The impact of laparoscopic, open, extended right, and left colectomy on clinical outcomes of splenic flexure colon cancer: A meta-analysis.

BACKGROUND: Surgical intervention is the recommended line for the management of colon cancer. The aim of this study was to evaluate the impact of different surgical techniques (laparoscopic, open, extended right, and left colectomy) on clinical outcomes such as mortality, postoperative complications, operation and hospitalization time, and oncological factors. METHODS: A total of 15 studies have been included in the current study. The outcomes of these studies were analyzed using a random-effect model and it was used to calculate the mean difference with 95% confidence intervals to quantify the impact of open, laparoscopic, extended right, and left colectomy. Inclusion criteria included studies in which subjects undergo splenic flexure colon cancer surgery with 2 comparable different surgical techniques. RESULTS: Laparoscopic splenic flexure colon cancer surgery showed a significant beneficial impact on the length of hospital stay (P < .001), the volume of blood loss during surgery (P < .001), postoperative complications (P < .001), and time to an oral diet (P < .001). On the other hand, there was no significance regarding anastomotic leakage, infection of the surgical site, and operation time. Regarding the comparison between extended right colectomy (ERC) and lift colectomy (LC), analysis findings showed a significant (P = .001) higher efficacy of ERC in harvested number of lymph nodes compared with LC. On the other hand, there was no significant difference for the rest of the parameters. The neoadjuvant therapy as an influencing factor on postoperative outcome showed a beneficial impact regarding the overall survival rate. CONCLUSION: Laparoscopic splenic flexure colon cancer surgery showed a significant beneficial impact compared with open surgery as proved by clinical outcomes. On the other hand, ERC and LC resulted in similar findings except for harvested lymph nodes, results were in favor of ERC.

High-Fat Diet Enhances the Liver Metastasis Potential of Colorectal Cancer through Microbiota Dysbiosis.

Obesity, metabolic changes, and intestinal microbiota disruption significantly affect tumorigenesis and metastasis in colorectal cancer (CRC). However, the relationships among these factors remain poorly understood. In this study, we found that a high-fat diet (HFD) promoted gut barrier dysfunction and inflammation in the colorectum and liver. We further investigated gut microbiota changes through 16S rRNA sequencing of faecal samples from HFD-fed rats and CRC hepatic metastasis patients and found an abundance of Desulfovibrio (DSV). DSV could also induce barrier dysfunction in the colorectum and inflammation in the colorectum and liver, suggesting that it contributes to the formation of a microenvironment conducive to CRC tumorigenesis and metastasis. These findings highlight that HFD-induced microbiota dysbiosis, especially DSV abundance, could promote CRC initiation and metastasis.

Friend or Foe? An Unrecognized Role of Uric Acid in Cancer Development and the Potential Anticancer Effects of Uric Acid-lowering Drugs.

In recent years, metabolic syndrome (Mets) has been a hot topic among medical scientists. Mets has an intimate relationship with the incidence and development of various cancers. As a contributory factor of Mets, hyperuricemia actually plays an inseparable role in the formation of various metabolic disorders. Although uric acid is classically considered an antioxidant with beneficial effects, mounting evidence indicates that a high serum uric acid (SUA) level may serve as a pro-oxidant to generate inflammatory reactions and oxidative stress. In this review, we describe the unrecognized role of hyperuricemia in cancer development and summarize major mechanisms linking uric acid to carcinogenesis. Furthermore, we also discuss the potential mechanism of liver metastasis of cancer and list some types of uric acid-lowering agents, which may exert anticancer effects.

Risk for gastric cancer in patients with gastric atrophy: a systematic review and meta-analysis.

BACKGROUND: The risk for gastric cancer among patients with gastric atrophy is unclear. We investigated the association between the risk for gastric cancer and gastric atrophy. METHODS: We performed a comprehensive literature search in the PubMed and Embase databases and extracted relevant data from eligible studies. A fixed- or random-effects model was applied to pool study-specific risk according to heterogeneity across studies. RESULTS: Thirteen cohort or nested case-control studies with 655,937 participants and 2,794 patients with gastric cancer were analyzed. The pooled results suggested that gastric atrophy was associated with an elevated risk for gastric cancer [pooled risk ratio (RR) =2.91, 95% confidence interval (CI): 2.58-3.27]. The pooled RR (3.10, 95% CI: 2.58-3.73) of studies that used serum levels of pepsinogen for diagnosis of gastric atrophy was similar to that of those that used (pooled RR =2.79, 95% CI: 2.37-3.27) (for endoscopy). Gastric atrophy was positively associated with the risk for gastric cancer in both prospective and retrospective studies. Moreover, the pooled RRs did not significantly vary by country of origin (Asia and Europe) or gastric cancer subtype (cardia and non-cardia). CONCLUSIONS: Gastric atrophy is associated with an elevated risk for gastric cancer, and endoscopy and serum levels of pepsinogens can be used to predict the risk.

Clinicopathological features and prognosis of Borrmann type IV gastric cancer.

PURPOSE: Borrmann type IV gastric cancer is still detected at an advanced stage and survival rates for these patients remain poor. The purpose of this study was to provide valuable prognostic and surgical information on patients with Borrmann type IV gastric cancer. METHODS: We compared the clinicopathological features of Borrmann type IV gastric cancer with those of other types of gastric cancer. Clinicopathologic features of patients with Borrmann type IV gastric cancer were evaluated as prognostic predictors by univariate and multivariate analyses. RESULTS: The results showed that Borrmann type IV gastric cancer had more advanced and unfavorable clinicopathological factors compared with other Borrman types. The 5-year overall survival rate was 16.7%, and the median survival 25 months. The 5-year overall survival rate was influenced by tumor size, depth of invasion, lymph node metastasis, and chemotherapy. Of these, independent prognostic factors were lymph node metastasis (present vs absent, risk ratio 1.855, p=0.002) and radical (R0) resection (no vs yes, risk ratio 2.035, p<0.001). A significant survival benefit for radical resection was observed, with a 5-year overall survival rate of 30.7% compared with non-radically resected cases (4.8%). CONCLUSIONS: Early detection and radical resection were essential to improve the prognosis of patients with Borrmann type IV gastric cancer.