Predictive value of preoperative routine examination for the prognosis of patients with pT2N0M0 or pT3N0M0 colorectal cancer

BACKGROUND In recent years,the incidence of colorectal cancer(CRC)has been increasing.With the popularization of endoscopic technology,a number of early CRC has been diagnosed.However,despite current treatment methods,some patients with early CRC still experience postoperative recurrence and metastasis.AIM To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations.METHODS A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study.Results of blood routine test,liver and kidney function tests and tumor markers were collected before surgery.Patients were followed up through disease-specific database and telephone interviews.Tumor recurrence,metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis.RESULTS We comprehensively compared the predictive value of preoperative blood routine,blood biochemistry and tumor markers for disease-free survival(DFS)and overall survival(OS)of CRC.Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS[hazard ratio(HR)=0.995,95% confidence interval(CI):0.991-0.999,P=0.015],while serum carcinoembryonic antigen(CEA)level(HR=1.008,95%CI:1.001-1.016,P=0.027)and serum total cholesterol level(HR=1.538,95%CI:1.026-2.305,P=0.037)were independent risk factors for OS.The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL.Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level,the difference between the two groups was not statistically significant(P=0.075).CONCLUSION For patients with T2N0M0 or T3N0M0 CRC,preoperative platelet count was a protective factor for DFS,while serum CEA level was an independent risk factor for OS.Given that these measures are easier to detect and more acceptable to patients,they may have broader applications.

Preoperative carcinoembryonic antibody is predictive of distant metastasis in pathologically T1 colorectal cancer after radical surgery

AIM:To identify the predictors of distant metastasis in pathologically T1(pT1)colorectal cancer(CRC)after radical resection. METHODS:Variables including age,gender,preoperative carcinoembryonic antibody(CEA)level,tumor location,tumor size,lymph node status,and histological grade were recorded.Patients with and without metastasis were compared with regard to age,gender,CEA level and pathologic tumor characteristics using the independent t test orχ 2 test,as appropriate.Risk factors were determined by logistic regression analysis. RESULTS:Metastasis occurred in 6(3.8%)of the 159 patients during a median follow-up of 67.0(46.5%) mo.The rates of distant metastasis in patients with pT1 cancer of the colon and rectum were 6.7%and 2.9%, respectively(P<0.001).The rates of distant metastasis between male and female patients with T1 CRC were 6.25%and 1.27%,respectively(P<0.001).The most frequent site of distant metastasis was the liver. Age(P=0.522),gender(P=0.980),tumor location(P =0.330),tumor size(P=0.786),histological grade(P =0.509),and high serum CEA level(P=0.262)were not prognostic factors for lymph node metastasis.Univariate analysis revealed that age(P=0.231),gender(P =0.137),tumor location(P=0.386),and tumor size (P=0.514)were not risk factors for distant metastasis after radical resection for T1 colorectal cancer.Postoperative metastasis was only significantly correlated with high preoperative serum CEA level(P=0.001).Using multivariate logistic regression analysis,high preoperative serum CEA level(P=0.004;odds ratio 15.341; 95%CI 2.371-99.275)was an independent predictor for postoperative distant metastasis. CONCLUSION:The preoperative increased serum CEA level is a predictive risk factor for distant metastasis in CRC patients after radical resection.Adjuvant chemotherapy may be necessary in such patients,even if they have pT1 colorectal cancer.

Pouchitis

While restorative proctocolectomy with ileal pouch-anal anastomosis has significantly improved the quality of life in patients with underlying ulcerative colitis who require surgery,complications can occur.Pouchitis as the most common long-term complication represents a spectrum of disease processes ranging from acute,antibiotic-responsive type to chronic antibiotic-refractory entity.Accurate diagnosis using a combined assessment of symptoms,endoscopy and histology and the stratification of clinical phenotypes is important for treatment and prognosis the disease.The majority of patients respond favorably to antibiotic therapy.However,management of chronic antibiotic-refractory pouchitis remains a challenge.

Appropriate treatment of acute sigmoid volvulus in the emergency setting

AIM:To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting.METHODS:A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery,Changhai Hospital,Shanghai from January 2001 to July 2012 was performed.Following the diagnosis of acute sigmoid volvulus,an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis.RESULTS:Of the 28 patients with acute sigmoid volvulus,19(67.9%)were male and 9(32.1%)were female.Their mean age was 63.1 ± 22.9 years(range,21-93 years).Six(21.4%)patients had a history of abdominal surgery,and 17(60.7%)patients had a history of constipation.Abdominal radiography or computed tomography was performed in all patients.Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8%(26/28).Emergency surgery was required in the other two patients.Of the 26 successfully treated patients,seven(26.9%)had recurrent volvulus.CONCLUSION:Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus.Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful,or in those with peritonitis.

Research progress on the molecular biological characteristics of colorectal laterally spreading tumor

Colorectal laterally spreading tumor (LST) is a flat protuberant lesion originating from the colorectal mucosa, which is mainly charactherized by lateral superficial diffusion, and rarely vertically invades the deep wall of the intestine. LST is closely related to the occurrence and development of colorectal cancer, but its pathological morphology and molecular mechanism are different from those of general adenoma, and it has some particularity. At present, the related research on LST in China has just started, but we find that its incidence is not low. Therefore, the research progress of epidemiology, molecular biology as well as clinical diagnosis and treatment of this disease is reviewed.

Re-recognition of BMPR1A-related polyposis:beyond juvenile polyposis and hereditary mixed polyposis syndrome

Background Bone morphogenetic protein receptor type 1A(BMPR1A)is responsible for two individual Mendelian diseases:juvenile polyposis syndrome and hereditary mixed polyposis syndrome 2,which have overlapping phenotypes.This study aimed to elucidate whether these two syndromes are just two subtypes of a single syndrome rather than two isolated syndromes.Methods We sequenced the BMPR1A gene in 186 patients with polyposis and colorectal cancer,and evaluated the clinicopathological features and phenotypes of the probands and their available relatives with BMPR1A mutations.Results BMPR1A germline mutations were found in six probands and their three available relatives.The numbers of frameshift,nonsense,splice-site,andmissensemutations were one,one,two,and two,respectively;two of the sixmutations were novel.Typical juvenile polyps were found in only three patients.Two patients had colorectal cancer rather than any polyps.Conclusions Diseases in BMPR1A germline mutation carriers vary from mixed polyposis to sole colorectal cancer,and typical juvenile polyps do not always occur in these carriers.The variety of phenotypes reflected the features of BMPR1Amutation carriers,which should be recognized as a spectrum of one syndrome.Genetic testing may be a good approach to identifying BMPR1A-related syndromes.

Recurrent sigmoid volvulus relieved by transanal ileus tube implantation

Introduction Sigmoid volvulus(SV)is a main cause of colonic mechanical obstruction.The sigmoid colon has a long and narrow mesentery that is the anatomical basis for the volvulus.The anti-mesenteric border of the sigmoid colon elongates -20%more than the mesenteric border when it is inflated and this provides the driving force that initiates and sustains the volvulus,often resulting in a counterclockwise rotation to form a closed-loop obstruction[1].Colonoscopic decompression and detorsion is the first-line treatment for SV[2].