Surgery In Colorectal Cancer Patients Research Articles

The impact of preoperative sarcopenia on postoperative ileus following colorectal cancer surgery

PurposeSarcopenia is associated with poor short- and long-term patient outcomes following colorectal surgery. Despite postoperative ileus (POI) being a major complication following colorectal surgery, the predictive value of sarcopenia for POI is unclear. We assessed the association between sarcopenia and POI in patients with colorectal cancer.MethodsElective colorectal cancer surgery patients were retrospectively included (2018–2022). The cross-sectional psoas area was calculated using preoperative staging imaging at the level of the 3rd lumbar vertebrae. Sarcopenia was determined using gender-specific cut-offs. The primary outcome POI was defined as not achieving GI-2 by day 4. Demographics, operative characteristics, and complications were compared via univariate and multivariate analyses.ResultsOf 297 patients, 67 (22.6%) were sarcopenic. Patients with sarcopenia were older (median 74 (IQR 67–82) vs. 69 (58–76) years, p < 0.001) and had lower body mass index (median 24.4 (IQR 22.2–28.6) vs. 28.8 (24.9–31.9) kg/m2, p < 0.001). POI was significantly more prevalent in patients with sarcopenia (41.8% vs. 26.5%, p = 0.016). Overall rate of complications (85.1% vs. 68.3%, p = 0.007), Calvien-Dindo grade > 3 (13.4% vs. 10.0%, p = 0.026) and length of stay were increased in patients with sarcopenia (median 7 (IQR 5–12) vs. 6 (4–8) days, p = 0.013). Anastomotic leak rate was higher in patients with sarcopenia although the difference was not statistically significant (7.5% vs. 2.6%, p = 0.064). Multivariate analysis demonstrated sarcopenia (OR 2.0, 95% CI 1.1–3.8), male sex (OR 1.9, 95% CI 1.0–3.5), postoperative hypokalemia (OR 3.2, 95% CI 1.6–6.5) and increased opioid use (OR 2.4, 95% CI 1.3–4.3) were predictive of POI.ConclusionSarcopenia demonstrates an association with POI. Future research towards truly identifying the predictive value of sarcopenia for postoperative complications could improve informed consent and operative planning for surgical patients.

Postoperative circulating tumor DNA testing based on tumor naïve strategy after liver metastasis surgery in colorectal cancer patients.

There is still a lack of highly sensitive methods for monitoring recurrence of colorectal cancer patients after liver metastasis surgery. The aim of this study was to evaluate the prognostic value of tumor-naive ctDNA detection after resection of colorectal liver metastases (CRLM). Patients with resectable CRLM were prospectively enrolled. Based on the tumor-naive strategy, NGS panels containing 15 colorectal cancer hotspot mutated genes were used to detect ctDNA 3-6 weeks after surgery. A total of 67 patients were included in the study, and the positive rate of postoperative ctDNA was 77.6% (52/67). Patients with positive ctDNA had a significantly higher risk of recurrence after surgery (HR 3.596, 95% CI 1.479 to 8.744, P = 0.005), and a higher proportion relapsed within 3 months after surgery (46.7% vs 3.8%). The C-index of postoperative ctDNA in predicting recurrence was higher than that of CRS and postoperative CEA. The nomogram combining CRS and postoperative ctDNA can improve the accuracy of recurrence prediction. Tumor-naive ctDNA detection can detect molecular residual lesions in patients with colorectal cancer after liver metastasis, and its prognostic value is superior to conventional clinical factors.

Postoperative inpatient exercise facilitates recovery after laparoscopic surgery in colorectal cancer patients: a randomized controlled trial

BackgroundEarly mobilization is an integral part of an enhanced recovery program after colorectal cancer surgery. The safety and efficacy of postoperative inpatient exercise are not well known. The primary objective was to determine the efficacy of a postoperative exercise program on postsurgical recovery of stage I–III colorectal cancer patients.MethodsWe randomly allocated participants to postoperative exercise or usual care (1:1 ratio). The postoperative exercise intervention consisted of 15 min of supervised exercise two times per day for the duration of their hospital stay. The primary outcome was the length of stay (LOS) at the tertiary care center. Secondary outcomes included patient-perceived readiness for hospital discharge, anthropometrics (e.g., muscle mass), and physical function (e.g., balance, strength).ResultsA total of 52 (83%) participants (mean [SD] age, 56.6 [8.9] years; 23 [44%] male) completed the trial. The median LOS was 6.0 days (interquartile range; IQR 5–7 days) in the exercise group and 6.5 days (IQR 6–7 days) in the usual-care group (P = 0.021). The exercise group met the targeted LOS 64% of the time, while 36% of the usual care group met the targeted LOS (colon cancer, 5 days; rectal cancer, 7 days). Participants in the exercise group felt greater readiness for discharge from the hospital than those in the usual care group (Adjusted group difference = 14.4; 95% CI, 6.2 to 22.6; P < 0.01). We observed a small but statistically significant increase in muscle mass in the exercise group compared to usual care (Adjusted group difference = 0.63 kg; 95% CI, 0.16 to 1.1; P = 0.03).ConclusionPostsurgical inpatient exercise may promote faster recovery and discharge after curative-intent colorectal cancer surgery.Trial registrationThe study was registered at WHO International Clinical Trials Registry Platform (ICTRP; URL http://apps.who.int/trialsearch); Trial number: KCT0003920.

Appropriate time to radical surgery for colorectal cancer patients complicated with newly onset cerebral infarction: a propensity score matching analysis

The purpose of our study was to compare the short-term outcomes of early (within 3 months after stroke) and nonearly (more than 3 months after stroke) radical colorectal cancer surgery to find an appropriate time to surgery for these colorectal cancer patients complicated with new-onset cerebral infarction. A retrospective analysis of patients with stroke who underwent curative colorectal cancer surgery between January 2010 and December 2020 was conducted. Propensity score matching (PSM) analysis was performed to overcome patient selection bias between the two groups. A total of 395 patients were reviewed. After PSM, 40 patients in the early group and 40 patients in the nonearly group were compared. The median time to surgery was 4 weeks in the early group. The overall incidence of postoperative complications between the groups was not significantly different (p = 0.745). The early group was associated with less intraoperative blood loss (50 vs. 100, p = 0.029 ml), with no difference in 30-day morbidity and mortality. Additionally, multivariate logistic regression analysis showed that previous abdominal surgery (p = 0.049) was an independent risk factor for postoperative complications after matching. Before matching, multivariate logistic analysis showed that ESRS (p = 0.028) and MRS (p = 0.039) were independent risk factors. Radical surgery after 4 weeks of cerebral infarction may be feasible for colorectal cancer patients with new onset stroke, as it appear not to increase the perioperative complications of Clavien–Dindo grade II or higher, while strengthening the preoperative evaluation and perioperative monitoring.

The safety and prognosis of radical surgery in colorectal cancer patients over 80 years old

ObjectiveThe purpose of this study was to assess the safety and feasibility of radical surgery and to investigate prognostic factors influencing in colorectal cancer (CRC) patients over the age of 80.MethodsBetween January 2010 and December 2020, 372 elderly CRC patients who underwent curative resection at the National Cancer Center were enrolled in the study. Preoperative clinical characteristics, perioperative outcomes, and postoperative pathological features were all collected.ResultsA total of 372 elderly patients with colorectal cancer were included in the study, including 226 (60.8%) men and 146 (39.2%) women. A total of 219 (58.9%) patients had a BMI < 24 kg/m2, and 153 (41.1%) patients had a BMI ≥ 24 kg/m2. The mean operation time and intraoperative blood loss were 152.3 ± 58.1 min and 67.6 ± 35.4 ml, respectively. The incidence of overall postoperative complications was 28.2% (105/372), and the incidence of grade 3–4 complications was 14.7% (55/372). In the multivariable Cox regression analysis, BMI ≥ 24 kg/m2 (HR, 2.30, 95% CI, 1.27–4.17; P = 0.006) and N1-N2 stage (HR: 2.97; 95% CI, 1.48–5.97; P = 0.002) correlated with worse CSS.ConclusionThe findings of this study showed that radical resection for CRC is safe and feasible for patients over the age of 80. After radical resection, BMI and N stage were independent prognostic factors for elderly CRC patients.

Retrospective analysis of additional breathing exercise intervention on complications in a prospective database of colorectal cancer surgery patients

Retrospective analysis of additional breathing exercise intervention on complications in a prospective database of colorectal cancer surgery patients

Satisfactory short-term outcomes of totally laparoscopic ileostomy reversal compared to open surgery in colorectal cancer patients.

Recently, totally laparoscopic (TLAP) surgery has suggested its potential on ileostomy reversal. This study aimed to compare the short-term outcomes between TLAP and traditional open ileostomy reversal. From September 2016 to September 2021, 107 eligible patients underwent TLAP (n = 48) or open (n = 59) loop ileostomy reversal were retrospectively enrolled. Surgical parameters, postoperative recovery and complications were identified and compared between TLAP technique vs. open surgery. The operation time and estimated blood loss showed no obvious difference between TLAP and open group. However, TLAP reversal significantly decreased the incision length (4.5cm vs. 6cm, P < 0.001). Furthermore, patients underwent TLAP surgery showed quicker first ground activities (1 day vs. 2 days, P < 0.001), faster first flatus passage (2 days vs. 3 days, P = 0.004) and shorter postoperative stay (5 days vs. 7 days, P = 0.007). More importantly, postoperative complications were significantly reduced after TLAP reversal (3 cases vs. 10 cases, P = 0.026). Further logistic regression analyses also indicated the TLAP technique was associated with lower incidence of complications (OR=3.316, CI, 1.118-9.835; P = 0.031). TLAP surgery is competitive in promoting postoperative recovery as well as reducing complications compared to the traditional open ileostomy reversal.

The safety of Pfannenstiel incision for specimen extraction in laparoscopic colorectal surgery for colorectal cancer: a systematic review and meta-analysis.

The Pfannenstiel incision is often used in gynecological Cesarean section; however, there is limited research on the use of the Pfannenstiel incision for specimen extraction in laparoscopic surgery for the treatment of colorectal cancer. To evaluate the safety of using the Pfannenstiel incision for specimen extraction in laparoscopic surgery for colorectal cancer patients. PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP and WanFangData were searched for studies published up to March 10, 2023; a random-effects model (RCT) and a fixed-effect model were used to evaluate the safety. Operative time, length of extraction skin incision, overall complications, superficial wound infection, organ/space surgical site infection and incisional hernia were evaluated. A total of 5 studies were included in this research. There were no significant advantages in operation time, length of the incision, overall complications, superficial wound infection and organ/space surgical site in the Pfannenstiel group compared to the no Pfannenstiel group. However, the Pfannenstiel incision has a tendency to increase the length of the incision (SMD = 0.05; 95% CI = -0.22 to 0.33; p = 0.71) and the results of the remaining five (operative time,overall complications,incisional hernia, incisional infection and organ/space surgical site infection) are slightly skewed toward the Pfannenstiel incision. It is worth mentioning that incisional hernia (IH) may have an advantage in the Pfannenstiel group compared to the no Pfannenstiel group. Four studies were not at clear risk of bias and two studies were at risk of bias. Our study concludes that the Pfannenstiel incision has a good safety record and it is a good option for extracting specimens during laparoscopic surgery for colon cancer. The Pfannenstiel incision used for laparoscopic surgical specimen extraction has a significantly lower incidence of incisional hernia over no Pfannenstiel.

Effect of prehabilitation on patients with frailty undergoing colorectal cancer surgery: a systematic review and meta-analysis.

The effect of prehabilitation in patients with frailty undergoing colorectal cancer surgery remains controversial. This meta-analysis aimed to assess the impact of prehabilitation before colorectal surgery on the functional outcomes and postoperative complications in patients with frailty undergoing colorectal cancer surgery. PubMed, EMBASE, Cochrane Library, and Scopus databases were searched for articles published up to November 9, 2022. We included randomized and non-randomized trials in which the effects of prehabilitation in patients with frailty undergoing colorectal cancer surgery were investigated against a control group. Data extracted for our meta-analysis included the 6-minute walk test (6MWT), postoperative incidence of complications (Clavien-Dindo classification ≥IIIa), comprehensive complication index (CCI), and length of stay (LOS) in the hospital. Compared with the control group, we found a significant improvement in the incidence of postoperative complications and shorter LOS in the hospital in the prehabilitation group. However, the 6MWT and CCI results showed no significant differences between the 2 groups. Prehabilitation in patients with frailty who underwent colorectal cancer surgery improved the incidence of postoperative complications and LOS in the hospital. Hence, clinicians should consider conducting or recommending prehabilitation exercises prior to colorectal cancer surgery in patients with frailty.

Correlation between Albumin, Colon Leakage Score (CLS), and Anastomotic Leakage after Colorectal Cancer Resection

Anastomotic leakage is still the most undesirable complication of colorectal surgery. The reported incidence of anastomotic leakage after colorectal surgery varies from 1.8% to 15.9%. The impact of anastomotic leakage is increased morbidity, mortality (12–30%), length of stay, and cost of hospitalization; hence, this complication should be prevented as much as possible.Several studies have shown a correlation between low albumin levels and increased anastomotic leakage.The Colon Leakage Score (CLS) is a standard score for predicting anastomotic leakage, but this score does not include the albumin level as a parameter of anastomotic leakage despite the importance of the albumin level’s contribution on the anastomotic leakage. Therefore, this study sought to analyze the correlation between the albumin level, CLS, and the incidence of anastomotic leakage after anastomotic resection surgery in colorectal cancer (CRC) patients at Dr. Hasan Sadikin General Hospital Bandung, Indonesia. This study was a cross-sectional retrospective analytical study on medical records of CRC patients over the age of 18 who underwent intestinal anastomotic resection surgery between 2016–2020. There were thirty-two patients with colorectal cancer underwent anastomotic resection during the study period, with two patients experienced anastomotic leakage. Correlation analysis showed that the correlation coefficient for the albumin level and anastomotic leakage was 0.209, while the correlation coefficient between CLS and anastomotic leakage was 0.110. There is no correlation between albumin level, CLS, and the incidence of anastomotic leakage after anastomotic resection surgery in CRC patients treated at Dr. Hasan Sadikin General Hospital Bandung, Indonesia

Comparison of Oncological Outcomes After Colorectal Cancer Surgery in Patients Undergoing Laparoscopic Versus an Open Procedure

Objective: To compare the oncological outcomes after colorectal cancer surgery in patients undergoing laparoscopic versus open procedures for colorectal carcinoma.&#x0D; Study Design: Comparative Cross-sectional Study.&#x0D; Place and Duration of Study: Surgical Department Combined Military Hospital, Rawalpindi and Histopathology Department Armed Forces Institute of Pathology Rawalpindi Pakistan, from June 2021 to March 2022.&#x0D; Methodology: This study was conducted on 60 patients who underwent oncological surgery for colorectal cancer via the open or laparoscopic method. Data were collected for all the patients from the Histopathology Department regarding proximal margin involvement, circumferential margin involvement, distal margin involvement, tumour perforation and lymph nodes resected. These parameters were compared in patients undergoing open or laparoscopic methods.&#x0D; Results: Out of 60 patients included in the final analysis, 41(68.3%) were males, and 19(31.7%) were females. The mean age of patients who underwent open or laparoscopic surgery for colorectal cancer in our study was 44.67±7.537 years. 32(53.3%)patients underwent laparoscopic surgery, while 28(46.7%) underwent an open surgical procedure. Statistical tests revealed that both Groups found that proximal margin involvement, circumferential margin involvement, distal margin involvement,tumour perforation, and the number of lymph nodes resected were not statistically significant (p-value&gt;0.05).&#x0D; Conclusion: Oncological outcomes on histopathology were not different in patients undergoing the open or laparoscopic procedure. Therefore, laparoscopic colonic resection is oncologically equivalent to open resection.&#x0D;

The 30-day hospital readmission and mortality after surgery in colorectal cancer patients

PurposeHospital readmissions in the first weeks following surgery are common, expensive, and associated with increased mortality among colorectal cancer patients. This study is designed to assess the 30-day hospital readmission after colorectal cancer surgery and evaluate the risk factors that affect hospital readmission.MethodsThe study uses data from the Ministry of National Guard-Health Affairs Cancer Registry. All colorectal cancer patients who underwent colorectal cancer surgery between January 1, 2016, and November 31, 2021, were investigated. Factors examined were age, gender, marital status, Body Mass Index, Charlson Comorbidity Index, chemotherapy, radiotherapy, tumor stage, grade, site, surgical approach, length of stay, and discharge location. Kaplan–Meier curves were constructed to assess survival rates between readmitted and non-readmitted patients, and logistic regressions were performed to assess predictors of readmission.ResultsA total of 356 patients underwent tumor resection and 49 patients were readmitted within 30-day of index discharge. The most common reasons for hospital readmissions were gastrointestinal (22.45%), urinary tract infection (16.33%), and surgical site infection (12.24%). In the multivariable analysis, females were 89% more likely to be readmitted compared to males (odds ratio 1.89, 95% confidence intervals 1.00–3.58). Patients with distant metastatic tumors have higher odds of readmission (odds ratio 4.52, 95% confidence intervals 1.39–14.71) compared to patients with localized disease.ConclusionsColorectal cancer readmission is more common in patients with metastatic disease. Strategies to reduce readmission include planned transition to outpatient care, especially among patients with a high risk of readmission.

The effect of selective decontamination on the intestinal microbiota as measured with IS-pro: a taxonomic classification tool applicable for direct evaluation of intestinal microbiota in clinical routine

Selective decontamination of the digestive tract (SDD) is aimed at elimination of potential pathogenic microorganisms. In this study, the effect of SDD on gut microbiota was evaluated in a large homogenous group of elective colorectal cancer surgery patients. Rectal swabs were taken from 118 patients undergoing colorectal surgery. These patients were randomly assigned to receive perioperative SDD or to the control group (no SDD). Rectal swabs were taken prior to surgery, 3 days after commencing administration of SDD. Gut microbial profiles were obtained with the IS-pro technique, a standardized microbiota profiling assay applicable in clinical routine. Differences in abundance for different taxonomical groups and diversity between the groups were assessed. Unsupervised and supervised classification techniques were used to assess microbial signatures, differentiating between the SDD group and the control group. Patients in the SDD group had different gut microbial signatures than in the control group, also in phyla that are not a target for SDD. Escherichia coli, Sutterella spp., Faecalibacterium prausnitzii, and Streptococcus spp. were the species that differed the most between the two groups. The SDD group showed clustering into two subgroups. In one subgroup, a decrease in Proteobacteria was observed, whereas the other subgroup showed a shift in Proteobacteria species. This study shows that SDD not only decreases colonization of the gastrointestinal tract with potential pathogenic Gram-negative microorganisms, but also reduces the abundance of normal colonizers of our gastrointestinal system and leads to a shift in total microbiota composition.

Hospital factors and metastatic surgery in colorectal cancer patients, a population-based cohort study

BackgroundOnly a limited proportion of patients with metastatic colorectal cancer (mCRC) receives metastatic surgery (including local ablative therapy). The aim was to investigate whether hospital volume and hospital level were associated with the chance of metastatic surgery.MethodsThis national cohort retrieved from the CRCBaSe linkage included all Swedish adult patients diagnosed with synchronous mCRC in 2009–2016. The association between annual hospital volume of incident mCRC patients and the chance of metastatic surgery, and survival, were assessed using logistic regression and Cox regression models, respectively. Hospital level (university/non-university) was evaluated as a secondary exposure in a similar manner. Both uni- and multivariable (adjusted for sex, age, Charlson comorbidity index, year of diagnosis, cancer characteristics and socioeconomic factors) models were fitted.ResultsA total of 1,674 (17%) out of 9,968 mCRC patients had metastatic surgery. High hospital volume was not associated with increased odds of metastatic surgery after including hospital level in the model, whereas hospital level was (odds ratio (OR) (95% confidence interval (CI)): 1.94 (1.68–2.24)). All-cause mortality was lower in university versus non-university hospitals (hazard ratio (95% CI): 0.83 (0.78–0.88)).ConclusionsPatients with mCRC initially cared for by a university hospital experienced a greater chance to receive metastatic surgery and had superior overall survival. High hospital volume in itself was not associated with a greater chance to receive metastatic surgery nor a greater survival probability. Additional efforts should be imposed to provide more equal care for mCRC patients across Swedish hospitals.

ASO Visual Abstract: A Translational Randomized Trial of Perioperative Arginine Immunonutrition on Natural Killer Cell Function in Colorectal Cancer Surgery Patients.

ASO Visual Abstract: A Translational Randomized Trial of Perioperative Arginine Immunonutrition on Natural Killer Cell Function in Colorectal Cancer Surgery Patients.

A Translational Randomized Trial of Perioperative Arginine Immunonutrition on Natural Killer Cell Function in Colorectal Cancer Surgery Patients.

Surgery results in severe impairment of natural killer (NK) cell cytotoxicity (NKC) and activity (NKA, cytokine secretion), and a dramatic drop in arginine levels. Postoperative immunosuppression is associated with increased complications and recurrence. Perioperative arginine is reported to reduce postoperative complications. Because arginine modulates NK cell function, this study aimed to determine whether perioperative consumption of arginine-enriched supplements (AES) can improve NK cell function in colorectal cancer (CRC) surgery patients. This study randomized 24 CRC patients to receive the AES or isocaloric/isonitrogenous control supplement three times a day for five days before and after surgery. The AES contained 4.2 g of arginine per dose (12.6 g/day). The primary objective was to determine whether AES improved NKC by 50 % compared with the control group after surgery. On surgery day (SD) 1, NKC was significantly reduced postoperatively in the control group by 50 % (interquartile range [IQR], 36-55 %; p = 0.02) but not in the AES group (25 % reduction; IQR, 28-75 %; p = 0.3). Furthermore, AES had no benefit in terms of NKA or NK cell number. Compliance was much greater preoperatively (>91 %) than postoperatively (<46 %). However, despite excellent preoperative compliance, arginine was rapidly cleared from the blood within 4 h after consumption and therefore, did not prevent the postoperative drop in arginine. Oral consumption of arginine immunonutrition resulted in a modest improvement in NKC after surgery but was unable to prevent postoperative arginine depletion or the suppression of NKA (ClinicalTrials.gov NCT02987296).

Clinical covariates that improve surgical risk prediction and guide targeted prehabilitation: an exploratory, retrospective cohort study of major colorectal cancer surgery patients evaluated with preoperative cardiopulmonary exercise testing

BackgroundPreoperative risk stratification is used to derive an optimal treatment plan for patients requiring cancer surgery. Patients with reversible risk factors are candidates for prehabilitation programmes. This pilot study explores the impact of preoperative covariates of comorbid disease (Charlson Co-morbidity Index), preoperative serum biomarkers, and traditional cardiopulmonary exercise testing (CPET)-derived parameters of functional capacity on postoperative outcomes after major colorectal cancer surgery.MethodsConsecutive patients who underwent CPET prior to colorectal cancer surgery over a 2-year period were identified and a minimum of 2-year postoperative follow-up was performed. Postoperative assessment included: Clavien-Dindo complication score, Comprehensive Complication Index, Days at Home within 90 days (DAH-90) after surgery, and overall survival.ResultsThe Charlson Co-morbidity Index did not discriminate postoperative complications, or overall survival. In contrast, low preoperative haemoglobin, low albumin, or high neutrophil count were associated with postoperative complications and reduced overall survival. CPET-derived parameters predictive of postoperative complications, DAH-90, and reduced overall survival included measures of VCO2 kinetics at anaerobic threshold (AT), peakVO2 (corrected to body surface area), and VO2 kinetics during the post-exercise recovery phase. Inflammatory parameters and CO2 kinetics added significant predictive value to peakVO2 within bi-variable models for postoperative complications and overall survival (P < 0.0001).ConclusionConsideration of modifiable ‘triple low’ preoperative risk (anaemia, malnutrition, deconditioning) factors and inflammation will improve surgical risk prediction and guide prehabilitation. Gas exchange parameters that focus on VCO2 kinetics at AT and correcting peakVO2 to body surface area (rather than absolute weight) may improve CPET-derived preoperative risk assessment.

Cell-Free Circulating (Tumor) DNA before Surgery as a Prognostic Factor in Non-Metastatic Colorectal Cancer: A Systematic Review.

Simple SummaryPatients with colorectal cancer without distant metastases are often cured by surgical tumor resection. Follow-up is needed because of the risk of disease recurrence. Patients at risk of disease recurrence may benefit from additional chemotherapy. Detection of cell-free circulating tumor DNA (ctDNA) after surgery reflects the presence of remaining cancer cells and is associated with a very high risk of recurrence. Therefore, postsurgery detection of ctDNA is a promising approach to accurately identifying high-risk patients. However, postsurgery ctDNA analysis is challenging. Moreover, in some patients, chemotherapy before surgery might be more beneficial than chemotherapy after surgery. In this review, we provide an overview of current knowledge regarding the association between ctDNA detection before surgery and the risk of recurrence and conclude that the current literature is insufficient to determine this association. Dedicated studies that primarily focus on ctDNA before surgery in colorectal cancer patients are needed.Identification of non-metastatic colorectal cancer (CRC) patients with a high risk of recurrence after tumor resection is important to select patients who might benefit from adjuvant treatment. Cell-free DNA (cfDNA) and circulating tumor DNA (ctDNA) analyses after surgery are promising biomarkers to predict recurrence in these patients. However, these analyses face several challenges and do not allow guidance of neoadjuvant treatment, which might become a novel standard option in colon cancer treatment. The prognostic value of cfDNA/ctDNA before surgery is unclear. This systematic review aims to provide an overview of publications in which the prognostic value of presurgery cfDNA/ctDNA in non-metastatic CRC patients was studied and is performed according to PRISMA guidelines. A total of 29 out of 1233 articles were included and categorized into three groups that reflect the type of approach: measurement of cfDNA, ctDNA somatic alterations, and ctDNA methylation. Overall, a clear association between presurgery cfDNA/ctDNA and the outcome was not observed, but large studies that primarily focus on the prognostic value of presurgery cfDNA/ctDNA are lacking. Designing and performing studies that focus on the value of presurgery cfDNA/ctDNA is needed, in addition to standardization in the reporting of cfDNA/ctDNA results according to existing guidelines to improve comparability and interpretation among studies.

Anatomical features of inferior mesenteric and left colic arteries and surgery in colorectal cancer patients with persistent descending mesocolon.

Persistent descending mesocolon (PDM) is a fetal abnormality in which the left-sided colon is not fused to the retroperitoneum, and it is often accompanied by the adhesion between the mesocolon and small bowel mesentery. Due to its rarity, whether PDM exhibits anatomical characteristics of the inferior mesenteric artery (IMA) and left colic artery (LCA), and how the anomaly affects laparoscopic surgery are largely unknown. We investigated the branches of these arteries and outcomes of patients who underwent laparoscopic surgery. Based on computed tomography (CT) and three-dimensional CT angiography, branching patterns of the IMA, LCA and branches originating from the LCA were analysed in 954 patients with left-sided colon or rectal cancer. PDM was diagnosed by preoperative CT colonography, and confirmed at time of surgery. The anatomical features of the vessels and short-term outcomes of laparoscopic surgery were compared between patient groups stratified by PDM. Twelve patients (1.3%) were diagnosed with PDM. No branching pattern of the IMA specific to PDM was noted. On the other hand, patients with PDM had fewer branches (mean: 1.0) from the LCA than those without PDM (mean: 1.8, p= 0.009). In patients undergoing laparoscopic surgery, outcomes such as operative time, intraoperative blood loss, and number of harvested nodes were comparable between the two patient groups. Few branches of the LCA characterize PDM. PDM does not complicate laparoscopic surgery of the left-sided colon and rectum. However, the above anatomical feature increases the risk of poor colonic perfusion when dividing the LCA.

Impact of Antithrombotic Therapy on the Outcome of Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Systematic Literature Review.

In recent years, many operations have been performed as laparoscopic surgeries in the field of gastrointestinal surgery, but the effect of antithrombotic therapy (ATT) on hemorrhagic complications in patients who have undergone laparoscopic colorectal cancer surgery remains unknown. In addition, the efficacy and safety of pharmacotherapy for the prevention of venous thromboembolism (VTE) have not yet been concluded. The purpose of this systematic review study is to clarify the effect of ATT on hemorrhagic complications in patients undergoing laparoscopic colorectal cancer surgery.Articles published between 2013 and 2020 were searched on Google Scholar and PubMed, and research regarding ATT and laparoscopic colorectal cancer surgery was included after a thorough examination of each study. Each study yielded information on the study's design, type of surgical procedures, antithrombotic medications used, and surgical outcomes (both thromboembolic and hemorrhagic consequences).This systematic review comprised 20 published papers, including a total of 12,751 patients who received laparoscopic colorectal cancer surgery. Four studies on thrombosis prevention in VTE were randomized clinical trials, and the other 16 were cohort or case-control studies. For the effects of prolonged use of ATT on hemorrhagic complications, most studies demonstrated that laparoscopic colorectal cancer surgery with continued preoperative aspirin could be safely conducted without an increase in the frequency of bleeding complications. On the other hand, most included papers have shown that patients receiving VTE pharmacoprophylaxis may be at an increased risk of bleeding complications, but its effectiveness has not been statistically proven, especially in the Asian patient population.Laparoscopic colorectal cancer surgery in patients on prolonged ATT can be safely conducted with no increase in the incidence of hemorrhagic or thrombotic complications. The efficacy and safety of VTE pharmacoprophylaxis in laparoscopic colorectal surgery is still at issue. It is necessary to establish available protocols or guidelines by validating reliable studies.