Preadmission glucocorticoid use and anastomotic leakage after colon and rectal cancer resections: a Danish cohort study

Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective study

BACKGROUND

Preclinical studies suggest that glucocorticoids (GCs) promote the proliferation and development of colorectal cancer. Because GCs are broadly prescribed for treatment-related adverse events in patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (NCRT), it's essential to assess the effect of GCs on clinical outcomes.

METHODS

LARC cases treated with NCRT followed by surgery were assessed retrospectively. Evaluation of the relationship between GCs use (GCs vs. non-GCs) and neoadjuvant rectal (NAR) score (as a three-level categorical dependent variable) was performed using multivariable multinomial logistic regression (MLR). We also examined the relationship between the accumulated dose of GCs and NAR using multivariate MLR. Survival analysis of disease-free survival (DFS) and overall survival (OS) was performed using the Kaplan-Meier method. Multivariate Cox regression was used to assess confounding factors that could influence OS and DFS.

RESULTS

This retrospective cohort study included 790 patients with newly diagnosed non-metastatic LARC (T3-4/N + M0) who received NCRT followed by surgery between January 2012 and April 2017. The end of the follow-up period was May 11, 2022. Among the 790 patients with LARC, 342 (43.2%) received GCs treatment and 448 (56.8%) did not during the NCRT-to-surgery period. GCs medication was significantly different between mid-NAR (8-16) and low-NAR (< 8) (odds ratio [OR], 0.615; 95% CI, 0.420-0.901; P = 0.013), and the high-NAR (> 16) and low-NAR (0.563; 0.352-0.900; 0.016). Patients exposed to GCs, had a decreased 5-year OS (GCs vs. non-GCs = 80.01% (95% CI, 75.87%-84.37%) vs. 85.30% (82.06%-88.67%), P = 0.023) and poorer 5-year DFS (73.99% (69.45%-78.82%) vs. 78.7% (75.14%-82.78%), P = 0.045). The accumulated dose of GCs was an independent risk factor for OS (hazard ratio [HR], 1.007 [1.001-1.014], 0.036) and DFS (1.010 [1.004-1.017], 0.001).

CONCLUSIONS AND RELEVANCE

Our study revealed that GCs were associated with reduced efficacy of NCRT and worse clinical outcomes in patients with LARC during the NCRT-to-surgery period.

Safety profile of a multimodal fail-safe model to minimize postoperative complications in oncologic colorectal resections-a cohort study

BACKGROUND

Despite innovations in surgical techniques, major complications following colorectal surgery still lead to a significant morbidity and mortality. There is no standard protocol for perioperative management of patients with colorectal cancer. This study evaluates the effectiveness of a multimodal fail-safe model in minimizing severe surgical complications following colorectal resections.

METHODS

We compared major complications in patients with colorectal cancers who underwent surgical resections with anastomosis during 2013-2014 (control group) with patients treated during 2015-2019 (fail-safe group). The fail-safe group had preoperative bowel preparation and a perioperative single dose of antibiotics, on-table bowel irrigation and early sigmoidoscopic assessment of anastomosis in rectal resections. A standard surgical technique for tension-free anastomosis was adapted in the fail-safe approach. The chi-square test measured relationships between categorical variables, t-test estimated the probability of differences, and the multivariate regression analysis determined the linear correlation among independent and dependent variables.

RESULTS

A total of 924 patients underwent colorectal operations during the study period; however, 696 patients had surgical resections with primary anastomoses. There were 427 (61.4%) laparoscopic and 230 (33.0%) open operations, while 39 (5.6%) laparoscopic procedures were converted. Overall, the rate of major complications (Dindo-Clavien grade IIIb-V) significantly reduced from 22.6% for the control group to 9.8% for the fail-safe group (p < 0.0001). Major complications mainly occurred due to non-surgical reasons such as pneumonia, heart failure, or renal dysfunction. The rates of anastomotic leakage (AL) were 11.8% (22/186) and 3.7% (n = 19/510) for the control and fail-safe groups, respectively (p < 0.0001).

CONCLUSION

We report an effective multimodal fail-safe protocol for colorectal cancer during the pre-, peri-, and postoperative period. The fail-safe model showed less postoperative complications even for low rectal anastomosis. This approach can be adapted as a structured protocol during the perioperative care of patients for colorectal surgery.

TRIAL REGISTRATION

This study was registered in the German Clinical Trial Register (Study ID: DRKS00023804 ).

Intestinal epithelial glucocorticoid receptor promotes chronic inflammation-associated colorectal cancer

Synthetic immunosuppressive glucocorticoids (GCs) are widely used to control inflammatory bowel disease (IBD). However, the impact of GC signaling on intestinal tumorigenesis remains controversial. Here, we report that intestinal epithelial GC receptor (GR), but not whole intestinal tissue GR, promoted chronic intestinal inflammation-associated colorectal cancer in both humans and mice. In patients with colorectal cancer, GR was enriched in intestinal epithelial cells and high epithelial cell GR levels were associated with poor prognosis. Consistently, intestinal epithelium–specific deletion of GR (GR iKO) in mice increased macrophage infiltration, improved tissue recovery, and enhanced antitumor response in a chronic inflammation–associated colorectal cancer model. Consequently, GR iKO mice developed fewer and less advanced tumors than control mice. Furthermore, oral GC administration in the early phase of tissue injury delayed recovery and accelerated the formation of aggressive colorectal cancers. Our study reveals that intestinal epithelial GR signaling repressed acute colitis but promoted chronic inflammation–associated colorectal cancer. Our study suggests that colorectal epithelial GR could serve as a predictive marker for colorectal cancer risk and prognosis. Our findings further suggest that, although synthetic GC treatment for IBD should be used with caution, there is a therapeutic window for GC therapy during colorectal cancer development in immunocompetent patients.

[Immunosuppression, Surgery, Complication?]

Immunosuppression, Surgery, Complication? Abstract. Surgical conditions sometimes pose major diagnostic and therapeutic challenges for immunosuppressed patients. Especially in patients suffering from diseases with potential septic emergencies or postoperative complications, the indication for elective surgery should be discussed at an early stage. This is best done across disciplines, involving all experts and the patient.

Mometasone furoate inhibits growth of acute leukemia cells in childhood by regulating PI3K signaling pathway

OBJECTIVES

Acute lymphoblastic leukemia (ALL) is the most common cancer before the age of 15 years, seriously endangering the health of children. The main treatment for Childhood ALL was pharmacotherapy. But these drugs have many side effects and some of them could develop drug resistance quickly. Mometasone furoate (MF) is an efficient glucocorticoid for topical treatment of inflammation on the skin, lung and nose.

METHODS

In this study, we investigated whether the MF had effects on ALL cells proliferation and migration.

RESULTS

The CCK-8 proliferation test showed that the cell viability was the lowest at 25 nM MF treatment and the increased OD value was time-dependent. In transwell assay, the number of CCRF-CEM cells was reduced in MF treated group. We found the expression of anti-apoptotic protein bcl-2 decreased the expression of pro-apoptotic protein caspase3 and bax increased in CCRF-CEM cell line treated with MF. The expression of p-AKT, p-mTOR, p70S6 K, vascular endothelial growth factor and CyclinD1 were decreased in MF treated group.

CONCLUSION

This study reveals that MF can inhibit proliferation and invasion/migration and induce apoptosis in Childhood ALL cells, which may be regulated by Phosphatidylinositol 3-kinase signaling pathway. These results suggest MF may be a potential new drug target for clinical ALL treatment.

Effect of thymoquinone on the healing of left colon anastomosis: an experimental study

Aim

To evaluate the effect of thymoquinone on the healing of experimental left colon anastomosis in rats.

Methods

Forty Wistar albino rats weighing 250–300 g were randomly divided into four groups (10 rats/group). Group 1 (control group) rats were not administered Thymoquinone (TQ) for 3 days after the operation. Group 2 was administered daily TQ for 3 days starting from the first day after the operation. Group 3 was not administered TQ for 7 days after the operation. Group 4 was administered daily TQ for 7 days starting from the first day after the operation. Thymoquinone was administered as a single dose oral gavage through a 4F feeding catheter per each day. The bursting strength of the anastomosis was measured on 3rd and 7th postoperative days (POD) and resection was performed. Subsequently, the hydroxyproline level in the resected tissue was measured and a histological evaluation was performed.

Results

The bursting pressures of the anastomoses were measured to be statistically significantly greater on 7th POD in TQ administered groups compared to those without TQ administration. Tissues were stained with Masson’s trichrome dye in order to evaluate the amount of fibrous tissue reaction for histopathological examination; there was no significant difference in the amount of fibrous tissue between groups 1 and 2, while a very marked increase in the fibrous tissue was detected in groups 3 and 4. Mean tissue hydroxyproline levels of the groups 3 and 4 on 7th POD were 1.30 and 2.72 μg/g-protein, respectively. The difference between the groups was statistically significant (p = 0.001).

Conclusions

TQ significantly increased the bursting pressure of the anastomosis, tissue hydroxyproline level, and fibrous tissue production.