The safety and effectiveness of prophylactic hyperthermic intraperitoneal chemotherapy in patients with pathological T3-4 locally advanced colon cancer.

INTRODUCTION: The safety and effectiveness of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) in pathological T3-4 locally advanced (pT3N + M0 and pT4NxM0) colon cancer (CC) patients with radical resection need further study. METHODS: Clinical and pathological information of pT3-4 locally advanced CC patients who received radical surgery in our hospital from January 2018 to December 2020 were analyzed. The prognosis of patients was estimated using Cox proportional hazards regression analysis and Kaplan-Meier method. RESULTS: Among 927 patients, 10.4% (96/927) received prophylactic HIPEC based on 5-FU, 4.6% (43/927) received prophylactic HIPEC based on lobaplatin, 85.0% (788/927) received conventional therapy. The incidence of metachronous peritoneal carcinomatosis (mPC) was 9.4%. Complications occurred in 32 patients (4.1%) in the conventional therapy group, 6 patients (6.3%) in the prophylactic HIPEC group based on 5-FU and 3 patients (7.0%) in the prophylactic HIPEC group based on lobaplatin within 30 days after surgery (5-FU vs. conventional therapy group, p = 0.464; Lobaplatin vs. conventional therapy group, p = 0.591). Multivariate Cox regression analysis revealed that prophylactic HIPEC based on either 5-FU or lobaplatin regimen could not effectively improve mPC-free survival (5-FU: p = 0.020, HR = 1.927, 95% CI, 1.111-3.343; Lobaplatin: p = 0.167, HR = 0.247, 95% CI, 0.034-1.796), overall survival (5-FU: p = 0.361, HR = 1.360, 95% CI, 0.703-2.634; Lobaplatin: p = 0.780, HR = 0.816, 95% CI, 0.195-3.416) and disease-free survival (5-FU: p = 0.525, HR = 1.149, 95% CI, 0.749-1.760; Lobaplatin: p = 0.117, HR = 0.488, 95% CI, 0.199-1.198). CONCLUSION: Early prophylactic HIPEC based on 5-FU or lobaplatin subsequent to radical resection for patients with pT3-4 locally advanced CC is safe, but not effective in reducing the risk for mPC.

Prognostic Implications of Endoscopic Obstruction in Patients with Pathological Stage II Colon Cancers: a Single-Center Retrospective Cohort Study.

BACKGROUND: The prognostic effect of endoscopic obstruction (eOB) on the survival of stage II colon cancer patients and the role of eOB in guiding postoperative adjuvant chemotherapy of stage II colon cancer are little known. METHODS: In this retrospective, single-center cohort study, patients who had undergone curative surgery and preoperative colonoscope for stage II colon carcinoma were included. The eOB was defined as severe luminal colon obstruction that prevented the standard colonoscope from passing beyond the tumor. The association between eOB and stage II colon cancer survival and the predictive role of eOB for adjuvant chemotherapy were evaluated using multivariate Cox regression analysis. RESULTS: Of 1102 included patients, 616 (55.9%) had eOB and 486 (44.1%) had no eOB. The median follow-up was 49 months (interquartile range, 38-68 months). Kaplan-Meier curves showed that patients with eOB had poor 5-year overall survival (OS; 85.3% vs. 95.3%, p < 0.001) compared to patients without eOB. Five-year disease-free survival (DFS; 78.5% vs. 87.6%, p = 0.004) was also poor in these patients. Multivariate analysis demonstrated eOB was a significant prognostic factor for poor OS (hazard ratio [HR] = 2.531, p < 0.001), but not for DFS (p = 0.081). Even when patients with clinical colonic obstruction were excluded from the population with eOB, the worse OS (HR = 2.262, p = 0.001) was observed. The OS and DFS of eOB patients improved slightly after adjuvant chemotherapy, but there was no statistical significance. CONCLUSIONS: Stage II colon cancer patients with eOB have a poor prognosis. However, whether eOB can guide adjuvant chemotherapy still needs further study.

A rare postoperative complication after a step-up approach for walled-off pancreatic necrosis: locating a difficult digestive duct fistula.

We present the case of a gallbladder-abscess cavity fistula in a 46-year-old male with walled-off pancreatic necrosis (WOPN). A step-up approach was used for two months, which consisted of a minimally invasive necrosectomy followed by postoperative percutaneous lavages with two drainage tubes. The range of the abscess was significantly reduced, as shown by the computerized tomography scan (Fig. 1). However, a substantial amount of odorless, pale yellow, feculent fluid (almost 1,000 ml daily) was discharged from the drainage tubes over the following days, without lavages.

Relationships of interleukin-17 polymorphisms with recurrent aphthous ulcer risk in a Han Chinese population.

OBJECTIVE: Interleukin (IL)-17 is a multifunctional cytokine with important roles in inflammatory and autoimmune diseases. This case-control study explored the relationships of IL-17A rs2275913 and IL-17F rs763780 single-nucleotide polymorphisms (SNPs) with recurrent aphthous ulcer (RAU) morbidity and severity. METHODS: IL-17A rs2275913 and IL-17F rs763780 SNPs were measured in 125 patients with RAU and 116 healthy control participants. The genotype distributions, disease risks, and relationships with RAU severity were analyzed. RESULTS: RAU risk was associated with rs2275913 after adjustment for age, body mass index, sex, smoking status, and drinking status (AA vs. GG: odds ratio [OR], 2.759; 95% confidence interval [CI], 1.381-5.512; A allele vs. G allele: OR, 1.783; 95% CI, 1.242-2.560). TC and CC genotypes in rs763780, and the corresponding C allele, demonstrated greater prevalence among patients with RAU, compared with the TT genotype (TC vs. TT, OR: 1.895; 95% CI: 1.088-3.301; CC vs. TT, OR: 4.080, 95% CI: 1.079-15.425; C allele vs. T allele, OR: 1.969, 95% CI: 1.257-3.083). Serum IL-17 concentrations were also higher in patients with RAU than in control participants. These concentrations were associated with IL-17 polymorphisms. CONCLUSIONS: IL-17 polymorphisms might be associated with greater risk of RAU pathogenesis.

[Value of preoperative abdominal contrast-enhanced multiple-row detector computed tomography in predicting the postoperative 1-year disease-free survival for gastric cancer].

OBJECTIVE: To investigate the value of preoperative abdominal contrast-enhanced multiple-row detector computed tomography (ceMDCT) in predicting the postoperative 1-year disease-free survival (DFS) for gastric cancer. METHODS: Between January 2009 and December 2015, 237 gastric cancer patients at Peking University People's Hospital with complete preoperative clinical, image and follow-up data were enrolled in this retrospective study. INCLUSION CRITERIA: (1) primary gastric cancer was confirmed by pathology; (2) radical gastrectomy and D2 lymph node dissection were performed;(3) patients underwent preoperative ceMDCT. Patients with gastric stump cancer, concurrent metastasis, other malignancies, and undergoing neoadjuvant treatment were excluded. According to ceMDCT examination with or without ctEMVI (extramural venous invasion), patients were divided into ctEMVI-positive and ctEMVI-negative group. ctEMVI-positive was defined as that there was a continuous tubular and nodular soft tissue filling defect from the tumor to the adjacent blood vessel lumen in ceMDCT, suggesting the tumor directly invaded the blood vessels outside the muscularis propria of the gastrointestinal smooth muscle. Log-rank test was used to compare differences in 1-year DFS between ctEMVI-positive group and ctEMVI-negative group. According to the 8th edition of the American Joint Committee on Cancer (AJCC), the T staging in ceMDCT (ctT) and lymph node metastasis (lymph nodes with shorter diameter > 8 mm) were determined. The patients were subdivided into four subgroups, ctT4N(+), ctT4N(-), ctT1-3N(+), and ctT1-3N(-), to further compare the difference in postoperative 1-year DFS between ctEMVI-positive and -negative patients in each subgroups. Kaplan-Meier univariate analysis was performed on preoperative imaging data (ctT, ctN, ctEMVI, tumor location/growth pattern, and ctSize). Cox proportional hazard regression was used to find the independent risk factors of 1-year DFS rate. According to the number of independent risk factors, the patients were classified to different risk stratifications. The difference of 1-year DFS rate between different risk stratifications was compared. RESULTS: According to the results of ceMDCT, 72 patients (30.4%) were divided into the ctEMVI-positive group and 165 patients(69.6%) into the ctEMVI-negative group. The ctEMVI-positive group had significantly lower 1-year DFS rate (55.3%) than the ctEMVI-negative group (90.2%) (χ²=40.17, P<0.001). The 1-year DFS in the ctEMVI-positive ctT4N(+) subgroup was 34.5%, which was significantly lower than that of the ctMVI-negative ctT4N(+) subgroup (85.3%) (χ²=19.13, P<0.001). In the ctEMVI-positive ctT1-3N(-) subgroup, the 1-year DFS was 77.8%, which was also significantly lower than 98.5% of the ctEMVI-negative ctT1-3N(-) subgroup(χ²=15.09, P=0.003). In Cox proportional hazards regression analysis, ctT, ctN and ctEMVI were identified as independent prognostic factors of 1-year DFS with hazard ratio (HR) of 3.351(95%CI:1.249-8.986, P=0.017), 1.987(95%CI:1.085-3.637, P=0.027) and 3.398(95%CI:1.785-6.469, P<0.001), respectively. Risk classification was carried out according to the number of independent risk factors (ctT, ctN and ctEMVI). Grade 0 had no independent risk factors, grade 1 had one independent risk factor, grade 2 had two independent factors and grade 3 had 3 independent risk factors. The risk grading result showed that the numbers of patients form grade 0 to 3 were 71, 65, 68, 33, respectively, and the 1-year DFS rates were 98.5%, 82.1%, 79.0%, 34.5%, respectively(P<0.001). With the increase of the number of independent risk factors, 1-year DFS rate decreased gradually in patients with gastric cancer (P<0.001). Differences of 1-year DFS between grade 0 and grade 1(P=0.002), between grade 2 and grade 3(P<0.001) were both significant. Meanwhile the difference between grade 1 and grade 2 was not significant (P=0.578). CONCLUSIONS: ctEMVI, ctT and ctN defined by preoperative ceMDCT are independent risk factors for the prognosis of gastric cancer. With the increase of risk factors, the 1-year DFS decreases gradually.