Shiraz University of Medical Sciences
Iranian Journal of Colorectal Research
2783-2430
9
1
2021
03
01
CTLA-4 blockade in the treatment of colorectal cancer with microsatellite instability
1
6
EN
Diana
Russo
0000-0002-3393-4681
Centro Hospitalar Universitário São João, Porto
di.ana_leite@hotmail.com
Francisco
Mendes
Centro Hospitalar Universitário São João, Porto
francisco.cnm@gmail.com
10.30476/acrr.2021.90603.1093
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. <br /> 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.<br /> 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.<br /> 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.<br /> <br /> KEY-WORDS<br /> Colorectal cancer; CTLA-4; Immune checkpoint; Immunotherapy; Ipilimumab; Microsatellite instability
Colorectal cancer,ctla-4,Immune checkpoint,immunotherapy,Ipilimumab,Microsatellite instability
https://colorectalresearch.sums.ac.ir/article_47431.html
https://colorectalresearch.sums.ac.ir/article_47431_ac63d1a4093a549920d81669e44aa075.pdf
Shiraz University of Medical Sciences
Iranian Journal of Colorectal Research
2783-2430
9
1
2021
03
01
Sigmoid volvulus: 10-year report from Maharat Nakhon Ratchasima Hospital
7
11
EN
Warut
Boonnithi
0000-0002-6854-3322
Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
bank_ashura@hotmail.com
10.30476/acrr.2021.89658.1081
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.<br /> 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.<br /> 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. <br /> 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.
Sigmoid disease,Volvulus,Thailand
https://colorectalresearch.sums.ac.ir/article_47324.html
https://colorectalresearch.sums.ac.ir/article_47324_e5acbb76e70bb1722d617c715c04b92f.pdf
Shiraz University of Medical Sciences
Iranian Journal of Colorectal Research
2783-2430
9
1
2021
03
01
Clinical Outcome after Resection Rectopexy in patients with Constipation and Rectal Prolapse
12
17
EN
Adisa
Poljo
0000-0003-2378-7048
Clinic for General and Visceral Surgery, Kepler University Clinic
adisa.poljo@gmx.at
Bettina
Klugsberger
Clinic for General and Visceral Surgery, Kepler University Clinic
bettina.klugsberger@kepleruniklinikum.at
Günther
Klimbacher
Clinic for General and Visceral Surgery, Kepler University Clinic
guenther.klimbacher@kepleruniklinikum.at
Wolfgang
Schimetta
Department of Applied Systems Research and Statistics, Johannes Kepler University
wolfgang.schimetta@asoklif.at
Andreas
Shamiyeh
Clinic for General and Visceral Surgery, Kepler University Clinic
andreas.shamiyeh@kepleruniklinikum.at
10.30476/acrr.2021.90321.1089
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.<br /> 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).<br /> 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. <br /> 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.
Outlet Obstruction,Laparoscopy,Colorectal Surgery,Cleveland Clinic Constipation Score,Gastrointestinal Quality of Life Index
https://colorectalresearch.sums.ac.ir/article_47384.html
https://colorectalresearch.sums.ac.ir/article_47384_e95ba002256f66c28ed99ea74014879e.pdf
Shiraz University of Medical Sciences
Iranian Journal of Colorectal Research
2783-2430
9
1
2021
03
01
Concomitant enterostomy closure and ventral abdominal wall reconstruction using the Lázaro da Silva technique
18
23
EN
Renato
Miranda
Melo
0000-0001-5230-2789
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
dr.renatomelo@gmail.com
Pedro
Ducatti
Oliveira-e-Silva
Senior Resident in Digestive Surgery, Goiânia General Hospital, Goiânia, Brazil
pedroducatti@gmail.com
Enio Chaves
Chaves
Oliveira
0000-0002-3502-7532
Department of Surgery (Colo-Proctology), School of Medicine, Universidade Federal de Goiás (Goiania, BRAZIL)
eco1.br@gmail.com
10.30476/acrr.2021.90252.1086
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.
Intestinal Fistula,Incisional hernia,Surgical Mesh
https://colorectalresearch.sums.ac.ir/article_47427.html
https://colorectalresearch.sums.ac.ir/article_47427_f46f0d8484bde5fdea06162cd488c978.pdf
Shiraz University of Medical Sciences
Iranian Journal of Colorectal Research
2783-2430
9
1
2021
03
01
Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study
24
31
EN
BHUPENDRA
KUMAR
JAIN
Consultant Surgeon, St. Joseph’s Hospital, Mayiam Nagar, Ghaziabad 201003, India
bhupendrakjain@gmail.com
HITESH
GUPTA
Senior Resident, Department of Burns, Plastic, and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi 110029,
India
hitg9medico@gmail.com
MEDHA
MOHTA
Director Professor, Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur
Hospital, Delhi 10095, India
medhamohta@gmail.co
NAVEEN
SHARMA
Professor, Department of General Surgery, All India Institute of Medical Sciences, Jodhpur 342005, India
drnsemail@gmail.con
SANJAY
GUPTA
Director Professor and Head, Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi
10095, India
drsanjaygupta1@gmail.com
10.30476/acrr.2021.90260.1085
ABSTRACT<br /> 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.<br /> 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. <br /> 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). <br /> 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.
Fistula in ano,Intersphincteric anal fistula,Transsphinteric Anal fistula,Complex anal fistula,Magnetic resonance scan,Operative surgery
https://colorectalresearch.sums.ac.ir/article_47426.html
https://colorectalresearch.sums.ac.ir/article_47426_70ace9c3042b6cd5f44a9aecd3a2bb3e.pdf
Shiraz University of Medical Sciences
Iranian Journal of Colorectal Research
2783-2430
9
1
2021
03
01
Bioactive compounds as a potential inhibitor of colorectal cancer; an insilico study of Gallic acid and Pyrogallol
32
39
EN
Debanjan
Mitra
Department of Microbiology, Raiganj University, Raiganj, WB, India
debanjanmitra267@gmail.com
Anumita
Dey
Department of Microbiology, Raiganj University, Raiganj, WB, India
anumitadey15@gmail.com
Ishita
Biswas
Department of Microbiology, Raiganj University, Raiganj, WB, India
ishitabiswas1307@gmail.com
Pradeep
K
Das Mohapatra
0000-0002-9292-992X
Department of Microbiology, Raiganj University, Raiganj, WB, India
pkdmvu@gmail.com
10.30476/acrr.2021.89642.1080
Abstract<br /> 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. <br /> 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. <br /> 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. <br /> 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.
Colorectal cancer,descriptor properties,molecular docking,binding energy
https://colorectalresearch.sums.ac.ir/article_47450.html
https://colorectalresearch.sums.ac.ir/article_47450_224f0bde28b2fefd56816886d6dc4b96.pdf
Shiraz University of Medical Sciences
Iranian Journal of Colorectal Research
2783-2430
9
1
2021
03
01
Colorectal Cancer in People with Cystic Fibrosis under the Age of 40: A Case Series
40
43
EN
Sunjay
R
Devarajan
0000-0001-8360-5934
Section of Pulmonary/Critical Care, Baylor College of Medicine, Houston, TX, USA
sunjay.devarajan@bcm.edu
Benjamin
Musher
Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
blmusher@bcm.edu
James
Abraham
University of MichiganDivision of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
jamabrah@med.umich.edu
10.30476/acrr.2021.89837.1083
Introduction<br /> 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. <br /> <br /> Case Presentations<br /> 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.<br /> <br /> Conclusion<br /> 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.
Colon cancer syndrome,Polyp,Colorectal,cystic fibrosis,Colonoscopy
https://colorectalresearch.sums.ac.ir/article_47424.html
https://colorectalresearch.sums.ac.ir/article_47424_6cee0ecf9d7b203b7fa96761b2451ada.pdf
Shiraz University of Medical Sciences
Iranian Journal of Colorectal Research
2783-2430
9
1
2021
03
01
Perforation Due to Rectal Foreign Body and Radiological Findings
44
46
EN
Saim
Turkoglu
0000-0001-8247-2009
Van Traınıng and Research Hospıtal, Van, Turkey
mdsaimturkoglu@gmail.com
Adem
Yokus
Department of Radiology, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
drademyokus@gmail.com
Fırat
Aslan
Department of General Surgery, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
dr.aslan.2609@hotmail.com
10.30476/acrr.2021.90332.1090
Perforation Due to Rectal Foreign Body and Radiological Findings<br /> <br /> 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. <br /> 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. <br /> 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. <br /> 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.
Key Words: Rectal salami,Computed Tomography,Emergency Surgery,Foreign bodies
https://colorectalresearch.sums.ac.ir/article_47430.html
https://colorectalresearch.sums.ac.ir/article_47430_c9c98987b8192b408556993f34043272.pdf