Rectum Colon Research Articles

Peroxisome proliferators-activated receptor gamma polymorphisms and colorectal cancer risk.

Several studies evaluated the association between peroxisome proliferators-activated receptor gamma (PPARγ) Pro12Ala (rs1801282), and His477His (rs3856806) polymorphisms and the risk of colorectal cancer (CRC). However, the results were not stable. We searched databases containing PubMed and EMBASE. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the strength of the associations. A significantly decreased CRC risk was found for PPARγ Pro12Ala polymorphism (OR = 0.88, 95% CI 0.83-0.94, P < 0.0001). In the subgroup analysis by race, a significantly decreased risk was found in the Caucasian population (OR = 0.89, 95% CI 0.83-0.95, P = 0.0003) but not in Asian population (OR = 0.76, 95% CI 0.57-1.02, P = 0.07). In the subgroup analysis by CRC location, significantly decreased risks were found in rectal cancer (OR = 0.88, 95% CI 0.77-1.00, P = 0.05) and colon cancer (OR = 0.82, 95% CI 0.73-0.92, P = 0.0008). In addition, a significantly decreased CRC risk was also detected for PPARγ His477His polymorphism (OR = 0.66, 95% CI 0.44-1.00, P = 0.05). In the subgroup analysis by race, a significantly decreased risk was found in the Caucasian population (OR = 0.43, 95% CI 0.26-0.69, P = 0.0006) but not in Asian population (OR = 0.95, 95% CI 0.73-1.25, P = 0.72). PPARγ Pro12Ala and His477His polymorphisms might be associated with susceptibility of CRC.

Sa1051 FREQUENCY OF RIGHT-SIDED PRECANCEROUS POLYPS REMAINS HIGH DESPITE ABSENCE OF POLYPS IN THE LEFT COLON

Flexible sigmoidoscopy has become an important tool for colorectal cancer screening but unfortunately lacks visualization of more proximal colonic lesions. Colorectal lesions found during flexible sigmoidoscopy may warrant further proximal colonic lesion investigation. There however is limited research on the frequency of right-sided precancerous polyps in the absence of polyps in the left colon. Assess the likelihood of finding a polyp, adenoma or sessile serrated adenoma/polyp (SSA/P) in the right colon when no polyps are seen within the left colon. Colonoscopy quality data was collected prospectively at our single tertiary referral center from June 2012 to Nov 2017 using Qualoscopy (Docbot, Inc.). We included all colonoscopies for patients of all ages. We compared detection rates of polyps (PDR), adenomas (ADR) and sessile serrated adenomas/polyps (SSADR/SSPDR) with the left colon (rectum to splenic flexure) and right colon (transverse colon to cecum). 2777 colonoscopies met our inclusion criteria. 49% of patients were male and 51% were female. Mean age was 58.1 years, average Boston prep scores was 7.9 out of 10 and average cecal intubation rate was 98%. Table 1 shows the detection rates and mean number of polyps, adenomas, SSAs and SSPs within the right colon. The ‘Independent of Left Colon Findings’ row shows right colon detection rates that are independent of lesions within the left colon. The ‘No Polyps’ row shows these same values when no polyp was found within the left colon. The ‘Adenoma’ row shows these same values when at least 1 adenoma was found in the left colon. The ‘Sessile Serrated Polyp’ row shows these same values when at least 1 SSA or 1 hyperplastic polyp was found in the left colon. The PDR, ADR and SSADR in the right colon when no polyp was found within the left colon were, 0.33%, 0.22% and 0.058%, respectively. Table 1 also shows the rates of PDR, ADR and SSADR/P are higher when an adenoma or SSP was found within the left colon. Our data demonstrate a higher detection rate of polyps, adenomas and SSA/Ps in the right colon if an adenoma or SSP is found within the left colon. More importantly and interestingly, our data also reveals the absence of polyps in the left colon does not reliably predict the rate of precancerous polyps in the right colon. High PDR, ADR and SSADR within the right colon despite an absence of polyps in the left colon suggest that limited colonoscopies such as flexible sigmoidoscopies may miss many significant precancerous lesions more proximally.Tabled 1Detection Rates within the Right ColonRIGHT COLONLEFT COLONColonoscopiesPDRADRSSADRSSPDRMean Polyps PPMean Adenomas PPMean SSAs PPMean SSPs PPIndependent of Left Colon Findings27770.440.290.08N/A2.201.941.51N/ANo Polyps17010.330.220.0580.630.380.075Adenoma5470.640.490.121.621.080.20Sessile Serrated Polyp5360.620.39N/A0.291.570.76N/A0.55PDR-polyp detection rate, ADR-adenoma detection rate, SSADR -sessile serrated adenoma detection rate, SSPDR – sessile serrated polyp detection rate (SSADR + hyperplastic polyp detection rate), PP - per procedure, SSA -sessile serrated adenoma, SSP – sessile serrated polyp Open table in a new tab PDR-polyp detection rate, ADR-adenoma detection rate, SSADR -sessile serrated adenoma detection rate, SSPDR – sessile serrated polyp detection rate (SSADR + hyperplastic polyp detection rate), PP - per procedure, SSA -sessile serrated adenoma, SSP – sessile serrated polyp

Clinical Etiology of Hypermetabolic Pelvic Lesions in Postoperative Positron Emission Tomography/Computed Tomography for Patients With Rectal and Sigmoid Cancer.

PurposeThe purpose of this study was to present various clinical etiologies of hypermetabolic pelvic lesions on postoperative positron emission tomography/computed tomography (PET/CT) images for patients with rectal and sigmoid cancer.MethodsPostoperative PET/CT images for patients with rectal and sigmoid cancer were retrospectively reviewed to identify hypermetabolic pelvic lesions. Positive findings were detected in 70 PET/CT images from 45 patients; 2 patients who were lost to follow-up were excluded. All PET findings were analyzed in comparison with contrast-enhanced CT.ResultsA total of 43 patients were classified into 2 groups: patients with a malignancy including local recurrence (n = 30) and patients with other benign lesions (n = 13). Malignant lesions such as a local recurrent tumor, peritoneal carcinomatosis, and incidental uterine malignancy, as well as various benign lesions such as an anastomotic sinus, fistula, abscess, reactive lymph node, and normal ovary, were observed.ConclusionPET/CT performed during postoperative surveillance of rectal and sigmoid colon cancer showed increased fluorodeoxyglucose uptake not only in local recurrence, but also in benign pelvic etiologies. Therefore, physicians need to be cautious about the broad clinical spectrum of hypermetabolic pelvic lesions when interpreting images.

Tumor characteristics and treatment in early-onset colorectal cancer.

566 Background: While overall incidence and mortality of colorectal cancer (CRC) has declined, incidence and mortality are increasing in those &lt; 50 years old (early-onset CRC). Our objective was to better understand early-onset CRC by comparing tumor characteristics and initial treatment type between early-onset and normal/late-onset CRC. Methods: We used health system and national tumor registries to identify patients diagnosed with adenocarcinoma of the colon or rectum from 2010-2014 at 6 US integrated health systems in the Patient Outcomes To Advance Learning (PORTAL) network. Tumor registry data included: age at diagnosis, stage, grade, anatomic site, histology, number of lymph nodes examined, and receipt of initial systemic therapy (chemotherapy or immunotherapy). Demographics and other patient characteristics were obtained from the EHR. We used logistic regression to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing the distribution of tumor characteristics and treatment patterns in early-onset ( &lt; 50 years old) vs. normal/late-onset CRC. Results: There were 1,424 early-onset and 10,810 normal/late onset CRC cases in our analyses. Compared to normal/late onset cases, patients with early-onset CRC were more likely to be Hispanic, obese, never smokers, and to have Charlson comorbidity scores &lt; 3. After adjustment for patient characteristics, compared to normal/late onset CRC, early-onset CRC was associated with more advanced stage disease (OR for stage 4 vs. stage 1 = 2.8, CI: 2.4-3.4), high grade histology (OR for poorly differentiated/undifferentiated vs. well/moderately differentiated = 1.2, CI: 1.1-1.5), signet ring histology (OR for signet ring vs. non-mucinous adenocarcinoma = 1.7, CI: 1.1, 2.6), and rectal (OR for rectum vs. cecum = 2.4, CI: 1.9-2.9) or left colon location (OR for left colon vs. cecum = 2.2, CI: 1.8-2.8). After adjustment for patient and tumor characteristics, early-onset patients were more likely than normal/late onset patients to have &gt; 12 lymph nodes examined (OR = 1.6, CI: 1.4-1.8) and to receive systemic therapy (OR = 2.8, CI: 2.4, 3.4). Conclusions: Early-onset CRC is associated with aggressive tumor characteristics, distal location, and systemic therapy use.

A Case of Ischemic Colitis of the Residual Colon after Rectal and Transverse Colon Cancer Surgery

症例は65歳女性，10年前に直腸癌Rs pT2N0M0 pStage Ⅰに対して低位前方切除術（D3郭清，両側側方郭清あり，左結腸動脈温存），受診３カ月前に肝彎曲部の横行結腸癌pT4N0M0 pStage Ⅱに対して結腸右半切除術（D3郭清，中結腸動脈左枝温存）を他院にて施行した手術既往がある．結腸右半切除術後から下痢と食思不振が出現し，前医で入退院を繰り返していたが，転居に伴い当科を紹介受診した．造影CTでは残結腸炎を認め，中結腸動脈左枝や左結腸動脈は同定できなかったが，残結腸から下腸間膜静脈へ環流する静脈はあり，血流は保たれていると考えられた．注腸造影検査では直腸吻合部より近位側の残結腸に，遠位側に優位な狭窄を認めた．残結腸の虚血性大腸炎と診断，数カ月間の保存的加療で改善がなく，低栄養状態を伴うことから，残結腸全摘術と回腸人工肛門造設術を施行した．術後は経過良好で，初診時1.7g/dlだったアルブミン値は術後11日目には2.7g/dlまで上昇し，栄養状態と共に浮腫も改善して，軽快退院となった．さらに，２カ月後には施設基準値の3.9g/dlまで改善を認めた．大腸癌術後に生じた虚血性大腸炎は報告例が少ない．今回われわれは２回の大腸癌手術後に生じた虚血性大腸炎の症例を経験したため，若干の文献的考察を加えて報告する．

Choice of surgical procedures and control of surgical risks in chronic constipation

Surgery, as one of the methods for the treatment of chronic constipation, is the final choice after the failure of non-surgical treatment with its specific particularity. The history of surgical treatment of chronic constipation is complex and tortuous. How to select operation among many kinds of surgery, and control risk is difficult for clinician. The choice of surgical procedure depends mainly on the patient's conditions, the objective examination basis and the experience of physician teams. Based on the previous reports and the team's experience, this paper discusses the choice of surgical treatment for the following types of chronic constipation: (1) Slow transit constipation: subtotal colorectal resection plus ileorectal anastomosis or ascending colon rectum anastomosis is widely used at present in the domestic, and its efficacy is quite good. (2) Outlet obstructive constipation: surgical treatment needs to be cautious with no consensus, and surgeons must follow the advice of "minimally invasive first" principle. (3) Mixed constipation: there is no clear and unified surgical treatment, while Jinling surgery is a promising way of operation. (4) Adult Hirschsprung's disease: surgery is the only treatment, and removing the stenosis segment, transitional segment and obvious expansion segment is the basic principle, and preventive ileostomy at the same time is also recommended. (5) Adult idiopathic megacolon: subtotal colectomy with ileorectal anastomosis or ascending colon rectum anastomosis is highly recommended. (6) Hypoganglionosis: it is rare, and no consensus has been reached in surgical treatment. How to select the proper timing and mode of operation, and how to control the operation risk are the contents that clinicians must master. With the development of laparoscopic surgical technology, minimally invasive surgery is becoming the main direction of constipation treatment.

Diabetes and risk of cancer incidence: results from a population-based cohort study in northern Italy

BackgroundAim of this study was to compare cancer incidence in populations with and without diabetes by cancer site. Furthermore, we aimed at comparing excess risk of cancer according to diabetes type, diabetes duration and treatment, the latter as regards Type 2 diabetes.MethodsBy use of the Reggio Emilia diabetes registry we classified the resident population aged 20–84 at December 31st 2009 into two groups: with and without diabetes. By linking with the cancer registry we calculated the 2010–2013 cancer incidence in both groups. The incidence rate ratios (IRR) by cancer site, type of diabetes, diabetes duration, and as concerns Type 2 diabetes, by treatment regimen were computed using Poisson regression model and non-diabetic group as reference.ResultsThe cohort included 383,799 subjects without diabetes and 23,358 with diabetes. During follow-up, we identified 1464 cancer cases in subjects with diabetes and 9858 in the remaining population. Overall cancer incidence was higher in subjects with diabetes than in those without diabetes (IRR = 1.22, 95%CI 1.15–1.29), with similar results focusing on subjects with at least 2-year diabetes duration. Cancer sites driving overall increased risk were liver, pancreas, Colon rectum, and bladder in both sexes, corpus uteri for females. There was also suggestion of an increased risk for kidney cancer in females and a decreased risk for prostate cancer. Excess risk was found in patients with Type 2 diabetes, more marked among insulin users, especially with combined therapy.We observed an increasing risk for diabetes duration up to 10 years from diagnosis (IRR = 1.44, 95%CI 1.29–1.61) and a subsequent decrease to moderate-higher risk (IRR = 1.15, 95%CI 1.04–1.30).ConclusionsOur study indicates that the strength of association depends on specific cancer site. Insulin, monotherapy or combined therapy, per se or as an indication of poor blood glucose control, in addition to diabetes duration, may play a role in the association of diabetes and cancer.

Protective measures in laparoscopic resection for upper or mid rectal cancer and sigmoid colon cancer with transrectal specimen extraction surgery

To introduce the use of a self-made specimen protective sleeve in laparoscopic resection for upper or mid rectal cancer and sigmoid colon cancer with transrectal specimen extraction surgery and the improvement of implantation method, so as to avoid and reduce bacterial contamination and tumor cell dissemination in abdominal cavity. During June 2015 and May 2017, 48 cases of high located rectal or sigmoid colon cancer were operated laparoscopically with natural orifices specimen extraction surgery (NOSES) using a self-made specimen protecting sleeve. Operation indication: (1) Rectum and sigmoid colon cancer with the distance of more than 6 cm from tumor inferior margin to dentate line. (2) The maximum diameter of intestine together with mesangial and tumor <7 cm by intraoperative judgment. (3) No anal and distal rectal surgery, no anorectal stenosis or lack of expansion capacity caused by trauma. (4) No ulcerative colitis, Crohn's disease or radiation proctitis. After transecting the rectum, the specimen protective sleeve was inserted through the right lower 12 mm main Trocar (This sleeve was tailored from the laparoscopic protective sleeve produced by China 3L Corporation, which was intercepted with 25-35 cm from one end of the sleeve according to the length of distal rectal retention. One end was ligated and the other was open with a ligature band. About 5 ml paraffin oil was used to rinse and lubricate during the operation). The rectal stump retained 7-8 cm in abdominal cavity. The transanal ligation part of the protective sleeve was cut off, then the stapler nail seat was inserted and specimen was pull out through the sleeve and rectum. There were 30 males and 18 females. The average age was (64.5±14.1) years, the BMI was (25.4±3.9) kg/m2, the tumor diameter was (3.3±1.1) cm, the maximum diameter of specimen was (5.4±1.5) cm and the length of specimen was (18.6±4.3) cm. Among these 48 cases, specimens of 36 patients were pulled out through inside of the sleeve easily, while specimens of 12 patients were quite difficult with resistance. Of 12 cases, 7 needed the help of transverse forceps, 4 needed to make 1 cm incision in pull-through bowel and insert a suction to decrease the volume of large specimens with gathering of gas and fluid, and 1 received small abdominal incision to remove specimen and perform intestinal reconstruction due to big specimen (the diameter of tumor and mesentery was 7.5 cm). Specimen tears of 6 patients didn't result in dissemination thanks to the specimen protecting sleeve. The operation time was (113.2±76.1) min, the bleeding amount was (38.5±17.3) ml, the time to first oral intake was (47.9±4.4) h, and the postoperative hospitalization length was (8.5±1.7) d. Anastomotic leakage occurred in 1 case (2.1%). No intra-abdominal and trocar infection, and obstruction were found. The use of protective sleeve and the improvement of the method of intraperitoneal implantation can effectively reduce the abdominal contamination during the specimen extraction. It can be applied to big specimens as well.

Prevalence and clinical significance of focal incidental 18F-FDG uptake in different organs: an evidence-based summary

Several meta-analyses and systematic reviews have reported data about the prevalence and the malignancy risk of focal incidental uptake detected by 18F-FDG PET (FIU). This review aims to summarize the published evidence-based data about the most common sites, prevalence and malignancy risk of FIU, to derive schematic estimates in this setting. A comprehensive computer literature search of meta-analyses or systematic reviews regarding FIU and published in PubMed/MEDLINE and/or Cochrane library database through June 2017 was carried out. Twelve articles were discussed in our summary and different organs were evaluated. The pooled prevalence of FIU ranged, respectively, from 1.6 to 3.6% for colon–rectum, from 1 to 2.46% for thyroid, being 0.4% for breast, 1.8% for prostate and 0.6% for parotid. Despite that, the pooled risk of malignancy considering histology as reference standard was quite high in all organs evaluated in the summary, except for parotid gland. In fact, it ranged from 61.5 to 76% for FIU in the colon–rectum (including both premalignant and malignant lesions), from 33.2 to 37% for FIU in the thyroid gland, and it was 60 and 62%, respectively, for breast and prostate FIU. For parotid FIU pathologically proven the pooled risk of malignancy was only 20.4%. Our summary showed that the most frequent sites of FIUs are colon and thyroid according to literature data. The risk of malignancy is quite high for FIU in colon-rectum, thyroid, breast and prostate especially when histologically analyzed. Beyond the localization, when FIU are detected further investigation is warranted.

Inflammatory cell distribution in colon mucosa as a new tool for diagnosis of irritable bowel syndrome: A promising pilot study.

Currently, there are no histological criteria to diagnose irritable bowel syndrome (IBS). Our aims were (i) to examine the distribution of inflammatory cells in the colon of healthy and IBS subjects and (ii) to find histological diagnosis criteria for IBS. Colonic biopsies were taken from four distinct regions of the colon from 20 controls (HC) and 11 patients with IBS (4 with constipation (IBS-C) and 7 with diarrhea (IBS-D) and embedded in paraffin. Macrophages, mast cells, eosinophils, and T lymphocytes were immunostained and positive cells counted. In both HC and IBS patients, global cellularity decreased from the cecum to the rectum (P<.01) which is attributed to reduced number of macrophages (P<.05) and eosinophils (P<.001) but not T cells. Mast cells were reduced in IBS (P<.05) but not in HC, particularly in IBS-D (P<.05). Results showed higher number of macrophages in the left colon of IBS subjects than HC (P<.05). Here we report a decreasing gradient of immune cells from the cecum to the rectum of the human colon. Although global cellularity cannot be used to distinguish between IBS and HC, closer analysis of macrophages and mast cells may be useful markers to confirm IBS histologically and to differentiate between IBS-C and IBS-D when clinical presentation alternates between constipation and diarrhoea. This pilot study remains to be confirmed with greater number of patients.

The association between dietary protein intake and colorectal cancer risk: a meta-analysis

BackgroundAssociation between dietary protein intake and colorectal cancer risk has not been fully quantified, while the results were controversial. This study aimed to evaluate the role of protein intake in the development of colorectal cancer.MethodsPUBMED and EMBASE were searched up to December 2016. Two independent reviewers independently extracted data from eligible studies. Relative risk (RR) with 95% confidence intervals (CI) was pooled using random-effects model to estimate the result. Besides, publication bias and sensitivity analysis were conducted.ResultsThirteen articles involving 21 studies comprising 8187 cases were included in this report. The pooled RR of colorectal cancer was 1.006 (95% CI = 0.857–1.179) indicating that there is no significant association between dietary protein intake and colorectal cancer risk. Furthermore, the pooled RRs for colon cancer and rectum cancer were 1.135(95% CI = 0.871–1.480) and 0.773(95% CI = 0.538–1.111), respectively, with the highest category of dietary protein intake. The association was not significant either in subgroup analysis of study design, protein type (animal protein or vegetable protein), sex, and or geographic locations.ConclusionsThe present study indicated that the highest category compared to the lowest category of protein intake had no significant association on colorectal cancer risk. Dose-response analysis was not conducted due to limited information provided. Therefore, more studies with large cases and participants as well as detailed amounts of dietary protein intake are wanted to confirm this result.

Separation of low and high grade colon and rectum carcinoma by eukaryotic translation initiation factors 1, 5 and 6.

Colorectal cancer (CRC) is the third most common cause of cancer related death worldwide. Furthermore, with more than 1.2 million cases registered per year, it constitutes the third most frequent diagnosed cancer entity worldwide. Deregulation of protein synthesis has received considerable attention as a major step in cancer development and progression. Eukaryotic translation initiation factors (eIFs) are involved in the regulation of protein synthesis and are functionally linked to the phosphatidylinositol-3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) signaling pathway.The identification of factors accounting for colorectal carcinoma (CRC) development is a major gap in the field. Besides the importance of eIF3 subunits and the eIF4 complex, eIF1, eIF5 and eIF6 were found to be altered in primary and metastatic CRC. We observed significant difference in the expression profile between low and high grade CRC. eIF1, eIF5 and eIF6 are involved in translational control in CRC. Our findings also indicate a probable clinical impact when separating them into low and high grade colon and rectum carcinoma.eIF and mTOR expression were analysed on protein and mRNA level in primary low and high grade colon carcinoma (CC) and rectum carcinoma (RC) samples in comparison to non-neoplastic tissue without any disease-related pathology. To assess the therapeutic potential of targeting eIF1, eIF5 and eIF6 siRNA knockdown in HCT116 and HT29 cells was performed. We evaluated the eIF knockdown efficacy on protein and mRNA level and investigated proliferation, apoptosis, invasion, as well as colony forming and polysome associated fractions.These results indicate that eIFs, in particular eIF1, eIF5 and eIF6 play a major role in translational control in colon and rectum cancer.

Heterogeneity of colon cancer: from bench to bedside

The large bowel shows biomolecular, anatomical and bacterial changes that proceed from the proximal to the distal tract. These changes account for the different behaviour of colon cancers arising from the diverse sides of the colon–rectum as well as for the sensitivity to the therapy, including immunotherapy. The gut microbiota plays an important role in the modulation of the immune response and differs between the right colon cancer and the left colorectal cancer. The qualitative and quantitative difference of the commensal bacteria between the right side and the left side induces epigenetic changes in the intestinal epithelial cells as well as in the resident immune population. The second player in the pathological homeostasis of colorectal cancer is the differences of the genetic features of cancer cells and the different effects that microsatellite instability, chromosomal instability and the CpG island methylator phenotype induce on the immunological organisation of the tumour microenvironment. The third player is the immunological composition of the tumour microenvironment, which changes under the influence of both genetic structures and gut microbiota. All these three players influence each other. This review describes these three aspects, highlights their interactions and discusses data from reported clinical trials.Listen to the Podcast

69-Year-Old Man With Abdominal Pain and Obstipation

69-Year-Old Man With Abdominal Pain and Obstipation

Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Annual hazard rate of relapse of stage II and III colorectal cancer after primary therapy.

To report the annual hazard of relapse in stages II and III colorectal cancer (CRC) Tunisian patients treated with curative intent. We also aim to evaluate impact of oxaliplatine according to anatomo-clinical features. We collected data about clinico-pathological parameters of 331 CRCs. We analyzed annual hazard of recurrence (locoregional and/or distant) of the overall population and several subgroups: colon cancer vs rectal cancer and stage II vs stage III. We also analyzed impact of adjuvant oxaliplatine on recurrence within these subgroups. Relapse rate was 38.1%, with a mean time to relapse of 27.6months. We noted 23.8% local recurrence, 69.8% distant recurrence, and 6.4% both. We observed higher local relapse rate in rectal cancer (26.8 vs 3.2%) vs colon cancer (p=0.004). Stage III had a higher metastatic relapse rate vs stage II (31.6 vs 20.8%, p=0.043). Annual hazard of recurrence for the overall population showed two peaks: [1-2] year-interval by 10.1% and [3-4] year-interval by 11.3%. Stage III showed significantly higher and earlier recurrence hazard peak compared to stage II (16.3 vs 8.1% in [1-2] year-interval). Oxaliplatine significantly improved annual hazard of recurrence in each year-interval from year 1-4, in colon cancer and in stage III but without impact in rectal cancer and stage II. Extended follow-up to 4years should be considered in Tunisian population. Impact of oxaliplatine showed same features to reported occidental series.

Malignant tumors of the rectum, rectosigmoid connections and colon and hygienic evaluation of carcinogenic chemicals entering the oral route

The ranking of municipal formations of the Orenburg region on the incidence of malignant neoplasms of the colon, rectosigmoidal junction and rectum, and the level of carcinogens in food and drinking water has been ranked. Based on average concentrations, the total coefficients of carcinogens supplied with drinking water from centralized water supply and food products were calculated. Priority carcinogens have been identified in drinking water and food products that affect the occurrence of colon cancer, rectosigmoidal connective and rectum, as well as the risk area, with an increased incidence of colon cancer, rectosigmoid and rectal cancer caused by a carcinogenic load in drinking water and food Products.

Bone marrow tolerance during postoperative chemotherapy in colorectal carcinomas.

This study seeks to quantify and compare bone marrow tolerance during postoperative chemotherapy therapy between rectal cancer vs. colon cancer patients. During rectal cancer treatment, patients receive neoadjuvant chemoradiation (CRT) irradiation which can exacerbate the hematologic toxicity (HT) via incidental irradiation of the pelvic bone marrow (PBM) during myelosuppressive postoperative chemotherapy. In contrast, colon cancer patients receive the same postoperative myelosuppressive chemotherapy but do not routinely receive preoperative chemoradiation therapy. This comparison will help elucidate the lasting myelosuppressive effects of incidental pelvic bone marrow (PBM) irradiation on rectal cancer patients during neoadjuvant preoperative chemoradiation therapy. Rectal cancer patients treated with preoperative CRT followed by postoperative 5-Fluorouracil and oxaliplatin (OxF) chemotherapy (n=35) were compared to colon cancer patients who received only postoperative OxF chemotherapy (n=42). End points were ≥ grade 3 hematologic toxicity (HT3) or hematologic event (HE) defined as ≥ grade 2 HT and a dose reduction in OxF. Wilcoxon rank sum test tested continuous variables and Chi-squared test measured differences in categorical variables. HT3 and HE probability during postoperative chemotherapy was estimated with Kaplan-Meier curves and Cox regression analysis. During OxF chemotherapy, 40.0% (n=14) of rectal cancer patients experienced HT3 compared to 26.1% (n=11) of colon cancer patients (P=0.4). HE was experienced by 48% (n=17) of rectal cancer patients compared to 36% (n=15) of colon cancer patients (P=0.36). Rectal cancer patients were likelier to experience HT3 on multivariable cox regression analysis, controlling for several clinical covariates, with a hazard ratio (HR) of 2.49, [(95% CI: 1.02-6.02), P=0.045] than colon cancer patients. While rectal cancer patients were more likely to experience HE than colon cancer patients on multivariable Cox regression analysis with a HR of 1.8 (95% CI: 0.95-3.75), this only trended in statistical significance, P=0.07. Rectal cancer patients are more likely than colon cancer patients to experience hematologic toxicities impacting the tolerance of standard of care chemotherapeutics during adjuvant therapy. Focused PBM sparing during radiation therapy for rectal cancer patients may improve tolerance of myelosuppressive chemotherapeutic agents delivered in the postoperative setting.

Serum Trimethylamine N-oxide, Carnitine, Choline, and Betaine in Relation to Colorectal Cancer Risk in the Alpha Tocopherol, Beta Carotene Cancer Prevention Study.

Background: Trimethylamine N-oxide (TMAO), a choline-derived metabolite produced by gut microbiota, and its biomarker precursors have not been adequately evaluated in relation to colorectal cancer risk.Methods: We investigated the relationship between serum concentrations of TMAO and its biomarker precursors (choline, carnitine, and betaine) and incident colorectal cancer risk in a nested case-control study of male smokers in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study. We measured biomarker concentrations in baseline fasting serum samples from 644 incident colorectal cancer cases and 644 controls using LC/MS-MS. Logistic regression models estimated the ORs and 95% confidence interval (CI) for colorectal cancer by quartile (Q) of serum TMAO, choline, carnitine, and betaine concentrations.Results: Men with higher serum choline at ATBC baseline had approximately 3-fold greater risk of developing colorectal cancer over the ensuing (median ± IQR) 14 ± 10 years (in fully adjusted models, Q4 vs. Q1, OR, 3.22; 95% CI, 2.24-4.61; Ptrend < 0.0001). The prognostic value of serum choline for prediction of incident colorectal cancer was similarly robust for proximal, distal, and rectal colon cancers (all P < 0.0001). The association between serum TMAO, carnitine, or betaine and colorectal cancer risk was not statistically significant (P = 0.25, 0.71, and 0.61, respectively).Conclusions: Higher serum choline concentration (but not TMAO, carnitine, or betaine) was associated with increased risk of colorectal cancer.Impact: Serum choline levels showed strong prognostic value for prediction of incident colorectal cancer risk across all anatomical subsites, suggesting a role of altered choline metabolism in colorectal cancer pathogenesis. Cancer Epidemiol Biomarkers Prev; 26(6); 945-52. ©2017 AACR.

A prospective study of feasibility and short term outcome of stoma reversal under local anaesthesia

Background: Stoma fashioning (ileostomy and colostomy) are very important and established procedures for deviation of bowel contents to procure the distal anostomosis. It is a very common procedure in cases of bowel obstruction, perforation, inflammatory bowel disease and large bowel disorders like Ca colon and Ca rectum, colonic fistulas, trauma to colon and rectum. Stoma reversal is a routine procedure but is usually performed using general or regional anaesthesia but large number of patient list for stoma reversal under general or regional anaesthesia, led to unnecessary delay in stoma reversal due to paucity of anaesthesia. Local anaesthesia has thus proved useful to handle a large load of stoma reversal, so we investigated feasibility of performing stoma reversal using local anaesthetic agent.Methods: Total 54 patients underwent for stoma reversal under local anaesthesia, admitted to Department of General Surgery, Nehru Hospital, B. R. D. Medical College, Gorakhpur, Uttar Pradesh, India.Results: Reversal of stoma could be comfortably done under safe dose of local anaesthesia, most of the patients remain comfortable intraoperatively, 4 out of 54 patients had systemic complications like vomiting and bradycardia and 2 had associated bowel injury. only 2 patients had minor anostomotic leak and 1 had developed fecal fistula while rest had normal intact anostomosis. Only 2 patients had reported moderate pain and 1 had mild pain according to visual analog scale and in 42 out of 54 patients had normal wound healing while 5 had minor erythema, 6 had seroma formation and 1 had complain of pus discharge.Conclusions: Reversal of STOMA can be performed safely and comfortably under local anaesthesia. Post op short term outcome and complications are comparable to that done under general or regional anaesthesia.