To evaluate the effect of laparoscopic or open colectomy with fast track or standard perioperative care on patient's immune status and stress response after surgery.
Patients with nonmetastasized ...colon cancer were randomized to laparoscopic or open colectomy with fast track or standard care. Blood samples were taken preoperatively (baseline), and 1, 2, 24, and 72 hours after surgery. Systemic HLA-DR expression, C-reactive protein, interleukin-6, growth hormone, prolactin, and cortisol were analyzed.
Nineteen patients were randomized for laparoscopy and fast track care (LFT), 23 for laparoscopy and standard care (LS), 17 for open surgery and fast track care (OFT), and 20 for open surgery and standard care (OS). Patient characteristics were comparable. Mean HLA-DR was 74.8 in the LFT group, 67.1 in the LS group, 52.8 in the OFT group, and 40.7 in the OS group. Repeated-measures 2-way analysis of variance (ANOVA) showed this can be attributed to type of surgery and not aftercare (P = 0.002). Interleukin-6 levels were highest in the OS group. Repeated-measures 2-way ANOVA showed this can be attributed to type of surgery and not aftercare (P = 0.001). C-reactive protein levels were highest in the OS group. Following repeated-measures 2-way ANOVA, this can be attributed to type of surgery and not aftercare (P = 0.022). Growth hormone was lowest in the LFT group. Following repeated-measures 2-way ANOVA, this can be attributed to type of aftercare and not to type of surgery (P = 0.033). No differences between the groups were seen regarding prolactin or cortisol. No differences in (infectious) complication rates were observed between the groups.
This randomized trial showed that immune function of HLA-DR in patients undergoing laparoscopic surgery with fast track care remains highest. This can be attributed to type of surgery and not aftercare. These results may indicate a reason for the accelerated recovery of patients treated laparoscopically within a fast track program as described in the LAparoscopy and/or FAst track multimodal management versus standard care (LAFA-Trial) (www.trialregister.nl, protocol NTR222).
Background
Laparoscopic surgery offers patients with rectal cancer short-term benefits and similar survival rates as open surgery. However, selecting patients who are suitable candidates for ...laparoscopic surgery is essential to prevent intra-operative conversion from laparoscopic to open surgery. Clinical and pathological variables were studied among patients who had converted laparoscopic surgeries within the COLOR II trial to improve patient selection for laparoscopic rectal cancer surgery.
Methods
Between January 20, 2004, and May 4, 2010, 1044 patients with rectal cancer enrolled in the COLOR II trial and were randomized to either laparoscopic or open surgery. Of 693 patients who had laparoscopic surgery, 114 (16 %) were converted to open surgery. Predictive factors were studied using multivariate analyses, and morbidity and mortality rates were determined.
Results
Factors correlating with conversion were as follows: age above 65 years (OR 1.9; 95 % CI 1.2–3.0:
p
= 0.003), BMI greater than 25 (OR 2.7; 95 % CI 1.7–4.3:
p
< 0.001), and tumor location more than 5 cm from the anal verge (OR 0.5; CI 0.3–0.9). Gender was not significantly related to conversion (
p
= 0.14). In the converted group, blood loss was greater (
p
< 0.001) and operating time was longer (
p
= 0.028) compared with the non-converted laparoscopies. Hospital stay did not differ (
p
= 0.06). Converted procedures were followed by more postoperative complications compared with laparoscopic or open surgery (
p
= 0.041 and
p
= 0.042, respectively). Mortality was similar in the laparoscopic and converted groups.
Conclusions
Age above 65 years, BMI greater than 25, and tumor location between 5 and 15 cm from the anal verge were risk factors for conversion of laparoscopic to open surgery in patients with rectal cancer.
Short-term fasting protects tumor-bearing mice against the toxic effects of chemotherapy while enhancing therapeutic efficacy. We randomized 131 patients with HER2-negative stage II/III breast ...cancer, without diabetes and a BMI over 18 kg m
, to receive either a fasting mimicking diet (FMD) or their regular diet for 3 days prior to and during neoadjuvant chemotherapy. Here we show that there was no difference in toxicity between both groups, despite the fact that dexamethasone was omitted in the FMD group. A radiologically complete or partial response occurs more often in patients using the FMD (OR 3.168, P = 0.039). Moreover, per-protocol analysis reveals that the Miller&Payne 4/5 pathological response, indicating 90-100% tumor-cell loss, is more likely to occur in patients using the FMD (OR 4.109, P = 0.016). Also, the FMD significantly curtails chemotherapy-induced DNA damage in T-lymphocytes. These positive findings encourage further exploration of the benefits of fasting/FMD in cancer therapy. Trial number: NCT02126449.
Double-lumen tubes (DLT) and endobronchial blockers (EB) are used for one-lung ventilation in thoracic surgery. More complications are seen when using DLT when compared to EB, while major ...complications are rarely seen.
This case report describes a perforation of the right mainstem bronchus by an EZ-Blocker EB in a patient undergoing a minimally invasive esophagectomy after neoadjuvant chemoradiation.
We advise to insert an EZ-BlockerTM EB with caution and only under direct bronchoscopic visualization, especially in previous irradiated patients.
Effects of genetic variation in porcine adipocyte and heart fatty acid-binding protein genes, A-FABP and H-FABP, respectively, on intramuscular fat (IMF) content and backfat thickness (BFT) were ...examined in F2 crossbreds of Meishan and Western pigs. The involvement of each FABP gene in IMF accretion was studied to confirm previous results for Duroc pigs. The F2 crossbred pigs were genotyped for various markers including microsatellite sequences situated within both FABP genes. Linkage analysis assigned the A-FABP and H-FABP genes to marker intervals S0001-S0217 (20 cM) on SSC4 and Sw316-S0003 (16.6 cM) on SSC6, respectively, refining previous chromosomal assignments. Next, the role of both chromosome regions/genes on genetic variation in IMF content and BFT was studied by 1) screening SSC4 and SSC6 for QTL affecting both traits by performing a line-cross analysis and 2) estimation of the effect of individual A-FABP and H-FABP alleles on both traits. In the first analysis, suggestive and chromosome-wise significant evidence for a QTL affecting IMF was detected on SSC6. The H-FABP gene is a candidate gene for this effect because it resides within the large region containing this putative QTL. The second analysis showed a considerable but nonsignificant effect of H-FABP microsatellite alleles on IMF content. Suggestive evidence for a QTL affecting BFT was found on SSC6, but H-FABP was excluded as a candidate gene. In conclusion, present and previous results support involvement of H-FABP gene polymorphisms in IMF accretion independently from BFT in pigs. Therefore, implementation of these polymorphisms in marker-assisted selection to control IMF content independently from BFT may be considered. In contrast to previous findings for Duroc pigs, no evidence was found for an effect of the A-FABP gene on IMF or BFT in this population.
We employed the contact forces induced by a near-field tip to tune and probe the optical resonances of a mechanically compliant photonic crystal molecule. Here, the pressure induced by the near-field ...tip is exploited to control the spectral proprieties of the coupled cavities in an ultrawide spectral range, demonstrating a reversible mode shift of 37.5 nm. Besides, by monitoring the coupling strength variation due to the vertical nanodeformation of the dielectric structure, distinct tip-sample interaction regimes have been unambiguously reconstructed with a nano-Newton sensitivity. These results demonstrate an optical method for mapping mechanical forces at the nanoscale with a lateral spatial resolution below 100 nm.
BACKGROUND: It is suggested that the skill of the physician performing the embryo transfer may influence the outcome of the procedure. In this study we investigated the effects of a change in embryo ...transfer technique on the variability in success rates among physicians. METHODS: Retrospectively 4439 transfer cycles in which two different embryo transfer techniques were applied by seven physicians were studied. In the first 2210 cycles, transfers were performed using the ‘clinical touch’ method. In the following 2229 cycles, the so‐called fixed distance technique was used. RESULTS: With the clinical touch method pregnancy rates differed greatly among providers, whereas after the introduction of the fixed distance technique these differences disappeared. Furthermore, the overall clinical pregnancy rate increased from 33.6 to 40.4% per transfer. Using smoothing spline curves we failed to detect a sudden rise in pregnancy rates at the time the transfer method was changed. CONCLUSIONS: The introduction of the fixed distance technique greatly reduced the variation in pregnancy rates among physicians. The overall increase in pregnancy rates after the introduction is likely to be related to the change in technique although definite proof is difficult. Both observations are suggested to be attributable to the atraumatic character of the fixed distance technique.
Summary Background No consensus exists on the validity of the sentinel-lymph-node procedure for assessment of nodal status in patients with colorectal cancer. We aimed to assess the diagnostic ...performance of this procedure. Methods We searched Embase and PubMed databases for studies published before March 20, 2010. Eligible studies had a prospective design, a sample size of at least 20 patients, and reported the rate of sentinel-lymph-node positivity. Individual patient data were requested for localisation and T-stage stratification. A subset of reports with high methodological quality was selected and analysed. Findings We identified 52 eligible studies, which included 3767 sentinel-lymph-node procedures (2961 78·6% colon and 806 21·4% rectal carcinomas). Most tumours 2339 (62·1%) were stage T3 or T4. 1887 (50·1%) of patients were male, 1880 (49·9%) female. Mean overall weighted-detection rate was 0·94 (95% CI 0·92–0·95), at a pooled sensitivity of 0·76 (0·72–0·80) with limited heterogeneity (χ2 =286·08, degrees of freedom=51; p=0·003). A mean weighted upstaging of 0·15 (95% CI 0·12–0·19) was noted. Individual patient data were available from 19 studies that included 1168 patients. Analysis of these data showed no significant difference in sensitivity between colon (0·86 95% CI 0·83–0·90) and rectal cancer (0·82 0·77–0·88; p=0·23). Also, there was no dependency of sensitivity on T stage for both colon (pT1: 0·79 95% CI 0·73–0·84, pT2: 0·76 0·62–0·90, pT3: 0·73 0·59–0·87, pT4: 0·73 0·53–0·93) and rectal cancer (T1 or T2: 0·81 0·52–0·94 vs T3 or T4: 0·80 0·51–0·93). The subgroup of eight studies with high methodological quality showed a mean detection rate of 0·96 (95% CI 0·90–0·99) for colonic tumours and 0·95 (0·75–0·99) for rectal tumours, and a mean sensitivity of 0·90 (95% CI 0·86–0·93) for colonic tumours and 0·82 (0·60–0·93) for rectal tumours. Interpretation The sentinel-lymph-node procedure shows a low sensitivity, regardless of T stage, localisation, or pathological technique. For every patient diagnosed with colon or rectal cancer without clinical evidence of lymph-node involvement or metastatic disease, this procedure in addition to conventional resection should be considered, since the prognostic information provided by this technique could be clinically significant. Funding Cancer Center Amsterdam Foundation, Amsterdam, Netherlands.
PDF
