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Anticancer Research Aug 2023The standard of care for patients with colorectal cancer and liver metastases, who fail to respond to systemic chemotherapy has not yet been established. Therefore, we...
BACKGROUND/AIM
The standard of care for patients with colorectal cancer and liver metastases, who fail to respond to systemic chemotherapy has not yet been established. Therefore, we investigated the prognostic value of transarterial chemoembolization (TACE) using irinotecan-loaded drug-eluting beads (DEBIRI) in treating liver metastases due to colorectal cancer.
PATIENTS AND METHODS
Forty-six patients with colorectal cancer and unresectable liver metastases, who received systemic chemotherapy beyond the third line at our hospital between July 2014 and April 2020 were analyzed. They were divided into two groups: 1) Seventeen patients who received TACE with DEBIRI, and 2) twenty-nine patients who did not receive TACE.
RESULTS
The median age was 68 years (range=37-85 years), and the male-to-female ratio was 29:17. The primary sites were the cecum in six cases, ascending colon in seven cases, transverse colon in two cases, descending colon in three cases, sigmoid colon in 14 cases, and rectum in 14 cases. All patients had received at least two prior systemic chemotherapy regimens including oxaliplatin-based and irinotecan-based regimens, and trifluridine tipiracil hydrochloride (38 patients) or regorafenib (12 patients) as the third line or beyond (overlap). Median survival was 272 days overall, 416 days in the TACE group, and 229 days in the non-TACE group, with significantly better survival in the TACE group (p=0.0126).
CONCLUSION
TACE with DEBIRI may improve the prognosis of patients with liver metastases from unresectable colorectal cancer. We suggest that TACE with DEBIRI should be highly considered, especially in patients in whom liver metastasis may be a prognostic factor.
Topics: Humans; Male; Female; Aged; Irinotecan; Camptothecin; Prognosis; Antineoplastic Agents, Phytogenic; Liver Neoplasms; Carcinoma, Hepatocellular; Treatment Outcome; Chemoembolization, Therapeutic; Topoisomerase I Inhibitors; Colorectal Neoplasms
PubMed: 37500124
DOI: 10.21873/anticanres.16545 -
Digestive Diseases and Sciences Nov 2023Several bowel preparation scales have been developed, but they are variably validated to guide clinical practice. The aim of this study was to assess the interobserver...
BACKGROUD/AIMS
Several bowel preparation scales have been developed, but they are variably validated to guide clinical practice. The aim of this study was to assess the interobserver reliability between internal and external endoscopists using the Harefield Cleaning Scale (HCS).
METHODS
Data was collected from a study evaluating the efficacy of oral sulfate tablets in patients undergoing colonoscopy. The assessments of bowel cleansing were carried out by four internal endoscopists at the time of the procedure, and colonoscopy video recordings were reviewed independently by three external endoscopists. Interobserver reliability was quantified using Cohen's Kappa coefficient, and scores and grades of each segment were compared between internal and external endoscopist groups.
RESULTS
Among 83 colonoscopy videos, interobserver reliability yielded a fair agreement between internal and external endoscopists, with a Cohen's Kappa coefficient of 0.39 (95% CI 0.08-0.70). Successful overall preparation rates (100% vs 98.8%) and high-quality preparation rates (88% vs 94%) were excellent and comparable between the two groups. In contrast, one case of unsuccessful cleansing (grade C) was documented, only in the external group. In addition, the interobserver reliability between internal and external endoscopists comparing each segmental score yielded a slight agreement in the descending colon (0.11, 95% CI - 0.02 to 0.23) and sigmoid colon (0.04, 95% CI - 0.18 to 0.26).
DISCUSSION
Interobserver reliability between internal and external endoscopists using the HCS was fair. However, the HCS may be limited as a reliable scale for assessing bowel preparation quality in the left colon, where liquid is mainly retained in the left lateral position.
PubMed: 37740890
DOI: 10.1007/s10620-023-08114-w -
Pharmaceutical Development and... Mar 2024The current budesonide formulations are inadequate for addressing left-sided colitis, and patients might hesitate to use an enema for a prolonged time. This study...
The current budesonide formulations are inadequate for addressing left-sided colitis, and patients might hesitate to use an enema for a prolonged time. This study focuses on developing a single-layer coating for budesonide pellets targeting the descending colon. Pellets containing budesonide (1.5%w/w), PVP K30 (5%w/w), lactose monohydrate (25%w/w) and Avicel pH 102 (68.5%w/w) were prepared using extrusion spheronization technique. Coating formulations were designed using response surface methodology with pH and time-dependent Eudragits. Dissolution tests were conducted at different pH levels (1.2, 6.5, 6.8, and 7.2). Optimal coating formulation, considering coating level and the Eudragit (S + L) ratio to the total coating weight, was determined. Budesonide pellets were coated with the optimized composition and subjected to continuous dissolution testing simulating the gastrointestinal tract. The coating, with 48% S, 12% L, and 40% RS at a 10% coating level, demonstrated superior budesonide delivery to the descending colon. Coated pellets had a spherical shape with a uniform 30 µm thickness coating, exhibiting pH and time-dependent release. Notably, zero-order release kinetics was observed for the last 9 h in colonic conditions. The study suggests that an optimized single-layer coating, incorporating pH and time-dependent polymers, holds promise for consistently delivering budesonide to the descending colon.
Topics: Humans; Budesonide; Drug Delivery Systems; Colon; Colon, Descending; Solubility; Drug Implants; Polymethacrylic Acids
PubMed: 38392961
DOI: 10.1080/10837450.2024.2321250 -
Journal of Gastroenterology and... Aug 2023Eosinophils contribute to tissue homeostasis, damage, and repair. The mucosa of colonic diverticula has not been evaluated for eosinophils by quantitative histology. We...
AIMS
Eosinophils contribute to tissue homeostasis, damage, and repair. The mucosa of colonic diverticula has not been evaluated for eosinophils by quantitative histology. We aimed to investigate whether mucosal eosinophils and other immune cells are increased in colonic diverticula.
METHODS
Hematoxylin and eosin stained sections from colonic surgical resections (n = 82) containing diverticula were examined. Eosinophils, neutrophils, and lymphocytes, in five high power fields in the lamina propria were counted at the base, neck, and ostia of the diverticulum and counts compared to non-diverticula mucosa. The cohort was further subgrouped by elective and emergency surgical indications.
RESULTS
Following an initial review of 10 surgical resections from patients with diverticulosis, a total of 82 patients with colonic resections containing diverticula from the descending colon were evaluated (median age 71.5, 42 M/40F). Eosinophil counts for the entire cohort were increased in the base and neck (median 99 and 42, both P = <0.001) compared with the control location (median 16). Eosinophil counts remained significantly increased in the diverticula base (both P = <0.001) and neck (P = 0.01 and <0.001, respectively) in both elective and emergency cases. Lymphocytes were also significantly increased at the diverticula base compared to controls in both elective and emergency subgroups.
CONCLUSION
Eosinophils are significantly and most strikingly increased within the diverticulum in resected colonic diverticula. While these observations are novel, the role of eosinophil and chronic inflammation is as yet unclear in the pathophysiology of colonic diverticulosis and diverticular disease.
Topics: Humans; Diverticulum, Colon; Eosinophils; Diverticulosis, Colonic; Mucous Membrane; Eosinophilia
PubMed: 37415341
DOI: 10.1111/jgh.16278 -
Annals of Surgery Feb 2024The aim of this study was to determine the genuine prognostic relevance of primary tumor sidedness (PTS) in patients with early-stage colorectal cancer (CRC).
OBJECTIVE
The aim of this study was to determine the genuine prognostic relevance of primary tumor sidedness (PTS) in patients with early-stage colorectal cancer (CRC).
BACKGROUND
The prognostic relevance of PTS in early-stage CRC remains a topic of debate. Several large epidemiological studies investigated survival only and did not consider the risk of recurrence so far.
METHODS
Patients with stage II/III adenocarcinoma of the colon and upper rectum from 4 randomized controlled trials were analyzed. Survival outcomes were compared according to the tumor location: right-sided (cecum to transverse colon) or left-sided (descending colon to upper rectum).
RESULTS
A total of 4113 patients were divided into a right-sided group (N=1349) and a left-sided group (N=2764). Relapse-free survival after primary surgery was not associated with PTS in all patients and each stage [hazard ratio (HR) adjusted =1.024 (95% CI: 0.886-1.183) in all patients; 1.327 (0.852-2.067) in stage II; and 0.990 (0.850-1.154) in stage III]. Also, overall survival after primary surgery was not associated with PTS in all patients and each stage [HR adjusted =0.879 (95% CI: 0.726-1.064) in all patients; 1.517 (0.738-3.115) in stage II; and 0.840 (0.689-1.024) in stage III]. In total, 795 patients (right-sided, N=257; left-sided, N=538) developed recurrence after primary surgery. PTS was significantly associated with overall survival after recurrence (HR adjusted =0.773, 95% CI: 0.627-0.954).
CONCLUSIONS
PTS had no impact on the risk of recurrence for stage II/III CRC. Treatment stratification based on PTS is unnecessary for early-stage CRC.
Topics: Humans; Prognosis; Neoplasm Recurrence, Local; Randomized Controlled Trials as Topic; Colorectal Neoplasms; Rectum; Retrospective Studies
PubMed: 37551612
DOI: 10.1097/SLA.0000000000006076 -
PloS One 2024Recent magnetic resonance imaging (MRI) studies showed that colonic volumes in children are different between health and functional constipation. The length of the colon...
Recent magnetic resonance imaging (MRI) studies showed that colonic volumes in children are different between health and functional constipation. The length of the colon has however been rarely measured and principally using unphysiological colon preparations or cadaver studies. The main objective of this study was to measure the length of the undisturbed colon in children with functional constipation (FC) and healthy controls. Here, the colon of 19 healthy controls (10-18 years old) and 16 children with FC (7-18 years old) was imaged using MRI. Different regions of the colon (ascending, transverse, descending, and sigmoid-rectum) were first segmented manually on the MRI images. Three-dimensional skeletonization image analysis methods were then used to reduce the regions of interest to a central, measurable line. Total colon length (corrected for body surface area) in healthy controls was 56±2 cm/m2 (mean±SEM). Total colon length was significantly longer in children with FC 69±3 cm/m2 compared to controls (p = 0.0037). The colon regions showing the largest differences between groups were the ascending colon (p = 0.0479) and the sigmoid-rectum (p = 0.0003). In a linear regression model, there was a positive significant correlation between total colon length and age (R = 0.45, p = 0.0064), height (R = 0.49, p = 0.0031), weight (R = 0.46, p = 0.0059) and colon volume (R = 0.4543, p = 0.0061). Our findings showed significant differences in colon lengths between healthy controls and children with constipation. A new objective diagnostic imaging endpoint such as colon length may help to improve knowledge of colon morphology and function and, in turn, understanding of colon functional pathology.
Topics: Humans; Child; Adolescent; Colon; Constipation; Colon, Sigmoid; Rectum; Magnetic Resonance Imaging
PubMed: 38165858
DOI: 10.1371/journal.pone.0296311 -
Revista Medica Del Instituto Mexicano... Sep 2023The colon has two different embryological origins, which is why it can be divided into right and left with different characteristics each one; therefore, neoplastic... (Observational Study)
Observational Study
BACKGROUND
The colon has two different embryological origins, which is why it can be divided into right and left with different characteristics each one; therefore, neoplastic lesions have a different clinical picture and are also associated with different pathologies.
OBJECTIVE
To describe the clinical and histopathological characteristics of malignant colon tumors acording to their location.
MATERIAL AND METHODS
Descriptive, retrospective study with 94 patients diagnosed with colon cancer. Descriptive statistics were performed with the calculation of frequencies and percentages, and chi-squared tests were calculated.
RESULTS
Mean age was 61.3 years, 49 (52.1%) were women; 53 (56.4%) were left-sided and 41 (43.6%) right-sided. The main symptom was hematochezia in 32 (60.4%), in patients with left cancer; and diarrhea in 20 (48.8%), in patients with right-sided colon cancer. The presentation of stage I tumors and polyps, p = 0.044 and p = 0.043, respectively, was more frequent on the right side compared to the left side; in the left, hematochezia (p = 0.001), narrow stools(p = 0.05), and a history of type 2 diabetes mellitus (T2DM) (p= 0.036) were more frequent compared to the opposite site.
CONCLUSIONS
Stage I and the presence of polyps were more frequent in right-sided cancer compared to left-sided cancer; T2DM, as well as hematochezia and narrow stools were more associated with the left side compared to the right side.
Topics: Humans; Female; Middle Aged; Male; Retrospective Studies; Diabetes Mellitus, Type 2; Colonic Neoplasms; Gastrointestinal Hemorrhage; Neoplasm Staging; Prognosis
PubMed: 37769029
DOI: 10.5281/zenodo.8316446 -
Diseases of the Colon and Rectum May 2024Splenic flexure mobilization is typically required in the management of left-sided colon and rectal resections to achieve tension-free anastomosis. Although the da Vinci...
BACKGROUND
Splenic flexure mobilization is typically required in the management of left-sided colon and rectal resections to achieve tension-free anastomosis. Although the da Vinci Xi® surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was designed for multi-quadrant operations, robotic mobilization of the splenic flexure continues to be challenging for some surgeons. Re-docking and patient repositioning may be required, which can be time-consuming, especially in centers without motion-activated operating tables. However, there are some tips and tricks to overcome these challenges. Here, we describe our single docking crossed-arm technique, which facilitates splenic flexure mobilization.
INTERVENTION
We demonstrate our technique in a 61-year-old woman with sigmoid colon cancer, and informed consent was obtained. The operation starts in the medial-to-lateral approach by ligating the inferior mesenteric artery and vein. After the left colon mobilization, robotic arm one (tip-up fenestrated grasper) is positioned on the patient's left, while arms two, three, and four are on the patient's right. A tip-up fenestrated grasper, inserted through port #1, retracts the descending colon medial and inferior towards the cecum. Then, we cross the arms from the lateral aspect of arm one and takedown the flexure without the collision of robotic arms. After the lateral side dissection is completed, we change the position of the instruments to mobilize the transverse colon. This time, the tip-up grasping instrument is used to retract the colon through the left lower quadrant, which enables us to work in the medial aspect of the grasping instrument. Dissection can be performed using bipolar forceps, monopolar scissors, or vessel-sealing devices.
OUTCOMES
We achieved complete mobilization of the splenic flexure. With this technique, dissection can be carried medially and cranially beyond the falciform ligament. After the splenic flexure takedown and freeing up the mesocolon above the pancreatic body, tension-free anastomosis can be performed. In this approach, re-docking is not necessary.
CONCLUSION
During robotic left-sided colorectal surgery, the crossed-arm technique with single docking avoids robotic arms collision and restricted mobility of the left upper quadrant instrument (port#1). This technique facilitates robotic splenic flexure mobilization and eliminates re-docking/repositioning, leading to shorter operative time and improved intraoperative flow. See Video Vignette.
PubMed: 38772012
DOI: 10.1097/DCR.0000000000003241 -
International Journal of Molecular... Nov 2023This study aimed to determine the effects of Zn sources, used with potato fiber (PF) or lignocellulose (LC), on electrolyte concentration and the mucus layer in the...
Comparison between Organic and Inorganic Zinc Forms and Their Combinations with Various Dietary Fibers in Respect of the Effects on Electrolyte Concentrations and Mucosa in the Large Intestine of Pigs.
This study aimed to determine the effects of Zn sources, used with potato fiber (PF) or lignocellulose (LC), on electrolyte concentration and the mucus layer in the large intestine of pigs. The experiment involved 24 barrows with an initial body weight of 10.8 ± 0.82 kg, divided into four groups fed the following diets: LC and ZnSO, LC and Zn glycinate (ZnGly), PF and ZnSO, or PF and ZnGly. Fiber supplements provided 10 g crude fiber/kg diet, while Zn additives introduced 120 mg Zn/kg diet. After four weeks of feeding, the pigs were sacrificed and digesta and tissue samples were taken from the cecum and colon. PF increased the water content and decreased the phosphorus concentration in the large intestine in comparison with LC. PF also increased calcium, iron, and chloride concentrations in the descending colon. Mucus layer thickness and histological parameters of the large intestine were not affected. ZnGly diets increased expression in the cecum as compared to the LC-ZnSO group. In the ascending colon, the PF-ZnGly diet increased expression, while both PF groups had greater expression in comparison with the LC-ZnSO group. In the transverse colon, the LC-ZnGly group and both PF groups had higher expression in comparison with the LC-ZnSO group, and both ZnGly groups had higher expression than ZnSO groups. PF and ZnGly increased and expression in the descending colon. PF and ZnGly may exert a beneficial effect on colon health in pigs by upregulating the expression of the and genes and are more effective than LC and ZnSO.
Topics: Swine; Animals; Zinc; Zinc Sulfate; Dietary Fiber; Dietary Supplements; Diet; Intestine, Large; Electrolytes; Mucous Membrane; Animal Feed
PubMed: 38069066
DOI: 10.3390/ijms242316743