Background. Colorectal cancer (CRC) is the third most common cancer in the world. The cornerstone of CRC treatment is surgical resection. However, patients in the same TNM stage show different recurrence rates and survival. Of patients with a local disease without lymph node or a distant metastasis, 20–25% still develop recurrence. There is evidence that inflammatory reaction is one of the key elements in tumour development. Materials and methods. We reviewed literature on colorectal cancer and its relationships with the immune system, with special focus on local and systemic inflammatory reaction. The Pubmed and ClinicalKey databases were searched using the key words colorectal cancer, local inflammation, systemic inflammation, markers of inflammation. The relevant literature was reviewed and included in the article. Results. The immune system has two-sided relationships with cancer, so it not only performs anti-tumour activities, but can also promote tumour growth and spread. Research has shown that signs of local inflammation are associated with a better prognosis in CRC. Systemic inflammation has been associated with more aggressive behaviour and a worse prognosis for patients with several cancers, including CRC. Conclusions. Recent findings in tumour biology have improved our understanding of colorectal cancer and of the natural course of this disease. Several markers of local and systemic inflammatory reaction have been identified. The next step is to find the most accurate and applicable marker, so that this promising tool can be used in clinical practice and aid in decision making.

No abstract

WHAT THIS PAPER ADDS This study shows that pre-operative evaluation of patients undergoing lower extremity surgical revascularisation using coronary computed tomography derived fractional flow reserve can identify high risk patients with silent coronary ischaemia. This information can facilitate a multidisciplinary team approach to improve patient outcome. Increased focus on peri-operative cardiac care combined with selective post-operative coronary revascularisation of patients with silent ischaemia resulted in fewer cardiovascular deaths and myocardial infarctions, and improved one year survival compared with patients having standard pre-operative cardiac evaluation. If confirmed by future studies, this strategy may improve long term survival of patients with peripheral vascular disease. Objective: Patients undergoing peripheral vascular surgery have increased risk of death and myocardial infarction (MI), which may be due to unsuspected (silent) coronary ischaemia. The aim was to determine whether preoperative diagnosis of silent ischaemia using coronary computed tomography (CT) derived fractional flow reserve (FFR CT) can facilitate multidisciplinary care to reduce post-operative death and MI, and improve survival. Methods: This was a single centre prospective study with historic controls. Patients with no cardiac symptoms undergoing lower extremity surgical revascularisation with pre-operative coronary CTA-FFR CT testing were compared with historic controls with standard pre-operative testing. Silent coronary ischaemia was defined as FFR CT 0.80 distal to coronary stenosis with FFR CT 0.75 indicating severe ischaemia. End points included cardiovascular (CV) death, MI, and all cause death through one year follow up. Results: There were no statistically significant differences between CT angiography (CTA-FFR CT) (n ¼ 135) and control (n ¼ 135) patients with regard to age (66 AE 8 years), sex, comorbidities, or surgery performed. Coronary CTA showed ! 50% stenosis in 70% of patients with left main stenosis in 7%. FFR CT revealed silent coronary ischaemia in 68% of patients with severe ischaemia in 53%. The status of coronary ischaemia was unknown in the controls. At 30 days, CV death and MI in the CTA-FFR CT group were not statistically significantly different from controls (0% vs. 3.7% [p ¼ .060] and 0.7% vs. 5.2% [p ¼ .066], respectively). Post-operative coronary revascularisation was performed in 54 patients to relieve silent ischaemia (percutaneous coronary intervention in 47, coronary artery bypass graft in seven). At one year, CTA-FFR CT patients had fewer CV deaths (0.7% vs. 5.9%; p ¼ .036) and MIs (2.2% vs. 8.1%; p ¼ .028) and improved survival (p ¼ .018) compared with controls. Conclusion: Pre-operative diagnosis of silent coronary ischaemia in patients undergoing lower extremity revascularisation surgery can facilitate multidisciplinary patient care with selective post-operative coronary revascularisation. This strategy reduced post-operative death and MI and improved one year survival compared with st...

Gastric cancer induces systemic inflammatory reaction (SIR) manifesting with changes in counts of white blood cell fractions and concentrations of acute phase proteins, clotting factors and albumins. Thus, protein-based scores or blood cell ratios (neutrophil to lymphocyte ratio (NLR); platelet to lymphocyte ratio (PLR)) are used to evaluate SIR. SIR tests are biologically justified by multiple clinically important and fascinating events including bone marrow activation, development of immune-suppressing immature myeloid cells, generation of pre-metastatic niches and neutrophil extracellular trap formation from externalised DNA network in bidirectional association with platelet activation. Despite biological complexity, clinical SIR assessment is widely available, patient-friendly and economically feasible. Here we present concise review on NLR, PLR, Glasgow prognostic score and fibrinogen -parameters that have prognostic role regarding overall, cancer-free and cancer-specific survival in early and advanced cases. Tumour burden can be predicted helping in preoperative detection of serosal or lymph node involvement. Practical consequences abound, including selection of surgical approach in respect to tumour burden, adjustments in treatment intensity by prognosis or evaluation of chemotherapy response. The chapter also scrutinises main controversies including different cut-off levels. Future developments should include elaboration of complex scores as described here. SIR parameters should be wisely incorporated in patients' treatment.