Growing evidence has demonstrated that circulating tumor DNA (ctDNA) detection in colorectal cancer might be a promising approach to address current important clinical questions. During chemotherapy ...for metastatic colorectal cancer, tumor cells acquire potential resistance by generating additional somatic mutations related to therapeutic resistance. ctDNA can capture the tumor landscape, including heterogeneity, which might provide the opportunity for additional treatment options. Moreover, ctDNA detection is advantageous, because it can monitor tumor heterogeneity serially, in a non-invasive manner. ctDNA is considered valid for detecting minimal residual disease after a curable resection. By utilizing ctDNA detection, adjuvant chemotherapy for patients with stage II–III colorectal cancer might be omitted for patients at low risk of recurrence; or conversely, adjuvant chemotherapy might be highly recommended for patients at high risk, based on ctDNA findings. During multidisciplinary treatments for locally advanced rectal cancer, it is essential to monitor the responses to sequential treatments to make appropriate decisions. Currently, these decisions are mainly based on radiological or pathological findings. ctDNA can add value by providing the real-time status of locally advanced rectal cancer. In this review, we summarized the current evidence and discussed future strategies for using ctDNA in the treatment of colorectal cancer.
Background
Accurate identification of tumor sites during laparoscopic colorectal surgery helps to optimize oncological clearance. We aimed to assess the timing of the local injection preoperatively ...and clarify the usefulness and limitation of tumor site marking using indocyanine green (ICG) fluorescence imaging.
Methods
Consecutive patients who underwent primary colorectal cancer surgery from September 2017 to January 2019 were included. Preoperatively, lower endoscopy was used to inject the ICG solution into the submucosal layer near the tumor. During laparoscopic surgery, ICG fluorescence marking as the tumor site marking was detected using a laparoscopic near-infrared camera system. The detection rate and factors associated with successful intraoperative ICG fluorescence visualization including the interval between local injection and surgery were evaluated.
Results
One hundred sixty-five patients were enrolled. Using the laparoscopic near-infrared system, the intraoperative detection rates of ICG marking were 100% for ICG injection within 6 days preoperatively, 60% for injection between 7 and 9 days preoperatively, and 0% for injection earlier than 10 days preoperatively. There were no complications associated with ICG marking. Additionally, this method did not disturb the progress of the surgical procedure because injected ICG in the submucosal layer did not cause any tissue inflammation, and if ICG spilled into the serosa, it was invisible by white light.
Conclusion
Advantages of ICG fluorescence tumor site marking were high visibility of infrared imaging during laparoscopic colorectal surgery and minimal adverse events of surgery. One of the most important findings regarding practical use was a rapid decrease in fluorescence marking visibility if one week passed from the time of ICG local injection.
Purpose
The low anterior resection syndrome (LARS) score (LS) has been widely validated and has become an international tool for evaluating postoperative bowel dysfunction. However, many physicians ...still use the conventional incontinence scores in LARS treatment. Moreover, interpretation of LS and its relationship with conventional incontinence scores are not yet well understood. Here we compared the LS with the Cleveland Clinic Incontinence Score (CCIS) to clarify the clinical utility and characteristics of the LARS score.
Methods
We performed a multicentre observational study, recruiting 246 rectal cancer patients following sphincter-preserving surgery. Patients completed the LS, CCIS, and SF36 questionnaires.
Results
The response rate was 76.4%, and a total of 180 patients were analysed. The LS was strongly correlated with the CCIS (
P
< 0.001, rs = 0.727). However, among 116 patients determined to not have incontinence (CCIS 0–5), 51 (44%) were diagnosed with LARS (29 with minor LARS and 22 with major LARS). Among 68 patients without LARS, only 3 were diagnosed as having incontinence (CCIS > 6). In comparison with background factors, aging and elapsed time were associated with only LS. High LS and CCIS both showed significant quality-of-life impairment as assessed by the SF-36.
Conclusion
This is the first study to determine the difference in the numeric values between the CCIS and LS. The LS can be a convenient tool for LARS screening, identifying a wide range of patients with LARS, including those with incontinence evaluated by CCIS. Assessment using the CCIS may often underestimate LARS.
Purpose
Some recent studies have suggested that fluorescence angiography with indocyanine green (ICG) might be useful for preventing anastomotic leakage (AL) after laparoscopic colorectal surgery. ...However, its efficacy has not been proven. We evaluated whether intraoperative ICG fluorescence angiography could decrease the AL rate with laparoscopic colorectal cancer surgery.
Methods
This retrospective study included patients with colorectal cancer who underwent laparoscopic surgery at our institution between March 2014 and December 2018. Patients were divided into two groups: with or without ICG fluorescence angiography. The primary outcome was the rate of AL.
Results
A total of 488 patients were included: 223 patients in the ICG group and 265 patients in the no-ICG group. In the ICG group, the transection line was changed to a more proximal location in seven patients (3.1%), including one patient with transverse colon surgery and six with rectal surgery. None of these seven patients developed AL. There were 18 ALs (3.7%) overall. The AL rate was 1.8% in the ICG group and 5.3% in the no-ICG group. For colon cancer, there were no significant differences in the AL rate between the groups (
p
= 0.278). In rectal cancer, the AL rate was significantly lower in the ICG group than in the no-ICG group (3.5% vs. 10.5%,
p =
0.041). After propensity score matching, the AL rate was also significantly lower in the ICG group for rectal cancer (
p =
0.044).
Conclusion
ICG fluorescence angiography can potentially reduce the AL rate with laparoscopic rectal cancer surgery.
Aim Although MRI has a substantial role in directing treatment decisions for locally advanced rectal cancer, precise interpretation of the findings is not necessarily available at every institution. ...In this study, we aimed to develop artificial intelligence-based software for the segmentation of rectal cancer that can be used for staging to optimize treatment strategy and for preoperative surgical simulation. Method Images from a total of 201 patients who underwent preoperative MRI were analyzed for training data. The resected specimen was processed in a circular shape in 103 cases. Using these datasets, ground-truth labels were prepared by annotating MR images with ground-truth segmentation labels of tumor area based on pathologically confirmed lesions. In addition, the areas of rectum and mesorectum were also labeled. An automatic segmentation algorithm was developed using a U-net deep neural network. Results The developed algorithm could estimate the area of the tumor, rectum, and mesorectum. The Dice similarity coefficients between manual and automatic segmentation were 0.727, 0.930, and 0.917 for tumor, rectum, and mesorectum, respectively. The T2/T3 diagnostic sensitivity, specificity, and overall accuracy were 0.773, 0.768, and 0.771, respectively. Conclusion This algorithm can provide objective analysis of MR images at any institution, and aid risk stratification in rectal cancer and the tailoring of individual treatments. Moreover, it can be used for surgical simulations.
To achieve continuous frail care in the daily lives of the elderly, we propose AHOBO, a frail care robot for the elderly at home. Two types of support systems by AHOBO were implemented to support the ...elderly in both physical health and psychological aspects. For physical health frailty care, we focused on blood pressure and developed a support system for blood pressure measurement with AHOBO. For psychological frailty care, we implemented reminiscent coloring with the AHOBO as a recreational activity with the robot. The usability of the system was evaluated based on the assumption of continuous use in daily life. For the support system in blood pressure measurement, we performed a qualitative evaluation using a questionnaire for 16 subjects, including elderly people under blood pressure measurement by the system. The results confirmed that the proposed robot does not affect the blood pressure readings and is acceptable in terms of ease of use based on subjective evaluation. For the reminiscent coloring interaction, subjective evaluation was conducted on two elderly people under the verbal fluency task, and it has been confirmed that the interaction can be used continuously in daily life. The widespread use of the proposed robot as an interface for AI that supports daily life will lead to a society in which AI robots support people from the cradle to the grave.
The intrahepatic bile duct (IHBD) is a highly organized tubular structure consisting of cholangiocytes, biliary epithelial cells, which drains bile produced by hepatocytes into the duodenum. Although ...several models have been proposed, it remains unclear how the three‐dimensional (3D) IHBD network develops during liver organogenesis. Using 3D imaging techniques, we demonstrate that the continuous luminal network of IHBDs is established by 1 week after birth. Beyond this stage, the IHBD network consists of large ducts running along portal veins (PVs) and small ductules forming a mesh‐like network around PVs. By analyzing embryonic and neonatal livers, we found that newly differentiated cholangiocytes progressively form a continuous and homogeneous luminal network. Elongation of this continuous network toward the liver periphery was attenuated by a potent Notch‐signaling inhibitor N‐N‐(3,5‐difluorophenacetyl)‐L‐alanyl‐S‐phenylglycine t‐butyl ester. Subsequent to this first step, the fine homogenous network is reorganized into the mature hierarchical network consisting of large ducts and small ductules. Between E17 and E18, when the homogenous network is radically reorganized into the mature hierarchical network, bile canaliculi rapidly extend and bile flow into IHBDs may increase. When formation of bile canaliculi was blocked between E16 and E18 by a multidrug resistance protein 2 inhibitor (benzbromarone), the structural rearrangement of IHBDs was significantly suppressed. Conclusion: Establishment of the mature IHBD network consists of two sequential events: (1) formation of the continuous luminal network regulated by the Notch‐signaling pathway and (2) dynamic rearrangement of the homogeneous network into the hierarchical network induced by increased bile flow resulting from the establishment of hepatobiliary connections. (Hepatology 2016;64:175–188)
Background
The aim of this study was to evaluate the effectiveness of pelvic floor rehabilitation (PFR) for patients with bowel dysfunction after intersphincteric resection (ISR) and to compare the ...treatment response to that of patients after low anterior resection (LAR).
Methods
Thirty patients with postoperative bowel dysfunction for more than 6 months were enrolled and treated with PFR for 6 months.
Results
In the ISR group, significant improvements in the number of bowel movements and the use of antidiarrheal medications were observed, but no significant improvement was observed in the Wexner score (WS) and the fecal incontinence severity index (FISI). Meanwhile, in the LAR group, WS and FISI were better post-treatment than pre-treatment (WS: 10.7–5.7;
p
= 0.01, FISI: 28–11;
p
= 0.01). In the assessment of fecal incontinence quality of life (FIQL), only the Coping/Behavior category was improved in the ISR group (1.56 before, 2.16 after PFR;
p
= 0.01), while all four categories were improved significantly in the LAR group. The anorectal manometric examination showed no significant increase in sphincter pressure and the tolerable volume in patients after ISR.
Conclusions
PFR improved several clinical symptoms of patients after ISR. Compared with patients after LAR, patients after ISR showed an insufficient response to PFR in improving fecal incontinence. Considering the result of the generalized assessment of the quality of life scale, PFR may offer a therapeutic effect for several symptoms of patients after ISR.
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