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Alternative Therapies in Health and... Apr 2024Appendicitis (AP) is a prevalent and sudden disease, and although surgery can be effective in treating it, post-surgical care is of great importance in improving the...
BACKGROUNDS
Appendicitis (AP) is a prevalent and sudden disease, and although surgery can be effective in treating it, post-surgical care is of great importance in improving the patient's recovery.
OBJECTIVE
To analyze the impact of Failure Mode and Effect Analysis (FMEA)-based nursing on patients with AP after surgery.
METHODS
A total of 104 patients with AP who received treatment in Fuyang Shi Hospital of TCM from December 2021 to February 2023 were enrolled and randomly divided into a control group (n = 52) who received routine nursing and a research group (n = 52) who receive FMEA-based nursing. The time to recovery of bowel sounds, time to defecation by anus, time to anal exhaust, and length of stay were statistically analyzed in both groups after surgery. Pain, sleep, and psychological status of patients before and after surgery were assessed using the visual analog scale (VAS), Pittsburgh Sleep Quality Index (PSQI), and self-rating anxiety scale/self-rating depression scale (SAS/SDS). Patients' satisfaction with nursing was also investigated, and the incidence of postoperative complications was recorded.
RESULTS
After surgery, the research group showed shorter time to recovery of bowel sounds, time to defecation by anus, time to anal exhaust, and length of stay, and lower scores of VAS, PSQI, SAS, and SDS than those of the control group (P < .05). As indicated by the satisfaction survey, compared with the control group, the research group showed a larger number of patients who were very satisfied with nursing and a smaller number of patients who thought their nursing should be improved; the incidence of postoperative complications was also lower in the research group (P < .05).
CONCLUSION
For patients with AP, FMEA-based nursing improves their postoperative recovery, alleviates their pain, and ameliorates their sleep quality, which is of high clinical application value.
PubMed: 38607205
DOI: No ID Found -
Surgery Sep 2023Although squamous cell carcinoma is the most common malignancy of the anal canal, it rarely affects the rectum. The present study aimed to assess the differences in...
BACKGROUND
Although squamous cell carcinoma is the most common malignancy of the anal canal, it rarely affects the rectum. The present study aimed to assess the differences in characteristics, treatments, clinical and pathologic outcomes, and survival between anal and rectal squamous cell carcinoma.
METHODS
The United States National Cancer Databases (2004-2020) of anal canal and rectal cancer were used for this retrospective cohort analysis. Patients with anal or rectal squamous cell carcinoma were included in the analysis. The study's primary outcome was overall survival, and secondary outcomes were 30-day and 90-day mortality, 30-day readmission, and positive resection margins.
RESULTS
The present study included 76,830 patients with anal squamous cell carcinoma and 7,908 with rectal squamous cell carcinoma. Patients with anal squamous cell carcinoma presented more often with early clinical stage I and stage II disease (50.4% vs 45.9%, P < .001) and less often with stage IV disease (6.5% vs 15.1%, P < .001). Anal squamous cell carcinomas were more often treated with upfront surgery than were rectal squamous cell carcinomas (37.7% vs 19.7%, P < .001), whereas rectal squamous cell carcinomas were more often treated with chemoradiation therapy alone (68.3% vs 59.8%, P < .001). Anal squamous cell carcinomas were treated more often with local excision (33.4% vs 15.8%, P < .001) than rectal squamous cell carcinoma. Anal squamous cell carcinoma was associated with a higher incidence of positive resection margins (41.9% vs 32.8%, P < .001). The 30-day and 90-day mortality rates were higher after surgery for rectal squamous cell carcinoma than for anal squamous cell carcinoma (1.5% vs 0.4% and 4.1% vs 1.6%, respectively, P < .001). Anal squamous cell carcinoma had longer median overall survival (145.3 vs 90.3 months, P < .001) than rectal squamous cell carcinoma.
CONCLUSION
Patients with anal squamous cell carcinoma presented more often with early-stage disease and less often with distant metastasis and were more often treated with upfront surgery, mainly local excision. Anal squamous cell carcinoma was associated with lower 30-day and 90-day mortality and longer overall survival than rectal squamous cell carcinoma.
Topics: Humans; United States; Retrospective Studies; Anal Canal; Margins of Excision; Neoplasm Staging; Rectal Neoplasms; Anus Neoplasms; Carcinoma, Squamous Cell; Treatment Outcome
PubMed: 37380571
DOI: 10.1016/j.surg.2023.05.028 -
Annals of Palliative Medicine Nov 2023Colorectal (CRC) and anal (AC) cancer, both lower gastrointestinal (GI) cancers vary in their presentation and treatment. Overall, the incidence of CRC has decreased.... (Review)
Review
Colorectal (CRC) and anal (AC) cancer, both lower gastrointestinal (GI) cancers vary in their presentation and treatment. Overall, the incidence of CRC has decreased. However, the incidence of CRCs in younger adults has increased over the last 5 years. The incidence of ACs has increased, too. Women are disproportionally impacted by AC which is frequently associated with human papilloma virus (HPV). Patients diagnosed with both cancers often experience multiple symptoms including pain, constipation, nausea, and vomiting. Psychosocial distress including embarrassment and shame often results from both the cancers itself as well as surgical procedures such as creation of ostomy. Palliative care (PC) is an emerging specialty that focuses on maximizing the quality of life (QOL) for patients through expert symptom assessment and management, psychosocial support, and improved communication around illness. The evidence to support earlier integration of PC has steadily increased over the last ten years. The literature shows that early involvement of PC for these populations can result in improved QOL, improved symptom control and decreased intensity of care at the end of life. This article will review the palliative needs of patients diagnosed with CRC and discuss how PC as a specialty is well poised to support these needs.
Topics: Adult; Humans; Female; Palliative Care; Quality of Life; Gastrointestinal Neoplasms; Anus Neoplasms; Pain
PubMed: 37731305
DOI: 10.21037/apm-22-1390 -
Immune-checkpoint inhibitors in anal squamous cell carcinoma: a systematic review and meta-analysis.Seminars in Oncology Dec 2023Squamous cell carcinoma of the anus (SCCA) is a rare tumor. While most patients with locally advanced disease are cured with chemo-radiotherapy, about a quarter... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Squamous cell carcinoma of the anus (SCCA) is a rare tumor. While most patients with locally advanced disease are cured with chemo-radiotherapy, about a quarter eventually experience metastatic recurrence. Standard treatment for advanced disease is chemotherapy, but recently evidence on the activity of immunotherapy has been reported. We performed a systematic review and meta-analysis of prospective trials testing immune-checkpoint inhibitors (ICIs) in patients with SCCA.
OBJECTIVE
We aimed to evaluate the overall response rate (ORR) and the disease control rate (DCR) of ICIs in patients with advanced SCCA.
METHODS
We systematically searched PubMed, Embase, and Scopus, through December 31, 2022, for prospective trials assessing ICIs in patients with advanced SCCA. The primary and secondary endpoints were respectively ORR and DCR.
RESULTS
Six prospective trials were included in the analysis, one of which was randomized. Overall, seven treatment arms and 347 patients have been analyzed. Five treatment arms tested ICIs as monotherapy and two arms examined ICIs in combination with cetuximab and bevacizumab, respectively. The pooled ORR was 13% (95%CI, 10%-17%), with a DCR of 57% (95%CI, 40%-74%). Results did not change in a sensitivity analysis, which excluded the two treatment arms testing the combination of ICIs with other drugs.
CONCLUSIONS
The efficacy of ICIs in SCCAs is low. Combination strategies with targeted drugs or chemotherapy might represent a better therapeutic strategy for these patients. Further studies are awaited to identify resistance mechanisms to ICIs and optimize their efficacy.
Topics: Humans; Immune Checkpoint Inhibitors; Prospective Studies; Carcinoma, Squamous Cell; Cetuximab; Bevacizumab
PubMed: 38065801
DOI: 10.1053/j.seminoncol.2023.11.002 -
International Journal of Radiation... Oct 2023Intensity modulated radiation therapy (IMRT) has confirmed its superiority in improving acute treatment-related toxicities in anal cancer, without compromising tumor...
Long-Term Patient-Reported Quality of Life of Anal Cancer Survivors Treated With Intensity Modulated Radiation Therapy and Concurrent Chemotherapy: Results From a Prospective Phase II Trial.
PURPOSE
Intensity modulated radiation therapy (IMRT) has confirmed its superiority in improving acute treatment-related toxicities in anal cancer, without compromising tumor control. However, the effect of IMRT on long-term quality of life (QOL) is poorly documented. The study prospectively evaluated the long-term patient-reported QOL after IMRT-based chemoradiation in anal cancer.
METHODS AND MATERIALS
Fifty-eight patients treated with IMRT and concurrent 5 fluorouracil/mitomycin-C were enrolled in the study. A prespecified secondary endpoint was prospective evaluation of long-term QOL. Fifty-four patients underwent QOL evaluation at baseline, after treatment, and during follow-up until 60 months, with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) scales and the Colorectal Cancer-Specific Quality Of Life Questionnaire (QLQ-CR29) scales. The QOL scores at baseline and posttreatment periods were compared.
RESULTS
For QLQ-C30, at 60 months, the mean scores of global health status, all functional scales, and all symptoms except diarrhea had improved, indicating normalization of QOL. Clinically and statistically significant improvements in the global health status (15.4; P = .003), role functioning (19.3; P = .0017), emotional functioning (18.9; P = .008), and social functioning (29.8; P ≤ .001) were observed. Diarrhea persisted as a concern over the years (P = .172). For European Organization for Research and Treatment of Cancer QLQ-CR29, rectal pain (-38.6; P = .001), mucous or blood discharge per rectum (-22.8; P = .005), and perianal soreness (-37.3; P ≤ .001) were improved both clinically and statistically. Clinically significant fecal leakage was reported by 16% of patients (5.6; P = .421). Volumes receiving 45 and 54 Gy were independent predictors for fecal incontinence. Clinically and statistically significant urinary incontinence occurred in 21% of patients (17.5; P = .014). Deterioration of dyspareunia was clinically significant (26.7; P = .099) at 60 months.
CONCLUSIONS
Compared with historical data, IMRT is associated with reduced long-term effects on QOL. The majority of patients treated with IMRT experienced clinically significant recovery of function and improvement in QOL over 5 years after completion of treatment. Specific toxicities such as chronic diarrhea, fecal incontinence, and urinary and sexual dysfunction were primarily responsible for deterioration of the long-term QOL. Future research aimed at reducing such toxicities is needed to further improve long-term QOL in anal cancer.
Topics: Female; Humans; Quality of Life; Radiotherapy, Intensity-Modulated; Cancer Survivors; Fecal Incontinence; Anus Neoplasms; Diarrhea; Patient Reported Outcome Measures
PubMed: 37148982
DOI: 10.1016/j.ijrobp.2023.04.023 -
Diseases of the Colon and Rectum Apr 2024
Topics: Humans; Abscess; Anus Diseases; Drainage; Skin Diseases; Rectal Fistula; Treatment Outcome
PubMed: 38150305
DOI: 10.1097/DCR.0000000000002949 -
Chirurgie (Heidelberg, Germany) Oct 2023Despite the increasing incidence, anal cancer is still a rare gastrointestinal tumor, so that due to the broadness of the primary care there is often little experience...
Despite the increasing incidence, anal cancer is still a rare gastrointestinal tumor, so that due to the broadness of the primary care there is often little experience in the care of affected patients. Squamous cell cancer (SCC) constitutes more than 90% of all anal cancers and is nearly always associated with an infection by the human papillomavirus. This article concentrates on SCC of the anal canal and anal margin. The focus is on the primary diagnostics, surgical treatment, response assessment and aftercare. Treatment is carried out according to the decision of the interdisciplinary tumor board, independent of the tumor location and stage. Anal margin cancer in stage I (and IIa) can be successfully treated by an R0 excision. Combined chemoradiotherapy as the standard treatment in stages II and III is briefly summarized. The article is essentially based on the new German S3 guidelines on anal cancer.
Topics: Humans; Aftercare; Neoplasm Staging; Anus Neoplasms; Combined Modality Therapy; Chemoradiotherapy; Carcinoma, Squamous Cell
PubMed: 37042989
DOI: 10.1007/s00104-023-01849-2 -
Techniques in Coloproctology Dec 2023
Topics: Humans; Anal Canal; Anus Diseases; Fecal Incontinence; Manometry
PubMed: 38071670
DOI: 10.1007/s10151-023-02893-0 -
Current Genomics Oct 2023Crohn's disease (CD) is a chronic idiopathic inflammatory bowel disease affecting the entire gastrointestinal tract from the mouth to the anus. These patients often...
BACKGROUND
Crohn's disease (CD) is a chronic idiopathic inflammatory bowel disease affecting the entire gastrointestinal tract from the mouth to the anus. These patients often experience a period of symptomatic relapse and remission. A 20 - 30% symptomatic recurrence rate is reported in the first year after surgery, with a 10% increase each subsequent year. Thus, surgery is done only to relieve symptoms and not for the complete cure of the disease. The determinants and the genetic factors of this disease recurrence are also not well-defined. Therefore, enhanced diagnostic efficiency and prognostic outcome are critical for confronting CD recurrence.
METHODS
We analysed ileal mucosa samples collected from neo-terminal ileum six months after surgery (M6=121 samples) from Crohn's disease dataset (GSE186582). The primary aim of this study is to identify the potential genes and critical pathways in post-operative recurrence of Crohn's disease. We combined the differential gene expression analysis with Recursive feature elimination (RFE), a machine learning approach to get five critical genes for the postoperative recurrence of Crohn's disease. The features (genes) selected by different methods were validated using five binary classifiers for recurrence and remission samples: Logistic Regression (LR), Decision tree classifier (DT), Support Vector Machine (SVM), Random Forest classifier (RF), and K-nearest neighbor (KNN) with 10-fold cross-validation. We also performed weighted gene co-expression network analysis (WGCNA) to select specific modules and feature genes associated with Crohn's disease postoperative recurrence, smoking, and biological sex. Combined with other biological interpretations, including Gene Ontology (GO) analysis, pathway enrichment, and protein-protein interaction (PPI) network analysis, our current study sheds light on the in-depth research of CD diagnosis and prognosis in postoperative recurrence.
RESULTS
PLOD2, ZNF165, BOK, CX3CR1, and ARMCX4, are the important genes identified from the machine learning approach. These genes are reported to be involved in the viral protein interaction with cytokine and cytokine receptors, lysine degradation, and apoptosis. They are also linked with various cellular and molecular functions such as Peptidyl-lysine hydroxylation, Central nervous system maturation, G protein-coupled chemoattractant receptor activity, BCL-2 homology (BH) domain binding, Gliogenesis and negative regulation of mitochondrial depolarization. WGCNA identified a gene co-expression module that was primarily involved in mitochondrial translational elongation, mitochondrial translational termination, mitochondrial translation, mitochondrial respiratory chain complex, mRNA splicing spliceosome pathways, .; Both the analysis result emphasizes that the mitochondrial depolarization pathway is linked with CD recurrence leading to oxidative stress in promoting inflammation in CD patients.
CONCLUSION
These key genes serve as the novel diagnostic biomarker for the postoperative recurrence of Crohn's disease. Thus, among other treatment options present until now, these biomarkers would provide success in both diagnosis and prognosis, aiming for a long-lasting remission to prevent further complications in CD.
PubMed: 37994325
DOI: 10.2174/1389202924666230601122334 -
American Journal of Obstetrics and... Dec 2023Extramammary Paget's disease recurs often after traditional surgical excision. Margin-controlled surgery improves the recurrence rate for male genital disease but is... (Observational Study)
Observational Study
BACKGROUND
Extramammary Paget's disease recurs often after traditional surgical excision. Margin-controlled surgery improves the recurrence rate for male genital disease but is less studied for female anatomy.
OBJECTIVE
This study aimed to compare surgical and oncologic outcomes of margin-controlled surgery vs traditional surgical excision for female genital Paget's disease.
STUDY DESIGN
We conducted a prospective observational trial of patients with vulvar or perianal Paget's disease treated with surgical excision guided by Mohs micrographic surgery between 2018 and 2022. The multidisciplinary protocol consisted of office-based scouting biopsies and modified Mohs surgery followed by surgical excision with wound closure under general anesthesia. Modified Mohs surgery cleared peripheral disease margins using a moat technique with cytokeratin 7 staining. Medial disease margins (the clitoris, urethra, vagina, and anus) were assessed using a hybrid of Mohs surgery and intraoperative frozen sections. Surgical and oncologic outcomes were compared with the outcomes of a retrospective cohort of patients who underwent traditional surgical excision. The primary outcome was 3-year recurrence-free survival.
RESULTS
Three-year recurrence-free survival was 93.3% for Mohs-guided excision (n=24; 95% confidence interval, 81.5%-100.0%) compared to 65.9% for traditional excision (n=63; 95% confidence interval, 54.2%-80.0%) (P=.04). The maximum diameter of the excisional specimen was similar between groups (median, 11.3 vs 9.5 cm; P=.17), but complex reconstructive procedures were more common with the Mohs-guided approach (66.7% vs 30.2%; P<.01). Peripheral margin clearance was universally achieved with modified Mohs surgery, but positive medial margins were noted in 9 patients. Reasons included intentional organ sparing and poor performance of intraoperative hematoxylin and eosin frozen sections without cytokeratin 7. Grade 3 or higher postoperative complications were rare (0.0% for Mohs-guided excision vs 2.4% for traditional excision; P=.99).
CONCLUSION
Margin control with modified Mohs surgery significantly improved short-term recurrence-free survival after surgical excision for female genital Paget's disease. Use on medial anatomic structures (the clitoris, urethra, vagina, and anus) is challenging, and further optimization is needed for margin control in these areas. Mohs-guided surgical excision requires specialized, collaborative care and may be best accomplished at designated referral centers.
Topics: Female; Humans; Male; Biopsy; Genital Diseases, Female; Keratin-7; Margins of Excision; Mohs Surgery; Neoplasm Recurrence, Local; Vagina; Prospective Studies
PubMed: 37633576
DOI: 10.1016/j.ajog.2023.08.018