Why is early detection of colon cancer still not possible in 2023?

Colorectal cancer(CRC)screening is a fundamental tool in the prevention and early detection of one of the most prevalent and lethal cancers.Over the years,screening,particularly in those settings where it is well organized,has succeeded in reducing the incidence of colon and rectal cancer and improving the prognosis related to them.Despite considerable advancements in screening technologies and strategies,the effectiveness of CRC screening programs remains less than optimal.This paper examined the multifaceted reasons behind the persistent lack of effect-iveness in CRC screening initiatives.Through a critical analysis of current methodologies,technological limitations,patient-related factors,and systemic challenges,we elucidated the complex interplay that hampers the successful reduction of CRC morbidity and mortality rates.While acknowledging the ad-vancements that have improved aspects of screening,we emphasized the necessity of addressing the identified barriers comprehensively.This study aimed to raise awareness of how important CRC screening is in reducing costs for this disease.Screening and early diagnosis are not only important in improving the prognosis of patients with CRC but can lead to an important reduction in the cost of treating a disease that is often diagnosed at an advanced stage.Spending more sooner can mean saving money later.

Pain in chronic pancreatitis:What can we do today?

The aim of this study is to illustrate the complexity of pain management in chronic pancreatitis(CP).In this context,pain represents the most common and debilitating symptom,and it deeply affects patient’s quality of life.Multiple rating scales(unidimensional,bidimensional and multidimensional)have been proposed to quantify CP pain.However,it represents the result of complex mechanisms,involving genetic,neuropathic and neurogenic factors.Considering all these aspects,the treatment should be discussed in a multidisciplinary setting and it should be approached in a stepwise manner.First,a lifestyle change is recommended and nonsteroidal anti-inflammatory drugs represent the gold standard among medical treatments for CP patients.The second step,after medical approach,is endoscopic therapy,especially for complicated CP.In case of failure,tailored surgery represents the third step and decompressive or resection procedures can be chosen.In conclusion,CP pain’s management is challenging considering all these complex aspects and the lack of international protocols.

Impact of anastomotic leakage on long-term prognosis after colorectal cancer surgery

Colorectal cancer(CRC)is one of the most common malignancies in the world.Despite significant improvements in surgical technique,postoperative complications still occur in a fair percentage of patients undergoing colorectal surgery.The most feared complication is anastomotic leakage.It negatively affects shortterm prognosis,with increased post-operative morbidity and mortality,higher hospitalization time and costs.Moreover,it may require further surgery with the creation of a permanent or temporary stoma.While there is no doubt about the negative impact of anastomotic dehiscence on the short-term prognosis of patients operated on for CRC,still under discussion is its impact on the long-term prognosis.Some authors have described an association between leakage and reduced overall survival,disease-free survival,and increased recurrence,while other Authors have found no real impact of dehiscence on long term prognosis.The purpose of this paper is to review all the literature about the impact of anastomotic dehiscence on long-term prognosis after CRC surgery.The main risk factors of leakage and early detection markers are also summarized.

Pancreatic cancer in 2021:What you need to know to win

Pancreatic cancer is one of the solid tumors with the worst prognosis.Five-year survival rate is less than 10%.Surgical resection is the only potentially curative treatment,but the tumor is often diagnosed at an advanced stage of the disease and surgery could be performed in a very limited number of patients.Moreover,surgery is still associated with high post-operative morbidity,while other therapies still offer very disappointing results.This article reviews every aspect of pancreatic cancer,focusing on the elements that can improve prognosis.It was written with the aim of describing everything you need to know in 2021 in order to face this difficult challenge.

Early diagnosis of pancreatic cancer:What strategies to avoid a foretold catastrophe

While great strides in improving survival rates have been made for most cancers in recent years,pancreatic ductal adenocarcinoma(PDAC)remains one of the solid tumors with the worst prognosis.PDAC mortality often overlaps with incidence.Surgical resection is the only potentially curative treatment,but it can be performed in a very limited number of cases.In order to improve the prognosis of PDAC,there are ideally two possible ways:the discovery of new strategies or drugs that will make it possible to treat the tumor more successfully or an earlier diagnosis that will allow patients to be operated on at a less advanced stage.The aim of this review was to summarize all the possible strategies available today for the early diagnosis of PDAC and the paths that research needs to take to make this goal ever closer.All the most recent studies on risk factors and screening modalities,new laboratory tests including liquid biopsy,new imaging methods and possible applications of artificial intelligence and machine learning were reviewed and commented on.Unfortunately,in 2022 the results for this type of cancer still remain discouraging,while a catastrophic increase in cases is expected in the coming years.The article was also written with the aim of highlighting the urgency of devoting more attention and resources to this pathology in order to reach a solution that seems more and more unreachable every day.

Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction:A review of the literature after 2020

It has been found that 8%-29%of colorectal cancers are obstructive.The use of“stent as bridge to surgery”is one of the most debated topics in obstructive leftsided colorectal cancer management.The endoscopic placement of a selfexpanding metallic stent as bridge to surgery(BTS)could turn an emergency surgery to an elective one,increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one.However,in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted.Therefore,despite the useful short-term outcomes related to BTS,the recent literature has focused on long-term outcomes investigating the disease-free survival,the recurrence rate and the overall survival.Due to discordant data,international guidelines are still conflicting,and the debate is still open.There is not agreement about using self-expanding metallic stent for BTS as the gold standard.

Laparoscopic appendectomy,stump closure and endoloops:A meta-analysis

BACKGROUND Acute appendicitis(AA)is one of the main indications for urgent surgery.Laparoscopic appendectomy(LA)has shown advantages in terms of clinical results and cost-effectiveness,even if there is still controversy about different devices to utilize,especially with regards to the endoloop(EL)vs endostapler(ES)when it comes to stump closure.AIM To compare safety and cost-effectiveness of EL vs ES.METHODS From a prospectively maintained database,data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery-St Orsola University Hospital,Bologna(Italy)were retrieved.A metaanalysis was performed in terms of surgical complications,in comparison to the international literature published from 1995 to 2021.RESULTS The meta-analysis showed no evidence regarding wound infections,abdominal abscesses,and total post-operative complications,in terms of superiority of a surgical technique for the stump closure in LA.CONCLUSION Even when AA is complicated,the routine use of EL is safe in most patients.

Liver surgery for colorectal metastasis:New paths and new goals with the help of artificial intelligence

Colorectal cancer is one of the most common neoplasia with an high risk to metastatic spread.Improving medical and surgical treatment is moving along with improving the precision of diagnosis and patient's assessment,the latter two aided more and more with the use of artificial intelligence(AI).The management of colorectal liver metastasis is multidisciplinary,and surgery is the main option.After the diagnosis,a surgical assessment of the patient is fundamental.Reaching a R0 resection with a proper remnant liver volume can be done using new techniques involving also artificial intelligence.Considering the recent application of artificial intelligence as a valid substitute for liver biopsy in chronic liver diseases,several authors tried to apply similar techniques to pre-operative imaging of liver metastasis.Radiomics showed good results in identifying structural changes in a unhealthy liver and in evaluating the prognosis after a liver resection.Recently deep learning has been successfully applied in estimating the remnant liver volume before surgery.Moreover AI techniques can help surgeons to perform an early diagnosis of neoplastic relapse or a better differentiation between a colorectal metastasis and a benign lesion.AI could be applied also in the histopathological diagnostic tool.Although AI implementation is still partially automatized,it appears faster and more precise than the usual diagnostic tools and,in the short future,could become the new gold standard in liver surgery.