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Background: Rectal cancer (RC) is one of the most common types of cancer worldwide. With the development of artificial intelligence (AI), the application of AI in preoperative evaluation and follow-up treatment of RC based on magnetic resonance imaging (MRI) has been the focus of research in this field. This review was conducted to develop comprehensive insight into the current research progress, hotspots, and future trends in AI based on MRI in RC, which remains to be studied. Methods: Literature related to AI based on MRI and RC, as of November 2023, was obtained from the Web of Science Core Collection database. Visualization and bibliometric analyses of publication quantity and content were conducted to explore temporal trends, spatial distribution, collaborative networks, influential articles, keyword co-occurrence, and research directions. Results: A total of 177 papers (152 original articles and 25 reviews) were identified from 24 countries/regions, 351 institutions, and 81 journals. Since 2019, the number of studies on this topic has rapidly increased. China and the United States have contributed the highest number of publications and institutions, cultivating the most intimate collaborative relationship. The highest number of articles derive from Sun Yat-sen University, while Frontiers in Oncology has published the highest number of relevant articles. Research on MRI-based AI in this field has mainly focused on preoperative diagnosis and prediction of treatment efficacy and prognosis. Conclusions: This study provides an objective and comprehensive overview of the publications on MRI-based AI in RC and identifies the present research landscape, hotspots, and prospective trends in this field, which can provide valuable guidance for scholars worldwide.

Photoacoustic microscopy offers functional information regarding tissue vasculature while ultrasound characterizes tissue structure. Combining these two modalities provides novel clinical applications including response assessment among rectal cancer patients undergoing therapy. We have previously demonstrated the capabilities of a co-registered photoacoustic and ultrasound device in vivo, but multiple challenges limited broad adoption. In this paper, we report significant improvements in an acoustic resolution photoacoustic microscopy and ultrasound (ARPAM/US) system characterized by simulation and phantom study, focusing on resolution, optical coupling, and signal characteristics. In turn, higher in-probe optical coupling efficiency, higher signal-to-noise ratio, higher data throughput, and better stability with minimal maintenance requirements were all accomplished. We applied the system to 19 ex vivo resected colorectal cancer samples and found significantly different signals between normal, cancer, and post-treatment tumor tissues. Finally, we report initial results of the first in vivo imaging study.

Rectal oncological pathology usually involves surgical treatment, which presents a relatively high degree of difficulty in terms of the surgical approach. With the development of minimally invasive surgery, technology has also diversified its possibilities for performing digestive anastomoses, noting significant advances in the techniques currently available for performing mechanical anastomoses. The evolution of mechanical sutures through the use of staplers has become a true landmark of technological progress on this topic, as they have led to significant improvements in both the operative technique and the therapeutic results obtained. The aim of this paper is to highlight the advantages of using staplers in rectal surgery, which seem to contribute to a lower percentage of postoperative complications (lower incidences of suppuration, fistulae and evisceration) and a lower rate of mortality. The use of mechanical anastomoses has also increased the technical possibilities of performing lower anastomoses, thus reducing the number of colostomies and the hospitalization period, aspects that have improved the compliance of patients who require major oncological surgical interventions.

In this paper we interpretated the background about Standardized surgical procedure of conformal sphincter-preservation operation (CSPO) for low rectal cancer (2023 edition), and several key issues need to be attention, for example, the definition of conformal resection, the clarity of relevant anatomical concepts, the functional advantages of CSPO, the main differences between CSPO and intersphincteric resection(ISR), the clinical value and indications, the principles and details of surgery, and the key issues of perioperative nursing.

Abstract Background Preoperative education can improve postoperative quality of life in patients undergoing stoma surgery. However, the prevalence and when, where, and how preoperative education is implemented are unclear. Therefore, this study aimed to assess the current status of outpatient preoperative education for patients undergoing stoma surgery for rectal cancer as perceived by nurses. Additionally, it sought to identify the information provided by Japanese healthcare providers as a part of preoperative education. Methods This cross-sectional study included 1,716 wound, ostomy, and continence nurses (WOCNs) in charge of stoma clinics at Japanese hospitals. Unsigned self-administered survey forms were mailed to the participants, and paper- or web-based responses were obtained. The main questions included: overview of the participants and their facilities, provision of outpatient preoperative education, status of implementation, and preoperative education components. To examine the factors associated with preoperative education, the independent variable was the presence or absence of preoperative education in the clinic, and the explanatory variables were the years of experience as a nurse, years of experience as a WOCN, type of hospital, number of beds, and number of intestinal stoma surgeries per year. Regression analysis was performed. Results We received 773 valid responses (valid response rate: 45%). Duration of experience as a nurse and as a WOCN were 24.6 and 10.9 years, respectively. Outpatient preoperative education was provided by 24% of the participants. Most preoperative education sessions were conducted for patients or caregivers. Preoperative education took 31–60 min per patient, and one to five patients received preoperative education each month. Booklets, ostomy appliances, and stoma models/dolls were used as supplementary materials for preoperative education. The most frequently mentioned components of preoperative education were stoma care, daily life, social security, stoma clinic, traveling and going out, quality of life after stoma surgery, and precautions for medical treatment. In addition, education on the use of restrooms on the go, disaster preparedness, defecation disorders after restorative proctectomy, and complications after stoma closure were considered necessary. Conclusions The implementation rate of outpatient preoperative education was low (24%). Future challenges include the development of specific educational content and procedures suitable for the Japanese medical environment and the establishment of preoperative medical care teams for stoma surgery to promote the provision of outpatient preoperative education.

This paper summarized the common complications and influencing factors after preventive ileostomy closure for lower rectal cancer. Related nursing strategies were analyzed to provide reference for reducing complication rates and relieve clinical symptoms of patients undergoing preventive ileostomy closure for lower rectal cancer. (本文总结低位直肠癌预防性肠造口还纳术后常见的并发症和影响因素, 分析护理策略, 旨在为降低低位直肠癌预防性回肠造口患者并发症发生率, 或减轻相应的症状提供参考依据。)

PURPOSEThis paper aims to investigate the diagnostic performance of magnetic resonance imaging (MRI) in predicting the pathologic stage of locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT) and the role of MRI in selecting patients with a pathologic complete response (ypCR).METHODSRestaging MRI (yMRI) examinations of 136 patients with LARC treated with neoadjuvant CRT followed by surgery were retrospectively analyzed by two radiologists. All examinations were performed on a 1.5 Tesla MRI machine with a pelvic phased-array coil. T2-weighted turbo spin-echo images and diffusion-weighted imaging were obtained. Histopathologic reports of the surgical specimens were the reference standard. The accuracy, sensitivity, specificity, positive and negative predictive values (PPV and NPV) of yMRI in predicting the pathologic T-stage (ypT), N-stage, and ypCR were calculated. The inter-observer agreement was evaluated using kappa statistics.RESULTSThe yMRI results showed 67% accuracy, 59% sensitivity, 80% specificity, 81% PPV, and 56% NPV in identifying ypT (ypT0-2 versus ypT3-4). In predicting the nodal status, the yMRI results revealed 63% accuracy, 60% sensitivity, 65% specificity, 47% PPV, and 75% NPV. In predicting ypCR, the yMRI results showed 84% accuracy, 20% sensitivity, 92% specificity, 23% PPV, and 90% NPV. The kappa statistics revealed substantial agreement between the two radiologists.CONCLUSIONUtilization of yMRI showed high specificity and PPV in predicting the tumor stage and high NPV in predicting the nodal stage; in addition, yMRI revealed moderate accuracy in the T and N classifications, mainly due to underestimating the tumor stage and overestimating the nodal status. Finally, yMRI revealed high specificity and NPV but low sensitivity in predicting the complete response.

Background: Over a decade, tissues dissected adjacent to primary tumors have been considered “normal” or healthy samples (NATs). However, NATs have recently been discovered to be distinct from both tumorous and normal tissues. The ability to predict the survival rate of cancer patients using NATs can open a new door to selecting optimal treatments for cancer and discovering biomarkers. Methods: This paper introduces an artificial intelligence (AI) approach that uses NATs for predicting the 5-year survival of pre-operative radiotherapy patients with rectal cancer. The new approach combines pre-trained deep learning, nonlinear dynamics, and long short-term memory to classify immunohistochemical images of RhoB protein expression on NATs. Results: Ten-fold cross-validation results show 88% accuracy of prediction obtained from the new approach, which is also higher than those provided from baseline methods. Conclusion: Preliminary results not only add objective evidence to recent findings of NATs’ molecular characteristics using state-of-the-art AI methods, but also contribute to the discovery of RhoB expression on NATs in rectal-cancer patients. Clinical impact: The ability to predict the survival rate of cancer patients is extremely important for clinical decision-making. The proposed AI tool is promising for assisting oncologists in their treatments of rectal cancer patients.

Low rectal cancer is a common gastrointestinal malignancy. Organ preservation in the treatment of low rectal cancer is a challenge. By combining surgical resection with freezing—a complementary treatment for low rectal cancer—the anus can be preserved in some patients. However, we lack unified standards for colorectal cancer cryotherapy. Our hospital has been treating patients with cryotherapy since 1976. In our department, the indications for and contraindications to low rectal and anal cancer treatment are well established. In this paper, we summarize the indications for and contraindications to cryotherapy for colorectal cancer by reviewing the literature, drawing on our experience, and considering current imaging and histological techniques. Our aim is to facilitate clinical discussion and promote appropriate treatment.

This paper accompanies the paper titled ''Defining and predicting early recurrence in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy'' presented by the same authors to the European Journal of Surgical Oncology [1]. The present article describes the relevant clinical data of patterns of initial recurrence after curative surgery for rectal cancer with neoadjuvant therapy. This data was collected from the hospital records, Chinese Population Registration and Health Insurance System.

PurposeIn recent years, total neoadjuvant therapy (TNT) has emerged as a new therapeutic strategy against advanced rectal cancer (RC). After administration of TNT, some patients show complete clinical response (cCR) to treatment however, disputes about the effects of TNT and the alternative treatment plans in case of recurrence after cCR still exist.MethodsA total of 100 patients were included in this paper. CR and non-CR was observed when these patients were administered with TNT at the First Affiliated Hospital of Dalian Medical University, China from May 2015 to June 2021. These patients received different chemotherapeutic regimens, with close monitoring and watch and wait (W&W) strategy being applied by a multidisciplinary team (MDT). According to treatment results, patients were divided into a cCR group and a non-cCR group; according to the recurrence during W&W, they were divided into a recurrence group and a no-local-recurrence group. This study analyzed the factors that may affect the prognosis, and summarized the surgery and treatment after recurrence.ResultsThe TNT strategy was effective, and 85% of patients achieved local remission. However, W&W did not affect the survival time of CR patients, nor did it cause new distant metastasis due to local recurrence during the observation period (P > 0.05). However, for patients with positive CRM, we do not recommend W&W as the first choice of treatment (P

Locally advanced and relapsed rectal cancer represent one of the most commonly reported indications for total pelvic exenteration especially in men, while in women the surgical procedure might be limited to a posterior exenteration. This procedure is still associated with high risks of postoperative complications and high rates of perioperative mortality, therefore careful selection of the cases is mandatory. However, in the last decades improvement in the field of oncology treatment leaded to the increase of the lifespan of patients diagnosed with rectal cancer; in this respect, it is easy to be understood the fact that an increased number of cases will develop at a certain moment of their evolution pelvic recurrences which need more extended surgical procedures at a more advanced age. Therefore, extended procedures such as pelvic exenterations are needed in these cases; the aim of this paper is to study whether pelvic exenteration is suitable for elderly patients and which cases could benefit most from this aggressive surgical approach.

Currently, surgery, usually supplemented with other adjunctive therapies, is the only potentially curative treatment modality for rectal cancer. There are tree common types of radical resection of rectal carcinoma: abdominoperineal resection (Miles procedure), low anterior resection (Dixon procedure) and Hartmann’s procedure. This paper summarized the nursing management of a rectal cancer patient with skin mucous membrane separation after Hartmann’s procedure. The enterostomal therapist carried out skin care, dressing management, home-based care and psychological care, in order to treat complications of enterostomy and improve the rehabilitation of the patient. (目前手术切除是治疗结直肠癌的主要方法, 同时辅以放疗化疗等综合治疗方法。直肠癌根治术分为3种: Miles术、Dixon术、Hartmann术。本文总结1例直肠癌患者行Hartmann术后肠造口皮肤黏膜分离的护理体会。肠造口治疗师通过皮肤护理、敷料选择、患者及其家属居家护理以及心理护理, 解决患者肠造口并发症, 促进患者康复, 提高生活质量。)

The management of locally advanced rectal cancer (LARC) suffered changes thanks to the development of improved surgical procedures, radiation delivery, and chemotherapy. Although treatment options improved individually, the optimal order is still debated. Neoadjuvant chemo-radiotherapy followed by total mesorectal excision (TME) has been the “golden standard” for locally advanced rectal cancer. There is no common ground in international guidelines on the indications of adjuvant chemotherapy (ADJCHT), with differences between the American, European, and Japanese guidelines. This paper studies the preferences of Romanian oncologists in prescribing ADJCHT. We conducted a single-institution, retrospective study of all nonmetastatic, ECOG 0-1 LARC patients staged II-III who underwent TME and were admitted to the Oncology or Radiotherapy Department of Colțea Clinical Hospital, Bucharest between January 2017 and March 2021. A total of 186 patients were included in the study. A positive correlation was found between ADJCHT and each of the following: (y)pT > 2, (y)pN > 0, and the presence of perineural invasion (PNI+). A strong positive correlation was found between ADJCHT and the presence of at least one risk factor: (y)pT > 2, (y)pN > 0, PNI+, lymphovascular invasion, positive margins, or tumor grade > 1. Tumor downstaging decreased the risk of metastases in the first 2 years and was associated with the use of neoadjuvant radiotherapy, while adding neoadjuvant chemotherapy increased the chance of nodal downstaging. ADJCHT practice for LARC in Romania follows either NCCN or ESMO guidelines, at the discretion of the oncologist, due to the lack of national guideline.

Combination of neoadjuvant chemoradiotherapy with subsequent total mesorectum excision and 6-months of adjuvant chemotherapy remains a standard approach to treatment of locally advanced rectal cancer (T3 or T4 and / or N1–3; M0) for more than 15 years, which is reflected in practical guidelines of most leading oncological societies. However, recent data suggests possibilities of more individualized treatment conceptions with a potential of further improvement of long-term therapy outcomes and patient’s quality of life. In this paper we present review of results of clinical trials which investigated new approaches to treatment of locally advanced rectal cancer.

Abstract Rectal cancer has the eighth highest cancer incidence worldwide, and it is increasing in young individuals. However, in countries with a high human development index, mortality is decreasing, which may reflect better patient management, imaging being key. We rely on imaging to establish the great majority of clinical tumour features for therapeutic decision-making, namely tumour location, depth of invasion, lymph node involvement, circumferential resection margin status and extramural venous invasion. Despite major improvements in technique resulting in better image quality, and notwithstanding the dissemination of guidelines and examples of standardised reports, rectal cancer staging is still challenging on the day-to-day practice, and we believe there are three reasons. First, the normal posterior pelvic compartment anatomy and variants are not common knowledge to radiologists; second, not all rectal cancers fit in review paper models, namely the very early, the very low and the mucinous; and third, the key clinical tumour features may be tricky to analyse. In this review, we discuss the normal anatomy of the rectum and posterior compartment of the pelvis, systematise all rectal cancer staging key points and elaborate on the particularities of early, low and mucinous tumours. We also include our suggested reporting templates and a discussion of its comparison to the reporting templates provided by ESGAR and SAR.

Summary: Objective: To evaluate the optimal timing of surgery after short-course radiation therapy and to compare the efficacy of short-course radiotherapy (SCRT) and long-course radiotherapy (LCRT) in patients with rectal cancer, a systematic review with network analysis was conducted. Methods: A systematic literature search of the Cochrane Central Register of Controlled Trials, Embase, and MEDLINE (PubMed) was conducted to identify papers published before June 4, 2018, without language or publication date restrictions. The use of surface under the cumulative ranking curve (SUCRA) within a network meta-analysis framework provided a numerical presentation of the overall ranking, thus providing a ranking of treatment options from which patients can choose from. Within the primary search that yielded 1435 studies, 11 relevant randomized trials were identified. Results: No statistically significant difference was found in overall mortality and metastasis between short-course radiotherapy with early surgery (SCES), short-course radiotherapy with delayed surgery (SCDS), and long-course radiotherapy with delayed surgery (LCDS). For overall metastasis, using SUCRA analysis, SCES, LCDS, and SCDS respectively had the highest to lowest SUCRA rank, respectively. Thus, SCES was the most likely to be effective, followed by LCDS and SCDS. Conclusion: Regarding the optimal timing of surgery for patients with advanced rectal cancer undergoing short-course radiation therapy, SCES is recommended as the optimal choice according to the available evidence and considering the control of future metastasis.

The objective of this paper was to find correlations between clinico-pathological parameters and survival and tumor recurrence indices with the purpose of improving treatment results and asses better the prognosis of the patients with rectal cancer. The study included 69 patients with rectal cancer in stages I-III according to the AJCC classification (8th edition), who didn’t undergo neoadjuvant treatment and were operated (curative surgery) in the General Department of the Emergency Clinical Hospital Bucharest in a period of 2 years, 01.01.2016 – 31.12.2017. Our statistical analysis showed significant correlations between the quality of the mesorectum and tumor localization, type of surgery or overall survival. Also, we registered important associations between the N stage from TNM classification and tumor grading or lymphovascular invasion. In conclusion, we can say that these correlations observed in our study between clinico-pathological and prognostic parameters in patients with rectal cancer are useful in the treatment and for determining the outcome of these patients.

Abstract Background A lymph node harvest (LNH) of < 12 is a predictor for poor prognosis in rectal cancer patients. However, neoadjuvant chemoradiotherapy (NACRT) is known to decrease LNH; hence, a cut-off of 12 is inappropriate in such patients. This paper aims to establish a LNH cut-off predictive for disease-free and overall survival in NACRT patients. Methods A retrospective review of patients who underwent elective surgery for rectal cancer from 2006 to 2013 was performed. All patients with R1/2 resections and presence of metastases and those operated on for recurrence were excluded. Patient demographics, clinical features, operative details, LNH, 30-day mortality and disease-free and overall survival were recorded. P values of < 0.05 were considered significant. Results A total of 257 patients were studied, with 174 (68%) males and a median age of 66 years. Ninety-four (37%) patients received long-course NACRT, and 122 (48%) patients were stage 2 and below. Median LNH was 17, which was reduced in the NACRT group (14 versus 23, P < 0.01). Average length of stay was 9 ± 8 days, with a major post-operative complication rate of 4%. Using hazard ratio plots for the NACRT subgroup, LNH cut-offs of 16.5 and 8.5 were obtained for disease-free survival (DFS) and overall survival (OS) respectively. Survival analysis showed that a LNH cut-off of 8.5 was a significant predictor of OS (P < 0.001). Conclusion LNH is reduced in patients receiving NACRT before rectal cancer surgery. A LNH of 9 and above is associated with improved overall survival. We propose that this can be used as a tool for prognosis.

Aims and Objectives: This study aimed to perform a systematic review of all the available published data on CRC in Nigerians over a period of 53years as a proximate indication of the burden of the disease. Materials & Methods: The data were sourced from PubMed, MEDLINE, EMBASE and Google Scholar search engines as well as direct contact with some authors. All published studies on histologically confirmed CRC in Nigerians constitute the materials. Selected papers were independently reviewed by the authors. Results: Of 35 papers found, 19 met the criteria and a total of 2497 cases reported in these 19 publications constituted the materials utilised for the review. There is increasing incidence as evident by increase in annual frequency increased from 18.2/annum in the early years (1954-1969) to 86.8/annum in the latter years (1991-2007). The average age incidence was 46years (peak=41-50 age group); 674(32%) of all the cases were aged below 40years. The male to female ratio was .3:1. Of the 2238 cases in which site was reported, rectum 1349(60%) was the commonest site followed by caecum 260(17%). All the cases were adenocarcino- mas and 1043(56%) were well differentiated. Mucinous carcinoma and signet ring type accounted for 309(17%) and 32(2%) respectively. Of 1061 cases in which Duke′s staging was reported, 622(59%) presented in stage B disease fol- lowed by stage C 266(25%). Conclusions: The incidence is of CRC is increasing in Nigeria. The mean age is low and incidence appears to be increasing in younger patients.

Abstract Background Post-treatment management is essential for improving the health and quality of life of colorectal cancer (CRC) survivors. The number of cancer survivors is continually increasing, which is causing a corresponding growth in the need for effective post-treatment management programs. Current research on the topic indicates that such programs should include aspects such as physical activity and a proper diet, which would form the basis of lifestyle change among CRC survivors. Therefore, this study aimed to identify the impact of physical activity and diet on the quality of life of CRC survivors. Methods We performed a systematic literature review regarding CRC survivors. We searched the Embase, PubMed, and EBSCOhost databases, considering papers published between January 2000 and May 2017 in any language, using a combination of the following subject headings: “colorectal cancer,” “colorectal carcinoma survivor,” “survivorship plan,” “survivorship care plan,” “survivorship program,” “lifestyle,” “activities,” “exercise,” “diet program,” and “nutrition.” Results A total of 14,036 articles were identified, with 35 satisfying the eligibility criteria for the systematic review. These articles were grouped by the study questions into physical activity and diet: 24 articles were included in the physical activity group and 11 in the diet group. Conclusions The research showed that an effective survivorship program can significantly help CRC survivors maintain good health and quality of life for long periods. However, there is a lack of consensus and conclusive evidence regarding how the guidelines for such a program should be designed, in terms of both its form and content.

Colorectal cancer is one of the most common malignant diseases in Russia worldwide making up 5-6% of all human malignant tumors. Neutrophilic granulocytes are actively involved in development of antitumor response. A key role in tumor regression is assigned to active forms of oxygen produced by neutrophils. In connection with these pre-requisites, our goal was to study functional characteristics of spontaneous and induced chemiluminescent activity of neutrophil granulocytes in patients with rectal cancer before starting pathogenetic therapy and in subsequent dynamics. The paper presents some laboratory results, i.e., functional indices of neutrophilic granulocytes’ activity in 36 patients with rectal cancer being at different stages of oncological process. The control group consisted of 112 practically healthy volunteers, comparable in sex and age to the group of patients under study. To perform the study venous blood was taken from patients to vacuum test tubes with lithium heparin in the morning time before surgical treatment, and on day 7 after the surgical intervention. Evaluation of spontaneous and induced chemiluminescence was performed for 90 minutes in a 36-channel “CL 3606” chemiluminescence analyzer (Russia). The following characteristics were determined: time of the curve transition to maximal chemiluminescence intensity (Tmax), maximal value of chemiluminescence intensity (Imax), integral area under the chemiluminescence curve (S). Luminol was used as the chemiluminescence enhancer. Opsonized zymosan was used to induce the respiratory explosion. Chemiluminescence amplification induced by opsonized zymosan was evaluated by the ratio of induced-tospontaneous chemiluminescence (Sind/spont) designated as an activation index.Analysis of chemiluminescence activity in neutrophilic granulocytes showed a significant increase in spontaneous chemiluminescence activity at the stages III and IV of the disease. The production of active oxygen forms induced in neutrophilic granulocytes by opsonized zymosan increased in all the study groups, relative to control parameters. The area under the curves of spontaneous and induced chemiluminescence in patients with colorectal cancer at all stages of the oncological process is less, as compared to the control group, which, despite high indices of maximal chemiluminescence activity, may indicate insufficient total production of reactive oxygen species. The time-to-peak values of the chemiluminescence curves in patients with rectal cancer at all stages of the disease did not show statistically significant differences from the control group.

Online MRI-guided radiotherapy (MRgRT) is one of the most recent technological advances in radiotherapy. MRgRT permits the visualization of tumorous and healthy tissue while the patient is on the treatment table and online daily plan adaptations following the observed anatomical changes. In the context of rectal cancer, online MRgRT is a very promising modality due to the pronounced geographical variability of tumor tissues and the surrounding healthy tissues. This current paper will discuss the possible applications of online MRgRT, in particular, in terms of radiotherapy dose escalation and response prediction in organ preservation approaches for rectal cancer.

Neoadjuvant chemoradiotherapy (nCRT) followed by radical surgery is the standard of care for patients with Locally Advanced Rectal Cancer (LARC). Current selection for nCRT is based on clinical criteria regardless of any molecular marker. Pharmacogenomics may be a useful strategy to personalize and optimize nCRT in LARC. This review aims to summarize the most recent and relevant findings about the role of germline and somatic pharmacogenomics in the prediction of nCRT outcome in patients with LARC, discussing the state of the art of their application in the clinical practice. A systematic literature search of the PubMed database was completed to identify relevant English-language papers published up to January 2020. The chemotherapeutic backbone of nCRT is represented by fluoropyrimidines, mainly metabolized by DPD (Dihydro-Pyrimidine Dehydrogenase, DPYD). The clinical impact of testing DPYD*2A, DPYD*13, c.2846A > T and c.1236G > A-HapB3 before a fluoropyrimidines administration to increase treatment safety is widely acknowledged. Other relevant target genes are TYMS (Thymidylate Synthase) and MTHFR (Methylene-Tetrahydro-Folate Reductase), whose polymorphisms were mainly studied as potential markers of treatment efficacy in LARC. A pivotal role of a TYMS polymorphism in the gene promoter region (rs34743033) was reported and was pioneeringly used to guide nCRT treatment in a phase II study. The pharmacogenomic analysis of other pathways mostly involved in the cellular response to radiation damage, as the DNA repair and the activation of the inflammatory cascade, provided less consistent results. A high rate of somatic mutation in genes belonging to PI3K (Phosphatidyl-Inositol 3-Kinase) and MAPK (Mitogen-Activated Protein Kinase) pathways, as BRAF (V-raf murine sarcoma viral oncogene homolog B1), KRAS (Kirsten Rat Sarcoma viral oncogene homolog), NRAS (Neuroblastoma RAS viral (v-ras) oncogene homolog), PIK3CA (Phosphatidyl-Inositol-4,5-bisphosphate 3-Kinase, Catalytic Subunit Alpha), as well as TP53 (Tumor Protein 53) was reported in LARC. Their pharmacogenomic role, already defined in colorectal cancer, is under investigation in LARC with promising results concerning specific somatic mutations in KRAS and TP53, as predictors of tumor response and prognosis. The availability of circulating tumor DNA in plasma may also represent an opportunity to monitor somatic mutations in course of therapy.

Introduction. Colon and rectal cancer (CC, RC) are different entities from a clinical and tumor biological point of view. Up to now, both, CC and RC, are synonymously called “Colorectal Cancer” (CRC). With our experience in basic and clinical research and routine work in this field we now have come to the opinion, that the term “CRC” should definitely be questioned, and if justified, be abandoned.Materials/Methods. We analyzed the actual available data from the literature and our own results from the Ulm based study group FOGT to proof or reject our hypothesis.Results. The following evident differences were recognized: Anatomically, the risk to develop RC is 4× higher than for CC. Molecular changes in carcinogenesis in CC are different from RC. Physical activity helps to prevent CC, not RC. Pathologically there are differences between RC and CC. In addition, there are also major clinical differences between CC and RC, such as in surgical topography and– procedures, multimodal treatment (MMT) approaches (RC in MMT is less sensitive to chemotherapy than CC), and prognostic factors for the spontaneous course and for success of MMT (e.g. TS or DPD ). Discussion. CC ´sand RC´s definitely are different in parameters of causal and formal carcinogenesis, effectivity of primary prevention by physical activity, conventional and molecular pathology.According to our findings we can demand from the preclinical point of view that CC and RC are two different tumor entities in terms of various representative biological characteristics.CC and RC are also differing substantially in many clinical features, as outlined in a separate paper from our group.Conclusion. “CRC” should no longer be used in basic and clinical research and other fields of cancer classification as a single disease entity. CC is not the same as RC. CC might even be divided into right and left CC.

Prostate cancer is a common cancer among male patients. With the development of science and technology, the diagnosis and treatment of prostate cancer are becoming more and more advanced, which significantly extends the survival time of patients and improves their quality of life, so that many prostate cancer patients are diagnosed with secondary primary cancer. This paper reviews the general situation, etiology, diagnosis, treatment and prognosis of the second primary cancer in prostate cancer patients.

The objective of the study Rectal cancer represents a public health issue, considering the increased incidence among the general population in Romania. At present, the ideal management of patients diagnosed with rectal neoplasms, leading to oncological healing while preserving all physiological functions, includes the low anterior resection of the rectum (LARS) with the partial or total excision of the mesorectum. The aim of the paper is to analyze the physiological, psychological and oncological impact of surgical intervention on patients diagnosed with rectal cancer. Material and methods Our study was retrospective, observative, descriptive, unicentric, and took place in the General Surgery and Emergency Clinic IIIrd of the Bucharest University Emergency Hospital, Romania, during 1 January, 2005 –31 December, 2016. The study included a total of 92 patients. Results The values of LARS score ranged from 0-42. The mean LARS scores in the study group were 12.46 with a median of 7 and a 13.06 standard deviation. Conclusions The distance from the anastomosis level to the pectinate line, side-to-end anastomosis, the impossibility to identify the nerves, the occurrence of anastomotic fistula are predictive factors for the occurrence of major LARS during post-surgery evolution.

Sufficient length, as well as an adequacy of the blood supply to the distal part of the relegated colon in the formation of primary anastomosis are major intraoperative factors that can reduce the number of anastomotic leak in case of colon resections. Intraoperative fluorescence angiography allows you to assess an adequacy of the blood supply. It is easily feasible and reproducible technique. In this paper we publish our first experience of using this technique in 7 patients. In 1 of them intraoperative surgical tactics was changed after the study. Further developments in this direction are necessary in order to evaluate clinical significance of intraoperative fluorescence angiography in perfusion objectification during surgical operations on the colon.

The paper describes a clinical case of successful treatment in a female patient with disseminated rectal cancer by minimally invasive technologies that could perform one-stage simultaneous intervention into the rectum and lung, which promoted rapid patient rehabilitation and reduced systemic chemotherapy initiation time.

We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an inoperable rectal tumor with involvement of surrounding structures. In this paper, we discuss the diagnostic work-up of this patient with a diagnosis of pelvic/perirectal inflammatory myofibroblastic tumor (IMT). IMT is a rare tumor with intermediate malignant potential that frequently mimics clinical and imaging features of malignancy. Additionally, to the best of our knowledge, this is the first case of a pelvic IMT that regressed without surgical excision.

The paper presents an analysis of rectal cancer incidence in the Republic of Belarus over the 30-year time period, assessing earliness of the diagnosis and treatment outcomes. From 1980 through 2010, rectal cancer incidence in Belarus increased 2.4-fold (from 8.9 to 21.0 per 100 000 population). The proportion of rectal cancer patients undergoing radical surgery grew from 32.4 % in 1985 to 57.2 % in 2010. One-year mortality rates decreased and were 37.6 % in 1994 and 27.2 % in 2010. The share of rectal cancer patients followed up for 5 years and more after establishing the diagnosis was 34.5 % in 1990 and 51.7 % in 2010.

Introduction. Functional results after low anterior resection for rectal cancer are an issue of increasing attention among colorectal surgeons and others interested in this subject. The consensus on ideal reconstruction type has not been achieved to date, although the number of papers on this subject has been published in recent years. Objective. We conducted a prospective, parallel group study comparing latero-terminal with colonic J-pouch anastomosis in terms of defecatory function in patients undergoing stapled low colorectal/ coloanal anastomosis. Methods. A total of 80 patients were included in this study with either latero-terminal or colonic J-pouch anastomosis. Defecatory function was evaluated using the modified version of MSKCC questionnaire 6, 12 and 24 months after the operation. Fecal continence was evaluated using the Wexner continence score. Results. In both groups, trend towards improvement was registered in all measured variables in all three control intervals. This can apply to bowel frequency, urgency, night soiling, fragmentation and incomplete evacuation. However, the difference was not statistically significant, and when reviewing the trend of results we can note that in the J-pouch group steady state has not been reached even after 24 month control. Conclusion. This trial did not reveal any significant differences in defecatory function 6, 12 and 24 months after low anterior resection (LAR) between patients with a latero-terminal anastomosis and those with colonic J-pouch anastomosis. Our results did not confirm superiority of colonic J-pouch over the lateroterminal anastomosis.

To summarize the advances in the multidisciplinary treatment of rectal cancer and to analyze the existing problems and development prospects. The full text database retrieval system of MEDLINE and the periodicals of CHKD were searched. The words “rectal cancer, diagnosis, surgery, chemotherapy, radiotherapy, targeted therapy, analysis” were used as key words for retrieval of literature concerning the values and clinical significance of rectal cancer multidisciplinary treatment from January, 2000 to December, 2007. Thirty papers were selected, of which 26 were used in analysis at last. Accurate preoperative staging of rectal cancer is a key factor in the multidisciplinary and comprehensive treatment of patients. A new therapy which is combined with radical operation can reduce the rate of local recurrence, prolong survival time, and particularly, promote the rate of sphincter preservation. Radical surgery combined with adjuvant therapy is still recognized as standard treatment modality for the patients with rectal cancer in stage II-III. Total removal of resectable metastases followed by prompt standard adjuvant therapy may extend survival time. The introduction of new chemical drugs, drugs of targeting therapy, and a regimen of combination therapy may improve outcomes in treatment for rectal cancer patients. A treatment standard for rectal cancer patients needs to be actively pursued. Compared with colon cancer patients, there has not been sufficient evidence to confi rm that the total survival rate of rectal cancer patients a t er multidisciplinary and comprehensive treatments has been improved; therefore, it needs to be further studied.

Objective: transanal endoscopic microsurgery (TEM) allows locally complete excision of rectal neoplasms and provides an alternative to conventional surgery for benign tumours. However, its role in the curative treatment of invasive carcinoma is controversial. This paper examines the results of TEM compared with radical surgery (RS) for T1 rectal cancer. Methods: 51 patients with T1 rectal tumours treated by RS, or local excision by means of TEM were included. The following parameters were evaluated: operating time, blood loss, hospital stay and complications, as well as local recurrence rate and survival. Results: 17 patients were treated by RS and 34 by TEM. Operative time, blood loss, and duration of hospitalization were significantly lower in the TEM group compared with the RS group. In the RS group there were 4 patients with complications which required an operative revision (23.5%), compared to 1 reintervention (2.9%) in the TEM group. Local recurrence was 5.88% (n = 2) in the TEM group compared with none after RS (p = 0.547). The overall survival and disease-free survival showed not significant statistical differences between both groups (p = 0.59; p = 1.000, resp.). Conclusions: although local recurrence was only observed after local excision, patients treated with TEM showed no significant differences in terms of overall survival and disease-free survival compared with patients who underwent RS. Inasmuch as local excision represents a minimally invasive technique in terms of morbidity, mortality and functional outcome, TEM should be offered as a valid option for well selected patients with early rectal cancer.Objetivo: la cirugía transanal endoscópica (TEM) permite la resección completa de neoplasias de recto siendo una alternativa a la cirugía convencional para tumores benignos. Existe controversia sobre su papel en el tratamiento curativo del cáncer de recto. Esta publicación compara los resultados entre la resección radical (RS) y la exéresis local vía TEM del cáncer de recto en estadio precoz. Métodos: se evaluaron 51 pacientes con neoplasia de recto cuya infiltración se limitaba a la submucosa (T1) y que fueron tratados mediante RS o TEM. Se evaluaron los siguientes parámetros: tiempo quirúrgico, pérdidas sanguíneas, estancia hospitalaria y complicaciones así como recidiva local y supervivencia. Resultados: 17 pacientes fueron tratados mediante RS y 34 vía TEM. El tiempo quirúrgico, el posible sangrado y la estancia hospitalaria fueron significativamente menores en el grupo TEM. En el grupo RS, 4 pacientes presentaron complicaciones que obligaron a una revision quirúrgica (23,5%), comparado con sólo 1 reintervención (2,9%) en grupo TEM. La recidiva local sólo fue observada en dos pacientes (5,88%) del grupo TEM (p = 0,547). La supervivencia global y libre de enfermedad no mostró diferencias estadísticamente significativas entre ambos grupos (p = 0,59 y p = 1,000, respectivamente). Conclusiones: si bien el grupo tratado con TEM advirtió dos recidivas locales, no se observaron diferencias en términos de supervivencia global y libre de enfermedad entre los dos grupos analizados. En tanto la resección local representa una técnica mínimamente invasiva en términos de morbilidad, mortalidad y resultados funcionales, la exéresis mediante TEM debe ser ofertada como una opción válida para pacientes muy bien seleccionados con carcinoma de recto en estadio precoz.

Objective: transanal endoscopic microsurgery (TEM) allows locally complete excision of rectal neoplasms and provides an alternative to conventional surgery for benign tumours. However, its role in the curative treatment of invasive carcinoma is controversial. This paper examines the results of TEM compared with radical surgery (RS) for T1 rectal cancer. Methods: 51 patients with T1 rectal tumours treated by RS, or local excision by means of TEM were included. The following parameters were evaluated: operating time, blood loss, hospital stay and complications, as well as local recurrence rate and survival. Results: 17 patients were treated by RS and 34 by TEM. Operative time, blood loss, and duration of hospitalization were significantly lower in the TEM group compared with the RS group. In the RS group there were 4 patients with complications which required an operative revision (23.5%), compared to 1 reintervention (2.9%) in the TEM group. Local recurrence was 5.88% (n = 2) in the TEM group compared with none after RS (p = 0.547). The overall survival and disease-free survival showed not significant statistical differences between both groups (p = 0.59; p = 1.000, resp.). Conclusions: although local recurrence was only observed after local excision, patients treated with TEM showed no significant differences in terms of overall survival and disease-free survival compared with patients who underwent RS. Inasmuch as local excision represents a minimally invasive technique in terms of morbidity, mortality and functional outcome, TEM should be offered as a valid option for well selected patients with early rectal cancer.