Objective:To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial.Background:Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment.Methods:Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287). Initial diagnostic laparoscopy showing Hinchey III was followed by randomization. Clinical data was collected up to 12 weeks postoperatively.Results: Eighty-three patients were randomized, out of whom 39 patients in laparoscopic lavage and 36 patients in the Hartmann procedure groups were available for analysis. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay.Conclusions:In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III was feasible and safe in the short-term.
Cancer-associated autoantibodies hold promise as sensitive biomarkers for early detection of cancer. Aberrant posttranslational variants of proteins are likely to induce autoantibodies, and changes in O-linked glycosylation represent one of the most important cancer-associated post-translational modifications (PTMs). Short aberrant O-glycans on proteins may introduce novel glycopeptide epitopes that can elicit autoantibodies because of lack of tolerance. Technical barriers, however, have hampered detection of such glycopeptide-specific autoantibodies. Here, we have constructed an expanded glycopeptide array displaying a comprehensive library of glycopeptides and glycoproteins derived from a panel of human mucins (MUC1, MUC2, MUC4, MUC5AC, MUC6 and MUC7) known to have altered glycosylation and expression in cancer. Seromic profiling of patients with colorectal cancer identified cancer-associated autoantibodies to a set of aberrant glycopeptides derived from MUC1 and MUC4. The cumulative sensitivity of the array analysis was 79% with a specificity of 92%. The most prevalent of the identified autoantibody targets were validated as authentic cancer immunogens by showing expression of the epitopes in cancer using novel monoclonal antibodies. Our study provides evidence for the value of glycopeptides and other PTM-peptide arrays in diagnostic measures.Colorectal cancer develops in a multistep process that arises from genetic or epigenetic alterations.1 Most colorectal cancers can be treated by removal of early malignant lesions, 2,3 but despite this colorectal cancer remains the second most common cause of cancer-related death in the western world. 4 Current screening techniques, which include fecal occult blood, sigmoid and colonoscopy and computed tomographic colonography, are complicated with low compliance and high cost.5 Therefore, there is a need for biomarkers, which can identify colorectal cancer at early stages and aid in the surveillance and identification of high-risk populations.Broad genomic and proteomic approaches for identification of biomarkers have so far failed to develop simple, reliable and noninvasive screening test for early detection of colorectal cancer.6 Current serum assays detecting cancer glycoproteins such as CEA and CA-19-9 have limited use for early stages with low specificity and sensitivity. 7,8 As an alternative, circulating autoantibodies elicited by exposure to aberrant cancer proteins lacking immunological tolerance are emerging as promising biomarkers for the early detection of cancer.9-13 However, relatively few autoantibody epitopes have been identified and characterized to date.14 In a small study, we recently demonstrated the existence of such cancerassociated autoantibodies to the aberrantly O-glycosylated MUC1 mucin in patients with breast, ovarian and prostate cancer at time of diagnosis.15 These results provide basis for further discovery of autoantibody targets with the aim to increase sensitivity and organ specificity of biomarker assays through signatures of autoantibo...
High lymph node count was associated with improved overall survival in colon cancer. Lymph node ratio was superior to N-stage in differentiating overall survival in Stage III colon cancer. Stage migration was observed.
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