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.

Progress of mechanism of metformin against colorectal cancer / 肿瘤研究与临床

Colorectal cancer is a common gastrointestinal malignant tumor with morbidity and mortality rising year by year. In recent years, the studies in and out of China have reported that metformin could inhibit the growth of colorectal cancer cells and improve the prognosis of patients by indirectly reducing the levels of insulin and glucose in the blood, or directly activating the AMP-activated protein kinase signaling pathways, promoting apoptosis of tumor cells, enhancing sensitivity to chemotherapy, inhibiting inflammatory responses, affecting the intestinal flora, and regulating the immune function, etc. This article reviews the current research status and controversies related to metformin against colorectal cancer, in an effort to provide new evidences for the treatment of colorectal cancer.

Correlation of gene mutations and microsatellite instability in colorectal cancer tissues with clinicopathological features of patients / 肿瘤研究与临床

Objective:To explore KRAS, NRAS, BRAF gene mutations and microsatellite instability(MSI) in colorectal cancer tissues as well as their correlation with the clinicopathological characteristics of patients.Methods:The clinicopathological data of 473 colorectal cancer patients in Shanxi Province Cancer Hospital from October 2020 to May 2021 were retrospectively analyzed. The mutation status of KRAS, NRAS and BRAF gene in the paraffin tissues were detected by using amplification refractory mutation system (ARMS) method. Polymerase chain reaction (PCR)-capillary electrophoresis was used to analyze MSI status, and the correlation of the clinicopathological characteristics of patients with gene mutations and MSI status was analyzed.Results:The mutation rates of KRAS, NRAS and BRAF were 45.03% (213/473), 2.96% (14/473) and 5.50% (26/473), respectively in 473 patients with colorectal cancer. No case harbored both 2 gene mutations was detected. The mutation rate of KRAS gene in well differentiated adenocarcinoma was higher than that in poorly differentiated adenocarcinoma [47.4% (175/369) vs. 36.5% (38/104), χ2 = 3.89, P = 0.049]. NRAS mutation rate in female was higher than that in male [5.0% (10/202) vs. 1.5% (4/271), χ2 = 4.86, P = 0.027], and the NRAS mutation rate in patients with tumor diameter ≤ 3 cm was higher than that in those with tumor diameter >3 cm [7.1% (7/98) vs. 1.9% (7/375), P = 0.013]. BRAF mutation rate of tumors located in colon was higher than that in rectum [11.7% (20/171) vs.2.0% (6/302), χ2 = 19.81, P < 0.001]; BRAF mutation rate in poorly differentiated tumor was higher than that in well differentiated tumor [10.6% (11/104) vs. 4.1% (15/369), χ2 = 6.62, P = 0.010]; BRAF mutation rate in patients with mucus was higher than that in those without mucus [10.9% (11/101) vs. 4.0% (15/372), χ2 = 7.19, P = 0.007]; BRAF mutation rate in patients with lymphatic metastasis was higher than that in patients without lymphatic metastasis [8.2% (15/182) vs.3.8% (11/291), χ2 = 4.29, P = 0.038]. The incidence of high frequency MSI (MSI-H) in 473 colorectal cancer tissues was 7.19% (34/473). The incidence of MSI-H in colon was higher than that in rectum [14.0% (24/171) vs. 3.3% (10/302), χ2 = 18.82, P < 0.001]; the incidence of MSI-H in patient with poor differentiated tumor was higher than that in those with well differentiated tumor [17.3% (18/104) vs. 4.3% (16/369), χ2 = 20.46, P < 0.001]; the incidence of MSI-H in patients with mucus was higher than that in those without mucus [11.9% (12/101) vs. 5.9% (22/372), χ2 = 4.24, P = 0.039]; and the incidence of MSI-H in patients without lymphatic metastasis was higher than that in patients with lymphatic metastasis [10.0% (29/291) vs. 2.7% (5/182), χ2 = 8.75, P = 0.003]. In addition, the incidence of MSI-H was on the rise in patients with BRAF mutation ( P < 0.001). Conclusions:KRAS, NRAS, BRAF gene mutations and MSI status are correlated with the clinicopathological characteristics of patients with colorectal cancer; there is a close relationship between MSI-H and BRAF mutation.

Progress of the effect of circular RNA on the sensitivity to chemotherapy drugs in colorectal cancer / 肿瘤研究与临床

The pathogenesis of colorectal cancer involves a variety of molecules and genes, among which circular RNA (circRNA) has received extensive attention in regulating the development and progression of tumors and mediating drug resistance. circNRA has been identified as tumor promoters or tumor suppressors that influence the sensitivity to chemotherapy drugs and mediate the onset and metastasis of colorectal cancer. The influence of circRNA on the drug resistance sensitivity of conventional chemotherapy has become a new direction for the research of anti-tumor chemotherapy drugs. This paper discusses the biological characteristics of circRNA and introduces the relationship between circRNA and the sensitivity to chemotherapy drugs in colorectal cancer.

Efficacy and cardiotoxicity observation of different doses of capecitabine in patient-derived tumor xenograft of mice with colorectal cancer / 肿瘤研究与临床

Objective:To explore the correlation of the dose of capecitabine with the efficacy and cardiotoxicity in patient-derived tumor xenograft (PDX) model of mice with colorectal cancer.Methods:The fresh cancer tissues of 1 colorectal cancer patient were transplanted into the bilateral axillary subcutaneous of immunodeficient NOG mice to establish PDX model and passage stably. And then the morphology of tumor cells in primary generation and the second-generation tumor tissues was observed by using HE staining. The expression of tumor markers was detected by using immunohistochemistry method, and the model was evaluated. Mice were intragastrically infused with 200, 300 and 400 mg/kg capecitabine once a day, which were treated as low, middle and high dose groups respectively, 5 rats in each group; in the control group, 0.9% NaCl solution was perfused into the stomach; 14 d in total, use stop for 7 d, consecutively administered in this way. The body weight was measured every day and the tumor volume was measured every 3 days. After 100 days of observation, the mice were killed, and the tumor tissue was taken to measure the tumor weight and then the tumor volume, tumor volume inhibition rate and tumor inhibition rate were calculated. The morphology of tumor tissues was observed by using HE staining. The protein levels of anti-tumor effect indexes like rasP21, cyclooxygenase 2 (COX2), prostaglandin E2 (PGE2), cardiac troponin Ⅰ (cTn-Ⅰ) and brain natriuretic peptide (BNP) in serum of mice were detected by using enzyme linked immunosorbent assay (ELISA).Results:PDX model of mice with colorectal cancer was successfully constructed, and the histological characteristics of the primary tumor in the model were well preserved. During administration, 1 mouse died in the capecitabine high dose group; a slow down in tumor volume growth could be found with the increased dose of capecitabine. There was no statistically significant difference in body weight among 4 groups until all mice were killed ( P > 0.05). The tumor volume and tumor weight in the low, middle and high dose groups were lower than those in the control group (all P < 0.05), and the tumor volume and tumor weight showed an obvious decrease with the increase in dose. The tumor volume inhibition rates of low, middle and high dose groups were 42.61%, 67.61% and 77.27%, respectively, and the tumor inhibition rates were 35.53%, 67.77% and 75.09%, respectively. The serum anti-tumor effect indexes rasP21, COX2 and PGE2 in the middle and high dose groups were decreased compared with those in the control group (all P < 0.05), while cTn-Ⅰ and BNP levels were increased compared with those in the control group (all P < 0.05). Conclusions:The established PDX model of mice with colorectal cancer can better retain the histological characteristics of the original tumor. After treatment of middle and high dose of capecitabine, the tumor inhibition effect is obvious, but the risk of myocardial damage should be noticed.

Progress of endoscopic treatment for early-stage colorectal cancer and precancerous lesions / 肿瘤研究与临床

With the continuous development of endoscopic technology, more and more early-stage colorectal cancer and precancerous lesions have been found by endoscopy, and endoscopic treatment has dominated the treatment of early-stage colorectal cancer for its characteristics of small trauma, rapid recovery and good effect. At present, there are many methods of endoscopic treatment, but their indications are still controversial, and some new technologies still need further verified. Based on the latest guidelines at home and abroad and some hot issues, this article reviews the progress of endoscopic treatment of early-stage colorectal cancer and precancerous lesions, mainly including the indications of various endoscopic treatment methods, some important technical improvement of endoscopic treatment methods, and the application of some new endoscopic treatment technologies, in order to provide some references for the minimally invasive treatment of early-stage colorectal cancer and precancerous lesions.

Colonoscopy follow-up in patients with simultaneous multiple primary colorectal cancer and patients with sporadic colorectal cancer: a matched-pair study / 中华消化杂志

Objective:To investigate the incidences of metachronous advanced adenoma (MAA) in patients with simultaneous multiple primary colorectal cancer (CRC) and patients with sporadic CRC.Methods:From January 1, 2008 to September 30, 2022, at Beijing Shijitan Hospital, Capital Medical University, CRC patients who underwent surgery and 3 years follow-up with endoscopy were enrolled. The patients completed colonoscopy at least 2 times during follow-up in 6 to 36 months after surgery, and the interval between the 2 times colonoscopies was over 6 months. Clinical data including age, gender, and tumor location, stage, pathological features, combined underlying diseases, preoperative carcinoembryonic antigen, hemoglobin and other laboratory results, baseline colonoscopy results, and detection of MAA were collected. According to age (±2 years old), gender, location of primary lesion and stage of tumor, patients with simultaneous CRC or sporadic CRC were matched at 1∶1 ratio by propensity score matching. The cumulative risks of MAA in patients with simultaneous multiple primary CRC and patients with sporadic CRC were calculated. Cox proportional hazard regression was used to analyze the influencing factors in the occurrence of MAA.Results:A total of 814 CRC patients were enrolled and matched. After paired matching, there were 36 cases of simultaneous multiple primary CRC (78 lesions) and 78 cases of sporadic CRC (78 lesions). The cumulative incidences of MAA at 1, 2 and 3 years of simultaneous CRC group were 11.1%(4/36), 22.2%(8/36) and 33.3%(12/36), respectively. The cumulative incidences of MAA at 1-, 2- and 3-year of sporadic CRC group were 3.8%(3/78), 12.8%(10/78) and 20.5%(16/78), respectively.Simultaneous CRC was correlated with an increase in the 3-year cumulative incidence of MAA ( HR=4.163, 95% confidence interval(95% CI) 1.032 to 4.721, P=0.047). Especially in left-sided CRC, the risk of MAA in simultaneous CRC increased ( HR=7.186, 95% CI 1.602 to 20.787, P=0.010). The results of multivariate cox-regression analysis indicated that detection of simultaneous advanced adenoma at baseline endoscopy was an independent risk factor of MAA ( HR=3.175, 95% CI 1.411 to 7.142, P=0.005). Conclusion:Colouoscopy follow-up should be strengthened in patients with simultaneous multiple primary CRC and simultaneous advanced adenomas.

Application of deep learning to the differenciation of the invasion depth in colorectal adenomas / 中华消化内镜杂志

Objective:To evaluate deep learning for differentiating invasion depth of colorectal adenomas under image enhanced endoscopy (IEE).Methods:A total of 13 246 IEE images from 3 714 lesions acquired from November 2016 to June 2021 were retrospectively collected in Renmin Hospital of Wuhan University, Shenzhen Hospital of Southern Medical University and the First Hospital of Yichang to construct a deep learning model to differentiate submucosal deep invasion and non-submucosal deep invasion lesions of colorectal adenomas. The performance of the deep learning model was validated in an independent test and an external test. The full test was used to compare the diagnostic performance between 5 endoscopists and the deep learning model. A total of 35 videos were collected from January to June 2021 in Renmin Hospital of Wuhan University to validate the diagnostic performance of the endoscopists with the assistance of deep learning model.Results:The accuracy and Youden index of the deep learning model in image test set were 93.08% (821/882) and 0.86, which were better than those of endoscopists [the highest were 91.72% (809/882) and 0.78]. In video test set, the accuracy and Youden index of the model were 97.14% (34/35) and 0.94. With the assistance of the model, the accuracy of endoscopists was significantly improved [the highest was 97.14% (34/35)].Conclusion:The deep learning model obtained in this study could identify submucosal lesions with deep invasion accurately for colorectal adenomas, and could improve the diagnostic accuracy of endoscopists.

Predictors of colorectal polyps complicating colorectal laterally spreading tumors and the risk factors for malignancy in coexistence / 中华消化内镜杂志

Objective:To investigate the independent predictors of colorectal polyps complicating colorectal laterally spreading tumors (CLST) and the independent risk factors for malignancy in CLST coexisting with colorectal polyps.Methods:Clinical data of 260 patients with CLST who underwent endoscopy and received treatment in the Second Affiliated Hospital of Dalian Medical University from January 2016 to December 2021 were retrospectively collected. Patients were divided into the coexisting group ( n=135) and the non-coexisting group ( n=125) according to the presence or absence of polyps. Differences in clinicopathological characteristics between the two groups were compared and binary logistic regression was used to analyse the predictors of coexistence. Then the coexisting group was further divided into coexisting malignant group ( n=38) and coexisting non-malignant group ( n=97) according to the infiltration depth of CLST, and binary logistic regression was used to analyse the risk factors for malignancy in CLST coexisting with colorectal polyps. Results:Male ( P=0.002, OR=2.355, 95% CI:1.354-4.099), villous tubular adenoma ( P=0.022, OR=3.873, 95% CI: 1.214-12.355) and polyps history ( P=0.001, OR=2.738, 95% CI: 1.527-4.909) were independent predictors for colorectal polyps coexisting with CLST. Area under the curve (AUC) of the predictive model was 0.725 ( P<0.001, 95% CI: 0.664-0.786). Polyp diameter≥10 mm ( P=0.007, OR=6.266, 95% CI:1.634-24.034), CLST diameter≥20 mm ( P<0.001, OR=11.879, 95% CI:4.078-34.601), granular-mixed type CLST ( P=0.003, OR=8.584, 95% CI: 2.126-34.660), flat-elevated type CLST ( P=0.021, OR=4.399, 95% CI: 1.250-15.482) and pseudo-depressed type CLST ( P<0.001, OR=31.426, 95% CI: 4.975-198.509) were independent risk factors for malignancy in CLST coexisting with polyps. AUC of the predictive model was 0.854 ( P<0.001, 95% CI: 0.775-0.933). Conclusion:Male CLST patients with polyps history and a pathological type of villous tubular adenoma are more likely to develop coexistence. In patients with CLST which is granular-mixed type, flat-elevated type and pseudo-depressed type coexisting with colorectal polyps, the larger the diameter of the polyp and the diameter of the CLST, the more likely it is to be malignant.

Clinicopathological characteristics and endoscopic treatment efficacy of de novo early colorectal cancer / 中华消化内镜杂志

Objective:To analyze the clinicopathological features of de novo early colorectal cancer and to evaluate the efficacy of endoscopic treatment.Methods:Patients with de novo early colorectal cancer who underwent endoscopic resection in Beijing Friendship Hospital, Capital Medical University from June 2020 to May 2022 were enrolled. The baseline data, endoscopic manifestations, treatment methods, postoperative pathological results and prognosis of the patients were collected retrospectively.Results:A total of 33 patients with de novo early colorectal cancer were enrolled with the age of 62.67 ± 8.62 years, and the male to female ratio was 7.25∶1. The long diameter of lesions was 0.96 ± 0.36 cm. The lesion morphology was mainly superficial phenotype (type 0-Ⅱ), accounting for 72.7% (24/33). Endoscopic submucosal dissection (ESD) was performed in 29 cases and endoscopic mucosal resection (EMR) was performed in 4 cases. Postoperative pathology showed that 11 cases (33.3%) were well differentiated tubular adenocarcinoma, of which the superficial submucosal layer was invaded in 2 cases. Twenty cases (60.6%) were moderately differentiated tubular adenocarcinoma, of which the superficial submucosa layer was invaded in 5 cases and the deep submucosa layer in 15 cases. Two cases (6.1%) were moderately-poorly differentiated tubular adenocarcinoma, where the deep submucosa layer was invaded in both. There was significant correlation between the depth of invasion and the degree of differentiation ( P<0.001), and moderately and moderately-poorly differentiated lesions were more likely to invade the deep submucosa layer. The en bloc resection rate was 100.0% (33/33), the complete resection rate was 97.0% (32/33), and the curative resection rate was 42.4% (14/33). Among the 19 patients who did not achieve curative resection, 13 patients received supplementary surgical treatment. No tumor residue or lymph node metastasis was found in the postoperative pathology. All patients were followed up for 3-25 months, and no signs of local recurrence or metastasis were found. Conclusion:Most de novo early colorectal cancers are superficial phenotype under endoscopy. The pathology is mainly moderately differentiated tubular adenocarcinoma. Endoscopic resection of de novo early colorectal cancer shows encouraging short-term efficacy.

Application value of endoscopic Nd-Fe-B magnet ring tracer technique to laparoscopy for colorectal lesions (with video) / 中华消化内镜杂志

Objective:To explore the clinical application value of preoperative colonoscopic marking by Nd-Fe-B magnet ring to assist laparoscopy.Methods:A total of 51 patients with colorectal tumor who underwent radical laparoscopy from January 2020 to October 2021 at the Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital were recruited. The patients were marked by Nd-Fe-B magnet ring under endoscopy one day before the operation, another magnet ring was sent into the abdominal cavity during the radical laparoscopy through cannula. The two magnet rings were attracted and clung to each other to orient the lesions. The basic information of patients, location of preoperative marks under endoscopy and laparoscopy conditions were recorded.Results:All 51 Nd-Fe-B magnet rings were successfully located to the position of colorectal tumor and fixed. According to the location of the lesions, there were 15 cases of transverse colon, 12 cases of descending colon, 19 cases of sigmoid colon, and 5 cases of upper rectal segment. According to the lesion type, there were 21 cases of colon cancer, 25 cases of polyp carcinomatosis, and 5 cases of laterally spreading tumors with partial carcinomatosis. There were 5 cases with positive margins after endoscopic mucosal resection and 1 case with positive margin after endoscopic submucosal dissection. All lesions were accurately located during the operation. The marking time was 4.1±1.2 min (3-6 min) before the operation and the localization time was 1.5±1.1 min (0.9-5.3 min) during the operation. All magnet rings were removed from the body by laparoscope. The mean distances between the tumor and the cutting edge of the proximal and distal intestinal segments were 5.5 cm and 6.3 cm, respectively. No complications such as colon mucosal injury, bleeding, intestinal perforation or local inflammatory reactions occurred.Conclusion:Nd-Fe-B magnet ring tracer technique for laparoscopic orientation is simple, fast, accurate and safe with no need for additional equipment or apparatus, which is worthy of clinical application.

The experience on trocar layout method for robotic "3+2" mode gastrointestinal surgery / 中华普通外科杂志

Objective:Based on experience of robotic gastrointestinal surgery at the Department of General Surgery, Clinical Medicine Center of Gansu Provincial Hospital, this study explored the principles and methods of trocar layout for robotic "3+2" mode gastrointestinal surgery, suitable for beginners.Methods:From Apr 2017 to Oct 2022, the robotic gastrointestinal surgery team of Gansu Provincial Hospital completed 998 cases of robotic "3+2" mode gastrointestinal surgery, including 600 cases of gastric cancer, 100 cases of rectal cancer, 98 cases of descending colon and sigmoid colon cancer, 20 cases of transverse colon cancer, and 180 cases of right colon cancer. Through the continuous optimization and improvement of the problems encountered during the operation, combined with the operator's experience, and taking into account various aspects, we developed the robotic "3+2" mode trocar layout for gastrointestinal surgery.Results:Four principles of trocar layout were developed, namely, the principle of lens placement around the navel, the principle of symmetry in the main operation, the principle of 8-10cm distance between trocar holes, and the principle of symmetry in the auxiliary hole lens. Three trocar layout methods and principles applicable to robotic gastric surgery, and four applicable to robotic colorectal surgery were developed.Conclusion:The trocar layout method of robotic "3+2" mode gastrointestinal surgery is established based on a large number of robotic gastrointestinal surgery experiences. This method is simple and easy to learn, with strong repeatability and operability.