Assessing the Prognostic Value of NLR, PLR, APRI, SII, and Liver Function Tests for Fistula Formation after Colorectal Cancer Surgery.

Background: This study evaluates the predictive value of preoperative inflammatory markers (NLR, PLR, APRI, SII) and liver function tests in determining the risk of fistula development postcolorectal cancer surgery. The objective was to determine the association between elevated marker levels and fistula risk and establish thresholds for preoperative risk stratification. Methods: A retrospective cohort study was conducted at the "Pius Brinzeu" Clinical Emergency Hospital from 2018 to 2023, analyzing data from 219 patients undergoing colorectal cancer surgery. Results: Among the markers studied, the Systemic Inflammation Index (SII) with a cutoff 460.5 showed the highest sensitivity (75.6%) and specificity (71.3%), resulting in an AUC of 0.774 (p=0.001). Albumin levels 2.9 g/dL also significantly predicted fistula occurrence with 77.3% sensitivity and 73.8% specificity (AUC 0.788, p 0.001). Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) presented cutoffs of 3.95 and 191.6 respectively, demonstrating substantial predictive value with AUCs of 0.732 and 0.746 (p 0.001 and p=0.001, respectively). Conclusions: Elevated levels of specific preoperative inflammatory markers and liver function tests are significantly associated with the risk of developing fistulas in patients undergoing colorectal cancer surgery. These findings support the integration of these biomarkers into preoperative evaluations to enhance patient risk stratification and optimize surgical outcomes, providing a valuable tool for clinical decision-making in colorectal surgery settings.

Impact of Systemic Treatments on Outcomes and Quality of Life in Patients with RAS-Positive Stage IV Colorectal Cancer: A Systematic Review.

This systematic review critically evaluates the impact of systemic treatments on outcomes and quality of life (QoL) in patients with RAS-positive stage IV colorectal cancer, with studies published up to December 2023 across PubMed, Scopus, and Web of Science. From an initial pool of 1345 articles, 11 relevant studies were selected for inclusion, encompassing a diverse range of systemic treatments, including panitumumab combined with FOLFOX4 and FOLFIRI, irinotecan paired with panitumumab, regorafenib followed by cetuximab ± irinotecan and vice versa, and panitumumab as a maintenance therapy post-induction. Patient demographics predominantly included middle-aged to elderly individuals, with a slight male predominance. Racial composition, where reported, showed a majority of Caucasian participants, highlighting the need for broader demographic inclusivity in future research. Key findings revealed that the addition of panitumumab to chemotherapy (FOLFOX4 or FOLFIRI) did not significantly compromise QoL while notably improving disease-free survival, with baseline EQ-5D HSI mean scores ranging from 0.76 to 0.78 and VAS mean scores from 70.1 to 74.1. Improvements in FACT-C scores and EQ-5D Index scores particularly favored panitumumab plus best supportive care in KRAS wild-type mCRC, with early dropout rates of 38-42% for panitumumab + BSC. Notably, cetuximab + FOLFIRI was associated with a median survival of 25.7 months versus 16.4 months for FOLFIRI alone, emphasizing the potential benefits of integrating targeted therapies with chemotherapy. In conclusion, the review underscores the significant impact of systemic treatments, particularly targeted therapies and their combinations with chemotherapy, on survival outcomes and QoL in patients with RAS-positive stage IV colorectal cancer, and the need for personalized treatment.

Three-Year Analysis of the Rectal Cancer Care Trajectory after the COVID-19 Pandemic.

The global pandemic period from 2020 to 2022 caused important alterations in oncology care. This study aimed to describe the trends and variations in patient characteristics, comorbidities, and treatment approaches during this time in Romania. We conducted a retrospective database search to identify patients with rectal cancer who underwent surgical intervention between 2020 and 2022 and the year 2019, which served as a pre-pandemic period control. This study included 164 patients, with a yearly increase of approximately 10% in surgical interventions noted from 2020 (1709 interventions) to 2022 (2118 interventions), but an overall 34.4% decrease compared with the pre-pandemic period. Notable shifts were observed in the type of surgeries performed, with laparoscopic procedures doubling from 2020 (25%) to 2022 (47.5%), confirming the decrease in emergency presentations during the last year of the COVID-19 pandemic and a recovery to normality with planned, elective interventions. Elective interventions increased significantly in 2022 (79.7%) compared with the previous years (p = 0.043), with a concurrent rise in neoadjuvant therapy uptake in 2022 (35.6%). However, significant alterations in the TNM staging, from 12.5% stage IV cases in 2020 to 25.4% in 2022 (p = 0.039), indicated an increased diagnosis of advanced stages of rectal cancer as the years progressed. There was a significant difference in albumin levels over the years (p = 0.019) and in the American Society of Anesthesiology (ASA) scores (from 6.2% ASA stage IV in 2020 to 16.9% in 2022), denoting an increase in case complexity (p = 0.043). This study reveals a trend of increasing surgical interventions and the prevalence of more advanced stages of rectal cancer during the pandemic years. Despite the subtle fluctuations in various patient characteristics and treatment approaches, notable shifts were documented in the severity at diagnosis and surgery types, pointing toward more advanced disease presentations and changes in surgical strategies over the period studied. Nevertheless, the trends in ICU admission rates and mortality did not alter significantly during the pandemic period.

Metabolic and Hormonal Changes after Sleeve Gastrectomy and Mini Gastric Bypass in a Rat Model of Induced Type 2 Diabetes Mellitus and Obesity.

Introduction: Obesity is one of the leading causes of social, economic and health problems throughout the world and in the past years bariatric surgery has emerged as a method to alleviate this problem. We have conducted an experimental study aimed at comparing the metabolic and hormonal changes after sleeve gastrectomy and mini gastric by-pass, two bariatric procedures showing promising results. Material and Methods: We have designed a study using a rat model with induced type 2 diabetes mellitus and obesity divided into three groups: a sleeve gastrectomy group, a mini gastric by-pass group and a sham operated group, all of which had their glycemia, lipid profile, ghrelin and insulin levels measured before and after the procedures. Results: The results showed a significant decrease (p 0.05) in fasting glucose levels, lipid profile and ghrelin levels in the mini gastric bypass compared to the sleeve gastrectomy group. Conclusions: This study has demonstrated that both SG and MGB are effective treatments for morbid obesity and T2DM and both procedures can significantly resolve obesity-related metabolic changes.

Correlation between leptin and ghrelin expression in adipose visceral tissue and clinical-biological features in malignant obesity.

Morbid obesity is a metabolic disease characterized by an excessive accumulation of adipose tissue (=40%). This disorder is commonly associated with cardiovascular disease, arteriosclerosis, type 2 diabetes, hypothyroidism and some types of cancer. The most common metabolic signals associated with the disease are leptin, ghrelin, with antagonic effects. Our study aimed at highlighting leptin and ghrelin expression levels, as well as establishing correlations between them and clinical-biological parameters in obese patients. The biological material was taken intraoperatively from the visceral adipose tissue. Expression of genes of interest was performed after total RNA extraction and reverse transcription-polymerase chain reaction (RT-PCR) and amplification with TaqMan specific primers. The results of the study showed significant differences in the expression of leptin mRNA between obese patients and the control group as well as the gender of the subjects. Ghrelin levels correlated positively with obesity, but not with gender. There were no significant correlations between the expression of the genes of interest and the parameters studied (age, body mass index - BMI, cholesterol, triglycerides, glycemia, diabetes, hypothyroidism and hypertension). The results of the study suggest that the evaluation of leptin levels can be used clinically in assessing the metabolic status of the patient with malignant obesity.