BACKGROUND Study showed that systemic holistic care not only aids in disease treatment and physical recovery to a certain extent but also effectively enhances patient psychological well-being,social support,and overal...BACKGROUND Study showed that systemic holistic care not only aids in disease treatment and physical recovery to a certain extent but also effectively enhances patient psychological well-being,social support,and overall quality of life(QoL).AIM To assess systematic holistic care impact on the recovery and well-being of postoperative patients with colon cancer.METHODS Our randomized controlled trial included 98 postoperative patients with colon cancer admitted to our hospital from June 2021 to June 2022.Patients were divided into control and study groups.The control group received conventional postoperative nursing care,whereas the study group received systematic holistic nursing care.We monitored gastrointestinal function recovery,and recorded changes in serum albumin(ALB),prealbumin(PA),psychological state,selfmanagement,self-efficacy,QoL,and the occurrence of complications in patients before,at discharge,and 2 wk post-discharge.Spearman analysis assessed correlations between psychological state,self-management,self-efficacy,and QoL of patients in the study group 2 wk post-discharge.RESULTS Following the nursing intervention,we observed significantly shorter postoperative bowel sound recovery time,anal exhaust time,and defecation time in the study group than in the control group(P<0.05).Patient ALB and PA levels,psychological status,self-management ability,self-efficacy and QoL at discharge and 2 wk post-discharge significantly improved,with greater improvements observed in the study group(P<0.05).Both groups experienced complications post-interventions,but the intervention group had significantly lower complication rate(3/49,6.12%)(P<0.05).In the study group,patient anxiety,depression,self-management and QoL scores at 2 wk post-discharge exhibited a significant negative correlation(3/49,6.12%)with QoL scores,with correlation coefficients of r=-0.273,-0.522,-0.344,and P<0.01,respectively.Conversely,patient self-efficacy scores 2 wk postdischarge showed a positive correlation with QoL scores(r=0.410,P=0.000).CONCLUSION Systemic holistic nursing significantly benefits postoperative patients with colon cancer by promoting gastrointestinal recovery,improving post-operation well-being,reducing complications,and enhancing QoL.展开更多
We report a rare case of Pseudo-Meigs' Syndrome caused by ovarian metastasis from sigmoid colon cancer, which was accompanied by peritoneal dissemination. A 58-year-old female patient presented with massive right ...We report a rare case of Pseudo-Meigs' Syndrome caused by ovarian metastasis from sigmoid colon cancer, which was accompanied by peritoneal dissemination. A 58-year-old female patient presented with massive right pleural effusion, ascites and a huge pelvic mass. Under the diagnosis of an advanced ovarian tumor, bilateral oophorectomy was performed and sigmoidectomy was also carried out after intraoperative diagnosis of peritoneal dissemination involving the sigmoid colon. How- ever, immunohistochemical staining revealed that the ovarian lesions were metastasis from the primary advanced colon cancer. Postoperatively, ascites and pleural effusion subsided, and the diagnosis of Pseudo-Meigs' Syndrome due to a metastatic ovarian tumor from colon cancer was determined. The patient is now undergoing a regimen of chemotherapy for colon cancer without recurrence of ascites or hydrothorax 10 mo after the surgery. Pseudo-Meigs' Syndrome due to a metastaticovarian tumor from colon cancer is rare but clinically important because long-term alleviation of symptoms can be achieved by surgical resection. This case report suggests that selected patients, even with peritoneal dissemination, may obtain palliation from surgical resection of metastatic ovarian tumors.展开更多
Background: We retrospectively identified prognostic factors in patients with Stage III colon cancer and considered the effectiveness of postoperative adjuvant chemotherapy based on these prognostic factors. Methods: ...Background: We retrospectively identified prognostic factors in patients with Stage III colon cancer and considered the effectiveness of postoperative adjuvant chemotherapy based on these prognostic factors. Methods: Two hundred and thirty four patients with lymph node metastases who underwent curative surgery for colon cancer between 1999 and 2005 were enrolled in the present study. Firstly, clinicopathological factors and survival data, were analyzed to determine prognostic factors related to cancer-specific survival. Secondly, we examined the effectiveness of postoperative adjuvant chemotherapy based upon these prognostic factors. Results: The multivariate analysis revealed that differentiation (P = 0.03, Hazard ratio = 2.50), lymphatic invasion (P = 0.02, Hazard ratio = 3.23) and the TNM classification, 7th?edition (P = 0.04, Hazard ratio = 1.94) were found to be significant independent prognostic factors. Among the patients classified as TNM IIIA, the recurrence-free survival rates were extremely good. Among the patients classified as IIIB and IIIC, there was no significant difference between the patients with and without postoperative adjuvant chemotherapy. Conclusion: The present study suggests that the patients with Stage IIIA colon cancer may not require postoperative adjuvant chemotherapy. The addition of oxaliplatin to 5-FU should be considered for the patients with Stage IIIB and IIIC colon cancer, for whom the prognoses are far from satisfactory.展开更多
Pseudo-Meigs' syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female ...Pseudo-Meigs' syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female with a history of surgery for transverse colon cancer and peritoneal dissemination suffered from metachronous ovarian metastases during treatment with systemic chemotherapy. At first, neither ascites nor pleural effusion was observed, but she later complained of progressive abdominal distention and dyspnea caused by rapidly increasing ascites and pleural effusion and rapidly enlarging ovarian metastases. Abdominocenteses were repeated, and cytological examinations of the fluids were all negative for malignant cells. We suspected pseudo-Meigs' syndrome, and bilateral oophorectomies were performed after thorough informed consent. The patient's postoperative condition improved rapidly after surgery. We conclude that pseudo-Meigs' syndrome should be included in the differential diagnosis of massive or rapidly increasing ascites and pleural effusion associated with large or rapidly enlarging ovarian tumors.展开更多
BACKGROUND With advancements in laparoscopic technology and the wide application of linear staplers,sphincter-saving procedures are increasingly performed for low rectal cancer.However,sphincter-saving procedures have...BACKGROUND With advancements in laparoscopic technology and the wide application of linear staplers,sphincter-saving procedures are increasingly performed for low rectal cancer.However,sphincter-saving procedures have led to the emergence of a unique clinical disorder termed anterior rectal resection syndrome.Colonic pouch anastomosis improves the quality of life of patients with rectal cancer>7 cm from the anal margin.But whether colonic pouch anastomosis can reduce the incidence of rectal resection syndrome in patients with low rectal cancer is unknown.AIM To compare postoperative and oncological outcomes and bowel function of straight and colonic pouch anal anastomoses after resection of low rectal cancer.METHODS We conducted a retrospective study of 72 patients with low rectal cancer who underwent sphincter-saving procedures with either straight or colonic pouch anastomoses.Functional evaluations were completed preoperatively and at 1,6,and 12 mo postoperatively.We also compared perioperative and oncological outcomes between two groups that had undergone low or ultralow anterior rectal resection.RESULTS There were no significant differences in mean operating time,blood loss,time to first passage of flatus and excrement,and duration of hospital stay between the colonic pouch and straight anastomosis groups.The incidence of anastomotic leakage following colonic pouch construction was lower(11.4%vs 16.2%)but not significantly different than that of straight anastomosis.Patients with colonic pouch construction had lower postoperative low anterior resection syndrome scores than the straight anastomosis group,suggesting better bowel function(preoperative:4.71 vs 3.89,P=0.43;1 mo after surgery:34.2 vs 34.7,P=0.59;6 mo after surgery:22.70 vs 29.0,P<0.05;12 mo after surgery:15.5 vs 19.5,P=0.01).The overall recurrence and metastasis rates were similar(4.3%and 11.4%,respectively).CONCLUSION Colonic pouch anastomosis is a safe and effective procedure for colorectal reconstruction after low and ultralow rectal resections.Moreover,colonic pouch construction may provide better functional outcomes compared to straight anastomosis.展开更多
AIM:To investigate our clinical experience with the colonic manifestations of phosphatase and tensin homolog on chromosome ten(PTEN)hamartoma tumor syndrome(PHTS)and to perform a systematic literature review regarding...AIM:To investigate our clinical experience with the colonic manifestations of phosphatase and tensin homolog on chromosome ten(PTEN)hamartoma tumor syndrome(PHTS)and to perform a systematic literature review regarding the same.METHODS:This study was approved by the appropriate institutional review board prior to initiation.A clinical genetics database was searched for patients with PHTS or a component syndrome that received gastrointestinal endoscopy or pathology interpretation at our center.These patient’s records were retrospectively reviewed for clinical characteristics(including family history and genetic testing),endoscopy results and pathology findings.We also performed a systematic review of the literature for case series of PHTS or component syndromes that reported gastrointestinal manifestations and investigations published after consensus diagnostic criteria were established in 1996.These results were compiled and reported.RESULTS:Eight patients from our institution met initial inclusion criteria.Of these,5 patients underwent4.2 colonoscopies at mean age 45.8±10.8 years.All were found to have colon polyps during their clinical course and polyp histology included adenoma,hyperplastic,ganglioneuroma and juvenile.No malignant lesions were identified.Two had multiple histologic types.One patient underwent colectomy due to innumerable polyps and concern for future malignant potential.Systematic literature review of PHTS patients undergoing endoscopy revealed 107 patients receiving colonoscopy at mean age 37.4 years.Colon polyps were noted in92.5%and multiple colon polyp histologies were reported in 53.6%.Common polyp histologies included hyperplastic(43.6%),adenoma(40.4%),hamartoma(38.3%),ganglioneuroma(33%)and inflammatory(24.5%)polyps.Twelve(11.2%)patients had colorectal cancer at mean age 46.7 years(range 35-62).Clinical outcomes secondary to colon polyposis and malignancy were not commonly reported.CONCLUSION:PHTS has a high prevalence of colon polyposis with multiple histologic types.It should be considered a mixed polyposis syndrome.Systematic review found an increased prevalence of colorectal cancer and we recommend initiating colonoscopy for colorectal cancer surveillance at age 35 years.展开更多
Lynch syndrome is the fourth most common cancer in the United States, with an early age of onset and poor prognosis. Here, we present a unique case of a patient with progressive colon cancer due to a late diagnosis of...Lynch syndrome is the fourth most common cancer in the United States, with an early age of onset and poor prognosis. Here, we present a unique case of a patient with progressive colon cancer due to a late diagnosis of Lynch syndrome showing excellent response to immunotherapy. A 59-year-old male with a history of rectal cancer 30 years ago came to the hospital due to a fever and further found a large necrotic colon mass. Biopsy was positive for colorectal cancer;however, due to the size of the tumor, the patient was deemed not a surgical candidate and offered hospice with palliative chemotherapy. Based on further workup, the patient was diagnosed with Lynch syndrome, with colon cancer determined to be responsive to Immunotherapy. He was started on JEMPERLI (Dosterlimab-gxly), and after three cycles of therapy, imaging and PET scan were repeated, showing decreased activity and extent of the tumor—a tremendous success.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Cancer colon is one of the most common malignancies.</span><sp...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Cancer colon is one of the most common malignancies.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">After colon cancer surgery patients may experience severe pain.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Several studies have reported that a significant decrease in postoperative pain with propofol while other studies have showed this effect was not significant. </span><b><span style="font-family:Verdana;">Aim:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Our goal was to assess the effect of combined epidural anaesthesia either with propofol</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">or sevoflurane on intraoperative fentanyl consumption and postoperative pain</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">in patients undergoing open surgical resection of colon cancer.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Patients and Methods:</span></b><span style="font-family:Verdana;"> 48 adult patients suffering from cancer colon scheduled for </span><span style="font-family:Verdana;">open surgical resection randomly allocated either to receive epidural-pro</span><span style="font-family:Verdana;">pofol</span><span style="font-family:Verdana;"> by total intra venous anaesthesia</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(TIVA)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(n</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">24) or epidural-sevoflu</span><span style="font-family:Verdana;">rane</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">anaesthesia (n</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">24),</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">intraoperative heart rate and fentanyl consumption and postoperative pain score</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(verbal analogue scale,</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">10) were recorded.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">In our study we found that</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">the intensity of postoperative pain was low in all patients and</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">the propofol based anaesthesia had relatively lower pain scores up to 24</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">hrs postoperatively in comparison to sevoflurane based anaesthesia,</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">intraoperative fentanyl consumption was lower with sevoflurane and heart rate lower with propofol group. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">we recommend that use of multimodal analgesia decrease postoperative pain in all cancer colon patients undergoing open surgery who anaesthetized with either propofol or sevoflurane.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Also use of propofol</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">showed better analgesic outcomes postoperatively.</span>展开更多
The cancer-associated anorexia-cachexia syndrome is observed in 80% of patients with advanced-stage cancer, and is one of the major obstacles in chemo- therapy. Ghrelin is a orexigenic hormone that has been proposed t...The cancer-associated anorexia-cachexia syndrome is observed in 80% of patients with advanced-stage cancer, and is one of the major obstacles in chemo- therapy. Ghrelin is a orexigenic hormone that has been proposed to prevent anorexia. Aim of the study was to determine whether the addition of the ghrelin agonist growth hormone releasing peptide 2 (GHRP-2) to cytotoxic therapy with 5-fluoruracil (5-FU) prevents the anorexia associated with chemotherapy in cancer cachectic mice. Thirty-three BALB/c female tumourbearing mice were randomized to receive a solution containing: (a) placebo; (b) GHRP-2; (c) 5-FU; or (d) 5-FU + GHRP-2. Ten BALB/c no tumour-bearing mice received placebo solution. Food intake and survival were checked. Six hours after the drug injection the cumulative food intake was signifi cantly increased in mice treated with the combination of 5-FU + GHRP-2 versus the 5-FU alone (P = 0.0096). On day 3, the cumulative food intake of mice treated with GHRP-2,5-FU and 5-FU + GHRP-2 signifi cantly increased com- pared with naive and vehicle groups (P = 0.0007, P = 0.0038 and P = 0.0166, respectively). The median survival time was longer in 5-FU + GHRP-2 treated mice than in those with 5-FU, although it was not signifi cant (18 d versus 15.5 d, P = 0.7). For the fi rst time, we demonstrated that the addition of GHRP-2 to cytotoxic therapy with 5-FU improved appetite in tumour-bearing mice with anorexia/cachexia syndrome in early stage. These data suggest that GHRP-2 may improve the effi cacy of therapy and the quality of life of cancer patients thank to the amelioration of their nutritional state.展开更多
Incidence of colorectal cancer(CRC)is on rise.While approximately 70%of all CRC cases are sporadic in nature,20%-25%have familial aggregation and only<5%is hereditary in origin.Identification of individuals with he...Incidence of colorectal cancer(CRC)is on rise.While approximately 70%of all CRC cases are sporadic in nature,20%-25%have familial aggregation and only<5%is hereditary in origin.Identification of individuals with hereditary predilection for CRC is critical,as it has an impact on their overall surgical management including surgical timing,approach&technique and determines the role of prophylactic surgery and outcome.This review highlights the concept of hereditary CRC,provides insight into its molecular basis,possibility of its application into clinical practice and emphasizes the current treatment strategies with surgical management,based on the available international guidelines.展开更多
BACKGROUND Although intracorporeal anastomosis(IA)for colon cancer requires longer operative time than extracorporeal anastomosis(EA),its short-term postoperative results,such as early recovery of bowel movement,have ...BACKGROUND Although intracorporeal anastomosis(IA)for colon cancer requires longer operative time than extracorporeal anastomosis(EA),its short-term postoperative results,such as early recovery of bowel movement,have been reported to be equal or better.As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum,there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells.However,intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified.abdominal cavity in IA.METHODS Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020,75 underwent EA(EA group),and 52 underwent IA(IA group).After propensity score matching,the primary endpoint was 3-year disease-free survival rates,and secondary endpoints were 3-year overall survival rates,type of recurrence,surgical site infection(SSI)incidence,number of days on antibiotics,and postoperative biological responses.RESULTS Three-year disease-free survival rates did not significantly differ between the IA and EA groups(87.2%and 82.7%,respectively,P=0.4473).The 3-year overall survival rates also did not significantly differ between the IA and EA groups(94.7%and 94.7%,respectively;P=0.9891).There was no difference in the type of recurrence between the two groups.In addition,there were no significant differences in SSI incidence or the number of days on antibiotics;however,postoperative biological responses,such as the white blood cell count(10200 vs 8650/mm^(3),P=0.0068),C-reactive protein(6.8 vs 4.5 mg/dL,P=0.0011),and body temperature(37.7 vs 37.5℃,P=0.0079),were significantly higher in the IA group.CONCLUSION IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.展开更多
Objective:The objective of the study was to observe and analyze the characteristics of negative emotions and quality of life(QoL)in patients with nonsmall cell lung cancer(NSCLC)from 1 to 3 months after surgery,and su...Objective:The objective of the study was to observe and analyze the characteristics of negative emotions and quality of life(QoL)in patients with nonsmall cell lung cancer(NSCLC)from 1 to 3 months after surgery,and summarize their population characteristics after surgery.Materials and Methods:The consolidation rehabilitation period was defined as 1 to 3 months after surgery.The main observation indicators were the general Hospital Anxiety and Depression Scale,the European Organization for the Research and Treatment of Cancer Core QoL Questionnaire(EORTC QLQ-C30),and EORTC QLQ-Lung Cancer-13.The secondary observation indicators were peripheral blood cytokines and immune function indicators.Statistical methods such as one-way analysis of variance and logistic regression were used to analyze the characteristics of this part of the population.Results:Among patients who underwent lung surgery,the overall incidence of anxiety during consolidation recovery was 13.66%,and that of depression was 10.38%.The scores of fatigue,pain,dyspnea,insomnia,and loss of appetite were significantly higher than those of other symptoms(P=0.000).The presence of anxiety was associated with the site of surgery(P<0.05)and the presence of depression was associated with emotional functioning and dyspnea(P<0.05).Conclusions:The occurrence of negative emotions in the postoperative NSCLC population is related to gender,and the degree of emotions is negatively correlated with QoL and positively correlated with the degree of symptoms.The main relevant syndromes are the pulmonary and meridian categories.展开更多
A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel ...A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel transperitoneal approach. In this procedure, both ultrasound and laparoscopic images assisted with the accurate injection of analgesic to the correct layer. The combination of laparoscopic visualization and ultrasound imaging ensured infiltration of analgesic into the correct layer without causing damage to the bowel. Twentyfour hours postoperatively, the patient's pain intensity as assessed by the numeric rating scale was 0-1 during coughing, and a continuous intravenous analgesic was not needed. Colostomy is often necessary in colon obstruction. Epidural anesthesia for postoperative pain cannot be used in patients with a coagulation disorder. We report the use of a novel laparoscopic rectus sheath block for colostomy. There has been no literature described about the nerve block with transperitoneal approach. The laparoscopic rectus sheath block was performed safely and had enough analgesic efficacy for postoperative pain. This technique could be considered as an optional anesthetic regimen in acute situations.展开更多
We present a patient with a history of colonic polyposis and family history significant for colon polyps and colorectal cancer(CRC). The patient and the family also had a history of bone loss of the jaw and early toot...We present a patient with a history of colonic polyposis and family history significant for colon polyps and colorectal cancer(CRC). The patient and the family also had a history of bone loss of the jaw and early tooth loss, consistent with oligodontia. Genetic testing revealed the patient to have a previously unpublished variant of unknown significance(VUS) in the AXIN2 gene. These clinical findings have been demonstrated previously in only two other families, both of which exhibited oligodontia, colorectal neoplasia(polyps and cancer) and a heterozygous mutation in AXIN2. The AXIN2 protein is component of the Wnt pathway, which is known to be vital for organism development and cellular homeostasis. Alterations of the Wnt pathway lead to cell proliferation and neoplasm, in addition to agenesis of physical structures(such as teeth). The analysis of our pedigree further supports an association between colonic neoplasm(polyposis and CRC), the AXIN2 gene in general, and this particular VUS. It also highlights the importance of analyzing and disseminating information on pedigrees with less commonly encountered genomic abnormalities so that genotypic-phenotypic correlations can be solidified.展开更多
文摘BACKGROUND Study showed that systemic holistic care not only aids in disease treatment and physical recovery to a certain extent but also effectively enhances patient psychological well-being,social support,and overall quality of life(QoL).AIM To assess systematic holistic care impact on the recovery and well-being of postoperative patients with colon cancer.METHODS Our randomized controlled trial included 98 postoperative patients with colon cancer admitted to our hospital from June 2021 to June 2022.Patients were divided into control and study groups.The control group received conventional postoperative nursing care,whereas the study group received systematic holistic nursing care.We monitored gastrointestinal function recovery,and recorded changes in serum albumin(ALB),prealbumin(PA),psychological state,selfmanagement,self-efficacy,QoL,and the occurrence of complications in patients before,at discharge,and 2 wk post-discharge.Spearman analysis assessed correlations between psychological state,self-management,self-efficacy,and QoL of patients in the study group 2 wk post-discharge.RESULTS Following the nursing intervention,we observed significantly shorter postoperative bowel sound recovery time,anal exhaust time,and defecation time in the study group than in the control group(P<0.05).Patient ALB and PA levels,psychological status,self-management ability,self-efficacy and QoL at discharge and 2 wk post-discharge significantly improved,with greater improvements observed in the study group(P<0.05).Both groups experienced complications post-interventions,but the intervention group had significantly lower complication rate(3/49,6.12%)(P<0.05).In the study group,patient anxiety,depression,self-management and QoL scores at 2 wk post-discharge exhibited a significant negative correlation(3/49,6.12%)with QoL scores,with correlation coefficients of r=-0.273,-0.522,-0.344,and P<0.01,respectively.Conversely,patient self-efficacy scores 2 wk postdischarge showed a positive correlation with QoL scores(r=0.410,P=0.000).CONCLUSION Systemic holistic nursing significantly benefits postoperative patients with colon cancer by promoting gastrointestinal recovery,improving post-operation well-being,reducing complications,and enhancing QoL.
文摘We report a rare case of Pseudo-Meigs' Syndrome caused by ovarian metastasis from sigmoid colon cancer, which was accompanied by peritoneal dissemination. A 58-year-old female patient presented with massive right pleural effusion, ascites and a huge pelvic mass. Under the diagnosis of an advanced ovarian tumor, bilateral oophorectomy was performed and sigmoidectomy was also carried out after intraoperative diagnosis of peritoneal dissemination involving the sigmoid colon. How- ever, immunohistochemical staining revealed that the ovarian lesions were metastasis from the primary advanced colon cancer. Postoperatively, ascites and pleural effusion subsided, and the diagnosis of Pseudo-Meigs' Syndrome due to a metastatic ovarian tumor from colon cancer was determined. The patient is now undergoing a regimen of chemotherapy for colon cancer without recurrence of ascites or hydrothorax 10 mo after the surgery. Pseudo-Meigs' Syndrome due to a metastaticovarian tumor from colon cancer is rare but clinically important because long-term alleviation of symptoms can be achieved by surgical resection. This case report suggests that selected patients, even with peritoneal dissemination, may obtain palliation from surgical resection of metastatic ovarian tumors.
文摘Background: We retrospectively identified prognostic factors in patients with Stage III colon cancer and considered the effectiveness of postoperative adjuvant chemotherapy based on these prognostic factors. Methods: Two hundred and thirty four patients with lymph node metastases who underwent curative surgery for colon cancer between 1999 and 2005 were enrolled in the present study. Firstly, clinicopathological factors and survival data, were analyzed to determine prognostic factors related to cancer-specific survival. Secondly, we examined the effectiveness of postoperative adjuvant chemotherapy based upon these prognostic factors. Results: The multivariate analysis revealed that differentiation (P = 0.03, Hazard ratio = 2.50), lymphatic invasion (P = 0.02, Hazard ratio = 3.23) and the TNM classification, 7th?edition (P = 0.04, Hazard ratio = 1.94) were found to be significant independent prognostic factors. Among the patients classified as TNM IIIA, the recurrence-free survival rates were extremely good. Among the patients classified as IIIB and IIIC, there was no significant difference between the patients with and without postoperative adjuvant chemotherapy. Conclusion: The present study suggests that the patients with Stage IIIA colon cancer may not require postoperative adjuvant chemotherapy. The addition of oxaliplatin to 5-FU should be considered for the patients with Stage IIIB and IIIC colon cancer, for whom the prognoses are far from satisfactory.
基金Supported by Fujieda Municipal General Hospital,Surugadai,Fujieda,Shizuoka,Japan
文摘Pseudo-Meigs' syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female with a history of surgery for transverse colon cancer and peritoneal dissemination suffered from metachronous ovarian metastases during treatment with systemic chemotherapy. At first, neither ascites nor pleural effusion was observed, but she later complained of progressive abdominal distention and dyspnea caused by rapidly increasing ascites and pleural effusion and rapidly enlarging ovarian metastases. Abdominocenteses were repeated, and cytological examinations of the fluids were all negative for malignant cells. We suspected pseudo-Meigs' syndrome, and bilateral oophorectomies were performed after thorough informed consent. The patient's postoperative condition improved rapidly after surgery. We conclude that pseudo-Meigs' syndrome should be included in the differential diagnosis of massive or rapidly increasing ascites and pleural effusion associated with large or rapidly enlarging ovarian tumors.
基金Supported by Chongqing Key Diseases Research and Application Demonstration Program(Colorectal Cancer Prevention and Treatment Technology and Research Application Demonstration),No.2019ZX003.
文摘BACKGROUND With advancements in laparoscopic technology and the wide application of linear staplers,sphincter-saving procedures are increasingly performed for low rectal cancer.However,sphincter-saving procedures have led to the emergence of a unique clinical disorder termed anterior rectal resection syndrome.Colonic pouch anastomosis improves the quality of life of patients with rectal cancer>7 cm from the anal margin.But whether colonic pouch anastomosis can reduce the incidence of rectal resection syndrome in patients with low rectal cancer is unknown.AIM To compare postoperative and oncological outcomes and bowel function of straight and colonic pouch anal anastomoses after resection of low rectal cancer.METHODS We conducted a retrospective study of 72 patients with low rectal cancer who underwent sphincter-saving procedures with either straight or colonic pouch anastomoses.Functional evaluations were completed preoperatively and at 1,6,and 12 mo postoperatively.We also compared perioperative and oncological outcomes between two groups that had undergone low or ultralow anterior rectal resection.RESULTS There were no significant differences in mean operating time,blood loss,time to first passage of flatus and excrement,and duration of hospital stay between the colonic pouch and straight anastomosis groups.The incidence of anastomotic leakage following colonic pouch construction was lower(11.4%vs 16.2%)but not significantly different than that of straight anastomosis.Patients with colonic pouch construction had lower postoperative low anterior resection syndrome scores than the straight anastomosis group,suggesting better bowel function(preoperative:4.71 vs 3.89,P=0.43;1 mo after surgery:34.2 vs 34.7,P=0.59;6 mo after surgery:22.70 vs 29.0,P<0.05;12 mo after surgery:15.5 vs 19.5,P=0.01).The overall recurrence and metastasis rates were similar(4.3%and 11.4%,respectively).CONCLUSION Colonic pouch anastomosis is a safe and effective procedure for colorectal reconstruction after low and ultralow rectal resections.Moreover,colonic pouch construction may provide better functional outcomes compared to straight anastomosis.
文摘AIM:To investigate our clinical experience with the colonic manifestations of phosphatase and tensin homolog on chromosome ten(PTEN)hamartoma tumor syndrome(PHTS)and to perform a systematic literature review regarding the same.METHODS:This study was approved by the appropriate institutional review board prior to initiation.A clinical genetics database was searched for patients with PHTS or a component syndrome that received gastrointestinal endoscopy or pathology interpretation at our center.These patient’s records were retrospectively reviewed for clinical characteristics(including family history and genetic testing),endoscopy results and pathology findings.We also performed a systematic review of the literature for case series of PHTS or component syndromes that reported gastrointestinal manifestations and investigations published after consensus diagnostic criteria were established in 1996.These results were compiled and reported.RESULTS:Eight patients from our institution met initial inclusion criteria.Of these,5 patients underwent4.2 colonoscopies at mean age 45.8±10.8 years.All were found to have colon polyps during their clinical course and polyp histology included adenoma,hyperplastic,ganglioneuroma and juvenile.No malignant lesions were identified.Two had multiple histologic types.One patient underwent colectomy due to innumerable polyps and concern for future malignant potential.Systematic literature review of PHTS patients undergoing endoscopy revealed 107 patients receiving colonoscopy at mean age 37.4 years.Colon polyps were noted in92.5%and multiple colon polyp histologies were reported in 53.6%.Common polyp histologies included hyperplastic(43.6%),adenoma(40.4%),hamartoma(38.3%),ganglioneuroma(33%)and inflammatory(24.5%)polyps.Twelve(11.2%)patients had colorectal cancer at mean age 46.7 years(range 35-62).Clinical outcomes secondary to colon polyposis and malignancy were not commonly reported.CONCLUSION:PHTS has a high prevalence of colon polyposis with multiple histologic types.It should be considered a mixed polyposis syndrome.Systematic review found an increased prevalence of colorectal cancer and we recommend initiating colonoscopy for colorectal cancer surveillance at age 35 years.
文摘Lynch syndrome is the fourth most common cancer in the United States, with an early age of onset and poor prognosis. Here, we present a unique case of a patient with progressive colon cancer due to a late diagnosis of Lynch syndrome showing excellent response to immunotherapy. A 59-year-old male with a history of rectal cancer 30 years ago came to the hospital due to a fever and further found a large necrotic colon mass. Biopsy was positive for colorectal cancer;however, due to the size of the tumor, the patient was deemed not a surgical candidate and offered hospice with palliative chemotherapy. Based on further workup, the patient was diagnosed with Lynch syndrome, with colon cancer determined to be responsive to Immunotherapy. He was started on JEMPERLI (Dosterlimab-gxly), and after three cycles of therapy, imaging and PET scan were repeated, showing decreased activity and extent of the tumor—a tremendous success.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Cancer colon is one of the most common malignancies.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">After colon cancer surgery patients may experience severe pain.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Several studies have reported that a significant decrease in postoperative pain with propofol while other studies have showed this effect was not significant. </span><b><span style="font-family:Verdana;">Aim:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Our goal was to assess the effect of combined epidural anaesthesia either with propofol</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">or sevoflurane on intraoperative fentanyl consumption and postoperative pain</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">in patients undergoing open surgical resection of colon cancer.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Patients and Methods:</span></b><span style="font-family:Verdana;"> 48 adult patients suffering from cancer colon scheduled for </span><span style="font-family:Verdana;">open surgical resection randomly allocated either to receive epidural-pro</span><span style="font-family:Verdana;">pofol</span><span style="font-family:Verdana;"> by total intra venous anaesthesia</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(TIVA)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(n</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">24) or epidural-sevoflu</span><span style="font-family:Verdana;">rane</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">anaesthesia (n</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">24),</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">intraoperative heart rate and fentanyl consumption and postoperative pain score</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(verbal analogue scale,</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">10) were recorded.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">In our study we found that</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">the intensity of postoperative pain was low in all patients and</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">the propofol based anaesthesia had relatively lower pain scores up to 24</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">hrs postoperatively in comparison to sevoflurane based anaesthesia,</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">intraoperative fentanyl consumption was lower with sevoflurane and heart rate lower with propofol group. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">we recommend that use of multimodal analgesia decrease postoperative pain in all cancer colon patients undergoing open surgery who anaesthetized with either propofol or sevoflurane.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Also use of propofol</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">showed better analgesic outcomes postoperatively.</span>
基金Supported by (in part) A Grant-in-Aid for Scientic Research (B:16390208) from the Ministry of Education, Culture, Sports, Science and Technology of Japan (to A.I.)
文摘The cancer-associated anorexia-cachexia syndrome is observed in 80% of patients with advanced-stage cancer, and is one of the major obstacles in chemo- therapy. Ghrelin is a orexigenic hormone that has been proposed to prevent anorexia. Aim of the study was to determine whether the addition of the ghrelin agonist growth hormone releasing peptide 2 (GHRP-2) to cytotoxic therapy with 5-fluoruracil (5-FU) prevents the anorexia associated with chemotherapy in cancer cachectic mice. Thirty-three BALB/c female tumourbearing mice were randomized to receive a solution containing: (a) placebo; (b) GHRP-2; (c) 5-FU; or (d) 5-FU + GHRP-2. Ten BALB/c no tumour-bearing mice received placebo solution. Food intake and survival were checked. Six hours after the drug injection the cumulative food intake was signifi cantly increased in mice treated with the combination of 5-FU + GHRP-2 versus the 5-FU alone (P = 0.0096). On day 3, the cumulative food intake of mice treated with GHRP-2,5-FU and 5-FU + GHRP-2 signifi cantly increased com- pared with naive and vehicle groups (P = 0.0007, P = 0.0038 and P = 0.0166, respectively). The median survival time was longer in 5-FU + GHRP-2 treated mice than in those with 5-FU, although it was not signifi cant (18 d versus 15.5 d, P = 0.7). For the fi rst time, we demonstrated that the addition of GHRP-2 to cytotoxic therapy with 5-FU improved appetite in tumour-bearing mice with anorexia/cachexia syndrome in early stage. These data suggest that GHRP-2 may improve the effi cacy of therapy and the quality of life of cancer patients thank to the amelioration of their nutritional state.
文摘Incidence of colorectal cancer(CRC)is on rise.While approximately 70%of all CRC cases are sporadic in nature,20%-25%have familial aggregation and only<5%is hereditary in origin.Identification of individuals with hereditary predilection for CRC is critical,as it has an impact on their overall surgical management including surgical timing,approach&technique and determines the role of prophylactic surgery and outcome.This review highlights the concept of hereditary CRC,provides insight into its molecular basis,possibility of its application into clinical practice and emphasizes the current treatment strategies with surgical management,based on the available international guidelines.
基金This study was reviewed and approved by the Ethics Review Committee of the Research Ethics Committee,Tokai University School of Medicine(23RC011).
文摘BACKGROUND Although intracorporeal anastomosis(IA)for colon cancer requires longer operative time than extracorporeal anastomosis(EA),its short-term postoperative results,such as early recovery of bowel movement,have been reported to be equal or better.As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum,there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells.However,intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified.abdominal cavity in IA.METHODS Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020,75 underwent EA(EA group),and 52 underwent IA(IA group).After propensity score matching,the primary endpoint was 3-year disease-free survival rates,and secondary endpoints were 3-year overall survival rates,type of recurrence,surgical site infection(SSI)incidence,number of days on antibiotics,and postoperative biological responses.RESULTS Three-year disease-free survival rates did not significantly differ between the IA and EA groups(87.2%and 82.7%,respectively,P=0.4473).The 3-year overall survival rates also did not significantly differ between the IA and EA groups(94.7%and 94.7%,respectively;P=0.9891).There was no difference in the type of recurrence between the two groups.In addition,there were no significant differences in SSI incidence or the number of days on antibiotics;however,postoperative biological responses,such as the white blood cell count(10200 vs 8650/mm^(3),P=0.0068),C-reactive protein(6.8 vs 4.5 mg/dL,P=0.0011),and body temperature(37.7 vs 37.5℃,P=0.0079),were significantly higher in the IA group.CONCLUSION IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.
基金supported by the National Natural Science Foundation of China(No.81973810)Shanghai Science and Technology Commission“Science and Technology Innovation Action Plan”medical innovation research special project(No.22Y31920400)Clinical Collaboration Pilot Project of Traditional Chinese and Western Medicine from Shanghai Municipal Health Commission(ZXYXZ-201901)。
文摘Objective:The objective of the study was to observe and analyze the characteristics of negative emotions and quality of life(QoL)in patients with nonsmall cell lung cancer(NSCLC)from 1 to 3 months after surgery,and summarize their population characteristics after surgery.Materials and Methods:The consolidation rehabilitation period was defined as 1 to 3 months after surgery.The main observation indicators were the general Hospital Anxiety and Depression Scale,the European Organization for the Research and Treatment of Cancer Core QoL Questionnaire(EORTC QLQ-C30),and EORTC QLQ-Lung Cancer-13.The secondary observation indicators were peripheral blood cytokines and immune function indicators.Statistical methods such as one-way analysis of variance and logistic regression were used to analyze the characteristics of this part of the population.Results:Among patients who underwent lung surgery,the overall incidence of anxiety during consolidation recovery was 13.66%,and that of depression was 10.38%.The scores of fatigue,pain,dyspnea,insomnia,and loss of appetite were significantly higher than those of other symptoms(P=0.000).The presence of anxiety was associated with the site of surgery(P<0.05)and the presence of depression was associated with emotional functioning and dyspnea(P<0.05).Conclusions:The occurrence of negative emotions in the postoperative NSCLC population is related to gender,and the degree of emotions is negatively correlated with QoL and positively correlated with the degree of symptoms.The main relevant syndromes are the pulmonary and meridian categories.
文摘A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel transperitoneal approach. In this procedure, both ultrasound and laparoscopic images assisted with the accurate injection of analgesic to the correct layer. The combination of laparoscopic visualization and ultrasound imaging ensured infiltration of analgesic into the correct layer without causing damage to the bowel. Twentyfour hours postoperatively, the patient's pain intensity as assessed by the numeric rating scale was 0-1 during coughing, and a continuous intravenous analgesic was not needed. Colostomy is often necessary in colon obstruction. Epidural anesthesia for postoperative pain cannot be used in patients with a coagulation disorder. We report the use of a novel laparoscopic rectus sheath block for colostomy. There has been no literature described about the nerve block with transperitoneal approach. The laparoscopic rectus sheath block was performed safely and had enough analgesic efficacy for postoperative pain. This technique could be considered as an optional anesthetic regimen in acute situations.
文摘We present a patient with a history of colonic polyposis and family history significant for colon polyps and colorectal cancer(CRC). The patient and the family also had a history of bone loss of the jaw and early tooth loss, consistent with oligodontia. Genetic testing revealed the patient to have a previously unpublished variant of unknown significance(VUS) in the AXIN2 gene. These clinical findings have been demonstrated previously in only two other families, both of which exhibited oligodontia, colorectal neoplasia(polyps and cancer) and a heterozygous mutation in AXIN2. The AXIN2 protein is component of the Wnt pathway, which is known to be vital for organism development and cellular homeostasis. Alterations of the Wnt pathway lead to cell proliferation and neoplasm, in addition to agenesis of physical structures(such as teeth). The analysis of our pedigree further supports an association between colonic neoplasm(polyposis and CRC), the AXIN2 gene in general, and this particular VUS. It also highlights the importance of analyzing and disseminating information on pedigrees with less commonly encountered genomic abnormalities so that genotypic-phenotypic correlations can be solidified.
