Aim
Our aim was to evaluate the efficacy of indocyanine green (ICG) fluorescence angiography (FA) in reducing the incidence of anastomotic leakage (AL) following colorectal anastomosis.
Method
A ...single‐centre randomized trial was undertaken between 2018 and 2019. Those patients who underwent a stapled colorectal anastomosis were randomized 1:1 for ICG FA versus visual clinical assessment of blood perfusion of the anastomosed colon and rectal stump (non‐ICG FA group). The primary end‐point was to assess whether ICG FA was associated with a reduction in the incidence of AL. Secondary outcomes were the rate of postoperative complications and change in the level of bowel resection.
Results
A total of 380 patients undergoing sigmoid and rectal resection were enrolled. After randomization, three patients were excluded. The results of 377 cases were available for analysis; 187 had ICG FA and 190 were in the non‐ICG FA group. ICG FA identified impaired blood perfusion of the colon in 36 (19%) cases. An AL (grade A, B or C) developed in 48 patients: 17 (9.1%) in the ICG FA group and 31 (16.3%) in the non‐ICG FA group (P = 0.04). ICG FA did not decrease the rate of AL of high anastomoses (9–15 cm from the anal verge), at 1.3% vs 4.6% in the non‐ICG FA group (P = 0.37). In contrast, a decrease in AL rate was found for low (4–8 cm) colorectal anastomoses (14.4% in ICG FA vs 25.7% in the non‐ICG FA group; P = 0.04).
Conclusion
ICG FA is associated with a reduction in AL following low anterior resection.
Aim
The aim was to assess the rate and independent risk factors of postoperative ileus after colorectal cancer surgery.
Methods
Three hundred consecutive patients underwent colorectal surgery for ...cancer at the State Scientific Centre of Coloproctology, Moscow, Russia, between November 2015 and August 2016. Postoperative ileus was diagnosed as an absence of intestinal function for 72 h or more after operation and was confirmed by plain radiography. Univariate and multivariate logistic regression of the tumour‐, patient‐ and treatment‐related factors was performed. All patients had epidural catheters with multimodal analgesia.
Results
Thirty‐nine patients (13%) had postoperative ileus. The variables associated with this condition in univariate analysis were age < 64 years (P = 0.02), male gender (P = 0.02), body mass index ≥ 25 kg/m2 (P = 0.02), moderate drinking (P = 0.02), heavier drinking (P < 0.0001), opioids (P = 0.02), history of abdominal operation (P = 0.003), firm extensive adhesions as a result of previous surgery (P = 0.005), multivisceral resection (P = 0.009), blood loss ≥ 150 ml (P = 0.006), haemotransfusion (P = 0.01) and open approach (P = 0.006). In the multivariate logistic regression, body mass index ≥ 26 kg/m2 (P = 0.008), opioids (P = 0.04), history of abdominal operation (P = 0.04) and adhesions (P = 0.03) were identified as independent risk factors.
Conclusion
Postoperative ileus is a common complication in colorectal surgery. The results of our study suggest at least two surgeon‐dependent risk factors, i.e. open approach and opioids in the postoperative period.
Familial adenomatous polyposis (FAP) is a hereditary syndrome characterized by the presence of multiple adenomatous polyps in the colon. The main cause of the disease is a germline mutation in the ...APC gene. Here we report 4 unrelated FAP patients with different large deletions in the APC gene detected by Multiplex Ligation-dependent Probe Amplification (MLPA) method: deletion of exons 7-15, deletion of promoters B, A, and 5'-UTR region and deletion of promoter B (in 2 patients). The deletion of promoters B, A, and 5'-UTR was not described in the literature earlier, so we report it for the first time. In 2 families with promoter B deletion, we could identify the tendency for decreasing the age of disease manifestation in each next generation, in contrast to the previous one. The incidence of large deletions in APC among Russian patients with FAP reached 4.8% and our finding suggests the need to study this gene by MLPA in "no mutation patients" after Sanger's sequencing.
Colorectal cancer is highly metastatic even when the tumors are small. To disseminate, cells use a complex and multistage process known as the epithelial-mesenchymal transition, in which epithelial ...phenotype is transformed into mesenchymal phenotype. The objective of this study is to describe the epithelial-mesenchymal transition in terms of gene expression profile and somatic alterations in samples of colorectal cancer with or without peritoneal carcinomatosis. We analyzed samples taken from 38 patients with colorectal cancer (stages II-IV) and samples from 20 patients with colorectal cancer complicated by peritoneal carcinomatosis. The expression of ZEB1, ZEB2, CDH1, VIM, and SNAI1 was analyzed by real-time PCR. KRAS/BRAF mutations were mapped using sequencing. Microsatellite instability was evaluated by fragment analysis. Epithelial-mesenchymal transition was detected in 6 out of 38 samples of colorectal cancer (stages II-IV), 7 out of 20 tumors from patients with peritoneal carcinomatosis, and 19 out of 20 samples taken from carcinomatous nodules. Tumors of the mesenchymal subtype displayed high frequency of somatic mutations, microsatellite stability, and low degree of differentiation. The identification of epithelial-mesenchymal transition may be used as a marker of high metastatic potential, which is particularly relevant at early stages of tumor growth.
Background
Loop ileostomy is widely employed as a defunctioning procedure for left-sided colonic anastomoses. Closure of the stoma carries a risk of morbidity and even mortality. The aim of this ...prospective trial was to evaluate the ability of stapled stoma closure to decrease the rates of perioperative morbidity.
Methods
One hundred and nineteen patients (mean age 56.2 ± 5.4 years) underwent two-stage operations for rectal carcinoma with protective loop ileostomy between 2005 and 2008. All patients were randomly divided into two groups: 56 patients had conventional ileostomy takedown, while in the other 63, a functional end-to-end anastomosis was created using a linear stapler. Groups were comparable in terms of age, gender, body mass index, and other parameters.
Results
Mean time of stoma closure using functional end-to-end anastomosis was 68 ± 7, when compared to 92 ± 11 min (
P
= 0.01) for conventional stoma closure. The overall morbidity rate after ileostomy closure using a stapler was 3.2%: one patient (1.6%) developed a wound infection and self-limited bleeding from the anastomotic line, while another patient (1.6%) had an ileal obstruction caused by adhesions and required additional intervention. Conventional ileostomy closure resulted in a 14.3% morbidity rate: six patients (10.7%) had prolonged ileus, 2 (3.6%) had small bowel obstruction, and 2 (3.6%) had wound infections (
P
= 0.04).
Conclusion
Functional end-to-end anastomosis reduces operating time and morbidity compared to conventional ileostomy takedown.
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Cancer immunotherapy represents a promising and rapidly developing approach for the treatment of oncological diseases. Among the methods of personalized adjuvant immunotherapy, neoantigenic ...peptide-based drugs have demonstrated substantial efficiency. These drugs are designed to target mutant proteins arising from somatic alterations in the genome of tumor cells and thus stimulate immune response against tumor tissues. The methods of individual screening for potentially immunogenic mutations are mostly based on next-generation exome sequencing of tumor samples, which is a complex and costly procedure for clinical application. Targeted gene sequencing panels limited to a certain set of genes represent a reasonable alternative to whole exome sequencing (WES). Targeted sequencing is also more efficient when there is a low amount of the sample DNA available. We have estimated the potential efficiency of targeted oncological panels in terms of somatic neoantigen profiling in colorectal cancer (colon and rectal adenocarcinoma). The methods of detection of some frequent somatic variants currently used in clinical practice do not provide the neoantigen profiling of the tumor sufficient for design of effective drugs for low and medium mutated cancers such as colorectal cancer. Our analysis of 11 commercially available panels covering different number of genes has shown that neither the larger size of a panel nor its initial customization for colorectal cancer provides a significantly better estimation of an individual neoantigenic profile. The optimal approach is to use the general-purpose medium-sized cancer panels (2300–11 200 amplicons and/or 150–600 genes). Such panels allow to detect a sufficient number of immunogenic epitopes (>3) for over 30–50% of patients.
Transanal endoscopic microsurgery (TEM) is a main treatment technique for rectal adenomas, but can also be used for selected malignant tumors. This study presents TEM experience.
The study enrolled ...patients with rectal adenomas, and selected adenocarcinomas. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic MRI.
Three hundred and thirty patients mean age of 61,4±10 (33–88) underwent TEM. The mean size ± SD of tumors was 3.2±1.2 cm (0.6–10.0). Mean distance from anal verge was 6.7±2.6 cm (2.0–14.0). Preoperative biopsy revealed: adenoma ― 263/330 (79,7%), adenocarcinoma ― 67/330 (20,3%). The median operating time was 40 (15–220) min. Tumor-free margins were obtained in all operative specimens. In 5/330 (1.5%) cases tumors were fragmented. The morbidity rate was 19/330 (5.7%). Pathological investigation revealed: adenoma in 192/330 (58.1%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 138/330 (41.9%). Median follow-up lasted for 24 (1–57) months. Five patients (2.0%) with adenoma and four patients (5.2%) with adenocarcinoma had local recurrence.
Transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.
The expression levels of microRNAs miR-200c and miR-145 in two groups of colorectal cancer differing by the presence/absence of epithelial-mesenchymal transition (EMF) were studied. In the ...EMF-positive cancer, the level of miR-145 is increased, whereas the level of miR-200c is reduced. The reverse situation is observed in the EMI-negative cancer. MiR-145 can serve as a marker of the mesenchymal subtype of cancer. Gene expression profiles and microRNAs allow prognostically unfavorable tumors of the mesenchymal subtype to be distinguished.
We report a case of sigmoid colon resection by single-incision laparoscopic surgery using transvaginal access. The patient was a 54-year-old woman with early stage sigmoid cancer who had no previous ...surgery and had a body mass index of 23.5 kg/m
2
. The operative time was 270 min, and the blood loss was negligible. We used only transvaginal access, since no transabdominal assistance was required. No complications occurred. Minimal postoperative pain and a rapid recovery of gastrointestinal function were observed. As novel equipment is introduced into clinical practice, transvaginal laparoscopic procedures will most likely become increasingly popular in abdominal surgery. In particular, this type of procedure will have a more defined role in colorectal surgery. Indeed, in the future, it may become an alternative for natural orifice transluminal endoscopic surgery.
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