Gender and plasma iron biomarkers, but not HFE gene mutations, increase the risk of colorectal cancer and polyps.

A cohort study of patients included in the Basque Country colorectal cancer (CRC) screening programme was carried out to assess the risk of adenomatous polyps and CRC (P-CRC) associated with HFE gene mutations, with gender and with iron biomarkers (serum ferritin (SF), iron (Fe) and transferrin saturation index (TSI)). Among 432 included patients (mean age 59.8 years), 263 were men (60.9 %) and 169 women (39.1 %). P-CRC were identified in 221 patients (51.2 %) and no polyps (NP) in 211 patients (48.8 %). HFE mutations were identified in 43.8 % of the patients. C282Y/wt genotypic frequency was 6.8 % in the P-CRC group and 1.4 % in the NP group (p < 0.05). The allelic frequency was 3.8 versus 1.2 % (p < 0.05). For laboratory, all three iron biomarkers showed a statistically significant difference: mean Fe, 91.29 ± 34 for P-CRC and 80.81 ± 30.59 for NP group. Mean TSI for P-CRC was 24.95 ± 8.90 and 22.74 ± 8.79 for NP group. Mean SF 308.09 ± 536.32 for P-CRC and 177.55 ± 159.95 for NP group. In a multivariate logistic regression analysis, only male gender (odds ratio (OR) = 2.04, 1.29-3.22), SF (OR = 1.001, 1.0004-1.003) and Fe (OR = 1.01, 1.004-1.02) were related with the presence of CRC and adenoma. Men gender and raised serum iron biomarkers increase the risk of P-CRC.

[Benign anastomotic strictures after oncologic rectal cancer surgery. Results of treatment with hydrostatic dilation]. / Estenosis anastomóticas benignas en la cirugía radical del cáncer de recto. Resultados del tratamiento con dilatación hidrostática.

INTRODUCTION: Benign anastomotic strictures after rectal cancer surgery are common and their treatment can vary from conservative measures to surgical resection. PATIENTS AND METHODS: Between March 2001 and August 2008, 422 patients with rectal cancer underwent anterior resection and 83.8% were treated with primary anastomosis. Anastomotic stricture has been defined as the inability to pass a colonoscope. Hydrostatic balloon dilation was performed. Results of success and failure dilation were assessed. RESULTS: Twenty-six patients (7.34%) with anastomotic stricture were treated; 16 men and 10 women, with a median age of 66 years (57-74). A total of 26 anterior resections were performed, as well as 10 end-to-end anastomosis, 10 side-to-end, 4 j-pouch and 2 pouch coloplasties. The median stricture height was 10cms (4-12). Thirteen patients had preoperative radiotherapy (50%), and 9 patients had an ileostomy (34.7%). The median time of diagnosis was 6 months (3-10). The diagnosis was made by: rectal digital examination in 19.2%, colonoscopy 23.1% and clinical symptoms in 57.7%. The median number of dilation sessions required was 2 (1-4). The median of follow-up was 39 months (23 to 49). Results were successful 88.5,% and unsuccessful in 11.5%. Morbidity was 3.8% (one perforation after dilation). There was no mortality. CONCLUSIONS: Benign anastomotic strictures after rectal cancer surgery are frequent (7.05%), develop symptoms (52.9%) and can be successfully treated by hydrostatic dilation in more than 88% patients.

Estenosis anastomóticas benignas en la cirugía radical del cáncer de recto. Resultados del tratamiento con dilatación hidrostática / Benign anastomotic strictures after oncologic rectal cancer surgery. Results of treatment with hydrostatic dilation

Introducción Las estenosis anastomóticas tras cirugía de cáncer de recto son frecuentes y precisan tratamientos desde medidas conservadoras hasta cirugía de resección Pacientes y método De marzo de 2001 a agosto de 2008 se intervinieron 422 carcinomas de recto, en el 83,8% se realizó anastomosis. Se definió la estenosis como la incapacidad de pasar el colonoscopio. Se realizó tratamiento mediante dilatación hidrostática. Se analizaron las diferencias entre los tratamientos con y sin éxito. Resultados Serie de 26 pacientes con estenosis de anastomosis (7,34%). Dieciséis varones y 10 mujeres, con una mediana de 66 años (57–74). Las intervenciones fueron 26 resecciones anteriores: 10 anastomosis término-terminales, 10 lateroterminales, 4 reservorios en J y 2 coloplastias . La mediana de altura de la estenosis fue de 10 cm (4–12). Trece pacientes recibieron radioterapia (RT) preoperatoria (50%). Nueve pacientes portaban ileostomía (34,7%). La mediana de diagnóstico fue 6 meses (3–10). El diagnóstico se realizó: por tacto rectal en 19,2%, por colonoscopia 23,1% y por clínica en 57,7%. Se realizaron una mediana de 2 (1–4) sesiones de dilatación. La mediana de seguimiento fue de 39 meses (23 a 49). El resultado fue bueno en el 88,5% y fracasó en 11,5%. La morbilidad fue del 3,8% (una perforación tras la dilatación). No existió mortalidad. ConclusionesLas estenosis anastomóticas tras cirugía de cáncer de recto son frecuentes (7,05%), suelen originar clínica (52,9%) y pueden tratarse con éxito mediante dilatación en más del 88% de los pacientes (AU)

Introduction Benign anastomotic strictures after rectal cancer surgery are common and their treatment can vary from conservative measures to surgical resection. Patients and methods Between March 2001 and August 2008, 422 patients with rectal cancer underwent anterior resection and 83.8% were treated with primary anastomosis. Anastomotic stricture has been defined as the inability to pass a colonoscope. Hydrostatic balloon dilation was performed. Results of success and failure dilation were assessed. Results Twenty-six patients (7.34%) with anastomotic stricture were treated; 16 men and 10 women, with a median age of 66 years (57–74). A total of 26 anterior resections were performed, as well as 10 end-to-end anastomosis, 10 side-to-end, 4 j-pouch and 2 pouch coloplasties. The median stricture height was 10cms (4–12). Thirteen patients had preoperative radiotherapy (50%), and 9 patients had an ileostomy (34.7%). The median time of diagnosis was 6 months (3–10). The diagnosis was made by: rectal digital examination in 19.2%, colonoscopy 23.1% and clinical symptoms in 57.7%. The median number of dilation sessions required was 2 (1–4). The median of follow-up was 39 months (23 to 49). Results were successful 88.5,% and unsuccessful in 11.5%. Morbidity was 3.8% (one perforation after dilation). There was no mortality. Conclusions Benign anastomotic strictures after rectal cancer surgery are frequent (7.05%), develop symptoms (52.9%) and can be successfully treated by hydrostatic dilation in more than 88% patients (AU)