[Prognosis Analysis of Additional Surgical Treatment for High-Risk T1 Colorectal Cancer Patients After Endoscopic Resection]

Objective

To analyze the effect of additional surgery on the survival and prognosis of high-risk T1 colorectal cancer patients who have undergone endoscopic resection.

Methods

The clinical data of patients with high-risk T1 colorectal cancer were retrospectively collected. The patients were divided into the endoscopic resection (ER) plus additional surgical resection (SR) group, or the ER+SR group, and the ER group according to whether additional SR were performed after ER. Baseline data of the patients and information on the location, size, and postoperative pathology of the lesions were collected. Patient survival-related information was obtained through the medical record system and patient follow-up. The primary outcome indicators were the overall survival and the colorectal cancer-specific survival. Univariate Cox regression analysis was used to screen survival-related risk factors and hazard ratio (HR) was calculated. Multivariate Cox regression analysis was used to analyze the independent influencing factors.

Results

The data of 109 patients with T1 high-risk colorectal cancer were collected, with 52 patients in the ER group and 57 patients in the ER+SR group. The mean age of patients in the ER group was higher than that in the ER+SR group (65.21 years old vs. 60.54 years old, P=0.035), and the median endoscopic measurement of the size of lesions in the ER group was slightly lower than that in the ER+SR group (2.00 cm vs. 2.50 cm, P=0.026). The median follow-up time was 30.00 months, with the maximum follow-up time being 119 months, in the ER+SR group and there were 4 patients deaths, including one colorectal cancer-related death. Whereas the median follow-up time in the ER group was 28.50 months, with the maximum follow-up time being 78.00 months, and there were 4 patient deaths, including one caused by colorectal cancer. The overall 5-year cumulative survival rates in the ER+SR group and the ER group were 94.44% and 81.65%, respectively, and the cancer-specific 5-year cumulative survival rates in the ER+SR group and the ER group were 97.18% and 98.06%, respectively. The Kaplan-Meier analysis showed no significant difference in the overall cumulative survival or cancer-specific cumulative survival between the ER+SR and the ER groups. Univariate Cox regression analysis showed that age and the number of reviews were the risk factors of overall survival (HR=1.16 and HR=0.27, respectively), with age identified as an independent risk factor of overall survival in the multivariate Cox regression analysis (HR=1.10, P=0.045).

Conclusion

For T1 colorectal cancer patients with high risk factors after ER, factors such as patient age and their personal treatment decisions should not be overlooked. In clinical practice, additional caution should be exercised in decision-making concerning additional surgery.

Efficacy and safety of endoscopic resection in treatment of small gastric stromal tumors: A state-of-the-art review

Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract, but gastric stromal tumors (GSTs) are the most common. All GSTs have the potential to become malignant, and these can be divided into four different grades by risk from low to high: Very low risk, low risk, medium risk, and high risk. Current guidelines all recommend early complete excision of GSTs larger than 2 cm in diameter. However, it is not clear whether small GSTs (sGSTs, i.e., those smaller than 2 cm in diameter) should be treated as early as possible. The National Comprehensive Cancer Network recommends that endoscopic ultrasonography-guided (EUS-guided) fine-needle aspiration biopsy and imaging (computed tomography or magnetic-resonance imaging) be used to assess cancer risk for sGSTs detected by gastroscopy to determine treatment. When EUS indicates a higher risk of tumor, surgical resection is recommended. There are some questions on whether sGSTs also require early treatment. Many studies have shown that endoscopic treatment of GSTs with diameters of 2-5 cm is very effective. We here address whether endoscopic therapy is also suitable for sGSTs. In this paper, we try to explain three questions: (1) Does sGST require treatment? (2) Is digestive endoscopy a safe and effective means of treating sGST? and (3) When sGSTs are at different sites and depths, which endoscopic treatment method is more suitable?

[Clinical high risk factors and prognosis of 25 pulmonary mucormycosis cases]

Objective: To analyze high risk factors, therapeutic regimen and prognosis of patients with pulmonary mucormycosis. Methods: A retrospective analysis was performed on the clinical data of 25 patients who were diagnosed as pulmonary mucormycosis in the First Affiliated Hospital, School of Medicine, Zhejiang University, between January 2009 and December 2017. Results: Univariate analysis revealed that no risk factor had significant effect on prognosis of these 25 cases, while multivariate logistic regression analysis confirmed that the exposure to antifungal drugs was correlated to worse prognosis(P=0.046). All 4 patients who had received surgical lesionectomy were cured, and 8 patients who had not received any therapy targeted to mucormycosis were all dead. Seven of 13 patients received antifungal drug to mucormycosis were effective, with an effective rate of 54.0%. The mortality rate of the operative group was lower than that of the non-operative group (P=0.026), and the prognosis of the patients received drug treatment was better than patients without treatment(P=0.022). There was no significant difference in the prognosis between groups of single drug or combination of amphotericin B and posaconazole. Conclusions: Pulmonary mucormycosis is more likely to occur in patients with tumor of the hematopoietic and lymphoid tissues, immunosuppression after solid organ transplantation, long-term glucocorticoid usage and diabetes. Surgical lesionectomy can improve the survival rate, and the treatment with amphotericin B and /or posaconazole can also improve the prognosis of the patients.

High risk factors for recurrence after resection of colorectal polyps

AIM: To investigate the high risk factors for recurrence after resection of colorectal polyps.

METHODS: A retrospective analysis was performed of patients who underwent endoscopic resection of colorectal polyps more than twice from January 2012 to December 2015 at Shanghai Putuo District Central Hospital to identify the high risk factors for recurrence.

RESULTS: A total of 54 patients was included. Univariate analysis showed that male gender, old age, low intestinal cleaning degree, adenomatous polyps, polyps < 1 cm, APC electric cauterization combined with high frequency electrocoagulation, and multiple polyps were risk factors for postoperative recurrence of colorectal polyps. Multivariate analysis showed that only age was an independent risk factor for postoperative recurrence of colorectal polyps.

CONCLUSION: Age, gender, polyp number, polyp pathology, and intestinal cleanliness are risk factors for postoperative recurrence of colorectal polyps. Insufficient bowel preparation and smaller polyps will increase the rate of missed diagnosis and increase the risk of postoperative recurrence.