@article { author = {Jothimani, Muralidharan and Loganathan, Lakshmanan and Palanisamy, Prahashini and Muthusamy, Karthikeyan}, title = {Regulatory pathways of colorectal cancer and their synergistic cross-talk mechanism}, journal = {Iranian Journal of Colorectal Research}, volume = {8}, number = {3}, pages = {105-119}, year = {2020}, publisher = {Shiraz University of Medical Sciences}, issn = {2783-2430}, eissn = {2783-2430}, doi = {10.30476/acrr.2020.86258.1046}, abstract = {Context: Cancer is the leading cause of death in the human population, ensuing from the accumulation of damage to genetic materials and affecting various parts of the organs. This review is focused on the cell signaling cross-talk mechanism of colorectal cancer (CRC) and its regulations. Genomic instability acts as the major driving force for CRC. The major CRC cascade mechanisms such as Wnt, Ras, TOPK, p53, and ubiquitin pathways were discussed. These interlinked signals cross-talk with one another in various regulatory mechanisms and play a unique role in CRC. Evidence Acquisition: The major cross-talking signals of CRC are the most significant part of this review. Wnt is a resource and center of axis for cross-talk and interlinked signaling mechanism. Wnt/β-catenin signaling was regulated by frizzled receptor, co-factors, Ras, TOPK, and many other mechanisms; related literature of CRC were collected through a literature survey and categorized using the keywords. The pathways with high specificity interlinked with Wnt were identified and used as the major targets for this review. Results and Conclusion: The interlinked signaling pathways and gene networks were explained with their specificity role in CRC. We highlighted the major regulatory signaling and interlinked pathways of CRC, as new multi targets approach. Furthermore, we discussed the potent targeted genes, bio-markers for a better prognosis, and therapies for CRC patients. Through highlighting the gene cross-talking signaling cascade; we have provided the source for gene network interaction and targeted therapy. This study paves the way for multi-targeting of interlinked pathways and suggesting these would be perfect for suppressing of CRC. The signaling pathways discussed in this review are not only focused on CRC but also the new potent targets and bio-markers for different types of cancers. Targeting multiple interlinked pathways could be useful for developing new potential bio-markers for treatment and diagnosis purposes.}, keywords = {Colorectal cancer,Cross-talking,Wnt/β-catenin,Ras,TOPK,p53,Ubiquitin}, url = {https://colorectalresearch.sums.ac.ir/article_46977.html}, eprint = {https://colorectalresearch.sums.ac.ir/article_46977_6d3179be717ae8f45ee5df86d294e492.pdf} } @article { author = {Hussain, Abdulzahra and Manejula, Owais and Ghosh, Anngona and Shuaib, Shariq and Soliman, Hesham and Hafeez, Rehana and EL-Hasani, Shamsi}, title = {Impact of COVID-19 on Emergency General Surgery}, journal = {Iranian Journal of Colorectal Research}, volume = {8}, number = {3}, pages = {120-124}, year = {2020}, publisher = {Shiraz University of Medical Sciences}, issn = {2783-2430}, eissn = {2783-2430}, doi = {10.30476/acrr.2020.88275.1064}, abstract = {Background There are limited data on emergency surgical practice during the covid-19 era. Objectives To evaluate the outcomes for emergency surgery before and during Covid-19. Methods This is a retrospective study of emergency admissions to one general surgery department during November 2019 (which is likely to represent our normal working pattern) and April 2020 (which was the peak of the Covid-19 crisis in our population). Data of each of these 2 months were collected separately. Patients demographic features, type of procedures, blood test results, procedure approach( open, laparoscopic), morbidities and mortality were reported. Statistical analysis using descriptive statistics, Chi-square, and Z -tests were used for statistical significance analysis value taken as The primary endpoints were Covid-19 diagnosis, the number and types of surgical admissions and procedures. The secondary endpoints were complications, mortality, laparoscopic and open approaches,CRP and white cell count, length of stay, age and gender. Results: 332 patients were admitted [146 patients during April 2020, and 177 patients during November 2019. There were 147 male and 176 female. The mean age was 51 year for November group and 49 years for April group. There were 146 procedures performed during November while 117 operations were conducted during April. Length of stay was 5.87 and 5.43 for November and April patients respectively. There were 7 patients tested +ve for Covid-19 and 3 mortality in each group. Acute cholecystitis, abscess, diverticulitis and CRP are showing significant differences between the two groups, P-value Conclusions The postoperative complications, mortality and acute cholecystitis are significantly higher while abscess and diverticulitis are significantly reduced}, keywords = {COVID-19,Emergency Surgery,Complications}, url = {https://colorectalresearch.sums.ac.ir/article_46974.html}, eprint = {https://colorectalresearch.sums.ac.ir/article_46974_faab7484cc0a5355cb99da191ead9b64.pdf} } @article { author = {khashayar, Arash and Khaleghnejad Tabari, Ahmad and Mohajerzadeh, Leily and Ghoroubi, Javad and Samami, Mahdieh}, title = {Outcomes of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube}, journal = {Iranian Journal of Colorectal Research}, volume = {8}, number = {3}, pages = {125-128}, year = {2020}, publisher = {Shiraz University of Medical Sciences}, issn = {2783-2430}, eissn = {2783-2430}, doi = {10.30476/acrr.2020.84600.1024}, abstract = {Background: The corrosive esophageal injury would result in mucosal damage related to type, exposure time, and volume of ingested substance ranging from mild burn to severe necrosis. It is usually seen in childhood. Stricture and dysphagia are common. Swallowing problems are due to prolonged stricture and would require surgery. However postoperative problems should also be considered. The purpose of this study was to determine the results of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube. Methods: In this observational descriptive-comparative study, 50 consecutive patients attending to Mofid children hospital since 2006 to 2016 were enrolled and the results of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube among them were determined and compared according to other variables. Results: The results in this study demonstrated that 68% required surgery that 82.3% had repeat surgery. Out of them 22 were performed with Gastric Pull up method that was successful in majority of subjects. Esophageal stricture (74%), vomiting (46%), and dysphagia (40%) were most common preoperative problems and dysphagia (46%), stricture (36%), and vomiting (26%) were most common postoperative problems. There were 4 mortality cases. Conclusion: Totally, according to the obtained results, it may be concluded that esophagus substitution in the management of corrosive esophageal injury is effective that Gastric Pull up method is best option.}, keywords = {Esophagus substitution,Corrosive esophageal injury,Surgical outcomes}, url = {https://colorectalresearch.sums.ac.ir/article_46932.html}, eprint = {https://colorectalresearch.sums.ac.ir/article_46932_0dbc3c10981626126c4a81598a657ba2.pdf} } @article { author = {Singhal, Tarun and Dudek, Joanna and Sharmin, Afroza and Sudhanva, Malur and Hussain, Abdulzahra and EL-Hasani, Shamsi}, title = {Ground plan for performing Emergency Surgery in suspected and confirmed COVID-19 patients}, journal = {Iranian Journal of Colorectal Research}, volume = {8}, number = {3}, pages = {129-135}, year = {2020}, publisher = {Shiraz University of Medical Sciences}, issn = {2783-2430}, eissn = {2783-2430}, doi = {10.30476/acrr.2020.46945}, abstract = {Background: Covid-19 crisis has created a huge challenge to the healthcare systems all over the world. Different health policies have been adopted with variable success. This paper aims to provide a practical pathway of managing surgical patients in current Covid-19 pandemic. Methods: A modified framework of local policy and pathways is suggested to deal with acute surgical admissions and semi-emergency conditions. This included logistic changes in the hospitals' infrastructures, staff allocations and the use of suitable personal protection equipment. Results: The introduction of the suggested changes is expected to improve the delivery of the services and reduce risks to patients and the staff. About 80 operations were conducted since the application of these changes. Conclusion: Challenges with Covid-19 pandemic has required each health system to adequately respond to the crisis by the introduction of an urgent fundamental change to the current surgical practice and is likely to change the management and local policies of each hospital after the crisis.}, keywords = {COVID-19,Emergency Surgery,Personal protective equipment}, url = {https://colorectalresearch.sums.ac.ir/article_46945.html}, eprint = {https://colorectalresearch.sums.ac.ir/article_46945_abe15e6eb521e1c90afd3c4dbf51f857.pdf} } @article { author = {Khazraei, Hajar and Hosseini, Seyed Vahid and Zamani, Mozhdeh and Al-Hurry, Ahmed and Rahimi, Masoumeh and Ghahramani, Leila and Haji Hosseini, Fahimeh}, title = {Relationship between episiotomy and fecal incontinence after delivery}, journal = {Iranian Journal of Colorectal Research}, volume = {8}, number = {3}, pages = {136-140}, year = {2020}, publisher = {Shiraz University of Medical Sciences}, issn = {2783-2430}, eissn = {2783-2430}, doi = {10.30476/acrr.2020.87186.1054}, abstract = {Background: Fecal incontinence is an embarrassing problem and decreases the woman’s quality of life. The literature has shown that women with obstetric trauma especially by episiotomy had damaged anal sphincter (Internal and External). We aimed to find the role of episiotomy in the fecal incontinence in women after delivery. Methods: In this study, 71 females with previous vaginal deliveries were investigated by endoanal ultrasonography. The degree of FI was measured using the incontinence score of Wexner. The number of episiotomies was measured for each patient. Results: The mean Wexner score was 9.0±0.7 in the incontinent patients. The mean of normal vaginal delivery was 3.48±0.3 and 33.8% of the patients whom had a history of hemorrhoidectomy. Of patients, 70% had undergone one or more prior episiotomies during their deliveries. Conclusion: Episiotomy could be one of the risk factors in fecal incontinence but we did not find any significant difference in Wexner score between patients with or without episiotomy. Endoanal sonography seems an effective tool to evaluate and prediction of anal injury during episiotomy in some critical cases.}, keywords = {Episiotomy,Anal,Fecal incontinence,Iran}, url = {https://colorectalresearch.sums.ac.ir/article_46947.html}, eprint = {https://colorectalresearch.sums.ac.ir/article_46947_29346fa8ed3790366854408459aee5a7.pdf} } @article { author = {Lyra Junior, Humberto and Minatti, Luiz Henrique and de Oliveira, João Carlos and Gerber, Marlus and de Novaes Gerber, Flavia and Vieira, Daniella and dos Santos, José Mauro}, title = {Analysis of Rectal Neoplasms Operated After Neoadjuvant Therapy in A Period of 10 Years}, journal = {Iranian Journal of Colorectal Research}, volume = {8}, number = {3}, pages = {141-147}, year = {2020}, publisher = {Shiraz University of Medical Sciences}, issn = {2783-2430}, eissn = {2783-2430}, doi = {10.30476/acrr.2020.87993.1063}, abstract = {Background: With the advances of neoadjuvant chemoradiotherapy, the identification of complete tumor responses, and the reduction of local recurrence even with the adoption of expectant approaches aimed at sphincter preservation, several authors have published results analyzing these aspects with conflicting results, which require further investigation. Objectives: This study aims to evaluate the anatomopathological changes in surgical specimens of rectal resection due to adenocarcinoma in patients undergoing neoadjuvant therapy, including the complete response rate, in addition to estimating the sensitivity and specificity indexes of the imaging methods used in the preoperative period. Methods: This was an observational, retrospective, cross-sectional study in which 44 medical records of patients with cancer of the middle and lower rectum who underwent neoadjuvant chemoradiotherapy and subsequently underwent oncological surgical resections over 10 years were studied. Demographic data, CT scans, colonoscopies, anatomopathological reports and surgical reports were analyzed. Results: Abdominoperineal resection of the rectum (APR) was performed in 16 cases (36.4%), and abdominal rectosigmoidectomy (AR) was performed in 28 cases (63.6%). Preoperative computerized tomography (CT) showed a sensitivity of 75% and specificity of 77.8% for the detection of lymph node metastases. The complete pathological response to neoadjuvant chemoradiotherapy was found in 11.36% of cases. The local recurrence was detected in 23.9% cases and distant metastasis in 15.2% of the patients on the follow-up period, additionally, there was a 77.7% 5-years disease-free survival and the overall survival was 73.9%. Conclusions: The rate of complete pathological response to neoadjuvant therapy was 11.36%. Locally advanced disease and angiolymphatic embolization were associated with a higher frequency of lymph node involvement. CT obtained high rates of sensitivity and specificity for comparison with anatomopathological results.}, keywords = {Colorectal neoplasms,neoadjuvant therapy,Rectal Neoplasms,organ preservation}, url = {https://colorectalresearch.sums.ac.ir/article_46989.html}, eprint = {https://colorectalresearch.sums.ac.ir/article_46989_1b208e42066db886eb37ce9a420fba4a.pdf} } @article { author = {De Vincenti, Rosita and Cianchi, Fabio and Coratti, Francesco}, title = {Transanal endoscopic operation (TEO) repair of rectovaginal fistula and anastomotic leakage: a case series}, journal = {Iranian Journal of Colorectal Research}, volume = {8}, number = {3}, pages = {148-151}, year = {2020}, publisher = {Shiraz University of Medical Sciences}, issn = {2783-2430}, eissn = {2783-2430}, doi = {10.30476/acrr.2020.85927.1040}, abstract = {Introduction. Interest in transanal endoscopic surgery has increased in the last decade. This approach allows primary procedures such as polypectomy, local tumor excision, as well as the treatment of postoperative complications including bleeding, leakage and fistula formation. The aim of this study was to describe our group’s use of Transanal endoscopic operation (TEO) in the repair of fistulae and anastomotic leakage, performed by one experienced surgeon (F.C.). Case presentation. Here, we describe three patients who developed postoperative complications after been subjected to anterior rectal resection. One of them developed a leakage of the anastomosis in third postoperative day, the others developed recurrent fistulae a long time after the surgery. These complications were all treated using TEO (transanal endoscopic operation) platform. The transanal procedure in one case was performed three times, because of the recurrence of the fistula. In another case it was associated with laparoscopy to treat peritonitis occurred after anastomotic disruption. In the last case, the patient had history of years of fistula recurrence associated with pelvic abscess, TEO approach proved to be determinant in the resolution of the problem. In all cases the transanal surgery definitively repaired the defect, the patients were discharged and, up to date, they are without recurrence. Conclusions. Thus, in the hands of experienced surgeons and in selected cases, TEO system appears to be a valid option to treat post-operative complications, such as fistulae and anastomotic leakage, avoiding major surgery with greater associated morbidity and showing excellent results.}, keywords = {Transanal endoscopic microsurgery,transanal endoscopic surgery,rectovaginal fistula,Minimally Invasive Surgery}, url = {https://colorectalresearch.sums.ac.ir/article_46978.html}, eprint = {https://colorectalresearch.sums.ac.ir/article_46978_3946e925364bbd246ff8ae7ce1dd99d6.pdf} } @article { author = {Naik, Lesley-Ann and Stefan, Samuel and Ball, Christopher and Khan, Jim}, title = {Robotic Subtotal Colectomy with en-bloc Resection of the Left Chest wall for Locally Advanced Colonic Cancer: A Case Report and Literature Review}, journal = {Iranian Journal of Colorectal Research}, volume = {8}, number = {3}, pages = {152-155}, year = {2020}, publisher = {Shiraz University of Medical Sciences}, issn = {2783-2430}, eissn = {2783-2430}, doi = {10.30476/acrr.2020.87288.1056}, abstract = {Abstract Locally advanced colonic cancers requiring multivisceral en-bloc resections are typically undertaken in an open or laparoscopic approach. Here, we report a case of a complex robotic subtotal colectomy with en-bloc resection of the chest wall and left 10th to 12th ribs for management of a locally advanced descending colon cancer and peritumoral abscess at our institution in June 2020. The procedure was augmented with intraoperative ultrasound scan-guided marking to delineate tumoural extent. Histologically, negative excision margins (R0) were achieved. We also undertook a brief review of relevant literature. There are very few publications on the multivisceral resections for advanced colonic cancer; this is the second reported case of robotic en-bloc colonic resection in English literature. A similar case report published in 2019 enforced the value of multidisciplinary team collaboration and the benefits of robotic over laparoscopic surgery in en-bloc resections. Considering improved short-term outcomes and comparable oncological safety granted by laparoscopic surgery, minimally-invasive surgery has a clear role in the surgical management of locally-advanced colorectal cancers. Key words: en-bloc resection, multivisceral resection, colonic cancer, robotic surgery, subtotal colectomy, peritumoural abscess}, keywords = {en-bloc resection,multivisceral resection,colonic cancer,robotic surgery,subtotal colectomy,peritumoural abscess}, url = {https://colorectalresearch.sums.ac.ir/article_46979.html}, eprint = {https://colorectalresearch.sums.ac.ir/article_46979_3090b90d9ce1222f8a0667b4923de8f0.pdf} }