RESUMO

Background: Comorbidity with type 2 diabetes (T2D) results in worsening of cancer-specific and overall prognosis in colorectal cancer (CRC) patients. The treatment of CRC per se may be diabetogenic. We assessed the impact of different types of surgical cancer resections and oncological treatment on risk of T2D development in CRC patients. Methods: We developed a population-based cohort study including all Danish CRC patients, who had undergone CRC surgery between 2001 and 2018. Using nationwide register data, we identified and followed patients from date of surgery and until new onset of T2D, death, or end of follow-up. Results: In total, 46,373 CRC patients were included and divided into six groups according to type of surgical resection: 10,566 Right-No-Chemo (23%), 4645 Right-Chemo (10%), 10,151 Left-No-Chemo (22%), 5257 Left-Chemo (11%), 9618 Rectal-No-Chemo (21%), and 6136 Rectal-Chemo (13%). During 245,466 person-years of follow-up, 2556 patients developed T2D. The incidence rate (IR) of T2D was highest in the Left-Chemo group 11.3 (95% CI: 10.4-12.2) per 1000 person-years and lowest in the Rectal-No-Chemo group 9.6 (95% CI: 8.8-10.4). Between-group unadjusted hazard ratio (HR) of developing T2D was similar and non-significant. In the adjusted analysis, Rectal-No-Chemo was associated with lower T2D risk (HR 0.86 [95% CI 0.75-0.98]) compared to Right-No-Chemo.For all six groups, an increased level of body mass index (BMI) resulted in a nearly twofold increased risk of developing T2D. Conclusions: This study suggests that postoperative T2D screening should be prioritised in CRC survivors with overweight/obesity regardless of type of CRC treatment applied. Funding: The Novo Nordisk Foundation (NNF17SA0031406); TrygFonden (101390; 20045; 125132).


Assuntos
Neoplasias Colorretais , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Dinamarca/epidemiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/cirurgia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Estudos de Coortes , Fatores de Risco , Incidência , Idoso de 80 Anos ou mais , Adulto , Sistema de Registros
10.
Langenbecks Arch Surg ; 409(1): 189, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38896303

RESUMO

PURPOSE: Although there have been many reports on learning curves for robotic surgery, it is unclear how surgeons' conventional laparoscopic surgical skills influence their ability in performing robotic surgery for colorectal cancer (CRC). The aim of this study was to determine the surgical outcomes of robotic surgery for CRC during the induction phase by skilled laparoscopic surgeons. METHODS: Surgical outcomes of consecutive CRC cases between January 2021 and March 2023 following the skilled phase of laparoscopic surgery and introductory phase of robotic surgery performed by three skilled laparoscopic surgeons were compared. RESULTS: Overall, 77 consecutive patients diagnosed with sigmoid colon or rectosigmoid cancer were analysed, including 50 in the laparoscopy group (LAP) and 27 in the robotic group (Ro). Patient characteristics, including age, sex, body mass index, and tumour progression, did not differ between the groups. The median operation time was 204 min in the robotic group and 170 min in the laparoscopic group (p < 0.001). Blood loss was significantly lower in the robotic group (p = 0.0059). The incidence of grade 2 or higher complications did not differ between the two groups (LAP, 10.0% vs. Ro, 7.4%, p = 1). In the robotic group, the time required for lymph node dissection had a greater impact on operative duration. CONCLUSION: Skills acquired from performing conventional laparoscopic surgery may contribute to the safe and reliable performance of robotic surgery for CRC. TRIAL REGISTRATION: UMIN000050923.


Assuntos
Competência Clínica , Neoplasias Colorretais , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Humanos , Masculino , Feminino , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/patologia , Idoso , Pessoa de Meia-Idade , Duração da Cirurgia , Curva de Aprendizado , Estudos Retrospectivos , Resultado do Tratamento , Idoso de 80 Anos ou mais
11.
Langenbecks Arch Surg ; 409(1): 182, 2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38860986

RESUMO

PURPOSE: The aim of this study was to report the outcomes of conversion surgery for initially unresectable advanced colorectal cancer and to identify factors that enable successful conversion surgery. METHODS: We compared the outcomes of patients with colorectal cancer with distant metastases, including extrahepatic metastases, who underwent upfront surgery, neoadjuvant chemotherapy, conversion surgery, and chemotherapy only at our department from 2007 to 2020. In addition, factors influencing the achievement of conversion surgery in patients who were initially unresectable were examined in univariate and multivariate analyses. RESULTS: Of 342 colorectal cancer patients with distant metastases treated during the study period, 239 were judged to be initially unresectable, and 17 (conversion rate: 7.1%) underwent conversion surgery. The prognosis for the conversion surgery group was better than that of the chemotherapy only group but worse than that of the upfront surgery group. In the conversion surgery group, the recurrence-free survival after resection was significantly shorter than that upfront surgery group and neoadjuvant chemotherapy group, and no patients have been cured. Among patients who were initially unresectable, left-sided primary cancer and normal CA19-9 level were identified as independent factors contributing to the achievement of conversion surgery in a multivariate analysis. CONCLUSIONS: Although relapse after conversion surgery is common, and no patients have been cured thus far, overall survival was better in comparison to patients who received chemotherapy only. Among unresectable cases, patients with left-sided primary cancer and normal CA19-9 levels are likely to be candidates for conversion surgery.


Assuntos
Neoplasias Colorretais , Humanos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Prognóstico , Terapia Neoadjuvante , Estudos Retrospectivos , Adulto , Idoso de 80 Anos ou mais , Estadiamento de Neoplasias , Colectomia/métodos
13.
World J Surg Oncol ; 22(1): 155, 2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38872183

RESUMO

BACKGROUND: The role of tumor-draining lymph nodes in the progression of malignant tumors, including stage III colorectal cancer (CRC), is critical. However, the prognostic and predictive value of the number of examined lymph nodes (ELNs) are not fully understood. METHODS: This population-based study retrospectively analyzed data from 106,843 patients with stage III CRC who underwent surgical treatment and registered in three databases from 2004 to 2021. The Surveillance, Epidemiology, and End Results (SEER) cohort was divided using into training and test cohorts at a ratio of 3:2. We employed restricted cubic spline (RCS) curves to explore nonlinear relationships between overall survival (OS) and ELNs counts and performed Cox regression to evaluate hazard ratios across different ELNs count subtypes. Additional validation cohorts were utilized from the First Affiliated Hospital, Sun Yat-sen University and The Cancer Genome Atlas (TCGA) under the same criteria. Outcomes measured included OS, cancer-specific survival (CSS), and progression-free survival (PFS). Molecular analyses involved differential gene expression using the "limma" package and immune profiling through CIBERSORT. Tissue microarray slides and multiplex immunofluorescence (MIF) were used to assess protein expression and immune cell infiltration. RESULTS: Patients with higher ELNs counts (≥ 17) demonstrated significantly better long-term survival outcomes across all cohorts. Enhanced OS, CSS, and PFS were notably evident in the LN-ELN group compared to those with fewer ELNs. Cox regression models underscored the prognostic value of higher ELNs counts across different patient subgroups by age, sex, tumor differentiation, and TNM stages. Subtype analysis based on ELNs count revealed a marked survival benefit in patients treated with adjuvant chemotherapy in the medium and large ELNs counts (≥ 12), whereas those with fewer ELNs showed negligible benefits. RNA sequencing and MIF indicated elevated immune activation in the LN-ELN group, characterized by increased CD3+, CD4+, and CD8 + T cells within the tumor microenvironment. CONCLUSIONS: The number of ELNs independently predicts survival and the immunological landscape at the tumor site in stage III CRC, underscoring its dual prognostic and predictive value.


Assuntos
Neoplasias Colorretais , Linfonodos , Estadiamento de Neoplasias , Humanos , Masculino , Feminino , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/imunologia , Estudos Retrospectivos , Linfonodos/patologia , Linfonodos/cirurgia , Pessoa de Meia-Idade , Taxa de Sobrevida , Prognóstico , Idoso , Seguimentos , Programa de SEER , Metástase Linfática , Valor Preditivo dos Testes
14.
Medicine (Baltimore) ; 103(24): e38584, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38875378

RESUMO

The investigation into individual survival rates within the patient population was typically conducted using the Cox proportional hazards model. This study was aimed to evaluate the performance of machine learning algorithm in predicting survival rates more than 5 years for individual patients with colorectal cancer. A total of 475 patients with colorectal cancer (CRC) and complete data who had underwent surgery for CRC were analyze to measure individual's survival rate more than 5 years using a machine learning based on penalized Cox regression. We conducted thorough calculations to measure the individual's survival rate more than 5 years for performance evaluation. The receiver operating characteristic curves for the LASSO penalized model, the SCAD penalized model, the unpenalized model, and the RSF model were analyzed. The least absolute shrinkage and selection operator penalized model displayed a mean AUC of 0.67 ±â€…0.06, the smoothly clipped absolute deviation penalized model exhibited a mean AUC of 0.65 ±â€…0.07, the unpenalized model showed a mean AUC of 0.64 ±â€…0.09. Notably, the random survival forests model outperformed the others, demonstrating the most favorable performance evaluation with a mean AUC of 0.71 ±â€…0.05. Compared to the conventional unpenalized Cox model, recent machine learning techniques (LASSO, SCAD, RSF) showed advantages for data interpretation.


Assuntos
Neoplasias Colorretais , Aprendizado de Máquina , Modelos de Riscos Proporcionais , Humanos , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Taxa de Sobrevida , Curva ROC , Medicina de Precisão/métodos , Algoritmos
15.
BMC Surg ; 24(1): 184, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38877479

RESUMO

BACKGROUND: Colorectal cancer has created a significant burden worldwide, including in Iran. Open and laparoscopic surgery are important treatment methods for this disease. The aim of this study is to compare postoperative outcomes of laparoscopic versus open surgery in Iran, with a particular emphasis on controlling confounding factors. METHODS: To control confounding factors in between-group comparisons of observational studies, a method based on propensity scores was used. The current study was conducted on 916 patients with colorectal cancer in the city of Shiraz between the years 2011 to 2022. The required data regarding treatment outcomes, type of surgery, demographic characteristics, and clinical factors related to cancer was extracted from the Colorectal Cancer Research Center of Shiraz University of Medical Sciences. To control confounding factors, we used the Inverse Probability of Treatment Weighting (IPTW) as one of the analytical approaches based on Propensity Score analysis. After IPTW analysis, univariate logistic regression was used for treatment effect estimation. Stata 17 was used for statistical analysis. RESULTS: After controlling for 24 clinical and demographic covariates, negative post-operative outcomes were significantly lower in laparoscopic than open surgery. There were significant differences between the two groups of surgery in the percentages of death due to cancer (P < 0.01), recurrence (P < 0.01), and metastasis (P < 0.05). The treatment effect univariate logistic regression analysis indicated that laparoscopic surgery reduced the risk of negative postoperative outcomes including death due to cancer (OR = 0.411, P < 0.01), recurrence (OR = 0.343, P < 0.01) and metastasis (OR = 0.611, P < 0.05) compared to open surgery. CONCLUSIONS: In terms of postoperative outcomes including cancer-related mortality, recurrence, and metastasis, the laparoscopic surgery outperformed open surgery. Therefore, further development of laparoscopic surgery can lead to better health outcomes for the population and optimize the utilization of healthcare resources.


Assuntos
Neoplasias Colorretais , Laparoscopia , Pontuação de Propensão , Humanos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Irã (Geográfico)/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/mortalidade , Idoso , Complicações Pós-Operatórias/epidemiologia , Adulto
16.
Radiol Oncol ; 58(2): 153-169, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38860690

RESUMO

BACKGROUND: Patients with familial adenomatous polyposis (FAP) develop early colorectal adenomas and if left untreated, progression to cancer is an inevitable event. Prophylactic surgery does not prevent further development of cancer in the rectal remnant, rectal cuff in patients with ileal pouch anal anastomosis (IPAA) and even on the ileal mucosa of the pouch body. The aim of this review is to assess long-term rates of cancer and adenoma development in patients with FAP after prophylactic surgery and to summarise current recommendations for endoscopic management and surveillance of these patients. MATERIALS AND METHODS: A systematic literature search of studies from January 1946 through to June 2023 was conducted using the PRISMA checklist. The electronic database PubMed was searched. RESULTS: Fifty-four papers involving 5010 patients were reviewed. Cancer rate in the rectal remnant was 8.8-16.7% in the western population and 37% in the eastern population. The cumulative risk of cancer 30 years after surgery was 24%. Mortality due to cancer in the rectal remnant is 1.1-11.1% with a 5-year survival rate of 55%. The adenoma rate after primary IPAA was 9.4-85% with a cumulative risk of 85% 20 years after surgery and a cumulative risk of 12% for advanced adenomas 10 years after surgery. Cumulative risk for adenomas after ileorectal anastomosis (IRA) was 85% after 5 and 100% after 10 years. Adenomas developed more frequently after stapled (33.9-57%) compared to hand-sewn (0-33%) anastomosis. We identified reports of 45 cancers in patients after IPAA of which 30 were in the pouch body and 15 in the rectal cuff or at the anastomosis. CONCLUSIONS: There was a significant incidence of cancer and adenomas in the rectal remnant and ileal pouch of FAP patients during the long-term follow-up. Regular endoscopic surveillance is recommended, not only in IRA patients, but also in pouch patients after proctocolectomy.


Assuntos
Polipose Adenomatosa do Colo , Colectomia , Proctocolectomia Restauradora , Humanos , Polipose Adenomatosa do Colo/cirurgia , Proctocolectomia Restauradora/métodos , Proctocolectomia Restauradora/efeitos adversos , Colectomia/métodos , Colectomia/efeitos adversos , Adenoma/cirurgia , Procedimentos Cirúrgicos Profiláticos/métodos , Neoplasias Colorretais/cirurgia
17.
J Nurs Res ; 32(3): e327, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38814994

RESUMO

BACKGROUND: Sarcopenia, prevalent in patients with cancer, negatively affects quality of life. However, generic tools are unable to capture the minor effects of sarcopenia on quality of life. The short-form version of the Sarcopenia Quality of Life (SF-SarQoL) questionnaire was developed as an efficient tool to assess the impact of sarcopenia on quality of life in older adults. However, its clinimetric properties in patients with cancer remain unknown. PURPOSE: This study was designed to examine the clinimetric properties of the Chinese SF-SarQoL in patients with colorectal cancer, particularly with regard to its ability to detect changes in quality of life. METHODS: A longitudinal survey was conducted using the SF-SarQoL and other questionnaires on 408 patients with colorectal cancer planning to undergo surgery. Follow-up was subsequently conducted on 341 of these patients 1 month after surgery. The clinimetric properties of the SF-SarQoL were examined, including reliability (internal consistency), validity (construct validity, concurrent validity), sensitivity (ability to detect changes, discriminative ability), and floor and ceiling effects. RESULTS: The internal consistency of the SF-SarQoL was found to be acceptable (Cronbach's alpha = .94 and McDonald's omega = .94). Strong scalability of the total score and each item was confirmed using Mokken analysis. Concurrent validity analyses indicate the SF-SarQoL is significantly correlated with muscle-related and health-related questionnaire scores. The SF-SarQoL showed adequate sensitivity due to its good ability to detect changes in quality of life with a moderate effect size (Cohen's d = 0.56) and discriminate between sarcopenic and nonsarcopenic patients (area under the curve = 0.73, 95% CI [0.66, 0.79]) using receiver operating characteristic curve analyses. No floor or ceiling effects were observed. CONCLUSIONS: The Chinese SF-SarQoL exhibits good clinimetric properties in preoperative patients with colorectal cancer and is sufficiently sensitive to capture changes in quality of life after surgery.


Assuntos
Qualidade de Vida , Sarcopenia , Humanos , Qualidade de Vida/psicologia , Inquéritos e Questionários/normas , Sarcopenia/psicologia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Estudos Longitudinais , Reprodutibilidade dos Testes , China , Psicometria/instrumentação , Psicometria/métodos , Psicometria/normas , Neoplasias Colorretais/psicologia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/cirurgia , Idoso de 80 Anos ou mais , População do Leste Asiático
18.
Sci Rep ; 14(1): 12353, 2024 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-38811758

RESUMO

A positive resection margin after colorectal endoscopic submucosal dissection (ESD) is associated with an increased risk of recurrence. We aimed to identify the clinical significance of positive resection margins in colorectal neoplasms after ESD. We reviewed 632 patients who had en bloc colorectal ESD at two hospitals between 2015 and 2020. The recurrence rates and presence of residual tumor after surgery were evaluated. The rate of additional surgery after ESD and recurrence rate were significantly higher in patients with incomplete resection (n = 75) compared to patients with complete resection (n = 557). When focusing solely on non-invasive lesions, no significant differences in recurrence rates were observed between the groups with complete and incomplete resection (0.2% vs. 1.9%, p = 0.057). Among 84 patients with submucosal invasive carcinoma, 39 patients underwent additional surgery due to non-curative resection. Positive vertical margin and lymphovascular invasion were associated with residual tumor. Lymphovascular invasion was associated with lymph node metastasis. However, no residual tumor nor lymph node metastases were found in patients with only one unfavorable histological factor. In conclusion, a positive resection margin in non-invasive colorectal lesions, did not significantly impact the recurrence rate. Also, in T1 colorectal cancer with a positive vertical resection margin, salvage surgery can be considered in selected patients with additional risk factors.


Assuntos
Neoplasias Colorretais , Ressecção Endoscópica de Mucosa , Margens de Excisão , Recidiva Local de Neoplasia , Humanos , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/patologia , Masculino , Feminino , Ressecção Endoscópica de Mucosa/métodos , Idoso , Recidiva Local de Neoplasia/patologia , Pessoa de Meia-Idade , Neoplasia Residual/patologia , Resultado do Tratamento , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Metástase Linfática
19.
Eur J Oncol Nurs ; 70: 102549, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38692158

RESUMO

OBJECTIVE: To evaluate the effectiveness of Orem's self-care model in preparing hospitals for the discharge of patients with colorectal cancer who undergo enterostomy. METHODS: 92 patients with enterostomy were recruited between February 2022 and February 2023 from a general tertiary hospital. The participants were assigned to either the intervention group or the control group randomly. The intervention group received Orem's self-care program and a three-month follow-up, whereas the control group received only routine care and a three-month follow-up. Discharge readiness, self-care ability, and stoma-quality-of-life data were collected at hospital discharge (T1), 30 days (T2), and 90 days (T3) after discharge. RESULTS: The intervention group had substantially higher discharge readiness (knowledge, p < 0.001; coping ability, p = 0.006; personal status, p = 0.001; expected support, p = 0.021; total score, p < 0.001), better self-care ability at T1 (self-care knowledge, p < 0.001; self-care skills, p = 0.010), better total quality of life (QoL) at T1, T2, and T3 (p < 0.001; p = 0.006; p = 0.014); better stoma management and daily routine at T1 (p = 0.004; p < 0.001); and better daily routine at T2 (p = 0.009) than the control group. CONCLUSIONS: The designed discharge readiness program based on Orem's self-care could promote effective patient discharge readiness, self-care knowledge, self-care skills, and QoL. TRIAL REGISTRATION: The trial number ChiCTR2200056302 registered on ClinicalTrials.gov.


Assuntos
Neoplasias Colorretais , Enterostomia , Alta do Paciente , Qualidade de Vida , Autocuidado , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Neoplasias Colorretais/cirurgia , Adulto , Adaptação Psicológica
20.
J Robot Surg ; 18(1): 202, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38713324

RESUMO

Colorectal surgery has progressed greatly via minimally invasive techniques, laparoscopic and robotic. With the advent of ERAS protocols, patient recovery times have greatly shortened, allowing for same day discharges (SDD). Although SDD have been explored through laparoscopic colectomy reviews, no reviews surrounding robotic ambulatory colorectal resections (RACrR) exist to date. A systematic search was carried out across three databases and internet searches. Data were selected and extracted by two independent reviewers. Inclusion criteria included robotic colorectal resections with a length of hospital stay of less than one day or 24 h. 4 studies comprising 136 patients were retrieved. 56% of patients were female and were aged between 21 and 89 years. Main surgery indications were colorectal cancer and recurrent sigmoid diverticulitis (43% each). Most patients had low anterior resections (48%). Overall, there was a 4% complication rate postoperatively, with only 1 patient requiring readmission due to postoperative urinary retention (< 1%). Patient selection criteria involved ASA score cut-offs, nutritional status, and specific health conditions. Protocols employed shared similarities including ERAS education, transabdominal plane blocks, early removal of urinary catheters, an opioid-sparing regime, and encouraged early oral intake and ambulation prior to discharge. All 4 studies had various follow-up methods involving telemedicine, face-to-face consultations, and virtual ward teams. RACrRs is safe and feasible in a highly specific patient population; however, further high-quality studies with larger sample sizes are needed to draw more significant conclusions. Several limitations included small sample size and the potential of recall bias due to retrospective nature of 2 studies.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Tempo de Internação , Procedimentos Cirúrgicos Robóticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Procedimentos Cirúrgicos Ambulatórios/métodos , Colectomia/métodos , Neoplasias Colorretais/cirurgia , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
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