Surgical Treatment Of Colorectal Cancer Research Articles

Update on surgical treatment of colorectal cancer -latest preoperative treatment and the subsequent non-operative management

Update on surgical treatment of colorectal cancer -latest preoperative treatment and the subsequent non-operative management

Embracing My Stoma: Psychosocial Adjustment of Indonesian Colorectal Cancer Survivors Living With a Stoma.

After surgical treatment of colorectal cancer (CRC), most survivors need to have an ostomy, which can lead to restrictions in their psychological and social functioning. How Indonesian CRC survivors adjust to living well with the stoma remains an understudied area. This study aimed to explore the lived experiences of Indonesian CRC survivors living with a stoma regarding their psychosocial adjustment. This study adopted Heidegger's interpretive phenomenology approach. Using semistructured in-depth interviews, data were collected until saturation from 11 CRC survivors. Data were analyzed using thematic analysis, with a Heideggerian stance. Three themes with corresponding subthemes were identified: (1) achieving self-reconciliation (subthemes: stoma as a savior, embracing the stoma's existence, being confident as an ostomate), (2) getting tremendous social support (subthemes: getting support from partner, family and community, and peer ostomates), and (3) making practical adjustments in daily life (subthemes: adjustment in clothing, food and drink, physical activities and exercise, religious activities, and traveling). These 3 themes describe the essence of the "lived psychosocial experiences of the CRC survivors with stoma." In contrast to previous study findings conducted primarily in Western countries, most of the Indonesian CRC survivors living with a stoma described positive psychosocial adjustment regarding their ostomy. In this work, social support and cultural-religious aspects made a significant contribution to this adjustment. Healthcare professionals, especially nurses, can use this knowledge in providing psychosocial support for CRC survivors with ostomy to facilitate a smooth adaptation and adjustment journey.

Recent updates in the surgical treatment of colorectal cancer

Recent updates in the surgical treatment of colorectal cancer

Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old.

Background: An increasing proportion of the population of patients with cancer presents at an advanced age, increasing the challenges of successful and well-tolerated treatments. In the older spectrum of the geriatric cancer patients, those older than 80 years old, challenges are even higher because of increasing comorbidities and decreasing organ function reserves. Methods: Studies regarding colorectal cancer presentation, treatment, and prognosis in patients older than 80 years old available in the literature were evaluated and were compiled within a narrative review. Molecular attributes of colorectal cancer in the subset of patients older than 80 years old in published genomic cohorts were also reviewed and were compared with similar attributes in younger patients. Results: Characteristics of colorectal cancer in octogenarians are in many aspects similar to younger patients, but patients older than 80 years old present more often with right colon cancers. Surgical treatment of colorectal cancer in selected patients over 80 years old is feasible and should be pursued. Adjuvant chemotherapy is under-utilized in this population. Although combination chemotherapy is in most cases not advisable, monotherapy with fluoropyrimidine derivatives is feasible and efficacious. Conclusions: Outcomes of colorectal cancer patients over the age of 80 years old may be optimized with a combination of standard treatments adjusted to the individual patient's functional status and organ reserves. Increased support for the older age group during their colorectal cancer treatment modalities would improve oncologic outcomes with decreasing adverse outcomes of therapies.

ASO Author Reflections: Identifying Racial Disparities for Minimally Invasive Approaches to the Surgical Treatment of Colorectal Cancer.

ASO Author Reflections: Identifying Racial Disparities for Minimally Invasive Approaches to the Surgical Treatment of Colorectal Cancer.

Comparison of Selected Older and Younger Patients Regarding Optimal Surgical Treatment of Colorectal Cancer: A Prospective Cohort Study.

Current evidence regarding the optimal management of older colorectal cancer patients, is conflicting. Functional deficits impact long-term survival prognosis, while frailty often results to optimal treatment postponement. Thus, the characteristics of this subgroup combined with treatment deviations further perplex optimal oncological management. The study aim was to compare survival and optimal surgery rates between older and younger colorectal cancer patients. This study was designed as a prospective cohort. All adult (³18 years) colorectal cancer patients operated, during the 2016-2020 period, in the Department of Surgery, University Hospital of Larissa, were considered as eligible. The primary endpoint of the study was the difference in terms of the overall survival between older (>70 year) and younger (<70 years) colorectal cancer patients. Overall, 166 patients (60 younger and 106 older) were enrolled. Although the older subgroup displayed a higher rate (p=0.007) of ASA II and ASA III patients, mean CCI scores were comparable (p=0.384). The two subgroups were similar in terms of performed operations (p=0.140). No delay in surgery was noted. Most operations were performed using an open approach (open: 57.8% vs. laparoscopic: 42.2%), under an elective status (elective: 91% vs. emergency: 1.8%). There was no difference in terms of overall complications rate (p=0.859). Overall survival was similar (p=0.227) between the older and younger subgroups (25.68 vs. 28.48 months). Older operated patients did not differ from their younger counterparts with regard to their overall survival. Due to several study limitations, further trials are required to confirm these findings.

Artificial intelligence in improving the outcome of surgical treatment in colorectal cancer.

A considerable number of recent research have used artificial intelligence (AI) in the area of colorectal cancer (CRC). Surgical treatment of CRC still remains the most important curative component. Artificial intelligence in CRC surgery is not nearly as advanced as it is in screening (colonoscopy), diagnosis and prognosis, especially due to the increased complexity and variability of structures and elements in all fields of view, as well as a general shortage of annotated video banks for utilization. A literature search was made and relevant studies were included in the minireview. The intraoperative steps which, at this moment, can benefit from AI in CRC are: phase and action recognition, excision plane navigation, endoscopy control, real-time circulation analysis, knot tying, automatic optical biopsy and hyperspectral imaging. This minireview also analyses the current advances in robotic treatment of CRC as well as the present possibility of automated CRC robotic surgery. The use of AI in CRC surgery is still at its beginnings. The development of AI models capable of reproducing a colorectal expert surgeon's skill, the creation of large and complex datasets and the standardization of surgical colorectal procedures will contribute to the widespread use of AI in CRC surgical treatment.

Financial toxicity following surgical treatment for colorectal cancer: a cross-sectional study.

Financial toxicity has become a global public health issue. The purpose of the study is to investigate and analyze the influencing factors of financial toxicity in patients with non-metastatic colorectal cancer. A convenient sample of 250 patients with stage I-III colorectal cancer was investigated in the study. They completed a set of questionnaires, including the Comprehensive Score for Financial Toxicity questionnaire, the Perceived Social Support Scale, and the Hospital Anxiety and Depression Scale. Univariate and multivariate linear regression were performed to investigate the influencing factors of financial toxicity. Over half (52.8%, n = 132) of the colorectal cancer survivors experienced financial toxicity. Multivariate regression analysis showed that the factors associated with financial toxicity were young age, unemployment, low annual household income, chemotherapy, and the lack of sufficient social support (p < 0.05). Financial toxicity is common among non-metastatic colorectal cancer survivors. Young age, lower annual household income, unemployment, chemotherapy, and insufficient social support were associated with financial toxicity.

Current trends and outcomes of surgical treatment of colorectal cancer with liver metastasis

Aim. To analyze multimodal treatment outcomes in patients with liver metastases from colorectal cancer, who were treated at multidisciplinary cancer clinic. Material and methods. From 2007 to 2021, 315 colorectal cancer patients with liver metastases underwent liver resections (201, 63.8 %), radiofrequency ablation (RFA) (29, 9.2 %), microwave ablation (MWA) (22, 6.9 %), transarterial chemoembolozation (TACE) in combination with RFA (22, 6.9 %), and TACE + RFA + TACE combination (41, 13.2 %) at the department of liver and pancreas surgery, Moscow Botkin Clinical Hospital. Results. A 90-day mortality rate was 1.9% in 6 patients who underwent liver resection. Postoperative complications after liver resection were observed in 49 patients (24.3 %). The overall 5- and 10-year survival rates after liver resection were 38.8 % and 23.2 %, respectively. The factors of poor prognosis after liver resection were: age over 70 years (p=0.03), localization of the primary tumor in the right half or rectum (p=0.037), three or more metastatic foci in the liver (p=0.01), maximum size of the tumor of more than 5 cm (p=0.021), synchronous colorectal liver metastases (p=0.039), and bilobar colorectal liver metastases (p=0.007). Postoperative complications after RFA, TACE + RFA, TACE + RFA + TACE WERE 5.8 %, 9.1 % and 7.3 %, respectively. In patients with a size of metastases of no more than 3 cm, the 3-year disease-free and overall survival rates after rfa were 45.8 % and 54.2 %, respectively. In patients with a size of metastases from 3 to 5 cm, the 3-year disease-free and overall survival rates after TACE + RFA + TACE were 56.1 % and 63.4 %, respectively. Conclusion. In colorectal cancer patients with liver metastases, multimodal treatment within a multi-disciplinary setting demonstrated significant improvements in their survival.

Perioperative Changes in Serum Concentration of Glial Fibrillar Acid Protein and Delayed Cognitive Recovery: an Experimental Observational Study

A number of studies have found an association between the increased concentration of glial fibrillar acid protein (GFAP) in blood serum in patients with various types of brain damage (ischemic stroke, traumatic brain injury, neurodegenerative and neuro-oncological diseases), as well as with a rapid decline in cognitive functions in elderly people with initially normal cognitive abilities.The objective: to identify the relationship between delayed cognitive recovery and changes in serum GFAP concentration in the perioperative period in patients operated for various oncological diseases.Subjects and Methods. The study included 30 patients who underwent surgical treatment for prostate cancer, colorectal cancer and pancreatic cancer under combined general anesthesia.The inclusion criteria were the expected duration of the operation over 300 minutes and the age over 60 years. GFAP was determined in plasma by enzyme immunoassay before anesthesia, the next day after surgery and on the 4th–5th day. Neuropsychological testing was performed before surgery and on the 4th–5th postoperative day. Delayed cognitive recovery was defined as a decrease in the composite z-score of more than one standard deviation (SD) compared to the preoperative assessment.Correlation analysis was performed between changes in the composite z-score (in absolute values) and the difference in GFAP concentration between the outcome and the first postoperative day, the outcome and the 4th–5th postoperative day and the first and 4th–5th postoperative days.Results. In five cases (16.6%), a decrease in the composite z-score &gt; 1 SD was revealed indicating a delayed cognitive recovery. In the remaining 25 (83.4%) patients, changes in the composite z-score were less than one standard deviation. The median concentration of GFAP in patients with delayed cognitive recovery was 0.13 [0.1; 0.14] before surgery, 0.12 [0.09; 0.14] the day after surgery and 0.16 [0.05; 0.19] on the 4th–5th day after surgery. In patients without cognitive impairment, the concentration of GFAP was 0.15 [0.125; 0.184] before surgery, 0.15 [0.121; 0.163] 24 hours after surgery and 0.13 [0.079; 0.151] on the 4th–5th day after surgery. The correlation values between changes in the composite z-score and the difference in GFAP concentrations were: between the outcome and the first postoperative day – rs = 0.107, p = 0.37, outcome and the 4th–5th postoperative day – rs = 0.134, p = 0.37, the first and 4th‒5th postoperative days – rs = 0.21, p = 0.37.Discussion. There was no statistically significant difference in GFAP levels between patients with delayed cognitive recovery and patients without cognitive impairment. There was also no correlation between the difference in GFAP concentrations in plasma before surgery and 24 hours after, before surgery and on the 4th–5th day of the postoperative period and the composite z-score.Conclusions. The use of GFAP to predict cognitive decline associated with surgical treatment of colorectal cancer, prostate cancer and pancreatic cancer under general anesthesia is not yet possible.

Prospective Evaluation of the Quality of Life of Patients after Surgical Treatment of Rectal Cancer: A 12-Month Cohort Observation.

This study constitutes a prospective, three-stage evaluation of quality of life among patients receiving surgical treatment for colorectal cancer depending on the type of surgery performed (open anterior resection, laparoscopic anterior resection, abdominoperineal resection, or Hartmann’s procedure). The study included 82 patients treated at the Surgical Oncology Outpatient Department of the Oncology Center in Bydgoszcz from June 2019 to August 2021. The study tools consisted of diagnostic surveys and analyses of medical records. The standardized study tools were the surveys EORTC QLQ-C30 and QLQ-CR29. In addition, a proprietary questionnaire was developed to collect demographic data. Quality of life was measured at three time-points: the day before the surgery and 6 and 12 months post-surgery. Statistically significant differences (p < 0.05) were observed in the domains of role functioning (III, p = 0.030), body image (II, p < 0.001; III, p < 0.001), sexual functioning (II, p = 0.037), buttocks/anal area/rectum pain (III, p = 0.031), and embarrassment (II, p = 0.022; III, p = 0.010). Statistically significant differences in the functional and symptom scale scores were also observed within each group at different stages of cancer treatment. As shown by our study, the quality of life of patients treated for colorectal cancer is determined not only by the operating technique but also by sociodemographic and clinical factors. The use of minimally invasive surgical techniques enables patients to return to their social roles more quickly and improves their self-assessment of body image.

Impact of Preoperative Visceral Fat Area Measured by Bioelectrical Impedance Analysis on Clinical and Oncologic Outcomes of Colorectal Cancer.

Background: Some studies have shown that an increase in visceral fat is associated with postoperative clinical and oncologic outcomes. However, no studies have used bioelectrical impedance analysis (BIA) to determine the effects of visceral fat on the oncologic outcomes of colorectal cancer (CRC). This study aimed to investigate the impact of preoperative visceral fat area measured by bioelectrical impedance analysis on clinical and oncologic outcomes of colorectal cancer Methods: This study included 203 patients who underwent anthropometric measurements by BIA before surgical treatment for CRC between January 2016 and June 2020. Results: According to the cut-off level of VFA by receiver operating characteristic curve analysis, 85 (40.5%) patients had a low VFA, and 119 (59.5%) had a high VFA. Multivariate analysis found that preoperative CRP (hazard ratio (HR), 3.882; 95% confidence interval (CI), 1.001–15.051; p = 0.050) and nodal stage (HR, 7.996; 95% CI, 1.414–45.209; p = 0.019) were independent prognostic factors for overall survival, while sex (HR, 0.110; 95% CI, 0.013–0.905; p = 0.040), lymphovascular invasion (HR, 3.560; 95% CI, 1.098–11.544; p = 0.034), and VFA (HR, 4.263; 95% CI, 1.280–14.196; p = 0.040) were independent prognostic factors for disease-free survival (DFS). Conclusions: Preoperative VFA measured by BIA had no significant impact on postoperative clinical outcomes and was an independent prognostic factor for disease-free survival.

THE ROLE OF INFLAMMATION MARKERS IN THE EARLY POSTOPERATIVE PERIOD FOR MANAGEMENT PATIENTS WITH COLORECTAL CANCER

Objective: To evaluate the role of inflammatory markers in the early diagnosis of complications of colorectal cancer surgical treatment.Methods: the study was conducted in the Medical Research and Education Center of Moscow State University named after M.V. Lomonosov from 2019 to 2021. The study included all patients who underwent surgical treatment for colorectal cancer in the 1st surgical department of the Moscow Research and Educational Center, Lomonosov Moscow State University. M.V. Lomonosov. The study examined clinical and laboratory data based on case histories of patients with stage II-III colorectal cancer, who underwent elective colorectal cancer treatment with lymph node dissection with the formation of a primary anastomosis. All patients underwent routine proctography in the early postoperative period.Results: The study included 80 patients with stage I-III colorectal cancer, of which 26 had septic complications, including clinically insignificant anastomosis leakage. Statistically significant differences was found between the groups of patient with and without septic complications on the 2nd day of the postoperative day in terms of the absolute level of leukocytes (p=0.01), hemoglobin (p=0.07), total protein (p=0.02) and C-reactive protein (p=0.03).Conclusion: An increase in the level of markers of the inflammatory response, such as the number of leukocytes, the level of total protein and the level of C-reactive protein, can be observed already at a relatively early postoperative period in patients with infectious complications, including those with clinically insignificant intestinal anastomotic leaks.

Хірургічне лікування раку прямої кишки: обсяг лімфодисекції і проявів неспроможності швів колоректального анастомозу (ретроспективне дослідження)

The purpose of the study was a retrospective analysis and evaluation of the effectiveness of surgical treatment of colorectal cancer, taking into account the technique of surgery, the volume of lymph dissection and postoperative incidence of colorectal anastomotic sutures failure. Materials and methods. The current retrospective analysis includes the results of a comprehensive examination and treatment of 102 patients divided into 2 groups depending on the technique of surgery: 53 people (52%) – laparoscopic anterior resection of the rectum with the formation of hardware "end-to-end" type and 49 (48%) – a similar operation using fluorescent angiography (ICG-technology). Results and discussion. According to the generalized results of retrospective analysis of examination and comprehensive treatment of 102 patients with colorectal cancer, the study groups were formed homogeneously and by statistically significant differences in age, sex, body mass index, nature and spread of tumor growth, location and stage of neoplastic process. The presence of a statistically significant correlation between rectosigmal localization of the nonplastic process, as well as the severity of the tumor response to preoperative chemotherapy / radiation therapy and the number of metastatic affected regional lymph nodes. It was demonstrated that in the study population of 102 patients with regional metastatic spread, the median number of affected lymph nodes was 2.0, and the lower and upper quartiles corresponded to 1 and 3 metastatic lymph nodes. At the same time, N0 samples were intentionally excluded from the analysis in order to ensure the adequacy of the results in the presence of metastatic lesions, because in this case it is important to assess the adequacy of the volume of lymphadenectomy. According to the results of fluorescent angiography, in 3 of 49 patients (6.1%) of group 2, the resection border was moved in the proximal direction to the area of adequate blood supply with subsequent formation of colorectal hardware anastomosis. At the same time, in 53 patients of group 1, the change of the place of application of the conjunctiva, taking into account the results of traditional visual inspection, was not performed at all. Preventive stoma, the need for which was determined by the surgeon, was formed in all 102 (100%) patients. Also in all 102 operated lymphadenectomy was performed. The median duration of surgery in both groups was 200.5 (125–310) minutes. Conclusion. Significant advantages of laparoscopic rectal resection using fluorescent angiography with green indocyanine have been demonstrated, as evidenced by a statistically significant reduction in lymphadenectomy volume – the number of intraoperatively removed lymph nodes, reduction in surgery duration and postoperative period compared with a group of patients who underwent radical surgery without the use of ICG-technology

Research Results on Survival Rate for Postoperative Colon Cancer Surgery

Objective: Although the incidence of colorectal cancer is relatively low in Mongolia, the postoperative survival rate has not been fully studied. Thus, we have aimed in the present study to analyze the survival rate after surgical treatment of colorectal cancer. Methods: We studied the patient history of all patients who underwent surgery in the General Surgery Department, National Cancer Center of Mongolia from January 2013 to December 2015 and evaluated the results. Results: The average survival rate of all patients was 42 months or 95 %. In patients with colorectal cancer, the 5-year survival rate after surgery was 59.3 %. By stages, the percentage of patients diagnosed in stage I was 100 %, in stage II 75 %, in stage III 64.4 %, and in stage IV 12.5 %, and the survival rate varied from stage to stage. It was also found that early diagnosis was directly related to survival rate (p = 0.000). Furthermore, the outcome of postoperative chemotherapy had a direct effect on the postoperative survival rate (p = 0.000). The average survival rate is 1280 days 1172.7 - 1389.06 (95 % conf. Interval), 42 months 38.5 - 45.6 (95 % conf. Interval), 3.5 years 3.2 - 3.8 (95 % conf. Interval), which was relatively high compared to other cases of cancer. In addition, the survival time is statistically related to the outcome of surgery and postoperative treatment (p = 0.000). Conclusion: The results of our study show that viability decreases statistically in later stages of cancer manifestation.

Recent Advances in the Treatment of Colorectal Cancer: A Review.

Colorectal cancer (CRC) is the third most common cancer worldwide, and surgical treatment remains the first-line treatment to provide a cure. In addition to the aging population, obesity, low physical activity, and smoking habits increase CRC risk. Despite advances in surgical techniques, chemotherapy, and radiotherapy, colorectal cancer remains the second leading cause of cancer-related deaths worldwide. For early-stage CRC, endoscopic treatment, including endoscopic mucosal resection and endoscopic submucosal dissection, has been performed. However, lymph node dissection is an integral part of surgical treatment for advanced-stage cancer because of the high incidence of lymph node metastasis. Conventional open surgery has evolved into laparoscopic and robotic surgery. Although prospective studies have confirmed the safety and feasibility of laparoscopic surgery for CRC, relevant treatment models of transverse colon cancer and rectal cancer still need to be further explored and validated. Furthermore, multidisciplinary treatment is needed to cure CRC completely. This review aimed to provide an update on recent advances in the surgical treatment of CRC.

Thromboprophylaxis in surgically treated colorectal cancer patients with tinzaparin: Intermediate results from the Onco-CAST trial.

e15611 Background: The incidence of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) after colorectal surgery is approximately 29% and 1.6% respectively. The incidence of asymptomatic postoperative DVT in colorectal cancer (CRC) patients has been reported as high as 20%, even under thromboprophylaxis. Thus, thromboprophylaxis after surgical treatment for CRC is crucial. Latest guidelines from International Initiative on Thrombosis and Cancer (ITAC 2019) recommend use of highest prophylactic dose of Low Molecular Weight Heparin (LMWH). Methods: Onco-CAST is a prospective, phase IV, observational, non-interventional cohort study evaluating a) current management approach for CRC surgical prophylaxis and b) efficacy and safety of tinzaparin at 8.000 Anti-Xa IU, once daily (OD), for at least one month post hospital discharge. Patients enrolled after signing informed consent. Onco-CAST was conducted by the Hellenic Society of Coloproctology. Results: Results from 175 CRC patients from 9 Onco Surgical Clinics are reported. Participation completed 79% of patients at report time: 66% males, 67±12 years, BMI: 27.4±5.5. Histology: adenocarcinomas NOS 81%, mucinous adenocarcinomas 9%, small cell neuroendocrine carcinomas 2%, and others. High grade differentiation indicated: 26% and 5% metastatic. 32% treated with right hemicolectomy, 20% with low anterior resection, 12% with sigmoid colectomy, 9% with abdominal-perineal resection, 9% with left hemicolectomy and other methods. 67% treated open and 33% laparoscopic while the median number of lymph nodes dissected for left and right hemicolectomy was 32.5 (Q1-Q3:26-38) and 24 (Q1-Q3: 14.5-32), p = 0.0253. Factors related to thrombosis risk are presented in table, notably, 95% of patients accumulated ≥3 risk factors. Median thromboprophylaxis duration with tinzaparin 8.000 Anti-Xa IU, OD, was: 37 days (1st-3rd quartile: 33-45 days). Three thrombotic events occurred (efficacy 98.3%, 95% CI: 95.1-99.4%), one DVT+PE, one DVT and one due to Central Venous Catheter (CVC). Eight patients experienced bleeding events (4.6%, 95%CI: 2.3-8.8%), 3 minor, 3 major and 2 CNMB, 2 had a possible relation to thromboprophylaxis (1.1%, 95%CI: 0.3-4.1%). Conclusions: Thromboprophylaxis in Surgically Treated Colorectal Cancer Patients with Tinzaparin intermediate dose seems safe and efficient approach.[Table: see text]

Assessment of the quality of life in patients treated for colorectal cancer

Colorectal cancer is a common cause of death. The incidence of cancer increases every year, it is caused by better secondary prevention - screening and early stage cancer detection. The early stages of neoplasms enable the implementation of effective treatment. The method of treating colon cancer is radical treatment - surgery. The quality of life in patients with chronic diseases such as cancer is variable in each phase of the disease.&#x0D; The presented work aims to show the quality of life of patients on the day of admission to the hospital for the surgical treatment of colorectal cancer. The study used standardized QLQ-C30 forms with the extension of the CR29 module. Comprehensive assessment of the quality of life enables the presentation of the patient's condition before the procedure and is the starting point for the assessment of the patient after the procedure.&#x0D; The studies show that patients have the lowest assessment of the overall quality of life and emotional functioning. They judge physical and mental functioning well. Symptoms related to the disease, such as abdominal pain, significantly reduce the quality of life.&#x0D; The presented research shows that each time before the procedure, the patient should have the quality of life assessed in order to possibly further compare the changes in the subjective assessment of the quality of life. The research shows that patients diagnosed with cancer have a low quality of life assessment and preventive measures should be implemented in the form of consultations.

Surgical Treatment for Colorectal Cancer Partially Restores Gut Microbiome and Metabolome Traits.

ABSTRACTAccumulating evidence indicates that the gut microbiome and metabolites are associated with colorectal cancer (CRC). However, the influence of surgery for CRC treatment on the gut microbiome and metabolites and how it relates to CRC risk in postoperative CRC patients remain partially understood. Here, we collected 170 fecal samples from 85 CRC patients pre- and approximately 1 year postsurgery and performed shotgun metagenomic sequencing and capillary electrophoresis-time of flight mass spectrometry-based metabolomics analyses to characterize alterations between pre- and postsurgery. We determined that the relative abundance of 114 species was altered postsurgery (P < 0.005). CRC-associated species, such as Fusobacterium nucleatum, were decreased postsurgery. On the other hand, Clostridium scindens, carcinogenesis-associated deoxycholate (DCA)-producing species, and its biotransformed genes (bai operon) were increased postsurgery. The concentration of 60 fecal metabolites was also altered postsurgery (P < 0.005). Two bile acids, cholate and DCA, were increased postsurgery. We developed methods to estimate postoperative CRC risk based on the gut microbiome and metabolomic compositions using a random forest machine-learning algorithm that classifies large adenoma or early-stage CRC and healthy controls from publicly available data sets. We applied methods to preoperative samples and then compared the estimated CRC risk between the two groups according to the presence of large adenoma or tumors 5 years postsurgery (P < 0.05). Overall, our results show that the gut microbiome and metabolites dynamically change from pre- to postsurgery. In postoperative CRC patients, potential CRC risk derived from gut microbiome and metabolites still remains, which indicates the importance of follow-up assessments.IMPORTANCE The gut microbiome and metabolites are associated with CRC progression and carcinogenesis. Postoperative CRC patients are reported to be at an increased CRC risk; however, how gut microbiome and metabolites are related to CRC risk in postoperative patients remains only partially understood. In this study, we investigated the influence of surgical CRC treatment on the gut microbiome and metabolites. We found that the CRC-associated species Fusobacterium nucleatum was decreased postsurgery, whereas carcinogenesis-associated DCA and its producing species and genes were increased postsurgery. We developed methods to estimate postoperative CRC risk based on the gut microbiome and metabolomic compositions. We applied methods to compare the estimated CRC risk between two groups according to the presence of large adenoma or tumors after 5 years postsurgery. To our knowledge, this study is the first report on differences between pre- and postsurgery using metagenomics and metabolomics data analysis. Our methods might be used for CRC risk assessment in postoperative patients.

Does the level of medical facility impact short-term results of surgical treatment of colorectal cancer

The study objective was to evaluate the impact of medical hospital volume on short-term colorectal cancer treatment results.Materials and methods. The retrospective study included 93 patients with colorectal cancer operated on by one surgeon at two medical centers in Moscow from 2018 to 2020: 32 patients of the first group were operated in tertiary medical center (N.I. Pirogov National Medical and Surgical Center) and 61 of the second group – in regional low volume hospital (Centrosoyuz Hospital). The endpoints of the study were the short-term outcomes: surgery duration, blood loss, postoperative hospital stay, intra- and postoperative complications, lymph node harvested and the quality of specimen.Results. Surgery duration as well as blood loss in two groups were similar (258 min vs 240 min, p = 0.47 and 100 ml and 100 ml, p = 0.89, accordingly). Hospital stay after surgery was significantly less in the first group (9 days vs 16 days, p &lt;0.01). The frequency of postoperative complications of type I–II according to the Clavien–Dindo classification was higher in the first group (6/8 vs 1/8, p &lt;0.05) but reoperations performed more in the second group due to III Clavien–Dindo complications (2/8 vs 7/8, p = 0.012). Grade 2–3 rectal cancer specimen quality was 94.7 % vs 77.8 %, p = 0.13 and harvested lymph nodes &gt;12 was 71.9 % vs 78.7 %, p = 0.485 in first and second group, respectively.Conclusion. Hospital volume does not affect rectal cancer specimen quality, surgery duration and blood loss, if the surgical interventions are performed by one experienced surgeon but associated with the incidence of postoperative complications and the length of stay.