Caecal Carcinoma Research Articles

Sidedness is not a prognostic factor in an unselected cohort of patients with colon cancer but prognosis for caecal carcinoma is worse – A multivariate analysis of a large single institution database

PurposeSidedness has emerged as a prognostic factor for metastatic colorectal cancer treated with modern systemic therapies. This study investigates whether it is also relevant for an unselected patient cohort including all stages.MethodsAll consecutive patients admitted with colon cancer between 1995 and 2018 were retrieved from an institution-held database. Patients were divided into two cohorts. The first cohort included patients without distant metastases who were able to undergo curative resection. The second cohort presented with distant metastases (stage IV). Potentially prognostic factors were subjected to multivariate Cox Regression analysis.ResultsOverall, 1,606 patients met the inclusion and exclusion criteria. An R0-resection was achieved in 1,222 patients without distant metastases. Five-year cause-specific survival rate was 89.3% for this group. There was no difference between right- and left-sided cancers (88.2% vs. 90.1%, p = 0.220). However, prognosis of caecal carcinoma was significantly worse than that of all other sites combined (83.5% vs. 90.2%, p = 0.007). In multivariate analysis, pT-category, pN-category, grading, vascular invasion, emergency operation, adjuvant chemotherapy, and caecal carcinoma remained as independent prognostic factors. In the 384 patients with stage IV-disease, 3-year overall survival for right- vs. left-sided cancers differed only in univariate analysis (17.7% vs. 28.6%, p = 0.013).ConclusionIn non-metastatic colon cancer, location in the caecum is an independent prognostic factor. In unselected patients with stage IV colon cancer, sidedness was not found to be a prognostic factor. Differentiation into right- and left-sided tumors may be simplistic, and further studies on the biological behavior of different colonic sites are warranted.

CA-cecum Presenting as Large Bowel Obstruction with Appendicitis: A Rare Case Report

Introduction: Caecal tumors, though rare, pose diagnostic challenges due to their insidious onset and anatomical features. This case study emphasises the importance of a high index of suspicion for early diagnosis and treatment of caecal carcinoma. Case Report: A 63-year-old female presented with symptoms suggestive of large bowel obstruction and acute appendicitis. Imaging revealed a tubular structure in the subcecal location, prompting emergency laparotomy. The patient underwent right hemicolectomy, revealing a 6 cm adenocarcinoma involving the terminal ileum, ileocecal junction, and cecum. Surgical biopsy confirmed moderately differentiated infiltrating adenocarcinoma. Discussion: The discussion delves into the increasing incidence of colon cancer in India, particularly in patients presenting with acute appendicitis. Diagnostic challenges, including interpreting diffusely dilated colon images, are explored. Surgical management is detailed, emphasising the need for right hemicolectomy for caecal lesions and various approaches for left-sided lesions. The multidisciplinary approach to patient care, involving medical and radiation oncologists, is highlighted for complex colorectal diseases. Conclusion: This case underscores the significance of considering caecal carcinoma in patients with intestinal obstruction, leading to appropriate diagnostic measures and timely surgical intervention. The importance of a multidisciplinary approach to patient care is crucial for effective

A retrospective comparative study on stapler verses hand sewn technique in gastrointestinal anastomosis of twenty-five cases each

Background: In gastrointestinal surgery after resection of bowel loops, anastomosis of the bowel loops forms the main part of the surgery. The evolution of mechanical sutures by stapler devices is a technological advancement which helps anastomosis of bowel loops with less tissue injury and decreased time duration of procedure. Objective of current study was to compare the hand sewn anastomosis with stapler anastomosis in various types of elective gastrointestinal surgeries. Methods: A retrospective comparative study was conducted in department of general surgery at New Civil Hospital, Surat. The study included 50 patients of either gender and different age groups. Results: Out of 50 patients, 7 patients had Benign Gastric Outlet Obstruction (GOO), 18 patients had Post corrosive esophageal stricture, 5 patients had obstruction, 6 patients had post ileostomy status, 5 patients had carcinoma of ascending colon, 1 patient had carcinoma of caecum, 4 patients had ileo-caecal growth, 3 patients had carcinoma of descending colon, and 1 patient had sigmoid colon growth. In stapler anastomosis group Mean Total operative time was (156.20±45.21) mins whereas in handsewn anastomosis group Mean Total operative time was (188.40±48.32) mins with p value of 0.019. Conclusions: In this study, one distinct advantage of staplers was the consistent reduction in operating time. However, no significant difference was found between the stapler and hand-sewn groups with respect to other parameters such as restoration of intestinal function, postoperative hospital stay, and postoperative complications like leakage, fistula or stricture formation.

Evidence based diagnostic protocol and management for pain in right iliac fossa

Background: Right iliac fossa pain is most common clinical presentation encountered in surgical OPD. Usually during evaluation, diagnosis is uncertain in some cases and patient suffers a lot. Clinical symptoms usually not involved during evaluation of patient this also makes diagnosis more difficult. Therefore, aim of the study was that how we would proceed in this case. Methods: This was prospective study and total 30 patients were analyzed. Study was done at tertiary centre. All patients suspected with pain in right iliac fossa included in this study. First evaluated clinically then biochemical and radiological investigated. Histological and acid-fast bacilli culture was not included. Results: Out of 30 cases, acute appendicitis were in 15 cases (50%), followed by appendicular lump (7 cases, 23%), irritable bowel disease (3 cases, 10%), tubercular lesion (2 cases, 6.7%), carcinoma of caecum (1 case, 3.33%), appendicular abscess (1 case, 3.33%), both appendicitis with tubercular lesion were also present (1 case, 3.33%). All cases of acute appendicitis, appendicular lump, carcinoma of caecum were managed surgically while appendicular abscess and ilieocaecal tuberculosis was managed conservatively. Conclusions: The diagnosis of right iliac fossa pain is very difficult. Be very cautious during clinical evaluation. Even if CT scan is still unclear about the diagnosis and till date no definite diagnostic protocol has made. Before validate this protocol, a large data must be needed.

Occurrence and Severity of Adverse Reactions of Immune Checkpoint Inhibitors (PD-1 and PD L1) Based on Mordovian Dispensary Data Analysis

Background: Recently, a novel therapeutic technique has been revealed to recruit PDL1 and PD1 inhibitors to promote and enhance the cytotoxic T cell activity in combating the tumor. But unfortunately, several followed patients who didn’t tolerate the drug appeared unfavorable autoimmune side effects, such as anemia, pneumonitis, hepatitis, colitis, in addition to fatigue/ asthenia, decreased appetite, nausea, cough, dyspnea, constipation. Aim: To assess the severity of the adverse reactions of PD-1 and PD-L1 inhibitors in treating patients with positive PD-1 or PD-L1; non-small cell lung cancer patients (NSCLCs), small cell lung cancer (SCLC), nodular sclerosis Hodgkin lymphoma, classic Hodgkin's lymphoma, gastric cancer, renal cell carcinoma, caecal carcinoma, buccal mucosa carcinoma, nasopharyngeal carcinoma, laryngopharynx cancer, bladder cancer, cervical cancer, and melanoma. Materials and Methods: The study data was collected and analyzed randomly from the period of January 2019 to November 2020 from the Mordovian oncological dispensary. The data are collected from the electronic archive of the hospital. Then, we followed up with the patients for the same period, and we recorded the presented adverse reactions. The patients received anti-tumor drug; PD-L1/PD-L inhibitors (Atezolizumab; 1200mg, Pembrolizumab; 200mg, and Nivolumab; 240mg or 3 mg/kg) every 21 or 14 days they got IV infusion of PD-1 and/or PD-L1 inhibitors. After the progression and metastasis of the tumor, the patients received a combination of chemotherapy prior to the immunotherapy. Results: The analyzed data have shown 7.14% of the studied patients (n=28) have developed adverse reactions that ranged from mild to moderate severity (anemia and biochemical tests deviation). Conclusion: These clinical findings supported the moderate risk of developing life-threatening adverse reactions after administration of immune checkpoint inhibitors (Nivolumab, Pembrolizumab, Atezolizumab) to patients with advanced-stage tumors. The patients who were treated with PD-1 inhibitors developed less severe adverse reactions than patients who were treated with PD-L1 inhibitors. The adverse reaction severity depends on the period of administration and the type of the treated tumor, which consequently determines the dose of immunotherapy. Also, the aggressiveness of the autoimmune reactions depends on the patient's immune state and its reactivity.

Perforated caecal carcinoma within a strangulated inguinal hernia.

Perforated caecal carcinoma within a strangulated inguinal hernia.

Adapting a 2-week-wait colorectal service in the pandemic using the quantitative faecal immunochemical test.

The coronavirus pandemic has brought about an economic and healthcare crisis. This has resulted in delays in virtually all areas of patient care and has forced clinicians to review and adapt their processes, in order to ensure patients continue to have access to timely and effective services. In the author's local Trust, this manifested in altered protocols, developed in order to maintain patient and staff safety while conducting invasive and potentially virus-spreading investigations. A new (temporary) standard operating procedure was developed in conjunction with Cancer Alliance South West to introduce the quantitative faecal immunochemical test (qFIT) as an indicator for diagnostic testing after the majority of diagnostic services were suspended or drastically reduced. Patients would then have their investigation(s) deferred on the basis of a negative result (<10 mcg Hb/g). This cohort (n=120) were revisited once diagnostic services were resumed and referred for CT examination. Audits carried out on the data showed that nine cancers had been identified in the negative qFIT population (lung, prostate, breast, bladder, small bowel carcinoid, oesophageal and three occurrences of caecal carcinoma. This article provides an overview of the experiences and outcomes of a colorectal 2-week-wait service in response to this global pandemic and how this experience will shape the service in the future.

RIGHT ILIAC FOSSA LESIONS CLINICAL PROFILE AND ITS MANAGEMENT

Introduction: Around 5 to 10 % of every gastrointestinal puncturing (barring supplement holes) have been accounted for to be because of tuberculosis. Caecal carcinoma is progressively normal in individuals of the high financial gathering who utilize less stringy eating regimen. Neighborhood control keeps on being a huge issue in the administration of retroperitoneal sarcoma. Objectives of study were to assess the most well-known reason for right iliac fossa lesion, mode of presentation, and various modalities of investigations, treatment, and prognosis what's more, to recognize the factors this can help in better administration of these cases. Methods A hospital based planned study was finished .with 50 patients to evaluate right iliac fossa lesions - its clinical profile and it‘s Management. 50 patients who are having right iliac fossa lesions either clinically or on Ultrasonography of the abdomen were included. Patients less than 12 years and more than 75 years were excluded. Results The most common disease in our investigation was appendicular mass (40%) followed by appendicular abscess (30%), iliopsoas abscess (10%), Ileocaecal tuberculosis (8%) and carcinoma cecum (6%). The most elevated number of cases (46%) was in the 21–30 years age group, 11 patients (55%) had a background marked by less than 1 week, and Tachycardia was present in all the patients (100%). On an average 200 ml of pus was drained. Ileocaecal tuberculosis represented for 8% of all the cases in this study. Conclusion The overall incidence seems to be higher in males. Laparotomy with histopathological assessment of resected biopsy or assessment of ascetic liquid is as often as possible important to set up the finding.

Challenging emergency laparoscopic right colectomy for completely obstructing caecal carcinoma – a video vignette

We present a video-vignette illustrating an emergency laparoscopic right colectomy in an 87 year-old female with an obstructing carcinoma of the caecum (Fig.1). The small bowel loops were extremely dilated, making the procedure particularly challenging because they impaired the laparoscopic view. Both the operator and the assistant holding the camera needed to be particularly skilled and able to navigate in the abdominal cavity. By careful blunt mobilization of the distended loops a proper working space was achieved. This article is protected by copyright. All rights reserved.

CARCINOMA OF CAECUM;

Objectives: To determine the frequency, clinical presentation and managementstrategies for carcinoma of caecum among pathologies in right iliac fossa excludinggynaecological disorders at Liaquat university hospital Hyderabad / Jamshoro. Study Design:Cross sectional multi-disciplinary study. Period: Thirty months. Setting: Liaquat UniversityHospital Hyderabad / Jamshoro. Patients and Methods: All the patients presented with GIsymptoms, intestinal obstruction, and appendicitis or had mass in the right iliac fossa wereselected and recruited and further evaluated for existence of carcinoma of caecum andpreceded for management strategies. The data was analyzed in SPSS 16 and the frequencyand percentage was calculated and the level of significance was p-value ≤0.05. Results: Total50 patients were diagnosed as caecum cancer during thirty months study period. The cancerof caecum was common in older age group. The mean age ± SD for whole population andmale as well as female gender was 67.53±6.98, 66.32±8.75 and 65.34±5.96 and of fifty cases,thirty two (64%) were males and eighteen (36%) were females respectively. The commonpresentation identified was mass in right iliac fossa in 28 patients (p=0.03) while the commonoperative procedure performed was ileotransverse anastomosis with right hemicolectomy in 34patients which is non-significant in relation to age (p=0.7) whereas it was significant in contextto gender (p=0.04) respectively. Conclusion: The common presentations for carcinoma ofcaecum detected was right iliac fossa mass while the predominant age, gender and operativeprocedure performed were seventy plus years, male gender population and Ileotransverseanastamosis with right hemicolectomy.

Right extended hemicolectomy, falls and low B₁₂

Background: Falls are common and can be multifactorial. Settings: An older man presented with a fall and an unremarkable past medical history including a right extended hemicolectomy for a caecal carcinoma and a left hip replacement. Results: Clinically he had a marked peripheral neuropathy and low serum cobalamin. Conclusion: The removal of the terminal ilium may remove the site of uptake of vitamin B₁₂ even in the presence of intrinsic factor. Therefore, older patients in whom curative surgery for colonic carcinoma has been undertaken should be monitored for B₁₂ deficiency five years following surgery and until death. B₁₂ may be replaced in the usual fashion in such individuals

Periappendiceal abscess due to perforated adenocarcinoma of the caecum

Colon adenocarcinomas rank among the most common malignancies. Characteristic complications include obstruction and chronic anaemia. Perforation with consequent abscess formation is a rather atypical presentation. We present the case of a 62-year-old male patient with a periappendiceal abscess resulting from perforated caecal carcinoma. Since clinical and intraoperative findings were suggestive of associated malignancy, a right hemicolectomy with latero-lateral ileotransverse anastomosis was performed. Periappendiceal mass is a common surgical entity. The differential diagnosis includes a variety of benign conditions (infectious or inflammatory) and neoplasia. The diagnosis of associated malignancy, when radiological examination is not diagnostic, requires a high index of suspicion in order to provide the appropriate treatment.

Demographic data comparison of prevalence of mass in right iliac fossa: a prospective hospital based study

Mass in the right iliac fossa is one of the commonest problems faced in surgical practice. The present study was conducted to find the incidence of mass in patients attending surgery department. A total of 50 cases were included in the study. Their demographic data was collected and analysed to find the incidence of mass in right iliac fossa. The results showed a high incidence of appendicular mass (44%) with male preponderance; followed by ileocaecal tuberculosis and carcinoma of caecum. The incidence of appendicular mass was highest in the age of 21-30 years. Appendicular abscess and ileocaecal tuberculosis showed highest incidence in the age group of 31-40 years. In the age group of 51-60 years carcinoma of caecum was observed the most. Several factors like age, gender, food habits and occupation caused the development of mass in the abdomen. Coolies and agriculturists were more prone to development of mass in the right iliac fossa.

Necrotising soft tissue infection of the lower limb due to a perforated caecal carcinoma: a case report.

IntroductionWe report the first case to our knowledge where an ascending colorectal tumour presented as a necrotising lower leg infection.Case presentationWe describe the unusual presentation of a previously unknown caecal carcinoma in a 69-year-old Caucasian man, which presented as a rapidly spreading limb infection due to a perforated caecal adenocarcinoma. This case presented a diagnostic dilemma and we document the investigation and management in our patient and compare this to the current published literature.ConclusionsAlthough rare, this case highlights how leg swelling and in particular, thigh and gluteal swelling, have the potential to be an unusual presentation of a caecal carcinoma.

Laparoscopic Right Hemicolectomy in an Automated Peritoneal Dialysis Patient without Removal of the PD Catheter: A Case Report.

Introduction. Laparotomy in patients on peritoneal dialysis (PD) is associated with an increased risk of morbidity. Furthermore, standard protocol recommends removal of the PD catheter when surgery on the intestine is required. As far as we are aware, this is the first case report of laparoscopic right hemicolectomy in a patient on automated PD where the PD catheter was left in situ. Case Report. A 61-year-old man man on APD who presented with a caecal carcinoma was stabilised on temporary haemodialysis (HD) prior to undergoing a laparoscopic right hemicolectomy without removal of the PD catheter. He made an uneventful recovery and APD was resumed successfully 2 weeks after surgery. Discussion. PD patients undergoing intra-abdominal surgery are at increased risk of complications. While the benefits of laparoscopic surgery in the standard surgical population are well established, there is limited experience of the technique in PD patients. Possible advantages could theoretically be early resumption of PD as well as less PD failure due to the formation of adhesions. Conclusion. Our experience with this case indicates that laparoscopic right hemicolectomy in a background of PD can be undertaken without removal of the PD catheter and is associated with early resumption of PD.

PTH-042 Iron Deficiency Anaemia in Young Males: Do Gi Symptoms and Haemoglobin Level Affect Diagnostic Yield?

IntroductionYoung males with iron deficiency (IDA) routinely undergo endoscopy. There is paucity of data on the diagnostic yield of bi-directional endoscopy, level of HB that requires investigation and the yield...

Single incision laparoscopic right hemicolectomy: different approaches

Background Single incision laparoscopic colectomy has been performed in recent years, and has been shown to be feasible and safe. This study was to assess the feasibility of single incision laparoscopic right hemicolectomy and to compare the differences in different approaches. Methods This retrospective study included eighteen patients with carcinoma of caecum and ascending colon, undergoing single incision laparoscopic right hemicolectomy. This study also compared single incision laparoscopic right hemicolectomy using different approaches: (1) single incision multiport, (2) single access port and (3) glove port. Results There was no statistical difference in surgical outcomes. Concerning the surgeon's satisfaction toward three methods, overcrowding and durability were similar but the single incision multiport was associated with the highest gas-leak and the “glove” port was associated with poor durability. However, the method of single incision multiport has the lowest average cost of the special trocar or port in each operation. The operative time and blood loss of the operations in this study were comparable to previous publications. Conclusion There was no significant difference between different approaches of single incision laparoscopic right hemicolectomy for colonic cancer in right side colon.

Adenocarcinomas of caecum have distinctive cinicopathological features

Aims Recent molecular data has identified that caecal adenocarcinoma differs significantly from adenocarcinoma of the contiguous right colon by exhibiting frequent KRAS mutation but less common BRAF mutation. We sought to examine whether this molecular finding translates to clinicopathological differences in an unselected series of colorectal carcinoma. Methods Colorectal carcinoma resections reported at Envoi Pathology in 2011 were reviewed for the following features: age, sex, site, tumour size, stage, morphology, venous invasion, tumour budding and mismatch repair status. Carcinoma of caecum was compared to carcinoma at other sites. Results 354 carcinomas from 335 patients were reviewed. Caecal adenocarcinoma occurred at an older age (mean 72.4 years vs 66.9 years; p p p =0.05) than carcinoma from other sites. Compared to other carcinoma of right colon, caecal adenocarcinoma was more frequent in males ( p p Discussion Our data support the concept that the caecal adeno-carcinoma is different from other sites. Understanding of the reason for this may provide useful insights into the pathogenesis of colorectal carcinoma.

Amphicrine carcinoma of caecum: a case report and literature review

Background Amphicrine carcinomas are a rare subgroup of mixed adenoneuroendocrine carcinomas (MANECs) in which tumour cells show evidence of both glandular and endocrine differentiation. Methods We present a case of caecal amphicrine carcinoma in a 76-year-old woman. She developed metastatic peritoneal disease 2 months after her right hemicolectomy. Light microscopy and immunohistochemical findings with regard to diagnostic and prognostic factors are described and the literature is reviewed. Conclusion Mixed exocrine-neuroendocrine neoplasms, now renamed as mixed adenoneuroendocrine carcinomas (MANECs) are, by definition, neoplasms in which each component represents at least 30% of the lesion. In apmhicrine tumours, first described by Feyrter (1938), exocrine and neuroendocrine features are co-expressed by same neoplastic cells. There has not been a consistent classification system of these tumours for many decades. Following the recent WHO classification of neuroendocrine tumours of digestive system (2010), Rosa et al . divided MANECs into two groups: high and intermediate grade malignant neoplasms. They classified amphicrine carcinomas as intermediate grade malignancies. The optimal strategy of management of MANECs is largely unknown, due to rarity of these neoplasms. The adaptation of a consistent classification system is the first step in gathering more accurate prognostic data and evaluating treatment options.

Evaluation of the utility of abdominal CT scans in the diagnosis, management, outcome and information given at discharge of patients with non-traumatic acute abdominal pain

The role of CT imaging in the diagnosis and management of acute abdominal pain is well established, but its utility is limited in a minority of cases. The aim of this study was to quantify the degree to which radiological and clinical findings differ. Interobserver variability in CT reporting was also assessed. Clinical data and CT reports were analysed retrospectively for any discrepancies by comparing CT diagnosis, clinical diagnosis as stated on the discharge summary and final diagnosis (based on consensus review of all information). Blinded review of all CT imaging was performed to determine interobserver variability. 120 consecutive scans fulfilled the inclusion criteria (114 patients; 79 women; mean age 55 years). The correct clinical diagnosis was made in 87.5% of cases based on CT findings. The lack of intravenous contrast limited diagnostic interpretation in 6 of the 15 discrepant cases. CT was unable to define early inflammatory changes in three patients and early caecal carcinoma in one. A right paraduodenal internal hernia was difficult to detect in another patient. Interobserver agreement was 93%, but with a low kappa value of 0.27. A paradox exists due to an imbalance in the positive and negative agreement of 96% and 31%, respectively. The utility of CT imaging in the diagnosis and management of patients presenting with acute abdominal pain is confirmed, but is limited in a minority of cases where poor negative interobserver agreement exists. Good communication to the reporting radiologist of the relevant patient history and clinical question becomes important.