ORIGINAL_ARTICLE
CTLA-4 blockade in the treatment of colorectal cancer with microsatellite instability
Context: Colorectal cancer is one of the most common tumours worldwide, with around 10-15% of these related to microsatellite instability which is, in turn, responsible for a high neoantigen load and subsequent high tumour mutational burden. These characteristics are responsible for the poor response of these tumours to chemotherapy, highlighting the need for a different approach in the treatment of patients with microsatellite unstable colorectal cancer. Immunotherapy was proven important in the treatment of these patients, with immune checkpoint inhibition such as CTLA-4 blockade being one of the most promising targets so far. Evidence Acquisition: A PubMed search was done on February 2021 where the used query obtained a total of 33 articles. After the inclusion and exclusion criteria, a total of 21 articles were obtained and used in this narrative review. Results: Several studies with microsatellite unstable colorectal tumours have been done in order to evaluate the advantages and adverse events of CTLA-4 blockade in these patients. Studies show a benefit regarding the progression-free survival, overall survival and overall response rates in patients receiving ipilimumab (anti-CTLA-4) when compared to those who weren’t. Besides, the main adverse events are manageable and are more tolerable than those observed with chemotherapy. Nonetheless, unlike PD-1 blockade, anti-CTLA-4 drugs are currently only approved for the use as a combination therapy in microsatellite unstable colorectal cancer, still awaiting approval as a monotherapy. Conclusion: Microsatellite unstable colorectal tumours deserve a different treatment path, as their characteristics make these tumours poor responders to chemotherapy while at the same time great candidates for immunotherapy, namely with CTLA-4 inhibitors. KEY-WORDS Colorectal cancer; CTLA-4; Immune checkpoint; Immunotherapy; Ipilimumab; Microsatellite instability
https://colorectalresearch.sums.ac.ir/article_47431_ac63d1a4093a549920d81669e44aa075.pdf
2021-03-01
1
6
10.30476/acrr.2021.90603.1093
Colorectal cancer
ctla-4
Immune checkpoint
immunotherapy
Ipilimumab
Microsatellite instability
Diana
Russo
di.ana_leite@hotmail.com
1
Centro Hospitalar Universitário São João, Porto
LEAD_AUTHOR
Francisco
Mendes
francisco.cnm@gmail.com
2
Centro Hospitalar Universitário São João, Porto
AUTHOR
1. Hirano, H., Takashima, A., Hamaguchi, T., Shida, D., Kanemitsu, Y., and Colorectal Cancer Study Group of the Japan Clinical Oncology, G., Current status and perspectives of immune checkpoint inhibitors for colorectal cancer. Jpn J Clin Oncol, 2021. 51(1): p. 10-19.
1
2. Morse, M.A., Hochster, H., and Benson, A., Perspectives on Treatment of Metastatic Colorectal Cancer with Immune Checkpoint Inhibitor Therapy. Oncologist, 2020. 25(1): p. 33-45.
2
3. Afrasanie, V.A., Marinca, M.V., Alexa-Stratulat, T., Gafton, B., Paduraru, M., Adavidoaiei, A.M., Miron, L., and Rusu, C., KRAS, NRAS, BRAF, HER2 and microsatellite instability in metastatic colorectal cancer - practical implications for the clinician. Radiol Oncol, 2019. 53(3): p. 265-274.
3
4. Russo, D.M.L.d.C. and Barbosa, L.E.R., PD-1 blockade as a future treatment for colorectal cancer with microsatellite instability. Journal of Coloproctology, 2021. 40(04): p. 412-420.
4
5. Franke, A.J., Skelton, W.P., Starr, J.S., Parekh, H., Lee, J.J., Overman, M.J., Allegra, C., and George, T.J., Immunotherapy for Colorectal Cancer: A Review of Current and Novel Therapeutic Approaches. J Natl Cancer Inst, 2019. 111(11): p. 1131-1141.
5
6. Nguyen, M., Tipping Smith, S., Lam, M., Liow, E., Davies, A., Prenen, H., and Segelov, E., An update on the use of immunotherapy in patients with colorectal cancer. Expert Rev Gastroenterol Hepatol, 2021. 15(3): p. 291-304.
6
7. De Souza, A., Finding the hot spot: identifying immune sensitive gastrointestinal tumors. Transl Gastroenterol Hepatol, 2020. 5: p. 48.
7
8. Thomas, J., Leal, A., and Overman, M.J., Clinical Development of Immunotherapy for Deficient Mismatch Repair Colorectal Cancer. Clin Colorectal Cancer, 2020. 19(2): p. 73-81.
8
9. Loupakis, F., Maddalena, G., Depetris, I., Murgioni, S., Bergamo, F., Dei Tos, A.P., Rugge, M., Munari, G., Nguyen, A., Szeto, C., Zagonel, V., Lonardi, S., and Fassan, M., Treatment with checkpoint inhibitors in a metastatic colorectal cancer patient with molecular and immunohistochemical heterogeneity in MSI/dMMR status. J Immunother Cancer, 2019. 7(1): p. 297.
9
10. Cohen, R., Pellat, A., Boussion, H., Svrcek, M., Lopez-Trabada, D., Trouilloud, I., Afchain, P., and Andre, T., Immunotherapy and metastatic colorectal cancers with microsatellite instability or mismatch repair deficiency. Bull Cancer, 2019. 106(2): p. 137-142.
10
11. Tan, E. and Sahin, I.H., Defining the current role of immune checkpoint inhibitors in the treatment of mismatch repair-deficient/microsatellite stability-high colorectal cancer and shedding light on future approaches. Expert Rev Gastroenterol Hepatol, 2021: p. 1-8.
11
12. Wilt, C. and Le, D.T., Integrating Immunotherapy Into Colorectal Cancer Care. Oncology (Williston Park), 2018. 32(10): p. 494-8.
12
13. Cohen, R., Bennouna, J., Meurisse, A., Tournigand, C., De La Fouchardiere, C., Tougeron, D., Borg, C., Mazard, T., Chibaudel, B., Garcia-Larnicol, M.L., Svrcek, M., Vernerey, D., Menu, Y., and Andre, T., RECIST and iRECIST criteria for the evaluation of nivolumab plus ipilimumab in patients with microsatellite instability-high/mismatch repair-deficient metastatic colorectal cancer: the GERCOR NIPICOL phase II study. J Immunother Cancer, 2020. 8(2).
13
14. Chen, E.X., Jonker, D.J., Loree, J.M., Kennecke, H.F., Berry, S.R., Couture, F., Ahmad, C.E., Goffin, J.R., Kavan, P., Harb, M., Colwell, B., Samimi, S., Samson, B., Abbas, T., Aucoin, N., Aubin, F., Koski, S.L., Wei, A.C., Magoski, N.M., Tu, D., and O'Callaghan, C.J., Effect of Combined Immune Checkpoint Inhibition vs Best Supportive Care Alone in Patients With Advanced Colorectal Cancer: The Canadian Cancer Trials Group CO.26 Study. JAMA Oncol, 2020. 6(6): p. 831-838.
14
15. Saad, P. and Kasi, A., Ipilimumab, in StatPearls. 2021: Treasure Island (FL).
15
16. Das, S., Allen, A., and Berlin, J., Immunotherapy After Immunotherapy: Response Rescue in a Patient With Microsatellite Instability-high Colorectal Cancer Post-Pembrolizumab. Clin Colorectal Cancer, 2020. 19(2): p. 137-140.
16
17. Rotte, A., Combination of CTLA-4 and PD-1 blockers for treatment of cancer. J Exp Clin Cancer Res, 2019. 38(1): p. 255.
17
18. Nivolumab plus Ipilimumab Achieves Responses in dMMR/MSI-H Tumors. Cancer Discov, 2018. 8(3): p. 263.
18
19. Overman, M.J., Lonardi, S., Wong, K.Y.M., Lenz, H.J., Gelsomino, F., Aglietta, M., Morse, M.A., Van Cutsem, E., McDermott, R., Hill, A., Sawyer, M.B., Hendlisz, A., Neyns, B., Svrcek, M., Moss, R.A., Ledeine, J.M., Cao, Z.A., Kamble, S., Kopetz, S., and Andre, T., Durable Clinical Benefit With Nivolumab Plus Ipilimumab in DNA Mismatch Repair-Deficient/Microsatellite Instability-High Metastatic Colorectal Cancer. J Clin Oncol, 2018. 36(8): p. 773-779.
19
20. Chu, J.N., Choi, J., Ostvar, S., Torchia, J.A., Reynolds, K.L., Tramontano, A., Gainor, J.F., Chung, D.C., Clark, J.W., and Hur, C., Cost-effectiveness of immune checkpoint inhibitors for microsatellite instability-high/mismatch repair-deficient metastatic colorectal cancer. Cancer, 2019. 125(2): p. 278-289.
20
21. Morse, M.A., Overman, M.J., Hartman, L., Khoukaz, T., Brutcher, E., Lenz, H.J., Atasoy, A., Shangguan, T., Zhao, H., and El-Rayes, B., Safety of Nivolumab plus Low-Dose Ipilimumab in Previously Treated Microsatellite Instability-High/Mismatch Repair-Deficient Metastatic Colorectal Cancer. Oncologist, 2019. 24(11): p. 1453-1461.
21
22. Tauber, M., Cohen, R., Laly, P., Josselin, L., Andre, T., and Mekinian, A., Severe necrotizing myositis associated with long term anti-neoplastic efficacy following nivolumab plus ipilimumab combination therapy. Clin Rheumatol, 2019. 38(2): p. 601-602.
22
ORIGINAL_ARTICLE
Sigmoid volvulus: 10-year report from Maharat Nakhon Ratchasima Hospital
Introduction: Sigmoid volvulus is an uncommon cause of colonic obstruction in adults. There have been fewer reports of sigmoid volvulus in Thailand. The aims of this study were to assess characteristics and outcomes of treatment in patients who were diagnosed with sigmoid volvulus at Maharat Nakhon Ratchasima Hospital over a 10-year period. Methods: This retrospective study included 42 sigmoid volvulus patients between 01/2010 and 12/2019. Patients’ characteristics, investigations for diagnosis, operative details and postoperative outcomes were analyzed. Results: From 42 sigmoid volvulus patients, 34 (80%) were males with average age of 64.6 years. Two most common co-morbidities were hypertension (33.3%) and bedridden status (14.2%). Classic “Coffee bean” sign on plain abdominal radiography was found in 33 patients (78.6%). Colonoscopic detorsion was attempted in 17 patients (40.5%) with a success rate of 76.5%. From 13 patients who had successful detorsion, only 5 patients (38.5%) underwent sigmoidectomy with primary anastomosis in the same index admission. Overall 30-day mortality rate was 9.5% and mortality rate was 10.3% for emergency surgery. Conclusions: Sigmoid volvulus usually presents in elderly patients. Endoscopic detorsion should be the initial management of patients without peritonitis. Sigmoidectomy should be done in the same index admission.
https://colorectalresearch.sums.ac.ir/article_47324_e5acbb76e70bb1722d617c715c04b92f.pdf
2021-03-01
7
11
10.30476/acrr.2021.89658.1081
Sigmoid disease
Volvulus
Thailand
Warut
Boonnithi
bank_ashura@hotmail.com
1
Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
LEAD_AUTHOR
1. Halabi WJ, Jafari MD, Kang CY, Nguyen VQ, Carmichael JC, Mills S, et al. Colonic Volvulus in the United States: Trends, Outcomes, and Predictors of Mortality. Ann Surg. 2014 Feb;259(2):293–301.
1
2. C B. Volvulus of the sigmoid colon and its treatment. Surgery. 1947.
2
3. Vogel JD, Feingold DL, Stewart DB, Turner JS, Boutros M, Chun J, et al. Clinical Practice Guidelines for Colon Volvulus and Acute Colonic Pseudo-Obstruction: Dis Colon Rectum. 2016 Jul;59(7):589–600.
3
4. Raveenthiran V, Madiba TE, Atamanalp SS, De U. Volvulus of the sigmoid colon. Colorectal Dis. 2010 Mar.
4
5. Perry EG. INTESTINAL VOLVULUS: A NEW CONCEPT. Aust N Z J Surg. 2008 Jan 21;53(5):483–6.
5
6. Beck DE, Wexner SD, Rafferty JF. Gordon and Nivatvongs’ Principles and Practice of Surgery for the Colon, Rectum, and Anus. 4 edition. Thieme; 2018. 964 p.
6
7. Ballantyne GH, Brandner MD, Beart R w., Ilstrup DM. Volvulus of the Colon: Incidence and Mortality. Ann Surg. 1985 Jul;202(1):83–92.
7
8. Asbun HJ, Castellanos H, Balderrama B, Ochoa J, Arismendi R, Teran H, et al. Sigmoid volvulus in the high altitude of the Andes: Review of 230 cases. Dis Colon Rectum. 1992 Apr;35(4):350–3.
8
9. Gama AH, Haddad J, Simonsen O, Warde P, Manzione A, da Silva JH, et al. Volvulus of the sigmoid colon in Brazil: A report of 230 cases. Dis Colon Rectum. 1976 May;19(4):314–20.
9
10. van Leeuwen JHS. Sigmoid volvulus in a West African population: Dis Colon Rectum. 1985 Oct;28(10):712–6.
10
11. Grossmann EM, Longo WE, Stratton MD, Virgo KS, Johnson FE. Sigmoid volvulus in Department of Veterans Affairs Medical Centers: Dis Colon Rectum. 2000 Mar;43(3):414–8.
11
12. Turan M, Sen M, Karadayi K, Koyuncu A, Topcu O, Yildirir C, et al. Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process. Rev Esp Enfermedades Dig. 2004 Jan;96(1).
12
13. Bruzzi M, Lefèvre JH, Desaint B, Nion-Larmurier I, Bennis M, Chafai N, et al. Management of acute sigmoid volvulus: short- and long-term results. Colorectal Dis. 2015 Oct;17(10):922–8.
13
14. Ören D, Atamanalp SS, Aydinli B, Yildirgan İM, Başoğlu M, Polat YK, et al. An Algorithm for the Management of Sigmoid Colon Volvulus and the Safety of Primary Resection: Experience with 827 Cases: Dis Colon Rectum. 2007 Apr;50(4):489–97.
14
ORIGINAL_ARTICLE
Clinical Outcome after Resection Rectopexy in patients with Constipation and Rectal Prolapse
Introduction: Laparoscopic resection rectopexy (LRR) is an established procedure for the treatment of rectal prolapse. This study evaluated constipation and gastrointestinal quality of life in patients before and after LRR for rectal prolapse. Methods: 30 patients (24 females, 6 males) underwent laparoscopic anterior (n = 14), posterior (n = 8) and suture resection rectopexy (n = 8) for rectal prolapse during 2010 – 2020. 25 were retrospectively evaluated for constipation and gastrointestinal quality of life using validated Cleveland Clinic Constipation Score (CCCS) and Gastrointestinal Quality of Life Index (GIQLI). Results: Constipation score was significantly reduced from median 16.0 ± 6.4 to 6.0 ± 4.7 after 68.0 ± 42.8 months (p < 0.001). Constipation was improved in 20 patients (80.0%), unaltered in 2 patients and worse in 3 patients. Prior abdominal surgeries were associated with less improvement for constipation (p < 0,05). Significant improvement in GIQLI score was observed, with median total GIQLI score increasing from 95.0 ± 14.8 to 124.0 ± 18.2 (p < 0.001). Quality of life improved in 21 patients (84.0%). Positive changes were also observed in GIQLI subgroups of gastrointestinal symptoms, emotions, physical status, social dysfunction and effects of medical treatment (p < 0.001). There was no difference in outcome between the three procedures. Conclusion: Laparoscopic resection rectopexy for rectal prolapse is safe, feasible, and very effective regarding both perioperative results and long-term functional outcome. Our results suggest that LRR significantly improves constipation in patients with outlet obstruction and clearly contributes to a higher quality of life.
https://colorectalresearch.sums.ac.ir/article_47384_e95ba002256f66c28ed99ea74014879e.pdf
2021-03-01
12
17
10.30476/acrr.2021.90321.1089
Outlet Obstruction
Laparoscopy
Colorectal Surgery
Cleveland Clinic Constipation Score
Gastrointestinal Quality of Life Index
Adisa
Poljo
adisa.poljo@gmx.at
1
Clinic for General and Visceral Surgery, Kepler University Clinic
LEAD_AUTHOR
Bettina
Klugsberger
bettina.klugsberger@kepleruniklinikum.at
2
Clinic for General and Visceral Surgery, Kepler University Clinic
AUTHOR
Günther
Klimbacher
guenther.klimbacher@kepleruniklinikum.at
3
Clinic for General and Visceral Surgery, Kepler University Clinic
AUTHOR
Wolfgang
Schimetta
wolfgang.schimetta@asoklif.at
4
Department of Applied Systems Research and Statistics, Johannes Kepler University
AUTHOR
Andreas
Shamiyeh
andreas.shamiyeh@kepleruniklinikum.at
5
Clinic for General and Visceral Surgery, Kepler University Clinic
AUTHOR
1. Jacobs LK, Lin YJ, Orkin BA. The best operation for rectal prolapse. Surg Clin North Am. 1997; 77(1):49–70.
1
2. Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg. 2005; 140(1):63–73.
2
3. Vergeldt TFM, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73.
3
4. Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(9):1582–91; quiz 1581, 1592.
4
5. Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum. 1989;32(1):1–8.
5
6. Shin EJ. Surgical treatment of rectal prolapse. Journal of the Korean Society of Coloproctology. 2011 Feb;27(1):5-12.
6
7. Hany S, Abo-Elkheir M, Ahmed S, El-Awady S, Farid M, Ghazy H. Laparoscopic resection rectopexy versus laparoscopic mesh rectopexy for rectoanal intussusception. Egypt J Surg. 2015; 34(1):48.
7
8. Rickert A, Kienle P. Laparoscopic surgery for rectal prolapse and pelvic floor disorders. World J Gastrointest Endosc. 2015;7(12):1045–54.
8
9. Tou S, Brown SR, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database of Systematic Reviews [Internet]. 2008; (4):CD001758
9
10. D’Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. BJS (British Journal of Surgery). 2004;91(11):1500–5.
10
11. Bove A, Bellini M, Battaglia E, Bocchini R, Gambaccini D, Bove V, u. a. Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (Part II: Treatment). World J Gastroenterol. 2012;18(36):4994–5013.
11
12. Formijne Jonkers HA, Maya A, Draaisma WA, Bemelman WA, Broeders IA, Consten ECJ, u. a. Laparoscopic resection rectopexy versus laparoscopic ventral rectopexy for complete rectal prolapse. Tech Coloproctol. 2014;18(7):641–6.
12
13. Laubert T, Kleemann M, Schorcht A, Czymek R, Jungbluth T, Bader FG, u. a. Laparoscopic resection rectopexy for rectal prolapse: a single-center study during 16 years. Surg Endosc. 2010; 24(10):2401–6.
13
14. Mollen RM, Kuijpers JH, van Hoek F. Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function. Dis Colon Rectum. 2000;43(9):1283–7.
14
15. Xynos E, Chrysos E, Tsiaoussis J, Epanomeritakis E, Vassilakis JS. Resection rectopexy for rectal prolapse. The laparoscopic approach. Surgical endoscopy. 1999;13:862–4.
15
16. Ashari LHS, Lumley JW, Stevenson ARL, Stitz RW. Laparoscopically-assisted resection rectopexy for rectal prolapse: ten years’ experience. Dis Colon Rectum. 2005;48(5):982–7.
16
17. Senapati A, Gray RG, Middleton LJ, Harding J, Hills RK, Armitage NCM, u. a. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013;15(7):858–68.
17
18. Stevenson ARL, Stitz RW, Lumley JW. Laparoscopic-assisted resection-rectopexy for rectal prolapse: Early and medium follow-up. Diseases of the Colon & Rectum. 1998;41(1):46–54.
18
19. Kariv Y, Delaney CP, Casillas S, Hammel J, Nocero J, Bast J, u. a. Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study. Surg Endosc. 2006;20(1):35–42.
19
ORIGINAL_ARTICLE
Concomitant enterostomy closure and ventral abdominal wall reconstruction using the Lázaro da Silva technique
We present a small series of patients who underwent concomitant treatment of external digestive bypass (stoma) and incisional hernia, using the Lázaro da Silva technique - a special method of purely tissue repair. The rational was not to use meshes on contaminated wounds. Initially, five patients were enrolled and all were operated on by the same group. Some demographic data were recorded, but also the time interval between the making of the stoma (or the appearance of the enterocutaneous fistula). Some characteristics of the hernia and data related to surgical procedures were also pointed out. The primary outcome was to verify the rate of hernial recurrence, but also the surgical site occurrences in the first 30 days. Only one patient had superficial wound infection and in none of them was a recurrence detected. Our work raises some questions about the best approach in these more complex cases, such as dissociating or not dissociating the procedures, the use of meshes anyway, and employment of mini-invasive surgery in some steps.
https://colorectalresearch.sums.ac.ir/article_47427_f46f0d8484bde5fdea06162cd488c978.pdf
2021-03-01
18
23
10.30476/acrr.2021.90252.1086
Intestinal Fistula
Incisional hernia
Surgical Mesh
Renato
Melo
dr.renatomelo@gmail.com
1
Department of Surgery, School of Medicine, Universidade Federal de Goiás, Goiânia, Brazil Division of Abdominal Wall Hernias, Goiânia General Hospital and Santa Casa de Misericórdia, Goiânia, Brazil
LEAD_AUTHOR
Pedro
Oliveira-e-Silva
pedroducatti@gmail.com
2
Senior Resident in Digestive Surgery, Goiânia General Hospital, Goiânia, Brazil
AUTHOR
Enio Chaves
Oliveira
eco1.br@gmail.com
3
Department of Surgery (Colo-Proctology), School of Medicine, Universidade Federal de Goiás (Goiania, BRAZIL)
AUTHOR
Mathes T, Walgenbach M, Siegel R. Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis. World J Surg 2016;40:826–835. DOI 10.1007/s00268-015-3311-2
1
Bondre IL, Holihan JL, Askenasy EP, Greenberg JA, Keith JN, Martindale RG, Roth JS, Liang MK; Ventral Hernia Outcomes Collaborative. Suture, synthetic, or biologic in contaminated ventral hernia repair. J Surg Res. 2016 Feb;200(2):488-94. doi: 10.1016/j.jss.2015.09.007
2
Brooks DC, Cone J. Management of ventral hernias. UpToDate 2020 (Topic 96301 Version 11.0), assessed on Aug, 3rd. 2020.
3
Kokotovic D, Bisgaard T, Helgstrand F. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 2016;316(15):1575-82.
4
Birolini C, Miranda JS, Utiyama EM, Rasslan S. A retrospective review and observations over a 16-year clinical experience on the surgical treatment of chronic mesh infection. What about replacing a synthetic mesh on the infected surgical field? Hernia 2015;19:239-246. DOI 10.1007/s10029-014-1225-9
5
Birolini C, Miranda JS, Utiyama EM, Rasslan S, Birolini D. Active Staphylococcus aureus infection: is it a contra-indication to the repair of complex hernias with synthetic mesh? A prospective observational study on the outcomes of synthetic mesh replacement, in patients with chronic mesh infection caused by Staphylococcus aureus. Int J Surg 2016;28:56-62. http://dx.doi.org/10.1016/j.ijsu.2016.02.062
6
Lázaro da Silva A. Surgical correction of longitudinal median and paramedian incisional hernia. Surg Gynecol Obstet 1979;148:579-583.
7
Lázaro da Silva A (2004) Recidiva da hérnia incisional após o tratamento pela transposição peritônio-aponeurótica longitudinal bilateral. Arq Gastroenterol 41(2):134-136.
8
Miranda de Melo R (2018) El cincuentenario de la «transposición con el saco herniario» de Lázaro da Silva para reconstrucción de la pared abdominal ventral. Rev Hispanoam Hernia 6(3):156–162. https ://doi.org/10.20960 /rhh.128
9
10. Melo RM. Would surgeons be definitively forbidden to restore the abdominal wall without using a mesh? Hernia published online: 27 April 2020. https://doi.org/10.1007/s10029-020-02195-6
10
11. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional abdominal wall hernias. Hernia 2009;13:407-414. DOI 10.1007/s10029-009-0518-x
11
12. Salvadalena G, Hendren S, McKenna L, Muldoon R, Netsch D, Paquette I, Pittman J, Ramundo J, Steinberg G. WOCN Society and ASCRS position statement on preoperative stoma site marking for patients undergoing colostomy or ileostomy surgery. J Wound Ostomy Continence Nurs. 2015;42(3):249-252. DOI: 10.1097/WON.0000000000000119
12
13. Francone TD. Overview of surgical ostomy for fecal diversion. UpToDate 2020, assessed on Aug, 24th. 2020.
13
14. Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 2009;144:1056-1059.
14
15. Millbourn D, Cengiz Y, Israelsson LA. Risk factors for wound complications in midline abdominal incisions related to the size of stitches. Hernia 2011;15:261-266. DOI 10.1007/s10029-010-0775-8
15
16. Israelsson LA, Millbourn D. Prevention of incisional hernias: how to close a midline incision. Surg Clin N Am 2013;93:1027-1040. http://dx.-doi.org/10.1016/j.suc.2013.06.009
16
17. Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson LA, Jairam A, Jänes A, Jeekel J, López-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Śmietański M, Venclauskas L, Berrevoet F. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015;19:1-24.
17
18. Carbonell-Tatay F, Bonafé-Diana, S, García-Pastor P, Gómez i Gavara C, Baquero-Valdelomar R. Nuevo método de operar en la eventración compleja: separación anatómica de componentes con prótesis y nuevas inserciones musculares. Cir Esp. 2009;86(2):87–93. doi:10.1016/j.ciresp.2009.03.015
18
19. Slater NJ, van Goor H, Bleichrodt RP. Large and complex ventral hernia repair using “components separation technique” without mesh results in a high recurrence rate. Am J Surg 2015;209:1709.
19
20. Reinpold W. Transversus abdominis muscle release: technique, indication, and results. Int J Abdom Wall Hernia Surg 2018;1:79-86.
20
ORIGINAL_ARTICLE
Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study
ABSTRACT PURPOSE: To evaluate (i) acceptability of surgery for simple anal fistula under local anesthesia with conscious sedation by the patients and (ii) accuracy of a set of clinical criteria for diagnosis of simple anal fistula. METHODS: A set of clinical criteria based on physical findings was used to diagnose patients with simple anal fistula. These patients were operated under local anesthesia with conscious sedation. Intravenous paracetamol, diclofenac sodium, and midazolam were administered as adjuvants. Fistulotomy with/without marsupialisation was performed in most patients. Clinical diagnosis was matched with operative findings. RESULTS: Among 193 patients presenting with anal fistula, 61 patients were diagnosed as simple anal fistula and were scheduled for surgery under local anesthesia with conscious sedation. One patient was found to have complex anal fistula during intraoperative assessment and surgery was deferred. Surgery could be completed under local anesthesia with conscious sedation for 58/60 (96.7%) patients. Acceptability of the procedure was assessed with two parameters: the patients’ satisfaction score on visual analogue scale and their willingness to undergo fistula surgery under local anesthesia again, if required. Median (interquartile range) visual analogue scale score for patients’ satisfaction was 10 (9-10). All the patients expressed their willingness to undergo fistula surgery under local anesthesia again, if required. The clinical criteria was successful in diagnosing simple anal fistula in 58/61 (95.1%) patients. The remaining three patients had high intersphincteric fistula (1) and blind sinus (2). CONCLUSIONS: Acceptability of surgery for simple anal fistula under local anesthesia with conscious sedation was excellent. The proposed clinical criteria were highly accurate in diagnosing simple anal fistula.
https://colorectalresearch.sums.ac.ir/article_47426_70ace9c3042b6cd5f44a9aecd3a2bb3e.pdf
2021-03-01
24
31
10.30476/acrr.2021.90260.1085
Fistula in ano
Intersphincteric anal fistula
Transsphinteric Anal fistula
Complex anal fistula
Magnetic resonance scan
Operative surgery
BHUPENDRA
JAIN
bhupendrakjain@gmail.com
1
Consultant Surgeon, St. Joseph’s Hospital, Mayiam Nagar, Ghaziabad 201003, India
LEAD_AUTHOR
HITESH
GUPTA
hitg9medico@gmail.com
2
Senior Resident, Department of Burns, Plastic, and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
AUTHOR
MEDHA
MOHTA
medhamohta@gmail.co
3
Director Professor, Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 10095, India
AUTHOR
NAVEEN
SHARMA
drnsemail@gmail.con
4
Professor, Department of General Surgery, All India Institute of Medical Sciences, Jodhpur 342005, India
AUTHOR
SANJAY
GUPTA
drsanjaygupta1@gmail.com
5
Director Professor and Head, Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 10095, India
AUTHOR
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Cryptoglandular anal fistulas. Dtsch Arztebl Int 2011; 103238/arztebl.2011.0707
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ORIGINAL_ARTICLE
Bioactive compounds as a potential inhibitor of colorectal cancer; an insilico study of Gallic acid and Pyrogallol
Abstract Introduction- Now a day’s colorectal cancer (CRC) is one of the most deadly cancers in the world. The objective of this investigation was to evaluate the protective effect of gallic acid and pyrogallol in colorectal cancer. Previous reports suggest that there is an association present between some tannase producing bacteria and colorectal cancer. Tannase hydrolyze tannic acid into gallic acid and pyrogallol. Are those compounds have any therapeutic effect on colorectal cancer? This study will help to find those quarries. Methods-The remedial effect of gallic acid and pyrogallol was studied by descriptor properties and molecular docking methods. 100 CRC causing protein structures were docked in this investigation. Results- Lipinski Rule of Five and other descriptor properties of those compounds have showed their nontoxic and therapeutic nature. Molecular docking studies have showed highest score -38.22 KJ/Mol with gallic acid and -33.6 KJ/Mol with pyrogallol. Conclusion- This is the first report on docking investigation of these large numbers of protein. The findings of this research concluded that gallic acid and pyrogallol have a protective effect in colorectal cancer by stopping the effect of those CRC causing protein.
https://colorectalresearch.sums.ac.ir/article_47450_224f0bde28b2fefd56816886d6dc4b96.pdf
2021-03-01
32
39
10.30476/acrr.2021.89642.1080
Colorectal cancer
descriptor properties
molecular docking
binding energy
Debanjan
Mitra
debanjanmitra267@gmail.com
1
Department of Microbiology, Raiganj University, Raiganj, WB, India
AUTHOR
Anumita
Dey
anumitadey15@gmail.com
2
Department of Microbiology, Raiganj University, Raiganj, WB, India
AUTHOR
Ishita
Biswas
ishitabiswas1307@gmail.com
3
Department of Microbiology, Raiganj University, Raiganj, WB, India
AUTHOR
Pradeep
Das Mohapatra
pkdmvu@gmail.com
4
Department of Microbiology, Raiganj University, Raiganj, WB, India
LEAD_AUTHOR
Testa U, Pelosi E, Castelli G. Colorectal cancer: genetic abnormalities, tumor progression, tumor heterogeneity, clonal evolution and tumor-initiating cells. Medical Sciences. 2018 Jun;6(2):31.
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53
ORIGINAL_ARTICLE
Colorectal Cancer in People with Cystic Fibrosis under the Age of 40: A Case Series
Introduction Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause cystic fibrosis (CF), a disease which affects primarily the respiratory and gastrointestinal (GI) tracts. The lifetime risk of colorectal cancer (CRC) in patients with CF is approximately 5-10 times that of the general population. In 2018, the CF Foundation CRC Screening Task Force recommended initiating CRC screening in adults with CF at age 40. Case Presentations In this case series, we present three cases of females with CF younger than age 40 diagnosed with CRC with variable presentations and stages. We discuss the data supporting current CRC screening guidelines in CF in an effort to raise awareness among clinicians regarding young-onset CRC in this population. Furthermore, we aim for this case series to help drive further investigation into the mechanisms underlying CF-related CRC and to open the door to changes in current screening practices. Conclusion People with CF are at substantially higher risk of development of CRC relative to the general population. While current CRC screening practices advocate for earlier screening in this population compared to average-risk patients, this case series highlights potential limitations to current screening guidelines.
https://colorectalresearch.sums.ac.ir/article_47424_6cee0ecf9d7b203b7fa96761b2451ada.pdf
2021-03-01
40
43
10.30476/acrr.2021.89837.1083
Colon cancer syndrome
Polyp
Colorectal
cystic fibrosis
Colonoscopy
Sunjay
Devarajan
sunjay.devarajan@bcm.edu
1
Section of Pulmonary/Critical Care, Baylor College of Medicine, Houston, TX, USA
LEAD_AUTHOR
Benjamin
Musher
blmusher@bcm.edu
2
Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
AUTHOR
James
Abraham
jamabrah@med.umich.edu
3
University of MichiganDivision of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
AUTHOR
1. Maisonneuve P, Marshall BC, Knapp EA, et al. Cancer risk in cystic fibrosis: a 20-year nationwide study from the United States. J Natl Cancer Inst 2013;105:122-9.
1
2. Neglia JP, FitzSimmons SC, Maisonneuve P, et al. The risk of cancer among patients with cystic fibrosis. Cystic Fibrosis and Cancer Study Group. N Engl J Med 1995;332:494-9.
2
3. Chaun H, Paty B, Nakielna EM, et al. Colonic carcinoma in two adult cystic fibrosis patients. Can J Gastroenterol 1996;10:440-2.
3
4. Ibele AR, Koplin SA, Slaughenhoupt BL, et al. Colonic adenocarcinoma in a 13-year-old with cystic fibrosis. J Pediatr Surg 2007;42:E1-3.
4
5. Hadjiliadis D, Khoruts A, Zauber AG, et al. Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations. Gastroenterology 2018;154:736-745 e14.
5
6. Knapp EA, Fink AK, Goss CH, et al. The Cystic Fibrosis Foundation Patient Registry. Design and Methods of a National Observational Disease Registry. Ann Am Thorac Soc 2016;13:1173-9.
6
7. Abraham JM, Mahan K, Mettler T, et al. Case report of synchronous post-lung transplant colon cancers in the era of colorectal cancer screening recommendations in cystic fibrosis: screening "too early" before it's too late. BMC Gastroenterol 2019;19:137.
7
8. Abraham JM, Taylor CJ. Cystic Fibrosis & disorders of the large intestine: DIOS, constipation, and colorectal cancer. J Cyst Fibros 2017;16 Suppl 2:S40-S49.
8
9. Maisonneuve P, FitzSimmons SC, Neglia JP, et al. Cancer risk in nontransplanted and transplanted cystic fibrosis patients: a 10-year study. J Natl Cancer Inst 2003;95:381-7.
9
10. Gory I, Brown G, Wilson J, et al. Increased risk of colorectal neoplasia in adult patients with cystic fibrosis: a matched case-control study. Scand J Gastroenterol 2014;49:1230-6.
10
11. Billings JL, Dunitz JM, McAllister S, et al. Early colon screening of adult patients with cystic fibrosis reveals high incidence of adenomatous colon polyps. J Clin Gastroenterol 2014;48:e85-8.
11
12. Hegagi M, Aaron SD, James P, et al. Increased prevalence of colonic adenomas in patients with cystic fibrosis. J Cyst Fibros 2017;16:759-762.
12
13. Niccum DE, Billings JL, Dunitz JM, et al. Colonoscopic screening shows increased early incidence and progression of adenomas in cystic fibrosis. J Cyst Fibros 2016;15:548-53.
13
14. Than BL, Linnekamp JF, Starr TK, et al. CFTR is a tumor suppressor gene in murine and human intestinal cancer. Oncogene 2016;35:4179-87.
14
15. Anderson KJ, Cormier RT, Scott PM. Role of ion channels in gastrointestinal cancer. World J Gastroenterol 2019;25:5732-5772.
15
16. Strubberg AM, Liu J, Walker NM, et al. Cftr Modulates Wnt/beta-Catenin Signaling and Stem Cell Proliferation in Murine Intestine. Cell Mol Gastroenterol Hepatol 2018;5:253-271.
16
17. Gini A, Zauber AG, Cenin DR, et al. Cost Effectiveness of Screening Individuals With Cystic Fibrosis for Colorectal Cancer. Gastroenterology 2018;154:556-567 e18.
17
18. Song LL, Li YM. Current noninvasive tests for colorectal cancer screening: An overview of colorectal cancer screening tests. World J Gastrointest Oncol 2016;8:793-800.
18
19. Imperiale TF, Ransohoff DF, Itzkowitz SH. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014;371:187-8.
19
20. Prenner S, Levitsky J. Comprehensive Review on Colorectal Cancer and Transplant. Am J Transplant 2017;17:2761-2774.
20
ORIGINAL_ARTICLE
Perforation Due to Rectal Foreign Body and Radiological Findings
Perforation Due to Rectal Foreign Body and Radiological Findings İntroduction: Rectal foreign bodies have been increasingly seen and cause urgent surgical complications. Diagnosis and treatment of these cases in emergency departments may be difficult. The effective use of radiological imaging techniques can accelerate and facilitate this process. Case presentation: A 65-year-old male patient, who underwent computed tomography with the suspicion of a foreign body in the rectum, was admitted to the emergency outpatient clinic. The patient was a male patient with a psychiatric illness who later underwent emergency surgery. Since the patient had impaired consciousness during the examination, anamnesis could not be obtained, so surgical consultation in the emergency service was first consulted as perforation due to rectal tumoral thickening. In almost all cases, plain radiography is sufficient and can eliminate diagnostic difficulties. However, this is not possible in non-opaque objects. Therefore, CT played an important role in the diagnosis of this patient. A 30cm foreign body, salami, was removed from the abdomen of the patient, who was later taken into emergency surgery. Conlusion: The guiding role of radiological examinations in diagnosis and treatment was discussed, and it was emphasized that CT is a problem-solving tool for rectal foreign body.
https://colorectalresearch.sums.ac.ir/article_47430_c9c98987b8192b408556993f34043272.pdf
2021-03-01
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46
10.30476/acrr.2021.90332.1090
Key Words: Rectal salami
Computed Tomography
Emergency Surgery
Foreign bodies
Saim
Turkoglu
mdsaimturkoglu@gmail.com
1
Van Traınıng and Research Hospıtal, Van, Turkey
LEAD_AUTHOR
Adem
Yokus
drademyokus@gmail.com
2
Department of Radiology, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
AUTHOR
Fırat
Aslan
dr.aslan.2609@hotmail.com
3
Department of General Surgery, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
AUTHOR
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