ABSTRACT
Purpose@#Renin-angiotensin system (RAS) is involved in the pathophysiology of colonic inflammation. The aim of this study was to investigate whether small angiotensins (Angs) peptides play a role in the regulation of colonic motility and their roles are modulated in colitis. @*Methods@#Experimental colitis was induced by an intake of 5% dextran sulfate sodium (DSS) dissolved in tap water for 7 days in Sprague-Dawley rats. After sacrifice, plasma hormone concentrations and messenger RNAs (mRNAs) for RAS were measured. Functional analysis of colonic motility in response to Angs peptides was performed using Taenia coli. @*Results@#DSS-treated colon showed an increased necrosis with massive infiltration of inflammatory cells. The mRNA level of colonic angiotensin II receptor type 2 (AT2R) in DSS-treated rats was higher than that in control rats whereas the mRNA levels of angiotensin II converting enzyme (ACE), ACE2, AT1R, AT4R, and Mars receptor were not different from those in control rats. Ang III, Ang IV, and Ang-(1-9) (1, 3 μM) increased the frequency of basal colonic motility. Ang-(1-7) did not cause any significant changes in frequency and amplitude of basal motility. The order of potency for an increased frequency of basal motility seems to be Ang II>>Ang IV>Ang III=Ang-(1-9). The increased frequency of basal motility by Ang-(1-9) but not Ang IV was significantly enhanced in DSS-treated rat colon. @*Conclusion@#In conclusion, these data suggest that small Angs peptides are partly involved in the pathophysiological regulation of colonic motility in experimental colitis.
ABSTRACT
Indocyanine green (ICG) could be applied for multiple functions such as fluorescent tumor localization, fluorescence lymph node mapping (FLNM), and intraoperative angiography in colorectal cancer surgery. With the near-infrared (NIR) systems, colonoscopic ICG tattooing can be used to define the early colorectal cancer that cannot be easily distinguished through the serosal surface. The lymphatic pathways can be visualized under the NIR system when ICG is injected through the submucosal or subserosal layer around the tumor. Intraoperative ICG angiography can be applied to find a favorable perfusion segment before the colon transection. Although all fluorescence functions are considered essential steps in image-guided surgery, it is difficult to perform multifunctional ICG applications in a single surgical procedure at once because complex protocols could interfere with each other. Therefore, we review the multifunctional ICG applications for fluorescent tumor localization, FLNM, and ICG angiography. We also discuss the optimal protocol for fluorescence-guided colorectal surgery.
ABSTRACT
Rare cases of Fournier gangrene (FG) possibly associated with sodium-glucose cotransporter 2 inhibitors have been reported. We present a case of a 66-year-old male patient with type 2 diabetes mellitus on oral metformin, glimepiride, and dapagliflozin therapy. He presented with pain in the perineum and scrotum for 5 days. The clinical finding, computed tomography finding, and laboratory data were matched with FG. Emergency surgical drainage, debridement of necrotic tissue, and diverting loop ileostomy formation were performed by a urologist and a surgeon. The patient had no complications from diabetes before the onset of FG, and serum glucose management was good at the onset of FG. This case shows an FG patient with good glucose management taking dapagliflozin and suggests a possible association between dapagliflozin and FG. Further evaluation and additional research on this relationship are needed.
ABSTRACT
Indocyanine green (ICG) could be applied for multiple functions such as fluorescent tumor localization, fluorescence lymph node mapping (FLNM), and intraoperative angiography in colorectal cancer surgery. With the near-infrared (NIR) systems, colonoscopic ICG tattooing can be used to define the early colorectal cancer that cannot be easily distinguished through the serosal surface. The lymphatic pathways can be visualized under the NIR system when ICG is injected through the submucosal or subserosal layer around the tumor. Intraoperative ICG angiography can be applied to find a favorable perfusion segment before the colon transection. Although all fluorescence functions are considered essential steps in image-guided surgery, it is difficult to perform multifunctional ICG applications in a single surgical procedure at once because complex protocols could interfere with each other. Therefore, we review the multifunctional ICG applications for fluorescent tumor localization, FLNM, and ICG angiography. We also discuss the optimal protocol for fluorescence-guided colorectal surgery.
ABSTRACT
Rare cases of Fournier gangrene (FG) possibly associated with sodium-glucose cotransporter 2 inhibitors have been reported. We present a case of a 66-year-old male patient with type 2 diabetes mellitus on oral metformin, glimepiride, and dapagliflozin therapy. He presented with pain in the perineum and scrotum for 5 days. The clinical finding, computed tomography finding, and laboratory data were matched with FG. Emergency surgical drainage, debridement of necrotic tissue, and diverting loop ileostomy formation were performed by a urologist and a surgeon. The patient had no complications from diabetes before the onset of FG, and serum glucose management was good at the onset of FG. This case shows an FG patient with good glucose management taking dapagliflozin and suggests a possible association between dapagliflozin and FG. Further evaluation and additional research on this relationship are needed.
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Purpose@#The role of adjuvant chemotherapy for patients with ypT0–2N0 rectal cancer following neoadjuvantchemoradiotherapy (nCRT) and curative surgery is uncertain. We performed a meta-analysis using selected studies tocompare adjuvant chemotherapy with observation for this cohort of patients. @*Methods@#PubMed, Embase, and the Cochrane Library were searched. Data were pooled, and overall effect size wascalculated using random effect models. Outcome measures were 5-year overall survival (OS), disease-free survival (DFS),local, and distant recurrence. @*Results@#We included 17 nonrandomized studies for qualitative analysis and 16 nonrandomized studies that examined 4,747patients for the meta-analysis. In analysis of patients with ypT0N0 rectal cancer, adjuvant chemotherapy had no significanteffect on OS (odds ratio [OR], 1.53; 95% confidence interval [CI], 0.86–2.72; I2 = 27%), DFS (OR, 1.22; 95% CI, 0.61–2.42; I2 =5%), local recurrence (OR, 0.78; 95% CI, 0.08–7.37; I2 = 0%), and distant recurrence (OR, 1.04; 95% CI, 0.41–2.62; I2 = 0%).In analysis of patients with ypT1–2N0 rectal cancer, adjuvant chemotherapy also had no significant effect on OS (OR, 2.15;95% CI, 0.59–7.80; I2 = 26%), DFS (OR, 1.66; 95% CI, 0.35–7.85; I2 = 44%), local recurrence (OR, 2.56; 95% CI, 0.72–9.13; I2 =0%), and distant recurrence (OR, 1.15; 95% CI, 0.23–5.87; I2 = 0%). @*Conclusion@#Adjuvant chemotherapy may have no oncologic benefits in patients with ypT0–2N0 rectal cancer after nCRTand radical surgery. Routine use of adjuvant chemotherapy for those patients may be avoided.
ABSTRACT
Purpose@#The role of adjuvant chemotherapy for patients with ypT0–2N0 rectal cancer following neoadjuvantchemoradiotherapy (nCRT) and curative surgery is uncertain. We performed a meta-analysis using selected studies tocompare adjuvant chemotherapy with observation for this cohort of patients. @*Methods@#PubMed, Embase, and the Cochrane Library were searched. Data were pooled, and overall effect size wascalculated using random effect models. Outcome measures were 5-year overall survival (OS), disease-free survival (DFS),local, and distant recurrence. @*Results@#We included 17 nonrandomized studies for qualitative analysis and 16 nonrandomized studies that examined 4,747patients for the meta-analysis. In analysis of patients with ypT0N0 rectal cancer, adjuvant chemotherapy had no significanteffect on OS (odds ratio [OR], 1.53; 95% confidence interval [CI], 0.86–2.72; I2 = 27%), DFS (OR, 1.22; 95% CI, 0.61–2.42; I2 =5%), local recurrence (OR, 0.78; 95% CI, 0.08–7.37; I2 = 0%), and distant recurrence (OR, 1.04; 95% CI, 0.41–2.62; I2 = 0%).In analysis of patients with ypT1–2N0 rectal cancer, adjuvant chemotherapy also had no significant effect on OS (OR, 2.15;95% CI, 0.59–7.80; I2 = 26%), DFS (OR, 1.66; 95% CI, 0.35–7.85; I2 = 44%), local recurrence (OR, 2.56; 95% CI, 0.72–9.13; I2 =0%), and distant recurrence (OR, 1.15; 95% CI, 0.23–5.87; I2 = 0%). @*Conclusion@#Adjuvant chemotherapy may have no oncologic benefits in patients with ypT0–2N0 rectal cancer after nCRTand radical surgery. Routine use of adjuvant chemotherapy for those patients may be avoided.
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PURPOSE: The management of primary tumors in patients with stage IV colorectal cancer remains unclear. This meta-analysis evaluated the survival benefits of primary tumor resection (PTR) in patients with unresectable stage IV colorectal cancer in the era of modern chemotherapy. METHODS: Multiple comprehensive databases were searched for studies comparing survival outcomes in patients with metastatic colorectal cancer who did and did not undergo PTR. Outcome data were pooled, and overall effect size was calculated using random effect models. RESULTS: Seventeen nonrandomized studies involving 18,863 patients met the inclusion criteria. Meta-analysis showed that PTR significantly improved overall survival (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.56–0.71; P < 0.001) and progression free survival (HR, 0.76; 95% CI, 0.67–0.87; P < 0.001). Subgroup analyses and sensitivity analyses, performed by predefined methods, also indicated that PTR improved overall patient survival. CONCLUSION: Palliative resection of the primary tumor may have survival benefits in patients with unresectable stage IV colorectal cancer. Randomized controlled trials are needed to determine the optimal treatment for these patients.
Subject(s)
Humans , Colorectal Neoplasms , Colorectal Surgery , Disease-Free Survival , Drug Therapy , Palliative Care , PrognosisABSTRACT
PURPOSE: This study assessed optimal management of colonic diverticulitis as functions of disease location and severity and factors associated with complicated diverticulitis. METHODS: This retrospective review analyzed 202 patients diagnosed between 2007 and 2014 at Chonbuk National University Hospital, South Korea, with colonic diverticulitis by using abdominopelvic computed tomography. Diverticulitis location was determined, and disease severity was categorized using the modified Hinchey classification. RESULTS: Patients included 108 males (53.5%) and 94 females (46.5%); of these, 167 patients (82.7%) were diagnosed with right-sided and 35 (17.3%) with left-sided colonic diverticulitis. Of the 167 patients with right-sided colonic diverticulitis, 12 (7.2%) had complicated and 155 (92.8%) had uncomplicated diverticulitis; of these, 157 patients (94.0%) were successfully managed conservatively. Of the 35 patients with left-sided colonic diverticulitis, 23 (65.7%) had complicated and 12 (34.3%) had uncomplicated diverticulitis; of these, 23 patients (65.7%) were managed surgically. Among patients with right-sided diverticulitis, those with complicated disease were significantly older (54.3 ± 12.7 years vs. 42.5 ± 13.4 years, P = 0.004) and more likely to be smokers (66.7% vs. 32.9%, P = 0.027) than those with uncomplicated disease. However, among patients with left-sided diverticulitis, those with complicated disease had significantly lower body mass index (BMI; 21.9 ± 4.7 kg/m² vs. 25.8 ± 4.3 kg/m², P = 0.021) than those with uncomplicated disease. CONCLUSION: Conservative management may be effective in patients with right-sided diverticulitis and patients with uncomplicated left-sided colonic diverticulitis. Surgical management may be required for patients with complicated left-sided diverticulitis. Factors associated with complicated diverticulitis include older age, smoking and lower BMI.
Subject(s)
Female , Humans , Male , Body Mass Index , Classification , Colon , Diverticulitis , Diverticulitis, Colonic , Korea , Retrospective Studies , Risk Factors , Smoke , Smoking , Treatment OutcomeABSTRACT
PURPOSE: Anastomotic leakage following low anterior resection (LAR) for rectal cancer is a serious complication that increases morbidity and mortality rates. Transanal tube placement may reduce postoperative anastomotic leakage rate by reducing intraluminal pressure and preventing fecal extrusion through the staple line. This meta-analysis evaluated the effectiveness of transanal tube placement to prevent anastomotic leakage after LAR for rectal cancer using a stapling technique. METHODS: A systematic review of the literature was consistent with the recommendations of the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement. Multiple comprehensive databases, including PubMed, Embase, Cochrane Library and KoreaMed, were searched. The main study outcomes were anastomotic leakage. RESULTS: Two randomized clinical trials and 4 nonrandomized studies involving 1,118 patients were included. Subgroup analyses of randomized clinical trials found that transanal tube placement had no effect on study outcomes. Meta-analysis of nonrandomized studies showed that transanal tube placement was associated with a lower incidence of anastomotic leakage (relative risk, 0.32; 95% CI, 0.15-0.67; I2 = 0%). CONCLUSION: Transanal tube placement may be effective in preventing or reducing the occurrence of anastomotic leakage after LAR for rectal cancer using a stapling technique. Randomized clinical trials with sufficient power are needed to confirm the benefit of transanal tube placement.
Subject(s)
Humans , Anastomotic Leak , Colorectal Neoplasms , Colorectal Surgery , Incidence , Mortality , Rectal NeoplasmsABSTRACT
PURPOSE: The aim of this study was to investigate the clinical outcome of additional breast lesions identified with breast magnetic resonance imaging (MRI) in breast cancer patients. METHODS: A total of 153 patients who underwent breast MRI between July 2006 and March 2008 were retrospectively reviewed. Thirty-three patients (21.6&) were recommended for second-look ultrasound (US) for further characterization of additional lesions detected on breast MRI and these patients constituted our study population. RESULTS: Assessment for lesions detected on breast MRI consisted of the following: 25 benign lesions (73.5&), two indeterminate (5.9%), and seven malignant (20.6%) in 33 patients. Second-look US identified 12 additional lesions in 34 lesions (35.3%) and these lesions were confirmed by histological examination. Of the 12 lesions found in the 11 patients, six (50.0%) including one contralateral breast cancer were malignant. The surgical plan was altered in 18.2% (six of 33) of the patients. The use of breast MRI justified a change in treatment for four patients (66.7%) and caused two patients (33.3&) to undergo unwarranted additional surgical procedures. CONCLUSION: Breast MRI identified additional multifocal or contralateral cancer which was not detected initially on conventional imaging in breast cancer patients. Breast MRI has become an indispensable modality in conjunction with conventional modalities for preoperative evaluation of patients with operable breast cancer.
Subject(s)
Humans , Breast , Breast Neoplasms , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Magnetics , Magnets , Retrospective StudiesABSTRACT
PURPOSE: The selection of systemic therapy for breast cancer is based on the expression pattern of biological prognostic markers. Neoadjuvant chemotherapy has been considered the standard care for locally advanced breast cancer. However, its effect on the expression of biological prognostic markers is controversial. The aim of this study was to determine whether neoadjuvant chemotherapy may alter these expression patterns in patients suffering with breast cancer. METHODS: We determined the protein expression levels of estrogen receptor (ER), progesterone receptor (PR), p53 and HER-2/neu in the preoperative core needle biopsies and the final surgical specimens from 15 patients who received neoadjuvant chemotherapy between January 2002 and June 2007. As a control group, we analyzed the samples from patients who did not receive neoadjuvant chemotherapy. RESULTS: The pathologic complete tumor response rate (pCR) of the neoadjuvant chemotherapy group was 6.7% (1/15). Of those patients who did not achieve a pCR (n=14), no significant differences in the biological prognostic markers expression were observed between the two groups. Alteration of the ER or PR status occurred in 42.8% (6/14) of the patients after neoadjuvant chemotherapy and in 14.3% (2/14) of the control patients, showing there was no significant difference between the two groups (P=0.210). The hormonal receptor status was changed in 3 cases (21.4%) after neoadjuvant chemotherapy. CONCLUSION: There were no significant differences for the changes in the expression of ER, PR, p53 and HER-2/neu from the preoperative core needle biopsy to the final surgical specimens between those patients who had received neoadjuvant chemotherapy and those patients who didn't. However, changes of the ER or PR status and the hormonal receptor status occurred in 42.8% and 21.4%, respectively, of the patients who underwent neoadjuvant chemotherapy. As these changes may impact treatment, we suggest that immunohistochemical assay is necessary before and after neoadjuvant chemotherapy in patients with breast cancer.
Subject(s)
Humans , Biopsy, Large-Core Needle , Breast , Breast Neoplasms , Estrogens , Polymerase Chain Reaction , Receptors, Progesterone , Stress, PsychologicalABSTRACT
PURPOSE: The selection of systemic therapy for breast cancer is based on the expression pattern of biological prognostic markers. Neoadjuvant chemotherapy has been considered the standard care for locally advanced breast cancer. However, its effect on the expression of biological prognostic markers is controversial. The aim of this study was to determine whether neoadjuvant chemotherapy may alter these expression patterns in patients suffering with breast cancer. METHODS: We determined the protein expression levels of estrogen receptor (ER), progesterone receptor (PR), p53 and HER-2/neu in the preoperative core needle biopsies and the final surgical specimens from 15 patients who received neoadjuvant chemotherapy between January 2002 and June 2007. As a control group, we analyzed the samples from patients who did not receive neoadjuvant chemotherapy. RESULTS: The pathologic complete tumor response rate (pCR) of the neoadjuvant chemotherapy group was 6.7% (1/15). Of those patients who did not achieve a pCR (n=14), no significant differences in the biological prognostic markers expression were observed between the two groups. Alteration of the ER or PR status occurred in 42.8% (6/14) of the patients after neoadjuvant chemotherapy and in 14.3% (2/14) of the control patients, showing there was no significant difference between the two groups (P=0.210). The hormonal receptor status was changed in 3 cases (21.4%) after neoadjuvant chemotherapy. CONCLUSION: There were no significant differences for the changes in the expression of ER, PR, p53 and HER-2/neu from the preoperative core needle biopsy to the final surgical specimens between those patients who had received neoadjuvant chemotherapy and those patients who didn't. However, changes of the ER or PR status and the hormonal receptor status occurred in 42.8% and 21.4%, respectively, of the patients who underwent neoadjuvant chemotherapy. As these changes may impact treatment, we suggest that immunohistochemical assay is necessary before and after neoadjuvant chemotherapy in patients with breast cancer.