Complete mesocolic excision (CME) has been proposed as a way to improve the oncological outcomes in patients with colon cancer. To investigate whether there is rationale for adopting the technique in ...Scotland, our aim was to define the incidence of disease recurrence following standard right hemicolectomy and to compare this with published CME outcomes.
Data was collected on consecutive patients undergoing right or extended right hemicolectomy for colonic adenocarcinoma (2012–2017) at three hospitals in Scotland (Raigmore Hospital, Aberdeen Royal Infirmary and Glasgow Royal Infirmary). Emergency or palliative surgery was excluded. Patients were followed up with CT scans and colonoscopy for a minimum of 3 years.
689 patients (M 340, F 349) were included. 30-day mortality was 1.6%. Final pathological stage was Stage I (14%), Stage II (49.8%) and Stage III (36.1%). During follow-up, 10.5% developed loco-regional recurrence and 12.2% developed distant metastases. The 1, 3 and 5-year disease-free survival (DFS) was 94%, 84% and 82% respectively. Primary determinants of recurrence were T stage (p < 0.001), N stage (p < 0.001), apical node involvement (p < 0.001) and EMVI (p < 0.001). When compared to the literature, 30-day mortality was lower than many published series and DFS rates were similar to the largest CME study to date (4 year DFS 85.8% versus 83%).
The outcomes of patients undergoing right hemicolectomy in Scotland compare favourably with many published CME studies. The technique demands further evaluation before it can be recommended for adoption into routine surgical practice.
1.Most evidence for complete mesocolic excision (CME) is from historical controls.2.We provide up to date evidence of outcomes achieved in colon cancer without CME.3.We question a universal adoption of CME and propose further evidence is needed.
Fanconi anemia (FA) is a rare inherited disorder clinically characterized by congenital malformations, progressive bone marrow failure and cancer susceptibility. At the cellular level, FA is ...associated with hypersensitivity to DNA-crosslinking genotoxins. Eight of 17 known FA genes assemble the FA E3 ligase complex, which catalyzes monoubiquitination of FANCD2 and is essential for replicative DNA crosslink repair. Here, we identify the first FA patient with biallelic germline mutations in the ubiquitin E2 conjugase UBE2T. Both mutations were aluY-mediated: a paternal deletion and maternal duplication of exons 2-6. These loss-of-function mutations in UBE2T induced a cellular phenotype similar to biallelic defects in early FA genes with the absence of FANCD2 monoubiquitination. The maternal duplication produced a mutant mRNA that could encode a functional protein but was degraded by nonsense-mediated mRNA decay. In the patient's hematopoietic stem cells, the maternal allele with the duplication of exons 2-6 spontaneously reverted to a wild-type allele by monoallelic recombination at the duplicated aluY repeat, thereby preventing bone marrow failure. Analysis of germline DNA of 814 normal individuals and 850 breast cancer patients for deletion or duplication of UBE2T exons 2-6 identified the deletion in only two controls, suggesting aluY-mediated recombinations within the UBE2T locus are rare and not associated with an increased breast cancer risk. Finally, a loss-of-function germline mutation in UBE2T was detected in a high-risk breast cancer patient with wild-type BRCA1/2. Cumulatively, we identified UBE2T as a bona fide FA gene (FANCT) that also may be a rare cancer susceptibility gene.
Aims
The Scottish National Bowel Cancer Screening Programme aims to detect asymptomatic colorectal carcinomas and improve outcomes by identifying tumours at an earlier stage. We describe the ...characteristics of bowel cancers diagnosed through the screening programme since it was established in June 2007 by comparison with colorectal carcinomas from all other referral sources.
Methods
All patients with colorectal cancer discussed by our regional colorectal multidisciplinary team (MDT) from June 2007 to August 2011 were included. Patient and tumour characteristics were collated prospectively from MDT records. The database was then reviewed retrospectively.
Results
During the study 209 916 (58%) of 364 759 invitations to participate in screening were accepted yielding 3895 (1.9%) positive results. The 255 (17%) screening‐detected (SD) patients and 1232 (83%) other referrals (ORs) were discussed at the MDT within this period. Median age at diagnosis was 65.5 years for SD vs. 71.6 in OR (P < 0.001) with 64% vs. 53% male SD vs. OR (P < 0.001). There were more left‐sided tumours in SD (P = 0.005). Tumours were less advanced in SD group (P = 0.02) and more likely to undergo a laparoscopic resection (P = 0.003). Thirty (11.7%) of SD patients were dead at last follow‐up compared with 458 (37.2%) of those from other sources (P < 0.001).
Conclusions
This cohort from a centre with an established screening programme supports the effect of screening in detecting earlier stage. Those with screen‐detected tumours were more likely to survive than patients from the OR group.
It is widely believed that adaptive optics only has a role in correcting turbulent wavefronts on large telescopes using very bright reference stars. Unfortunately these are very scarce and many ...astronomical targets require wavefront correction to work over much of the sky. We therefore need to be able to use very much fainter reference objects. Laser guide stars in principle can allow 0.1 arcsecond resolution but have a number of severe technical problems that limit their application. Our aims are to provide imaging at even higher resolution than Hubble. Lucky Imaging completely eliminates the tip-tilt errors in astronomical wavefront detection. Most of the power that remains is in low order, large scale structures. These may be detected with high sensitivity using photon-counting EMCCD detectors working at high frame rate, up to ~100Hz. With a new design of curvature wavefront sensor, wavefront errors may be measured and corrected to give near diffraction-limited performance on large groundbased telescopes in the visible. Reference stars (and reference compact galaxies) fainter than I~17.5 mag may be used routinely. This paper will describe how these work, what detector and other hardware is needed and what software should be used to measure the wavefront errors and drive deformable mirror hardware. The software techniques that are used are those routinely applied for MRI and CT imaging. They are fast and relatively easy to implement. The net effect is that imaging systems can be constructed that improve substantially over Hubble resolution from the ground for a relatively modest sum of money.
Abstract
Aims
The
S
cottish National Bowel Cancer Screening Programme aims to detect asymptomatic colorectal carcinomas and improve outcomes by identifying tumours at an earlier stage. We describe ...the characteristics of bowel cancers diagnosed through the screening programme since it was established in
J
une 2007 by comparison with colorectal carcinomas from all other referral sources.
Methods
All patients with colorectal cancer discussed by our regional colorectal multidisciplinary team (
MDT
) from
J
une 2007 to
A
ugust 2011 were included. Patient and tumour characteristics were collated prospectively from
MDT
records. The database was then reviewed retrospectively.
Results
During the study 209 916 (58%) of 364 759 invitations to participate in screening were accepted yielding 3895 (1.9%) positive results. The 255 (17%) screening‐detected (
SD
) patients and 1232 (83%) other referrals (
OR
s) were discussed at the
MDT
within this period. Median age at diagnosis was 65.5 years for
SD
vs. 71.6 in
OR
(
P
< 0.001) with 64% vs. 53% male
SD
vs.
OR
(
P
< 0.001). There were more left‐sided tumours in
SD
(
P
= 0.005). Tumours were less advanced in
SD
group (
P
= 0.02) and more likely to undergo a laparoscopic resection (
P
= 0.003). Thirty (11.7%) of
SD
patients were dead at last follow‐up compared with 458 (37.2%) of those from other sources (
P
< 0.001).
Conclusions
This cohort from a centre with an established screening programme supports the effect of screening in detecting earlier stage. Those with screen‐detected tumours were more likely to survive than patients from the
OR
group.
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