Computed tomography colonography(CTC) in colorectal cancer(CRC) screening has two roles:one present and the other potential.The present role is,without any further discussion,the integration into established screening...Computed tomography colonography(CTC) in colorectal cancer(CRC) screening has two roles:one present and the other potential.The present role is,without any further discussion,the integration into established screening programs as a replacement for barium enema in the case of incomplete colonoscopy.The potential role is the use of CTC as a first-line screening method together with Fecal Occult Blood Test,sigmoidoscopy and colonoscopy.However,despite the fact that CTC has been officially endorsed for CRC screening of average-risk individuals by different scientif ic societies including the American Cancer Society,the American College of Radiology,and the US Multisociety Task Force on Colorectal Cancer,other entities,such as the US Preventive Services Task Force,have considered the evidence insuff icient to justify its use as a mass screening method.Medicare has also recently denied reimbursement for CTC as a screening test.Nevertheless,multiple advantages exist for using CTC as a CRC screening test:high accuracy,full evaluation of the colon in virtually all patients,non-invasiveness,safety,patient comfort,detection of extracolonic findings and cost-effectiveness.The main potential drawback of a CTC screening is the exposure to ionizing radiation.However,this is not a major issue,since low-dose protocols are now routinely implemented,delivering a dose comparable or slightly superior to the annual radiation exposure of any individual.Indirect evidence exists that such a radiation exposure does not induce additional cancers.展开更多
Pancreatic schwannoma is a very uncommon tumor of the pancreas,with only 27 cases reported.Most pancreatic schwannomas are benign,with only four malignant tumors reported.We describe a case of giant malignant schwanno...Pancreatic schwannoma is a very uncommon tumor of the pancreas,with only 27 cases reported.Most pancreatic schwannomas are benign,with only four malignant tumors reported.We describe a case of giant malignant schwannoma of the pancreatic body and tail,which involved the transverse colon.The tumor was treated successfully with en bloc distal splenopancreatectomy and colon resection.This is believed to be the first reported radical operation for malignant schwannoma of the pancreatic body,with infiltration of the transverse colon,with excellent longterm results.The patient is alive and well 28 mo after the operation.The authors conclude that pancreatic schwannomas should be considered in the differential diagnosis of cystic neoplasms of the pancreas,although the diagnosis can only be confirmed by microscopic examination.In the case of the benign tumors,local excision is adequate,but in the case of malignant schwannoma,oncological standards must be fulfilled.展开更多
Approximately 10%–18%of patients with colon cancer present with obstruction at the initial diagnosis.Despite active screening efforts,the incidence of obstructive colon cancer remains stable.Traditionally,emergency s...Approximately 10%–18%of patients with colon cancer present with obstruction at the initial diagnosis.Despite active screening efforts,the incidence of obstructive colon cancer remains stable.Traditionally,emergency surgery has been indicated to treat patients with obstructive colon cancer.However,compared to patients undergoing elective surgery,the morbidity and mortality rates of patients requiring emergency surgery for obstructive colon cancer are high.With the advancement of colonoscopic techniques and equipment,a self-expandable metal stent(SEMS)was introduced to relieve obstructive symptoms,allowing the patient’s general condition to be restored and for them undergo elective surgery.As the use of SEMS placement is growing,controversies about its application in potentially curable diseases have been raised.In this review,the short-and longterm outcomes of different treatment strategies,particularly emergency surgery vs SEMS placement followed by elective surgery in resectable,locally advanced obstructive colon cancer,are described based on the location of the obstructive cancer lesion.Controversies regarding each treatment strategy are discussed.To overcome current obstacles,a potential diagnostic method using circulating tumor DNA and further research directions incorporating neoadjuvant chemotherapy are introduced.展开更多
Computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique,test characteristics,acceptance,safety,c...Computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique,test characteristics,acceptance,safety,cost-effectiveness,follow-up strategy,and extracolonic findings. In summary,CTC technique is still evolving,and further research is needed to clarify the role of automated colonic insufflation,smooth-muscle relaxants,intravenous and oral contrast,soft-ware rendering,and patient positioning. Currently,full bowel preparation is still required to achieve optimal results. The sensitivity for detecting large polyps (> 1 cm) can be as high as 85%,with specificity of up to 97%. These test characteristics are almost comparable to those of conventional colonoscopy. Patient acceptance of CTC is generally higher than that for colonoscopy,especially in patients who have never undergone either procedure. CTC is generally safe,although uncommon instances of colonic perforation have been documented. In terms of cost-effectiveness,most decision analyses have concluded that CTC would only be cost-effective if it were considerably cheaper than conventional colonoscopy. The proper follow-up strategy for small polyps or incidental extracolonic findings discovered during CTC is still under debate. At present,the exact clinical role of virtual colonoscopy still awaits determination. Even though widespread CTC screening is not available today,in the future there may eventually be a role for this technology. Technological advances in this area will undoubtedly continue,with multi-detector row CT scanners allowing thinner collimation and higher reso-lution images. Stool-tagging techniques are likely to evolve and may eventually allow for low-preparation CTC. Perceptual and fatigue-related reading errors can potentially be minimized with the help of computer-aided detection software. Further research will define the exact role of this promising technology in our diagnostic armamentarium.展开更多
BACKGROUND Changes in bowel function after right-sided colectomy are not well understood compared to those associated with left-sided colectomy or rectal resection.In particular,there are concerns about bowel function...BACKGROUND Changes in bowel function after right-sided colectomy are not well understood compared to those associated with left-sided colectomy or rectal resection.In particular,there are concerns about bowel function after right-sided colectomy with complete mesocolic excision,which has become popular in the West.AIM To evaluate the functional outcomes of patients who underwent right-sided colectomy with D3 lymphadenectomy for colon cancer.METHODS Functional data from patients who underwent minimally invasive right-sided colectomy for colon cancer from October 2017 to September 2018 were prospectively collected.Functional outcomes were evaluated preoperatively and at 3,6,12,and 18 mo postoperatively.RESULTS Prior to surgery,57 patients answered the questionnaire,and 47 responded at three months,52 at 6 mo,52 at 12 mo,and 25 at 18 mo postoperatively.Most scales of quality of life and bowel function improved significantly over time.Urgency persisted to a high degree throughout the period without a significant change over time.The use of medications for defecation was about 10%over the entire period.Gas(P=0.023)and fecal frequency(P<0.001)increased,and bowel dysfunction group(P=0.028)was more common among patients taking medication.At six months,resected bowel and colon lengths were significantly different as a risk factor between the dysfunction group and the no dysfunction group[odd ratio(OR):1.095,P=0.026;OR:1.147,P=0.031,respectively]in univariate analysis,but not in multivariate analysis.CONCLUSION Despite D3 lymphadenectomy,most bowel symptoms improved over time after right-sided colectomy using a minimally invasive approach,and continuous medication was needed in only approximately 10%of patients.展开更多
BACKGROUND The use of intra-operative colonic lavage(IOCL)with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies,with alternatives including Hartmann’s procedure,manual dec...BACKGROUND The use of intra-operative colonic lavage(IOCL)with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies,with alternatives including Hartmann’s procedure,manual decompression and subtotal colectomy.AIM To compare the peri-operative outcomes of IOCL to other procedures.METHODS Electronic databases were searched for articles employing IOCL from inception till July 13,2020.Odds ratio and weighted mean differences(WMD)were estimated for dichotomous and continuous outcomes respectively.Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.RESULTS Of 28 studies were included in this meta-analysis,involving 1142 undergoing IOCL,and 634 other interventions.IOCL leads to comparable rates of wound infection when compared to Hartmann’s procedure,and anastomotic leak and wound infection when compared to manual decompression.There was a decreased length of hospital stay(WMD=-7.750;95%CI:-13.504 to-1.996;P=0.008)compared to manual decompression and an increased operating time.Single-arm meta-analysis found that overall mortality rates with IOCL was 4%(CI:0.03-0.05).Rates of anastomotic leak and wound infection were 3%(CI:0.02-0.04)and 12%(CI:0.09-0.16)respectively.CONCLUSION IOCL leads to similar rates of post-operative complications compared to other procedures.More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.展开更多
BACKGROUND Approximately 40%of colorectal cancer(CRC)cases are linked to Kirsten rat sarcoma viral oncogene homolog(KRAS)mutations.KRAS mutations are associated with poor CRC prognosis,especially KRAS codon 12 mutatio...BACKGROUND Approximately 40%of colorectal cancer(CRC)cases are linked to Kirsten rat sarcoma viral oncogene homolog(KRAS)mutations.KRAS mutations are associated with poor CRC prognosis,especially KRAS codon 12 mutation,which is associated with metastasis and poorer survival.However,the clinicopathological characteristics and prognosis of KRAS codon 13 mutation in CRC remain unclear.AIM To evaluate the clinicopathological characteristics and prognostic value of codonspecific KRAS mutations,especially in codon 13.METHODS This retrospective,single-center,observational cohort study included patients who underwent surgery for stage I-III CRC between January 2009 and December 2019.Patients with KRAS mutation status confirmed by molecular pathology reports were included.The relationships between clinicopathological characteristics and individual codon-specific KRAS mutations were analyzed.Survival data were analyzed to identify codon-specific KRAS mutations as recurrence-related factors using the Cox proportional hazards regression model.RESULTS Among the 2203 patients,the incidence of KRAS codons 12,13,and 61 mutations was 27.7%,9.1%,and 1.3%,respectively.Both KARS codons 12 and 13 mutations showed a tendency to be associated with clinical characteristics,but only codon 12 was associated with pathological features,such as stage of primary tumor(T stage),lymph node involvement(N stage),vascular invasion,perineural invasion,tumor size,and microsatellite instability.KRAS codon 13 mutation showed no associations(77.2%vs 85.3%,P=0.159),whereas codon 12 was associated with a lower 5-year recurrence-free survival rate(78.9%vs 75.5%,P=0.025).In multivariable analysis,along with T and N stages and vascular and perineural invasion,only codon 12(hazard ratio:1.399;95%confidence interval:1.034-1.894;P=0.030)among KRAS mutations was an independent risk factor for recurrence.CONCLUSION This study provides evidence that KRAS codon 13 mutation is less likely to serve as a prognostic biomarker than codon 12 mutation for CRC in a large-scale cohort.展开更多
This study was a systematic review of the available evidence on quality of life in patients after laparoscopic or open colorectal surgery. A systematic review was performed of all randomized clinical trials (RCTs) tha...This study was a systematic review of the available evidence on quality of life in patients after laparoscopic or open colorectal surgery. A systematic review was performed of all randomized clinical trials (RCTs) that compared laparoscopic with open colorectal surgery. Study selection, quality assessment and data extraction were carried out independently by two reviewers. Primary endpoint was quality of life after laparoscopic and open colorectal surgery, as assessed by validated questionnaires. The search resulted in nine RCTs that included 2263 patients. Shortand long-term results of these RCTs were described in 13 articles. Postoperative follow-up ranged from 2 d to 6.7 years. Due to clinical heterogeneity, no meta-analysis could be conducted. Four RCTs did not show any difference in quality of life between laparoscopic or open colorectal surgery. The remaining five studies reported a better quality of life in favor of the laparoscopic group on a few quality of life scales at time points ranging from 1 wk to 2 years after surgery. In conclusion, based on presently available high-level evidence, this systematic review showed no clinically relevant differences in postoperative quality of life between laparoscopic and open colorectal surgery.展开更多
BACKGROUND Lymphangiomatosis is a multisystem disorder that is rarely localized to the gastrointestinal tract.Lymphangiomatosis usually has no specific clinical presentation and is easily misdiagnosed.A case report an...BACKGROUND Lymphangiomatosis is a multisystem disorder that is rarely localized to the gastrointestinal tract.Lymphangiomatosis usually has no specific clinical presentation and is easily misdiagnosed.A case report and review of the literature on lymphangiomatosis associated with protein-losing enteropathy will help to improve the overall understanding of this disease.CASE SUMMARY We report a case of lymphangiomatosis of the bowel and other solid organs.A 78-year-old man presented with recurrent bowel bleeding and protein-losing enteropathy,as well as cystic lesions in the spleen,liver,and kidney.Imaging examinations revealed many cystic lesions on the spleen,liver,kidney,and thickened wall of the ascending colon,as well as pleural effusion and ascites.Colonoscopy revealed a strawberry mucosa,variable spontaneous bleeding,and surface erosion located in the terminal ileum.Several cystic masses with a translucent and smooth surface as well as diffuse white spots were located in the colon.A laterally spreading tumor(LST)was located in the ascending colon.Pathology indicated highly differentiated adenocarcinoma(LST)and lymphangiomatoid dilation,and D2-40 was positive.The final diagnosis was lymphangiomatosis.The patient underwent surgery for LST and then was administered thalidomide 75-150 mg/d.His condition,however,did not improve.He eventually died 6 mo after the initial diagnosis.CONCLUSION Lymphangiomatosis usually occurs diffusely and can involve many organs,such as the spleen,kidney,liver,lung,mesentery,and bowel.Recurrent bowel bleeding or protein-losing enteropathy is an important indicator that should alert clinicians about the possibility of this disease when it afflicts the bowel.Doctors should improve the medical understanding of lymphangiomatosis.展开更多
Colon capsule endoscopy(CCE)was introduced nearly two decades ago.Initially,it was limited by poor image quality and short battery time,but due to technical improvements,it has become an equal diagnostic alternative t...Colon capsule endoscopy(CCE)was introduced nearly two decades ago.Initially,it was limited by poor image quality and short battery time,but due to technical improvements,it has become an equal diagnostic alternative to optical colonoscopy(OC).Hastened by the coronavirus disease 2019 pandemic,CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics.A wider adoption of CCE would be bolstered by positive patient experience,as it offers a diagnostic investigation that is not inferior to other modalities.The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps.Solving this issue would improve the stratification of patients for polyp removal.Artificial intelligence(AI)has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations.Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs.With this letter,we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.展开更多
OBJECTIVE: To observe the anticancer effects of the granular preparation of Tenglong Buzhong decoction(藤龙补中汤,TBD), i.e Tenglong Buzhong granules(藤龙补中颗粒, TBG), in human SW620 colon cancer. METHODS: BALB/c nu...OBJECTIVE: To observe the anticancer effects of the granular preparation of Tenglong Buzhong decoction(藤龙补中汤,TBD), i.e Tenglong Buzhong granules(藤龙补中颗粒, TBG), in human SW620 colon cancer. METHODS: BALB/c nude mice were subcutaneously transplanted with SW620 cells, and treated with TBG(2.56 g/kg, once per day) and/or 5-Fu(104 mg/kg, once per week) for 21 d. Apoptosis, Caspase activities and cellular senescence were measured by commercial kits. The protein expression and phosphorylation were detected by Western blot or immunohistochemistry. RESULTS: TBG and 5-Fu inhibited tumor growth. The tumor inhibition rate of the TBG, 5-Fu, and TBG+5-Fu groups was 42.25%, 51.58%, and 76.08%, respectively. Combination of TBG and 5-Fu showed synergetic anticancer effects. TBG and 5-Fu induced apoptosis, activated caspase-3,-8, and-9, increased SMAC expression, inhibited XIAP expression. TBG induced cellular senescence, upregulated cyclin-dependent kinase inhibitor 1a(CDKN1a) and cyclin-dependent kinase inhibitor 2a(CDKN2a) expression, and inhibited phosphorylation of retinoblastoma-associated protein(RB) and expression of cyclin E1(CCNE1) and cyclindependent kinases(CDK) 2. TBG also inhibited angiogenesis accompanied by downregulation of vascular endothelial growth factor(VEGF) and hypoxiainducible factor-1α(HIF-1α). CONCLUSIONS: TBG inhibits SW620 colon cancer growth, induces apoptosis via SMAC-XIAP-Caspases signaling, induces cellular senescence through CDKN1a/CDKN2a-RB-E2F signaling, inhibits angiogenesis by down-regulation of HIF-1α and VEGF, and enhances the effects of 5-Fu.展开更多
文摘Computed tomography colonography(CTC) in colorectal cancer(CRC) screening has two roles:one present and the other potential.The present role is,without any further discussion,the integration into established screening programs as a replacement for barium enema in the case of incomplete colonoscopy.The potential role is the use of CTC as a first-line screening method together with Fecal Occult Blood Test,sigmoidoscopy and colonoscopy.However,despite the fact that CTC has been officially endorsed for CRC screening of average-risk individuals by different scientif ic societies including the American Cancer Society,the American College of Radiology,and the US Multisociety Task Force on Colorectal Cancer,other entities,such as the US Preventive Services Task Force,have considered the evidence insuff icient to justify its use as a mass screening method.Medicare has also recently denied reimbursement for CTC as a screening test.Nevertheless,multiple advantages exist for using CTC as a CRC screening test:high accuracy,full evaluation of the colon in virtually all patients,non-invasiveness,safety,patient comfort,detection of extracolonic findings and cost-effectiveness.The main potential drawback of a CTC screening is the exposure to ionizing radiation.However,this is not a major issue,since low-dose protocols are now routinely implemented,delivering a dose comparable or slightly superior to the annual radiation exposure of any individual.Indirect evidence exists that such a radiation exposure does not induce additional cancers.
文摘Pancreatic schwannoma is a very uncommon tumor of the pancreas,with only 27 cases reported.Most pancreatic schwannomas are benign,with only four malignant tumors reported.We describe a case of giant malignant schwannoma of the pancreatic body and tail,which involved the transverse colon.The tumor was treated successfully with en bloc distal splenopancreatectomy and colon resection.This is believed to be the first reported radical operation for malignant schwannoma of the pancreatic body,with infiltration of the transverse colon,with excellent longterm results.The patient is alive and well 28 mo after the operation.The authors conclude that pancreatic schwannomas should be considered in the differential diagnosis of cystic neoplasms of the pancreas,although the diagnosis can only be confirmed by microscopic examination.In the case of the benign tumors,local excision is adequate,but in the case of malignant schwannoma,oncological standards must be fulfilled.
文摘Approximately 10%–18%of patients with colon cancer present with obstruction at the initial diagnosis.Despite active screening efforts,the incidence of obstructive colon cancer remains stable.Traditionally,emergency surgery has been indicated to treat patients with obstructive colon cancer.However,compared to patients undergoing elective surgery,the morbidity and mortality rates of patients requiring emergency surgery for obstructive colon cancer are high.With the advancement of colonoscopic techniques and equipment,a self-expandable metal stent(SEMS)was introduced to relieve obstructive symptoms,allowing the patient’s general condition to be restored and for them undergo elective surgery.As the use of SEMS placement is growing,controversies about its application in potentially curable diseases have been raised.In this review,the short-and longterm outcomes of different treatment strategies,particularly emergency surgery vs SEMS placement followed by elective surgery in resectable,locally advanced obstructive colon cancer,are described based on the location of the obstructive cancer lesion.Controversies regarding each treatment strategy are discussed.To overcome current obstacles,a potential diagnostic method using circulating tumor DNA and further research directions incorporating neoadjuvant chemotherapy are introduced.
文摘Computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique,test characteristics,acceptance,safety,cost-effectiveness,follow-up strategy,and extracolonic findings. In summary,CTC technique is still evolving,and further research is needed to clarify the role of automated colonic insufflation,smooth-muscle relaxants,intravenous and oral contrast,soft-ware rendering,and patient positioning. Currently,full bowel preparation is still required to achieve optimal results. The sensitivity for detecting large polyps (> 1 cm) can be as high as 85%,with specificity of up to 97%. These test characteristics are almost comparable to those of conventional colonoscopy. Patient acceptance of CTC is generally higher than that for colonoscopy,especially in patients who have never undergone either procedure. CTC is generally safe,although uncommon instances of colonic perforation have been documented. In terms of cost-effectiveness,most decision analyses have concluded that CTC would only be cost-effective if it were considerably cheaper than conventional colonoscopy. The proper follow-up strategy for small polyps or incidental extracolonic findings discovered during CTC is still under debate. At present,the exact clinical role of virtual colonoscopy still awaits determination. Even though widespread CTC screening is not available today,in the future there may eventually be a role for this technology. Technological advances in this area will undoubtedly continue,with multi-detector row CT scanners allowing thinner collimation and higher reso-lution images. Stool-tagging techniques are likely to evolve and may eventually allow for low-preparation CTC. Perceptual and fatigue-related reading errors can potentially be minimized with the help of computer-aided detection software. Further research will define the exact role of this promising technology in our diagnostic armamentarium.
文摘BACKGROUND Changes in bowel function after right-sided colectomy are not well understood compared to those associated with left-sided colectomy or rectal resection.In particular,there are concerns about bowel function after right-sided colectomy with complete mesocolic excision,which has become popular in the West.AIM To evaluate the functional outcomes of patients who underwent right-sided colectomy with D3 lymphadenectomy for colon cancer.METHODS Functional data from patients who underwent minimally invasive right-sided colectomy for colon cancer from October 2017 to September 2018 were prospectively collected.Functional outcomes were evaluated preoperatively and at 3,6,12,and 18 mo postoperatively.RESULTS Prior to surgery,57 patients answered the questionnaire,and 47 responded at three months,52 at 6 mo,52 at 12 mo,and 25 at 18 mo postoperatively.Most scales of quality of life and bowel function improved significantly over time.Urgency persisted to a high degree throughout the period without a significant change over time.The use of medications for defecation was about 10%over the entire period.Gas(P=0.023)and fecal frequency(P<0.001)increased,and bowel dysfunction group(P=0.028)was more common among patients taking medication.At six months,resected bowel and colon lengths were significantly different as a risk factor between the dysfunction group and the no dysfunction group[odd ratio(OR):1.095,P=0.026;OR:1.147,P=0.031,respectively]in univariate analysis,but not in multivariate analysis.CONCLUSION Despite D3 lymphadenectomy,most bowel symptoms improved over time after right-sided colectomy using a minimally invasive approach,and continuous medication was needed in only approximately 10%of patients.
文摘BACKGROUND The use of intra-operative colonic lavage(IOCL)with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies,with alternatives including Hartmann’s procedure,manual decompression and subtotal colectomy.AIM To compare the peri-operative outcomes of IOCL to other procedures.METHODS Electronic databases were searched for articles employing IOCL from inception till July 13,2020.Odds ratio and weighted mean differences(WMD)were estimated for dichotomous and continuous outcomes respectively.Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.RESULTS Of 28 studies were included in this meta-analysis,involving 1142 undergoing IOCL,and 634 other interventions.IOCL leads to comparable rates of wound infection when compared to Hartmann’s procedure,and anastomotic leak and wound infection when compared to manual decompression.There was a decreased length of hospital stay(WMD=-7.750;95%CI:-13.504 to-1.996;P=0.008)compared to manual decompression and an increased operating time.Single-arm meta-analysis found that overall mortality rates with IOCL was 4%(CI:0.03-0.05).Rates of anastomotic leak and wound infection were 3%(CI:0.02-0.04)and 12%(CI:0.09-0.16)respectively.CONCLUSION IOCL leads to similar rates of post-operative complications compared to other procedures.More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.
文摘BACKGROUND Approximately 40%of colorectal cancer(CRC)cases are linked to Kirsten rat sarcoma viral oncogene homolog(KRAS)mutations.KRAS mutations are associated with poor CRC prognosis,especially KRAS codon 12 mutation,which is associated with metastasis and poorer survival.However,the clinicopathological characteristics and prognosis of KRAS codon 13 mutation in CRC remain unclear.AIM To evaluate the clinicopathological characteristics and prognostic value of codonspecific KRAS mutations,especially in codon 13.METHODS This retrospective,single-center,observational cohort study included patients who underwent surgery for stage I-III CRC between January 2009 and December 2019.Patients with KRAS mutation status confirmed by molecular pathology reports were included.The relationships between clinicopathological characteristics and individual codon-specific KRAS mutations were analyzed.Survival data were analyzed to identify codon-specific KRAS mutations as recurrence-related factors using the Cox proportional hazards regression model.RESULTS Among the 2203 patients,the incidence of KRAS codons 12,13,and 61 mutations was 27.7%,9.1%,and 1.3%,respectively.Both KARS codons 12 and 13 mutations showed a tendency to be associated with clinical characteristics,but only codon 12 was associated with pathological features,such as stage of primary tumor(T stage),lymph node involvement(N stage),vascular invasion,perineural invasion,tumor size,and microsatellite instability.KRAS codon 13 mutation showed no associations(77.2%vs 85.3%,P=0.159),whereas codon 12 was associated with a lower 5-year recurrence-free survival rate(78.9%vs 75.5%,P=0.025).In multivariable analysis,along with T and N stages and vascular and perineural invasion,only codon 12(hazard ratio:1.399;95%confidence interval:1.034-1.894;P=0.030)among KRAS mutations was an independent risk factor for recurrence.CONCLUSION This study provides evidence that KRAS codon 13 mutation is less likely to serve as a prognostic biomarker than codon 12 mutation for CRC in a large-scale cohort.
文摘This study was a systematic review of the available evidence on quality of life in patients after laparoscopic or open colorectal surgery. A systematic review was performed of all randomized clinical trials (RCTs) that compared laparoscopic with open colorectal surgery. Study selection, quality assessment and data extraction were carried out independently by two reviewers. Primary endpoint was quality of life after laparoscopic and open colorectal surgery, as assessed by validated questionnaires. The search resulted in nine RCTs that included 2263 patients. Shortand long-term results of these RCTs were described in 13 articles. Postoperative follow-up ranged from 2 d to 6.7 years. Due to clinical heterogeneity, no meta-analysis could be conducted. Four RCTs did not show any difference in quality of life between laparoscopic or open colorectal surgery. The remaining five studies reported a better quality of life in favor of the laparoscopic group on a few quality of life scales at time points ranging from 1 wk to 2 years after surgery. In conclusion, based on presently available high-level evidence, this systematic review showed no clinically relevant differences in postoperative quality of life between laparoscopic and open colorectal surgery.
基金The National Natural Science Foundation of China,No.81502025China Postdoctoral Science Foundation,No.2018M632631.
文摘BACKGROUND Lymphangiomatosis is a multisystem disorder that is rarely localized to the gastrointestinal tract.Lymphangiomatosis usually has no specific clinical presentation and is easily misdiagnosed.A case report and review of the literature on lymphangiomatosis associated with protein-losing enteropathy will help to improve the overall understanding of this disease.CASE SUMMARY We report a case of lymphangiomatosis of the bowel and other solid organs.A 78-year-old man presented with recurrent bowel bleeding and protein-losing enteropathy,as well as cystic lesions in the spleen,liver,and kidney.Imaging examinations revealed many cystic lesions on the spleen,liver,kidney,and thickened wall of the ascending colon,as well as pleural effusion and ascites.Colonoscopy revealed a strawberry mucosa,variable spontaneous bleeding,and surface erosion located in the terminal ileum.Several cystic masses with a translucent and smooth surface as well as diffuse white spots were located in the colon.A laterally spreading tumor(LST)was located in the ascending colon.Pathology indicated highly differentiated adenocarcinoma(LST)and lymphangiomatoid dilation,and D2-40 was positive.The final diagnosis was lymphangiomatosis.The patient underwent surgery for LST and then was administered thalidomide 75-150 mg/d.His condition,however,did not improve.He eventually died 6 mo after the initial diagnosis.CONCLUSION Lymphangiomatosis usually occurs diffusely and can involve many organs,such as the spleen,kidney,liver,lung,mesentery,and bowel.Recurrent bowel bleeding or protein-losing enteropathy is an important indicator that should alert clinicians about the possibility of this disease when it afflicts the bowel.Doctors should improve the medical understanding of lymphangiomatosis.
文摘Colon capsule endoscopy(CCE)was introduced nearly two decades ago.Initially,it was limited by poor image quality and short battery time,but due to technical improvements,it has become an equal diagnostic alternative to optical colonoscopy(OC).Hastened by the coronavirus disease 2019 pandemic,CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics.A wider adoption of CCE would be bolstered by positive patient experience,as it offers a diagnostic investigation that is not inferior to other modalities.The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps.Solving this issue would improve the stratification of patients for polyp removal.Artificial intelligence(AI)has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations.Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs.With this letter,we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.
基金Supported by Natural Science Foundation of Shanghai Municipality:Tenglong Buzhong Decoction Inhibiting Metastasis of Colorectal Cancer by Regulation of HIF-1 α/LOX/PTK2 Signal Transduction (No. 20ZR1458700)Program from Science and Technology Commission of Shanghai Municipality:Real World Study of Tenglong Buzhong Decoction on Colorectal Cancer Metastasis and Circulating miRNAs (No. 19401933400)。
文摘OBJECTIVE: To observe the anticancer effects of the granular preparation of Tenglong Buzhong decoction(藤龙补中汤,TBD), i.e Tenglong Buzhong granules(藤龙补中颗粒, TBG), in human SW620 colon cancer. METHODS: BALB/c nude mice were subcutaneously transplanted with SW620 cells, and treated with TBG(2.56 g/kg, once per day) and/or 5-Fu(104 mg/kg, once per week) for 21 d. Apoptosis, Caspase activities and cellular senescence were measured by commercial kits. The protein expression and phosphorylation were detected by Western blot or immunohistochemistry. RESULTS: TBG and 5-Fu inhibited tumor growth. The tumor inhibition rate of the TBG, 5-Fu, and TBG+5-Fu groups was 42.25%, 51.58%, and 76.08%, respectively. Combination of TBG and 5-Fu showed synergetic anticancer effects. TBG and 5-Fu induced apoptosis, activated caspase-3,-8, and-9, increased SMAC expression, inhibited XIAP expression. TBG induced cellular senescence, upregulated cyclin-dependent kinase inhibitor 1a(CDKN1a) and cyclin-dependent kinase inhibitor 2a(CDKN2a) expression, and inhibited phosphorylation of retinoblastoma-associated protein(RB) and expression of cyclin E1(CCNE1) and cyclindependent kinases(CDK) 2. TBG also inhibited angiogenesis accompanied by downregulation of vascular endothelial growth factor(VEGF) and hypoxiainducible factor-1α(HIF-1α). CONCLUSIONS: TBG inhibits SW620 colon cancer growth, induces apoptosis via SMAC-XIAP-Caspases signaling, induces cellular senescence through CDKN1a/CDKN2a-RB-E2F signaling, inhibits angiogenesis by down-regulation of HIF-1α and VEGF, and enhances the effects of 5-Fu.
