Left-sided Colon Research Articles

Short-term Outcomes of Robotic Left Colectomy Reconstructed by Intracorporeal Overlap Anastomosis for Left-sided Colon Cancer: A Single-center Report from Japan.

Surgery for colon cancer requires covering a wide area and performing both tumor resection and precise lymph node dissection. Robotic left-sided colectomy (RLC) has not been thoroughly established due to the rarity of descending colon cancer. Therefore, we investigated 19 patients who underwent RLC for left-sided colon cancer. Between January 2023 and July 2024, a total of 19 consecutive patients underwent robotic radical left colectomy, which included mobilization of the splenic flexure. We compared the intra- and postoperative factors between left-sided colectomy with and without stent placement. Total operative time (p=0.002), console time (p=0.001), and lymph node harvest time (p=0.001) were significantly different. The total operative time with stent placement was longer than that without stent placement (421.6 vs. 302.0, p<0.01). Console time with stent placement was longer than that without stent placement (315.0 vs. 202.0, p<0.01). More lymph nodes were harvested with stent placement than without (33.1 vs. 11.0, p<0.01). We did not experience any conversions to open surgery, and two Grade II complications were observed according to the Clavien-Dindo classification. Both total operative and console times were longer in cases with stent placement compared to those without. Nevertheless, we safely performed robotic left colectomy, regardless of whether the left-sided colon cancer was treated with stent placement, even in cases where the anastomosis overlapped naturally. Our postoperative outcomes showed no anastomosis-related complications. Therefore, RLC reconstruction using an intracorporeal overlap anastomosis is feasible for left-sided colon cancer, both in terms of intraoperative and postoperative outcomes.

A Study on Lymph Node Distribution in the Main Lymph Node Area for Left-sided Colon Cancer.

In advanced left-sided colorectal cancer, cutting the root of the inferior mesenteric artery (IMA) branching from the aorta is recommended for complete lymph node dissection. However, this procedure sometimes causes severe complications. This study aimed to elucidate the lymph nodes' distribution around the IMA and identify the most critical sites for lymph node dissection. This study included 30 consecutive patients with left-sided colorectal cancer who underwent curative resection with main lymph node dissection in a single institution between January and June of 2022. The mesenteric sections (main lymph nodes, IMA, left colic artery [LCA], and inferior mesenteric vein) were removed from the surgically excised specimen. Subsequently, whole-tissue sections were prepared and stained with hematoxylin and eosin. The positional relationships between each blood vessel and respective lymph nodes were then assessed using the pathological findings. The main lymph nodes were identified in 26 out of 30 patients. The total number of dissected lymph nodes per patient was 0-30 (average: 5.3), and the median distance from the IMA to the main lymph node was 7.61 mm (1.87-43.26 mm). Dividing the lymph nodes into segments, we found 18%, 46%, and 36% of the lymph nodes in the proximal, middle, and distal segments, respectively. Additionally, all lymph nodes were found outside of the IMA sheath surrounding each arterial wall. In left-sided colorectal cancer, the main lymph nodes are mostly located around the LCA bifurcation, which may be essential to ensure main lymph node dissection for advanced stage cases.

Predictive Value of PHRI for Recurrence within One Year after UC Treatment: A Retrospective Study.

Aims/Background Accurate prediction of recurrence after treatment is crucial for controlling the progression and improving the prognosis of active ulcerative colitis (UC) patients. Previous studies have evaluated the therapeutic response in UC patients by assessing mucosal healing, using measures such as the Paddington International Virtual ChromoendoScopy Score (PICaSSO) and the PICaSSO Histological Remission Index (PHRI). The PHRI is effective for evaluating treatment response and disease control in UC patients, but its predictive value for short-term recurrence has not been reported in the literature. Therefore, this retrospective analysis of clinical data aims to explore the predictive value of the PHRI and provide a reference for improving the prognosis of UC patients. Methods Clinical data of UC patients in clinical remission admitted to our hospital from June 2017 to June 2023 were retrospectively collected. Patients were divided into the recurrence group and the non-recurrence group, based on whether they experienced recurrence during the one-year follow-up. Clinical data, laboratory test results, and PHRI scores were collected. Variables that showed statistically significant differences between groups in univariate analysis were included in multivariate logistic regression analysis. The predictive value of PHRI was analyzed with receiver operating characteristic (ROC) curve analysis. Results One hundred and two UC patients in the clinical remission stage were included in this study, and there were no cases of loss to follow-up. Among them, 36 patients (35.29%) experienced recurrence within the one-year follow-up, whereas 66 patients (64.71%) did not. Compared with the non-recurrence group, the recurrence group had a more number of cases with lesions in the left-sided colon and extensive colon, higher percentages of cases that were moderate or severe, and a significantly higher colonoscopy score (p < 0.05). Compared with the non-recurrence group, the PHRI score of the recurrence group was significantly higher (p < 0.001). Multivariate logistic regression analysis showed that that the lesion range (OR = 4.127, p = 0.005), disease severity (OR = 3.889, p = 0.019), colonoscopy score (OR = 6.128, p < 0.001), and PHRI score (OR = 5.466, p < 0.001) were independent risk factors for recurrence in UC patients. The results of ROC curve analysis showed that the area under the curve of the PHRI score in predicting the recurrence of UC patients was 0.838 (95% CI: 0.760-0.916). When the optimal cut-off value was 1 point, the sensitivity and specificity were the highest, which were 89.58% and 65.58%, respectively, indicating that PHRI score had good predictive value. Conclusion The lesion extent, disease severity, endoscopic score, and PHRI score are associated with recurrence within one year in UC patients in the clinical remission stage, and the PHRI score has good predictive value.

Sidedness and Molecular Pattern in Defining the Risk of Lymph Node Metastasis in Nonmetastatic Colorectal Cancer: Single-Center Retrospective Study.

Background: Lymphadenectomy plays a central role in the treatment of localized colon cancer. While in left colon cancer the D3 lymphadenectomy/CME is considered the standard of care, lymphatic stations to be removed in right colon cancer are still a matter of discussion. The individuation of LNM risk factors could help in choosing the lymphadenectomy in right-sided tumors. This study aims to analyze the correlation of histopathological and molecular characteristics with lymph node metastasis, both in right- and left-sided colon cancer, and their impact on survival; Methods: We conducted a single-center observational retrospective study. The following data were collected and analyzed for each patient: demographics, histopathological and molecular data, and intraoperative and perioperative data. Statistical analyses were performed, including descriptive statistics, multivariate logistic regression and survival analysis; Results: An association between tumor size (pT, p < 0.001), grading (p = 0.013), budding (p < 0.001), LVI (79,4% p < 0.001) and LNM was observed. A multivariate analysis identified pT4 (OR 5.45, p < 0.001) and LVI+ (OR 10.7, p < 0.001) as significant predictors of LNM. Right-sided patients presented a worse OS when associated with LNM, while no significant difference was observed in N0 patients; Conclusions: histological and molecular analysis can help identify high risk patients, which could benefit from extended lymphadenectomies. These patients could be ideal candidates for the D3 lymphadenectomy/CME.

Research progress on the distribution patterns and surgical dissection of central lymph nodes in left-sided colon cancer

Lymphatic metastasis is one of the main pathways of colorectal cancer spread and also a crucial factor in patient long-term prognosis. Lymph node dissection in the possible tumor drainage area, particularly the central group of lymph nodes at the root of the tumor-associated supplying artery, is a key and challenging aspect of surgical techniques. Currently, the patterns of lymphatic drainage and the distribution of central lymph nodes in left-sided colon cancer are not well illustrated, and there is no consensus on the necessity and extent of central lymph node dissection. This has led to significant variability in the extent of lymph node dissection among different surgeons in clinical practice, a lack of quality control standards for surgical procedures, and impacts on postoperative treatment strategy and long-term outcomes. Moreover, current research on lymphatic drainage and metastasis is primarily based on traditional anatomy, whereas individualized, precise approaches to lymph node dissection have not been realized. The application of preoperative and intraoperative lymph node imaging techniques based on functional anatomy in colorectal cancer patients is still under exploration.

Indocyanine Green (ICG) Fluorescence in the Assessment of Vascularity of Anastomotic Margins in Colorectal Surgery in a Lower Middle-Income Country (LMIC) Hospital.

One of the uses of indocyanine green (ICG) in the surgical field is the evaluation of the anastomotic margins in colorectal surgery. This is of particular importance because fluorescence imaging may aid in detecting vascular compromise, allowing the surgeon to change the resection margin thereby decreasing the chance of an anastomotic leak. To date, there has been no study with its use locally. This study aimed to determine whether the use of ICG can safely identify if the margins of resection are well-vascularized in patients undergoing left-sided colon or rectal surgery, which in turn may reduce anastomotic leak rates. Through a retrospective study design, the investigators gathered data of patients who underwent left-sided colon or rectal surgery. The groups were divided into those with and without the use of ICG and a comparative data on the anastomotic leak rates were analyzed. Eighty-six (86) patients with similar patient characteristics, tumor staging, and surgical approach were compared. Both the leak rates identified during the initial hospital stay and at 30 days post-operatively were lower in those where ICG was used (p=0.035, p=0.047, respectively) than those where ICG was not used. ICG fluorescence imaging may reduce the anastomotic leak rates in patients undergoing colorectal surgery.

Pan-immune-inflammation value as a prognostic biomarker for colon cancer and its variation by primary tumor location.

A growing body of research indicates significant differences between left-sided colon cancers (LCC) and right-sided colon cancers (RCC). Pan-immune-inflammation value (PIV) is a systemic immune response marker that can predict the prognosis of patients with colon cancer. However, the specific distinction between PIV of LCC and RCC remains unclear. To investigate the prognostic and clinical significance of PIV in LCC and RCC patients. This multicenter retrospective cohort study included 1510 patients with colon cancer, comprising 801 with LCC and 709 with RCC. We used generalized lifting regression analysis to evaluate the relative impact of PIV on disease-free survival (DFS) in these patients. Kaplan-Meier analysis, as well as univariate and multivariate analyses, were used to examine the risk factors for DFS. The correlation between PIV and the clinical characteristics was statistically analyzed in these patients. A total of 1510 patients {872 female patients (58%); median age 63 years [interquartile ranges (IQR): 54-71]; patients with LCC 801 (53%); median follow-up 44.17 months (IQR 29.67-62.32)} were identified. PIV was significantly higher in patients with RCC [median (IQR): 214.34 (121.78-386.72) vs 175.87 (111.92-286.84), P < 0.001]. After propensity score matching, no difference in PIV was observed between patients with LCC and RCC [median (IQR): 182.42 (111.88-297.65) vs 189.45 (109.44-316.02); P = 0.987]. PIV thresholds for DFS were 227.84 in LCC and 145.99 in RCC. High PIV (> 227.84) was associated with worse DFS in LCC [PIV-high: Adjusted hazard ratio (aHR) = 2.39; 95% confidence interval: 1.70-3.38; P < 0.001] but not in RCC (PIV-high: aHR = 0.72; 95% confidence interval: 0.48-1.08; P = 0.114). These findings suggest that PIV may predict recurrence in patients with LCC but not RCC, underscoring the importance of tumor location when using PIV as a colon cancer biomarker.

Microbiota-induced S100A11-RAGE axis underlies immune evasion in right-sided colon adenomas and is a therapeutic target to boost anti-PD1 efficacy

BackgroundTumourigenesis in right-sided and left-sided colons demonstrated distinct features.ObjectiveWe aimed to characterise the differences between the left-sided and right-sided adenomas (ADs) representing the early stage of colonic tumourigenesis.DesignSingle-cell and spatial...

Consensus molecular subtyping of metastatic colorectal cancer expands biomarker-directed therapeutic benefit for patients with CMS1 and CMS2 tumors.

We developed a whole transcriptome sequencing (WTS)-based Consensus Molecular Subtypes (CMS) classifier using FFPE tissue and investigated its prognostic and predictive utility in a large clinico-genomic database of CRC patients (n = 24,939). The classifier was trained against the original CMS datasets using an SVM model and validated in an independent blinded TCGA dataset (88.0% accuracy). Kaplan-Meier estimates of overall survival (OS) and time-on-treatment (TOT) were calculated for each CMS (p < 0.05 considered significant). CMS2 tumors were enriched on left-side of colon and conferred the longest median OS. In RAS-wildtype mCRC, left-sided tumors and CMS2 classification were associated with longer TOT with anti-EGFR antibodies (cetuximab and panitumumab). When restricting to only CMS2, there was no significant difference in TOT between right- versus left-sided tumors. CMS1 tumors were associated with a longer median TOT with pembrolizumab relative to other CMS groups, even when analyzing only microsatellite stable (MSS) tumors. A WTS-based CMS classifier allowed investigation of a large multi-institutional clinico-genomic mCRC cohort, suggesting anti-EGFR therapy benefit for right-sided RAS-WT CMS2 tumors and immune checkpoint inhibitor benefit for MSS CMS1. Routine CMS classification of CRC provides important treatment associations that should be further investigated.

Anastomotic leak after manual circular stapled left-sided bowel surgery: analysis of technology-, disease-, and patient-related factors.

Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists. A post-hoc analysis was conducted using a prospectively collected data set of patients from the 2017 European Society of Coloproctology snapshot audit who underwent elective left-sided resection (left hemicolectomy, sigmoid colectomy, or rectal resection) with a manual circular stapled anastomosis. Rates of anastomotic leak and unplanned intensive care unit stay in association with manual circular stapling were assessed. Patient-, disease-, geographical-, and surgeon-related factors as well as stapler brand were explored using multivariable regression models to identify predictors of adverse outcomes. Across 3305 procedures, 8.0% of patients had an anastomotic leak and 2.1% had an unplanned intensive care unit stay. Independent predictors of anastomotic leak were male sex, minimal-access surgery converted to open surgery, and anastomosis height C11 (lower third rectum) (all P < 0.050). Independent predictors of unplanned intensive care unit stay were minimal-access surgery converted to open surgery and American Society of Anesthesiologists grade IV (all P < 0.050). Stapler device brand was not a predictor of anastomotic leak or unplanned intensive care unit stay in multivariable regression analysis. There were no differences in rates of anastomotic leak and unplanned intensive care unit stay according to stapler head diameter, geographical region, or surgeon experience. In patients undergoing left-sided bowel anastomosis, choice of manual circular stapler, in terms of manufacturer or head diameter, is not associated with rates of anastomotic leak and unplanned intensive care unit stay.

A commentary on 'Timing of restoration of bowel continuity after decompressing stoma, in left-sided obstructive colon cancer: a nationwide retrospective cohort'.

A commentary on 'Timing of restoration of bowel continuity after decompressing stoma, in left-sided obstructive colon cancer: a nationwide retrospective cohort'.

Clinicopathological features and prognosis analysis of proximal colonic mucinous adenocarcinoma

Mucinous adenocarcinoma (MAC) is a distinct subtype of colorectal cancer. Previous studies have confirmed the poor prognosis of rectal or left-sided colon MAC, while the prognosis and response to chemotherapy in proximal colon MAC remains controversial. The aim of this study was to investigate the clinicopathological characteristics, prognosis, response to chemotherapy, and risk prediction factors of proximal colon MAC. Patients with proximal colon MAC and non-mucinous adenocarcinoma (NMAC) were retrospectively analyzed in this study. The analyzed variables included gender, age, smoking, drinking, chemotherapy, metastasis, pathological stage, and tumor size. Overall survival (OS) was the primary outcome. Kaplan–Meier analysis was used to assess the impact of mucinous subtype and chemotherapy on OS. We conducted univariate and multivariate Cox regression analyses to determine prognosis factors for proximal colon MAC and NMAC. A total of 284 cases of proximal colon MAC and 1384 cases of NMAC were included in the study. Compared to NMAC, proximal colon MAC was diagnosed at a younger age. The proportion of synchronous and metachronous metastasis was also higher, as well as the pathological stage and tumor size. Proximal colon MAC had a worse prognosis than NMAC, especially in stage 3. Moreover, the prognosis of proximal colon NMAC improved after chemotherapy, while MAC showed no improvement in prognosis after chemotherapy. Advanced age, N1 and N2 stage were independent prognostic factors for adverse outcomes in MAC. For proximal colon adenocarcinoma, the independent predictors of adverse outcomes included mucinous subtype, order age, N1 and N2 stages, and pathological stage 4. Proximal colon MAC had a worse prognosis compared to NMAC. Chemotherapy did not improve the prognosis of proximal colon mucinous adenocarcinoma.

Prognostic impact of codon-specific KRAS mutational status on survival in patients with metastatic colorectal cancer treated with TAS-102 or regorafenib.

75 Background: Previous study demonstrated KRAS (Kirsten rat sarcoma virus) codon G12 mutation as a potential biomarker of resistance in metastatic colorectal cancer (mCRC). Our study aimed to evaluate the prognostic impact of codon-specific KRAS mutational status on survival in patients with mCRC treated with TAS-102 or regorafenib. Methods: mCRC Patients treated with TAS-102 or regorafenib were retrospectively enrolled into our study. Patients were classified into KRAS G12 (KRASG12) mutation and no KRASG12 mutation according to extended RAS testing. Survival was estimated for comparison, stratified by KRAS mutational status and treatment. Kaplan-Meier curves were estimated for overall survival (OS). Results: A total of 183 patients were enrolled into our study, with 91 patients treated with TAS-102 and 92 patients treated with regorafenib. The median age was 63 years old in our cohort. Most patients were male (54%) with left side colon (85%). After extended RAS/RAF mutational testing, 28% patients had KRASG12 mutation, 50% had RAS/RAFWT, 9% had KRASG13 mutation, 8% had KRASother mutation, 3% had NRAS mutation and 2% had BRAF mutation. For patients treated with TAS-102 group, 20% patients had KRASG12 mutation, while for regorafenib group, 38% patients had KRASG12 mutation. The median OS of TAS-102 was 4.5 versus 11.3 months for KRASG12 mutation and no KRASG12 mutation, respectively (p= 0.013). The median OS of regorafenib was 10.5 versus 6.3 months for KRASG12 mutation and no KRASG12 mutation, respectively (p= 0.183). Furthermore, 34% patients with KRASG12 mutation received TAS-102, while 56% patients without KRASG12 mutation received TAS-102. For patients with KRASG12 mutation, the median OS was 4.5 m versus 10.5 months for TAS-102 and regorafenib group, respectively (p= 0.113). For patients without KRASG12 mutation, the median OS was 11.3m versus 6.3 months for TAS-102 and regorafenib group, respectively (p= 0.047). Conclusions: The prognostic impact of KRASG12 was divergent between mCRC patients treated with TAS-102 and regorafenib. Codon-specific KRAS mutational status should be taken into consideration before treatment.

Colorectal screening following appendectomy in adult patients: a systematic review.

Although the association between appendicitis and colorectal cancer in older patients has received attention, postoperative colorectal screening through endoscopy is not currently recommended. This study conducted a systematic review of the literature on colorectal screening following appendectomy in adult patients. A literature search was performed using online databases. Studies reporting colorectal surveillance after appendectomy in adult patients were retrieved for assessment. Eight articles including a total of 3,995 patients were published between 2013 and 2023. An age of 40 years was the lower threshold in 6 of the 8 articles. Postoperative colorectal screening occurred in 771 patients (19.3%). Endoscopy was performed in 95.2% of cases and computed tomography-colonography in 4.8%. During endoscopic examinations, a lesion was discovered in 184 of 771 patients (24.0%), and an adenomatous polyp was found in 154 of 686 patients (22.5%). The overall cancer rate was 3.9% (30 of 771 patients). The tumor was located in the right-sided colon in 46.7% of the patients, in the cecum in 20.0%, in the rectum in 16.7%, in the left-sided colon in 10.0%, and in the sigmoid colon in 6.7%. Performing post-appendectomy colorectal screening in patients >40 years of age could allow early detection of an underlying lesion.

Accuracy of Clinical Staging of Localized Colon Cancer: A National Cancer Database Cohort Analysis.

This study aimed to assess concordance between clinical and pathologic assessment of colon cancer. A retrospective cohort analysis of patients with stage I-III colon cancer in the National Cancer Database (2010-2019) was conducted. Concordance between clinical and pathologic assessment of colon cancer was calculated using Kappa coefficients and 95% confidence intervals (CIs). A total of 125,473 patients (51.2% female; mean age 68.2 years) were included. There was moderate concordance between clinical and pathologic T stage (Kappa = 0.606, 95%CI: 0.602-0.609) and between clinical and pathologic N stage (Kappa = 0.506, 95%CI: 0.501-0.511). For right-sided colon cancer, there was moderate agreement between clinical and pathologic T stage (Kappa = 0.594, 95%CI: 0.589-0.599) and N stage (Kappa = 0.530, 95%CI: 0.523-0.537). For left-sided colon cancer, there was substantial agreement between clinical and pathologic T stage (Kappa = 0.624, 95%CI: 0.619-0.630) and moderate agreement between N stage (Kappa 0.472, 95%CI: 0.463-0.480). Sensitivity of clinical assessment of T and N stage ranged from 64.3% to 77.2% and 41.6% to 54.5%, respectively. Specificity ranged from 96.7% to 97.7% for T stage and 95.7% to 97.3% for N stage. Clinical assessment of T and N stages of colon cancer had good diagnostic accuracy with moderate concordance withthe final pathologic stage. While clinical assessment was highly specific with < 3% of patients being over-staged, it had modest sensitivity, especially for detection of nodal involvement. Diagnostic accuracy of clinical assessment of right and left colon cancers was similar, except for higher sensitivity and accuracy of assessment of nodal involvement in right than left colon cancers.

Innovative pancreas-guided technique for splenic flexure mobilization in laparoscopic left hemicolectomy.

Splenic flexure mobilization (SFM) is a major challenge in laparoscopic left hemicolectomy. This study aims to assess the safety and effectiveness of the pancreas-guided SFM technique during laparoscopic left hemicolectomy. From January 2018 to December 2023, 352 patients with left-sided colon cancer underwent laparoscopic left hemicolectomy. Based on the SFM method used, the patients were divided into the pancreas-guided group (167 cases) or the "Three Approaches Roundabout"/classic group (185 cases). Clinicopathologic characteristics and intraoperative and postoperative variables were compared between the two groups. The two groups had no significant differences in baseline indicators (P > 0.05). All surgeries were successful without needing to convert to laparotomy, and there were no combined organ resections involving the spleen or pancreas in either group. The mean duration of surgery was significantly lower in the pancreas-guided group than in the classic group (P < 0.01). The median volume of intraoperative blood loss in the pancreas-guided group was lower than that in the classic group (P < 0.01). Through video playback, it was found that the retro-pancreaticspace had been entered during operation in 8 cases (4.3%) in the classic group, while there were no such occurrences in the pancreas-guided group. This difference was statistically significant (P < 0.05). The difference in the number of lymph nodes cleared, postoperative hospital stays, and incidence of complications were not statistically significant (all P > 0.05) between the groups. The pancreas-guided SFM technique is a safe and feasible option for laparoscopic left hemicolectomy. Our study's findings suggest that this approach facilitates accurate access to the correct anatomic plane, potentially improving surgical efficiency.

Cecal intubation rates: data from the New Hampshire Colonoscopy Registry

Women and older or thinner patients have lower colonoscopy cecal intubation rates. We used data from the New Hampshire Colonoscopy Registry (NHCR) to examine the association between these and other endoscopist factors and trends of colonoscopy cecal intubation rates. Our sample included patients ≥40 years from the NHCR with an adequate bowel preparation. We examined colonoscopy completion rates over quartiles (2004-2011, 2012-2014, 2015-2017, and 2018-2021) as stratified by men versus women and body mass index (BMI). In addition to these factors, we also adjusted for age and year of examination. Other variables of interest were specialty of the endoscopist and adenoma detection rates (ADRs). Our sample included 143,095 individuals (52.5% women [n = 75,180]). Multivariable analysis showed that BMI <25 (odds ratio [OR], .87; 95% confidence interval [CI], .76-.99), obesity (BMI ≥30) (OR, .88; 95% CI, .77-.99), and older age (per year) (OR, .96; 95% CI, .96-.97) were associated with a decreased likelihood of having a complete colonoscopy. Men were more likely than women to have a higher completion rate (OR, 1.46; 95% CI, 1.30-1.63). Gastroenterology specialty (OR, 1.78; 95% CI, 1.56-2.03) and an ADR ≥25% (OR, 2.01; 95% CI, 1.79-2.26) were associated with an increased likelihood of cecal intubation. These endoscopist-related factors were also observed to be predictive of cecal intubation in a subset of thin (BMI <25) women. Men and obese patients (BMI ≥30) were more likely to have incomplete examinations halted in the right-sided versus left-sided colon. Even after adjusting for endoscopist factors, our study demonstrated that older or female patients and those with a BMI <25 or ≥30 had lower colonoscopy completion rates. Our data also suggest that colonoscopies performed in thin women were more likely to be completed if they were performed by a gastroenterologist as opposed to a nongastroenterologist.

Optimal glycaemic control and the reduced risk of colorectal adenoma and cancer in patients with diabetes: a population-based cohort study

ObjectiveWhether varying degrees of glycaemic control impact colonic neoplasm risk in patients with diabetes mellitus (DM) remains uncertain.DesignPatients with newly diagnosed DM were retrieved from 2005 to 2013. Optimal glycaemic...

Epigenetic differences in the tumor suppressor genes MLH1 and p16INK4a between Nepalese and Swedish patients with colorectal cancer

Abstract Objectives Colorectal cancer (CRC) is one of the most prevalent cancer types worldwide, exhibiting significant variance in incidence rates across different ethnicities and geographical regions. Notably, there is a rising incidence of CRC among younger adults, particularly evident in advanced stages, with a more pronounced trend observed in developing nations. Epigenetic alterations potentially play a role in the early onset of CRC and could elucidate interpopulation disparities. This study aimed to examine DNA methylation levels in the tumor suppressor genes MLH1 and p16INK4a, comparing Nepalese and Swedish patients with CRC. Methods Patients who underwent CRC surgery at Tribhuvan University Teaching Hospital, Nepal (n=39), and Sahlgrenska University Hospital, Sweden (n=39) were included. Demographic and clinicopathological data were analyzed, and pyrosequencing was employed to determine methylation levels in the MLH1 promoter region and the first exon of p16INK4a in tumor tissues and adjacent mucosa located 10 cm from the tumor site. Subsequently, methylation status was compared between Nepalese and Swedish patients and correlated with clinicopathological parameters. Results Nepalese and Swedish patients displayed equal levels of MLH1 and p16INK4a methylation in tumors, but Nepalese patients exhibited a significantly higher level of MLH1 methylation in mucosa compared to Swedish patients (p=0.0008). Moreover, a greater proportion of Nepalese patients showed MLH1 methylation in mucosa compared to Swedish patients (31 vs. 2.6 %). Aberrant methylation of p16INK4a was also observed in the mucosa of Nepalese patients, characterized by high methylation at specific sites rather than uniform methylation across CpG sites. There were no significant differences in methylation levels based on tumor location among Nepalese patients, whereas Swedish patients exhibited higher methylation in right- compared to left-sided colon tumors. Swedish patients showed an increase in p16INK4a methylation in tumors with advancing age. Conclusions Nepalese and Swedish patients displayed equal levels of MLH1 and p16INK4a methylation in tumors. In contrast, Nepalese patients had a higher level of MLH1 methylation as well as aberrant methylation of p16INK4a in mucosa compared to Swedish patients. These epigenetic differences may be linked to environmental and lifestyle factors. Ongoing research will further explore whether hypermethylation in the mucosa of Nepalese patients is associated with tumorigenesis and its potential utility in screening high-risk patients or predicting recurrence.

Surgery for Infrarenal Retroperitoneal Node Metastases from Colon Cancer.

Treatment of retroperitoneal lymph node metastases (RPN) from colon cancer (CC) is a therapeutic challenge. Available evidence supporting a curative approach is weak and uncertainties remain concerning the extent of the dissection, the optimal timing for surgery, and the role of adjuvant radiotherapy. We report the outcomes of a curative intent strategy in a recent monocentric series of patients. We did a retrospective review of all curative intent surgical treatment of RPN from CC performed consecutively in a French university hospital from June 2015 to April 2021. Demographics, clinicopathological, and molecular characteristics were evaluated. We describe recurrence-free and overall survival and factors related to recurrence. Records from 18 patients were reviewed. The median age was 69years. Most of the patients were male (55%), ASA 1-2 (94%), had a left-sided primary colon cancer (73%), and had metachronous RPN (62%). Thirteen patients (72%) experienced recurrence. Recurrence was often limited to RPN (27%) or liver (22%). Four patients underwent a second surgery for RPN recurrence. Median disease-free and overall survival were 22months and 50months after RPN surgery. We did not find any factor associated with recurrence. Short-term recurrence (< 6months) was associated with shorter overall survival (0.031). The current results suggest that RPN resection is feasible and associated with long survival in selected patients. Further studies evaluating the benefit of curative strategies including radical surgery for patients with potentially resectable RPN are warranted.