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Background: Single-incision plus one-port laparoscopic surgery (SILS + 1) has been demonstrated to be minimally invasive while possessing better cosmesis and less pain compared with conventional laparoscopic surgery (CLS). However, SILS + 1 as an alternative to CLS for colorectal cancer is still controversial. Methods: A total of 1071 patients who underwent curative laparoscopic surgery for colon cancer between 2015 and 2018 were included. Of these patients, 258 SILS + 1 cases and 516 CLS cases were analyzed using propensity score matching. The baseline characteristics, surgical outcomes, pathologic findings and recovery course, morbidity and mortality within postoperative 30 days and 3-year disease-free and overall survival were compared. Results: Baseline characteristics were balanced between the groups. The mean operating time was significantly shorter in SILS + 1 group, with less estimated blood loss. Tumor size, tumor differentiation, number of harvested lymph nodes, resection margin and pathologic T, N, TNM stage was similar between the groups. There was no significant difference in overall perioperative complications. Uni- and multivariate analyses revealed that SILS + 1 was not a risk factor for complications. Postoperatively, SILS + 1 group showed faster recovery than CLS group in terms of ambulation, bowel function, oral intake and discharge. The 3-year disease-free survival rates of SILS + 1 and CLS groups were 90.1% and 87.3%(p = 0.59), respectively and the 3-year overall survival rates were 93.3% vs. 89.8%(p = 0.172). Discussion: Our study revealed that SILS + 1 is safe, feasible, oncologically efficient, and may be considered as a surgical option for selected patients with colorectal cancer. [ABSTRACT FROM AUTHOR]

Colorectal Cancer (CRC), a leading cause of cancer-related deaths, can be abated by timely polypectomy. Computer-aided classification of polyps helps endoscopists to resect timely without submitting the sample for histology. Deep learning-based algorithms are promoted for computer-aided colorectal polyp classification. However, the existing methods do not accommodate any information on hyperparametric settings essential for model optimisation. Furthermore, unlike the polyp types, i.e., hyperplastic and adenomatous, the third type, serrated adenoma, is difficult to classify due to its hybrid nature. Moreover, automated assessment of polyps is a challenging task due to the similarities in their patterns; therefore, the strength of individual weak learners is combined to form a weighted ensemble model for an accurate classification model by establishing the optimised hyperparameters. In contrast to existing studies on binary classification, multiclass classification require evaluation through advanced measures. This study compared six existing Convolutional Neural Networks in addition to transfer learning and opted for optimum performing architecture only for ensemble models. The performance evaluation on UCI and PICCOLO dataset of the proposed method in terms of accuracy (96.3%, 81.2%), precision (95.5%, 82.4%), recall (97.2%, 81.1%), F1-score (96.3%, 81.3%) and model reliability using Cohen's Kappa Coefficient (0.94, 0.62) shows the superiority over existing models. The outcomes of experiments by other studies on the same dataset yielded 82.5% accuracy with 72.7% recall by SVM and 85.9% accuracy with 87.6% recall by other deep learning methods. The proposed method demonstrates that a weighted ensemble of optimised networks along with data augmentation significantly boosts the performance of deep learning-based CAD. [ABSTRACT FROM AUTHOR]

Background: Single incision laparoscopic surgery (SILS) is a recent advancement in minimally invasive techniques for colorectal cancer (CRC). However, SILS is a technically challenging procedure for novice surgeons. The aim of this study was to evaluate clinical outcomes of SILS for CRC performed by novice surgeons compared with those performed by well‐experienced surgeons. Methods: We retrospectively analyzed 1004 consecutive patients with stage I‐IV CRC who underwent SILS between May 2009 and December 2018, using propensity score‐matched analysis. Results: After propensity score‐matching, we enrolled 344 patients (n = 172 in each group). Before matching, significant group‐dependent differences were observed in terms of age (P = 0.034) and tumor location (P < 0.001). After matching, preoperative clinical factors were similar between groups, but operative time was longer in the Novice group (213 vs 171 min, P < 0.001). Other operative factors and morbidity rates did not differ significantly between groups. The number of harvested lymph nodes was smaller in the Novice group (23 vs 25, P = 0.040), and the number of patients with lymph node metastases was smaller in the Novice group (57 vs 86, P = 0.002). The 3‐year disease‐free survival rate was 85.8% in the Novice group and 89.9% in the Experienced group (P = 0.512). Three‐year overall survival rate was 92.2% in the Novice group and 90.0% in the Experienced group (P = 0.899). Conclusion: SILS for CRC was safely performed by novice surgeons under the guidance of well‐experienced surgeons, and could provide satisfactory oncological outcomes. [ABSTRACT FROM AUTHOR]

Introduction: There are little data concerning the long-term outcome of single-incision laparoscopic surgery (SILS) for colon cancer. Therefore, we investigated not only the short-term outcomes but also the long-term outcomes of SILS for right-side colon cancer. Methods: We retrospectively compared short- and long-term outcomes of SILS and conventional laparoscopic surgery (CLS) for right-sided colon cancer in our institution. Intergroup differences of short-term outcomes were evaluated using χ2 or Fisher exact tests and 2-sample Student t tests. The disease-free survival rates (long-term outcome) of stage II and III patients were estimated using the Kaplan-Meier method and compared using log-rank tests. Results: There were 290 operations conducted for right-side (cecum and ascending) colorectal cancers from April 2011 to July 2018. Open surgery was performed in 12 cases from start to the operation. SILS was performed in 196 cases and CLS in 55 cases. One patient underwent intraoperative conversion from SILS to laparotomy for bleeding control. In addition, 1 port was added to SILS in 3 cases. These 4 cases were included in the analysis as the SILS group according to the principle of intent to treat. Background: Factors including age, gender, body mass index, performance status, and tumor stage were not statistically different between the SILS and CLS groups. In short-term outcomes, the number of harvested lymph nodes was not statistically different. SILS required less operating time (p < 0.001) and resulted in a reduced bleeding volume (p < 0.001). There was no statistical difference in the frequency of overall complications (p = 0.06). The disease-free survival of stage II and III patients was not statistically different between the 2 groups. Conclusions: With the proper adaptation of SILS by an experienced surgeon, the short- and long-term outcomes of SILS were not inferior to those of CLS. Therefore, SILS could be a treatment option for right-sided colon cancer. [ABSTRACT FROM AUTHOR]

Background: When endoscopically resected specimens of early colorectal cancer (CRC) show high-risk features, surgery should be performed based on current guidelines because of the high-risk of lymph node metastasis (LNM). The aim of this study was to determine the utility of an artificial intelligence (AI) with deep learning (DL) of hematoxylin and eosin (H&E)-stained endoscopic resection specimens without manual-pixel-level annotation for predicting LNM in T1 CRC. In addition, we assessed AI performance for patients with only submucosal (SM) invasion depth of 1000 to 2000 μm known to be difficult to predict LNM in clinical practice.Methods: H&E-stained whole slide images (WSIs) were scanned for endoscopic resection specimens of 400 patients who underwent endoscopic treatment for newly diagnosed T1 CRC with additional surgery. The area under the curve (AUC) of the receiver operating characteristic curve was used to determine the accuracy of AI for predicting LNM with a fivefold cross-validation in the training set and in a held-out test set.Results: We developed an AI model using a two-step attention-based DL approach without clinical features (AUC, 0.764). Incorporating clinical features into the model did not improve its prediction accuracy for LNM. Our model reduced unnecessary additional surgery by 15.1% more than using the current guidelines (67.4% vs. 82.5%). In patients with SM invasion depth of 1000 to 2000 μm, the AI avoided 16.1% of unnecessary additional surgery than using the JSCCR guidelines.Conclusions: Our study is the first to show that AI trained with DL of H&E-stained WSIs has the potential to predict LNM in T1 CRC using only endoscopically resected specimens with conventional histologic risk factors. [ABSTRACT FROM AUTHOR]

Background: Anal metastasis of colorectal adenocarcinoma is very rare, represented by only a handful of case reports in the literature. Previously, reports of metastasis to this region had occurred following a history of anorectal disease, such as anal fistulae. Antecedent trauma to the area from hemorrhoidectomy, fissures, or perineal retractor injury have also been implicated. Case Presentation: Herein we report the case of 69-year-old man without any history of anal disease presenting with a metachronous metastasis of a colorectal-type adenocarcinoma to the anal verge. He was previously treated for T1N0 rectal adenocarcinoma at the rectosigmoid junction with a low anterior resection 5 years prior, then had a T3N0 local recurrence at the colorectal anastomosis treated with neoadjuvant chemoradiation, and eventually a Hartmann's procedure 4 years later. Subsequently, on surveillance flexible sigmoidoscopy, a new tumor was identified on the perianal skin extending from the anal verge. Histopathology demonstrated colorectal-type adenocarcinoma. Flexible endoscopy identified no other residual or recurrent disease in the colon or rectal stump. The patient was treated with wide local excision and advancement flap reconstruction. Conclusion: Isolated metastasis to the anus is an extremely rare occurrence for colorectal adenocarcinoma. There exists little evidence to inform management. One option is to treat like a locally recurrent rectal cancer with aggressive tri-modality management consisting of chemoradiation, abdominal perineal resection, and adjuvant chemotherapy. In the absence of metastatic disease, local resection and close surveillance remain an option. As always, patient factors should guide management. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the characteristics and prognosis of de novo CRC patients who underwent liver or kidney transplantation. Methods: We retrospectively reviewed the medical records of 66 de novo CRC patients selected from 8,734 liver transplant (LT) or kidney transplant (KT) recipients. We analyzed characteristics and survival outcomes of de novo CRC patients and sporadic CRC patients who underwent radical surgery with stage I-III in Asan Medical Center between 2005 and 2016. Survival outcomes were analyzed via the 1:4 matching method. Results: The standard incidence ratio (SIR) of de novo CRC in KT recipients is 1.67 in men and 2.54 in women. That in LT recipients is 3.10 in men and 2.25 in women. Compared with sporadic CRC patients, de novo CRC patients had more colon cancer than rectal cancer (p=0.041). In 9 patients (13.6%), CRC was diagnosed within one year after transplantation, 21 patients (31.8%) were diagnosed between 1–5 years, and the remaining 36 patients (54.6%) were diagnosed thereafter. There were no significant differences in recurrence-free survival and overall survival between the two groups (p=0.211 and p=0.324, respectively). Conclusions: The risk of developing de novo CRC in transplant recipients was higher than in the general population. The survival outcome of de novo CRC was no different compared with the sporadic CRC. Therefore, regular surveillance is essential for timely diagnosis and treatment for transplantation patients. A large prospective study for an intense CRC surveillance program in transplantation patients is needed. [ABSTRACT FROM AUTHOR]

Purpose: To compare single-incision laparoscopic surgery (SILS) and multiport laparoscopic surgery (MLS) for colorectal cancer in terms of short- and long-term outcomes. Methods: A systematic literature search was performed in PubMed, Web of Science, and Embase. Randomized controlled trials (RCTs) and propensity-score matched (PSM) studies comparing SILS and MLS for colorectal cancer were enrolled. Outcomes of interests included intraoperative, postoperative, pathological, and survival outcomes. Results: Sixteen studies (6 RCTs and 10 PSM studies) published between 2012 and 2020 with a total of 2425 patients were enrolled. Compared with MLS, SILS was associated with less postoperative pain at postoperative day (POD) 1 (P = 0.02, MWD = −0.73, 95%CI: −1.37, −0.09) and POD2 (P < 0.001, MWD= −1.10, 95%CI: −1.45, −0.74) and shorter length of total incision length (P < 0.001, MWD = −3.31, 95%CI: −3.95, −2.67). No differences were observed in terms of operative time, blood loss, intraoperative and postoperative complications, incision hernia, and pathological or survival outcomes between SILS and MLS. Subgroup analysis for right-sided colon cancer, sigmoid colon cancer, and rectosigmoid colon cancer showed that the SILS group was only associated with less postoperative pain and shorter total incision length. The surgical and pathological outcomes were comparable between SILS and MLS. Conclusions: SILS is a beneficial alternative to MLS in select colorectal cancer patients, especially for right-sided colon cancer, sigmoid colon cancer, and rectosigmoid cancer, with better cosmetic effects and less postoperative pain. Simultaneously, SILS does not compromise intraoperative and postoperative complications, surgical quality, or long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Closed perineal wounds often fail to heal by primary intention after abdomino-perineal resection (APR) and are often complicated by surgical site infection (SSI) and/or wound dehiscence. Recent evidence showed encouraging results of prophylactic negative-pressure wound therapy (pNPWT) for prevention of wound-related complications in surgery. Our objective was to gather and discuss the early existing literature regarding the use of pNPWT to prevent wound-related complications on perineal wounds after APR. Methods: Medline, Embase, and Web of Science were searched for original publications and congress abstracts reporting the use of pNPWT after APR on closed perineal wounds. Results: Seven publications were included for analysis. Two publications reported significantly lower incidence of SSI in pNPWT patients than in controls with a risk reduction of about 25–30%. Two other publications described similar incidences of SSI between the two groups of patients but described SSI in pNPWT patients to be less severe. One study reported significantly lower incidence of wound dehiscence in pNPWT patients than in controls. Conclusion: The largest non-randomized studies investigating the effect of pNPWT on the prevention of wound-related complications after APR showed encouraging results in terms of reduction of SSI and wound dehiscence that deserve further investigation and confirmation. [ABSTRACT FROM AUTHOR]

Summary: Solid organ recipients have a 2–5 fold increased risk of malignancy compared to the general population. Because of the broader indications for transplantation, it is anticipated that an increasing number of organ graft recipients will present with malignancy. There are limited data about responses and tolerance to chemotherapy in solid organ transplanted patients. Twenty‐three of 46 colorectal cancer (CRC) patients with nonresectable liver metastases who had undergone liver transplantation (LT) in three different studies were included. All patients had received chemotherapy both prior to LT and after LT, at recurrence of metastatic CRC (mCRC). Adverse reactions (grades 3–4) and clinical and radiological outcome were retrospectively registered. Overall survival was determined from start of palliative chemotherapy after LT. No graft rejection was observed. Chemotherapy for mCRC was overall well‐tolerated and there was no increased bone marrow toxicity registered after LT; however, mucositis and diarrhea were more frequent in post‐LT chemotherapy. Median overall survival from start of palliative chemotherapy after LT was 13 months. No graft loss was observed when chemotherapy for mCRC was given to LT recipients who had developed nonresectable metastases. Overall, the chemotherapy for mCRC was well‐tolerated, induced responses, and long‐term survival was obtained in some patients. [ABSTRACT FROM AUTHOR]

Renal transplantation has become the sole most preferred therapy modality for end-stage renal disease patients. The growing tendency for renal transplants, and prolonged survival of renal recipients, have resulted in a certain number of post-transplant colorectal cancer patients. Antitumor pharmacotherapy in these patients is a dilemma. Substantial impediments such as carcinogenesis of immunosuppressive drugs (ISDs), drug interaction between ISDs and anticancer drugs, and toxicity of anticancer drugs exist. However, experience of antitumor pharmacotherapy in these patients is limited, and the potential risks and benefits have not been reviewed systematically. This review evaluates the potential impediments, summarizes current experience, and provides potential antitumor strategies, including adjuvant, palliative, and subsequent regimens. Moreover, special pharmaceutical care, such as ISDs therapeutic drug monitoring, metabolic enzymes genotype, and drug interaction, are also highlighted. [ABSTRACT FROM AUTHOR]

Background: Many studies have clearly reported the advantages of colonoscopy screening in terms of reducing the mortality rate of colorectal cancers in general population. However, the importance of colonoscopy screening in improving the survival rate of kidney transplant recipients is still unclear. So, the aim of this study is to survey the importance and feasibility of colonoscopy screening in kidney transplant recipients. Materials and Methods: This clinical study was conducted from February 2015 to November 2016. All participants received polyethylene glycolelectrolyte solution (PEG-ES) or magnesium hydroxide for bowel preparation. Colonoscopy was done and the location and the size of any lesions were recorded in all participants. Results: Among 247 post-kidney transplant patients who were visited routinely in Labbafi-Nejad Hospital in Tehran, 30 individuals with any signs or symptoms of malignant or non-malignant colorectal diseases and patients who had a colonoscopy during the previous year or had a failed transplant procedure and subsequent return to dialysis were excluded. Finally, 217 kidney transplant recipients were enrolled in this study, of which 121 patients completed the study. Conclusion: The results of this study, for the first time, confirm the safety and efficiency of colonoscopy as a routine gastrointestinal screening method among post-kidney transplant recipients in Iran, and suggest that it can be highly proficient in detecting gastrointestinal lesions and its implementation is without significant adverse effects in such patients. [ABSTRACT FROM AUTHOR]

Background & Aims: De novo malignancies after liver transplantation represent one of the leading causes of death in the long‐term. It remains unclear whether liver transplant recipients have an increased risk of colorectal cancer and whether this negatively impacts on survival, particularly in those patients affected by primary sclerosing cholangitis and ulcerative colitis. Methods: In this national multicentre cohort retrospective study, the incidence of colorectal cancer in 8115 evaluable adult patients undergoing a liver transplantation between 1 January 1990 and 31 December 2010 was compared to the incidence in the general population through standardised incidence ratios. Results: Fifty‐two (0.6%) cases of colorectal cancer were identified at a median of 5.6 years postliver transplantation, predominantly grade 2 (76.9%) and stage T3 (50%) at diagnosis. The incidence rate of colorectal cancer in the whole liver transplant population was similar to the general UK population (SIR: 0.92), but significantly higher (SIR: 7.0) in the group of patients affected by primary sclerosing cholangitis/ulcerative colitis. One‐, five‐ and ten‐year survival rates from colorectal cancer diagnosis were 71%, 48% and 31%, respectively, and the majority of colorectal cancer patients died of cancer‐specific causes. Conclusions: Liver transplantation alone is not associated with an increased risk of colorectal cancer development. The primary sclerosing cholangitis/ulcerative colitis liver transplant population showed a significantly higher risk of colorectal cancer development than the general population, with a high proportion of advanced stage at diagnosis and a reduced patient survival. [ABSTRACT FROM AUTHOR]

Purpose: Colorectal cancer is highly preventable by detecting and removing polyps, which are the precursors. Currently, the most accurate test is colonoscopy, but still misses 22% of polyps due to visualization limitations. In this paper, we preliminary assess the potential of microwave imaging and dielectric properties (e.g., complex permittivity) as a complementary method for detecting polyps and cancer tissue in the colon. The dielectric properties of biological tissues have been used in a wide variety of applications, including safety assessment of wireless technologies and design of medical diagnostic or therapeutic techniques (microwave imaging, hyperthermia, and ablation). The main purpose of this work is to measure the complex permittivity of different types of colon polyps, cancer, and normal mucosa in ex vivo human samples to study if the dielectric properties are appropriate for classification purposes. Methods: The complex permittivity of freshly excised healthy colon tissue, cancer, and histological samples of different types of polyps from 23 patients was characterized using an open‐ended coaxial probe between 0.5 and 20 GHz. The obtained measurements were classified into five tissue groups before applying a data reduction step with a frequency dispersive single‐pole Debye model. The classification was finally compared with pathological analysis of tissue samples, which is the gold standard. Results: The complex permittivity progressively increases as the tissue degenerates from normal to cancer. When comparing to the gold‐standard histological tissue analysis, the sensitivity and specificity of the proposed method is the following: 100% and 95% for cancer diagnosis; 91% and 62% for adenomas with high‐grade dysplasia; 100% and 61% for adenomas with low‐grade dysplasia; and 100% and 74% for hyperplastic polyps, respectively. In addition, complex permittivity measurements were independent of the lesion shape and size, which is also an interesting property comparing to current colonoscopy techniques. Conclusions: The contrast in complex permittivities between normal and abnormal colon tissues presented here for the first time demonstrate the potential of these measurements for tissue classification. It also opens the door to the development of a microwave endoscopic device to complement the outcomes of colonoscopy with functional tissue information. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the short-term outcomes of a right lower transverse incision with a vertical transumbilical incision for laparoscopic specimen extraction in patients with left-sided colorectal cancer. Methods: One hundred eighty-three patients who underwent laparoscopic resection for rectosigmoid colon or upper rectal cancer were included. Propensity score matching was performed to reduce bias caused by differences between the right lower transverse incision (RLT group) and vertical transumbilical incision (VTU group). Results: After matching, 57 patients in the RLT group and 57 patients in the VTU group were found to be equivalent regarding baseline clinicopathological characteristics. Median follow-up time was 31 months. The RLT group showed comparable results to those of the VTU group in terms of perioperative outcomes, postoperative course, and postoperative complications. However, the proportion of patients requiring an additional incision for diverting stoma was significantly lower in the RLT group (p = 0.003). Conclusions: A right lower transverse incision appears to be as effective as a vertical transumbilical incision regarding short-term outcomes after laparoscopic surgery for left-sided colorectal cancer and may be a preferred extraction site because of its lowered risk of additional mini-laparotomy for diverting stoma. [ABSTRACT FROM AUTHOR]

Laparoscopic surgery for colorectal cancer (CRC) has recently gained in popularity due to the fewer trocars and shorter incision, leading to reduced wound pain and improved cosmetic outcome. In July, 2013, reduced-port surgery (RPS) was introduced and has been performed thereafter in our hospital. An umbilical incision is used for a main port in RPS, through which the specimen is removed and the anastomosis is performed. In order to make the incision shorter, we introduced the Z skin incision in RPS. In this study, we aimed to discuss this method and evaluate the short-term outcome. Among CRC patients undergoing RPS, Z skin incision (n=14) was compared to conventional skin incision (n=15). The clinical and surgical factors were evaluated and there were no significant differences in terms of gender, age, body mass index, tumor site, procedure, operative time, blood loss or complications between the two groups. The median incision length at the umbilicus was significantly shorter in the Z incision group (P=0.004). Particularly in functional end-to-end anastomosis, the median incision length was 2.5 cm in the Z skin incision group and 4.0 cm in the conventional incision group (P=0.018). In conclusion, Z skin incision is a useful technique for achieving an effective length of skin incision in RPS for CRC [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether patients with end-stage kidney disease ( ESKD) on hemodialysis ( HD) undergoing kidney transplant evaluation are at higher risk for colonic neoplasia than the general population. This is a retrospective cohort study of patients with ESKD who underwent a first screening colonoscopy while undergoing kidney transplant evaluation. Data were collected on the prevalence of adenomatous polyps and advanced adenomas in 70 patients with ESKD and 70 controls, undergoing their first screening colonoscopy, matched for age, gender, and endoscopist. At the time of the colonoscopy, an average time on HD was 3.2 ± 2.9 yr. The prevalence of adenomatous polyps was significantly higher in ESKD on HD (54.3% vs. 32.9%, p = 0.008) than in controls. In a multivariate analysis controlling for other factors, ESKD on HD remained a risk factor for the presence of adenomas ( OR 3.06, 95% CI 1.21, 7.73). No colonoscopy-related complications were reported in the patients with ESKD on HD. We demonstrate a significantly higher prevalence of adenomatous polyps in patients with ESKD undergoing a first screening colonoscopy as part of kidney transplant evaluation. In addition, colonoscopy can be safely performed in this population. [ABSTRACT FROM AUTHOR]

Background: The reported incidence of postoperative delirium (POD) in elderly patients ranges from 6 to 53 %. Several preoperative and operative factors have been reported as risk factors of POD. Aim: The aim of this study was to determine the incidence of and risk factors for POD in patients with colorectal cancer who had undergone laparoscopic colorectal resection. Methods: A total of 311 consecutive patients aged 75 years and older who underwent laparoscopic surgery for colorectal cancer at our department from January 2008 to December 2013 were classified as delirious group ( n = 44) and nondelirious group ( n = 267). Short-term outcomes and risk factors for POD were analyzed. Results: POD was diagnosed in 14.1 % of elderly patients with colorectal cancer. Univariate analysis showed that older age, high American Society of Anesthesiology (ASA) score, performance status >2, low prognostic nutrition index (PNI), past history of delirium or dementia, operative approach, Organ/Space SSI, and cardiac or pulmonary disease were significantly associated with POD. Multivariate logistic regression analysis identified older age, past history of delirium or dementia, operative approach, and Organ/Space SSI as four independent risk factors for POD. Conclusions: Our results suggest that the risk of POD is associated with older age, past history of delirium or dementia, operative approach, Organ/Space SSI. [ABSTRACT FROM AUTHOR]

Background: Single-incision laparoscopic surgery (SILS) is an emerging minimally invasive surgery to reduce abdominal incisions. However, despite the increasing clinical application of SILS, no evidence from large-scale, randomized controlled trials is available for assessing the feasibility, short-term safety, oncological safety, and potential benefits of SILS compared with conventional laparoscopic surgery (CLS) for colorectal cancer.Methods/design: This is a single-center, open-label, noninferiority, randomized controlled trial. A total of 198 eligible patients will be randomly assigned to transumbilical single incision plus one port laparoscopic surgery (SILS plus one) group or to a CLS group at a 1:1 ratio. Patients ranging in age from 18 to 80 years with rectosigmoid cancer diagnosed as cT1-4aN0-2 M0 and a tumor size no larger than 5 cm are considered eligible. The primary endpoint is early morbidity, as evaluated by an independent investigator. Secondary outcomes include operative outcomes (operative time, estimated blood loss, and incision length), pathologic outcomes (tumor size, length of proximal and distal resection margins, and number of harvested lymph nodes), postoperative inflammatory and immune responses (white blood cells [WBC], neutrophil percentage [NE %], C-reactive protein [CRP], interleukin-6 [IL-6], and tumor necrosis factor-α [TNF-α]), postoperative recovery (time to first ambulation, flatus, liquid diet, soft diet, and duration of hospital stay), pain intensity, body image and cosmetic assessment, 3-year disease free survival (DFS), and 5-year overall survival (OS). Follow-up visits are scheduled for 1 and 3 months after surgery, then every 3 months for the first 2 years and every 6 months for the next 3 years.Discussion: This trial will provide valuable clinical evidence for the objective assessment of the feasibility, safety, and potential benefits of SILS plus one compared with CLS for the radical resection of rectosigmoid cancer. The hypothesis is that SILS plus one is feasible for the radical resection of rectosigmoid cancer and offers short-term safety and long-term oncological safety comparable to that of CLS, and that SILS plus one offers better cosmetic results and faster convalescence compared to CLS.Trial Registration: ClinicalTrials.gov: NCT02117557 (registered on 16 April 2014). [ABSTRACT FROM AUTHOR]

Aim The aim of this retrospective study was to compare the short-term surgical results of single-port surgery ( SPS) with those of multiport surgery ( MPS) for colorectal cancer. Method We studied 673 consecutive patients who underwent SPS or MPS for colorectal cancer in our department from January 2008 to December 2013. The operative parameters and oncological outcome were analysed and compared between the SPS and the MPS groups retrospectively. Results The SPS and MPS groups did not differ significantly in terms of preoperative evaluation. The median operative time was significantly shorter with SPS than with MPS (176 min vs 193 min; P < 0.001). The two groups did not differ significantly in terms of postoperative complications. Length of hospital stay was significantly shorter with SPS than with MPS (8 days vs 10 days; P < 0.001). Oncological resection was similar in the two groups. The disease-free survival rates at 2 years according to the TNM stage did not differ significantly between the two groups (Stage I, 98.5% vs 94.7%; Stage II, 93.4% vs 90.7%; and Stage III, 70.8% vs 68.4%). Conclusion Our experience demonstrates that SPS is safe and can provide oncological outcomes equal to those of MPS in patients with colorectal cancer. [ABSTRACT FROM AUTHOR]

Background: With the increasing burden of organ transplant recipients and improvements in allograft outcome, the incidence of neoplasms rising from these patients is an important issue. Objective: In this study, we investigated transplant recipients with colorectal cancer to determine its incidence, clinicopathological characteristics, and prognosis. Methods: The database of Severance Hospital was queried for all cases of colorectal adenocarcinoma among transplant recipients from August 2005 to January 2013. Results: A total of 29 patients were diagnosed with colorectal adenocarcinoma after transplantation, and the median age at diagnosis was 58.6 years. As for primary tumor stage, 17 (58.6%) patients had stage ≥3, and distant metastasis was found in 10 (34.4%) patients. The mean time from transplantation to tumor detection was 13.7 years. The median disease-free survival was 11.0 months and the median overall survival (OS) was 18.1 months. In multivariate analysis of prognostic factors for OS, surgical resection was a positive prognostic factor (HR 1.357, p = 0.010) and the presence of distant metastasis at diagnosis was a negative prognostic factor (HR 1.047, p = 0.006). Conclusion: The behavior of colorectal cancer in posttransplant patients is more aggressive and refractory to treatment. A separate guideline for the colorectal screening program for the posttransplant patients needs to be established. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A 76-year-old male underwent endoscopic mucosal resection for a stage T1 tumour of the sigmoid colon. We performed laparoscopic sigmoidectomy through 5 ports using needlescopic instruments. The resected specimen was extracted from the abdominal cavity transanally. After attaching an anvil to the sigmoidal stump, the rectal stump was reclosed using an endoscopic linear stapler, and then, colorectal anastomosis was conducted using the double stapling technique. Performing transanal specimen extraction using needlescopic forceps improves aesthetic outcomes and reduces post-operative pain and the risk of abdominal incisional hernias. This method is an easy to introduce a form of reduced-port surgery because of its feasibility and conventional port arrangement. Hence, we consider that it is an option for minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Colorectal cancer screening is widely promulgated in many parts of the world and population screening is occurring in many countries, especially in western Europe. Although, intuitively, it might be thought that the pathology resulting from screening should be straightforward, being mainly that of polyp diagnosis and the biopsy diagnosis and staging of established adenocarcinoma, in fact experience has shown that there are several areas of considerable difficulty and controversy. In the UK somewhat different programmes, all based on faecal occult blood (FOB) screening, have been developed and each has generated similar pathological conundra. These include the biopsy diagnosis of adenocarcinoma, colorectal serrated pathology, the diagnosis and management of polyp cancers and last, but certainly not least, the phenomenon of the large sigmoid colonic adenomatous polyp with epithelial misplacement/pseudo-invasion. Polyp cancers provide especially difficult management conundra and discussion of that management within a multidisciplinary team-based management meeting is regarded as essential in the UK. Large adenomatous polyps of the sigmoid colon with epithelial misplacement are selected into FOB-based screening programmes and have provided extraordinary diagnostic challenges. Finally, the quality assurance procedures introduced for screening can ensure a considerable overall improvement in the quality of lower gastrointestinal tract pathological reporting. [ABSTRACT FROM AUTHOR]