Surgery For Primary Colorectal Cancer Research Articles

Palliative excisional surgery for primary colorectal cancer in patients with incurable metastatic disease. Is there a survival benefit? A systematic review

Patients with stage IV colorectal cancer with unresectable metastases can either receive chemotherapy or palliative resection of the primary lesion. In the absence of any randomized data the choice of initial treatment in stage IV colorectal cancer is not based on firm evidence. A search of MEDLINE, Pubmed, Embase and the Cochrane Library database was performed from 1980 to 2010 for studies comparing palliative resection in stage IV colorectal cancer with other treatment modalities. Audits and observational studies were excluded. Median survival was the primary outcome measure. The morbidity and mortality of surgical and nonsurgical treatments were compared. Twenty-one studies (no randomized controlled trials) were identified. Most demonstrated a survival benefit for patients who underwent palliative resection. Multivariate analysis indicates that tumour burden and performance status are both major independent prognostic variables. Selection bias, incomplete follow up and nonstandardized reporting of complications make the data difficult to interpret. The studies indicate that there may be a survival benefit for primary resection of colorectal cancer in stage IV disease. The findings suggest that resection of the primary tumour should be based on tumour burden and performance status rather than on the presence or absence of symptoms alone.

B-cell lymphoma 2 and β-catenin expression in colorectal cancer and their prognostic role following surgery.

The prognosis of colorectal cancer depends on the stage of the disease. However, even within the same stage there may be different outcomes in terms of recurrence and survival. Therefore, it is clear that as well as pathological stage, novel biomarkers that are capable of improving risk stratification and therapeutic decision-making are required. The present study aimed to evaluate the potential roles of two previously proposed biomarkers of tumour status: B-cell lymphoma 2 (Bcl-2) and β-catenin. A total of 412 patients undergoing surgery for primary colorectal cancer were studied. Tumour specimens of the patients were collected, fixed and processed for immunohistochemical detection of Bcl-2 and β-catenin. The data were then analyzed in relation to disease-free survival and overall survival. Pathological stage was the only variable that was significantly correlated with both disease-free and overall survival. The expression levels of neither Bcl-2 nor β-catenin were able to accurately predict prognosis. However, there was a clear association between nuclear β-catenin expression levels and disease-free survival in the three tumour stages. There was an increased hazard ratio in stage I and II nuclear β-catenin positive tumours, whereas there was a marked decrease in risk in stage III positive tumours. A similar effect was also observed with regards to overall survival, however this finding was not significant. The results of the present study suggest that conventional pathological tumour staging is the only accurate prognostic method. Neither Bcl-2 or β-catenin were shown to be useful biomarkers for the prognosis of colorectal cancer. However, the heterogeneous behaviour of nuclear β-catenin expression in the various tumour stages may indicate a possible role in predicting the response of patients to chemotherapy. Therefore, nuclear β-catenin expression may be a biomarker for the prediction of improved responses to chemotherapy.

Polyp surveillance after surgery for colorectal cancer

Although it is known that those patients who have developed colorectal cancer (CRC) are at a higher risk to develop metachronous adenoma or CRC, no study has been performed to analyze the relationship between the risk factors and the time course for the formation of postoperative adenoma using survival analysis. One hundred seventy-six patients with CRC,who had received surgical resection, were endoscopically followed-up to detect the development of metachronous adenoma or adenocarcinoama. The association between the risk factors such as age, synchronous adenomas with index CRC or other clinicopathological variables and the formation of postoperative adenoma was assessed using the logrank test and the Cox proportional hazard model. Age over 60, synchronous lesions at the time of surgery for primary CRCs and presence of diabetes mellitus(DM) as the associated disease were positively related to the formation of postoperative adenoma. Among those patients with the three risk factors, only 27.8% remained adenoma-free during 5 years after operation, whereas in the group without any risk factor, it was 90.4%. From our data, age over 60, synchronous adenomas or CRCs and DM were the potential risk factors for the postoperative formation of adenoma or CRC, and they should be taken into consideration when defining the appropriate interval of postoperative colonoscopy.

Simultaneous surgery for primary colorectal cancer and metastatic lesions?

Approximately 20–25% of patients with colorectal cancer present with liver metastases at the time of diagnosis. Traditionally, resection of the primary tumor has been advocated in order to prevent complications of the primary tumor colorectal cancer in patients with synchronous liver metastases. The published data concerning long-term prognosis in this group of patients are discordant. Although some of the reports show survival benefits from resection of the primary tumor, these studies are retrospective with small number of patients and using single drug chemotherapy. For patients with resectable liver metastases, new studies indicate that progression-free survival is best in patients receiving perioperative chemotherapy. In patients with synchronous nonresectable liver metastases and colorectal cancer, there is no published prospective randomized study comparing initial surgery of the primary tumor with neoadjuvant chemotherapy. However, recent publications show that in patients receiving chemotherapy based on oxaliplatin or irinotecan combined with targeted treatments, the complications associated with the primary tumor are less than 10%. The conclusion should be that today prophylactic surgery of asymptomatic primary colorectal cancer in patients with liver metastases cannot be recommended.

Does T3 Subdivision Correlate with Nodal or Distant Metastasis in Colorectal Cancer?

PurposeWe analyzed the clinical data of T3 colorectal cancer patients to assess whether T3 subdivision correlates with node (N) or metastasis (M) staging and stage-independent factors.MethodsFive hundred fifty-five patients who underwent surgery for primary colorectal cancer from January 2003 to December 2009 were analyzed for T3 subdivision. T3 subdivision was determined by the depth of invasion beyond the outer border of the proper muscle (T3a, <1 mm; T3b, 1 to 5 mm; T3c, >5 to 15 mm; T3d, >15 mm). We investigated the correlation between T3 subdivision and N, M staging and stage-independent prognostic factors including angiolymphatic invasion (ALI), venous invasion (VI) and perineural invasion (PNI).ResultsThe tumors of the 555 patients were subclassified as T3a in 86 patients (15.5%), T3b in 209 patients (37.7%), T3c in 210 patients (37.8%) and T3d in 50 patients (9.0%). The nodal metastasis rates were 39.5% for T3a, 56.5% for T3b, 75.7% for T3c and 74.0% for T3d. The distant metastasis rates were 7.0% for T3a 9.1% for T3b, 27.1% for T3c and 40.0% for T3d. Both N and M staging correlated with T3 subdivision (Spearman's rho = 0.288, 0.276, respectively; P < 0.001). Other stage-independent prognostic factors correlated well with T3 subdivision (Spearman's rho = 0.250, P < 0.001 for ALI; rho = 0.146, P < 0.001 for VI; rho = 0.271, P < 0.001 for PNI).ConclusionSubdivision of T3 colorectal cancer correlates with nodal and metastasis staging. Moreover, it correlates with other prognostic factors for colorectal cancer.

Rate of Missed Polyps on Colonoscopy When Compared to Surgically Resected Specimens

Purpose: To compare the rate of polyps and lesions found at colonoscopy in comparison to surgically resected specimens. Methods: This retrospective analysis used the Saskatchewan Cancer Registry to identify patients who underwent resectional surgery for primary colorectal cancer and had colonoscopy within 3 months prior to the date of surgery. Synchronous colonic polyps and cancers were identified from the pathology report. Colonoscopy reports were then compared to the pathologic specimen to determine the missed polyp rate. Results: Analysis of pathologic specimens identified 97 synchronous lesions, 47 of which were missed at colonoscopy. Of the 47 missed polyps three were larger than 1cm including one colorectal cancer. Female gender was significantly associated with an increased rate of missed polyps (p<0.001). Location of cancer was weakly associated with missed polyps with more polyps being missed when the malignancy was located in the right colon (P=0.036). Presence of diverticulosis and endoscopist specialty did not affect the rate of missed polyps (p=0.48 & p=0.31 respectively). Because of inadequate reporting regarding quality of bowel preparation & patient tolerance for procedure we were unable to determine the effect these factors may have had on missed polyp rate. Conclusion: Colonoscopy is an effective tool to identify and obtain tissue diagnosis of polyps and colonic lesions; however, there is a considerable miss rate of lesions identified at colonoscopy when compared to pathologic specimens including clinically significant lesions. A prospective study is needed to address the risk factors that might significantly contribute to and affect the rate of missed polyps at colonoscopy and to determine why gender has a significantly different miss rate.

Antigen-Directed Cancer Surgery for Primary Colorectal Cancer: 15-Year Survival Analysis

Tumor-associated glycoprotein-72 (TAG-72) is a mucin-like high-molecular-weight glycosylated protein complex overexpressed by many adenocarcinomas. Antigen-directed cancer surgery using radiolabeled anti-TAG-72 murine monoclonal antibodies (muMAbs) has been previously investigated for colorectal cancer. Survival analysis of primary colorectal cancer patients with a minimum of 15-year follow-up after antigen-directed cancer surgery was performed to assess the impact of complete surgical resection of all detectable radiolabeled anti-TAG-72 muMAb. Survival analysis was performed on 92 patients (study group) with primary colorectal cancer (July 1990 to August 1995) treated with antigen-directed cancer surgery using (125)I-labeled anti-TAG-72 muMAb. The study group was subdivided into those with no detectable TAG-72 antigen-bearing tissues (TAG-72 negative, N=33) and those with persistent detectable TAG-72 antigen-bearing tissues (TAG-72 positive, N=59) at completion of surgery. Comparisons were made with a control group (546 patients) from the same time period. Study group and control group were demographically similar, as were TAG-72-negative subgroup and TAG-72-positive subgroup. TAG-72-negative subgroup had significantly improved median survival (8.8 versus 2.5 years; P=0.005) and time-dependent survival (45.4% versus 22.0% at 10 years; P=0.002 and 39.4% versus 20.3% at 15 years; P=0.003) compared with TAG-72-positive subgroup. TAG-72 positivity was as an independent predictor of long-term mortality risk, when controlled for pathologic stage of disease. Absence of detectable TAG-72 antigen within the surgical field at completion of antigen-directed cancer surgery for primary colorectal cancer is of significant prognostic value, conferring a long-term survival advantage to those in whom complete surgical removal of all tissues with detectable radiolabeled anti-TAG-72 muMAb was accomplished.

Outcome of surgical treatment of colorectal cancer in the elderly

The aim of this study is to compare the clinical features and the perioperative and long-term outcomes after primary surgery for colorectal cancer (CRC) in the elderly population with those observed in younger patients. All the patients over the age of 55 who underwent primary surgery for CRC in our clinic from 1988 to 2008 were included in this study and divided into two age groups: 55-75 and >75years considering the age of diagnosis. 914 consecutive patients were enrolled in the study (352>75years). In the elderly group, tumors were predominantly right sided, and the overall number of comorbidities was statistical more frequent. Elderly patients underwent emergency surgery more than the control group (p=0.0008). There were no significant differences between the two groups in terms of curative and palliative resections. The overall operative mortality rate was 5.9% in the study group compared with 2.1% in the control study (p=0.0033). The overall 3-year, 5-year and 10-year survival rates were, respectively, 37, 16.2 and 5.1% in the study group, when compared with 52.3, 35.1 and 24.7% in the control group (p=0.022, p=0.0001 and p=0.0001, respectively). More patients were lost during the follow-up in the elderly group (p=0.0003) and more deaths unrelated to cancer were found in the study group compared with the control group (p=0.0005). The cancer specific mortality was similar between the two groups. In conclusion, elderly patients that underwent major colorectal resection have an acceptable perioperative morbidity, mortality and survival rate when compared with younger patients. Age alone should not be considered a reason to deny surgery to these patients.

Trends in the treatment outcomes for advanced colorectal cancer: An analysis at a single community hospital in Japan

To evaluate the trends in the treatment outcomes for patients with colorectal cancer in Japan. We performed a retrospective analysis of patients undergoing surgery for primary colorectal cancer during a 16-year period (Group A [1992-2000, n = 258]; Group B [2001-2008, n = 258]) at Fukuoka City Hospital. Because no significant differences were found in the survival rates in stage 0, I, II, and III patients between the two groups, we concentrated on examining stage IV patients. The 3-year survival rate for stage IV patients in Group B (n = 26) was significantly higher than that in Group A (n = 31) (34.9% vs 3.9%, P < 0.05). The rate of curative resection for advanced liver metastases in Group B patients was also significantly higher than that of Group A patients (50.0% vs 13.3%, P < 0.05). As a result, the 2-year survival rate for the disease-free patients in Group B was significantly higher than that for the non-disease-free patients in Group B (46.0% vs 21.0%, P < 0.05). Group B had a greater proportion of patients receiving l-leucovorin/5-fluorouracil than Group A (8 patients vs none, P < 0.05). Recent advances in surgical innovations and the utilization of new chemotherapeutic agents may have led to significant improvements in the treatment outcomes for advanced colorectal cancer in Japan.

Tratamento do câncer colorretal em idosos extremos: relato de caso e revisão da literatura

Com o envelhecimento da população brasileira, cada vez mais o cirurgião colorretal se defrontará com pacientes chamados de idosos extremos, com idade superior a 75 ou 85 anos e apresentando diagnóstico de câncer colorretal (CaCR). A conduta é controversa diante desses casos. Este trabalho relata a abordagem de uma paciente de 97 anos com diagnóstico de adenocarcinoma de reto alto e faz uma revisão da literatura sobre o assunto. Esta paciente foi submetida à retossigmoidectomia paliativa vídeo-assistida, com incisão suprapúbica transversa para confecção da anastomose colorretal primária e retirada do espécime cirúrgico. Foi incluída no programa de reabilitação multimodal pós-operatória (fast-trac) para cirurgia colorretal, apresentou boa evolução e recebeu alta hospitalar no terceiro dia de pós-operatório. O estudo anatomopatológico da peça mostrou tratar-se de adenocarcinoma moderadamente diferenciado, invasor até a muscular própria e metastático em 2 de 12 linfonodos dissecados. De acordo com a literatura, em pacientes selecionados com mais de 75 anos, a cirurgia colorretal eletiva para CaCR pode ser realizada com taxa de morbimortalidade semelhante àquela de pacientes jovens, obtendo-se sobrevidas geral e livre de doença favoráveis. Comorbidades não definem isoladamente o prognóstico e nem contraindicam o procedimento.

Short- and medium-term results of totally laparoscopic resection for colorectal liver metastases

Laparoscopic surgery for primary colorectal cancer is now commonplace but the uptake of laparoscopic surgery for colorectal liver metastasis (CRLM) has been slow, mainly owing to doubts regarding safety, feasibility and oncological efficiency. Prospectively collected data of all patients treated for CRLM between 2004 and 2009 were reviewed retrospectively. The database was analysed for operative details, hospital stay, postoperative results and medium-term survival. Over 5 years, 135 patients underwent liver surgery for CRLM. For laparoscopic procedures, the median duration of operation was 220 min and median blood loss was 363 ml; a mean tumour-free resection margin of 17.0 mm was achieved (more than 1 cm in 76 per cent), and no port-site metastasis or surgical-site recurrence was observed. The procedure was converted to open surgery in six patients (two for bleeding). Overall survival for the laparoscopic group approached 90 per cent with median follow-up of 22 months. In this series totally laparoscopic CRLM resection had good short- and medium-term results in terms of mortality, morbidity, resection margins, local recurrence or port-site metastasis, and survival. Compared with contemporaneous open experience, the laparoscopic approach was safe and effective in a highly selected consecutive series.

Contrast-enhanced intraoperative ultrasound improves detection of liver metastases during surgery for primary colorectal cancer

BackgroundComputed tomography (CT) is the most common staging investigation in colorectal cancer (CRC). Up to 25% of patients are found to have previously undetected hepatic lesions when intraoperative ultrasound (IOUS) of the liver is used during CRC resection. We aimed to assess the ability of IOUS to detect additional liver lesions/metastases at primary colorectal resection, and to evaluate whether contrast-enhanced IOUS (CE-IOUS) improves the detection and characterization of hepatic lesions. MethodsWe performed a single-centre, prospective pilot study. At CRC resection, patients underwent IOUS of the liver. Contrast-enhanced IOUS of the liver was undertaken using i.v. sulphur hexafluoride micro-bubbles (SonoVue®, 4.8ml). Findings of CT, non-enhanced IOUS and CE-IOUS were compared. Changes in staging or management were noted. Additional lesions were corroborated with iron oxide magnetic resonance imaging (MRI). ResultsAmong 21 patients, IOUS demonstrated additional lesions in seven (33%). Contrast altered the diagnosis of non-enhanced IOUS in four (20%) and changed the management strategy in three (14%) patients. Thus, IOUS in combination with the contrast agent altered the intraoperative or postoperative management plan in four patients. ConclusionsIn the first study of its kind, early results suggest that the ability of IOUS to detect additional metastases is improved by CE-IOUS, and that this may impact on surgical staging and management.

Timely access and quality of care in colorectal cancer: are they related?

Colorectal cancer patients want both timely access and high-quality care. The objective of this study was to explore relationships between quality indicators and access time intervals specific to colorectal cancer patients. Prospective consecutive cohort study. Single health district. Between February 2002 and February 2004, all patients undergoing non-emergent surgery for primary colorectal cancer were enrolled. A standardized method was used to collect clinicodemographic, diagnostic and treatment event data. Associations between accepted colorectal cancer-specific quality indicators and benchmarked access time intervals for diagnosis, surgery and adjuvant therapy were examined using multivariate logistic regression, controlling for clinicodemographic factors. Among the 392 patients in the study cohort, 9.9% were diagnosed on screening examination, 53.1% underwent preoperative staging imaging and 74.5% underwent full preoperative colonic examination. On multivariate logistic regression, patients presenting via screening were more likely to move from presentation to diagnosis within the 4-week benchmark for this access time interval, compared with symptomatic patients (RR 8.1, P < 0.001). The absence of preoperative staging imaging was associated with achievement of the 4-week benchmark for the access time interval from diagnosis to surgery (RR 2.5, P < 0.001). Similarly, an absence of complete preoperative colonic examination was associated with achievement of the 8-week benchmark for the access time interval from surgery to adjuvant therapy (RR 6.6, P = 0.008). Although several associations between quality indicators and benchmarked access time intervals for colorectal cancer patients were identified, the relationship between quality and access is complex and far from universal. It is therefore clear that quality care and timely access are not synonymous, and that both must be studied to improve colorectal cancer care.

The Outcome of Surgery for Colorectal Cancer in Very Elderly Patients

The Outcome of Surgery for Colorectal Cancer in Very Elderly Patients

The need for a revised staging system of metastatic (M) colorectal cancer (CRC): Evidence from a national perspective on survival following surgically treated (HPX) liver metastases

4099 Background: AJCC V.6 (2002) places all patients with MCRC beyond the lymph node basin of the primary tumor in a homogenous Stage 4. Patients with inoperable hepatic MCRC can be made operable with curative intent with chemotherapy yet remaining in Stage 4. Via the linkage of routine health datasets across England this population-based study sought to determine the impact of HPX for MCRC on stage-matched survival at initial presentation. Methods: All patients between 1998–2001 undergoing surgery for CRC in England were identified via the national-linked cancer registry HES dataset. All care episodes in the 3 years following initial colorectal surgery were examined to determine the frequency of subsequent HPX. Kaplan-Meier curves and log- rank tests were used to examine 5-year survival following HPX for MCRC compared to all Stage 3 and Stage 4 at presentation. Survival was calculated from the date of resection of each patient's primary colorectal tumor. Results: 68,307 individuals were identified as undergoing surgery for primary CRC over the study period. 20,298 were Stage 3 at presentation. 1,483 (2.2%) subsequently underwent HPX &lt;3 years of their colorectal operation. 55 patients died within 30 days of HPX (mortality rate: 3.7%). Crude 5-year survival of patients who underwent HPX was 41.6% (95%CI 39.0–44.1%) from time of initial colectomy. This survival rate was significantly better than that for both Stage 3 (38.6% (95%CI 37.9%-39.2%, P&lt;0.01) and 4 (6.1% 95%CI 5.3–6.9%, P&lt;0.01) overall. Conclusions: 5-year survival following HPX for MCRC is better than that seen overall for all Stage 3 patients (with MCRC confined to the regional draining lymph node basin) following initial colectomy. Our data support the hypothesis that all MCRC that is potentially resectable with curative intent should be stratified within Stage 3, and Stage 4 should only contain those MCRC patients for whom surgery is not an option. If further evidence emerges to support this theory then a revision of the current staging system will be required. [Table: see text]

Titration of serum CEA, p53 antibodies and CEA-IgM complexes in patients with colorectal cancer

The early detection of colorectal cancer is key to the improvement of patient survival. Although fecal occult blood testing and carcinoembryonic antigen (CEA) in serum are widely used as non-invasive screening methods, they have limited sensitivity. Forty-five patients who underwent surgery for primary colorectal cancer were enrolled in this study. Sixteen (36%) were determined to have Stage I tumors, 15 (33%) Stage II tumors and 14 (31%) Stage III tumors. Serum samples from a non-colorectal cancer group of 22 patients with no tumors were analyzed as a control. In each serum sample, CEA, p53 antibodies and CEA-IgM complexes were measured. The combination of these three tests had an overall sensitivity of 53% (24/45), and revealed 31% (5/16) of the tumors to be in Stage I, 53% (8/15) to be in Stage II and 79% (11/14) to be in Stage III, while the false positive rate was 18% (4/22). The combined use of these three tests in serum is potentially an effective screening method for the detection of colorectal cancer, at even the early stages of the disease.

Adrenalectomy for solitary adrenal metastasis from colorectal cancer: A case report

BackgroundPatients with adrenal metastasis from various primary tumours are regarded as cases of diffuse systemic spread and considered unsuitable for surgical resection. We herein report an operable case of heterochronic adrenal metastasis from colorectal carcinoma in a 63-year-old woman.Case presentationSixteen months after low anterior resection for the primary tumour, left lower pneumonectomy was performed for a solitary lung metastasis. Four months later a right adrenal metastasis was detected by magnetic resonance imaging (MRI), as sole evidence of metastatic disease. A right adrenalectomy was performed. The histopathological examination revealed adenocarcinoma compatible with the colorectal carcinoma resected 19 months earlier. The patient received adjuvant chemotherapy after each operation and is alive and free of disease 21 months after the adrenalectomy.ConclusionThe possibility of adrenal metastasis should be considered in the follow-up of patients after primary surgery for colorectal cancer, even though other sites are the main metastatic sites. Although the prognosis of adrenal metastasis from colorectal cancer is poor, we suggest that patients with solitary adrenal metastasis may benefit from complete removal of it.

Clinical Characteristics of Multiple Primary Colorectal Cancers

Although multiple primary colorectal cancer has been recognized as a significant clinical entity, its clinical and pathological features and its prognosis are still controversial. The purpose of this study was to clarify clinical and pathological features of multiple primary colorectal cancer. Among 1669 patients who underwent surgery for primary colorectal cancer from January 1997 to June 2005, 26 patients (1.6%) with multiple primary colorectal cancer were identified. We reviewed clinical characteristics including diagnostic interval, lesions, operating methods, and TNM stage, and we defined the index lesion as the most advanced lesion among the synchronous lesions. For the purposes of the study, the colon and rectum were classified into three segments. The right-side colon included the appendix, cecum, ascending colon, hepatic flexure, and transverse colon, and the left-side colon included the splenic flexure, descending colon, and sigmoid colon. Of the 26 patients with multiple primary colorectal cancers, nineteen patients were male and seven patients were female, with a mean age of 61.5 years. Nineteen patients had synchronous colorectal cancers and seven patients had metachronous colorectal cancers. In the metachronous cases, the mean diagnostic interval was 36.8 months. The site of the first lesion in metachronous colorectal cancers was the right colon in five cases (71.4%) and the left colon in two cases (28.6%), and the site of the second lesion was the rectum in six cases (55.5%), the right colon in three cases (33.3%), and the left colon in one case. The TNM stage of the second lesions in the metachronous colorectal cancers was stage II in four cases (57.1%), stage III in one case (14.3%), and stage IV in one case (14.3%). For the synchronous colorectal cancers, the operation methods were single-segment resection combined with endoscopic mucosal resection in five cases (26.3%), single-segment resection alone in six cases, two-segment resection in six cases, and total colectomy in two cases. In metachronous colorectal cancers, the secondary lesions were later-stage cancer. Therefore, careful postoperative follow-up is necessary for patients who have undergone surgery for colorectal cancers. Further study of therapeutic modalities is important for synchronous colorectal cancers.

Conservative Management of Adhesive Small Bowel Obstructions in Patients Previously Operated on for Primary Colorectal Cancer

This study aimed to determine the incidence of adhesive small bowel obstruction (SBO) after primary colorectal cancer surgery and the outcomes of conservative management using gastrointestinal tubes in such cases. Between October 2000 and December 2005, 2,586 primary colorectal cancer patients underwent consecutive operations and were followed up completely for a median of 38 months. During the follow-up periods, 119 patients with 130 consecutive cases of adhesive SBO underwent conservative management using nasogastric tubes and long intestinal tubes. The overall adhesive SBO rate was 5.0% in 38 months of follow-up, and the observed incidence rate was 0.0013 per patient-month. Of the 130 cases, 104 cases (80%) were successfully treated by conservative management, and the symptoms of SBO were resolved by the sixth day (range 1 to 22). Twenty-six cases (20%) underwent surgery because of lack of clinical improvement (17) or signs of strangulation (9). The high success rate indicates that initial conservative management with intestinal decompression using gastrointestinal tubes is recommended for patients with adhesive SBO after primary colorectal cancer surgery.

Free circulating DNA as possible tumour marker in colorectal cancer

The purpose of this study is to evaluate the sensitivity and specificity of free circulating DNA (CFDNA) as a potential tumour marker in patients suffering from colorectal cancer (CRC). The quantification of plasma DNA was determined through the use of real-time quantitative polymerase chain reaction (PCR) amplification of the RNAse P gene. We studied patients undergoing surgery for primary CRC, at different stages of disease and a cohort of comparable healthy donors. Data were statistically analysed using Student's t-test. The mean DNA index of the tumour samples was 4771 ng/ml, about 50 times higher in comparison with healthy donors (mean value 0.85 ng/ml). In contrast the carcinoembryonic antigen (CEA) value of these patients was altered in only 47% of cases. This study shows that circulating free DNA levels in plasma of patients with CRC are significantly higher compared to healthy subjects, and suggest a new, non-invasive, approach for colon cancer detection and to identify high risk individuals for CRC screening.