Biomarkers and prognosis after R0 resection of colorectal liver metastases.

BACKGROUND: Evaluation of biomarkers and clinical factors associated with cancer-specific survival after curative resection for colorectal cancer liver metastases (LM). METHODOLOGY: All patients who had an R0 resection for LM between 2000-2006 were reviewed. Clinical and histological data were assessed; p53 expression was studied by IHC. ERCC1 codon 118 and XRCC1 codon 399 were analyzed by PCR-RFLP using BsrDI and HpaII, respectively. RESULTS: Out of 119 patients included (80 synchronous LM (67.2%), median number 2 (1-18)), 104 patients (87.4%) received chemotherapy before recurrence; 60 patients (50.4%) had a p53 negative tumor. ERCC1 distribution was: 31(26%) AAC/AAC, 44(37%) AAC/AAT and 44(37%) AAT/AAT. XRCC1 distribution was: 46(39%) CGG/CGG, 53(44.9%) CGG/CAG and 19(16.1%) CAG/CAG. Three and 5-years disease free survival (DFS) and overall survival (OS) were 31%, 22.7%, 77.4%, and 66.6%, respectively. Node ratio >0.2 (p = 0.0042), LM number >3 (p <0.0001), bilobar localization (p = 0.0074) and preoperative chemotherapy (p = 0.0036) were associated with a shorter DFS. None of the biomarkers was found to influence DFS. In multivariate analysis, a number of LM >3 was the only independent factor. No factor was found to influence OS. CONCLUSIONS: The studied biomarkers had no significant impact on prognosis. For routine practice, clinical factors remain the only usable available tools.

Transiliac hernia.

Lumbar hernias (and namely transiliac hernias) are not frequent. We report the case of a 76-year-old man presenting with an incarcerated transiliac hernia, in a context of exacerbated chronic obstructive pulmonary disease, 30 years after iliac bone harvesting for femur surgery. After imaging, the patient underwent a laparotomy, and a herniated left colic segment was identified through a hole in the left iliac crest. The left colon was reduced and the defect was closed by an omental patch. The patient recovered well and was discharged. Graft-site hernia is a rare complication of harvesting bone grafts from the iliac crest. Repeated increases in abdominal pressure can result in herniation of abdominal contents through the osseous defect. Computed tomography is commonly used to confirm the diagnosis.

Comparison of hyperthermia and adrenaline to enhance the intratumoral accumulation of cisplatin in a murine model of peritoneal carcinomatosis.

BACKGROUND: The best method to deliver intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis from ovarian cancer is not well defined. The aim of this study was to assess the ability of hyperthermia and adrenaline to enhance the intratumoral accumulation of cisplatin in a rat model of peritoneal carcinomatosis. METHODS: Four groups of 5 BDIX rats with ovarian peritoneal carcinomatosis underwent IPC with 30 mg/l of cisplatin according to the following conditions: normothermia at 37° for 1 or 2 hours, hyperthermia at 42°C for 1 hour or normothermia at 37°C for 2 hours with 2 mg/l adrenaline. Tissue platinum content was measured by atomic absorption spectroscopy. The effect of hyperthermia, adrenaline and the duration of exposure to the drug was measured in vivo (tissue concentration of platinum in tumor, abdominal and extra abdominal tissues) and in vitro (cytotoxicity on human ovarian cancer cells). RESULTS: In vitro, hyperthermia and longer exposure enhanced the accumulation and the cytotoxic effect of cisplatin on cancer cells. In vivo, only the 2 hours treatment with adrenaline resulted in increased platinum concentrations. The rats treated with adrenaline showed significantly lower concentrations of cisplatin in extra peritoneal tissues than those treated with hyperthermia. CONCLUSION: Adrenaline is more effective than hyperthermia in order to enhance the intratumoral concentration of cisplatin in rats with peritoneal carcinomatosis from ovarian origin. It may also decrease the systemic absorption of the drug.

C-reactive protein is an early predictor of septic complications after elective colorectal surgery.

BACKGROUND: Nowadays, most patients who undergo colorectal surgery are discharged early. An early predictor of septic complications could avoid readmissions and decrease morbidity. CRP could be a good predictor allowing a safe discharge. METHODS: A prospective, observational study was conducted from November 2007 to October 2008. All patients who underwent elective colorectal surgery were included. Clinical (temperature, pulse, abdominal tenderness, bowel movements) and laboratory data (C-reactive protein, leukocyte count) were recorded and evaluated as early predictors of septic complications (namely, anastomotic leaks). All detected leaks were considered fistulas, independently of their clinical significance. Clinical and inflammatory parameters were analyzed with univariate and multivariate techniques; logistic regression was performed and areas under the receiver operating characteristic curve were compared. RESULTS: A total of 133 patients were included. The overall incidence of anastomotic leaks was 15.5% and mortality was 4.5%. C-reactive protein at postoperative days 2 and 4 was a good predictor of anastomotic leak (areas under the curve were 0.715 and 0.845, respectively) and other postoperative septic complications (areas under the curve were 0.804 and 0.787), showing the highest accuracy among clinical and laboratory data. A cutoff of 125 mg/l in the level of C-reactive protein at postoperative day 4 yielded a sensitivity of 81.8% and a negative predictive value of 95.8% for the detection of anastomotic leakage. CONCLUSIONS: C-reactive protein is a simple way to ensure a safe discharge from hospital after elective colorectal surgery. Patients with CRP values >125 mg/l on the fourth postoperative day should not be discharged.

Clinical images. Gastric perforation caused by metastatic lung carcinoma.

A case of gastric perforation caused by metastases of small-cell lung carcinoma in an 85-year-old man is reported. This complication revealed the neoplasm. Biopsy should always be done in patients with gastric perforations, even if there is no palpable tumor. Minimal surgery is warranted because this event occurs often in patients with advanced disease and poor prognosis.

Aeroportia and acute abdominal pain: ischemic bowel necrosis.

Pneumatosis intestinalis and aeroportia are typical findings of mesenteric ischemia. The second carries a worse prognosis than the former. We report the case of a patient presenting with acute abdominal pain and acidosis after admission to the coronary unit for myocardial infarction. An emergent abdominal CT scan showed aeroportia. Laparotomy confirmed extended bowel necrosis. Aeroportia is a typical feature of ischemic bowel necrosis, often associated with advanced disease and bad prognosis. In the presence of acute abdominal pain, aeroportia should be considered as a sign of ischemic bowel necrosis. Emergent laparotomy is warranted.