BACKGROUND Colorectal anastomotic occlusion is a serious complication of colorectal cancer surgery.Although several treatment strategies have been proposed,the mana-gement of anastomotic occlusion remains challenging....BACKGROUND Colorectal anastomotic occlusion is a serious complication of colorectal cancer surgery.Although several treatment strategies have been proposed,the mana-gement of anastomotic occlusion remains challenging.In this report,we present a case of anastomotic occlusion recanalization performed using a novel technique involving two endoscopes,one for radial incision and the other serving as a guide light.This novel technique offers significant advantages in terms of operational feasibility,reduced invasiveness,rapid recovery,and shortened hospital stay.CASE SUMMARY A 37-year-old man underwent low anterior resection and prophylactic double-lumen ileostomy for rectal cancer in June,2023.Two months later,complete anastomotic occlusion was observed on colonoscopy.Therefore,we developed a novel atresia recanalization technique.Two endoscopes were placed,one through the colonic anastomosis and the other through the anus.A radial incision was successfully made from the colonic side,guided by the light of the endoscope from the anal side.Atresia recanal-ization was performed within 20 minutes.Three weeks after recanalization,colonoscopy revealed that the diameter of the colorectal anastomosis was approximately 16 mm and the patient therefore underwent stoma reversal in September.During the follow-up period of approximately one year,the patient remained well and no stenosis or obstruction symptoms were observed.CONCLUSION Endoscopic atresia recanalization of colorectal anastomotic occlusion assisted by an opposing light source is safe and effective.展开更多
Background:Inherited susceptibility accounts for nearly one-third of colorectal cancer(CRC)predispositions and has an 80%-100%lifetime risk of this disease.However,there are few data about germline mutations of heredi...Background:Inherited susceptibility accounts for nearly one-third of colorectal cancer(CRC)predispositions and has an 80%-100%lifetime risk of this disease.However,there are few data about germline mutations of hereditary CRC-related genes in Chinese patients with CRC.This study aimed to assess the prevalence of gene mutations related to cancer susceptibility among Chinese patients with CRC,differences between Chinese and Western patients,and the phenotypegenotype correlation.Methods:We retrospectively collected tumor samples from 526 patients with CRC under 70 years old who underwent hereditary CRC genetic testing.A series of bioinformatic analyses,as well as statistical comparisons,were performed.Results:We found that 77 patients(14.6%)harbored functional variants of the 12 genes.The mutation frequencies of the top 5 mutated genes were 6.5%for MutL homolog 1(MLH1),5.1%for MutS homolog 2(MSH2),1.0%for MSH6,0.8%for PMS1 homolog 2(PMS2),and 0.8%for APC regulator of the WNT signaling pathway(APC).Our data showed much higher rates of mutations of MSH6 and PMS2 genes among all mismatch repair(MMR)genes as compared with those in Western populations.Mutations in MLH1,MSH2,and MSH6 were found to be mutually exclusive.Patients with MLH1 or MSH2 mutations had higher frequencies of personal history of cancer(MLH1:20.6%vs.8.7%;MSH2:25.9%vs.8.6%)and family history of cancer than those without these mutations(MLH1:73.5%vs.48.4%;MSH2:70.4%vs.48.9%),and the lesions were more prone to occur on the right side of the colon than on the left side(MLH1:73.5%vs.29.3%;MSH2:56.0%vs.31.0%).The proportion of stage I/II disease was higher in patients with MLH1 mutations than in those without MLH1 mutations(70.6%vs.50.7%),and the rate of polyps was higher in patients withAPC mutations than in those with wild-type APC(75.0%vs.17.4%).Conclusion:These results provide a full-scale landscape of hereditary susceptibility over 12 related genes in CRC patients and suggest that a comprehensive multi-gene panel testing for hereditary CRC predisposition could be a helpful analysis in clinical practice.展开更多
Metabolic enzymes have an indispensable role in metabolic reprogramming,and their aberrant expression or activity has been associated with chemosensitivity.Hence,targeting metabolic enzymes remains an attractive appro...Metabolic enzymes have an indispensable role in metabolic reprogramming,and their aberrant expression or activity has been associated with chemosensitivity.Hence,targeting metabolic enzymes remains an attractive approach for treating tumors.展开更多
Objective:Knowledge about the impact of metabolic disturbances and parenteral nutrition(PN)characteristics on the survival of cancer patients receiving PN is limited.We aimed to assess the association between clinical...Objective:Knowledge about the impact of metabolic disturbances and parenteral nutrition(PN)characteristics on the survival of cancer patients receiving PN is limited.We aimed to assess the association between clinical and PN characteristics and survival in colorectal-cancer patients receiving PN support.Methods:Our study included 572 consecutive colorectal-cancer patients who had received PN support between 2008 and 2013.Patient characteristics,body mass index,weight,medical/surgical history,indication for PN,PN data and survival were recorded.Associations between clinical and PN characteristics and survival were analysed with important confounding factors.Results:The final cohort included 437 evaluable patients,with a mean age of 57 years.Eighty-one percent of the study population had advanced stage of colorectal cancer.Unstable weight(weight change≥2.5%)prior to PN initiation[hazard ratio(HR)=1.41,P=0.023]was adversely associated with survival after adjusting for multiple factors including cancer stage.Bowel obstruction(HR=1.75,P=0.017)as a PN indication was associated with worse survival when compared with without bowel obstruction.Higher PN amino acid by ideal body weight(g•kg^(-1))(HR=0.59,P=0.029)was associated with longer survival,whereas a higher percentage of non-PN intravenous calories(HR=1.04,P=0.011)was associated with shorter survival independently of confounding factors.Conclusions:Body mass index and weight stability can be useful nutritional indices for survival prediction in cancer patients receiving PN.PN planning should take into account of non-PN calories to achieve optimal energy support and balance.Future research is needed to define optimal PN amino-acid requirement and energy balance.展开更多
Background:The necessity for adjuvant chemotherapy(ACT)in locally advanced rectal cancer(LARC)patients who achieve pathological complete response(pCR)after pre-operative chemoradiotherapy(CRT)is still not identified.W...Background:The necessity for adjuvant chemotherapy(ACT)in locally advanced rectal cancer(LARC)patients who achieve pathological complete response(pCR)after pre-operative chemoradiotherapy(CRT)is still not identified.We aimed to investigate the therapeutic value of ACT in these patients.Methods:Clinical data were retrospectively collected from 105 consecutive LARC patients who achieved pCR after pre-operative CRT and underwent radical tumor resection between December 2008 and April 2014 in a comprehensive cancer center.Perioperative chemotherapy(CT)was administered by combining oxaliplatin with capecitabine(XELOX regimen).Disease-free survival(DFS)and overall survival(OS)rates of patients with or without ACT were compared.Results:Eighty-three(79.0%)patients received ACT and 22(21.0%)did not.With a median follow-up of 49 months,the ACT group had a significantly higher 3-year DFS rate(92.8 vs 86.4%,p=0.029)and 3-year OS rate(95.1 vs 86.1%,p=0.026)than the non-ACT group.In multivariable analyses,the presence of ACT was an independent prognostic factor for DFS(hazard ratio[HR]:0.271;95%confidence interval(CI):0.080–0.916;p=0.036)but not for OS.This benefit was more obvious in patients younger than 60 years via subgroup analysis(adjusted HR:0.106;95%CI:0.019–0.606;p=0.012).Conclusions:Oxaliplatin-containing ACT may confer survival benefits to patients with pCR,particularly younger patients.However,the routine use of ACT in patients with pCR needs further validation.展开更多
文摘BACKGROUND Colorectal anastomotic occlusion is a serious complication of colorectal cancer surgery.Although several treatment strategies have been proposed,the mana-gement of anastomotic occlusion remains challenging.In this report,we present a case of anastomotic occlusion recanalization performed using a novel technique involving two endoscopes,one for radial incision and the other serving as a guide light.This novel technique offers significant advantages in terms of operational feasibility,reduced invasiveness,rapid recovery,and shortened hospital stay.CASE SUMMARY A 37-year-old man underwent low anterior resection and prophylactic double-lumen ileostomy for rectal cancer in June,2023.Two months later,complete anastomotic occlusion was observed on colonoscopy.Therefore,we developed a novel atresia recanalization technique.Two endoscopes were placed,one through the colonic anastomosis and the other through the anus.A radial incision was successfully made from the colonic side,guided by the light of the endoscope from the anal side.Atresia recanal-ization was performed within 20 minutes.Three weeks after recanalization,colonoscopy revealed that the diameter of the colorectal anastomosis was approximately 16 mm and the patient therefore underwent stoma reversal in September.During the follow-up period of approximately one year,the patient remained well and no stenosis or obstruction symptoms were observed.CONCLUSION Endoscopic atresia recanalization of colorectal anastomotic occlusion assisted by an opposing light source is safe and effective.
基金This work was supported,in part,by the National Key Research and Development Program of China(2018YFC1313300,2017YFC1308900)National Natural Science Foundation of China(81930065,81872011,81903163)+4 种基金Science and Technology Program of Guangdong(2019B020227002)Science and Technology Program of Guangzhou(201904020046,201803040019,201704020228)Guangzhou Health and Medical Collaborative Innovation Project(201704020220)Guangdong Esophageal Cancer Institute Science and Technology Program(M201905)the Sun Yat-sen University Clinical Research 5010 Program(2018014).
文摘Background:Inherited susceptibility accounts for nearly one-third of colorectal cancer(CRC)predispositions and has an 80%-100%lifetime risk of this disease.However,there are few data about germline mutations of hereditary CRC-related genes in Chinese patients with CRC.This study aimed to assess the prevalence of gene mutations related to cancer susceptibility among Chinese patients with CRC,differences between Chinese and Western patients,and the phenotypegenotype correlation.Methods:We retrospectively collected tumor samples from 526 patients with CRC under 70 years old who underwent hereditary CRC genetic testing.A series of bioinformatic analyses,as well as statistical comparisons,were performed.Results:We found that 77 patients(14.6%)harbored functional variants of the 12 genes.The mutation frequencies of the top 5 mutated genes were 6.5%for MutL homolog 1(MLH1),5.1%for MutS homolog 2(MSH2),1.0%for MSH6,0.8%for PMS1 homolog 2(PMS2),and 0.8%for APC regulator of the WNT signaling pathway(APC).Our data showed much higher rates of mutations of MSH6 and PMS2 genes among all mismatch repair(MMR)genes as compared with those in Western populations.Mutations in MLH1,MSH2,and MSH6 were found to be mutually exclusive.Patients with MLH1 or MSH2 mutations had higher frequencies of personal history of cancer(MLH1:20.6%vs.8.7%;MSH2:25.9%vs.8.6%)and family history of cancer than those without these mutations(MLH1:73.5%vs.48.4%;MSH2:70.4%vs.48.9%),and the lesions were more prone to occur on the right side of the colon than on the left side(MLH1:73.5%vs.29.3%;MSH2:56.0%vs.31.0%).The proportion of stage I/II disease was higher in patients with MLH1 mutations than in those without MLH1 mutations(70.6%vs.50.7%),and the rate of polyps was higher in patients withAPC mutations than in those with wild-type APC(75.0%vs.17.4%).Conclusion:These results provide a full-scale landscape of hereditary susceptibility over 12 related genes in CRC patients and suggest that a comprehensive multi-gene panel testing for hereditary CRC predisposition could be a helpful analysis in clinical practice.
基金This research was supported by the National Natural Science Foundation of China(82022052,82173128,81930065,82073377,81772587)Natural Science Foundation of Guangdong Province(2018B030306049,2021A1515012439)Science and Technology Program of Guangdong(2019B020227002)+1 种基金Science and Technology Program of Guangzhou(201904020046)CAMS Innovation Fund for Medical Sciences(CIFMS)(2019-I2M-5-036).
文摘Metabolic enzymes have an indispensable role in metabolic reprogramming,and their aberrant expression or activity has been associated with chemosensitivity.Hence,targeting metabolic enzymes remains an attractive approach for treating tumors.
基金The University of Texas MD Anderson Cancer Center was supported in part by the NIH through Cancer Center Support Grant P30 CA016672.
文摘Objective:Knowledge about the impact of metabolic disturbances and parenteral nutrition(PN)characteristics on the survival of cancer patients receiving PN is limited.We aimed to assess the association between clinical and PN characteristics and survival in colorectal-cancer patients receiving PN support.Methods:Our study included 572 consecutive colorectal-cancer patients who had received PN support between 2008 and 2013.Patient characteristics,body mass index,weight,medical/surgical history,indication for PN,PN data and survival were recorded.Associations between clinical and PN characteristics and survival were analysed with important confounding factors.Results:The final cohort included 437 evaluable patients,with a mean age of 57 years.Eighty-one percent of the study population had advanced stage of colorectal cancer.Unstable weight(weight change≥2.5%)prior to PN initiation[hazard ratio(HR)=1.41,P=0.023]was adversely associated with survival after adjusting for multiple factors including cancer stage.Bowel obstruction(HR=1.75,P=0.017)as a PN indication was associated with worse survival when compared with without bowel obstruction.Higher PN amino acid by ideal body weight(g•kg^(-1))(HR=0.59,P=0.029)was associated with longer survival,whereas a higher percentage of non-PN intravenous calories(HR=1.04,P=0.011)was associated with shorter survival independently of confounding factors.Conclusions:Body mass index and weight stability can be useful nutritional indices for survival prediction in cancer patients receiving PN.PN planning should take into account of non-PN calories to achieve optimal energy support and balance.Future research is needed to define optimal PN amino-acid requirement and energy balance.
基金supported by grants from the National Natural Science Foundation of China(No.81772595)the Sun Yat-sen University Clinical Research 5010 Program(No.2015024)+2 种基金the Natural Science Foundation of Guangdong Province(No.2017A030310204)the Medical Scientific Research Foundation of Guangdong Province(No.A2017545)the Science and Technology Planning Project of Guangdong Province(No.2013B021800146).
文摘Background:The necessity for adjuvant chemotherapy(ACT)in locally advanced rectal cancer(LARC)patients who achieve pathological complete response(pCR)after pre-operative chemoradiotherapy(CRT)is still not identified.We aimed to investigate the therapeutic value of ACT in these patients.Methods:Clinical data were retrospectively collected from 105 consecutive LARC patients who achieved pCR after pre-operative CRT and underwent radical tumor resection between December 2008 and April 2014 in a comprehensive cancer center.Perioperative chemotherapy(CT)was administered by combining oxaliplatin with capecitabine(XELOX regimen).Disease-free survival(DFS)and overall survival(OS)rates of patients with or without ACT were compared.Results:Eighty-three(79.0%)patients received ACT and 22(21.0%)did not.With a median follow-up of 49 months,the ACT group had a significantly higher 3-year DFS rate(92.8 vs 86.4%,p=0.029)and 3-year OS rate(95.1 vs 86.1%,p=0.026)than the non-ACT group.In multivariable analyses,the presence of ACT was an independent prognostic factor for DFS(hazard ratio[HR]:0.271;95%confidence interval(CI):0.080–0.916;p=0.036)but not for OS.This benefit was more obvious in patients younger than 60 years via subgroup analysis(adjusted HR:0.106;95%CI:0.019–0.606;p=0.012).Conclusions:Oxaliplatin-containing ACT may confer survival benefits to patients with pCR,particularly younger patients.However,the routine use of ACT in patients with pCR needs further validation.
