Protocolo de recuperación mejorada después de cirugía (ERAS) atenúa el estrés y acelera la recuperación en pacientes después de resección radical por cáncer colorrectal: Experiencia en la Clínica Universitaria Colombia / Enhanced Recovery After Surgery (ERAS) protocol attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: Experience at Clínica Universitaria Colombia

Introducción. El conjunto de estrategias de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) constituye un enfoque de atención multimodal y multidisciplinario, cuyo propósito es reducir el estrés perioperatorio de la cirugía, disminuir la morbilidad y acortar la estancia hospitalaria. Este estudio tuvo como objetivo describir los resultados clínicos de pacientes sometidos a cirugía por cáncer colorrectal, identificando las complicaciones principales y los factores perioperatorios relacionados con el alta temprana. Métodos. Se analizaron los pacientes consecutivos sometidos a cirugía colorrectal entre los años 2020 y 2023, todos los cuales siguieron el protocolo ERAS institucional. Se evaluaron las características clínicas, los factores perioperatorios, los desenlaces postoperatorios y la tasa global de adherencia al protocolo. Resultados. Un total de 456 pacientes fueron sometidos a cirugía colorrectal, 51% de sexo masculino, con edad media de 60 años. La mayoría de las intervenciones se realizaron por laparoscopia (78 %), con una tasa de conversión del 14,5 %. Las complicaciones postoperatorias incluyeron fuga anastomótica (4,6 %), sangrado, infección intraabdominal y obstrucción intestinal. La estancia hospitalaria promedio fue de 4 días y la mortalidad del 2,8 %. La tasa global de adherencia al protocolo ERAS fue del 84,7 %. Conclusiones. El enfoque combinado de cirugía laparoscópica y protocolo ERAS es factible, seguro y se asocia con una estancia hospitalaria más corta. La implementación y adherencia al protocolo ERAS no solo mejora los resultados postoperatorios, sino que también resalta la importancia de acceder a datos sólidos, permitiendo mejorar la atención perioperatoria local.

Introduction. The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, multidisciplinary approach to care, the purpose of which is to reduce the perioperative stress of surgery, decrease morbidity, and shorten hospital stay. This study aimed to describe the clinical outcomes of patients undergoing surgery for colorectal cancer, identifying the main complications and perioperative factors related to early discharge. Methods. Consecutive patients undergoing colorectal surgery between 2020 and 2023 were analyzed, who followed the institutional ERAS protocol. Clinical characteristics, perioperative factors, postoperative outcomes, and overall protocol adherence rate were evaluated. Results. A total of 456 patients underwent colorectal surgery, 51% male, with a mean age of 60 years. Most interventions were performed laparoscopically (78%), with a conversion rate of 14.5%. Postoperative complications included anastomotic leak (4.6%), followed by bleeding, intra-abdominal infection, and intestinal obstruction. The average hospital stay was 4 days and mortality was 2.8%. The overall adherence rate to the ERAS protocol was 84.7%. Conclusions. The combined approach of laparoscopic surgery and ERAS protocol is feasible, safe, and associated with a shorter hospital stay. Implementation and adherence to the ERAS protocol not only improves postoperative outcomes, but also highlights the importance of accessing solid data, allowing for improved local perioperative care.

Logistíca e resultados de um programa de prevenção do câncer colorretal em um município do Sertão de Alagoas / Logistics and results of a colorectal cancer screening program in a municipality in the hinterland of alagoas

ABSTRACT Background: Colorectal cancer (CRC) has high mortality rates worldwide. In Brazil, it is the second most common cancer in both sexes. Delay in detecting premalignant lesions contributes to increased morbidity and mortality. In this scenario, the Piranhas project was created to track CRC in a low-income population in the hinterland of Alagoas. Objective: The study aimed to establish the main strategies and verify the feasibility of implementing a CRC tracking program and demonstrate the results obtained in the CRC Prevention Campaign in Piranhas/AL. Methods: The program took place in Piranhas, Alagoas, Brazil, through public-private partnerships. Individuals aged between 50 and 70 years of age were included for screening with a fecal occult blood test (FOBT) and colonoscopy in positive cases. Patient data were collected on standard forms. Results: A total of 2152 patients, aged between 50 and 70 years, were screened, 130 of which underwent colonoscopy. Several preneoplastic lesions were detected in 58 patients. The adenoma detection rate (ADR) was 33.85%. Conclusion: The study proved to be effective and viable since 44.6% of the program participants, who underwent screening with FOBT, followed by colonoscopy in positive cases, had some type of preneoplastic lesion. In addition, the program generated a significant social impact on the population of Piranhas due to the opportunity to diagnose and treat CRC precursor lesions.

RESUMO Contexto: O câncer colorretal (CCR) possui altas taxas de mortalidade em todo mundo. No Brasil é o segundo câncer mais comum em ambos os sexos. O atraso na detecção de lesões pré-malignas contribui com o aumento da morbimortalidade. Neste cenário, o projeto Piranhas foi criado para rastrear o CCR em uma população carente do sertão alagoano. Objetivo: O estudo teve como meta estabelecer as principais estratégias e verificar a viabilidade da implementação de um programa de rastreamento do CCR, assim como demonstrar os resultados obtidos na Campanha de prevenção de CCR no município de Piranhas/AL. Métodos: O programa aconteceu em Piranhas, Alagoas, Brasil, através de parcerias público-privadas. Foram incluídos indivíduos entre 50 e 70 anos para triagem com pesquisa de sangue oculto nas fezes (PSOF) e colonoscopia dos casos positivos. Os dados dos pacientes foram coletados em formulários padrão. Resultados: Foram rastreados um total de 2152 pacientes com idade entre 50 e 70 anos, sendo destes, 130 submetidos à colonoscopia. Várias lesões pré-neoplásicas foram detectadas em 58 pacientes. A taxa de detecção de adenoma foi de 33,85%. Conclusão: O estudo demonstrou-se eficaz e viável, uma vez que 44,6% dos participantes do programa que realizaram a triagem com PSOF seguido de colonoscopia nos casos positivos apresentava algum tipo de lesão pré-neoplásica. Além disso, o programa gerou grande impacto social na população de Piranhas, pela oportunidade de diagnóstico e tratamento de lesões precursoras do CCR.

Laparorrafia en pacientes con cáncer colorrectal. Hospital Enrique Cabrera, 2019-2021

Fundamento aún no se ha establecido una técnica ideal que permita realizar el cierre laparotómico que garantice la disminución de complicaciones. Objetivo comparar los resultados del cierre de la pared abdominal mediante puntos subtotales internos y puntos totales en pacientes intervenidos por cáncer colorrectal. Métodos: se realizó un estudio descriptivo, prospectivo y transversal en el Hospital General Docente Dr. Enrique Cabrera, en el trienio 2019-2021, con 80 pacientes intervenidos por cáncer colorrectal. Se empleó la prueba Chi-cuadrado, la prueba exacta de Fisher y la prueba U de Mann-Whitney, entre otros. Resultados el tumor se localizó en colon sigmoide en 35 % de los casos de los pacientes con cierre de puntos totales; y en 31,7 % del grupo con cierre mediante puntos subtotales. La cirugía fue urgente en 80 % del grupo con cierre de puntos totales; y electiva en 75 % de los de cierre con puntos subtotales. La incisión fue media supra e infraumbilical en 70 % de los pacientes del grupo con cierre de puntos totales; y xifopubiana en 66,7 % de los del cierre con puntos subtotales. Se presentaron medianas de 3 ± 2 y 1 ± 0 complicaciones para los de cierre con puntos totales y cierre con puntos subtotales, respectivamente. La mediana de la estadía hospitalaria fue mayor en el grupo con cierre de puntos totales (8 ± 6 días). Conclusiones en los pacientes donde se aplicaron puntos subtotales internos para el cierre de la pared abdominal, los resultados fueron mejores que en grupo donde se emplearon puntos totales.

Foundation an ideal technique has not been established yet to allow laparotomic closure to guarantee the reduction of complications. Objective to compare the results of abdominal wall closure using internal subtotal points and total points in patients operated on for colorectal cancer. Methods a descriptive, prospective and cross-sectional study was carried out at the Dr. Enrique Cabrera General Teaching Hospital, from 2019 to 2021, with 80 patients operated on for colorectal cancer. The Chi-square test, Fisher's exact test and the Mann-Whitney U test, among others, were used. Results the tumor was located in the sigmoid colon in 35% of patients with total suture closure; and in 31.7% of the group with closure by subtotal points. Surgery was urgent in 80% of the group with total stitch closure; and elective in 75% of the closing cases with subtotal points. The incision was median supra and infraumbilical in 70% of the patients in the group with total suture closure; and xiphopubic in 66.7% of those at closure with subtotal points. There were medians of 3 ± 2 and 1 ± 0 complications for closure with total stitches and closure with subtotal stitches, respectively. Median hospital stay was longer in the total stitch closure group (8 ± 6 days). Conclusions in the patients where internal subtotal sutures were applied for abdominal wall closure, the results were better than in the group where total sutures were used.

Cáncer colorrectal post-colonoscopia: Evaluación de una cohorte en sus características clínicas, colonoscópicas, sobrevida y sus causas según la Organización Mundial de Endoscopia

Cáncer colorrectal post-colonoscopia (CCRP) es el tumor que aparece posterior a una colonoscopia normal antes de cumplirse el tiempo establecido para seguimiento endoscópico. Origen multifactorial, refleja la calidad de la colonoscopia y las diferentes biologías tumorales entre los cánceres colorrectales detectados (CCRD) y el CCRP. Nuestro objetivo es describir las características del CCRP en nuestro medio, identificar factores de riesgo, discriminar sus causas según la Organización Mundial de Endoscopia (OME) y determinar el efecto en la sobrevida del paciente. El estudio se realizó en pacientes con cáncer-colorrectal (CCR) atendidos en consulta de gastro-oncología de dos instituciones en Medellín-Colombia, entre enero de 2012 y diciembre de 2021 que se habían sometido a una colonoscopia en los 6 a 36 meses anteriores a la colonoscopia en la que se diagnosticó el CCR. 919 pacientes durante 10 años por CCR, 68 casos de CCRP (6,9%), se encontró que se presenta con más frecuencia en pacientes mayores (74 vs. 66 años; p=0,03), con antecedentes de pólipos adenomatosos (36,8% vs. 20,1%; p=0,01) y en colon derecho (57,4% vs. 40,6%; p=0,006), con una tendencia en pacientes con diverticulosis (41,2% vs. 31,3%; p=0,05) y diabetes (25% vs. 14%; p=0,06); menor sobrevida a 5 y 10 años (58%-55,2% vs. 67%-63%; p<0,001). Según la OME, los CCRP se presentaron en 61,3% por lesiones omitidas en colonoscopias inadecuadas, 29% colonoscopias adecuadas y 9,7% resecciones incompletas de adenomas. En conclusión, la tasa de CCRP fue de 6,9%, con mayor propensión en pacientes de mayores, antecedente de resección de pólipos, y en colon derecho. Acorde a la OME, las lesiones omitidas más frecuentemente se relacionaron con colonoscopias inadecuadas. Los pacientes con CCRP tienen menor sobrevida.

Post-colonoscopy colorectal cancer (PCCRC) is a tumor that appears after a normal colonoscopy before the established time for the endoscopic follow up. Its origin reflects the quality of the colonoscopy and the different tumoral biologics between the CRC and the CRCPC. Our aim is to describe the characteristics of the PCCRC in our region, to identify risk factors, to discriminate the potential causes according to the World Endoscopý Organization (WEO) and to determine its impact in the patient's survival. We studied patients with colorectal cancer (CRC) attended at the gastro-oncology clinic of two institutions of Medellin-Colombia, between January 2012 and December 2021 that had been submitted to a colonoscopy between 6-36 months before the colonoscopy in which the CRC was diagnosed. 919 patients during 10 years for CRC, 68 cases of PCCRC (6.9%); It was more frequent in older patients (74 vs. 66 years; p=0.03), with background of adenomatous polyps (36.8% vs. 20.1%; p=0.01) and in right colon (57.4% vs. 40.6%; p=0.006), with a tendency in patients with diverticulosis (41.2% vs. 31.3%; p=0.05) and diabetes (25% vs. 14%; p=0.06); less survival at 5 and 10 years (58% and 55.2% vs. 67% and 63%; p<0.001). According to the WEO, the PCCRC presents in 61.3% because of abnormal findings omitted in inadequate colonoscopies, 29% in a suitable colonoscopy and 9.7% incomplete resections of adenomas. In conclusion, the rate of PCCRC was 6.9% with more propension in older patients, a background of polyp resection, and proximal colon. According to the WEO, the abnormal findings omitted more frequently were related with inadequate colonoscopies. The patients with PCCRC had less survival.

Cáncer colorectal en el embarazo. Reportes de caso

El cáncer colorrectal (CCR) durante el embarazo es una neoplasia poco frecuente, con una incidencia entre el 0,07- 0,1% en la población. Para un diagnóstico preciso es necesaria una alta sospecha y con ello realizar pruebas diagnósticas oportunas. Cuando no se tiene sospecha ni se busca el diagnóstico, el pronóstico suele ser malo, ya que muchas veces se halla en estado avanzado. Presentamos los casos de dos gestantes de 27 y 31 años, diagnosticadas de adenocarcinoma colorrectales medianamente diferenciados a las 29 y 30 semanas de gestación, respectivamente. Debido a la importancia de realizar un diagnóstico oportuno para mejorar la sobrevida de las pacientes, se realizó una búsqueda de información en la literatura en relación con el diagnóstico, manejo y pronóstico de esta patología.

Colon rectal cancer (CRC) during pregnancy is a rare neoplasia, with an incidence between 0.07-0.1% in the population. For an early diagnosis, a high suspicion is necessary and with it, timely diagnostic tests are carried out. When there is no suspicion and no diagnosis is sought, the prognosis is usually poor since it is often in an advanced state. We present the cases of two pregnant women aged 27 and 31 diagnosed with moderately differentiated colorectal adenocarcinoma at 29 and 30 weeks of gestation, respectively. Due to the importance of making an opportune diagnosis to improve the survival of the patients, a search of information was carried out in the literature in relation to the diagnosis, management and prognosis of this pathology.

Atenção à saúde do estomizado na rede de atenção à saúde na perspectiva de enfermeiros / Health care of the stomized in the health care network from the perspective of nurses / Atención sanitaria de estomizados en la red de salud desde la perspectiva de enfermeras

Objetivo: Identificar como é o cuidado oferecido às pessoas que vivem com estomias na rede de atenção à saúde na ótica dos enfermeiros. Métodos: Estudo qualitativo, descritivo, desenvolvido com 29 enfermeiros que atuavam na Rede de Atenção à Saúde que dispensam cuidados ao paciente com estomia. O referencial teórico metodológico utilizado foi a pesquisa social de Minayo, a qual apoia-se no materialismo histórico e dialético. Coleta de dados realizada nos meses de março e abril de 2018, por meio de uma entrevista semiestruturada. Realizada análise temática dos dados. Resultados: Foram identificadas fragilidades na comunicação na rede de atenção à saúde, bem como nas ações de cuidado efetivadas pelos enfermeiros às pessoas que vivem com estomas, demonstrou-se um cuidado centralizado e falha na atenção devido a falta de educação continuada. Conclusão: O cuidado aos estomizados possui pontos a serem melhorados como à definição de itinerário para este paciente, centralização do cuidado, garantia da continuidade do cuidado e integralidade, referência e contrarreferência, necessidade de uma comunicação efetiva entre as equipes de saúde que assistem estes pacientes bem como falta de educação continuada. (AU)

Objective: To identify how care is provided to people living with ostomy in the health care network from the perspective of nurses. Methods: Qualitative, descriptive study, developed with 29 nurses who worked in the Health Care Network who provide care to patients with ostomy. The methodological theoretical framework used was Minayo's social research, which is based on historical and dialectical materialism.Data collection carried out in March and April 2018, through a semi-structured interview. Thematic analysis of the data was carried out. Results: Weaknesses were identified in communication in the health care network, as well as in the care actions carried out by nurses to people living with stomas, demonstrating a centralized care and failure in care due to the lack of continuing education. Conclusion: The care of ostomy patients has points to be improved, such as defining an itinerary for this patient, centralization of care, ensuring continuity of care and completeness, referral and counter-referral, need for effective communication between the health teams that care for these patients as well as lack of continuing education. (AU)

Objetivo: Identificar cómo se atiende a las personas que viven con ostomía en la red asistencial desde la perspectiva del enfermero. Métodos: Estudio cualitativo, descriptivo, desarrollado con 29 enfermeras que laboraban en la Red de Atención de Salud que brinda atención a pacientes con ostomía. El marco teórico metodológico utilizado fue la investigación social de Minayo, que se basa en el materialismo histórico y dialéctico. Recolección de datos realizada en marzo y abril de 2018, mediante entrevista semiestructurada. Se realizó un análisis temático de los datos. Resultados: Se identificaron debilidades en la comunicación en la red de atención de salud, así como en las acciones de atención que realizan las enfermeras a las personas que viven con estoma, ubicando la atención centralizada y falla en la atención por falta de educación continua. Conclusión: La atención al paciente con ostomía tiene puntos a mejorar, como la definición de un itinerario para este paciente, la centralización de la atención, asegurar la continuidad y la integralidad de la atención, la derivación y contrarreferencia, la necesidad de una comunicación efectiva entre los equipos de salud que atienden. estos pacientes, así como la falta de educación continua. (AU)

Proteína C reactiva como biomarcador predictivo de fuga anastomótica en cirugía oncológica colorrectal: estudio de cohorte retrospectivo / C-reactive protein as a predictive biomarker of anastomotic leak in colorectal cancer surgery: A retrospective cohort study

Introducción. La fuga anastomótica es la complicación más grave del tratamiento quirúrgico del cáncer de colon por su alta morbimortalidad. El diagnóstico evidente, manifestado por la salida de contenido intestinal por drenajes o la herida quirúrgica, ocurre tardíamente (entre el 6º y 8º día). El objetivo de este trabajo fue estudiar la variación de los valores de la proteína C reactiva postoperatoria para hacer un diagnóstico precoz. Métodos. Estudio observacional, analítico, retrospectivo, de una cohorte de pacientes con neoplasia, en quienes se realizó cirugía oncológica con anastomosis intestinal, entre enero de 2019 y diciembre de 2021. Se midieron los valores en sangre de proteína C reactiva postoperatoria (1°, 3° y 5° días). Resultados. Se compararon 225 casos operados que no presentaron fuga con 45 casos con fuga. En los casos sin fuga, el valor de proteína C reactiva al 3º día fue de 148 mg/l y al 5º día de 71 mg/l, mientras en los casos con fuga, los valores fueron de 228,24 mg/l y 228,04 mg/l, respectivamente (p<0,05). Para un valor de 197 mg/l al 3º día la sensibilidad fue de 77 % y para un valor de 120 mg/l al 5º día la sensibilidad fue de 84 %. Conclusión. El mejor resultado de proteína C reactiva postoperatoria para detectar precozmente la fuga anastomótica se observó al 5º día. El valor de 127 mg/l tuvo la mejor sensibilidad, especificidad y valor predictivo negativo, lo cual permitiría el diagnóstico temprano y manejo oportuno de esta complicación

Introduction. Anastomotic leak is the most serious complication of surgical treatment of colon cancer due to its high morbidity and mortality. The obvious diagnosis manifested by the exit of intestinal content through drains or the operative wound, occurs late (between the 6th and 8th day). The objective of this work was to study the postoperative C-reactive protein values to make an early diagnosis. Methods. Observational, analytical, retrospective study of a cohort of patients undergoing colorectal surgery for neoplasia, between January 2019 and December 2021, who underwent oncological surgery with intestinal anastomosis and measured CRP blood values on 1st, 3rd and 5th post-operative days. Results. Two-hundred-twenty-five operated cases that did not present leaks were compared with 45 cases with leaks, with CRP values on the 3rd and 5th day of 148mg/l and 71mg/l in cases without leakage and CRP values of 228.24mg/l and 228.04 mg/l in cases with leakage on the 3rd and 5th day, respectively (p<0.05), CRP value of 197mg/l on the 3rd day has a sensitivity of 77%; CRP value of 120mg/l on the 5th day, has a sensitivity of 84%. Conclusions. The best result for CPR to early diagnosis of anastomotic leak was observed on the 5th day, having the value of 127 mg/l the best sensitivity, specificity and NPV, which would allow early diagnosis and timely management

Preoperative evaluation of sarcopenia in patients with colorectal cancer: a prospective study

SUMMARY OBJECTIVE: Colorectal cancer is the third most diagnosed malignant neoplasm in the world and the fourth leading cause of cancer mortality. The loss of muscle mass in oncological patients is the main aspect of cancer-related malnutrition. Associations between sarcopenia and poor outcomes, such as high postoperative mortality, chemotherapy toxicity, and reduced survival, have been recently described. The aim of this study was to prospectively assess the prevalence of preoperative sarcopenia in patients with colorectal cancer using validated methods to evaluate muscle strength, muscle mass, and physical performance. METHODOLOGY: This study included patients with colorectal cancer undergoing oncological staging at a Cancer Center in Brazil from May 2019 to March 2020 who had images from abdominal computed tomography available for analysis of body composition. The muscle strength test, physical performance, referred fatigue, and clinical and nutritional data were evaluated. RESULTS: A total of 31 patients were included, and most were diagnosed with colon cancer (77.4%) and clinical stage II in 41.9% of cases. The prevalence of probable sarcopenia was 22.6%; of these patients, sarcopenia was confirmed in 19.4%, and ultimately, 9.7% of the sample was classified as severe sarcopenia. We did not find a significant association between the presence of sarcopenia in our sample and age, sex, tumor staging, nutritional characteristics, referred patient fatigue, or postoperative complications. CONCLUSION: Considering the criteria established by the EWGSOP, the prevalence of preoperative sarcopenia in colorectal cancer patients was 19.4%.

Intervenciones endoscópicas para mejorar la tasa de detección de lesiones serradas durante la colonoscopia

El cáncer colorrectal (CCR) es una de las causas más frecuentes de mortalidad por cáncer en el mundo. Las lesiones serradas son responsables de 10 a 20% de todos los CCR. Los pólipos serrados, en particular los adenomas serrados sésiles (ASS) y adenomas serrados tradicionales (AST), tienen una apariencia sutil y localización proximal, y por ello presentan una alta tasa de lesiones perdidas. El objetivo de la presente revisión fue evaluar la evidencia disponible sobre el uso de diversas intervenciones endoscópicas para mejorar la tasa de detección de las lesiones serradas, para de esta forma, disminuir la mortalidad relacionada al CCR.

Colorectal cancer (CRC) is one of the most common causes of cancer mortality in the world. Serrated lesions are responsible for 10 to 20% of all CRCs. Serrated polyps, particularly sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA), have a subtle appearance and proximal location, and therefore have a high miss rate. The objective of this review was to evaluate the available evidence on the use of various endoscopic interventions for improving serrated lesion detection rate, thus reducing CRC related mortality.

Risk factors analysis and prediction model construction of submucosal deep infiltration of early colorectal tumor / 中华肿瘤杂志

Objective: To investigate the risk factors for the development of deep infiltration in early colorectal tumors (ECT) and to construct a prediction model to predict the development of deep infiltration in patients with ECT. Methods: The clinicopathological data of ECT patients who underwent endoscopic treatment or surgical treatment at the Cancer Hospital, Chinese Academy of Medical Sciences from August 2010 to December 2020 were retrospectively analyzed. The independent risk factors were analyzed by multifactorial regression analysis, and the prediction models were constructed and validated by nomogram. Results: Among the 717 ECT patients, 590 patients were divided in the within superficial infiltration 1 (SM1) group (infiltration depth within SM1) and 127 patients in the exceeding SM1 group (infiltration depth more than SM1). There were no statistically significant differences in gender, age, and lesion location between the two groups (P>0.05). The statistically significant differences were observed in tumor morphological staging, preoperative endoscopic assessment performance, vascular tumor emboli and nerve infiltration, and degree of tumor differentiation (P<0.05). Multivariate regression analysis showed that only erosion or rupture (OR=4.028, 95% CI: 1.468, 11.050, P=0.007), localized depression (OR=3.105, 95% CI: 1.584, 6.088, P=0.001), infiltrative JNET staging (OR=5.622, 95% CI: 3.029, 10.434, P<0.001), and infiltrative Pit pattern (OR=2.722, 95% CI: 1.347, 5.702, P=0.006) were independent risk factors for the development of deep submucosal infiltration in ECT. Nomogram was constructed with the included independent risk factors, and the nomogram was well distinguished and calibrated in predicting the occurrence of deep submucosal infiltration in ECT, with a C-index and area under the curve of 0.920 (95% CI: 0.811, 0.929). Conclusion: The nomogram prediction model constructed based on only erosion or rupture, local depression, infiltrative JNET typing, and infiltrative Pit pattern has a good predictive efficacy in the occurrence of deep submucosal infiltration in ECT.

Advances in three-dimensional tumor models for colorectal cancer / 中华肿瘤杂志

Conventional tumor culture models include two-dimensional tumor cell cultures and xenograft models. The former has disadvantages including lack of tumor heterogeneity and poor clinical relevance, while the latter are limited by the slow growth, low engraftment successful rate, and high cost. In recent years, in vitro three-dimensional (3D) tumor models have emerged as the tool to better recapitulate the spatial structure and the in vivo environment of tumors. In addition, they preserve the pathological and genetic features of tumor cells and reflect the complex intracellular and extracellular interactions of tumors, which have become a powerful tool for investigating the tumor mechanism, drug screening, and personalized cancer treatment. 3D tumor model technologies such as spheroids, organoids, and microfluidic devices are maturing. Application of new technologies such as co-culture, 3D bioprinting, and air-liquid interface has further improved the clinical relevance of the models. Some models recapitulate the tumor microenvironment, and some can even reconstitute endogenous immune components and microvasculature. In recent years, some scholars have combined xenograft models with organoid technology to develop matched in vivo/in vitro model biobanks, giving full play to the advantages of the two technologies, and providing an ideal research platform for individualized precision therapy for specific molecular targets in certain subtypes of tumors. So far, the above technologies have been widely applied in the field of colorectal cancer research. Our research team is currently studying upon the application of patient-derived tumor cell-like clusters, a self-assembly 3D tumor model, in guiding the selection of postoperative chemotherapy regimens for colorectal cancer. A high modeling success rate and satisfactory results in the drug screening experiments have been achieved. There is no doubt that with the advancement of related technologies, 3D tumor models will play an increasingly important role in the research and clinical practice of colorectal cancer.

Poly-G for tumor matched samples chronicles the evolution of human colorectal cancer / 中华肿瘤杂志

Objective: To analyze poly-guanine (poly-G) genotypes and construct the phylogenetic tree of colorectal cancer (CRC) and provide an efficient and convenient method for the study of intra-tumor heterogeneity and tumor metastasis pathway. Methods: The clinicopathological information of patients with primary colorectal cancer resection with regional lymph node metastases were retrospectively collected in the Department of General Surgery, General Hospital of Tianjin Medical University from January 2017 to December 2017. The paraffin sections of the paired tumor samples were performed consecutively, and multi-region microdissection was performed after histogene staining. The phenol-chloroform extraction and ethanol precipitation scheme was used to obtain DNA, and Poly-G multiplex PCR amplification and capillary electrophoresis detection were performed. The correlation between Poly-G mutation frequency and clinicopathological parameters was analyzed. Based on the difference of Poly-G genotypes between paired samples, the distance matrix was calculated, and the phylogenetic tree was constructed to clarify the tumor metastasis pathway. Results: A total of 237 paired samples were collected from 20 patients including 134 primary lesions, 66 lymph node metastases, 37 normal tissues, and Poly-G mutation was detected in 20 patients (100%). The mutation frequency of Poly-G in low and undifferentiated patients was (74.10±23.11)%, higher than that in high and medium differentiated patients [(31.36±12.04)%, P<0.001]. In microsatellite instability patients, the mutation frequency of Poly-G was (68.19±24.80)%, which was higher than that in microsatellite stable patients [(32.40±14.90)%, P=0.003]. The Poly-G mutation frequency was not correlated with age, gender, and pathological staging (all P>0.05). Based on Poly-G genotype difference of the paired samples, the phylogenetic trees of 20 patients were constructed, showing the evolution process of the tumor, especially the subclonal origins of lymph node metastasis. Conclusion: Poly-G mutations accumulate in the occurrence and development of CRC, and can be used as genetic markers to generate reliable maps of intratumor heterogeneity in large numbers of patients with minimal time and cost expenditure.

Risk factors for residual cancer or lymph node metastasis after endoscopic noncurable resection of early colorectal cancer / 中华肿瘤杂志

Objective: Risk factors related to residual cancer or lymph node metastasis after endoscopic non-curative resection of early colorectal cancer were analyzed to predict the risk of residual cancer or lymph node metastasis, optimize the indications of radical surgical surgery, and avoid excessive additional surgical operations. Methods: Clinical data of 81 patients who received endoscopic treatment for early colorectal cancer in the Department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences from 2009 to 2019 and received additional radical surgical surgery after endoscopic resection with pathological indication of non-curative resection were collected to analyze the relationship between various factors and the risk of residual cancer or lymph node metastasis after endoscopic resection. Results: Of the 81 patients, 17 (21.0%) were positive for residual cancer or lymph node metastasis, while 64 (79.0%) were negative. Among 17 patients with residual cancer or positive lymph node metastasis, 3 patients had only residual cancer (2 patients with positive vertical cutting edge). 11 patients had only lymph node metastasis, and 3 patients had both residual cancer and lymph node metastasis. Lesion location, poorly differentiated cancer, depth of submucosal invasion ≥2 000 μm, venous invasion were associated with residual cancer or lymph node metastasis after endoscopic (P<0.05). Logistic multivariate regression analysis showed that poorly differentiated cancer (OR=5.513, 95% CI: 1.423, 21.352, P=0.013) was an independent risk factor for residual cancer or lymph node metastasis after endoscopic non-curative resection of early colorectal cancer. Conclusions: For early colorectal cancer after endoscopic non-curable resection, residual cancer or lymph node metastasis is associated with poorly differentiated cancer, depth of submucosal invasion ≥2 000 μm, venous invasion and the lesions are located in the descending colon, transverse colon, ascending colon and cecum with the postoperative mucosal pathology result. For early colorectal cancer, poorly differentiated cancer is an independent risk factor for residual cancer or lymph node metastasis after endoscopic non-curative resection, which is suggested that radical surgery should be added after endoscopic treatment.

Expression level of miR-199b in human colorectal cancer tissues and its correlation with clinicopathological features and prognosis of patients / 中华肿瘤杂志

Objective: To investigate the relationship between miR-199b and clinicopathologic features and prognosis of patients with colorectal cancer. Methods: Cancer tissues and adjacent normal tissues of 202 patients with colorectal cancer treated in Cancer Hospital of Chinese Academy of Medical Sciences from March to December 2011 were collected. Reverse transcription-quantitative real-time polymerase chain reaction was used to detect the expression level of miR-199b in colorectal cancer tissues and corresponding adjacent normal tissues. Kaplan-Meier method and Log rank test were used for survival analysis, and receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of miR-199b in colorectal cancer patients. Results: The relative expression level of miR-199b in colorectal cancer tissues (-7.88±0.11) was lower than that in adjacent normal tissues (-6.49±0.12, P<0.001). The expression level of miR-199b in colorectal cancer tissues with lymph node metastasis (-7.51±0.14) was higher than that in colorectal cancer tissues without lymph node metastasis (-8.23±0.17, P<0.001). The relative expression levels of miR-199b in stage Ⅰ/Ⅱ, Ⅲ and Ⅳ colorectal cancer tissues were gradually increased, which were -8.26±0.17, -7.70±0.16 and -6.57±0.27, respectively, and the difference was statistically significant (P<0.001). The 5-year survival rates of patients with high and low expressions of miR-199b were 75.6% and 84.6%(P=0.045) respectively. ROC curve showed that when miR-199b was -7.965, the area under the curve was 0.578 (95% CI: 0.468, 0.688). Conclusion: The high expression of miR-199b in colorectal cancer tissues is associated with late TNM stage, lymph node metastasis and poor prognosis in colorectal cancer patients, and miR-199b may be used as a potential marker for postoperative progress and prognosis in colorectal cancer patients.

Comparison of the effects of laparoscopic versus open liver resection for colorectal cancer liver metastasis on the surgery-chemotherapy interval: a propensity score matching analysis / 中华肝胆外科杂志

Objective:To compare the effects of laparoscopic versus open liver resection for colorectal cancer liver metastasis on the interval between surgery and chemotherapy, the perioperative outcomes and the prognosis of patients.Methods:A total of 127 patients undergoing colorectal cancer liver metastasis resection in the Department of General Surgery, Huashan Hospital, Fudan University, from January 2014 to February 2023 were retrospectively analyzed, including 81 males and 46 females, aged (60.0±8.9) years. Based on surgical approaches, the patients were divided into the laparoscopic group ( n=33) and the open group ( n=94). After propensity score matching (PSM), 26 cases in the laparoscopic group were matched with 45 cases in the open group. The maximum tumor diameter, proportion of tumors involving both lobes, and proportion of solitary tumors, interval between surgery and first cycle of chemotherapy, postoperative complications, postoperative hospital stay and the prognosis of patients were compared between the two groups after matching. Survival curves and rates were analyzed by Kaplan-Meier and log-rank test. Results:After PSM, there were no significant differences in the baseline data of patients, including tumor maximum diameter, proportion of tumors involving both lobes, and proportion of solitary tumors between the two groups (all P>0.05), indicating comparability. After matching, the interval between surgery and first cycle of chemotherapy in the laparoscopic group (34.4±11.2) d was shorter than that in the open group (46.7±28.0) d, the laparoscopic group had a lower incidence of postoperative complications[0 vs 20.0%(9/45)] and a shorter postoperative hospital stay[6.0 (5.0, 6.2) d vs 8.0 (7.0, 11.5) d] compared to the open group (all P<0.05). There was no significant difference in the recurrence-free survival rate (χ 2=3.27, P=0.070) and the cumulative survival rate (χ 2=0.001, P=0.974) between the two groups. Conclusion:In patients with colorectal cancer liver metastasis, laparoscopic liver surgery showed a lower incidence of postoperative complications and a shorter postoperative hospital stay compared to open surgery. The interval between surgery and first cycle of chemotherapy is shorter after laparoscopic surgery. The long-term prognosis is comparable in the laparoscopic and open surgery.

The latest consensus and clinical application of the histopathological growth patterns of colorectal cancer liver metastasis / 中华肝胆外科杂志

The histopathological growth pattern (HGP) of colorectal cancer liver metastasis (CRLM) is correlated with the prognosis of patients. Patients with desmoplastic HGP have a better prognosis. The latest international scoring guidelines have modified the cut-off value of HGP, and divides it into two types: complete desmoplastic HGP and incomplete desmoplastic HGP. However, the relationship between the HGPs and the treatment response to systemic treatment is still unclear. It is necessary to develop non-invasive methods to evaluate changes in HGP during treatment in the future. This paper reviews the new scoring consensus and clinical applications of HGP in CRLM.

Efficacy of microwave ablation versus radiofrequency ablation in the treatment of colon cancer liver metastases: a meta-analysis / 中华肝胆外科杂志

Objective:To explore the best treatment for local ablation of colon cancer liver metastases (CRLM) by meta-analysis.Methods:The electronic databases of PubMed, Web of Science, Embase, CNKI and the Cochrane Library were searched from the establishment to August 22, 2022, and studies that report outcomes with comparison between microwave ablation (WMA) and radiofrequency ablation (RFA) in CRLM treatment were selected by inclusion and exclusion criteria. Furthermore, the perioperative and survival data were statistically summarized and analyzed by Review Manager 5.3 software.Results:A total of 5 retrospective studies were included with a total sample size of 648 cases, including 316 cases (48.8%) in the WMA group and 332 cases (51.2%) in the RFA group. The results of meta-analysis showed that locoregional recurrence rate in WMA group was significantly lower than that in RFA group. The 1-year and 2-year disease-free survival (DFS) of the WMA group was significantly better than that of the RFA group with HR of 1.77 ( P=0.04, 95% CI: 1.04-3.02) and 1.60 ( P=0.02, 95% CI: 1.09-2.35), respectively. Conclusion:The local control rate and 1-year and 2-year DFS of WMA were superior to RFA.

Factors influencing the occurrence of parastomal hernia after preventive ileostomy for colorectal cancer / 中国医师杂志

Objective:To explore the risk factors related to the formation of parastomal hernia (PSH) in patients with colorectal cancer after preventive ileostomy, provide Evidence-based medicine basis for prevention and treatment, and reduce the incidence of incision hernia (SSIH) at the stoma.Methods:The clinical data of 214 patients who underwent laparoscopic radical resection of colorectal cancer combined with preventive loop ileostomy in the General Surgery Department of the Linyi People′s Hospital from January 2019 to May 2021 were retrospectively analyzed. The incidence of PSH was statistically analyzed, and the risk factors of PSH were analyzed by binary logistic regression.Results:There were 177 cases of PSH in 214 patients, with an incidence rate of 82.71%. There were 5 cases of SSIH (2.34%). The results of single factor analysis showed that there were significant differences in body mass index (BMI), postoperative diversion time and the proportion of stoma through rectus abdominis muscle between the PSH group and the non PSH group (all P<0.05); The results of binary logistic regression analysis showed that BMI, postoperative diversion time, rectus abdominis muscle stoma, incision infection and liquefaction were important influencing factors for the formation of PSH after preventive loop ileostomy for colorectal cancer (all P<0.05). Conclusions:BMI, postoperative diversion time, rectus abdominis muscle stoma, incision infection and liquefaction are important influencing factors for the formation of PSH after preventive ileostomy. Intervention measures can be targeted to reduce the incidence of SSIH by reducing the risk of PSH.

Effects of primary location of colorectal cancer on surgical outcome of liver metastases / 中国基层医药

Objective:To analyze the effects of the primary location of colorectal cancer on the surgical outcome of liver metastases.Methods:A cross-sectional study was conducted on 178 patients with liver metastases from colorectal cancer admitted to Binzhou Central Hospital from January 2012 to January 2022. According to whether the patients had recurrence after surgery, they were divided into a recurrence group ( n = 88) and a control group ( n = 90). The general and clinical data were compared between the two groups. Logistic multivariate analysis of the factors with statistical significance was further performed to identify the risk factors of postoperative recurrence of liver metastases from colorectal cancer after surgery. The correlation between the primary location of colorectal cancer and each risk factor was analyzed. The recurrence of colorectal cancer was compared anong patients with different primary locations of colorectal cancer at 12 months after surgery. Results:Primary location at the right colon [55.68% (49/88), lymph node metastasis [92.05% (81/88)], D-dimer ≥ 180 μ g/L, albumin < 29 g/L, ineffective/no neoadjuvant chemotherapy [43.18% (33/38)], and high-risk clinical risk score [53.41% (47/88)] were risk factors for postoperative recurrence of liver metastases from colorectal cancer after surgery ( P = 0.024, 0.019, 0.001, 0.028, < 0.001, 0.001). The primary location of colorectal cancer was positively correlated with lymph node metastasis, D-dimer, and clinical risk score ( P = 0.043, 0.046, 0.030), and negatively correlated with albumin and the efficacy of neoadjuvant chemotherapy ( P = 0.004, 0.033). In 178 patients, the recurrence rate of liver metastases from colorectal cancer at 3 months [53.57% (15/70)], 6 months [55.17% (32/70)], and 12 months [55.68% (49/70)] was significantly higher in the right colon compared with the left colon [32.14% (9/40), 24.14% (14/40), 26.14% (23/40) and the rectum [14.29% (4/68), 20.69% (12/68), 18.18% (16/68)] ( χ2= 4.73, 7.85, 6.27, all P < 0.05). Conclusion:Right colon, lymph node metastasis, D-dimer, albumin, neoadjuvant chemotherapy efficacy, and clinical risk score are the risk factors for postoperative recurrence of liver metastases from colorectal cancer. Patients with the primary location at the right colon have a higher postoperative recurrence rate.

Expression and significance of programmed death ligand 1 and programmed death 1 in colorectal cancer complicated by schistosomiasis / 中国基层医药

Objective:To investigate the expression and significance of programmed death ligand 1 (PD-L1) and programmed death 1 (PD-1) in colorectal cancer complicated by schistosomiasis.Methods:A total of 134 patients with colorectal cancer who received treatment in Xuancheng People's Hospital during 2014-2021 were included in this study. These patients consisted of 74 patients with colorectal cancer combined with schistosomiasis (patient group) and 60 patients with only colorectal cancer (control group). The expression of PD-L1 and PD-1 in colorectal cancer tissue was detected by an immunohistochemical method. The differences in PD-L1 and PD-1 expression were compared between the two groups. The relationships between PD-L1 and PD-1 expression and clinical pathological characteristics were determined.Results:The positive expression rates of PD-L1 and PD-1 in cancer cells and interstitial lymphocytes were 55.4% and 60.8% respectively in the patient group and they were 35.0% and 40.0% respectively in the control group. The positive expression rates of PD-L1 and PD-1 were significantly higher in the patient group than the control group ( χ2 = 5.55, 5.74, both P < 0.05). The expressions of PD-L1 and PD-1 in the patient group were correlated with lymph node metastasis and high tumor-node-metastasis stage ( P < 0.05). Conclusion:PD-L1 and PD-1 are highly expressed in colorectal cancer complicated by schistosomiasis and are related to their invasive behavior. PD-1/PD-L1 singaling pathway may be involved in the molecular mechanism underlying the occurrence and development of colorectal cancer complicated by schistosomiasis. Blocking PD-1/PD-L1 signaling pathway may be a new strategy for immunotherapy of colorectal cancer complicated by schistosomiasis.