PurposeThis study was conducted to discover the clinical factors that can predict pathologically complete remission (pCR) after neoadjuvant chemoradiotherapy (CRT), so that those factors may help in deciding on a treatment program for patients with locally advanced rectal cancer.MethodsA total of 137 patients with locally advanced rectal cancer were retrospectively enrolled in this study, and data were collected retrospectively. The patients had undergone a total mesorectal excision after neoadjuvant CRT. Histologic response was categorized as pCR vs. non-pCR. The tumor area was defined as (tumor length) × (maximum tumor depth). The difference in tumor area was defined as pre-CRT tumor area – post-CRT tumor area. Univariate and multivariate logistic regression analyses were conducted to find the factors affecting pCR. A P-value < 0.05 was considered significant.ResultsTwenty-three patients (16.8%) achieved pCR. On the univariate analysis, endoscopic tumor circumferential rate <50%, low pre-CRT T & N stage, low post-CRT T & N stage, small pretreatment tumor area, and large difference in tumor area before and after neoadjuvant CRT were predictive factors of pCR. A multivariate analysis found that only the difference in tumor area before and after neoadjuvant CRT was an independent predictor of pCR (P < 0.001).ConclusionThe difference in tumor area, as determined using radiologic tools, before and after neoadjuvant CRT may be important predictor of pCR. This clinical factor may help surgeons to determine which patients who received neoadjuvant CRT for locally advanced rectal cancer should undergo surgery.
An internal hernia is defined as the protrusion of an internal organ through a defect in the abdominal cavity. Broad ligament hernia (BLH) is an extremely rare type of internal hernia that is difficult to diagnose preoperatively because the symptoms are nonspecific. However, early diagnosis is crucial, and early surgery is required to reduce complications such as strangulation. Laparoscopy has the advantage of enabling simultaneous diagnosis and treatment of BLH. With the advancement of the laparoscopic techniques, several cases of laparoscopic treatment of BLH have been reported. Nevertheless, open surgery is primarily performed in patients requiring bowel resection. We present a case of laparoscopic surgery for a strangulated internal hernia through a broad ligament defect. We successfully resected the strangulated small intestine and closed the defect of the broad ligament laparoscopically with a minor incision.
Background: Early detection of colorectal cancer (CRC) is essential to reduce cancer-related morbidity and mortality. Stool DNA (sDNA) testing is an emerging method for early CRC detection. Syndecan-2 (SDC2) methylation is a potential biomarker for the sDNA testing. Aberrant DNA methylation is an early epigenetic event during tumorigenesis, and can occur in the normal colonic mucosa during aging, which can compromise the sDNA test results. This study aimed to determine whether methylated SDC2 in sDNA normalizes after surgical resection of CRC. Methods: In this prospective study, we enrolled 151 patients with CRC who underwent curative surgical resection between September 2016 and May 2020. Preoperative stool samples were collected from 123 patients and postoperative samples were collected from 122 patients. A total of 104 samples were collected from both preoperative and postoperative patients. Aberrant promoter methylation of SDC2 in sDNA was assessed using linear target enrichment quantitative methylation-specific real-time PCR. Clinicopathological pararmeters were analyzed using the results of SDC2 methylation. Results: Detection rates of SDC2 methylation in the preoperative and postoperative stool samples were 88.6% and 19.7%, respectively. Large tumor size (³ 3 cm, P = 0.019) and advanced T stage (T3–T4, P = 0.033) were positively associated with the detection rate of SDC2 methylation before surgery. Female sex was associated with false positives after surgery (P = 0.030). Cycle threshold (CT) values were significantly decreased postoperatively compared with preoperative values (P < 0.001). The postoperative negative conversion rate for preoperatively methylated SDC2 was 79.3% (73/92) Conclusions: Our results suggested that the SDC2 methylation test for sDNA has acceptable sensitivity and specificity. However, small size and early T stage tumors are associated with a low detection rate of SDC2 methylation. As the CT values significantly decreased after surgery, SDC2 methylation test for sDNA had a high diagnostic value and may be used for surveillance after surgical resection of CRC.
Purpose Previous studies have reported that sarcopenia negatively impacts rectal cancer treatment. However, most published studies have analyzed only patients undergoing open surgery, and the association between sarcopenia and clinical outcomes in patients with rectal cancer undergoing laparoscopic surgery remains unclear. This study aimed to evaluate the effect of sarcopenia on the clinical and oncological outcomes of laparoscopic rectal cancer surgery. Methods Three hundred and one patients undergoing laparoscopic rectal cancer surgery were enrolled between December 2009 and May 2016. Body composition was assessed using computed tomography by measuring the muscle and fat areas at the third lumbar (L3) vertebra. The L3 skeletal muscle area was used to calculate the skeletal muscle index and evaluate sarcopenia. Results Sarcopenia was identified in 72/301 (23.9%) patients. Patients with sarcopenia had decreased skeletal muscle area (P < 0.001). However, there were no significant differences in visceral fat, subcutaneous fat, and body mass index. The time to tolerable soft diet and length of hospital stay were shorter in sarcopenia patients. The time to first flatus, postoperative complications, and overall and disease-free survival rates were not significantly different between those with and without sarcopenia. High American Society of Anesthesiologist classification (≥ 3; P = 0.014) and abdominoperineal resection (P = 0.003) were identified as risk factors for postoperative complications. Conclusion Sarcopenia does not negatively affect the functional recovery, postoperative complications, or survival after laparoscopic rectal cancer surgery. Further studies are necessary to validate that laparoscopic surgery could eliminate the negative impact of sarcopenia in patients with rectal cancer.
Purpose: Previous studies have reported that sarcopenia negatively impacts rectal cancer treatment. However, most published studies have analyzed only patients undergoing open surgery, and the association between sarcopenia and clinical outcomes in patients with rectal cancer undergoing laparoscopic surgery remains unclear. This study aimed to evaluate the effect of sarcopenia on the clinical and oncological outcomes of laparoscopic rectal cancer surgery.Methods: Three hundred and one patients undergoing laparoscopic rectal cancer surgery were enrolled between December 2009 and May 2016. Body composition was assessed using computed tomography by measuring the muscle and fat areas at the third lumbar (L3) vertebra. The L3 skeletal muscle area was used to calculate the skeletal muscle index and evaluate sarcopenia.Results: Sarcopenia was identified in 72/301 (23.9%) patients. Patients with sarcopenia had decreased skeletal muscle area (P < 0.001). However, there were no significant differences in visceral fat, subcutaneous fat, and body mass index. The time to tolerable soft diet and length of hospital stay were shorter in sarcopenia patients. The time to first flatus, postoperative complications, and overall and disease-free survival rates were not significantly different between those with and without sarcopenia. High American Society of Anesthesiologist classification (≥3; P = 0.014) and abdominoperineal resection (P = 0.003) were identified as risk factors for postoperative complications.Conclusion: Sarcopenia does not negatively affect the functional recovery, postoperative complications, or survival after laparoscopic rectal cancer surgery. Further studies are necessary to validate that laparoscopic surgery could eliminate the negative impact of sarcopenia in patients with rectal cancer.
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