Diagnosis Of Rectal Cancer Research Articles

Changes in the sexual function of male patients with rectal cancer over a 2-year period from diagnosis to 24-month follow-up: A prospective, multicenter, cohort study.

This prospective study aimed to identify long-term changes in sexual function of men with rectal cancer from point of diagnosis to 24 months postoperatively. Male patients undergoing laparoscopic rectal cancer surgery were prospectively enrolled. International Index of Erectile Function (IIEF) Questionnaire scores were collected at diagnosis; first follow-up; and 6, 12, and 24 months postoperatively. Missing values were managed via multiple imputations using the propensity score method. Paired t tests were applied to examine changes in IIEF scores over time. This study analyzed 115 patients. For erectile function, there were no significant changes in scores from the point of diagnosis to first treatment (9.4 vs. 9.8 as mean scores; p = .227). Scores deteriorated postoperatively and recovered until 12 months post-surgery, but did not improve significantly from 12 months to 24 months post-surgery (8.7 vs. 8.2 as mean scores; p = .440). This pattern of change was observed in all other domains: orgasmic function, sexual desire, orgasmic satisfaction, and overall satisfaction. Sexual function was not influenced by a rectal cancer diagnosis. Sexual function deteriorated following surgery and recovered until 12 months post-surgery; however, it did not significantly improve from 12 months to 24 months postoperatively.

Abstract 2042: The effect of time to treatment on survival varies by disease stage and surgery status for patients with colorectal cancer

Abstract Background: Despite national treatment guidelines for colorectal cancer (CRC), time to treatment (TT) is increasing. Currently, the impact of TT on survival among individuals with CRC is unknown. We examined the relationship between TT and CRC-specific survival and determined predictors of TT in the United States. Methods: We used the Surveillance, Epidemiology, and End Result (SEER) Registry-18 database to identify patients age≥20 with a histologic diagnosis of colon cancer (CC) or rectal cancer (RC) and no other malignancies between 2010 and 2015. TT was defined as the number of months between CRC diagnosis and first treatment regardless of the type of treatment. We conducted Cox proportional hazard regression models to examine the association between TT and CRC-specific survival, adjusting for year of diagnosis, age, sex, race, socioeconomic index, insurance, stage, grade, and surgery, and accounting for the moderation effect of tumor stage and surgery on survival in association with TT. We used logistic regression to explore the relationship between longer TT (>1 month) and stage, surgery, and year of diagnosis. Results: A total of 138,060 patients were included. During a median follow-up time of 30 (IQR 36) months, 4-year CRC-specific survival was 69.6% in CC and 72.7% in RC. Mean TT (SD) was 0.5 (1.0) in CC and 0.9 (1.2) months in RC. Among CC patients, 93% underwent surgery, compared to 82% of RC patients. After adjusting for other factors, the impact of TT varied by stage and surgery (interaction test P values<0.05). For stage I patients who did not undergo surgery, a 1-month increase in TT was associated with about 10% higher risk of death (CC: HR=1.12 [95% CI, 1.01-1.23]; RC: HR=1.10 [95%CI,1.02-1.18]). Inverse associations were found in later stage CC and RC. A 1-month increase in TT was significantly associated with 9%-22% lower risk of death in stage II/III/IV CC and this effect was more pronounced in patients who underwent surgery (Stage II: HR[surgery]=0.78, HR[no surgery]=0.87; Stage III: HR[surgery]=0.81, HR[no surgery]=0.90; Stage IV: HR[surgery]=0.82, HR[no surgery]=0.91). A similar effect was found in stage IV RC with an HR of 0.80 (95%CI: 0.76, 0.84) for patients undergoing surgery and 0.85 (95%CI: 0.82, 0.88) for those without surgery. Accounting for all covariates, patients diagnosed in later years, with earlier stage disease (ORs: 1.19-1.74, stage I/II/III vs. stage IV), and with surgery (CC: OR=3.71 [95%CI, 3.3-4.1]; RC: OR=2.3 [95%CI, 2.1-2.5]) were more likely to have longer TT (>1 month). Conclusion: Longer TT was associated with decreased survival for stage I CC/RC patients who did not have surgery. However, longer TT was associated with increased survival for late stage CC/RC and the impact was more pronounced for those who underwent surgery. Our findings highlight the complexity of late stage and surgical cases, and the importance of sufficient workup before treatment. Citation Format: Liu Yang, Aileen Bui, Anthony Myint, Folasade P. May. The effect of time to treatment on survival varies by disease stage and surgery status for patients with colorectal cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2042.

Clinicopathological characteristics and outcomes of metachronous rectal cancer in patients with a history of cervical cancer with and without remote radiotherapy: Reports of 45 cases.

The purpose of this study was to report the clinicopathological characteristics and treatment outcomes of 45 rectal cancer patients who have a history of cervical cancer with or without remote radiotherapy. Twenty-nine patients (64.4%) with a history of cervical cancer treated with pelvic radiotherapy were classified as group A, 16 (35.6%) patients with a history of cervical cancer not treated with radiotherapy were classified as group B. The median duration between radiotherapy for cervical cancer and rectal adenocarcinoma diagnosis was 18 years. At the time of rectal cancer diagnosis, 5 (17.2%) patients presented stage I disease, 15 (51.7%) had stage II, 1 (3.4%) had stage III, and 8 (27.6%) had stage IV. The patients in group A had older age, higher rates of gross ulcerative lesions, low hemoglobin levels, and a lower rate of lymph node metastases. The patients with secondary rectal cancer developed after radiotherapy for cervical cancer usually presented with abnormal abdominal symptoms, such as proctitis, cystitis, or rectal fistula. Higher colostomy rate was found in this group of patients due to severe pelvic fibrosis or proctitis.

Baseline anaemia increases locally advanced rectal cancer mortality in older patients undergoing preoperative chemoradiation.

The median diagnosis age of rectal cancer (RC) is 70years old. The standard of care for locally advanced RC (LARC) is preoperative chemoradiation (CRT) followed by surgery. Anaemia is a frequent condition in older patients but is not a pure consequence of ageing. The patients aged 65years or over, with clinical stage II/III LARC, and treated with preoperative concurrent CRT were retrospectively reviewed. Baseline haemoglobin (Hb) levels were collected. One hundred and seven patients enrolled in this study, but 17 were excluded in relation with treatment disruption. Fifty-seven (63.3%) males and 33 (36.7%) females completed preoperative CRT whose median age at diagnosis was 73. Twenty-five (27.8%) patients presented with anaemia at rectal cancer diagnosis, and median Hb was 13.5g/dL (IQR = 1.45) and 11.2g/dL (IQR = 1.35), for non-anaemic and anaemic patients, respectively. For the enrolled older population, only 2 patients reported acute grade 3 toxicity. Baseline anaemia tended to decrease the LARC-free interval and was associated with a significantly higher hazard of all-cause and LARC mortality, approximately 5 times (HR = 5.25; 95% CI 1.48-18.66) and 10 times (HR = 10.09; 95% CI 2.40-42.48), respectively. Patients older than 75 presented a significantly negative impact on overall survival (OS) and LARC-specific survival (HR = 6.20, 95% CI 2.00-19.22; and HR = 7.61, 95% CI 2.08-27.87, respectively). Conversely, no significant impact was found for age-adjusted Charlson comorbidity index on OS, LARC-specific survival and LARC-free interval. Overall and LARC-specific survival were significantly lower for the baseline anaemic older patients and for those aged 75years or over.

Chinese expert consensus on the diagnosis and treatment of presacral recurrent rectal cancer

Presacral recurrent rectal cancer which involves the presacral fascia and/or sacral bone is one subtype of locally recurrent rectal cancer. Presacral recurrent rectal cancer is fixed posteriorly to the pelvis due to presacral fascial and/or sacral bone involvement, which makes treatment difficult. There is lack of standardized diagnosis, treatment and surgical methods of presacral recurrent rectal cancer. The purpose of this expert consensus is to improve the understanding of this condition among Chinese specialists, and to help standardizing the diagnosis and therapeutic strategies for presacral recurrent rectal cancer. There are 17 statements on diagnosis (clinical symptoms, imaging, endoscopy, tumor marker detection and pathological biopsy), treatment (radiotherapy, chemotherapy and surgery), follow-up and prognosis for presacral recurrent rectal cancer. It is emphasized that radical surgery with the evaluation of multidisciplinary team (MDT) is the core method for the treatment. The choice of surgical approach should be based on the anatomic characteristics of presacral recurrence. The controversial issues in this consensus requires to further high-quality clinical research.

Imaging modalities in the assessment of presacral recurrent rectal cancer

Imaging plays a key role in the diagnosis and decision-making process including pre-treatment planning, surgical strategy, and follow-up. The critical point in diagnosis of presacral recurrent rectal cancer by imaging modalities is to distinguish the recurrent tumor from nonmalignant tissues induced by operation or radiotherapy. The practice guideline recommends CT as surveillance imaging modality for recurrent rectal cancer. MRI shows higher accuracy, sensitivity, and specificity in diagnosis of presacral recurrent rectal cancer compared with CT. If CT or MRI can not make final diagnosis in challenging cases, 18-fluorodeoxyglucose positron emission tomography ((18)FDG PET) is recommended to aid diagnosis with high sensitivity and specificity, though false-positivity and negativity should be considered. If new or enlarging soft tissue are shown in the follow-up examination, tumor recurrence should be suspected. In addition, tumor-related high risk factors, treatment protocol, surgery, quality of specimen and pathological stages should also be considered when presacral recurrent rectal cancer is to be diagnosed.

Population-based analysis of guideline adherence for patients with rectal cancer in California.

e19045 Background: The goal of oncology-specific evidence-based treatment guidelines is to improve cancer care. We sought to analyze adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines for rectal cancer in the state of California and the associated impacts on survival. Methods: Patients aged 18 to 79 years diagnosed with rectal adenocarcinoma between January 1, 2004 and December 31, 2017 with follow-up through November 30, 2018 were identified in the California Cancer Registry. Patient characteristics such as age, race, insurance status, socioeconomic status (SES), marital status, and tumor stage were identified. In addition, based on available data our investigators determined whether patients received NCCN guideline-adherent care. Odds ratios (OR) and 95% confidence intervals (CI) were used for logistic regression to analyze patients receiving NCCN adherent care. Disease specific-survival analysis was calculated using Cox regression model. Results: A total of 30,118 patients identified with diagnosis of rectal cancer in California, 16,442 (54.6%) of whom did not receive guideline-adherent care. Disease specific-survival was worse for those who did not receive NCCN adherent care with hazard ratio (HR) 1.52 (95% CI 1.41 - 1.63, p < 0.0001). Compared to Caucasians as a referent group, Asians (in aggregate) were more likely to receive guideline adherent care and had better disease specific survival with adjusted HR 0.88 (95% CI 0.80 -0.97, p = 0.008). Also compared to Caucasians, Hispanics were more likely to receive guideline adherent care and had better disease specific survival HR 0.90 (95% CI 0.83 – 0.98, p < 0.015). As compared to managed care insured patients, uninsured patients were least likely to receive care and were observed to have worse disease specific survival adjusted HR 1.34 (95% CI 1.18 – 1.54, p < 0.0001). Patients with Medicaid were also significantly associated with lower survival HR 1.39 (95% CI 1.26 – 1.53, p < 0.0001) – and the CIs indicate Medicaid and uninsured were not statistically different from each other. Comparing to patients with highest SES as a referent group, patients with lowest SES were least likely to receive guideline adherent care and also were observed to have worse disease-specific survival with HR 1.22 (95% CI 1.09 – 1.36, p < 0.0004). Conclusions: In this population-based analysis of rectal cancer patients in California, guideline-adherent care was associated with improved survival.

Patient-Reported Work Ability During the First Two Years After Rectal Cancer Diagnosis.

Rectal cancer treatment is associated with substantial short- and longer-term morbidity that may affect patients' ability to work. We evaluated patient-reported work ability during the first 2 years after rectal cancer diagnosis, relative to the Dutch general population. Also, we assessed the association between clinical factors and work ability. This is a prospective cohort study. This study was conducted at the Radiation-Oncology Department of a tertiary center. Patients with rectal cancer, <67 years of age, and treated with curative intent were selected. Work ability was assessed with the Work Ability Index before the start of treatment (baseline) and at 3, 6, 12, 18, and 24 months after. The Work Ability Index scores of patients with paid employment were compared with the scores of matched population controls. Mixed models were used to estimate the impact of clinical factors on work ability. Of the 230 eligible patients, 172 (75%) had paid employment. Work ability decreased at 3 and 6 months compared with baseline. At 12 months, work ability recovered to baseline level but remained significantly lower than in population controls up to 24 months. Fifty-four percent reported 100 to 365 days of sick leave during the first 12 months of treatment versus 2% in the general population. At 24 months, 32% needed substantial adaptations in work activities, worked reduced hours, or were unable to work due to the disease versus 6% in the general population. Female sex, multiple comorbidities, oligometastatic disease, chemoradiation, and abdominoperineal resection were associated with lower work ability. The study was limited by a decrease in questionnaire response rate from 83% to 64% over time. Patient-reported work ability deteriorates during rectal cancer treatment. Within 24 months after diagnosis, work ability returns to pretreatment level but remains lower than that of the general population. See Video Abstract at http://links.lww.com/DCR/B175. CAPACIDAD DE TRABAJO REPORTADO POR PACIENTES DURANTE LOS PRIMEROS DOS AÑOS DESPUÉS DEL DIAGNÓSTICO DE CÁNCER RECTAL: El tratamiento del cáncer rectal se asocia con una morbilidad significante a corto y largo plazo que puede afectar la capacidad de trabajo de pacientes.Evaluamos la capacidad de trabajo reportado por pacientes durante los primeros dos años después del diagnóstico de cáncer rectal, en relación con la población general holandesa. Además, evaluamos la asociación entre los factores clínicos y capacidad para trabajar.Estudio de cohorte prospectivo.Este estudio se realizó en el Departamento de Radiación Oncológica de en un centro de referencia de tercer nivel.Se seleccionaron pacientes con cáncer rectal, <67 años de edad, y tratados con intención curativa.La capacidad de trabajo se evaluó con el índice de capacidad de trabajo antes del inicio del tratamiento (línea de base) y a los 3, 6, 12, 18 y 24 meses después. Los puntajes de capacidad laboral de los pacientes con empleo remunerado se compararon con los puntajes de los controles de población pareados. Se utilizaron modelos mixtos para estimar el impacto de los factores clínicos en la capacidad laboral.De los 230 pacientes elegibles, 172 (75%) tenían empleo remunerado. La capacidad de trabajo disminuyó a los 3 y 6 meses en comparación con la línea de base. A los 12 meses, la capacidad de trabajo se recuperó al nivel de referencia, pero se mantuvo significativamente más baja que en los controles de la población hasta 24 meses. Durante los primeros 12 meses, el 54% reportó 100-365 días de baja por enfermedad versus el 2% en la población general. A los 24 meses, el 32% necesitaba adaptaciones sustanciales en las actividades laborales, trabajó horas reducidas o no pudo trabajar debido a la enfermedad frente al 6% en la población general. El sexo femenino, las comorbilidades múltiples, la enfermedad oligometastásica, la quimiorradiación y la resección abdominoperineal se asociaron con una menor capacidad de trabajo.El estudio estuvo limitado por una disminución en la tasa de respuesta al cuestionario del 83% al 64% a lo largo plazo.La capacidad laboral informada por el paciente se deteriora durante el tratamiento del cáncer rectal. Dentro de los 24 meses posteriores al diagnóstico, la capacidad laboral vuelve al nivel de pretratamiento, pero sigue siendo inferior a la de la población general. Consulte Video Resumen en http://links.lww.com/DCR/B175. (Traducción-Dr. Adrian Ortega).

Analysis of robotic natural orifice specimen extraction surgery on 162 cases with rectal neoplasms

Objective: To explore the safety and feasibility of da Vinci robot surgical systems in natural orifice specimen extraction surgery (NOSES) for rectal neoplasms. Methods: A descriptive cohort study was used. Inclusion criteria: (1) age ≥18 years old; (2) diagnosis of rectal cancer by biopsy via colonoscopy or benign neoplasm locating in rectum that could not be resected locally through the anus; (3) R0 resection can be achieved by preoperative evaluation; (4) the CDmax (maximum circumferential diameter) was ≤5 cm or specimens could still be extracted from the anus despite a CDmax exceeding 5 cm but was along the longitudinal axis of the rectum. Exclusion criteria: (1) emergency operation due to gastrointestinal obstruction, perforation, or bleeding; (2) distal metastasis, induding lung, bone, or liver, that could not be resected simultaneously; (3) history of abdominal surgery or any other contraindications for robotic surgery. Clinicopathological data of 162 patients with rectal neoplasms who underwent robotic NOSES at the General Surgery Department of the Second Xiangya Hospital of Central South University from March 2016 to July 2019 were retrospectively collected. Of 162 patients, 94 were male and 68 were female; the average age was (57±13) years; the average BMI was (23.5±3.2) kg/m(2); the average distance from tumor to the anal verge was (8.2±2.9) cm. Five trocars were used to perform total mesorectal excision (TME), and the descending colon artery was preserved. Sterile endoscope sleeve for the specimen extraction was inserted into the pelvic cavity through the anus, and the resected specimen was pulled out through the sleeve. Outcomes of safety (operation time, intraoperative blood loss and postoperative morbidity of complication) and oncological outcomes (number of lymph nodes harvested, rate of lymph node metastasis and rate of positive resection margin) were collected. Results: All the 162 cases completed robotic NOSES successfully with no conversion to laparotomy. The average operation time was (188.7±79.8) minutes; the average blood loss was (47.1±33.2) ml; the average and the maximum CDmax of specimens were (3.4±1.5) cm and 12 cm respectively. A total of 154 patients underwent robotic TME. One underwent robotic TME plus resection of liver metastasis; one underwent robotic TME plus partial transverse colectomy; two patients underwent robotic TME plus ovariectomy; another two underwent robotic TME plus hysterectomy; one patient underwent robotic TME plus left partial nephrectomy due to renal angioleiomyoma; another one underwent robotic TME plus ureteral repair due to intraoperative injury of the left ureter. All the specimens were extracted through the anus. Protective ileostomy was performed in 6.8% (11/162) of the patients. The average number of lymph node harvested was 14.9±5.1. According to pathological reports, 156 neoplasms were adenocarcinoma. Tis stage was 1.3% (2/156), T1 stage was 9.0% (14/156), T2 stage was 26.3% (41/156), T3 stage was 35.9% (56/156), and T4 stage was 27.6% (43/156). Lymph node metastasis accounted for 34.6% (54/156), and simultaneous liver metastasis was observed in one case. Circumferential resection margins (CRMs) and upper and lower resection margins were negative in all the patients. The average postoperative feeding time and postoperative hospital stay were (4.2±4.1) days and (11.4±7.7) days, respectively. Postoperative morbidity of complication was 12.3% (20/162). The incidence of anastomotic leakage was 4.9% (8/162), of which only 4 cases (2.5%) received ileostomy. Within postoperative 90-day, no anal dysfunction or death were found. Conclusion: Robotic NOSES for rectal neoplasms is safe and feasible.

Nomogram predicting cancer-specific mortality in early-onset rectal cancer: a competing risk analysis.

The incidence of rectal cancer has meaningfully increased in young patients. However, quantitative evaluation for the competing data of early-onset rectal cancer is lacking. So, we performed a competing risk analysis to calculate the cumulative incidence of death for patients with early-onset rectal cancer and developed a nomogram to predict the probability of cancer-specific mortality for these patients. We abstracted data of patients with early-onset rectal cancer between 2004 and 2016 by using the Surveillance, Epidemiology, and End Results program database. The cumulative incidence function was used to calculate the crude cancer-specific mortality of early-onset rectal cancer. Fine and Gray's proportional sub-distribution hazard model was adopted to explore the risk factors of cancer-specific death. Then, we establish a nomogram to predict their 3-, 5-, and 10-year probabilities. We identified 9917 patients with early-onset rectal cancer, and they were randomly divided into training (n = 6941) and validation (n = 2976) cohorts. In the training cohort, the 3-, 5-, and 10-year cumulative incidences of cancer-specific death after diagnosis for early-onset rectal cancer were 11.4%, 19.9%, and 28.8%, respectively. Fine and Gray's model showed that sex, race, marital status, histology, T stage, N stage, M stage, examined lymph nodes, and pretreatment carcinoembryonic antigen were independently associated with cancer-specific mortality. Such factors were selected to develop a prognostic nomogram. The competing risk nomogram has an ideal performance for predictive cancer-specific mortality in early-onset rectal cancer.

The Impact of Diagnostic Assessment Programs on the Diagnosis and Treatment of Colon and Rectal cancers in a Single Payer System

Introduction: To streamline the diagnostic and pre-treatment assessments for patients with colorectal cancer, specialised Diagnostic Assessment Programs (DAPs) were developed across the province of Ontario, Canada. We compared the performance of DAPs with usual care (non-DAPs). Methods: Patients with colorectal cancer diagnosed between 2014 and 2016 were identified from the Ontario Cancer Registry. Using administrative databases, we compared wait times, healthcare utilization, and overall survival between DAP and non-DAP patients. Results: A total 2,606/18,046 (14%) colorectal cancer patients attended a DAP for part of their diagnostic assessment. DAP patients were younger, lived closer to a DAP, had higher income, were more likely to have stage 2-3 disease (versus stage 1), had tumors in the rectum or rectosigmoid junction, and were less likely to have been an inpatient at the time of diagnosis [odds ratio 3.39 (2.68-4.29)]. DAP patients were more likely to receive diagnostic imaging before treatment, consultation with a medical oncologist or radiation oncologist, and chemotherapy or radiation compared with non-DAP patients. After adjusting for case mix, DAP patients had a time until treatment that was longer by 9.5 (7.4, 11.5) days, but better overall survival than non-DAP patients [hazard ratio 0.84 (0.75-0.94)]. A longer time from diagnosis until treatment was not associated with worse overall survival [hazard ratio 0.96 (0.93-1.00)]. Conclusion: Colorectal DAPs provide more comprehensive healthcare and are associated with better overall survival. Wait-times as efficiency metrics should be interpreted carefully, as this is affected by triaging or enhanced treatment planning that may promote improved outcomes.

Investigation of colorectal cancer distribution in mardin province

Colorectal cancers are the third most common tumors both in the world and in Turkey. Its frequency may vary according to geographical regions, environmental conditions and feeding habits. This study aimed to investigate the distribution of CRC patients admitted to Mardin State Hospital Medical Oncology Outpatient Clinic according to age, sex, diagnosis and stage. The records of patients admitted to Mardin State Hospital Medical Oncology Clinic between 2014-2018 were reviewed retrospectively. Patients over 18 years of age were included in the study. Gender, diagnosis and disease stages of the patients were recorded. A total of 1208 patients were examined. 160 colorectal cancer patients (13.2%) were detected. 74 (46.3%) of the patients were female and 86 (53.8%) were male. The male / female patient ratio was 1.16 / 1. While the median age of the whole group was 57 (19-93), the median age of the women was 57.78 (24-86) and the median age of the men was 56 (19-93). The ratio of colon cancer / rectal cancer in men was 54/32 (62.8 / 37.2%), whereas it was 44/30 (59.5 / 40.5%) in women. There was no difference in the age of the groups according to the diagnosis of colon and rectal cancer and gender (p = 0.37 and p = 0.59). There was no difference between the groups when the diagnoses and stages were compared by gender (p = 0.66 and p= 0.18). When the application stage was examined in all groups, the least application was in stage 1, and the most common application was in stage 4. 32 patients (20%) were over 70 years old and 19 (11.9%) were over 75 years old. The number of patients ≤49 years and 50-64 years were 51 (31.9%) and 64 (40%), respectively. This study includes the first CRC data of Mardin province. CRC patients in Mardin are diagnosed at a younger age and in an advanced stage. Since diagnosis and treatment methods are not sufficient in Mardin, patients are mostly diagnosed outside the province. Therefore, the number of patients is limited. Nevertheless, the statistics will be the first to guide future studies.

Short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction

Objective: To explore the short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction. Methods: A cohort study was carried out. The clinical data of consecutive patients with high rectal cancer who underwent robotic radical resection at the Department of General Surgery of The First Affiliated Hospital of Nanchang University from June 2017 to January 2018 were retrospectively analyzed. Inclusion criteria: (1) preoperative diagnosis of rectal cancer, and distance from tumor to anal margin≥10 cm undercolonoscopy; (2) T1-3 assessed by preoperative imaging examination, and no distant metastasis; (3) female, age≥50 years old, body mass index ≤ 30 kg/m(2); (4) without radiotherapy and chemotherapy before surgery; (5) implementation of robotic radical surgery for high rectal cancer. Fourteen female patients undergoing transvaginal removal of specimen without abdominal incision were included in the no incision group with age of (62.2±9.3) years old and distance from tumor to anal verge of (12.5±0.9) cm. As the match of 1:2, 28 simultaneous patients of high rectal cancer undergoing traditional robotic surgery (surgery interval <8 months) were enrolled to the control group, with age of (60.6±12.8) years old and distance from tumor to anal verge of (11.3±3.8) cm. Short-term efficacy and safty were compared between two groups. Follow-up ended in September 2018. Results: There was no significant difference in baseline data between the two groups (all P>0.05). Compared with the control group, the no incision group had longer operation time [(149.6±15.6) minutes vs. (130.9±12.9) minutes, t=-4.135, P<0.001], shorter time to postoperative flatus [(40.9 ±2.6) hours vs. (51.9±2.9) hours, t=12.049, P<0.001], lower pain score on the operation day and the first day after surgery (using Changhaipainstick) [(3.1±0.4) points vs. (4.6±0.7) points, t=7.458, P<0.001; (2.5±0.3) points vs. (3.3±0.5) points, t=6.142, P<0.001], shorter time to ground activity [(15.6±2.0) hours vs. (24.3±2.5) hours, t=11.102, P=0.030], and shorter postoperative hospital stay [(6.1±0.8) days vs. (7.2±1.3) days, t=2.806, P=0.008], whose differences were statistically significant. There were no significant differences in intraoperative blood loss, proportion of postoperative analgesia patients, and complication within 30 days after surgery (all P>0.05). In the no incision group and the control group,the tumor size was (3.1±0.4) cm and (3.6±0.9) cm, the proximal margin distance was (9.1±1.5) cm and (9.8±1.5) cm, the distal margin distance was (4.3±0.4) cm and (4.5±0.4) cm, the number of harvested lymph node was 15.8±2.4 and 15.2 ± 2.5, and the number of positive lymph node was 0.6±1.3 and 1.1±2.4, respectively, whose differences were not statistically significant (all P>0.05). The mean followed-up period was 10 months (7-14 months) in the no incision group, and 14 months (10-18 months) in the control group. No local recurrence and distant metastasis were found in both groups. Conclusion: Robotic radical resection for high rectal cancer with transvaginal specimen extraction is safe and feasible with advantages of rapid postoperative recovery, less postoperative pain and short hospital stay.

Association Between Inflammatory Bowel Disease and Colorectal Cancer Stage of Disease and Survival

BackgroundInflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). However, there are few data comparing outcomes between IBD and non–IBD-associated CRC. MethodsRetrospective cohort study of patients with CRC identified from the Veteran Affairs (VA) Central Cancer Registry from 1998 to 2012 linked to national VA administrative claims to identify patients with IBD using a previously validated algorithm. The association between IBD status and stage of disease and overall risk of death were evaluated using multivariable logistic and Cox regression, respectively. ResultsAmong 34,570 CRC patients, 217 had IBD. IBD patients were significantly younger for both colon and rectal cancer. IBD patients who developed rectal cancer were significantly more likely to present with locally advanced or metastatic disease (P = 0.007), but there was no difference in stage among patients with colon cancer. This difference persisted after multivariable adjustment (overall—odds ratio [OR] 1.40, 95% confidence interval [1.03-1.90]; colon—OR 1.22 [0.84-1.78]; rectum—OR 2.04 [1.22-3.40]). Total colectomy was more commonly performed among IBD patients. Overall, IBD was associated with a 52% increased risk of death (hazard ratio 1.52 [1.21-1.91]). ConclusionsAlthough IBD is associated with more advanced stage at diagnosis for rectal cancer, it is associated with a worse survival primarily in patients with colon cancer. Further work is needed to better understand the reason for these observed differences between IBD and non-IBD patients and to better delineate the impact of endoscopic surveillance on CRC care and outcomes in IBD patients.

A rare case of rectal cancer with perianal metastasis: a case report

BackgroundCancer metastasis from colon cancer to an anal fistula is very rare. We herein reported a rare case in which local excision was performed for metastatic anal fistula cancer originating from rectal cancer.Case presentationA 68-year-old man was referred to our institution with a diagnosis of rectal cancer. He had complained of anal fistula for 5 years. Based on a recent history of cerebral infarction, Hartmann’s operation was performed to treat the rectal cancer after the administration of preoperative chemotherapy for 3 months. However, 1 month after Hartmann’s operation, the anal fistula was found to have worsened. Pelvic magnetic resonance imaging (MRI) revealed tumor formation at the perianal lesion. Metastatic anal fistula cancer originating from the rectal cancer was diagnosed based on the examination of the biopsied tissue. We selected local excision because the anal tumor had not invaded the surrounding tissue. There has been no recurrence in the 31 months after the curative operation.ConclusionMetastatic cancer should be ruled out when treating left-sided colon cancer with anal fistula. Local excision is one possible treatment for metastatic anal fistula cancer.

Role of intravoxel incoherent motion MRI in preoperative evaluation of DNA mismatch repair status in rectal cancers

To explore the role of intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in evaluating DNA mismatch repair (MMR) status of rectal cancers preoperatively. Seventy-six patients with a diagnosis of rectal cancer confirmed at endoscopic biopsy were enrolled prospectively and underwent IVIM MRI before surgery. The perfusion fraction (f) values of MMR proteins (MMRP) positive rectal cancers were significantly higher than negative cancers. The f values could differentiate MMRP positive rectal cancers from negative cancers with an area under the curve (AUC) of 0.695. The vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor 2 (VEGFR2) expression rates of positive MMRP rectal cancers were significantly higher than negative cancers. This pilot study indicated that the f value derived from IVIM MRI differed significantly between rectal cancers with different MMRP expression levels, which might be involved with different VEGF and VEGFR2 expression rates.

High incidence of advanced stage cancer and prolonged rectal bleeding history before diagnosis in young-onset patients with colorectal cancer.

3576 Background: In contrast to the older population, the incidence of colorectal cancer (CRC) in younger patients (aged &lt; 50 years) has been increasing in the last three decades. Younger patients tend to present with more advanced disease, thought to be in part related to lack of routine screening colonoscopies. The goal of this study was to examine characteristics of young-onset CRC and potentially identify factors that may aid in earlier diagnosis and treatment. Methods: We collected data for patients available through the University of Colorado Cancer Center Cancer Registry. Inclusion criteria included: 1) Diagnosis of colon or rectal cancer between the years 2012-2018 and 2) age at diagnosis of less than 50 years. Pertinent data including baseline characteristics, clinical presentation, family history, pathology, molecular testing, staging, and treatment were collected. Results: 211 patients with young-onset CRC were available for review. Mean age at diagnosis was 42.4 years and 55.5% were males. A total of 42.1% had rectal cancer and a majority of the colon cancer diagnoses had left-sided tumors (66%). Regarding clinical presentation, 52.2% presented with rectal bleeding prior to diagnosis. Of those who presented with rectal bleeding, the average time from the onset of bleeding to diagnosis was 271.17 days. 42.9% of young-onset CRC were stage IV at the time of initial diagnosis. Evaluation of the pathology specimens showed that 89.6% were adenocarcinomas and 63.5% were grade 2 or higher. At diagnosis, the mean BMI was 26.6 and the mean CEA was 135.5. A total of 72.5% of young-onset patients had a positive family history of any cancer. KRAS or NRAS mutations were present in 49.6% of patients, BRAF V600E mutations were present in 3.8%, and 10.8% were MSI-H. Conclusions: Prolonged rectal bleeding history prior to diagnosis was noted in a significant proportion of young-onset patients with colorectal cancer. Patients and primary care physicians should be made aware of this finding in order to facilitate timely referral for colonoscopy which may lead to earlier diagnosis, less advanced disease at diagnosis, and improved outcomes.

Shear Wave Elastography in Rectal Cancer Staging, Compared with Endorectal Ultrasonography and Magnetic Resonance Imaging

The goal of the study described here was to investigate the value of shear wave elastography (SWE) in pre-operative staging of rectal cancer. Fifty-five patients with rectal cancer underwent pre-operative conventional endorectal ultrasonography (ERUS), SWE and enhanced magnetic resonance imaging (MRI) examinations. Pathologic results were used as the gold standard for cancer staging. The concordance rate with pathologic stage by ERUS and MRI and the stiffness values measured by SWE for tumors in different stages were compared. The concordance rates for cancer staging were 72.7% and 70.9% for conventional ERUS and enhanced MRI, respectively; the difference was not significant (p > 0.05). SWE indicated that the mean and maximum stiffness values of the tumors increased with advance in stage. The differences in stiffness values between T1 and T2, T1 and T3–4, as well as T2 and T3–4, were all statistically significant (p < 0.001). When the maximum stiffness values of 65.0 and 90.7 kPa are used for the diagnosis of T1, T2 and local advanced rectal cancer, the concordance rate of cancer staging was 85.5%, which was slightly higher than those of ERUS and MRI, although the difference was not statistically significant (p > 0.05). SWE is useful in judging the depth of invasion of rectal tumors. The value of tumor stiffness can provide a quantifiable indicator for pre-operative diagnosis of cancer staging and can be used as a supplement to conventional ERUS. Further studies with larger sample sizes are needed.

Influence of Body Mass Index on Long-Term Outcome in Patients with Rectal Cancer-A Single Centre Experience.

Background: Excess bodyweight is known to influence the risk of colorectal cancer; however, little evidence exists for the influence of the body mass index (BMI) on the long-term outcome of patients with rectal cancer. Methods: We assessed the impact of the BMI on the risk of local recurrence, distant metastasis and overall—survival in 612 patients between 2003 and 2010 after rectal cancer diagnosis and treatment at the University Hospital Erlangen. A Cox-regression model was used to estimate the hazard ratio and multivariate risk of mortality and distant-metastasis. Median follow up-time was 58 months. Results: Patients with obesity class II or higher (BMI ≥ 35 kg/m2, n = 25) and patients with underweight (BMI < 18.5 kg/m2, n = 5) had reduced overall survival (hazard ratio (HR) = 1.6; 95% confidence interval (CI) 0.9–2.7) as well as higher rates of distant metastases (hazard ratio HR = 1.7; 95% CI 0.9–3.3) as compared to patients with normal bodyweight (18.5 ≤ BMI < 25 kg/m2, n = 209), overweight (25 ≤ BMI <30 kg/m2, n = 257) or obesity class I (30 ≤ BMI <35 kg/m2, n = 102). There were no significant differences for local recurrence. Conclusions: Underweight and excess bodyweight are associated with lower overall survival and higher rates of distant metastasis in patients with rectal cancer.

Full convolutional network based multiple side-output fusion architecture for the segmentation of rectal tumors in magnetic resonance images: A multi-vendor study.

Accurate segmentation of rectal tumors is a basic and crucial task for diagnosis and treatment of rectal cancer. To avoid tedious manual delineation, an automatic rectal tumor segmentation model is proposed. A pretrained Resnet50 model was introduced for feature extraction. To reduce the complexity of the model, all layers after the 13th residual block of ResNet50 were removed, and three side-output modules were added to the hidden layer of ResNet50 to guide multiscale feature learning. The final boundaries of tumors were determined by fusion of the predictions from side-output modules. The proposed model was compared with two other models, and the effects of different region of interest (ROI) sizes, loss functions, and side-output fusion strategy were also evaluated. The models were trained and evaluated on data from four clinical centers; T2-weighted magnetic resonance images (T2W-MRIs) from 461 patients in the first clinical center were used for training, while T2W-MRIs from 51 patients in the same clinical center and 56 patients in three other clinical centers were used for performance evaluation. The proposed model was superior to the two other models and achieved an average Dice similarity coefficient of 82.39%, sensitivity of 86.32%, specificity of 92.25%, and Hausdorff distance of 12.10px. In addition, when the ROI contained rectal tumors, the smaller the ROI size, the higher the segmentation accuracy. For a certain ROI size, there were no considerable differences in segmentation results among the loss functions. Compared to the models with single side-output module, the proposed model performed better. The results show that the proposed model has potential clinical applications in rectal cancer treatment, particularly with regard to therapeutic response evaluation and preoperative planning.