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Cancers May 2023The incidence of colorectal cancer (CRC) is increasing in the young (under 50). Defining the clinicopathological features and cancer-specific outcomes of patients with...
The incidence of colorectal cancer (CRC) is increasing in the young (under 50). Defining the clinicopathological features and cancer-specific outcomes of patients with early-onset CRC is important to optimize screening and treatment strategies. This study evaluated disease-specific features and oncological outcomes of patients with early-onset CRC. Anonymized data from an international collaboration were analyzed. The inclusion criteria for this study were patients aged <50 years with stage I-III disease surgically resected with curative intent. Overall and disease-free survival were calculated using the Kaplan-Meier method. A total of 3378 patients were included, with a median age of 43 (18-49) and a slight male preponderance (54.3%). One-third had a family history of colorectal cancer. Almost all (>95%) of patients were symptomatic at diagnosis. The majority (70.1%) of tumors were distal to the descending colon. Approximately 40% were node positive. Microsatellite instability was demonstrated in one in five patients, representing 10% of rectal and 27% of colon cancers. A defined inherited syndrome was diagnosed in one-third of those with microsatellite instability. Rectal cancer displayed a worse prognosis stage for stage. Five-year disease-free survival for stage I, II, and III colon cancer was 96%, 91%, and 68%, respectively. The equivalent rates for rectal cancer were 91%, 81%, and 62%. The majority of EOCRC would be captured with flexible sigmoidoscopy. Extending screening to young adults and public health education initiatives are potential interventions to improve survivorship.
PubMed: 37296939
DOI: 10.3390/cancers15112979 -
The American Surgeon Sep 2023Breast cancer metastasis to the colon is exceedingly rare, with only 17 reported cases in the literature thus far. This report describes a 67-year-old female who...
Breast cancer metastasis to the colon is exceedingly rare, with only 17 reported cases in the literature thus far. This report describes a 67-year-old female who presented to the Emergency Department for large volume melena in the setting of bilateral metastatic ductal breast carcinoma, left triple negative and right HER2+, and T4N0M0 non-small cell lung cancer. On routine CT abdomen/pelvis imaging, the patient had a 7 cm mass arising from the transverse colon. Colonoscopy revealed a non-obstructing necrotic mass in the proximal descending colon. The patient underwent a partial colectomy, small bowel resection, and gastric wedge resection. The patient recovered from surgery and was discharged home with palliative services. The patient passed away four months after discharge due to numerous metastases.
Topics: Female; Humans; Aged; Breast Neoplasms; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Colon; Colectomy; Neoplasms, Second Primary; Melanoma, Cutaneous Malignant
PubMed: 37144362
DOI: 10.1177/00031348231173979 -
The American Surgeon Nov 2021Carl Florian Toldt was an Austrian anatomist who made meaningful contributions worldwide and defined what is one of the most important surgical landmarks in abdominal...
Carl Florian Toldt was an Austrian anatomist who made meaningful contributions worldwide and defined what is one of the most important surgical landmarks in abdominal surgery. Through his research studies, the embryologic dissection plane known as the "White Line of Toldt" represents an important anatomical landmark that helps to mobilize either the ascending or descending colon. His career spanned over 45 years, beginning in Verona and continuing to Prague and Vienna. He was an author of several innovative books and scientific articles regarding micro- and macroscopic anatomy. In addition, he received numerous recognitions and prizes for his work, making him an essential figure in the medical scientific community. Even a street in Vienna, Karl-Toldt-Weg, is named in his honor. The purpose of this historical article is to celebrate and honor Toldt 100 years following his death, remembering his scientific contributions to the medical and surgical fields and giving thanks for his numerous accomplishments. This article brings light to the man behind the eponym.
Topics: Anatomy; Austria-Hungary; Colon; Dissection; Histology; History, 19th Century; History, 20th Century; Humans; Italy; Mesocolon; Peritoneum; Retroperitoneal Space
PubMed: 33720793
DOI: 10.1177/0003134821991979 -
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 -
Journal of B.U.ON. : Official Journal... 2019Right-sided colon cancers (RCCs) and left-sided colon cancers (LCCs) have different embryological, epidemiological, physiological, pathological, genetic, and clinical... (Comparative Study)
Comparative Study
PURPOSE
Right-sided colon cancers (RCCs) and left-sided colon cancers (LCCs) have different embryological, epidemiological, physiological, pathological, genetic, and clinical characteristics, which result in differences in the course, prognosis, and outcome of disease. This study aimed to compare RCCs and LCCs regarding clinicopathological and survival characteristics.
METHODS
The present retrospective study included data of patients who were followed-up and treated for colon cancer from 2008 through 2017. Rectosigmoid, descending colon, and splenic flexure tumors were considered LCC, whereas hepatic flexure and ascending colon tumors were considered RCC. Tumors were staged according to the American Joint Committee on Cancer classification.
RESULTS
The study included 1725 patients (female, 58.7%) having colon cancer with a mean age of 64±12 years. Of the patients, 83.2% (n=1436) had LCC and 16.8% (n=289) had RCC. The rate of patients aged ≥65 years and the rate of patients with a family history of colon cancer were higher in the RCC patients. The rate of metastatic patients was 29.1% in the RCC group and 23.2% in the LCC group (p=0.087). The median follow-up period was 18 months in the RCC group and 23 months in the LCC group (p=0.011). Although the median survival time was higher in the LCC group (62 vs. 43 months), no significant difference was determined between the RCC and LCC groups in terms of survival.
CONCLUSIONS
There are numerous clinicopathological differences between RCC and LCC and these differences are reflected in prognostic and survival differences among certain subgroups.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Colonic Neoplasms; Female; Humans; Male; Middle Aged; Mutation; Neoplasm Staging; Retrospective Studies; Risk Factors; Time Factors; Young Adult
PubMed: 31786846
DOI: No ID Found -
Annals of Anatomy = Anatomischer... Jan 2022In invasive examinations of the colon, e.g. colonoscopy, the tortuosity of the colon is a crucial factor for successful completion of the procedure. If adjacent segments...
BACKGROUND
In invasive examinations of the colon, e.g. colonoscopy, the tortuosity of the colon is a crucial factor for successful completion of the procedure. If adjacent segments of the colon bend at acute angles (under 90°), endoscopy may become difficult and troublesome.
METHODS
We retrospectively enroled 227 individuals (96 female, 131 male) who underwent abdominopelvic computed tomography examination. For inclusion, subjects were required to have a negative history for colonic disease and abdominopelvic surgery. We measured the angle between the descending colon and the proximal part of the sigmoid (in degrees). In addition, the position of the descending-sigmoid flexure was assessed in relation to the left anterior superior iliac spine, the median plane, and anterior aspect of the 5th lumbar vertebra (in mm). The study protocol was reviewed and approved by the local ethics committee.
RESULTS
We visualised the descending-sigmoid flexure in all 227 subjects. In one third of cases, the flexure formed an angle smaller than/or 90°. In females, this landmark (mean ± standard deviation) was located 30.2 ± 8.4 mm from the left anterior superior iliac spine, 88.6 ± 14.2 mm from the median plane, and 115.4 ± 21.4 mm from the anterior aspect of the 5th lumbar vertebra. In males, the dimensions were: 32.1 ± 12.8 mm, 97.6 ± 15.8 mm, and 123.9 ± 22.9 mm, respectively. This landmark distance remained constant from the left anterior superior iliac spine regardless of subject age, height and weight. The other measured distances were related to age, height, weight or BMI.
CONCLUSIONS
The descending-sigmoid flexure is an important landmark in large intestine morphology situated approximately width of two fingers (3 cm) from the left anterior superior iliac spine and one hand width (9-10 cm) from the median plane. In approximately one third of the subjects, the flexure formed an angle of less than/or 90°, which can cause a problem during colonoscopy.
Topics: Colon; Colon, Sigmoid; Colonoscopy; Female; Humans; Male; Retrospective Studies
PubMed: 34530081
DOI: 10.1016/j.aanat.2021.151821 -
Frontiers in Surgery 2022In patients with Hirschsprung's disease (HD), persistent obstructive symptoms may develop after surgery. The causes of mechanical obstruction may be a retraction of the...
BACKGROUND
In patients with Hirschsprung's disease (HD), persistent obstructive symptoms may develop after surgery. The causes of mechanical obstruction may be a retraction of the pulled-through bowel due to insufficient mobilization of the mesentery or impaired blood supply in the area of the coloanal anastomosis in the case of excessive ligation of the supplying vessels. Leakage and stenosis are formidable complications and require repeated surgical intervention.
OBJECTIVE
The purpose of this study is to describe our experience and short-term results of the developed method: mobilization of the descending colon for its pull-through during the surgical treatment of the children with HD, which allows ensuring good mobility to the descending colon and maintaining blood supply at the same time.
METHODS
The medical records of 20 patients with rectosigmoid HD, who underwent parietal mobilization of the descending colon with preservation of the marginal artery, sigmoid arteries, and ligation of the left colon artery, were reviewed. This method is aimed at increasing the mobility of the brought-down bowel and maintaining the blood supply to the distal part of the brought-down bowel not only from the superior mesenteric artery but also from the lower one.The SPSS Statistics 26.0 package was used for statistical analysis. To describe the analyzed data with a normal distribution, the mean values and the error of the mean were used. To determine the differences, Student's -test was used, and the differences were considered significant at a significance level of < 0.05.
RESULTS
In all patients, the postoperative period was uneventful, without complications. The patients were discharged for outpatient treatment on average on the seventh day after the surgery. In all cases, there were no signs of anastomotic leakage or stricture on follow-up after 6-12 months.
CONCLUSION
The method of mobilization of the colon in the rectosigmoid form of HD, parietal mobilization of the descending part of the colon preserving the marginal artery, sigmoid arteries, and ligating the left colon artery, can reduce the risk of complications by eliminating the tension of the descending colon.
PubMed: 35865043
DOI: 10.3389/fsurg.2022.921789 -
Journal of Laparoendoscopic & Advanced... Sep 2021Standardized protocols for laparoscopic surgery of splenic flexure cancer (SFC) have not been established yet. We described a standardized laparoscopic procedure for...
Standardized protocols for laparoscopic surgery of splenic flexure cancer (SFC) have not been established yet. We described a standardized laparoscopic procedure for SFCs and examined its safety and feasibility. Laparoscopic colectomy for SFC was performed as follows. The sigmoid colon was mobilized to the descending mesocolon through the medial approach. After confirming the base of the inferior mesenteric artery, the left colic artery was dissected and resected at the base. Further dissection was carried out between the mesentery of the colon and the renal fascia until it exceeded the upper pole of the left kidney and the splenic flexure. The next dissection reached the white line at the lateral side and the sigmoid-descending colon junction. After making an incision at the greater omentum and gastrocolic ligament from the center of the transverse colon to the splenic flexure, the transverse mesocolon base was dissected from the inside splenic flexure for complete mobilization. This was performed by approaching from four directions toward the splenic flexure. Intestinal resection and anastomosis are performed. This procedure was performed in 70 patients with splenic flexure colon cancer (mean age 70 years). The mean operative time was 190 minutes, and the mean blood loss was 2.0 mL. No notable perioperative or postoperative complications were noted. Safe mobilization of the splenic flexure can be achieved by approaching from four directions, and standardization of left colectomy can facilitate complete mesenteric excision.
Topics: Aged; Colectomy; Colon, Transverse; Colonic Neoplasms; Humans; Laparoscopy; Mesocolon
PubMed: 33226876
DOI: 10.1089/lap.2020.0709 -
Emergency Radiology Feb 2022To evaluate the role of specific distributions of free air in predicting the location of gastrointestinal (GI) tract perforation.
PURPOSE
To evaluate the role of specific distributions of free air in predicting the location of gastrointestinal (GI) tract perforation.
MATERIALS AND METHODS
One hundred and fifteen patients with surgically proven GI tract perforation between January 2015 and June 2019 were included in the study. The site of perforation was based on surgical findings in all cases. Two radiologists retrospectively interpreted the computed tomography (CT) images of these patients for extraluminal free air distribution. Perforation sites were demonstrated intraoperatively in all cases and were categorized as follows: stomach and duodenum, jejunum and ileum, proximal colon (cecum, ascending colon, and transverse colon), distal colon (descending colon and sigmoid colon), rectum, and appendix.
RESULTS
There were 79 male and 36 female patients with a mean age of 56.4 years. Periportal, perihepatic, and perigastric free air were statistically significant in predicting gastroduodenal perforation. Mesenteric free air was significant in predicting both small bowel and distal colon perforations. Pelvic free air was statistically significant in distal colon perforations. Periappendiceal free air was found to be a strong predictor of acute perforated appendicitis.
CONCLUSION
Specific free air distributions may help to predict the site of gastrointestinal perforation, which would change the treatment plan.
Topics: Abdominal Injuries; Duodenum; Female; Humans; Intestinal Perforation; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34633581
DOI: 10.1007/s10140-021-01990-7 -
Automatic anatomical classification of colonoscopic images using deep convolutional neural networks.Gastroenterology Report Jun 2021A colonoscopy can detect colorectal diseases, including cancers, polyps, and inflammatory bowel diseases. A computer-aided diagnosis (CAD) system using deep...
BACKGROUND
A colonoscopy can detect colorectal diseases, including cancers, polyps, and inflammatory bowel diseases. A computer-aided diagnosis (CAD) system using deep convolutional neural networks (CNNs) that can recognize anatomical locations during a colonoscopy could efficiently assist practitioners. We aimed to construct a CAD system using a CNN to distinguish colorectal images from parts of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.
METHOD
We constructed a CNN by training of 9,995 colonoscopy images and tested its performance by 5,121 independent colonoscopy images that were categorized according to seven anatomical locations: the terminal ileum, the cecum, ascending colon to transverse colon, descending colon to sigmoid colon, the rectum, the anus, and indistinguishable parts. We examined images taken during total colonoscopy performed between January 2017 and November 2017 at a single center. We evaluated the concordance between the diagnosis by endoscopists and those by the CNN. The main outcomes of the study were the sensitivity and specificity of the CNN for the anatomical categorization of colonoscopy images.
RESULTS
The constructed CNN recognized anatomical locations of colonoscopy images with the following areas under the curves: 0.979 for the terminal ileum; 0.940 for the cecum; 0.875 for ascending colon to transverse colon; 0.846 for descending colon to sigmoid colon; 0.835 for the rectum; and 0.992 for the anus. During the test process, the CNN system correctly recognized 66.6% of images.
CONCLUSION
We constructed the new CNN system with clinically relevant performance for recognizing anatomical locations of colonoscopy images, which is the first step in constructing a CAD system that will support us during colonoscopy and provide an assurance of the quality of the colonoscopy procedure.
PubMed: 34316372
DOI: 10.1093/gastro/goaa078