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Journal of Cancer Research and Clinical... Sep 2022Functional capacity is an independent indicator of morbidity in colon and rectal cancer surgery. This systematic review describes the evaluated and synthesized effects... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Functional capacity is an independent indicator of morbidity in colon and rectal cancer surgery. This systematic review describes the evaluated and synthesized effects of exercise prehabilitation depending on the duration of interventions on functional and postoperative outcomes in colon and rectal cancer surgery.
METHODS
Three electronic databases (MEDLINE Pubmed, Web of Sciences, and Cochrane Registry) were systematically searched (January 2022) for controlled trials that investigated the effects of prehabilitation prior to colo-rectal cancer resection.
RESULTS
Twenty-three studies were included in this systematic review and 14 in our meta-analyses assessing these outcomes: the 6 min walk distance (6MWD), postoperative overall complications, and length of stay (LOS). We observed a significant improvement in preoperative functional capacity as measured with 6MWD (mean difference: 30.8 m; 95% CI 13.3, 48.3; p = 0.0005) due to prehabilitation. No reductions in LOS (mean difference: - 0.27 days; 95% CI - 0.93, 0.40; p = 0.5) or postoperative overall complications (Odds ratio: 0.84; 95% CI 0.53, 1.31; p = 0.44) were observed. Prehabilitation lasting more than 3 weeks tended to lower overall complications (Odds ratio: 0.66; 95% CI 0.4, 1.1; p = 0.11). However, the prehabilitation time periods differed between colon and rectal carcinoma resections.
CONCLUSION
Prehabilitation while the patient is preparing to undergo surgery for colorectal carcinoma improves functional capacity; and might reduce postoperative overall complications, but does not shorten the LOS. The studies we reviewed differ in target variables, design, and the intervention's time period. Multicenter studies with sufficient statistical power and differentiating between colon and rectal carcinoma are needed to develop implementation strategies in the health care system.
REGISTRATION
PROSPERO CRD42022310532.
Topics: Carcinoma; Colorectal Neoplasms; Humans; Postoperative Complications; Preoperative Care; Preoperative Exercise; Rectal Neoplasms
PubMed: 35695931
DOI: 10.1007/s00432-022-04088-w -
Annals of Surgery Oct 2023The aim of the present randomized controlled trial was to evaluate the superiority of indocyanine green fluorescence imaging (ICG-FI) in reducing the rate of anastomotic... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The aim of the present randomized controlled trial was to evaluate the superiority of indocyanine green fluorescence imaging (ICG-FI) in reducing the rate of anastomotic leakage in minimally invasive rectal cancer surgery.
BACKGROUND
The role of ICG-FI in anastomotic leakage in minimally invasive rectal cancer surgery is controversial according to the published literature.
METHODS
This randomized, open-label, phase 3, trial was performed at 41 hospitals in Japan. Patients with clinically stage 0-III rectal carcinoma less than 12 cm from the anal verge, scheduled for minimally invasive sphincter-preserving surgery were preoperatively randomly assigned to receive a blood flow evaluation by ICG-FI (ICG+ group) or no blood flow evaluation by ICG-FI (ICG- group). The primary endpoint was the anastomotic leakage rate (grade A+B+C, expected reduction rate of 6%) analyzed in the modified intention-to-treat population.
RESULTS
Between December 2018 and February 2021, a total of 850 patients were enrolled and randomized. After the exclusion of 11 patients, 839 were subject to the modified intention-to-treat population (422 in the ICG+ group and 417 in the ICG- group). The rate of anastomotic leakage (grade A+B+C) was significantly lower in the ICG+ group (7.6%) than in the ICG- group (11.8%) (relative risk, 0.645; 95% confidence interval 0.422-0.987; P =0.041). The rate of anastomotic leakage (grade B+C) was 4.7% in the ICG+ group and 8.2% in the ICG- group ( P =0.044), and the respective reoperation rates were 0.5% and 2.4% ( P =0.021).
CONCLUSIONS
Although the actual reduction rate of anastomotic leakage in the ICG+ group was lower than the expected reduction rate and ICG-FI was not superior to white light, ICG-FI significantly reduced the anastomotic leakage rate by 4.2%.
Topics: Humans; Indocyanine Green; Anastomotic Leak; Rectal Neoplasms; Perfusion; Optical Imaging; Anastomosis, Surgical
PubMed: 37218517
DOI: 10.1097/SLA.0000000000005907 -
Abdominal Radiology (New York) Nov 2019Rectal adenocarcinoma with mucinous components is an uncommon type of rectal cancer with two distinct histologic subtypes: mucinous adenocarcinoma and signet-ring cell... (Review)
Review
Rectal adenocarcinoma with mucinous components is an uncommon type of rectal cancer with two distinct histologic subtypes: mucinous adenocarcinoma and signet-ring cell carcinoma. Mucin can also be identified as pattern of response after neoadjuvant treatment. On imaging modalities, mucin typically demonstrates high signal intensity on T2-weighted images, low attenuation on computed tomography, and may be negative on 18-fluorodeoxyglucose positron emission tomography. After neoadjuvant CRT, cellular and acellular mucin share similar imaging features, and differentiating them is currently the main challenge faced by radiologists. Radiologists should be aware of pros, cons, and limitations of each imaging modality in the primary staging and restaging to avoid misinterpretation of the radiological findings.
Topics: Adenocarcinoma, Mucinous; Chemoradiotherapy; Humans; Neoadjuvant Therapy; Neoplasm Staging; Rectal Neoplasms
PubMed: 30993392
DOI: 10.1007/s00261-019-02019-x -
ESMO Open Aug 2021Squamous cell carcinoma of the rectum is a rare malignancy (0.3% of all rectal cancers), with no known risk factor. These tumours are assessed as rectal cancer using... (Review)
Review
Squamous cell carcinoma of the rectum is a rare malignancy (0.3% of all rectal cancers), with no known risk factor. These tumours are assessed as rectal cancer using immunohistochemical and radiological tests, and certain criteria (localisation, relationship with neighbouring structures) have to be fulfilled to make the diagnosis. Some clinicians used to stage them with the anal cancer TNM (tumour-node-metastasis), whereas others used the rectal cancer TNM. When localised, the tendency nowadays is to treat those tumours like squamous anal cancers with definitive chemoradiotherapy (5-fluorouracil and mitomycin) and to skip surgery. For metastatic disease there is no clearly validated regimen and treatment should be based on recommendations of squamous anal cancers because of their common histology. Concerning follow-up after a curative approach, techniques should follow those for anal cancer as well, evaluating a delayed response.
Topics: Anus Neoplasms; Carcinoma, Squamous Cell; Chemoradiotherapy; Fluorouracil; Humans; Rectal Neoplasms
PubMed: 34111760
DOI: 10.1016/j.esmoop.2021.100180 -
Journal of Medicine and Life 2017Colorectal cancer (CRC) is a major health problem worldwide. The objective of our study was to assess the histopathological (HP) and immunohistochemical (IHC) profile of...
Colorectal cancer (CRC) is a major health problem worldwide. The objective of our study was to assess the histopathological (HP) and immunohistochemical (IHC) profile of mucins from signet ring (SR) and mucinous rectal carcinoma, while evaluating their value as a prognostic factor and muco-secretive ability. The HP study (76 cases) included 4 categories of patients: pure mucinous (PM), mixed mucinous components (MM) (50-80% of the tumor cells), mixed mucinous components (Mm) (< 50% of the tumor cells) and signet ring (SR). The IHC study consisted of a total of 30 cases of MRC and was processed by the ABC/ HRP technique. The antibodies used have addressed their muco-secretive capacity: MUC1, 2 and MUC5AC. MRC cases were more frequent in the sixth decade, with a median age of 57.3 years. It could be noted that MRC tended to develop at younger ages. For the MP variant, the gender ratio was 1.37 in favor of men, while for the MM variant it was 1.16, 1.31 for the Mm and 1.6 in the case of signet ring type. Most of the MRC were moderately differentiated forms, except for the SR form, poorly differentiated forms predominating. Well-differentiated forms were the most underrepresented, being more common in the Mm version. Regarding the biochemical type of mucin, MP and SR were characterized by acid mucins and sialomucin, while in the Mm type, there was a balance of acidic and neutral mucins. The prevalence of mucin acids, respectively sulfomucin, was characteristic to younger ages and poor prognosis.
Topics: Adenocarcinoma, Mucinous; Goblet Cells; Humans; Immunohistochemistry; Middle Aged; Mucin 5AC; Mucins; Rectal Neoplasms
PubMed: 28616090
DOI: No ID Found -
Colorectal Disease : the Official... Apr 2021Surgical treatment of colorectal cancer with synchronous colorectal liver metastases (SCRLM) can follow three different strategies with regard to the timing of liver...
AIM
Surgical treatment of colorectal cancer with synchronous colorectal liver metastases (SCRLM) can follow three different strategies with regard to the timing of liver resection. The aim of this study was to describe the selection of surgical strategy, focusing on differences between colon and rectal cancer with SCRLM, postoperative morbidity/mortality and survival.
METHOD
This was a retrospective population-based study of patients with SCRLM registered in the Swedish Colorectal Cancer Registry in the Stockholm/Gotland region during 2010-2017 and treated with surgical resection of the primary tumour and liver metastases (LM). Patients were followed for 5 years or censored at 22 November 2018.
RESULTS
A total of 238 patients met the inclusion criteria during the study period. Patients with rectal cancer were treated with the 'liver first' strategy in 70% of cases, whereas the main treatment strategies for colonic tumours were 'simultaneous resection' (44%) and 'primary first' (37%). Rectal cancer had a superior 5-year survival rate compared with colon tumours with SCRLM (62 vs. 47%; p = 0.033). There was no difference in survival between treatment strategies irrespective of primary tumour location. Postoperative complications occurred most commonly among rectal tumours treated with simultaneous resection (p = 0.024).
CONCLUSION
Patients with rectal cancer and SCRLM were more often treated with the 'liver first' strategy than patients with colon cancer. Patients with rectal cancer and SCRLM where both primary tumour and LM were operated on had significantly better survival than corresponding patients with colon cancer.
Topics: Carcinoma; Cohort Studies; Colorectal Neoplasms; Hepatectomy; Humans; Liver Neoplasms; Rectal Neoplasms; Retrospective Studies
PubMed: 33259702
DOI: 10.1111/codi.15468 -
Cancer Biology & Therapy Mar 2018We aimed to characterize the expression pattern of UBE2C in rectal carcinoma and elucidate its fundamental involvement in rectal carcinoma biology. The relative...
We aimed to characterize the expression pattern of UBE2C in rectal carcinoma and elucidate its fundamental involvement in rectal carcinoma biology. The relative expression of UBE2C in rectal carcinoma was determined by immunoblotting and QPCR. The cell viability was measured using CCK-8 assay. The anchorage-independent growth was evaluated with soft agar assay. Cell apoptosis was detected by Annexin V-PI staining. Invasion capacity was determined by transwell chamber. Tumor growth was monitored in xenograft mice model. We demonstrated that UBE2C was aberrantly up-regulated in rectal carcinoma. SiRNA-mediated knockdown of UBE2C significantly inhibited cell viability, proliferation, colony formation, invasion and induced apoptosis in vitro. Moreover, tumor growth in xenograft mice was markedly suppressed upon UBE2C silencing. Furthermore, we have identified that miR-381 was involved in regulation of UBE2C in rectal carcinoma. Here we demonstrated that UBE2C was over-expressed in rectal carcinoma, which was subjected to miR-381 modulation and in turn promoted cell proliferation, invasion and inhibited cell apoptosis.
Topics: Animals; Apoptosis; Carcinoma; Cell Line, Tumor; Cell Movement; Cell Proliferation; Cell Survival; Gene Expression Regulation, Neoplastic; Gene Knockdown Techniques; Humans; Mice; Mice, Nude; MicroRNAs; RNA, Small Interfering; Rectal Neoplasms; Rectum; Ubiquitin-Conjugating Enzymes; Up-Regulation; Xenograft Model Antitumor Assays
PubMed: 29303411
DOI: 10.1080/15384047.2017.1416939 -
Proceedings of the Royal Society of... Sep 1970
Topics: Adenocarcinoma; Female; Humans; Middle Aged; Neoplasm Metastasis; Rectal Neoplasms
PubMed: 5477082
DOI: No ID Found -
Cancer Imaging : the Official... Oct 2012The role of imaging in the management of rectal malignancy has progressively evolved and undergone several paradigm shifts. Unlike a few decades ago when the role of a... (Review)
Review
The role of imaging in the management of rectal malignancy has progressively evolved and undergone several paradigm shifts. Unlike a few decades ago when the role of a radiologist was restricted at defining the longitudinal extent of the tumour with barium enema, recent advances in imaging techniques permit highly accurate locoregional and distant staging of the disease as well as prognostication on those who are likely to have a postoperative recurrence. Computed tomography (CT) has always been the mainstay of imaging when evaluating for distant metastasis, with the advent of positron emission tomography/CT improving its specificity. In rectal malignancy, it is the local extent of the disease that often influences the surgical decision making and need for neoadjuvant therapy. Although endoscopic ultrasound has been the traditional technique for determining the depth of tumour invasion, over the last decade magnetic resonance imaging (MRI) has emerged as a very effective tool for accurate T-staging. This review intends to address the status of various imaging modalities and their advantages and limitations in detection, pretreatment staging, and assessment of therapeutic efficacy in rectal cancer, with emphasis on MRI of high spatial resolution.
Topics: Endosonography; Humans; Liver Neoplasms; Lymphatic Metastasis; Magnetic Resonance Imaging; Multimodal Imaging; Neoplasm Staging; Positron-Emission Tomography; Rectal Neoplasms; Rectum; Tomography, X-Ray Computed
PubMed: 23033451
DOI: 10.1102/1470-7330.2012.0034 -
Cancer Medicine Dec 2016Large, population-based analyses of rectal squamous cell carcinoma (SCC) have not been previously conducted. We assessed patterns of care, prognostic factors, and...
Large, population-based analyses of rectal squamous cell carcinoma (SCC) have not been previously conducted. We assessed patterns of care, prognostic factors, and outcomes of rectal SCC and adenocarcinoma (AC) in population-based cohorts. Surveillance, Epidemiology, and End Results (SEER) registry searches were performed (1998-2011), producing 42,308 nonmetastatic rectal cancer patients (999 SCC and 41,309 AC). Patient, tumor, and treatment characteristics were compared. Based on risk factors, SCC/AC groups were subdivided into low-, intermediate-, and high-risk groups. Overall survival (OS) was compared between histological and risk groups using Kaplan-Meier method and log-rank test. Multivariate logistic regression models evaluated prognostic factors for 5-year survival. Cox regression modeling was performed on propensity-matched data. Rectal SCC, more common in females and associated with larger tumors of higher grade, was more often treated with radiotherapy (RT) than surgery. Surgery was associated with higher OS in AC but not SCC, and RT had proportionally greater benefits in SCC. These effects of RT and surgery were retained when stratified into risk groups (particularly high/intermediate-risk). Favorable prognostic factors for survival included younger age, non-black race, SCC histology, size ≤3.9 cm, localized stage, lower grade, surgery, and RT. For SCC, race, tumor grade, and surgery were not prognostic factors for survival. Cox regression modeling of propensity-matched data showed that AC histology increased risk of death versus SCC. In the largest analysis of rectal SCC to date, and in the notable absence (and unlikelihood) of prospective data, nonsurgical and RT-based treatment is recommended.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Patient Outcome Assessment; Population Surveillance; Prognosis; Propensity Score; Rectal Neoplasms; SEER Program; Survival Analysis; Tumor Burden; Young Adult
PubMed: 27781400
DOI: 10.1002/cam4.927