Malignant Neoplasms Of Colon Research Articles

Методика расчета эффективности профилактических осмотров и диспансеризации определённых групп взрослого населения при выявлении злокачественных новообразований.

One of the objectives of the Federal Project «Fighting Cancer» is to achieve «The proportion of malignant neoplasms detected at early stages, Percentage.» One method to achieve the set goals is to improve the efficiency of preventive medical examinations and screenings of certain adult population groups. The study aims to provide a methodological rationale for calculating the efficiency indicators of preventive medical examinations and screenings of certain adult population groups in terms of detecting malignant neoplasms. Materials and methods. For conducting the study, we used normative legal documents regulating the procedures for conducting preventive medical examinations and screenings of certain adult population groups, as well as industry-specific statistical report forms № 131/o «Information on conducting preventive medical examinations and screenings of certain adult population groups» from 11 subjects of the Northwestern Federal District for the period 2017–2022. Results. According to the analysis of the indicator «The share of residents of the Russian Federation subjects undergoing PME (Preventive Medical Examination) and SCS (Screening for Certain Groups) compared to the number of residents fitting the criteria for PME and SCS», this indicator has practically not changed over the period from 2017 to 2022, being 0,41 in 2017 and 0,42 in 2022. The coverage by preventive examinations and screenings of certain population groups in the Russian Federation subject in the Northwestern Federal District from 2017 to 2022 decreased from 0,92 to 0,75 of what was due. When calculating the actual coverage by preventive examinations and screenings of certain adult population groups in the Northwestern Federal District, the indicator slightly decreased from 0,37 in 2017 to 0,32 in 2022. The «overall» contribution of preventive medical examinations and screenings of certain adult population groups in the Northwestern Federal District slightly increased from 0,11% in 2017 to 0,14% in 2022. When analysing the «crude» index of the contribution of PME and SCS in detecting malignant neoplasms from 2017 to 2022, an increase from 3,34% to 7,6% is noted. The standardised contribution of preventive examinations and screenings of certain adult population groups to the diagnosis of breast cancer malignant neoplasms increased from 3,7% in 2017 to 8,5%, and the diagnosis of malignant neoplasms of colon, rectum, and anal canal (C18-C20) for the same period increased from 4% to 7,9%. Conclusion. Regardless of which indicator is used to calculate the efficiency of conducted preventive measures, manual data entry and the formation of statistical forms 131/o must be stopped. Manual data entry can lead to data distortion and introduce significant fluctuations in indicators when comparing the same indicator among different subjects of the Russian Federation.

Decreasing rates of colectomy for benign neoplasms: A nationwide analysis.

Despite advances in endoscopic techniques for management of benign colonic neoplasms, a rise in rates of surgical treatment has been reported. We used a nationally representative cohort to characterize temporal trends, patient characteristics, and outcomes associated with colectomy for colonic neoplasms. All patients undergoing elective partial colectomy for benign or malignant colonic neoplasms were identified using the 2012-2019 National Inpatient Sample. Those presenting with inflammatory bowel disease, or experiencing intestinal perforation were excluded. Patients with benign neoplasms were classified as the Benign cohort (others: Malignant). Trends, characteristics, and outcomes were assessed between groups. Of 569,280 colectomy procedures included for analysis, 153,435 (27.0%) were performed for benign lesions. The proportion of Benign operations decreased from 28.6% in 2012 to 23.7% in 2019 (P for trend<0.001). While overall national incidence of colectomy for benign neoplasms decreased from 2012 to 2019 (IRD -1.19, 95%CI -1.20- -1.19), Black patients demonstrated an incremental increase (IRD +0.04, 95%CI +0.02-0.06). On average, Benign was younger (66 [57-72] vs 68 years [58-77], P<0.001), and demonstrated a lower Elixhauser comorbidity index (2 [1-3] vs 3 [2-4], P<0.001), relative to Malignancy. Following adjustment, Benign demonstrated lower odds of in-hospital mortality (AOR 0.61, 95%CI 0.50-0.74; P<0.001), stoma creation (AOR 0.46, 95%CI 0.43-0.50; P<0.001), and infectious complications (AOR 0.68, 95%CI 0.63-0.73; P<0.001). The present national study identifies a decrease in colectomy for benign polyps from 2012-2019. Future investigations should identify patients who would most benefit from surgical resection and address persistent inequities in access to screening and treatment for colonic neoplasms.

Significant Rise of Colorectal Cancer Incidence in Younger Adults and Strong Determinants: 30 Years Longitudinal Differences between under and over 50s.

Simple SummaryWe aimed to assess the incidence of CRC in Crete from 1992–2021 and compare them among younger and older adults. The mean age-specific incidence rate (ASpIR/100,000/year) of colon cancer patients <50 years was 7.2 (95% CI 5.1–9.7), while for patients ≥50 years the ASpIR was 149 (95% CI 146.2–153.4). ASpIR presented a 29.6% increase from 2001 to 2011 in the age group of 20–34 years and further increase is expected from 2022–2030 (projected change, 42.8%). The main risk factors were the pack years (p = 0.01), alcohol consumption (0.02), and farmer occupation (0.04), especially during 2012–2021. We confirmed an increased incidence of CRC in young adults <50 in a European population with low cancer incidence in the past and a worrisome prediction for the near future. There is a clear indication that starting CRC screening at an earlier age may be essential.(1) Background: There is evidence in the recent literature that the incidence patterns of colorectal cancer (CRC) have changed considerably over the years, tending to rise rapidly in individuals under 50 years old compared with those over 50 years. The current study aimed to assess the incidence of CRC in Crete from 1992–2021 and compare them among younger and older adults. (2) Methods: Data on malignant neoplasms of colon, rectosigmoid junction, and rectum have been extracted from the database of the Regional Cancer Registry of Crete. (3) Results: The number of these cases for the period 1992–2021 was 3857 (n = 2895 colon and n = 962 rectum). The mean age-specific incidence rate (ASpIR/100,000/year) of colon cancer patients <50 years was 7.2 (95% CI 5.1–9.7), while for patients ≥50 years the ASpIR was 149 (95% CI 146.2–153.4). ASpIR presented a 29.6% increase from 2001 to 2011 in the age group of 20–34 years and further increase is expected from 2022–2030 (projected change, 42.8%). The main risk factors were the pack years (p = 0.01), alcohol consumption (0.02), and farmer occupation (0.04), especially during 2012–2021. (4) Conclusions: We confirmed an increased incidence of CRC in young adults <50 in a European population with low cancer incidence in the past and a worrisome prediction for the near future. The observed trends clearly indicate that starting CRC screening at an earlier age may be essential.

Small Bowel Adenocarcinoma: a Nationwide Population-Based Study.

Small intestinal cancers have a non-specific clinical presentation and hence a delayed diagnosis. The prevalence of small intestinal cancers is low, and there are no cost-effective methods of screening. This study aimed to identify clinical characteristics of duodenal and jejunal adenocarcinomas that can assist in the early detection and diagnosis of disease. Duodenal adenocarcinoma and jejunal adenocarcinoma in Explorys database (1999-2019) were compared using odds ratio (OR) with 95% confidence intervals. Data on demographic characteristics, risk factors, clinical features, and treatment were collected. Out of a total of 8100 patients with a diagnosis of primary adenocarcinoma of the small intestine, 5110 are primary adenocarcinoma of duodenum (63%), and 600 are primary adenocarcinoma of jejunum (7.4%). Patients with jejunal adenocarcinoma when compared with patients with duodenal adenocarcinoma are more obese (OR, 1.36) and have a significantly higher prevalence of malignant neoplasm of colon (OR, 3.07), Crohn's disease (OR, 4.42), and celiac disease (OR, 2.48). Jejunal adenocarcinoma patients presented more frequently with intestinal obstruction (OR, 1.99), whereas duodenal adenocarcinoma patients more commonly presented with iron deficiency anemia (OR, 0.16). Patients with jejunal adenocarcinoma are less likely to undergo therapy with anti-neoplastic agents when compared with duodenal adenocarcinoma (OR, 0.81). There are no differences in patients undergoing surgical intervention or a combination of surgical intervention and antineoplastic therapy. Jejunal adenocarcinoma is more commonly associated with colorectal cancer, celiac disease, and Crohn's disease. They also had lower odds of requiring chemotherapeutic agents.

Impact of COVID-19 on delay in cancer diagnostic testing.

e18786 Background: Early diagnosis is key to the best treatment options and possible outcomes for cancer patients. However, the COVID19 pandemic has put a heavy burden on the US healthcare system, causing hospitals and medical centers to stop or delay routine cancer screenings such as mammograms, pap tests, colonoscopies, CT scans and PSA assays. Subsequently, cancer diagnostic testing and cancer patient care have also been disrupted. Methods: To determine the extent of cancer diagnostic testing that was impacted during the COVID 19 pandemic in 2020, we analyzed the changes in cancer test volume at NeoGenomics Laboratories Inc. between 2019 and 2020, and especially between March and June 2020. Unique patient test counts were categorized by cancer types as determined by the diagnostic ICD 10 code C00-D49 (with a minimum of 100 tests in 2019). Results: Comparing test volumes in 2020 to 2019, an overall decrease in tests ordered in 2020 was seen for multiple cancers. These cancers include malignant neoplasms of breast (16%) and malignant neoplasm of bronchus and lung (19%), followed by malignant neoplasm of colon, polycythemia vera, and Hodgkin lymphoma. In addition, a decrease in benign cancers, and decreases in benign neoplasm of colon, rectum, anus and anal canal was observed. To determine if the US stay-at-home order implemented between March and early June 2020 had affected test volume, month-to-month comparison shows the greatest impact in test volume in malignant neoplasm of breast: a 28% decrease comparing April 2020 to April 2019, and a 32% decrease comparing May 2020 to May 2019. Similarly, a 24% and 33% decrease were seen in malignant neoplasm of bronchus and lung for the same months. Individual tests specific for breast and lung cancer also showed similar decreases: 49-56% decrease for Breast Triple Stain (CK5 + p63 + CK 8/18), 11-41% decrease for ER test, and up to 39% decrease for HER2 diagnostic tests. Tests for ALK fusions for lung cancer showed decreases in test volume ranging from 15% to 30% during April, May and June 2020 as compared to 2019. Interestingly, we found that the total test volumes for each age group (increments of 10 up to age 80) decreased April and May 2020 as well, compared to April and May 2019. We did not see a difference in test volume decreases based on patient gender. Conclusions: There was a decrease in cancer tests ordered during the pandemic in 2020 for most cancer types, with a large decrease found in breast, lung and colon cancer. The sharp decrease in breast cancer tests is important to note as breast cancer has recently been identified as the most diagnosed form of cancer, surpassing lung cancer. This impact in cancer testing may translate to delayed diagnosis and treatment options. It remains to be seen whether this will lead to more aggressive cancer treatments, or to a greater patient mortality. It is imperative that we continue to monitor and screen patients for cancer as the pandemic continues or during any healthcare crisis in the future.

944 Prevalence Rate of Colorectal Cancer in Various Chronic Liver Disease Groups in the United States Between 2014 and 2019: A Population-Based Study

INTRODUCTION: Prior studies have suggested that the risk of colorectal cancer (CRC) may be increased in individuals with cirrhosis and chronic liver disease (CLD). It is well known that a diagnosis of PSC has increased risk of CRC, but there is little date as to whether other causes of CLD have increased CRC risk as well. Some prior studies have been limited by small sample sizes, and to our knowledge no large study has been performed comparing CRC risk between the different causes of chronic liver disease. METHODS: We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the United States from 1999 to 2019. We identified an aggregated patient cohort of eligible patients with “Diagnosis: Alcoholic liver cirrhosis”, “Diagnosis: Chronic Viral hepatitis”, “Diagnosis: Autoimmune hepatitis”, and “Diagnosis: PBC” followed by a diagnosis of “Primary malignant neoplasm of colon and/or rectum” between May 2014 and May 2019, based on Systematized Nomenclature Of Medicine – Clinical Terms (SNOMED-CT). RESULTS: Of the 36,813,060 individuals active in the database between May 2014 and 2019, we identified 7,350 individuals with PBC with an overall prevalence rate of 20.0 per 100,000 persons; 66,160 individuals with alcoholic cirrhosis (AC) with overall prevalence rate of 180 per 100,000 persons; 186,840 individuals with chronic viral hepatitis (CVH) with overall prevalence rate of 508 per 100,000 persons; and 13,540 individuals with autoimmune hepatitis (AH) with overall prevalence rate of 36.8 per 100,00 persons. In the PBC group, 60 were found to have CRC with overall prevalence rate of 816/100,000, OR 2.1 [95%CI (1.62 to 2.64) P &lt; 0.0001]. In the AC group 400 were found to have CRC with overall prevalence rate of 605/100,000, OR 1.54 [95%CI (1.40 to 1.70) P &lt; 0.0001]. In the CVH group 890 were found to have CRC with overall prevalence of 473/100,000, OR 1.21 [95%CI (1.41 to 1.30) P &lt; 0.0001]. In the AH group 50 were found to have CRC with overall prevalence of 369/100,000, OR 0.94 [95%CI (0.712 to 1.24) P = 0.6647]. CONCLUSION: To our knowledge, this is one of the first large studies to describe the epidemiology of CRC in chronic alcoholic, viral, and autoimmune diseases. We found that the estimated prevalence of CRC to be the highest in the PBC group at 816/100,000 and that CRC in the PBC and AC groups had increased risk compared to non liver disease with ORs of 2.1 and 1.54 respectively.

Split-Dose Bowel Preparation Reduces the Need for Early Repeat Colonoscopy Without Improving Adenoma Detection Rate.

Split-dose bowel preparation is associated with improved mucosal visualization and patient tolerance, becoming a standard of care. However, quality measures data associated with this preparation are limited. At our academic tertiary-care facility, we aim to study the effect of changing from single- to split-dose preparation on colonoscopy quality measures. A retrospective cohort study with quality indicators was conducted using electronic medical record data. Cases were identified via ICD9 code V76.51, "Special screening for malignant neoplasms of colon." Single-dose preparation data was collected from 9/1/13 to 8/31/14. Split-dose preparation was implemented 11/2014, and data were collected from 1/1/15 to 8/31/15. A total of 1602 colonoscopies in the single-dose group and 1061 colonoscopies in the split-dose group were analyzed. The Boston Bowel Preparation Scale was significantly improved in the split-dose group 8.64±SD 1.25 versus 8.25±SD 1.61, p<0.001. There was no significant difference in adenoma detection rate 40.7% (95% CI 37.8-43.7%) versus 40.5% (95% CI 38.1-42.9%), p=0.92; however, the rate for recommending an early repeat examination due to an inadequate bowel preparation was significantly decreased to 3.9% (95% CI 2.7-5.0%) versus 8.9% (95% CI 1.52-2.97%), p<0.001. While split-dose preparation significantly improves overall bowel cleanliness, there is no significant adenoma detection rate improvement with high baseline rate, suggesting a threshold which may not improve with enhanced preparations. Split-dose preparation significantly reduces the frequency with which inadequate preparation prompts an early repeat examination, which has important clinical implications on performance, costs, and patient experience, providing further evidence supporting split-dose preparation use.

Danshen improves survival of patients with colon cancer and dihydroisotanshinone I inhibit the proliferation of colon cancer cells via apoptosis and skp2 signaling pathway

Ethnopharmacological relevanceDanshen (Salvia miltiorrhiza Bunge) is widely used in traditional Chinese medicine. However, it's definite clinical effect and mechanism on colon carcinoma is unclear. Aim of the studyTo test the hypothesis that the protective effect of danshen on colon cancer and discover the bioactive compounds through in vitro study. Materials and methodsWe conducted a nationwide cohort study by using population-based data from the Taiwan National Health Insurance Research Database (NHIRD). The study cohort comprised patients diagnosed with malignant neoplasm of colon (ICD-9-CM codes:153) in catastrophic illness database between January 1, 2000, and December 31, 2010. We used the Kaplan–Meier method to estimate lung cancer cumulative incidences. Next, human colon cancer cells (HCT 116 cells and HT29 cells) were used to investigate the effect of dihydroisotanshinone I (DT) on the proliferation and apoptosis of human colon cancer cells and the underlying mechanism through XTT assay and flow cytometry. The in vivo effect of DT treatment was investigated through a xenograft nude mouse model. ResultsIn our study, the in vivo protective effect of danshen in the different stage of colon cancer patients was validated through data from the National Health Insurance Research Database in Taiwan. In vitro, we found that dihydroisotanshinone I (DT), a bioactive compound present in danshen, can inhibit the proliferation of colon carcinoma cells, HCT 116 cells and HT-29 cells. Moreover, DT induced apoptosis of colorectal cancer cells. DT also repressed the protein expression of Skp2 (S-Phase Kinase Associated Protein 2) and the mRNA levels of its related gene, Snail1 (Zinc finger protein SNAI1) and RhoA (Ras homolog gene family, member A). In addition, DT also blocked the colon cancer cells recruitment ability of macrophage by decreasing CCL2 secretion in macrophages. DT treatment also significantly inhibited the final tumor volume in a xenograft nude mouse model. ConclusionDanshen has protective effects in colon cancer patients, which could be attributed to DT through blocking the proliferation of colon cancer cells through apoptosis.

The application of the minimally invasive technologies for the surgical treatment of the malignant colonic neoplasms

The application of the minimally invasive technologies for the surgical treatment of the malignant colonic neoplasms

Results of X-ray endovascular hemostasis in the treatment of malignant neoplasms of the colon and rectum, complicated by bleeding

There are present near results of X - ray endovascular hemostasis in patients suffering from malignant neoplasm of rectosigmoid colon and rectum complicated by bleeding. Patients were divided into basic group (n=16) where the X - ray-endovascular hemostasis was performed and control group (17 patients) where the conservative methods of hemostasis were used. For angiography there was used X-raysurgical complex “GE INNOVA 4100” (General Electric, USA) and ”SHIMADZU” (Shimadzu Corporation, Japan). After preformed hemostasis, the patients of the control and basic groups for rectal cancer were undergone to preoperative radiotherapy, then radical surgery, for rectosigmoid cancer - surgical treatment. The quantity, volume of donor blood products in the treatment ofpatients of the control group were used in a significantly greater extent (p

Risk analysis for the surgical treatment of colorectal cancer in elderly patients undergoing scheduled and urgent interventions.

Due to recorded growth both in living standards and latest researches in medicine, proportion of people in old age has significantly improved all over the world. Although old age people are several percent of the entire society, number of surgeries within the group does not exceed 40%. Also risk of malignant neoplasms among old age people, significantly grows. Malignant neoplasm of colon appears to be most visible problem in group of people in age over 75 years old. The aim of the study was a retrospective analysis of results in treatment of the sick over 75 years old, suffering from Malignant neoplasm of colon. Therapy was performed in the I Unit of General Surgery and Surgical Oncology in Provinical Hospital in Jelenia Góra. Subject to analysis were 63 patients that went under operations in years from 2006 to 2010 due to the colorectal cancer, who have been divided now into two groups. First group included 49 patients treated as per schedule, and the second stood for 14, who required urgent treatment. Reference group has involved 20 younger patients, treated in urgent and scheduled courses, due to the colon cancer. There are no contradictions to emergencies and scheduled surgeries for patients in advanced years, suffering from colon cancer. Complications after colon cancer emergencies are far more frequent than in case of scheduled surgeries. Death rates among patients over 75 years old are far more frequent after emergencies than after scheduled surgeries. Concomitant diseases occur the same frequent during emergenices as during scheduled operations. During emergencies, it was left side of the colon that occured to be infected with cancer more frequent. There is no significant diversity in hospitalization time frames after emergencies and scheduled surgeries. Dangerous surgical complications within group of older patients, those after emergencies and scheduled surgeries too, are far more frequent in comparison to the reference group.

Outcomes and Predictors of Mortality and Stoma Formation in Surgical Management of Colonoscopic Perforations

To perform a retrospective review of all patients with colonoscopic perforations managed in hospitals within the Eastern New Territories region of Hong Kong and to determine the predictors of mortality and stoma formation in patients with colonoscopic perforations. Retrospective computer-based review. Multicenter (1 university teaching hospital and 2 district hospitals). We reviewed the outcomes of patients with colonoscopic perforations surgically managed between January 1, 1998, and December 31, 2005. Predictors of mortality and stoma formation were identified with multivariable analysis. Mortality and stoma rates and their predictors. A total of 37,971 colonoscopies were performed during the study period, and 43 colonoscopic perforations were identified. The overall perforation rate was 0.113% and represented a decreasing trend. There was no significant difference in the perforation rate between gastroenterologists (0.148%) and surgeons (0.091%) (P = .15). Perforations that occurred during diagnostic colonoscopies were significantly larger than those that occurred during therapeutic colonoscopies (P = .04), and the patients presented earlier (P = .02). Surgical intervention was performed in 39 patients. The overall morbidity and mortality rate was 48.7% and 25.6%, respectively. The stoma rate was 38.5%. The predictors of stoma formation include moderate to severe peritoneal contamination and the presence of malignant colonic neoplasms (P = .01 and P = .008, respectively). The predictors of mortality include American Society of Anesthesiologists class 3 or higher and antiplatelet therapy (P = .009 and P = .001, respectively). Colonoscopic perforations were in a decreasing trend. Patients with predictors of mortality should not be treated conservatively. Other options of large bowel investigations should be considered in high-risk patients when the potential diagnostic yield is low.

'Avoidable' mortality among immigrants in Sweden.

The concept of studying 'avoidable' mortality as an indicator of the outcome of health care has been applied mainly in studies of time-trends and geographical and socio-economic variation. In this study, indicators of 'avoidable' mortality among immigrants in Sweden have been studied. Comparisons of death rates among immigrants and those born in Sweden were made using a linkage of the Population Census and the Cause of Death Register, nationwide sources. For a group of health policy indicators, such as liver cirrhosis and malignant neoplasms of the trachea, bronchus and lung, death rates were about 40-100% higher among immigrants from other Nordic countries, Yugoslavia and Eastern Europe than among the Swedish born population. For causes of death considered amenable to medical care intervention there were, however, small differences. For some conditions, such as cerebrovascular disease, malignant neoplasms of colon and rectum, chronic bronchitis and emphysema, high death rates were found among immigrants from other Nordic countries. For immigrants from other countries, there were no high death rates based on medical care indicators when compared to the Swedish-born population. There were few indications of inequity reflected in the mortality outcome of medical care. The variation found in death rates from health policy indicators may reflect differences in smoking and alcohol habits.

Rates of growth of human neoplasms: Part II.

Part I of this study [Spratt JS, Meyer JS, Spratt JA: J Surg Oncol 60:137-146, 1995] reviewed the early reports of investigators, predominantly mathematical biologists and statisticians considering the mathematical laws that would describe the growth of a neoplasm. Included were cytokinetic measurements of the mitotic index, thymidine labeling index, bromodeoxy-uridine labeling index, and the relation of these indices to the potential tumor volume doubling time. The actual doubling time of benign and malignant colonic neoplasms were reported. This second part provides the cumulative observations on the actual doubling times of pulmonary metastases, primary pulmonary cancers, skeletal sarcomas, melanomas, a chemodectoma, tumors of maxillary antrum, testicular cancers, prostate cancer, and the relation between the accumulation of multiple primary cancers and growth rates. The most complete data set is for breast cancer concluding that the cancer growth curve is a decelerating curve with great natural variance. Understanding of the rates of growth of human cancers is essential for understanding the spectrum of cancer behavior observed clinically.

Rates of growth of human solid neoplasms: Part I.

The purpose of this article is to consolidate data collected from a variety of sources that have permitted calculations of the rates of growth of human neoplasms. These sources include Fischel State Cancer Hospital (Columbia, MO); Mallinckrodt Institute of Radiology, (St. Louis, MO); Roentgen Diagnostic Institute, Allmanna Sjukhuset (Malmo, Sweden); University of Louisville (Louisville, Kentucky); University of Heidelberg (Heidelberg, Germany); and St. Luke's Hospital (St. Louis, MO). Included in the data are laboratory measurements of cell replication rates. All gross measurements were made either on imaging studies or with a centimeter scale for surface or palpable neoplasms. Data have been reported for breast and pulmonary cancers and metastases of many types, melanomas, skeletal sarcomas, benign and malignant colonic neoplasms, and isolated cases of less frequent neoplasms. Related cytokinetic measurements by tritriated thymidine labelling, bromodeoxyuridine labelling, S-phase fraction from DNA flow cytometric analysis, and mitotic indices are discussed. The various mathematical formulae applicable to the analysis of the collected data and the determination of rates and patterns of growth are included. Also considered are the clinical implications of these data and the importance of ever better knowledge on the cytokinetics of human cancer. Prior studies on the evolution of insight into this field are cited and discussed. The authors conclude that a more accurate quantification of the growth rates of human cancer is essential for understanding the biological variance of human cancers seen clinically.

Laparoscopically assisted subtotal colectomy.

A technique for laparoscopic total resection of the colon performed in six patients is reported. The diseased colon was separated from the mesocolon and the greater omentum by electrocoagulation and sharp dissection. The mesenteric vessels were divided using an Endo GIA stapling device (AutoSuture, France). The whole colon was removed after transection of the rectum and extraction through a right minilaparotomy. A primary stapled end-to-side ileorectal anastomosis was performed through the anus under laparoscopic guidance. This technique can be applied to cases involving a variety of benign lesions of the entire bowel or multifocal small malignant colonic neoplasms with a decrease in patient morbidity and shorter inpatient period.

Altered methylation of versican proteoglycan gene in human colon carcinoma

We show for the first time that DNA isolated from human colon carcinoma tissue exhibits a selective hypomethylation of versican gene, which encodes a large chondroitin sulfate proteoglycan. The degree of methylation of CpG sequences of versican gene locus, as determined by isoschizomeric endonucleases and Southern hybridization, is about three times lower than that found in either normal colon or ulcerative colitis tissues. Hypomethylation can be observed in both benign and malignant colonic neoplasms; however, there is no correlation with increased expression since versican mRNA levels do not significantly vary between normal and neoplastic tissues. We further show that versican gene locus from malignant tissue, but not from normal or ulcerative colitis tissues, contains Hind III hypersensitive sites which also comprise hypomethylated CpG sequences. Analysis of versican methylation status in colon carcinoma cells and benign mesenchymal cells derived from human colon suggests that the changes observed in vivo derive from demethylating events involving host stromal cells rather than tumor cells themselves. These findings demonstrate that changes in versican gene methylation are specific for colonic neoplasms, that these changes may precede malignant transformation, and that inflammation and tissue remodelling alone are not enough to generate these changes in proteoglycan gene methylation and nuclease hypersensitivity.

Adenocarcinoma of the appendix.

Patients presenting with adenocarcinoma of the vermiform appendix at the Royal Preston and Chorley District General Hospitals were reviewed for the 15 year period 1972-1986. Eleven cases were identified, representing a rate of 1 in 956 for all appendicectomies performed. A third of the cases presented as acute appendicitis. However, of 8 patients who initially had an appendicectomy, only 4 subsequently underwent further surgery (right hemicolectomy). One patient died of recurrent disease. Five of the patients presenting were under 60 years of age. During the same period, the total number of appendicectomies performed annually declined by 50%. The study highlights the need to subject all appendicectomy specimens to histological examination, and that the disease presents in a younger age group than commonly seen for malignant colonic neoplasms.

Distribution of histocompatibility and leucocyte differentiation antigens in normal human colon and in benign and malignant colonic neoplasms.

Monoclonal antibodies (McAbs) directed against the framework determinants of Class I and Class II products of the major histocompatibility complex (MHC) and against leucocyte differentiation antigens were used in an indirect immunoperoxidase technique to study their expression in normal, benign (adenomatous polyps) and malignant disease of the colon. Class I products (detected by the McAb 2A1) were strongly expressed on all cell types in normal and benign tissues but some carcinomas exhibited a heterogenous pattern of epithelial cell staining and 4/15 were completely negative. Class II products (detected by TDR31.1) were strongly expressed on cells (mainly B lymphocytes) within the lamina propria. In carcinomas TDR31.1 staining was mainly interstitial, but in 2/15, DR + epithelial cells were also detected. In normal and benign tissues, leucocytes (reactive with 2D1) found predominantly in the lamina propria, comprised T cells mainly of the helper/inducer (OKT4) subset, DR + cells in approx. equivalent proportion and a few OKM1+ cells mostly of macrophage morphology. Occasional intraepithelial lymphocytes were of cytotoxic/suppressor (OKT8) phenotype. In malignant neoplasms, there was wide inter and intra-tumour variation in the proportion of leucocytes which were heterogeneous with respect to cell type and confined mainly to the stroma. T cells were consistently predominant, but B cells and macrophages were also present. Two neoplasms showed unequivocal evidence of a shift (relative to peripheral blood) in favour of the OKT8+ subset, but in the majority of tumours OKT4+; and OKT8+ cells were present in roughly similar proportions. Natural killer cells (monitored with Leu7, HNK1) were virtually undetectable in both normal and malignant tissues. There were no apparent correlations between the extent and type of leucocyte infiltration, tumour differentiation or expression of MHC products. Some implications for the extrapolation of in vitro data on leucocyte function to the in vivo situation are discussed.

Benign and Malignant Neoplasms of Colon and Rectum: Diagnosis and Management

The diagnosis and basic principles of surgery for tumors of the colon and rectum are described. Results of surgical procedures, postoperative care, and complications are also highlighted.