Post-colonoscopy colorectal cancer rate in the era of highdefinition colonoscopy

AIM To investigate the post-colonoscopy colorectal cancer(PCCRC) rate for high-definition(HD) colonoscopy compared with that for standard-definition colonoscopy reported previously.METHODS Using medical records at Sano Hospital(SH) and Dokkyo Medical University Koshigaya Hospital(DMUKH), we retrospectively obtained data on consecutive patients diagnosed as having CRC between January 2010 andDecember 2015. The definition of PCCRC was diagnosis of CRC between 7 and 36 mo after initial high-definition colonoscopy that had detected no cancer, and patients were divided into a PCCRC group and a non-PCCRC group. The primary outcome was the rate of PCCRC for HD colonoscopy. The secondary outcomes were factors associated with PCCRC and possible reason for occurrence of early and advanced PCCRC.RESULTS Among 892 CRC patients, 11 were diagnosed as having PCCRC and 881 had non-PCCRC. The PCCRC rate was 1.7%(8/471) at SH and 0.7%(3/421) at DMUKH. In comparison with the non-PCCRC group, the PCCRC group had a significantly higher preponderance of smaller tumors(39 mm vs 19 mm, P = 0.002), a shallower invasion depth(T1 rate, 25.4% vs 63.6%, P = 0.01), a non-polypoid macroscopic appearance(39.0% vs 85.7%, P = 0.02) and an earlier stage(59.7% vs 90.9%, P = 0.03). Possible reasons for PCCRC were "missed or new" in 9 patients(82%), "incomplete resection" in 1(9%), and "inadequate examination'" in 1(9%). Among 9 "missed or new" PCCRC, the leading cause was non-polypoid shape for early PCCRC and blinded location for advanced PCCRC.CONCLUSION The PCCRC rate for HD colonoscopy was 0.7%-1.7%, being lower than that for standard-definition colonoscopy(1.8%-9.0%) reported previously employing the same methodology.

Improving colorectal cancer screening programs

In this editorial we comment on the article by Agatsuma et al published in the World Journal of Gastroenterology.They suggest policies for more effective colorectal screening.Screening is the main policy that has led to lower mortality rates in later years among the population that was eligible for screening.Colonoscopy is the gold standard tool for screening and has preventive effects by removing precancerous or early malignant polyps.However,colonoscopy is an invasive process,and fecal tests such as the current hemoglobin immunodetection were developed,followed by endoscopy,as the general tool for population screening,avoiding logistical and economic problems.Even so,participation and adherence rates are low.Different screening options are being developed with the idea that if people could choose between the ones that best suit them,participation in population-based screening programs would increase.Blood tests,such as a recent one that detects cell-free DNA shed by tumors called circulating tumor DNA,showed a similar accuracy rate to stool tests for cancer,but were less sensitive for advanced precancerous lesions.At the time when the crosstalk between the immune system and cancer was being established as a new hallmark of cancer,novel immune system-related biomarkers and information on patients’immune parameters,such as cell counts of different immune populations,were studied for the early detection of colorectal cancer,since they could be effective in asymptomatic people,appearing earlier in the adenoma-carcinoma development compared to the presence of fecal blood.sCD26,for example,detected 80.37%of advanced adenomas.To reach as many eligible people as possible,starting at an earlier age than current programs,the direction could be to apply tests based on blood,urine or salivary fluid to samples taken during routine visits to the primary health system.

Colorectal cancer screening:The value of early detection and modern challenges

The screening of colorectal cancer(CRC)is pivotal for both the prevention and treatment of this disease,significantly improving early-stage tumor detection rates.This advancement not only boosts survival rates and quality of life for patients but also reduces the costs associated with treatment.However,the adoption of CRC screening methods faces numerous challenges,including the technical limitations of both noninvasive and invasive methods in terms of sensitivity and specificity.Moreover,socioeconomic factors such as regional disparities,economic conditions,and varying levels of awareness affect screening uptake.The coronavirus disease 2019 pandemic further intensified these challenges,leading to reduced screening participation and increased waiting periods.Additionally,the growing prevalence of early-onset CRC necessitates innovative screening approaches.In response,research into new methodologies,including artificial intelligence-based systems,aims to improve the precision and accessibility of screening.Proactive measures by governments and health organizations to enhance CRC screening efforts are underway,including increased advocacy,improved service delivery,and international cooperation.The role of technological innovation and global health collaboration in advancing CRC screening is undeniable.Technologies such as artificial intelligence and gene sequencing are set to revolutionize CRC screening,making a significant impact on the fight against this disease.Given the rise in early-onset CRC,it is crucial for screening strategies to continually evolve,ensuring their effectiveness and applicability.

Standard-definition White-light,High-definition White-light versus Narrow-band Imaging Endoscopy for Detecting Colorectal Adenomas:A Multicenter Randomized Controlled Trial

Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colorectal lesions in the Chinese population.Methods This was a multicenter,single-blind,randomized,controlled trial with a non-inferiority design.Patients undergoing endoscopy for physical examination,screening,and surveillance were enrolled from July 2017 to December 2020.The primary outcome measure was the adenoma detection rate(ADR),defined as the proportion of patients with at least one adenoma detected.The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression.Results Out of 653 eligible patients enrolled,data from 596 patients were analyzed.The ADRs were 34.5%in the SD-WL group,33.5%in the HD-WL group,and 37.5%in the HD-NBI group(P=0.72).The advanced neoplasm detection rates(ANDRs)in the three arms were 17.1%,15.5%,and 10.4%(P=0.17).No significant differences were found between the SD group and HD group regarding ADR or ANDR(ADR:34.5%vs.35.6%,P=0.79;ANDR:17.1%vs.13.0%,P=0.16,respectively).Similar results were observed between the HD-WL group and HD-NBI group(ADR:33.5%vs.37.7%,P=0.45;ANDR:15.5%vs.10.4%,P=0.18,respectively).In the univariate and multivariate logistic regression analyses,neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL(HD-WL:OR 0.91,P=0.69;HD-NBI:OR 1.15,P=0.80).Conclusion HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients.It can be concluded that HD-NBI or HD-WL is not superior to SD-WL,but more effective instruction may be needed to guide the selection of different endoscopic methods in the future.Our study’s conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources,especially advanced imaging technologies.

New endoscopy advances to refine adenoma detection rate for colorectal cancer screening:None is the winner

Colorectal cancer(CRC) is the third most common cancer in males and second in females, and globally the fourth cause for cancer death worldwide. Oncological screening of CRC has a major role in the management of the disease and it is mostly performed by colonoscopy. Anyway, effectiveness of endoscopic screening for CRC strictly depends on adequate detection and removal of potentially precancerous lesions, and accuracy of colonoscopy in detection of adenomas is still suboptimal. For this reason, several technological advances have been implemented in order to improve the diagnostic sensitivity of colonoscopy in adenoma detection. Among these:(1) Visual technologies such as chromoendoscopy and narrow band imaging;(2) optical innovation as high definition endoscopy, full-spectrum endoscopy or Third Eye Retroscope; and(3) mechanical advances as Cap assisted colonoscopy, Endocuff, Endoring and G-Eye endoscope. All these technologies advances have been tested over time by clinical studies with mixed results. Which of them is more likely to be successful in the next future?

Expression of COX-2 and HER-2 in colorectal cancer and their correlation

AIM: To detect the expression of COX-2 and HER-2 in colorectal cancer and to analyze their correlation and clinical significance.METHODS: A total of 1026 colorectal cancer surgical specimens were collected from patients treated fromDecember 2002 to December 2007 at the First Affiliated Hospital of Anhui Medical University. All specimens were made into 4-μm slices. The expression of COX-2 and HER-2 were detected by immunohistochemistry using the streptavidin-biotin-peroxidase method. The correlations between COX-2 and HER-2 expression and colorectal cancer clinical features were analyzed.RESULTS: The positive rates of COX-2 and HER-2 expression in colorectal cancer were 77.97%(800/1026) and 46.20%(474/1026), respectively. There was a significant correlation between COX-2 and HER-2 expression in colorectal cancer(P < 0.05). In patients with tumor size ≥ 5 cm, the positive rates of COX-2 and HER-2 expression were 81.48%(308/378) and 57.94%(219/378), respectively. In patients with serosal invasion, the positive COX-2 and HER-2 expression rates were 80.53%(612/760) and 49.21%(374/760), respectively. In patients with lymph node metastasis, the positive expression rates were 85.04%(506/595) and 54.62%(325/595), respectively, and the positive expression rates differed significantly between patients with lymph node metastasis and those without(P < 0.05). In patients with Duke's C and D colorectal cancer, the positive COX-2 and HER-2 expression rates were 82.80%(443/535) and 57.94%(310/535), respectively. In patients with poorly differentiated colorectal cancer, the positive expression rates were 74.49%(210/282) and 52.84%(149/282), respectively(P < 0.05). In patients with distant metastasis, the positive expression rates were 82.27%(116/141) and 53.90%(76/141), respectively(P < 0.05). These findings suggest that COX-2 and HER-2 have synergistic effects in colorectal cancer. COX-2 and HER-2 expression had no significant correlation with sex, age, or tumor location. CONCLUSION: COX-2 and HER-2 are important markers for invasion and metastasis of colorectal cancer, and they act together to regulate the invasion and metastasis of colorectal cancer.

Global pattern and trends of colorectal cancer survival: a systematic review of population-based registration data

This review will describe the global patterns and trends of colorectal cancer survival,using data from the population-based studies or cancer registration.We performed a systematic search of China National Knowledge Infrastructure(CNKI),Wanfang Data,PubMed,Web of Science,EMBASE,and SEER and collected all population-based survival studies of colorectal cancer(up to June 2020).Estimates of observed and relative survival rates of colorectal cancer by sex,period,and country were extracted from original studies to describe the temporal patterns and trends from the late 1990s to the early 21st century.Globally,5-year observed survival rates were higher in Seoul,Republic of Korea(1993–1997;56.8%and 54.3%for colon and rectum cancers,respectively),Zhejiang province(2005–2010;52.9%for colon cancer),Tianjin(1991–1999;52.5%for colon cancer),Shanghai(2002–2006;50.0%for rectum cancer)of China,and in Japan(1993–1996,59.6%for colorectal cancer).Five-year relative survival rates of colorectal cancer in the Republic of Korea(2010–2014),Queensland,Australia(2005–2012),and the USA(2005–2009)ranked at relatively higher positions compared to other countries.In general,colorectal cancer survival rates are improving over time worldwide.Sex disparities in survival rates were also observed in the colon,rectum,and colorectal cancers in most countries or regions.The poorest age-specific 5-year relative survival rate was observed in patients>75 years of age.In conclusion,over the past 3 decades,colorectal cancer survival has gradually improved.Geographic variations,sex differences,and age gradients were also observed globally in colorectal cancer survival.Further studies are therefore warranted to investigate the prognostic factors of colorectal cancer.

Association of gene and protein expression and genetic polymorphism of CC chemokine ligand 4 in colorectal cancer

BACKGROUND Leukocytes,such as T cells and macrophages,play an important role in tumorigenesis.CC chemokine ligand(CCL)4,which is produced by lymphocytes and macrophages,has been found to be expressed in the mucosa of the gastrointestinal tract and is a potent chemoattractant for various leukocytes.AIM To examine CCL4 expression and its genetic polymorphism rs10491121 in patients with colorectal cancer(CRC)and evaluate their prognostic significance.METHODS Luminex technology was used to determine CCL4 Levels in CRC tissue(n=98),compared with paired normal tissue,and in plasma from patients with CRC(n=103),compared with healthy controls(n=97).Included patients had undergone surgical resection for primary colorectal adenocarcinomas between 1996 and 2019 at the Department of Surgery,Ryhov County Hospital,Jönköping,Sweden.Reverse transcription quantitative PCR was used to investigate the CCL4 gene expression in CRC tissue(n=101).Paired normal tissue and TaqMan single nucleotide polymorphism assays were used for the CCL4 rs10491121 polymorphism in 610 CRC patients and 409 healthy controls.RESULTS The CCL4 protein and messenger RNA expression levels were higher in CRC tissue than in normal paired tissue(90%,P<0.001 and 45%,P<0.05,respectively).CRC tissue from patients with localized disease had 2.8-fold higher protein expression levels than that from patients with disseminated disease.Low CCL4 protein expression levels in CRC tissue were associated with a 30%lower cancer-specific survival rate in patients(P<0.01).The level of plasma CCL4 was 11%higher in CRC patients than in healthy controls(P<0.05)and was positively correlated(r=0.56,P<0.01)with the CCL4 protein level in CRC tissue.The analysis of CCL4 gene polymorphism rs10491121 showed a difference(P<0.05)between localized disease and disseminated disease in the right colon,with a dominance of allele A in localized disease.Moreover,the rate of the A allele was higher among CRC patients with mucinous cancer than among those with nonmucinous cancer.CONCLUSION The present study indicates that the CRC tissue levels of CCL4 and CCL4 gene polymorphism rs10491121,particularly in the right colon,are associated with clinical outcome in CRC patients.

Colorectal cancer fecal screening test completion after age 74,sources and outcomes in French program

BACKGROUND Elderly patients aged at least 75 years old(Elderly_75),represent 45%of colorectal cancer(CRC)incidence.As others,the French Colorectal Cancer Screening Program(CRCSP)does not include Elderly_75.To date,there is little evidence to justify stopping screening at 74 years of age.AIM To describe CRC fecal screening test completion after age 74,source(CRCSP/Provider ordered)and outcomes of these tests.METHODS The study concerned 18704 Elderly_75 residing in eleven French districts(Ain,Doubs,Essonne,Haute-Saone,Hauts-de-Seine,Jura,Seine-Saint-Denis,Territoire-de-Belfort,Val-de-Marne,Val-d'Oise,Yonne),having performed a CRC screening test between January 2008 and December 2017.The tests performed in a circumstance of delayed response to a solicitation(DRS)from the local cancer screening managing center(Managing-Center)were distinguished from the tests non-solicited by the Managing-Center,performed after a recommendation by a General Practitioner(GP)or other provider ordered(RGP).DRS was any test realized by an Elderly_75 following an initial invitation from the ManagingCenter with a maximum 24 mo after this invitation.Any Non-DRS test was considered RGP.The outcomes of these tests were described according to the circumstances of test completion.RESULTS Of 18995 screening-tests were performed at ages:75(83.5%),76-80(13.4%)and>80(3.1%)years old.Elderly_75 performed the screening test in a circumstance of DRS(71.9%)or RGP(28.1%).The proportion of the tests that could not be analyzed and not restarted was 13.2%.For these unanalyzed tests,the reason was age-related in 78.0%of cases,related to the laboratory's refusal to analyze the test of people aged≥77.Reported colonoscopy completion rate was 81.3%.For those575 people with reported colonoscopy,no complication was listed.18.0%of the366 Elderly_75 with lesions had no anteriority in the CRCSP.The neoplasia(124 Low-risk-polyps,159 High-risk-polyps,13 Unspecified-polyps and 70 CRCs)detection rate was 19.3/1000 Elderly_75 screened and the CRC detection rate was3.7/1000 Elderly_75 screened.CONCLUSION The high rate of colonoscopy completion after a positive test and the high proportion of screened lesions observed suggest that the lengthening of the screening period could allow significant detection of CRC and polyps that occur in Elderly_75 excluded from CRCSP.

Endoscopic resection techniques for colorectal neoplasia:Current developments

Endoscopic polypectomy and endoscopic mucosal resection(EMR) are the established treatment standards for colorectal polyps. Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times. Cold snare resection is the emerging standard for the treatment of smaller(< 5 mm) polyps and is possibly also suitable for the removal of noncancerous polyps up to 9 mm. The method avoids thermal damage, has reduced procedure times and probably also a lower risk for delayed bleeding. On the other end of the treatment spectrum, endoscopic submucosal dissection(ESD)offers en bloc resection of larger flat or sessile lesions. The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer. Due to its minimal recurrence rate, it may also be an alternative to fractionated EMR of larger flat or sessile lesions. However, ESD is technically demanding and burdened by longer procedure times and higher costs. It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive cancer.The latest addition to endoscopic resection techniques is endoscopic fullthickness resection with specifically developed devices for flexible endoscopy.This method is very useful for the treatment of smaller difficult-to-resect lesions,e.g., recurrence with scar formation after previous endoscopic resections.

在亚洲的 colorectal 癌症幸存率和预后的概述

Colorectal cancer is a rapidly rising trend in Asia.The incidence in many Asian countries is on par with the West.Several studies have provided data regarding the survival of patients with colorectal cancer.In Asia,the overall cure rate of colorectal cancer has not improved dramatically in the last decade,5-year survival remaining at approximately 60%.Colorectal cancer survival time has increased in recent years,but mortality rate remains high.Although studies have determined a number of factors that can predict survival of patients after diagnosis,life expectancy has not been increased dramatically.It seems that among the prognostic factors explored so far,the most important are those that relate to early diagnosis of cancer.Primary detection is feasible since efficient screening modalities are available.Colonoscopic surveillance is needed,especially in subjects at higher risk.

An update on chemotherapy of colorectal liver metastases

Surgical resection of liver metastases of colorectal cancer greatly improves the clinical outcome of patients with advanced disease. Developments in chemotherapeutic agents and strategies bring hope of a cure to patients with initially unresectable colorectal liver metastases (CLM). Perioperative chemotherapy signif icantly improves the survival time of patients who receive curative-intent hepatectomy. Even for unresectable CLM, recent studies demonstrated that active preoperative chemotherapy could achieve shrinkage of liver metastasis and thus render some for resection. Furthermore, an increase in tumor resection rate and prolonged survival time among patients with CLM has been observed following the application of monoclonal antibodies in recent years. However, the value of chemotherapy via hepatic arterial infusion is still unclear. More trials should be conducted in patients with CLM in order to improve survival.

Risk factors associated with missed colorectal flat adenoma: A multicenter retrospective tandem colonoscopy study

AIM: To determine the miss rate for colorectal flat adenomas during colonoscopy and the risk factors.METHODS: Flat adenomas are frequently missed during colonoscopy. However, the risk factors that influence their miss rates are unclear. This was a multicenter,retrospective study in which patients diagnosed with colorectal adenomas at a diagnostic colonoscopy and followed within 3 mo by a second therapeutic colonos-copy were pooled out from the established database. The "per-patient" and "per-adenoma" adenoma miss rates(AMR) for overall adenomas and flat adenomas, and patient-, adenoma-, and procedure-related risk factors potentially associated with the "per-adenoma" AMR for flat adenomas were determined.RESULTS: Chromoscopy and high-definition colonoscopy were not taken under consideration in the study. Among 2093 patients with colorectal adenomas, 691(33.0%) were diagnosed with flat adenomas, 514 with concomitant protruding adenomas and 177 without. The "per-patient" AMR for flat adenomas was 43.3%(299/691); the rates were 54.3% and 11.3%, respectively, for those with protruding adenomas and those without(OR = 9.320, 95%CI: 5.672-15.314, χ2 = 99.084, P < 0.001). The "per-adenoma" AMR for flat adenomas was 44.3%(406/916). In multivariate analysis, older age, presence of concomitant protruding adenomas, poor bowel preparation, smaller adenoma size, location at the right colon, insufficient experience of the colonoscopist, and withdrawal time < 6 min were associated with an increased "per-adenoma" AMR for flat adenomas. The AMR for flat adenomas was moderately correlated with that for overall adenomas(r = 0.516, P < 0.0001). The AMR for flat adenomas during colonoscopy was high.CONCLUSION: Patient's age, concomitant protruding adenomas, bowel preparation, size and location of adenomas, proficiency of the colonoscopist, and withdrawal time are factors affecting the "per-adenoma" AMR for flat adenomas.

Retrograde inspection vs standard forward view for the detection of colorectal adenomas during colonoscopy: A back-to-back randomized clinical trial

BACKGROUND The adenoma detection rate(ADR)is inversely associated with the incidence of interval colorectal cancer and serves as a benchmark quality criterion during screening colonoscopy.However,adenoma miss rates reach up to 26%and studies have shown that a second inspection of the right colon in retroflected view(RFV)can increase ADR.AIM To assess whether inspection of the whole colon in RFV compared to standard forward view(SFV)can increase ADR.METHODS Patients presenting for screening or surveillance colonoscopy were invited to participate in this randomized controlled trial and randomized into two arms.In RFV arm colonoscopy was initially performed with SFV,followed by a second inspection of the whole colon in RFV.In the SFV arm first withdrawal was performed with SFV,followed by a second inspection of the whole colon again with SFV.Number,size and morphology of polyps found during first and second inspection in each colonic segment were recorded and all polyps were removed and sent for histopathology in separate containers.RESULTS Two hundred and five patients were randomly assigned to the RFV(n=101)and SFV(n=104)arm.In the RFV arm,both polyp detection rate(PDR)and ADR were increased under second inspection in RFV(PDR 1st SFV:39.8%,PDR 2nd RFV:46.6%;ADR 1st SFV:35.2%,ADR 2nd RFV:42%).Likewise,in the SFV arm,PDR and ADR were increased under second inspection(PDR 1st SFV:37.5%,PDR 2nd SFV:46.6%;ADR 1st SFV:34.1%,ADR 2nd SFV:44.3%)with no significant differences in ADR and PDR between the SFV and RFV arm.Mean number of adenomas per patient(APP)was increased in the RFV and SFV(APP RFV arm:1st SFV:1.71;2nd RFV:2.38;APP SFV arm:1st SFV:1.83,2nd SFV:2.2).The majority of adenomas additionally found during second inspection in RFV or in SFV were located in the transverse and left-sided colon and were>5 mm in size.CONCLUSION Second inspection of the whole colon leads to increased adenoma detection with no differences between SFV and RFV.Hence,increased detection is most likely a feature of the second inspection itself but not of the inspection mode.

Enteral stents for the management of malignant colorectal obstruction

Colorectal cancer(CRC) is the 3rd most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient's quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may beused to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient's condition for curative surgical intervention. An overall complication rate(major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.

Colorectal carcinoma in a Southern Mediterranean country: The Libyan scenario

AIM: To study the salient features of colorectal cancer(CRC) in Libya.METHODS: Patients records were gathered at the primary oncology clinic in eastern Libya for the period of one calendar year(2012). Using this data, various parameters were analyzed and age-standardized incidence rates were determined using the direct method and the standard population.RESULTS: During 2012, 174 patients were diagnosed with CRC, 51.7%(n = 90) male and 48.3%(n = 84) females. The average age was 58.7(± 13.4) years, with men around 57.3(± 13) years old and women usually 60.1(± 13.8) years of age. Libya has the highest rate of CRC in North Africa, with an incidence closer to the European figures. The age-standardized rate for CRC was 17.5 and 17.2/100000 for males and females respectively. It was the second most common cancer, forming 19% of malignancies, with fluctuation in ranking and incidence in different cities/villages. Increasingly, younger ages are being afflicted and a higher proportion of patients are among the > 40 years subset.Nearly two-thirds presented at either stage Ⅲ(22.4%) or Ⅳ(38.4%).CONCLUSION: Cancer surveillance systems should be established in order to effectively monitor the situation. Likewise, screening programs are invaluable in the Libyan scenario given the predominance of sporadic cases.

腹腔镜结直肠癌根治术治疗结直肠癌的疗效

目的 探究分析腹腔镜结直肠癌根治术治疗结直肠癌的疗效。方法 选取2019年2月至2023年1月我院普外科收治的50例结直肠癌患者作为研究对象,随机分为对照组(开腹手术)与观察组(腹腔镜结直肠癌根治术),对比两组的治疗效果、临床相关指标、应激反应状态、炎症因子水平、胃动素与胃泌素水平、并发症发生率以及生活质量。结果 观察组治疗效果、临床相关指标、应激反应状态、炎症因子水平、胃动素与胃泌素水平、并发症发生率以及生活质量均优于对照组(P <0.05)。结论 腹腔镜结直肠癌根治术可显著改善患者病情状态、临床效果、并发症发生情况以及生活质量,安全可靠。

县域医共体模式下提高结直肠癌重点人群肠镜筛查依从率及早癌检出率的研究

目的研究县域医共体模式下结直肠癌重点人群肠镜筛查依从率及早癌检出率情况。方法选取2020~2022年德清县大肠癌筛查民生项目中大肠癌初筛阳性8549例,依据随机数字表法分为实验组(采用“最多跑一次”结直肠癌流程)和对照组(采用正常预约肠镜流程)。比较两组其肠镜检查依从性和早癌检出率。结果实验组2020~2022年结肠镜依从率分别为64.55%、54.36%、64.65%,明显高于对照组的46.19%、37.08%、34.21%,差异均有统计学意义(χ^(2)分别=61.51、47.45、132.38,P均<0.05)。实验组2020~2022年早癌检出率分别为7.65%、8.05%、8.05%,明显高于对照组的5.10%、4.63%、3.74%,差异均有统计学意义(χ^(2)分别=5.74、9.17、14.36,P均<0.05)。结论通过发挥发展同质错位、资源统一调配、数据共享互通、上下贯通的医共体优势,在大肠癌筛查中设计出“最多跑一次”结直肠癌筛查流程,能够显著提高阳性人群的肠镜依从性,从而提高了早癌的检出率。

At-home cancer screening:a solution for China and other developing countries with a large population and limited number of healthcare practitioners

Five-year survival rate for patients with all cancers combined, in China, is only 30.9%, which is much lower than those in developed countries. The three main reasons for the low cancer curative rates in China include differences in the spectrum of cancer types, in early detection rates, and in the percentage of cancer patients receiving standardized treatment between China and developed countries.The most important mechanism for improving the curative rate is to improve early detection rates of major cancers in China using novel and affordable technologies that can be operated at home by the patients themselves.This attempt could be helpful in setting up a practical example for other developing countries with limited medical resources and a limited number of healthcare practitioners.

Adenoma and advanced neoplasia detection rates increase from 45 years of age

BACKGROUND Colonoscopy is considered a valid primary screening tool for colorectal cancer(CRC). The decreasing risk of CRC observed in patients undergoing colonoscopy is correlated with the adenoma detection rate(ADR). Due to the fact that screening programs usually start from the age of 50, very few data are available on the risk of adenoma between 40 and 49 years. However, the incidence of CRC is increasing in young populations and it is not uncommon in routine practice to detect adenomas or even advanced neoplasia during colonoscopy in patients under 50 years.AIM To compare the ADR and advanced neoplasia detection rate(ANDR) according to age in a large series of patients during routine colonoscopy.METHODS All consecutive patients who were scheduled for colonoscopy were included.Exclusion criteria were as follows: patients scheduled for partial colonoscopy or interventional colonoscopy(for stent insertion or stenosis dilation).Colonoscopies were performed in our unit by a team of 30 gastroenterologists in2016. We determined the ADR and ANDR in each age group in the whole population and in the population with an average risk of CRC(excluding patients with personal or family history of advanced adenoma or cancer).RESULTS6027 colonoscopies were performed in patients with a median age of 57 years(range, 15-96). The ADR and ANDR were 28.6% and 9.7%, respectively, in the whole population. When comparing patients aged 40-44(n = 382) and 45-49 years (n = 515), a strong increase in all parameters from 45 years was observed, with the ADR rising from 9.7% in patients aged 40-44 to 21.2% between 45 and 49(P <0.001) and the ANDR increasing from 3.1% in patients aged 40-44 to 6.4% in those aged 45-49 years(P < 0.03). With regard to patients aged 50-54(n = 849), a statistically significant increase in the ADR and ANDR was not observed between patients aged 45-49 and those aged 50-54 years. In the population with an average risk of CRC, the ADR and ANDR were still significantly higher in patients aged 45-49 compared with those aged 40-44 years.CONCLUSION This study shows a significant two-fold increase in the ADR and ANDR in patients aged 45 years and over.