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Bin Traiki TA, AlShammari SA, AlRabah RN, AlZahrani AM, Alshenaifi ST, Alhassan NS, Abdulla MH, Zubaidi AM, Al-Obeed OA, Alkhayal KA. Oncological outcomes of elective versus emergency surgery for colon cancer: A tertiary academic center experience. Saudi J Gastroenterol 2023; 29:316-322. [PMID: 37006086 PMCID: PMC10644994 DOI: 10.4103/sjg.sjg_31_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 04/04/2023] Open
Abstract
Background In this study, we aimed to identify the oncological outcomes in colon cancer patients who underwent elective versus emergency curative resection. Methods All patients who underwent curative resection for colon cancer between July 2015 and December 2019 were retrospectively reviewed and analyzed. Patients were divided into two groups based on the presentation into elective and emergency groups. Results A total of 215 patients with colon cancer were admitted and underwent curative surgical resection. Of those, 145 patients (67.4%) were elective cases, and 70 (32.5%) were emergency cases. Family history of malignancy was positive in 44 patients (20.5%) and significantly more common in the emergency group (P = 0.016). The emergency group had higher T and TNM stages (P = 0.001). The 3-year survival rate was 60.9% and significantly less in the emergency group (P = 0.026). The mean duration from surgery to recurrence, 3-year disease-free survival, and overall survival were 1.19, 2.81, and 3.11, respectively. Conclusion Elective group was associated with better 3-year survival, longer overall, and 3-year disease-free survival compared to the emergency group. The disease recurrence rate was comparable in both groups, mainly in the first two years after curative resection.
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Affiliation(s)
- Thamer A. Bin Traiki
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman A. AlShammari
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Saud T. Alshenaifi
- Department of Anesthesia, National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Noura S. Alhassan
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Maha-Hamadien Abdulla
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad M. Zubaidi
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Omar A. Al-Obeed
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khayal A. Alkhayal
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Zhou H, Jin Y, Wang J, Chen G, Chen J, Yu S. Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:41. [PMID: 36790519 DOI: 10.1007/s00384-023-04334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The objective of this study was to summarize relevant data from previous reports and perform a meta-analysis to compare short-term surgical outcomes and long-term oncological outcomes between emergency and elective surgery for colorectal cancer (CRC). METHODS A systematic literature search was performed using PubMed and Embase databases, and relevant data were extracted. Postoperative morbidity, hospital mortality within 30 days, postoperative recovery, overall survival (OS), and relapse-free survival (RFS) were compared using a fixed or random-effect model. RESULTS A total of 28 studies involving 353,686 participants were enrolled for this systematic review and meta-analysis, and 23.5% (83,054/353,686) of CRC patients underwent emergency surgery. The incidence of emergency presentations in CRC patients ranged from 2.7 to 38.8%. The lymph node yield of emergency surgery was comparable to that of elective surgery (WMD:0.70, 95%CI: - 0.74,2.14, P = 0.340; I2 = 80.6%). Emergency surgery had a higher risk of postoperative complications (OR:1.83, 95%CI:1.62-2.07, P < 0.001; I2 = 10.6%) and hospital mortality within 30 days (OR:4.62, 95%CI:4.18-5.10, P < 0.001; I2 = 42.9%) than elective surgery for CRC. In terms of long-term oncological outcomes, emergency surgery was significantly associated with poorer RFS (HR: 1.51, 95%CI:1.24-1.83, P < 0.001; I2 = 58.9%) and OS(HR:1.60, 95%CI: 1.47-1.73, P < 0.001; I2 = 63.4%) of CRC patients. In addition, the subgroup analysis for colon cancer patients revealed a pooled HR of 1.73 for OS (95%CI:1.52-1.96, P < 0.001), without the evidence of significant heterogeneity (I2 = 21.2%). CONCLUSION Emergency surgery for CRC had an adverse impact on short-term surgical outcomes and long-term survival. A focus on early screening programs and health education was warranted to reduce emergency presentations of CRC patients.
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Affiliation(s)
- Haiyan Zhou
- Nursing Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, 310000, China
| | - Yongyan Jin
- Nursing Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, 310000, China
| | - Jun Wang
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
| | - Guofeng Chen
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
| | - Jian Chen
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
| | - Shaojun Yu
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, 310000, China.
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Alkurt EG, Kartal B, Tutan MB, Lale A, Aygen E. Prognostic value of lymphovascular and perineural invasion in colorectal cancer. J Surg Med 2023; 7:138-143. [DOI: 10.28982/josam.7561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Background/Aim: Lymphovascular and perineural invasion (LVI and PNI, respectively) are associated with poor prognosis in various cancers. We sought to identify clinical variables associated with LVI and PNI in colorectal cancer (CRC) and their effects on survival.
Methods: Our study design is consistent with a retrospective cohort study. Data from 237 patients with documented LVI or PNI who underwent surgery for colorectal cancer between 2017 and 2021 were retrospectively reviewed. Demographic characteristics, surgery and pathology reports, disease-free and overall survival (DFS and OS, respectively) of the patients were examined.
Results: When the DFS duration of the patients were evaluated, The mean DFS of the LVI-negative group was 27.4 (15.09) months, and the mean of the LVI-positive patients was 20.45 (13) months. DFS was longer in the LVI-negative group (P<0.001). DFS was 52.26 (1.89) months in PNI-negative patients and 34.29 (2.71) months in PNI-positive patients. DFS expectation of PNI-positive patients was approximately 18 months less than that of negative patients (P<0.001). When the patients were evaluated in terms of OS duration, no significant difference was observed in LVI-negative and -positive patient groups, while the estimated OS duration was 52.29 (1.84) months in PNI-negative patients, and 40.10 (2.49) months in PNI-positive patients. OS was 12 months shorter in PNI-negative patients (P<0.001).
Conclusion: The use of PNI and LVI together was found to have a significant impact on the survival rates of patients with colorectal cancer. Documenting LVI and PNI status in biopsy specimens can aid in the management, prognosis, and decision-making for treating colorectal tumors.
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Blind N, Gunnarsson U, Strigård K, Brännström F. The impact of a patient's social network on emergency surgery for colon cancer. Eur J Surg Oncol 2023; 49:440-444. [PMID: 36243648 DOI: 10.1016/j.ejso.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/21/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
AIM The aim of this study was to investigate if patients with a weak social network and colon cancer are more likely to be operated as an emergency than those with a strong social network. METHODS Data from patients living in Västerbotten County, Sweden, who underwent colon cancer surgery between 2007 and 2020 were extracted from the Swedish Colorectal Cancer Registry (SCRCR). Patients identified were matched against the Västerbotten Intervention Program (VIP) and the longitudinal study Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA). These two databases include a survey that includes questions regarding quality and size of the patient's social network. Multivariable logistic regression was used for analysis. RESULTS Six items from the questions on social network, and the composite variables availability of social integration (AVSI) and availability of attachment (AVAT) were analysed. Data from 801 patients were analysed. The odds ratio for emergency surgery was significantly higher for divorced patients (OR 2.01 (CI 1.03-3.91)) and for male gender (OR 1.51 (CI 1.02-2.24)). A higher OR was seen amongst those with no-one to share feelings with (OR 1.57 (CI 0.82-3.03)) or to comfort them (OR1.33 (CI 0.78-2.28)). Quantitative aspects of social life such as the number of people greater than 10 that feel relaxed at the patient's home, showed a lower OR (OR 0.71(CI 0.35-1.43)). CONCLUSION The impact of social network on the risk for emergency surgery for colon cancer is limited. Divorced status and male gender were associated with an increased risk for emergency surgery.
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Affiliation(s)
- Niillas Blind
- Department of Surgical and Perioperative Sciences, Umeå University, Sweden.
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå University, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Umeå University, Sweden
| | - Fredrik Brännström
- Department of Surgical and Perioperative Sciences, Umeå University, Sweden
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Di Carlo S, Cavallaro G, La Rovere F, Usai V, Siragusa L, Izzo P, Izzo L, Fassari A, Izzo S, Franceschilli M, Rossi P, Dhimolea S, Fiori E, Sibio S. Synchronous liver and peritoneal metastases from colorectal cancer: Is cytoreductive surgery and hyperthermic intraperitoneal chemotherapy combined with liver resection a feasible option? Front Surg 2022; 9:1006591. [PMID: 36589624 PMCID: PMC9797824 DOI: 10.3389/fsurg.2022.1006591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
Background Traditionally, synchronous liver resection (LR), cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy for colorectal liver and peritoneal metastases have been contraindicated. Nowadays, clinical practice has promoted this aggressive treatment in selected cases. This study aimed to review surgical and survival results of an extensive surgical approach including CRS with hyperthermic intraperitoneal chemotherapy (HIPEC) and LR. Methods PubMed, EMBASE, and Web of Science databases were matched to find the available literature on this topic. The search period was limited to 10 years (January 2010-January 2021). A threshold of case series of 10 patients or more was applied. Results In the search period, out of 114 studies found about liver and peritoneal metastases from colorectal cancer, we found 18 papers matching the inclusion criteria. Higher morbidity and mortality were reported for patients who underwent such an extensive surgical approach when compared with patients who underwent only cytoreductive surgery and HIPEC. Also, survival rates seem worse in the former than in the latter. Conclusion The role of combined surgical strategy in patients with synchronous liver and peritoneal metastases from colorectal cancer remains controversial. Survival rates and morbidity and mortality seem not in favor of this option. A more accurate selection of patients and more restrictive surgical indications could perhaps help improve results in this subgroup of patients with limited curative options.
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Affiliation(s)
- Sara Di Carlo
- Department of Surgery, Minimally Invasive Surgery Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome, Italy
| | - Francesca La Rovere
- Department of Surgery, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome, Italy
| | - Valeria Usai
- Department of Surgery, Minimally Invasive Surgery Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - Leandro Siragusa
- Department of Surgery, Minimally Invasive Surgery Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - Paolo Izzo
- Department of Surgery, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome, Italy
| | - Luciano Izzo
- Department of Surgery, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome, Italy
| | - Alessia Fassari
- Department of Surgery, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome, Italy
| | - Sara Izzo
- Department of Surgery, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome, Italy
| | - Marzia Franceschilli
- Department of Surgery, Minimally Invasive Surgery Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - Piero Rossi
- Department of Surgery, Minimally Invasive Surgery Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - Sirvjo Dhimolea
- Department of Surgery, Minimally Invasive Surgery Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - Enrico Fiori
- Department of Surgery, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome, Italy
| | - Simone Sibio
- Department of Surgery, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome, Italy,Correspondence: Simone Sibio
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Di Carlo S, Siragusa L, Fassari A, Fiori E, La Rovere F, Izzo P, Usai V, Cavallaro G, Franceschilli M, Dhimolea S, Sibio S. Laparoscopic versus Open Total Gastrectomy for Locally Advanced Gastric Cancer: Short and Long-Term Results. Curr Oncol 2022; 29:8442-8455. [PMID: 36354725 PMCID: PMC9689079 DOI: 10.3390/curroncol29110665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy for early gastric cancer is widely accepted and routinely performed. However, it is still debated whether the laparoscopic approach is a valid alternative to open gastrectomy in advanced gastric cancer (AGC). The aim of this study is to compare short-and long-term outcomes of laparoscopic (LG) and open (OG) total gastrectomy with D2 lymphadenectomy in patients with AGC. METHODS A retrospective comparative study was conducted on patients who underwent LG and OG for ACG between January 2015 and December 2021. Primary endpoints were the following: recurrence rate, 3-year disease-free survival, 3-year and 5-year overall survival. Univariate and multivariate analysis was conducted to compare variables influencing outcomes and survival. RESULTS Ninety-two patients included: fifty-three OG and thirty-nine LG. No difference in morbidity and mortality. LG was associated with lower recurrence rates (OG 22.6% versus LG 12.8%, p = 0.048). No differences in 3-year and 5-year overall survival; 3-year disease-free survival was improved in the LG group on the univariate analysis but not after the multivariate one. LG was associated with longer operative time, lower blood loss and shorter hospital stay. Lymph node yield was higher in LG. CONCLUSION LG for AGC seems to provide satisfactory clinical and oncological outcomes in medium volume centers, improved postoperative results and possibly lower recurrence rates.
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Affiliation(s)
- Sara Di Carlo
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Alessia Fassari
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Enrico Fiori
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesca La Rovere
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Paolo Izzo
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Valeria Usai
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Marzia Franceschilli
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Sirvjo Dhimolea
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Simone Sibio
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
- Correspondence:
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Guida AM, Sensi B, Formica V, D'Angelillo RM, Roselli M, Del Vecchio Blanco G, Rossi P, Capolupo GT, Caricato M, Sica GS. Total neoadjuvant therapy for the treatment of locally advanced rectal cancer: a systematic minireview. Biol Direct 2022; 17:16. [PMID: 35698084 PMCID: PMC9195214 DOI: 10.1186/s13062-022-00329-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022] Open
Abstract
Colorectal carcinoma is the second leading cause of cancer-related deaths, and indeed, rectal cancer accounting for approximately one third of newly diagnosed patients. Gold standard in the treatment of rectal cancer is a multimodality approach, aiming at a good control of the local disease. Distant recurrences are the major cause of mortality. Currently, Locally Advanced Rectal Cancer (LARC) patients undergo a combined treatment of chemotherapy and radiotherapy, followed by surgery. Eventually, more chemotherapy, namely adjuvant chemotherapy (aCT), may be necessary. Total Neoadjuvant Therapy (TNT) is an emerging approach aimed to reduce distant metastases and improve local control. Several ongoing studies are analyzing whether this new approach could improve oncological outcomes. Published results were encouraging, but the heterogeneity of protocols in use, makes the comparison and interpretation of data rather complex. One of the major concerns regarding TNT administration is related to its effect on larger and more advanced cancers that might not undergo similar down-staging as smaller, early-stage tumors. This minireview, based on a systematic literature search of randomized clinical trials and meta-analysis, summarizes current knowledge on TNT. The aim was to confirm or refute whether or not current practice of TNT is based on relevant evidence, to establish the quality of that evidence, and to address any uncertainty or variation in practice that may be occurring. A tentative grouping of general study characteristics, clinical features and treatments characteristics has been undertaken to evaluate if the reported studies are sufficiently homogeneous in terms of subjects involved, interventions, and outcomes to provide a meaningful idea of which patients are more likely to gain from this treatment.
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Affiliation(s)
- Andrea M Guida
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Bruno Sensi
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Vincenzo Formica
- Department of Systems Medicine, Medical Oncology Unit, Policlinico Tor Vergata, Rome, Italy
| | - Rolando M D'Angelillo
- Department of Biomedicine and Prevention, Radiation Oncology, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology Unit, Policlinico Tor Vergata, Rome, Italy
| | | | - Piero Rossi
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Gabriella T Capolupo
- Department of Colorectal Surgery, Colorectal Surgery Unit, Campus Bio-Medico University, 00128, Rome, Italy
| | - Marco Caricato
- Department of Colorectal Surgery, Colorectal Surgery Unit, Campus Bio-Medico University, 00128, Rome, Italy
| | - Giuseppe S Sica
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy. .,Department of Surgery, Policlinico Tor Vergata, University of Rome, Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
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Gao Q, Zhang C, Dong Z, Guo Y, Zhang L, Roy S. Effect and Prognosis Factors of Combining Laparoscopic Radical Resection of Colon Adenocarcinoma with Docetaxel Therapy in Treating Middle and Advanced Colon Adenocarcinoma. Computational Intelligence and Neuroscience 2022; 2022:1-6. [PMID: 35669650 PMCID: PMC9167002 DOI: 10.1155/2022/6122261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/24/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
Abstract
Objective. The aim of the study is to explore the clinical efficacy and prognosis factors of joint application of laparoscopic radical resection of colon adenocarcinoma (COAD) and docetaxel therapy in treating COAD of middle and advanced stages. Methods. The clinical data of 103 COAD patients of middle and advanced stages treated in our hospital from July 2016 to July 2018 were selected for the retrospective analysis, all patients received the treatment scheme of combining laparoscopic radical resection of COAD with docetaxel therapy for the observation of short-term efficacy, follow-up was conducted to record their 3-year survival, and relevant factors affecting patient prognosis were analyzed by the logistic regression model. Results. After treatment, the total remission rate of patients was 75.73% (78/103), the total incidence rate of adverse reactions was 16.50% (17/103); patients’ level values of various serum tumor markers after treatment were significantly lower than those before treatment (
); according to the univariate analysis results, for COAD patients with different tumor diameters, differentiated degrees, TNM stages, perineural invasion degrees, pathological types, and depths of invasion, their modality rates were statistically different (
); and the logistic regression analysis showed that tumor diameter ≥5 cm, poor differentiation, TNM stage IV, perineural invasion, pathologically signet-ring cell carcinoma, and T3-invasion were the independent risk factors affecting patient prognosis (
). Conclusion. Combining laparoscopic radical resection of COAD with docetaxel therapy in treating COAD of middle and advanced stages achieves affirmed short-term efficacy, which can reduce patients’ level of serum tumor markers and ensure high safety and good survival prognosis. Tumor diameter, differentiated degree, TNM stage, perineural invasion, pathological type, and T3-invasion are the relevant factors affecting the prognosis of middle and advanced COAD.
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Ganini C, Amelio I, Bertolo R, Bove P, Buonomo OC, Candi E, Cipriani C, Di Daniele N, Juhl H, Mauriello A, Marani C, Marshall J, Melino S, Marchetti P, Montanaro M, Natale ME, Novelli F, Palmieri G, Piacentini M, Rendina EA, Roselli M, Sica G, Tesauro M, Rovella V, Tisone G, Shi Y, Wang Y, Melino G. Global mapping of cancers: The Cancer Genome Atlas and beyond. Mol Oncol 2021; 15:2823-2840. [PMID: 34245122 PMCID: PMC8564642 DOI: 10.1002/1878-0261.13056] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/04/2021] [Accepted: 07/09/2021] [Indexed: 12/20/2022] Open
Abstract
Cancer genomes have been explored from the early 2000s through massive exome sequencing efforts, leading to the publication of The Cancer Genome Atlas in 2013. Sequencing techniques have been developed alongside this project and have allowed scientists to bypass the limitation of costs for whole-genome sequencing (WGS) of single specimens by developing more accurate and extensive cancer sequencing projects, such as deep sequencing of whole genomes and transcriptomic analysis. The Pan-Cancer Analysis of Whole Genomes recently published WGS data from more than 2600 human cancers together with almost 1200 related transcriptomes. The application of WGS on a large database allowed, for the first time in history, a global analysis of features such as molecular signatures, large structural variations and noncoding regions of the genome, as well as the evaluation of RNA alterations in the absence of underlying DNA mutations. The vast amount of data generated still needs to be thoroughly deciphered, and the advent of machine-learning approaches will be the next step towards the generation of personalized approaches for cancer medicine. The present manuscript wants to give a broad perspective on some of the biological evidence derived from the largest sequencing attempts on human cancers so far, discussing advantages and limitations of this approach and its power in the era of machine learning.
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Affiliation(s)
- Carlo Ganini
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
- IDI‐IRCCSRomeItaly
| | - Ivano Amelio
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Riccardo Bertolo
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
- San Carlo di Nancy HospitalRomeItaly
| | - Pierluigi Bove
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
- San Carlo di Nancy HospitalRomeItaly
| | - Oreste Claudio Buonomo
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Eleonora Candi
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
- IDI‐IRCCSRomeItaly
| | - Chiara Cipriani
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
- San Carlo di Nancy HospitalRomeItaly
| | - Nicola Di Daniele
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | | | - Alessandro Mauriello
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Carla Marani
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
- San Carlo di Nancy HospitalRomeItaly
| | - John Marshall
- Medstar Georgetown University HospitalGeorgetown UniversityWashingtonDCUSA
| | - Sonia Melino
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | | | - Manuela Montanaro
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Maria Emanuela Natale
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
- San Carlo di Nancy HospitalRomeItaly
| | - Flavia Novelli
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Giampiero Palmieri
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Mauro Piacentini
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | | | - Mario Roselli
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Giuseppe Sica
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Manfredi Tesauro
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Valentina Rovella
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Giuseppe Tisone
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
| | - Yufang Shi
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
- CAS Key Laboratory of Tissue Microenvironment and TumorShanghai Institute of Nutrition and HealthShanghai Institutes for Biological SciencesUniversity of Chinese Academy of SciencesChinese Academy of SciencesShanghaiChina
- The First Affiliated Hospital of Soochow University and State Key Laboratory of Radiation Medicine and ProtectionInstitutes for Translational MedicineSoochow UniversityChina
| | - Ying Wang
- CAS Key Laboratory of Tissue Microenvironment and TumorShanghai Institute of Nutrition and HealthShanghai Institutes for Biological SciencesUniversity of Chinese Academy of SciencesChinese Academy of SciencesShanghaiChina
| | - Gerry Melino
- Department of Experimental MedicineTorvergata Oncoscience Research Centre of Excellence, TORUniversity of Rome Tor VergataItaly
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10
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Franceschilli M, Di Carlo S, Vinci D, Sensi B, Siragusa L, Bellato V, Caronna R, Rossi P, Cavallaro G, Guida A, Sibio S. Complete mesocolic excision and central vascular ligation in colorectal cancer in the era of minimally invasive surgery. World J Clin Cases 2021; 9:7297-7305. [PMID: 34616795 PMCID: PMC8464444 DOI: 10.12998/wjcc.v9.i25.7297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/14/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Since the 19th century, appropriate lymphadenectomy has been considered a cornerstone of oncologic surgery and one of the most important prognostic factors. This approach can be applied to any surgery for gastrointestinal cancer. During surgery for colon and rectal cancer, an adequate portion of the mesentery is removed together with the segment of bowel affected by the disease. The adequate number of lymph nodes to be removed is standardized and reported by several guidelines. It is mandatory to determine the appropriate extent of lymphadenectomy and to balance its oncological benefits with the increased morbidity associated with its execution in cancer patients. Our review focuses on the concept of “complete mesenteric excision (CME) with central vascular ligation (CVL),” a radical lymphadenectomy for colorectal cancer that has gained increasing interest in recent years. The aim of this study was to evaluate the evolution of this approach over the years, its potential oncologic benefits and potential risks, and the improvements offered by laparoscopic techniques. Theoretical advantages of CME are improved local-relapse rates due to complete removal of the intact mesocolic fascia and improved distance recurrence rates due to ligation of vessels at their origin (CVL) which guarantees removal of a larger number of lymph nodes. The development and worldwide diffusion of laparoscopic techniques minimized postoperative trauma in oncologic surgery, providing the same oncologic results as open surgery. This has been widely applied to colorectal cancer surgery; however, CME entails a technical complexity that can limit its wide minimally-invasive application. This review analyzes results of these procedures in terms of oncological outcomes, technical feasibility and complexity, especially within the context of minimally invasive surgery.
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Affiliation(s)
- Marzia Franceschilli
- Department of Surgery, Minimally Invasive Unit, Tor Vergata University of Rome, Rome 00133, Italy
| | - Sara Di Carlo
- Department of Surgery, Minimally Invasive Unit, Tor Vergata University of Rome, Rome 00133, Italy
| | - Danilo Vinci
- Department of Surgery, Minimally Invasive Unit, Tor Vergata University of Rome, Rome 00133, Italy
| | - Bruno Sensi
- Department of Surgery, Minimally Invasive Unit, Tor Vergata University of Rome, Rome 00133, Italy
| | - Leandro Siragusa
- Department of Surgery, Minimally Invasive Unit, Tor Vergata University of Rome, Rome 00133, Italy
| | - Vittoria Bellato
- Department of Surgery, Minimally Invasive Unit, Tor Vergata University of Rome, Rome 00133, Italy
| | - Roberto Caronna
- Department of Surgical Sciences, Unit of Pancreatic and Biliary Surgery, Sapienza University of Rome, Rome 00161, Italy
| | - Piero Rossi
- Department of Surgery, Minimally Invasive Unit, Tor Vergata University of Rome, Rome 00133, Italy
| | - Giuseppe Cavallaro
- Department of Surgery P Valdoni, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome 00161, Italy
| | - Andrea Guida
- Department of Surgery, Minimally Invasive Unit, Tor Vergata University of Rome, Rome 00133, Italy
| | - Simone Sibio
- Department of Surgery P Valdoni, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome 00161, Italy
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11
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Franceschilli M, Vinci D, Di Carlo S, Sensi B, Siragusa L, Guida A, Rossi P, Bellato V, Caronna R, Sibio S. Central vascular ligation and mesentery based abdominal surgery. Discov Oncol 2021; 12:24. [PMID: 35201479 PMCID: PMC8777547 DOI: 10.1007/s12672-021-00419-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022] Open
Abstract
In the nineteenth century the idea of a correct surgical approach in oncologic surgery moved towards a good lymphadenectomy. In colon cancer the segment is removed with adjacent mesentery, in gastric cancer or pancreatic cancer a good oncologic resection is obtained with adequate lymphadenectomy. Many guidelines propose a minimal lymph node count that the surgeon must obtain. Therefore, it is essential to understand the adequate extent of lymphadenectomy to be performed in cancer surgery. In this review of the current literature, the focus is on "central vascular ligation", understood as radical lymphadenectomy in upper and lower gastrointestinal cancer, the evolution of this approach during the years and the improvement of laparoscopic techniques. For what concerns laparoscopic surgery, the main goal is to minimize post-operative trauma introducing the "less is more" concept whilst preserving attention for oncological outcomes. This review will demonstrate the importance of a scientifically based standardization of oncologic gastrointestinal surgery, especially in relation to the expansion of minimally invasive surgery and underlines the importance to further investigate through new randomized trials the role of extended lymphadenectomy in the new era of a multimodal approach, and most importantly, an era where minimally invasive techniques and the idea of "less is more" are becoming the standard thought for the surgical approach.
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Affiliation(s)
- M Franceschilli
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - D Vinci
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy.
| | - S Di Carlo
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - B Sensi
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - L Siragusa
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - A Guida
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - P Rossi
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - V Bellato
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - R Caronna
- Department of Surgery Pietro Valdoni Unit of Oncologic and Minimally Invasive Surgery, Rome, Italy
- Department of Surgical Science, Sapienza University of Rome, Rome, Italy
| | - S Sibio
- Department of Surgery Pietro Valdoni Unit of Oncologic and Minimally Invasive Surgery, Rome, Italy
- Department of Surgical Science, Sapienza University of Rome, Rome, Italy
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12
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Bellato V, An Y, Cerbo D, Campanelli M, Franceschilli M, Khanna K, Sensi B, Siragusa L, Rossi P, Sica GS. Feasibility and outcomes of ERAS protocol in elective cT4 colorectal cancer patients: results from a single-center retrospective cohort study. World J Surg Oncol 2021; 19:196. [PMID: 34215273 PMCID: PMC8253238 DOI: 10.1186/s12957-021-02282-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Background Programs of Enhanced Recovery After Surgery reduces morbidity and shorten recovery in patients undergoing colorectal resections for cancer. Patients presenting with more advanced disease such as T4 cancers are frequently excluded from undergoing ERAS programs due to the difficulty in applying established protocols. The primary aim of this investigation was to evaluate the possibility of applying a validated ERAS protocol in patients undergoing colorectal resection for T4 colon and rectal cancer and to evaluate the short-term outcome. Methods Single-center, retrospective cohort study. All patients with a clinical diagnosis of stage T4 colorectal cancer undergoing surgery between November 2016 and January 2020 were treated following the institutional fast track protocol without exclusion. Short-term postoperative outcomes were compared to those of a control group treated with conventional care and that underwent surgical resection for T4 colorectal cancer at the same institution from January 2010 to October 2016. Data from both groups were collected retrospectively from a prospectively maintained database. Results Eighty-two patients were diagnosed with T4 cancer, 49 patients were included in the ERAS cohort and 33 in the historical conventional care cohort. Both, the mean time of tolerance to solid food diet and postoperative length of stay were significantly shorter in the ERAS group than in the control group (3.14 ± 1.76 vs 4.8 ± 1.52; p < 0.0001 and 6.93 ± 3.76 vs 9.50 ± 4.83; p = 0.0084 respectively). No differences in perioperative complications were observed. Conclusions Results from this cohort study from a single-center registry support the thesis that the adoption of the ERAS protocol is effective and applicable in patients with colorectal cancer clinically staged T4, reducing significantly their length of stay and time of tolerance to solid food diet, without affecting surgical postoperative outcomes.
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Affiliation(s)
- Vittoria Bellato
- Minimally Invasive Unit, Department of Surgery, Università "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.,Department of Colorectal Surgery, St Mark's Academic Hospital, London, UK
| | - Yongbo An
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Daniele Cerbo
- Minimally Invasive Unit, Department of Surgery, Università "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Michela Campanelli
- Minimally Invasive Unit, Department of Surgery, Università "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Marzia Franceschilli
- Minimally Invasive Unit, Department of Surgery, Università "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Krishn Khanna
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bruno Sensi
- Minimally Invasive Unit, Department of Surgery, Università "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Leandro Siragusa
- Minimally Invasive Unit, Department of Surgery, Università "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Piero Rossi
- Minimally Invasive Unit, Department of Surgery, Università "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Giuseppe S Sica
- Minimally Invasive Unit, Department of Surgery, Università "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
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13
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Siragusa L, Sensi B, Vinci D, Franceschilli M, Pathirannehalage Don C, Bagaglini G, Bellato V, Campanelli M, Sica GS. Volume-outcome relationship in rectal cancer surgery. Discov Oncol 2021; 12:11. [PMID: 35201453 PMCID: PMC8777490 DOI: 10.1007/s12672-021-00406-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR). METHODS A retrospective analysis of all consecutive patients undergoing ARR with primary anastomosis between November 2016 and December 2020 after centralization of rectal cancer cases in an academic Centre. Short-term outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. The primary outcome was estimated anastomotic leak rate. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes. RESULTS 86 patients were operated in the study period and outcomes compared to those of 101 patients operated during the previous ten years. Difference in volume of surgery was significant between the two periods (p 0.019) and the estimated leak rate was significantly lower in the higher volume unit (p 0.047). Mean operative time, need of conversion, postoperative use of blood transfusion and in-hospital stay (p < 0.05) were also significantly reduced in Group A. CONCLUSION This study suggests that the shift toward higher volume in rectal cancer surgery is associated to decreased anastomotic leak rate. Potentiation of lower volume surgical units may yield optimal perioperative outcomes.
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Affiliation(s)
- L Siragusa
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - B Sensi
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - D Vinci
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - M Franceschilli
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - C Pathirannehalage Don
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - G Bagaglini
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - V Bellato
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - M Campanelli
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - G S Sica
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
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14
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Luvisetto F, Shamali A, Rutgers MLW, Flashman K, Khan JS. Sphincter preservation in patients with low rectal cancer: striking the right oncological balance. Discov Oncol 2021; 12:7. [PMID: 33855312 PMCID: PMC7976658 DOI: 10.1007/s12672-021-00400-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/01/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The surgical treatment options for low rectal cancer patients include the Abdominoperineal Resection and the sphincter saving Low Anterior Resection. There is growing evidence towards better outcomes for patients being treated with a Low Anterior Resection compared to an Abdominoperineal Resection. OBJECTIVE The aim of this study was to evaluate the short term and oncological outcomes in low rectal cancer treatment. DESIGN This is a retrospective cohort study of prospectively collected data. SETTING Rectal cancer patients from a single center in the United Kingdom. PATIENTS Patients included all low rectal cancer patients (≤ 6 cm from the anal verge) undergoing Low Anterior Resection or Abdominoperineal Resection between 2006 and 2016. OUTCOME MEASURES To identify differences in postoperative complications and disease free and overall survival. RESULTS A total of 262 patients were included for analysis (Low Anterior Resection n = 170, Abdominoperineal Resection n = 92). Abdominoperineal Resection patients were significantly older (69 versus 66 years), had lower tumours (3 versus 5 cm), received more neo-adjuvant radiation, had longer hospital stay and more complications (wound infections and wound dehiscence). Low Anterior Resections had a significantly higher number of harvested lymph nodes (17 versus 12) however there was no difference in nodal involvement and R0 resection rate. No significant difference was found for recurrence, overall survival and disease free survival. LIMITATION Retrospective review of cancer database and single center data. CONCLUSION In the treatment of low rectal cancer Abdominoperineal Resection is associated with higher rates of postoperative complications and longer hospital stay compared to the Low Anterior Resection, with similar oncological outcomes.
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Affiliation(s)
- Federico Luvisetto
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Southwick Hill, Portsmouth, PO6 3LY UK
| | - Awad Shamali
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Southwick Hill, Portsmouth, PO6 3LY UK
| | - Marieke L. W. Rutgers
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Southwick Hill, Portsmouth, PO6 3LY UK
| | - Karen Flashman
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Southwick Hill, Portsmouth, PO6 3LY UK
- Honorary Associate Professor, School of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Jim S. Khan
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Southwick Hill, Portsmouth, PO6 3LY UK
- Honorary Associate Professor, School of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
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15
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Fadel MG, Malietzis G, Constantinides V, Pellino G, Tekkis P, Kontovounisios C. Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis. Discov Oncol 2021; 12:5. [PMID: 35201441 PMCID: PMC8762524 DOI: 10.1007/s12672-021-00398-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Histological subtypes of colorectal cancer may be associated with varied prognostic features. This systematic review and meta-analysis aimed to compare clinicopathological characteristics, recurrence and overall survival between colorectal signet-ring cell (SC) and mucinous carcinoma (MC) to conventional adenocarcinoma (AC). METHODS A literature search of MEDLINE, EMBASE, Ovid and Cochrane Library was performed for studies that reported data on clinicopathological and survival outcomes on SC and/or MC versus AC from January 1985 to May 2020. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed. RESULTS Thirty studies of 1,087,055 patients were included: 11,510 (1.06%) with SC, 110,179 (10.13%) with MC and 965,366 (88.81%) with AC. Patients with SC were younger than patients with AC (WMD - 0.47; 95% CI - 0.84 to -0.10; I2 88.6%; p = 0.014) and more likely to have right-sided disease (OR 2.12; 95% CI 1.72-2.60; I2 82.9%; p < 0.001). Locoregional recurrence at 5 years was more frequent in patients with SC (OR 2.81; 95% CI 1.40-5.65; I2 0.0%; p = 0.004) and MC (OR 1.92; 95% CI 1.18-3.15; I2 74.0%; p = 0.009). 5-year overall survival was significantly reduced when comparing SC and MC to AC (HR 2.54; 95% CI 1.98-3.27; I2 99.1%; p < 0.001 and HR 1.38; 95% CI 1.19-1.61; I2 98.6%; p < 0.001, respectively). CONCLUSION SC and MC are associated with right-sided lesions, advanced stage at presentation, higher rates of recurrence and poorer overall survival. This has strong implications towards surgical and oncological management and surveillance of colorectal cancer.
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Affiliation(s)
- Michael G Fadel
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.
| | - George Malietzis
- Department of Surgery and Cancer, Imperial College, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | | | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Paris Tekkis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
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16
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Tesauro M, Guida AM, Siragusa L, Sensi B, Bellato V, Di Daniele N, Divizia A, Franceschilli M, Sica GS. Preoperative Immunonutrition vs. Standard Dietary Advice in Normo-Nourished Patients Undergoing Fast-Track Laparoscopic Colorectal Surgery. J Clin Med 2021; 10:jcm10030413. [PMID: 33499058 PMCID: PMC7865842 DOI: 10.3390/jcm10030413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/11/2022] Open
Abstract
Immunonutrition (IN) appears to reduce infective complications and in-hospital length of stay (LOS) after major gastrointestinal surgery, but its use in normo-nourished patients is still controversial. The primary aim of this comparative observational study was to evaluate if pre-operative IN reduces in-hospital stay in patients undergoing laparoscopic colorectal resection for cancer under an enhanced recovery after surgery (ERAS) program. The influence of IN on time to first bowel movements, time to full oral diet tolerance, number and type of complications, reasons of prolonged LOS and readmission rate was evaluated as secondary outcome. Patients undergoing ERAS laparoscopic colorectal resection between December 2016 and December 2019 were reviewed. Patients who have received preoperative IN (group A) were compared to those receiving standard dietary advice (group B). Mean in-hospital LOS was significantly shorter in patients receiving preoperative IN than standard dietary advice (4.85 ± 2.25 days vs. 6.06 ± 3.95 days; p < 0.0492). No differences in secondary outcomes were observed. Preoperative IN associated with ERAS protocol in normo-nourished patients undergoing laparoscopic colorectal cancer resection seems to reduce LOS.
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Affiliation(s)
- Manfredi Tesauro
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy; (M.T.); (N.D.D.)
| | - Andrea M. Guida
- Department of Surgical Science, University Tor Vergata, 00133 Rome, Italy; (A.M.G.); (L.S.); (B.S.); (V.B.); (A.D.); (M.F.)
| | - Leandro Siragusa
- Department of Surgical Science, University Tor Vergata, 00133 Rome, Italy; (A.M.G.); (L.S.); (B.S.); (V.B.); (A.D.); (M.F.)
| | - Bruno Sensi
- Department of Surgical Science, University Tor Vergata, 00133 Rome, Italy; (A.M.G.); (L.S.); (B.S.); (V.B.); (A.D.); (M.F.)
| | - Vittoria Bellato
- Department of Surgical Science, University Tor Vergata, 00133 Rome, Italy; (A.M.G.); (L.S.); (B.S.); (V.B.); (A.D.); (M.F.)
| | - Nicola Di Daniele
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy; (M.T.); (N.D.D.)
| | - Andrea Divizia
- Department of Surgical Science, University Tor Vergata, 00133 Rome, Italy; (A.M.G.); (L.S.); (B.S.); (V.B.); (A.D.); (M.F.)
| | - Marzia Franceschilli
- Department of Surgical Science, University Tor Vergata, 00133 Rome, Italy; (A.M.G.); (L.S.); (B.S.); (V.B.); (A.D.); (M.F.)
| | - Giuseppe S. Sica
- Department of Surgical Science, University Tor Vergata, 00133 Rome, Italy; (A.M.G.); (L.S.); (B.S.); (V.B.); (A.D.); (M.F.)
- Correspondence: ; Tel.: +39-(06)-2090-2922
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17
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Xie H, Yuan G, Huang S, Kuang J, Yan L, Ruan G, Tang S, Gan J. The prognostic value of combined tumor markers and systemic immune-inflammation index in colorectal cancer patients. Langenbecks Arch Surg 2020; 405:1119-1130. [PMID: 32794068 DOI: 10.1007/s00423-020-01963-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/09/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE This study evaluated the significance of combining tumor markers (TM) and systemic immune-inflammation index (SII) for postoperative complications and long-term outcomes in colorectal cancer (CRC) patients. METHODS CRC patients (662) who underwent surgery between 2012 and 2014 were retrospectively enrolled into our study. Factors affecting postoperative complications were evaluated by logistic regression analysis. Prognostic factors were assessed using Kaplan-Meier and Cox proportional hazards models. Nomograms were constructed to predict the risk of postoperative complications and survival. A consistency index and a calibration curve were used to evaluate the predictive accuracy of nomograms. RESULTS TM-SII score was established by combining TM and SII. Logistic regression analyses showed that TM-SII score was an important predictor of postoperative complications in CRC patients. Kaplan-Meier analyses showed that TM-SII score was favorable for prognostic risk stratification. In addition, multivariate analyses indicated that TM-SII score was an independent prognostic indicator for disease-free survival and overall survival. TM-SII based nomograms had a moderate prediction accuracy. CONCLUSION TM-SII score is a good prognostic indicator for CRC patients. It may be used as a useful risk stratification tool for advanced CRC patients. TM-SII-based nomograms could be used to identify CRC patients with poor outcomes.
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Affiliation(s)
- Hailun Xie
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Guanghui Yuan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Shizhen Huang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Jiaan Kuang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Ling Yan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Guotian Ruan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Shuangyi Tang
- Deparment of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
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Stojkovic Lalosevic M, Milovanovic T, Micev M, Stojkovic M, Dragasevic S, Stulic M, Rankovic I, Dugalic V, Krivokapic Z, Pavlovic Markovic A. Perineural invasion as a prognostic factor in patients with stage I-III rectal cancer – 5-year follow up. World J Gastrointest Oncol 2020; 12:592-600. [PMID: 32461790 PMCID: PMC7235181 DOI: 10.4251/wjgo.v12.i5.592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/23/2020] [Accepted: 04/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Rectal cancer (RC) is one of the most common diagnosed cancers, and one of the major causes of cancer-related death nowadays. Majority of the current guidelines rely on TNM classification regarding therapy regiments, however recent studies suggest that additional histopathological findings could affect the disease course.
AIM To determine whether perineural invasion alone or in combination with lymphovascular invasion have an effect on 5-years overall survival (OS) of RC patients.
METHODS A prospective study included newly diagnosed stage I-III RC patients treated and followed at the Digestive Surgery Clinic, Clinical Center of Serbia, between the years of 2014–2016. All patients had their diagnosis histologically confirmed in accordance with both TMN and Dukes classification. In addition, the patient’s demographics, surgical details, postoperative pathological details, differentiation degree and their correlation with OS was investigated.
RESULTS Of 245 included patients with stage I-III RC, lymphovascular invasion (LVI) was identified in 92 patients (38%), whereas perineural invasion (PNI) was present in 46 patients (19%). Using Kaplan-Meier analysis for overall survival rate, we have found that both LVI and PNI were associated with lower survival rates (P < 0.01). Moreover when Cox multiple regression model was used, LVI, PNI, older age, male gender were predictors of poor prognosis (HR = 5.49; 95%CI: 2.889-10.429; P < 0.05).
CONCLUSION LVI and PNI were significant factors predicting worse prognosis in early and intermediate RC patients, hence more aggressive therapy should be reserved for these patients after curative resection.
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Affiliation(s)
- Milica Stojkovic Lalosevic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Tamara Milovanovic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Marjan Micev
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
- Clinic for Digestive Surgery - First Surgical Clinic, Clinical Center of Serbia, Belgrade 11000, Serbia
| | - Mirjana Stojkovic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Sanja Dragasevic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Milos Stulic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Ivan Rankovic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Vladimir Dugalic
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
- Clinic for Digestive Surgery - First Surgical Clinic, Clinical Center of Serbia, Belgrade 11000, Serbia
| | - Zoran Krivokapic
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
- Clinic for Digestive Surgery - First Surgical Clinic, Clinical Center of Serbia, Belgrade 11000, Serbia
| | - Aleksandra Pavlovic Markovic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade 11000, Serbia
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
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