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Background: There is mounting evidence that microscopically positive (R1) margins in patients with colorectal cancer (CRC) may represent a surrogate for aggressive cancer biology rather than technical failure during surgery. However, whether detectable biological differences exist between CRC with R0 and R1 margins is unknown. We sought to investigate whether mismatch repair (MMR) status differs between Stage III CRC with R0 or R1 margins. Methods: Patients treated for Stage III CRC from January 1, 2016 to December 31, 2019 were identified by using the Danish Colorectal Cancer Group database. Patients were stratified according to MMR status (proficient [pMMR] vs. deficient [dMMR]) and margin status. Outcomes of interest included the R1 rate according to MMR and overall survival. Results: A total of 3636 patients were included, of whom 473 (13.0%) had dMMR colorectal cancers. Patients with dMMR cancers were more likely to be elderly, female, and have right-sided cancers. R1 margins were significantly more common in patients with dMMR cancers (20.5% vs. 15.2%, p < 0.001), with the greatest difference seen in the rate of R1 margins related to the primary tumour (8.9% vs. 4.7%) rather than to lymph node metastases (11.6% vs. 10.5%). This association was seen in both right- and left-sided cancers. On multivariable analyses, R1 margins, but not MMR status, were associated with poorer survival, alongside age, pN stage, perineural invasion, and extramural venous invasion. Conclusions: In patients with Stage III CRC, dMMR status is associated with increased risks of R1 margins following potentially curative surgery, supporting the use of neoadjuvant immunotherapy in this patient group. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

(1) Background: In our study, we aimed to determine the accuracy rates of imaging methods for sigmoid, rectosigmoid colon, and rectum cancer. (2) Methods: Patients with tumors located in the rectosigmoid colon, sigmoid colon, and rectum who were operated on were included. Upon admission, we examined the patients' first diagnostic colonoscopies and their preoperative repeat control colonoscopies and computed tomography (CT) report. (3) Results: In this study, 23 patients (57.5%) were male. The overall accuracy rates were 80.0% (32/40) in colonoscopy, 65.0% (26/40) in preoperative CT, and 87.5% (35/40) in retro CT, and the differences among the examination methods were statistically significant (p = 0.049). The sensitivity levels decreased to 50.0% for colonoscopy and preoperative CT and 75.0% for retro CT in rectosigmoid colon tumors. In rectal tumors, the sensitivity levels were 75.0% in colonoscopy, 60.0% in preoperative CT, and 80.0% in retro CT. In two patients, the tumor location was given incorrectly, and postoperative pathological evaluations indicated T3N0 tumors; the initially planned treatment was thus changed to include radiotherapy in addition to chemotherapy in the postoperative period because the tumor was located in the middle rectum. (4) Conclusions: Accuracy in tumor localization in sigmoid, rectosigmoid, and rectum tumors still needs to be improved, which could be accomplished with prospective studies. CT evaluations for cancer localization in this patient group should be re-evaluated by a radiologist. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic and its associated restrictions have resulted in delayed diagnoses across various tumor entities, including rectal cancer. Our hypothesis was based on the expectation of a reduced number of primary operations due to higher tumor stages compared to the control group. Methods: In a single-center retrospective study conducted from 1 March 2018 to 1 March 2022, we analyzed 120 patients with an initial diagnosis of rectal cancer. Among them, 65 patients were part of the control group (pre-COVID-19), while 55 patients were included in the study group (during the COVID-19 pandemic). We compared tumor stages, treatment methods, and complications, presenting data as absolute numbers or mean values. Results: Fewer primary tumor resections during the COVID-19 pandemic (p = 0.010), as well as a significantly lower overall number of tumor resections (p = 0.025) were seen compared to the control group. Twenty percent of patients in the COVID-19 group received their diagnosis during lockdown periods. These patients presented significantly higher tumor stages (T4b: 27.3% vs. 6.2%, p = 0.025) compared to the control group prior to the pandemic. In addition, more patients with angiolymphatic invasion (ALI) were identified in the COVID-19 group following neoadjuvant treatment compared to the control group (p = 0.027). No differences were noted between the groups regarding complications, stoma placement, or conversion rates. Conclusions: The COVID-19 pandemic, particularly during lockdown, appears to have contributed to delayed diagnoses, resulting in higher tumor stages and a decreased number of surgeries. The quality of rectal cancer treatment can be maintained under pandemic conditions. [ABSTRACT FROM AUTHOR]

Background: Locally advanced rectal cancer often requires neoadjuvant treatment (NAT) before surgical intervention. This study aimed to assess the concordance between preoperative magnetic resonance imaging (MRI) findings and postoperative pathology results after NAT in rectal cancer patients. Method: A retrospective analysis of 52 patients who underwent NAT and subsequent surgery at Ankara Bilkent City Hospital between May 2019 and May 2023 was conducted. Demographics, preoperative MRIs, time intervals between NAT, MRI, and surgery, and postoperative pathology were assessed. Results: The median age of the cohort was 59 years, with a male predominance (76.9%). Tumour T stage (κ = 0.157), lymph node stage (κ = 0.138), and circumferential resection margin (κ = 0.138) concordance showed poor agreement between post‐neoadjuvant treatment (PNT) MRI and pathology. PNT MRI demonstrated a limited correlation with postoperative pathology. Conclusions: While preoperative MRI is commonly used for restaging after NAT in rectal cancer, our study highlights its limited concordance with postoperative pathology. The sensitivity and specificity metrics, although reported in the literature, should be interpreted alongside concordance assessments for a comprehensive evaluation. [ABSTRACT FROM AUTHOR]

The increased risk of colorectal cancer following ionizing radiation exposure was demonstrated in a number of epidemiological studies. Earlier, no impact of occupational radiation exposure on colorectal cancer incidence or mortality was observed in a cohort of workers of the nuclear industrial facility, Mayak Production Association (PA). Extension of the follow-up of the cohort and improvement of dose estimates for personnel made it possible to update the earlier findings. The study objective is to assess the risk of colorectal cancer incidence associated with chronic occupational radiation exposure taking into account non-radiation factor effects. The study cohort included 22,377 workers employed at the reactor, plutonium-producing and radiochemical plants of Mayak PA (hiring period 1948–1982; follow-up period ended on December 31, 2018). Using the Poisson regression (EPICURE software), the relative risks (RRs with 95 % confidence intervals, (95 % CI)) of colorectal cancer incidence were estimated depending on the most significant non-radiation factors (sex, age, smoking, alcohol consumption, excessive body mass and obesity, intestinal polyps, chronic colitis). These values were also calculated for certain ranges of occupational exposure doses relying on data provided by ‘The Mayak Worker Dosimetry System – 2013’. The linear model was used to analyze the dose-response relationship. In the study cohort, the RR of colorectal cancer incidence was lower in females than in males: 0.72 (95 % CI: 0.55; 0.96) for colon and 0.48 (95 % CI: 0.34; 0.67) for rectum. The increased RR of the rectum cancer incidence was observed for cases with intestinal polyps: 3.42 (95 % CI: 1.68; 6.19). The colon cancer incidence risk increased with increasing age of workers, but other non-radiation factors were not shown to affect the results. This study supported the earlier results: no association was observed between the risk of colorectal cancer incidence and doses of occupational external gamma-ray or internal alpha-particle exposures.

OBJECTIVE: Male erectile dysfunction is an important complication of rectal surgery. In this research, the effect of prostate dimensions on the development of postoperative erectile dysfunction in patients diagnosed with mid-rectum adenocarcinoma who underwent low anterior resection (LAR) is examined. PATIENTS AND METHODS: Thirty-one male patients diagnosed as mid-rectal adenocancer were included. The International Index of Erectile Function (IIEF) questionnaire was used to determine the patients' pre and postoperative erectile dysfunction levels, and the level of relationship between the change in these IIEF scores and prostate measurements determined by computed tomography were evaluated. RESULTS: There were statistically significant differences between IIEF index score and anterior posterior (AP) and transverse (TR) measurements (p≤0.001; p≤0.001), but no statistically significant difference was found between craniocaudal (CC) measurement values (p=0.169). CONCLUSIONS: The risk of nerve injury will be higher in those with a small prostate transverse diameter. Intraoperative nerve monitoring should be recommended primarily in younger patient groups. [ABSTRACT FROM AUTHOR]

In magnetic resonance- (MR-) based adaptive workflows for an MR-linac, the treatment plan is optimized and recalculated online using the daily MR images. The Unity MR-linac is supplied with a patient positioning device (ppd) using pelvic and abdomen thermoplastic masks attached to a board with high-density components. This study highlights the dosimetric effect of using this in such workflows when there are relative patient-ppd displacements, as these are not visualized on MR imaging and the treatment planning system assumes the patient is fixed relative to the ppd. The online adapted plans of two example rectum cancer patients treated at a Unity MR-linac were perturbed by introducing relative patient-ppd displacements, and the effect was evaluated on plan dosimetry. Forty-eight perturbed clinical adapted plans were recalculated, based on online MR-based synthetic computed tomography, and compared with the original plans, using dose-volume histogram parameters and gamma analysis. The target volume covered by the prescribed dose ( D pre ) and by at least 107% of D pre varied up to − 1.87% and + 3.67%, respectively for 0.5 cm displacements, and to − 3.18% and + 4.96% for 2 cm displacements; whilst 2%–2 mm gamma analysis showed a median value of 92.9%. The use of a patient positioning system with high-density components in a Unity MR-based online adaptive treatment workflow can introduce unrecognized errors in plan dosimetry and it is recommended not to use such a device for such treatments, without modifying the device and the workflow, followed by careful clinical evaluation, or alternatively to use other immobilization methods. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The principal aim of this research is to investigate the variables that exert a discernible impact on the overall survival (OS) of individuals afflicted with colorectal cancer (CRC) harboring pathologic stages 2-3, as delineated within the TNM staging schema tailored to CRC, an established framework governed by the American Joint Committee on Cancer (AJCC). PATIENTS AND METHODS: Patients with preoperative stages 1 and 4, patients with a history of other organ malignancy, patients who could not undergo curative resection, patients with systemic malignant diseases (leukemia, lymphoma, etc.), patients with synchronous tumors, and patients with positive surgical margins were excluded from the study. Notable pathological parameters, including tumor grade, perforation status, lymphovascular invasion, perineural invasion, the presence of mucinous components, and tumor size, were ascertained through pathological examination of resected specimens. RESULTS: Curative resection was performed on 241 patients. The mean age of all patients was calculated to be 65.67±16.04. The average tumor size was measured as 5.03±2.22 cm. The 1-year survival rate of the patients was found to be 84.3%, 3-year survival rate was 69.0%, and 5-year survival rate was 52.9%. According to the COX regression analysis, the categorical variables that were found to be significantly associated with OS were grade (p=0.046), emergency surgery (p<0.001), and tumor localization (p=0.015). CONCLUSIONS: The initial patient and tumor characteristics at baseline have demonstrated substantial predictive capacity regarding patient outcomes following disease recurrence. Survival analyses showed that undergoing emergency surgery, having the tumor located in the rectum, and having a "poor" tumor grade adversely affected survival. [ABSTRACT FROM AUTHOR]

Aims: Cancer is a major public health problem worldwide, the leading cause of death in developed countries. Radiotherapy is an important treatment for many malignancies. The main purpose of this study was to compare the two techniques of supine and prone in prostate and rectal cancers using DVH extraction parameters. Methods and Material: Clinical and dosimetry data of 41 rectal and prostate cancer patients were evaluated in both the supine and prone positions with belly board. Administered dose was daily 180 cGy. The four box fields in the first phase and two lateral fields in the second phase with 18 MV photon fields were used. Each patient underwent CT scan, at both the positions using a contrast agent with a full bladder. Statistical Analysis Used: By using IBM SPSS software v23, all the data were described. The normal distribution of the data was performed using the KS sample statistical test. For data analysis, paired t test was used in the normal data and the Wilcoxon test was used in the non-normal data. Results: In patients with rectal cancer, there is no change in the received minimum dose by organs at risk. A significant decrease in received maximum dose, except for the prostate organ, could be due to the spatial proximity of the two organs to each other. Also, the received average dose in the small intestine was significantly reduced (P = 0.005). But in other organs, the dose reduction was not significant. In patients with prostate cancer, there is no change in the received minimum dose by OARs, except for the bladder organ (P = 0.003). Except the bladder organs (P = 0.011), there is no significant decrease in the received average dose by OARs. The maximum dose of the OARs is significantly reduced, except for the colon where there was not much overlap in the PTV, in addition to receiving the dose in the range. There was no significant relationship between CI in the rectal field and UI in the prostate field (P > 0.05), but there was a significant relationship between CI in the prostate field and UI in the rectal field with change in patient position. Conclusions: In the prone position, in both patients' groups, the OARs receive an optimal and better dose than the supine position, especially the small intestine organ in the rectal field and the bladder and rectum organs in the prostate field. However, it seems that this change in the position of rectal cancer patients is ineffective in reducing the dose of prostate and needs further investigation. [ABSTRACT FROM AUTHOR]

Objective: The association of treatment-related side effects and tumor characteristics with sexual function, depression, and anxiety were investigated in patients with locally advanced rectum cancer (LARC) receiving neoadjuvant chemoradiotherapy (CRT). Material and Methods: Thirty-two patients who received neoadjuvant CRT with LARC were included. The Arizona Sexual Experiences (ASEX) Scale was used to determine the sexual function status whereas the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) were used to evaluate the depression and anxiety status of the patient, respectively. The patients were asked to fill these scales before and at least 4 weeks after the neoadjuvant CRT. T-test and Mann–Whitney U test were used for the comparison of values. Results: Median age was 52.5 years (range: 33–76). Twenty-six patients were male, and 6 patients were female. At presentation, the tumor was located mostly in lower third rectum (72%), and 69% of the patients had T3 tumors. There was a statistically significant deterioration in the sexual functions of the patients (p < 0.001), a statistically significant decrease in their anxiety level after CRT (p: 0.037). Depression level was changed from mild to minimal during this process (p: 0.17). A significant deterioration in the ASEX scale was observed especially in patients with grade 2 and above gastrointestinal side effects (p: 0.01). Conclusion: This prospective study showed that the patient's anxiety and depression levels had decreased during the treatment process probably due to the decrease in the patient's symptoms. However, deterioration of the sexual function status which might be correlated to increased gastrointestinal side effects during CRT has been observed. So, clinical and psychiatric support including therapies for sexual dysfunctions is needed for LARC patients during and after the neoadjuvant CRT. [ABSTRACT FROM AUTHOR]

(1) Background: In our study, we aimed to determine the accuracy rates of imaging methods for sigmoid, rectosigmoid colon, and rectum cancer. (2) Methods: Patients with tumors located in the rectosigmoid colon, sigmoid colon, and rectum who were operated on were included. Upon admission, we examined the patients’ first diagnostic colonoscopies and their preoperative repeat control colonoscopies and computed tomography (CT) report. (3) Results: In this study, 23 patients (57.5%) were male. The overall accuracy rates were 80.0% (32/40) in colonoscopy, 65.0% (26/40) in preoperative CT, and 87.5% (35/40) in retro CT, and the differences among the examination methods were statistically significant (p = 0.049). The sensitivity levels decreased to 50.0% for colonoscopy and preoperative CT and 75.0% for retro CT in rectosigmoid colon tumors. In rectal tumors, the sensitivity levels were 75.0% in colonoscopy, 60.0% in preoperative CT, and 80.0% in retro CT. In two patients, the tumor location was given incorrectly, and postoperative pathological evaluations indicated T3N0 tumors; the initially planned treatment was thus changed to include radiotherapy in addition to chemotherapy in the postoperative period because the tumor was located in the middle rectum. (4) Conclusions: Accuracy in tumor localization in sigmoid, rectosigmoid, and rectum tumors still needs to be improved, which could be accomplished with prospective studies. CT evaluations for cancer localization in this patient group should be re-evaluated by a radiologist.

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective·To evaluate the survival effects of neoadjuvant radiation therapy and adjuvant radiotherapy on the patients with rectal cancer treated with chemotherapy and surgery by using the Surveillance, Epidemiology and End Results (SEER) database of the United States.Methods·The patients with pathologically confirmed rectal cancer and treated with chemotherapy and surgical resection from 2005 to 2015 in the SEER database were included; the patients with autopsy or death-only proof of rectal cancer, or without follow-up time and incomplete clinical data were excluded. All the patients were divided into neoadjuvant radiotherapy combined with surgery group (RT+S group), surgical treatment group (S group) and surgery combined with adjuvant radiotherapy group (S+RT group). The propensity score matching (PSM) was used to match the included subjects in each group at the 1∶1 ratio, and the restricted mean survival time (RMST) was used to estimate the mean survival of rectal cancer patients over 5 and 10 years. Cox proportional risk models were used to determine the effects of neoadjuvant and adjuvant radiotherapies on overall survival (OS) and tumor-specific survival (CSS) in the patients with rectal cancer, and the specific benefit groups of neoadjuvant and adjuvant radiotherapies were determined by stratified analysis of patients.Results·From 2005 to 2015, 8 975 patients with rectal cancer who received chemotherapy and surgery were included, including 1 079 in the S group, 5 991 in the RT+S group, and 1 905 in the S+RT group. After PSM, the clinical base characteristics of the groups were balanced and comparable. The patients in the RT+S group had a significantly improved prognosis in 5 and 10 years compared with the S group (all P=0.000) after PSM, while the patients in the S+RT group had a significantly improved prognosis in 5 years only (both P0.05). Multivariate Cox regression analysis showed that neoadjuvant radiotherapy was an independent protective factor for the patients′ OS and CSS (both P=0.000), while adjuvant radiotherapy was not (both P>0.05). Subgroup analysis showed that neoadjuvant radiotherapy had no significant protective effect on OS and CSS in the patients aged0.05); whereas adjuvant radiotherapy had significant protective effects on OS and CSS in the patients with poorly differentiated/undifferentiated tumors, tumor size>50 mm or TNM stage Ⅳ (all P50 mm, or TNM stage Ⅳ may benefit from adjuvant radiotherapy.

Aim: to study changes in the activities of purine nucleotide degradation enzymes – adenosine deaminase (ADA) and xanthine oxidase (XO) in patients with rectum cancer (RC).Material and Methods. The activity of purine nucleotide degradation enzymes was studied in blood plasma and tissue homogenates: tumor tissue and normal rectal mucosa in 70 patients with stage I–IV RC. The histological type of RC was adenocarcinoma. The levels of ADA and XO activities were measured using spectrophotometry.Results. The activity of ADA and XO in blood serum of RC patients was significantly higher than that of healthy people. A significant increase in the activity of ADA and XO in tumor tissue compared to normal tissue was also found. The relationship between the activities of the enzymes of purine catabolism in blood plasma and tissues were revealed. An increase in purine catabolism depending on the stage of RC was found.Conclusion. The increased ADA and XO activities indicated the enhanced purine catabolism not only in malignant transformation, but also in tumor progression.

Background The surgery with total mesorectal excision recommended by R. J. Heald in 1982 is the gold standard. Rectal cancer (RC) surgery has a morbidity rate ranging from 6 to 35%, and it can cause functional issues such as sexual, urinary, and bowel dysfunction in the long term. Neoadjuvant chemoradiotherapy (CRT) has been gaining ground in patients with lesions in the middle and lower rectum. The aim of the present study is to present the experience of a reference service in the treatment of RC. Patients and Methods A retrospective study involving 53 patients diagnosed with RC between January 2017 and December 2019 with follow-up until December 2020. We examined tumor location, disease stage, digital rectal exam findings, carcinoembryonic antigen (CEA), therapeutic modality offered, and follow-up time. Results A total of 32% of the patients were men and 68% were women, with a mean age of 60 years old. Location: upper rectum in 6 cases, middle rectum in 21 cases, and lower rectum in 26 cases with evolution from 9.8 to 13.5 months. The most frequent complaints were hematochezia and constipation. A total of 36 patients underwent neoadjuvant therapy: 11 complete clinical response (CCR) (30.5%), 20 (55.5%) partial clinical response (PCR), and no response in 5 patients (14%). The follow-up ranged from 12 to 48 months, with a mean of 30.5 months. A total of 25% of the patients had RC that went beyond the mesorectal fascia, and 22.64% had metastases in other parts of the body when they were diagnosed. Conclusion Neoadjuvant radio and chemotherapy present themselves as an alternative in the treatment of rectal cancer. In 36 patients, 30.5% had a complete clinical response, 55.5% had a partial clinical response, and 14% had no response. It was worth doing the “Watch and Wait” (W&W) to sample. A definitive colostomy was avoided. However, it is necessary to expand the study to a larger follow-up and more patients. Additionally, it is necessary to implement a multicenter study.

Background: This study aims to assess the effect of primary tumour resection (PTR) on patients with metastatic colorectal cancer (mCRC) treated with cetuximab. Methods: This retrospective cohort study was conducted in a tertiary cancer center in Turkey. Patients with mCRC between January 2009 and December 2020 were extracted from the electronic hospital management system. Patients with RAS wild‐type synchronous metastatic left‐sided colon or rectum cancer who had cetuximab‐containing treatment protocol were included in the study. The primary outcomes were overall survival (OS) and progression‐free survival (PFS). The secondary outcome was response rates. Results: A total of 111 patients with mCRC were included in this study. PTR was performed in 57.7% of all patients. Fifty‐nine (53.2%) and 52 (46.8%) patients had rectal and left colon tumours, respectively. The combination treatment with cetuximab was FOLFIRI in 62.2% and FOLFOX in 29.7% of all patients. In subgroup analysis, the median PFS was 7.9 and 9 months in PTR (+) and PTR (−) patients, respectively. The difference between the groups was not statistically significant (P = 0.3). The median OS was 33 months in all patients. In subgroup analysis, the median OS was 39 and 27.9 months in PTR (+) and PTR (−) patients, respectively. The difference between the groups was statistically significant (P = 0.002). After adjusting for confounding factors, PTR and ECOG performance score were the independent prognostic factors for OS. Conclusion: PTR improved the OS in patients with RAS wild‐type synchronous left‐sided colon or rectum cancer treated with cetuximab‐containing chemotherapy regimens. [ABSTRACT FROM AUTHOR]

Objective·To evaluate the survival effects of neoadjuvant radiation therapy and adjuvant radiotherapy on the patients with rectal cancer treated with chemotherapy and surgery by using the Surveillance, Epidemiology and End Results (SEER) database of the United States. Methods·The patients with pathologically confirmed rectal cancer and treated with chemotherapy and surgical resection from 2005 to 2015 in the SEER database were included; the patients with autopsy or death-only proof of rectal cancer, or without follow-up time and incomplete clinical data were excluded. All the patients were divided into neoadjuvant radiotherapy combined with surgery group (RT+S group), surgical treatment group (S group) and surgery combined with adjuvant radiotherapy group (S+RT group). The propensity score matching (PSM) was used to match the included subjects in each group at the 1∶1 ratio, and the restricted mean survival time (RMST) was used to estimate the mean survival of rectal cancer patients over 5 and 10 years. Cox proportional risk models were used to determine the effects of neoadjuvant and adjuvant radiotherapies on overall survival (OS) and tumor-specific survival (CSS) in the patients with rectal cancer, and the specific benefit groups of neoadjuvant and adjuvant radiotherapies were determined by stratified analysis of patients. Results·From 2005 to 2015, 8 975 patients with rectal cancer who received chemotherapy and surgery were included, including 1 079 in the S group, 5 991 in the RT+ S group, and 1 905 in the S+RT group. After PSM, the clinical base characteristics of the groups were balanced and comparable. The patients in the RT+S group had a significantly improved prognosis in 5 and 10 years compared with the S group (all P=0.000) after PSM, while the patients in the S+RT group had a significantly improved prognosis in 5 years only (both P<0.05) and no significant improvement in 10 years (both P>0.05). Multivariate Cox regression analysis showed that neoadjuvant radiotherapy was an independent protective factor for the patients′ OS and CSS (both P=0.000), while adjuvant radiotherapy was not (both P>0.05). Subgroup analysis showed that neoadjuvant radiotherapy had no significant protective effect on OS and CSS in the patients aged<50 years, with highly differentiated tumors, tumor size≤30 mm or TNM stage Ⅰ‒ Ⅲ (all P>0.05); whereas adjuvant radiotherapy had significant protective effects on OS and CSS in the patients with poorly differentiated/undifferentiated tumors, tumor size>50 mm or TNM stage Ⅳ (all P<0.05). Conclusion·For the patients with rectal cancer treated with chemotherapy and surgery, neoadjuvant radiotherapy has a significant survival benefit, but it may not be applicable for the patients aged<50 years, with highly differentiated tumors, tumor size≤30 mm, or TNM stage Ⅰ‒ Ⅲ; whereas the patients with poorly differentiated/undifferentiated tumors, tumor size>50 mm, or TNM stage Ⅳ may benefit from adjuvant radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is the third leading cause of death in the world, accounting for 16% of all new cancer diagnoses. Patients with cancer should be closely monitored before making treatment decisions. Diagnosis of metastatic disease is especially important because it has a significant impact on the therapeutic approach. Magnetic resonance imaging (MRI) is considered a superior method for preoperative evaluation in colorectal cancer.Objectives: This study was performed to evaluate MRI findings in patients with rectosigmoid cancer in Golestan province, north of Iran in 2019 and 2020.Methods: This is a retrospective cross-sectional study that was performed on 43 patients with rectal cancer in Gorgan. Patients with other cancers, metastatic cancer, and a history of surgery were excluded. Demographic data (age, gender, and ethnicity) was obtained from patients 'electronic records and patients' MRI information was obtain through the picture archiving and communication system (PACS) of Gorgan MRI centers.Results: Among 43 patients with rectosigmoid cancer, 65.1% of them were male and the mean age was 58.58±14.73 years. The average mass length was 48.44 mm and the distance from Anal Verge was 69.81 mm. The most common morphology of patients' rectosigmoid mass in imaging was related to Semi Circumferncial (51.2%) and Circumferncial (32.6%). T1/T2, N2a, and M0 with the percentages of 41.9%, 39.5%, and 90.7%, respectively, had the highest frequency in patients. TNM Staging was not significantly related to gender or ethnicity. Peritoneal reflection was also more common in Sistani and Turkmen ethnic groups.Conclusion: The results of this study showed that high-resolution MRI under the imaging protocol for obtaining quality images can help to accurately regional staging necessary for optimal treatment.

Background: Rectal cancer patients require a multidisciplinary approach. In the case of locally advanced rectal cancer standard treatment includes neoadjuvant radiotherapy or chemoradiotherapy. Neoadjuvant treatment could cause postoperative complications, but there is no clear evidence of an association between anastomotic leakage and the preoperative treatment of rectal cancer. This study aimed to investigate the frequency of anastomotic leakage followed by the need for reoperation and to find predictive factors for reoperation in rectal cancer patients after neoadjuvant therapy. Patients and methods: One hundred and ten consecutive patients (median age: 65 years) with locally advanced operable rectal cancer, Clinical Stages II and III, were treated with neoadjuvant radiotherapy or chemoradiotherapy (72% were treated with short radiotherapy only, 3% with short radiotherapy and subsequent chemotherapy, 25% with long radiotherapy plus concomitant chemotherapy) and then anterior rectal resection with total mesorectal excision in the Regional Oncological Centre between January 2014 and December 2016. Results: The reoperation for anastomotic leakage was done in 17% of patients, 8 days (median) after primary surgery. In multivariate analysis reoperation for anastomotic leakage was significantly frequent in older patients (p = 0.03) and upper tumours (p = 0.04). Conclusions: Almost one-fifth of rectum cancer patients after preoperative radio- or chemoradiotherapy in the present study series required reoperation due to anastomotic leakage. The study findings are limited by its small sample size and retrospective character. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of our study is to compare the results of robotic surgery-assisted Low Anterior Resection (LAR) and Natural Orifice Specimen Extraction (NOSE) for Rectal Cancer (RC). PATIENTS AND METHODS: From November 2015 to June 2021, patients receiving robotic NOSES and robotic surgery assisted resection (RSAR) were retrospectively enrolled in the study. All robotic-assisted LAR of the rectum, NOSE, colorectal anastomosis and loop ileostomies were performed using the Da Vinci Xi system. RESULTS: A total of 57 patients with robotic NOSES and 93 with robotic RC resection were enrolled. Total mesorectal excision of the rectum, trans-anal or transvaginal specimen extraction (TVSE), anastomoses and protective ileostomy were conducted in all patients. ASA, BMI, tumor histology, stage, nodal stage, mean operative time, estimated blood loss, tumor size, lymph nodes removal, hospital stay morbidity and mortality were evaluated. No patient required conversion to conventional surgery. NOSE has less morbidity and significantly reduces postoperative pain and hospital stay (5.0 vs. 5.5). The two groups were similar in long-term survival. CONCLUSIONS: According to our literature search, this is the first study to compare RSAR and NOSE for RC using the Da Vinci Xi system. NOSE can be performed safely and successfully on selected patients, providing excellent good results. [ABSTRACT FROM AUTHOR]

Background: Preoperative chemoradiotherapy has long been accepted as a method to improve survival and lifetime quality of rectal cancer patients. However, physiologic effects of these therapies largely depend on the resistance of cells to the radiation, type of chemotherapeutic agents and individual responses. As one of the signaling cascades involved in chemo- or radiation- resistance, the present study focused on several proteins involved in pTEN/Akt/mTOR pathway to explore their prognostic significance. Materials and methods: Samples from advanced stage rectal cancer patients were analyzed to detect expression levels of pTEN/Akt/mTOR pathway related proteins pTEN, mLST8, REDD1, BNIP3, SAG and NOXA, together with p53, by RT-qPCR. Kaplan–Meier analysis was used to assess expression-survival relation and correlations among all proteins and clinicopathological features were statistically analyzed. Results.: Except p53, none of the proteins showed prognostic significance. High p53 expression presented clear impact on overall survival and disease free survival. It was also significantly related to pathologic complete response. p53 showed high correlation to local recurrence as well. On the other hand, strong correlation was observed with PTEN expression and tumor response, but not with survival. High associations were also observed between mLST8/REDD1, PTEN and NOXA, confirming their role in the same cascade. Conclusion: The contentious role of p53 as a prognostic biomarker in colorectal cancer was further affirmed, while PTEN and REDD1 could be suggested as potential candidates. Additionally, NOXA emerges as a conjunctive element for different signaling pathways. [ABSTRACT FROM AUTHOR]

Simple Summary: This prospective phase II–III randomized trial explores the value of modern technology for prudent radiation dose escalation in the curative management of patients with rectal cancer. It includes 40 operable patients with locally advanced operable rectal cancer. This manuscript illustrates the planned interim analysis, which was intended to confirm safety, including the absence of unexpected toxicities and the inability to perform salvage surgery. The treatment approach involves pelvic chemoradiotherapy followed by either an additional external beam radiation boost or three weekly boosts of brachytherapy, which are adapted in real-time to tumor response. This proof-of-principle study shows that careful radiotherapy dose escalation leads to high proportions of sustained complete clinical response in patients with rectal cancer with acceptable toxicity. Ongoing accrual to the phase III component of the trial is in progress. Background: We explored image-guided adaptive endorectal brachytherapy patients electing non-operative management for rectal cancer. We present the first pre-planned interim analysis. Methods: In this open-label phase II–III randomized study, patients with operable cT2-3ab N0 M0 rectal cancer received 45 Gy in 25 fractions of pelvic external beam radiotherapy (EBRT) with 5-FU/Capecitabine. They were randomized 1:1 to receive either an EBRT boost of 9 Gy in 5 fractions (Arm A) or three weekly adaptive brachytherapy (IGAEBT) boosts totaling 30 Gy (Arm B). Patient characteristics and toxicity are presented using descriptive analyses; TME-free survival between arms with the intention to treat the population is explored using the Kaplan–Meier method. Results: A total of 40 patients were in this analysis. Baseline characteristics were balanced; acute toxicities were similar. Complete clinical response (cCR) was 50% (n = 10/20) in Arm A and 90% in Arm B (n = 18/20). Median follow-up was 1.3 years; 2-year TME-free survival was 38.6% (95% CI: 16.5–60.6%) in the EBRT arm and 76.6% (95% CI: 56.1–97.1%) in the IGAEBT arm. Conclusions: Radiation intensification with IGAEBT is feasible. This interim analysis suggests an improvement in TME-free survival when comparing IGAEBT with EBRT, pending confirmation upon completion of this trial. [ABSTRACT FROM AUTHOR]

Introduction: colorectal cancer is the fourth leading cause of cancer-related mortality worldwide. The identi- fication of the metastases of this tumor in the preoperative stage is increasingly frequent due to the imaging studies currently available. We present the case of a patient with an infection caused by Enterobius vermicularis that simulates the presence of liver metastases. Case presentation: a female patient from a rural area showing a one-year abdominal pain evolution associated with lower gastrointestinal tract bleeding and weight loss. Endoscopic imaging and studies displayed a tumor lesion in the sigmoid colon, with biopsies reporting sigmoid colon adenocarcinoma and liver lesions suggesting malignancy. Anterior resection of the rectum and sigmoid was performed with high anastomosis and liver biopsies, which ruled out malignancy and reported the presence of liver infection by E. vermicularis. Discussion: in this case, the hepatic E. vermicularis infection was rare. This infection can simulate the presence of liver metastases; therefore, it should be considered a differential diagnosis of metastatic colorectal cancer. [ABSTRACT FROM AUTHOR]

Appendiceal cancer is rare and is often diagnosed incidentally in patients undergoing appendectomy for acute appendicitis. However, patients with appendiceal cancer are at increased risk of synchronous malignancy. In this case report, we present a 58-year-old man initially diagnosed with acute appendicitis after presenting to the emergency department with abdominal pain. He had an appendectomy and was discharged the following day. Unexpectedly, the postoperative histopathologic examination showed a primary adenocarcinoma in the appendix. A computed tomography scan showed rectal wall thickening and the patient was referred to colonoscopy where an experienced endoscopist found a rectal tumor during the digital rectal examination prior to the colonoscopy. The tumor was initially missed by the newly qualified doctor who examined the patient during his first admittance to hospital. The patient’s two primary cancers were treated with a laparoscopic right hemicolectomy for the appendiceal cancer and a low anterior resection for the rectal cancer. This case supports the importance of a full colorectal workup in patients with appendiceal cancer. It also emphasizes the value of a thorough digital rectal examination and the need for improved focus on teaching and practice of the procedure.

Objective:Colorectal cancer is the most common type of cancer in the gastrointestinal tract. Preoperative staging is important for applying appropriate treatment modalities. The role of endorectal ultrasonography (ERUS), magnetic resonance imaging (MRI) and positron emission-computed tomography (PET-CT) in rectal cancer patients was evaluated.Method:In this study, between October 2010-April 2012, 30 patients who were diagnosed as rectal cancer clinically and histopathologically were evaluated with ERUS, MRI and PET-CT preoperatively and results were compared with histopathologic findings.Results:Between October 2010-April 2012, 30 patients who were diagnosed as rectal cancer with biopsy in Bezmialem University Medical Faculty Hospital General Surgery Department were included in this study [20 male (66.6%), 10 female (33.3%) and their ages are 38-75 years old, 21 of them received neoadjuvant treatment and 9 of them did not received]. All patients were evaluated with MRI, ERUS and PETCT preoperatively. Rectal cancer patients who are primarily operated from rectal adenocarcinoma were included in this study. For T staging, preoperative MRI, ERUS and PET-CT staged 9 (31%), 12 (41%) and 12 (40%) of 30 patients accurately, respectively. For N staging, preoperative MRI, ERUS and PET-CT staged 15 (51%), 16 (55.1%) and 17 (56.6%) of 30 patients accurately, respectively. In comparison to other modalities, PET-CT did not yield a significant difference in staging and did not change operation strategy. PET-CT detected distant metastasis in 3 patients. One of them was liver and two of them were lung metastasis. Biopsies from mass predicted as lung metastasis did not result as metastasis. PET-CT has high rates of false positivity to detect distant metastasis. In statistical analysis, significant p-values for evaluation could not be obtained.Conclusion:Efficacy of routine use of PET-CT on staging, evaluation of T, N and extramesorectal spread could not be shown.

Objective: Our aim was to compare helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) plans with 3-dimensional conformal radiotherapy (3D-CRT) considering the planning target volume (PTV) and organs at risk (OARs) in rectal cancer patients treated with neoadjuvant radiotherapy. Patients and Methods: Thirty patients, previously treated with intensity modulated radiotherapy (IMRT) or 3D-CRT from January 2014 to February 2020 were selected and 3 plans were generated for each patient using VMAT, HT and 3D-CRT. Dosimetric comparisons were made for each plan regarding PTV and OARs. Integral dose (ID) was calculated and beam on times were analyzed. Results: The homogeneity index (HI) was significantly better in HT plans compared with VMAT and 3D-CRT plans (p<0.001), conformity index (CI) was better in VMAT plans. For small bowel, high doses were higher in 3D-CRT plans (p <0.001). HT produced lower doses for the bladder as compared to VMAT and 3D-CRT (p<0.005). The mean and maximum doses of bilateral femoral heads were higher in 3D-CRT plans. Beam on times were longer and IDs were higher in HT plans (p<0.001). Conclusion: Both VMAT and HT improved target homogeneity and conformity and decreased OAR doses compared to 3D-CRT. Although, VMAT was the best method to decrease ID, HT produced better bladder sparing. [ABSTRACT FROM AUTHOR]

Simple Summary: The high lethality of colorectal cancer (CRC) is anticipated to continue in the following decades. Early-stage CRC is entirely treatable with surgery and adjuvant therapy (chemotherapy/radiotherapy). However, recurrence is common, and cancer drug resistance increases the chances of treatment failure. At the same time, there are many risk factors leading to high prevalence among both genders. Despite significant improvements in treating other cancers, CRC management is not yet at a satisfactory level. In this comprehensive review, we discussed the development of CRC and its associated risk factors, preventive and treatment strategies and proposed some recommendations. Furthermore, besides chemotherapy and targeted therapy, we discussed natural products as therapeutics for CRC. Colorectal cancer (CRC) is the second most deadly cancer. Global incidence and mortality are likely to be increased in the coming decades. Although the deaths associated with CRC are very high in high-income countries, the incidence and fatalities related to CRC are growing in developing countries too. CRC detected early is entirely curable by surgery and subsequent medications. However, the recurrence rate is high, and cancer drug resistance increases the treatment failure rate. Access to early diagnosis and treatment of CRC for survival is somewhat possible in developed countries. However, these facilities are rarely available in developing countries. Highlighting the current status of CRC, its development, risk factors, and management is crucial in creating public awareness. Therefore, in this review, we have comprehensively discussed the current global epidemiology, drug resistance, challenges, risk factors, and preventive and treatment strategies of CRC. Additionally, there is a brief discussion on the CRC development pathways and recommendations for preventing and treating CRC. [ABSTRACT FROM AUTHOR]

Appendiceal cancer is rare and is often diagnosed incidentally in patients undergoing appendectomy for acute appendicitis. However, patients with appendiceal cancer are at increased risk of synchronous malignancy. In this case report, we present a 58-year-old man initially diagnosed with acute appendicitis after presenting to the emergency department with abdominal pain. He had an appendectomy and was discharged the following day. Unexpectedly, the postoperative histopathologic examination showed a primary adenocarcinoma in the appendix. A computed tomography scan showed rectal wall thickening and the patient was referred to colonoscopy where an experienced endoscopist found a rectal tumor during the digital rectal examination prior to the colonoscopy. The tumor was initially missed by the newly qualified doctor who examined the patient during his first admittance to hospital. The patient’s two primary cancers were treated with a laparoscopic right hemicolectomy for the appendiceal cancer and a low anterior resection for the rectal cancer. This case supports the importance of a full colorectal workup in patients with appendiceal cancer. It also emphasizes the value of a thorough digital rectal examination and the need for improved focus on teaching and practice of the procedure.

Aim: We aimed to assess the association between deficient levels of circulating vitamin D, dietary intake of vitamin D, calcium and retinol, and risk of colorectal cancer in an Iranian population. Methods: In this retrospective case‐control study that was conducted between 2012 and 2015, 278 first incident colorectal cancer cases (colon cancer = 103; rectal cancer = 175), and 278 sex and age matched healthy controls (HCs) were recruited. Serum 25(OH)D, dietary vitamin D, and calcium intake were assessed. Logistic regression was used to estimate the odds ratio (OR) between studied factors and colorectal cancer. Estimates of OR were calculated according to both bivariate analyses based on the matching factors and multivariate analyses, with additional adjustment for potential confounders. Results: A strong inverse linear dose‐response association was seen between serum 25(OH)D and colorectal cancer (P for trend =.002). In comparison to serum 25(OH)D more than 40 nmol/L, lower serum concentrations were significantly associated with an increased OR of colorectal cancer. When analyzing anatomical subsites separately, lower circulating 25(OH)D was associated with higher OR for both colon and rectum cancers. Dietary vitamin D and calcium intake were not associated with colorectal cancer. Interaction analysis between serum 25(OH)D and the amount of calcium intake demonstrated that the lowest level of both factors was associated with an increased OR of colorectal cancer. The highest OR of colorectal cancer that was associated with lowest circulating 25(OH)D was stronger at the highest retinol intakes. Conclusion: This study demonstrated an inverse strong association between 25(OH)D concentration and colorectal cancer in an Iranian population. [ABSTRACT FROM AUTHOR]

Aim:Although many factors affecting recurrence, including surgical margin involvement, have been considered in rectum cancer surgery, there is no consensus on the definition of a safe distal surgical margin (DSM).We aimed to investigate the oncological safety of a DSM closer than 10 mm and the factors affecting relapse in mid-distal located rectum tumours.Method:Patients who underwent sphincter-preserving rectal curative resection following neoadjuvant chemoradiotheraphy between February 2006 and June 2019 for mid-distal lying rectum tumours were investigated retrospectively. Patients with radial or distal surgical margin involvement, having a complete pathologic response, or being lost to follow-up were excluded from the study. Patients and tumour characteristics, clinical and pathological disease stages, and recurrence and disease-free survival rates were compared between groups created along a cut-off value of 10 mm in DSM (DSM

INTRODUCTION: Rectal cancers (RC) constitute one third of colorectal cancers. Chemoradiotherapy (CRT) is the standard treatment of locally advanced stage RC. European Organization for Research and Treatment of Cancer Quality of Life Questionnairer (EORTC-QLQ C30) is a quality of life scale and that is highly valid and reliable all over the world. State-Trait Anxiety Inventory (STAI) is an anxiety scoring questionnaire is examined in two forms; STAI1 (statefulness) and STAI2 (continuity). The Beck Depression Inventory measures depression symptoms. The aim of this study was to compare the quality of life, anxiety and depression of patients before and after radiotherapy (RT0) and after radiotherapy (RT1). METHODS: EORTC-QLQ C30, STAI1, STAI2 and Beck depression questionnaires were applied to 32 patients who applied to our clinic with the diagnosis of RC between November 2016-August 2019. RESULTS: Social function score, dyspnea which are compared at RT0 and RT1 times; was not statistically significant p> 0.05, borderline pain score was found to be significant p = 0.067 and the other quality of life scores were statistically significant p 0.05. DISCUSSION AND CONCLUSION: Based on these results, quality of life, anxiety and depression of the patients with RC should be closely controlled during RT.

Aim:Rectum cancer is a subtype of colorectal cancer. Its etiology and etiopathogenesis is similar to colon cancer. However, it is differentiated from colon tumors because of its anatomic location and treatment approach. In the literature, Mean Platelet Volume (MPV) has been shown to correlate with inflammation in gastrointestinal cancer patients. Based on this fact, we aimed to evaluate the MPV value for predicting prognosis of rectum cancer patients who are treated with neoadjuvant chemoradiotherapy.Materials and Methods:We retrospectively collected the data of 80 operated rectum adenocarcinoma patients who were treated neoadjuvant chemoradiotherapy between 2011 and 2018. MPV value was investigated as prognostic factors for disease free survival.Results:Fifty-five patients were male (69%). Median age was 56 (range 22 to 83 years). The most common histopathologic was adenocarcinoma (94%). The ideal cut-off value of pretreatment MPV that predicted disease-free survival was 7.65 in the ROC analysis [AUC:0.74 (0.63-0.85); p

Introduction Colorectal cancer (CRC) is rapidly increasing in developed countries. In Taiwan, the incidence rate of CRC has increased during the past decade, but the 5-year survival has remained at approximately 63%. In this study, we sought to determine the 5-year survival rate of patients diagnosed with colon and rectum cancer and to determine factors affecting survival. Material and methods All patients from the Taiwan Cancer Database of the medical center hospital in North Taiwan between 2007 and 2013 were identified. Survival analysis was performed using Kaplan-Meier curves, and differences between the curves were analyzed using the log-rank test. Cox proportional hazards regression models were used to analyze survival by each variable. Results A total of 869 patients were included: 554 (63.8%) patients had colon cancer and 315 (36.2%) had rectum cancer. The mean survival time was 71.27 ±1.27 months (colon group: 71.90 ±1.58 months; rectum group: 67.88 ±1.95 months). There was no significant difference (p = 0.493) between patients who had colon or rectum cancer. The forward stepwise Cox regression analysis results indicated that perineural invasion, distant metastasis, age, pathological differentiation grade, and obstruction were statistically significant for patients who had CRC, colon cancer or rectum cancer. Conclusions The long-term survival from CRC, colon cancer and rectum cancer remains promising, as 68.66%, 69.11% and 67.90% of patients are alive 5 years after being diagnosed, respectively. Perineural invasion was found to be an important factor related to the survival of patients who have CRC. Thus, early detection of CRC may help improve survival.

Purpose: A significant number of the protective stomas temporarily applied in order to reduce the effects of anastomosis complications after rectal cancer surgery cannot be closed and become permanent. In this study, the causes that can lead to a permanent stoma were investigated.Materials and Methods: Patients who underwent elective surgery with low anterior resection and protective ileostomy due to rectal cancer were included in the study. Patients whose stoma could not be closed within one year were evaluated as permanent stoma.Results: 66 patients were included in the study. The mean closing time for the stomas were found as 5, 6 +2,5 (1-12)months. The stomas of twelve (18.2%) of the patients could not be closed and became permanent. The presence of metastatic disease at the time of diagnosis, the proximity of the anastomosis to the anal entry, coloanal anastomosis, and the final pathology showing stage IIIC were found to be risk factors for permanent stoma.Conclusion: Some of the stomas applied temporarily due to surgical treatment of rectal cancer became permanent. Before the index operation, the patient and their relatives should be informed that in the presence of certain risk factors, these stomas may not be closed and become permanent.

Background/aim: This study aimed to evaluate the regression pattern with the distal intramural spread (DIS) of rectum cancer after preoperative chemoradiation. Materials and methods: Specimens from 56 patients who underwent radical resection after preoperative chemoradiation for rectal cancer were examined. The regression pattern (total, fragmented) of the tumor was recorded. DIS status was evaluated by creating sections 0.2 to 0.3 cm thick. Results: A single macroscopic residual area was detected in all specimens. In 10 patients (17.8 %), pathologically complete responses were identified, and DIS was detected in 33 patients (58.9%). The average DIS distance was 0.56 ± 0.3 cm (range 0.2 – 1.8 cm); the spread was < 1 cm in 87.9% of the patients (29/33). The overall survival rates for 5 and 7 years were 76.8% and 73.2%, respectively. The survival rates between patients with and without DIS were not statistically different (94.6 ± 5.5 vs. 75.1 ± 10.2 months, respectively). In all of the patients, tumor regression pattern was total shrinkage of the tumor. Conclusion: A sufficient distal resection margin for rectal cancer after preoperative chemoradiation is 1 cm in the vast majority of cases. However, DIS may exceed 1 cm in a small proportion of patients. [ABSTRACT FROM AUTHOR]

Purpose: This study was to investigate the effect of mesorectal fat tissue volume (MRV) on the pathological response to neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer. Methods: 88 patients who had been diagnosed with locally advanced rectal cancer between January 2017 and June 2020 were reviewed retrospectively. The total abdominal, subcutaneous, visceral, and mesorectal fatty tissue components were measured semiquantitatively by two radiologists using computed tomography (CT)-based findings. The patients were divided into two groups as those with and without a pathological response to nCRT. The relationship of MRV with the other fat tissue components of the body was also evaluated. Results: We performed a retrospective analysis of 88 patients (mean age 62.7 years [range, 33–90 years]; 31 males and 57 females). A positive response to nCRT was present in 47 patients. There were 59 patients with stage 3 disease. 46 patients demonstrated lymph node involvement. The mean MRV was 69.6 ± 31.0 ml in no-response group and 105.8 ± 47.5 ml in response-positive patients (p < 0.05). MRV showed the highest correlation with visceral fat volume (VFV). There was a negative correlation between the MRV and the N stage. A cut-off value of ≥ 69.4 for MRV predicted the repsonse to nCRT, with 82.9% sensitivity and 58.5% specificity [AUC: 0.757 (0.653–0.842), p < 0.001] in receiver operating characteristic (ROC) curve analysis Conclusions: MRV can be used as a novel parameter in predicting of pathological response to nCRT in locally advanced rectal cancer patients. [ABSTRACT FROM AUTHOR]

Submucosal tumor (SMT)-like colorectal cancer is relatively rare. The patient was a 59-year-old man who underwent colonoscopy after a positive fecal occult blood test. Colonoscopy showed a protruded lesion of 10 mm in the lower rectum. On initial observation, conventional endoscopy showed that the lesion was covered with normal mucosa and its surface was reddish with small dimples. A neuroendocrine tumor was suspected, and a biopsy was performed, but the pathological diagnosis was adenocarcinoma. Re-examination 3 weeks later showed a depression at the surface of the lesion owing to the biopsy. Magnifying NBI showed a vessel pattern of uneven and irregular distribution, and an irregular surface pattern in the depressed area. Magnifying observations with crystal violet staining showed irregular pit patterns. The preoperative diagnosis was submucosal invasive cancer, and operation was performed. The final pathological diagnosis was well-differentiated tubular adenocarcinoma with deep submucosal invasion. The tumor was primarily localized in the submucosal layer and was covered by non-neoplastic mucosa except for the depressed area. The tumor was not exposed on the surface and was proliferating under the mucosa, which resulted in an SMT-like morphology. Our present case indicates that colorectal cancers should be differentially considered when SMT lesions are detected. [ABSTRACT FROM AUTHOR]

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INTRODUCTION: To evaluate the follow-up imaging findings of the postoperative rectal carcinoma (RK) patients. METHODS: A total of 96 consecutive patients with RK were evaluated. Fifty-five of these patients who underwent surgery and had follow-up imaging examinations were evaluated for postoperative changes, complications and follow-up findings. RESULTS: The mean age of 55 patients (34E, 21K) was 58,7 (31-81). The mean follow-up time was 31,1 months (6-72 months). Granulation tissue-fibrotic changes were seen in 41 patients (74.5%). Granulation tissue-fibrotic changes were not changed in 27 patients (65.8%) and decreased in 11 patients (26.8%). There were an increase in postoperative changes in 3 patients (7.3%) which were found tumor recurrence in 2 patients (4.8%) and granulation tissue-fibrotic changes in 1 patient (6%). There were no significant pelvic lesions and postoperative fibrotic changes in 9 patients (16.4%). Fistulas (n: 4, 7,3%), cystic collections (n: 4, 7,3%), Hartman pouch leak, anastomosis leak, ileus, bone invasion and inguinal lymph node metastasis (n: 2, 3.6%, per each) were found in follow-up. DISCUSSION AND CONCLUSION: Most of the pelvic postoperative granulation tissue-fibrotic changes didn't show dimensional difference or decrease in size on follow-up. However, multimodality follow-up imaging methods are useful in diagnosis of tumor recurrence and postoperarive complications.

Abstract Background Rectum cancer is a type of colorectal cancer. Its etiology and etiopathogenesis are similar to other colon diseases. We aimed to evaluate the tumor budding for predicting prognosis of resected rectum cancer patients. Methods We retrospectively collected the data of 75 operated rectum adenocarcinoma patients who were treated neoadjuvant chemoradiotherapy between 2013 and 2018 in Umraniye Research and Training Hospital and Acıbadem University Medical Oncology Outpatient Clinic. Tumor budding was investigated as a prognostic factor for disease-free survival. Results This study included 75 rectum cancer patients and 51 were male (68%). Median age was 56 (range 19 to 77 years). There were 29 (39%) and 46 (61%) patients in tumor budding low-intermediate and high groups respectively. In multivariate analysis, tumor budding was found to be an independent prognostic factor for disease-free survival (p = 0.00). Conclusions According to our study, having high tumor budding suggests a high likelihood of relapse. Therefore, we might need additional follow-up protocol in these patients.

Appendiceal cancer is rare and is often diagnosed incidentally in patients undergoing appendectomy for acute appendicitis. However, patients with appendiceal cancer are at increased risk of synchronous malignancy. In this case report, we present a 58-year-old man initially diagnosed with acute appendicitis after presenting to the emergency department with abdominal pain. He had an appendectomy and was discharged the following day. Unexpectedly, the postoperative histopathologic examination showed a primary adenocarcinoma in the appendix. A computed tomography scan showed rectal wall thickening and the patient was referred to colonoscopy where an experienced endoscopist found a rectal tumor during the digital rectal examination prior to the colonoscopy. The tumor was initially missed by the newly qualified doctor who examined the patient during his first admittance to hospital. The patient’s two primary cancers were treated with a laparoscopic right hemicolectomy for the appendiceal cancer and a low anterior resection for the rectal cancer. This case supports the importance of a full colorectal workup in patients with appendiceal cancer. It also emphasizes the value of a thorough digital rectal examination and the need for improved focus on teaching and practice of the procedure.

Aim: A lot of studies are being carried out to predict recurrence and metastasis in rectal cancer, which is a common type of cancer in general surgery practice. It is thought that MLR (monocyte to lymphocyte ratio), an indice developed by division of monocyte count by lymphocyte count, may be a good marker to reflect the degree of tumor progression and predict prognosis. In our study, we investigated the role of MLR in predicting metastasis in rectal cancer. Materials and Methods: Fifty-seven patients diagnosed with rectal cancer in the Abant Izzet Baysal University general surgery clinic between 2012 and 2016 were retrospectively investigated. Albumin, CRP(C reactive protein), Platelet, Neutrophil, Lymphocyte, Monocyte values were obtained as the inflammatory markers in the blood count test of the patients before neoadjuvant treatment. Results: In this study, 25 patients who underwent neoadjuvant chemoradiotherapy and underwent full postoperative follow-up were evaluated. Eight of these 25 patients had metastasis until June 2019. There was a significant difference in monocyte and MLR values between groups with and without metastasis. Conclusion: This study is presented as a preliminary study. In our study, we showed that MLR value which measured before neoadjuvant therapy in rectum cancer patients may be useful in predicting metastasis development. [ABSTRACT FROM AUTHOR]

• This randomized trial explores induction oxaliplatin-based chemotherapy for rectal cancer. • It prospectively confirms improved compliance of oxaliplatin-based induction chemotherapy. • Outcomes appear highly favorable despite limited patient radiation exposure. Randomized studies have shown low compliance to adjuvant chemotherapy in rectal cancer patients receiving preoperative chemotherapy and external beam radiation (CT/EBRT) with total mesorectal excision. We hypothesize that giving neoadjuvant CT before local treatment would improve CT compliance. Between 2010–2017, 180 patients were randomized (2:1) to either Arm A (AA) with FOLFOX x6 cycles prior to high dose rate brachytherapy (HDRBT) and surgery plus adjuvant FOLFOX x6 cycles, or Arm B (AB), with neoadjuvant HDRBT with surgery and adjuvant FOLFOX x12 cycles. The primary endpoint was CT compliance to ≥85% of full-dose CT for the first six cycles. Secondary endpoints were ypT0N0, five-year disease free survival (DFS), local control and overall survival (OS). Patients were randomized to either AA (n = 120, median age (MA) 62 years) or AB (n = 60, MA 63 years). 175/180 patients completed HDRBT as planned (97.2%). In AA, two patients expired during CT; three patients post-randomization received short course EBRT because of progression under CT (n = 2, AA) or personal preference (n = 1, AB). ypT0N0 was 31% in AA and 28% in AB (p = 0.7). CT Compliance was 80% in AA and 53% in AB (p = 0.0002). Acute G3/G4 toxicity was 35.8% in AA and 27.6% in AB (p = 0.23). With a median follow-up of 48.5 months (IQR 33–72), the five-year DFS was 72.3% with AA and 68.3% with AB (p = 0.74), the five-year OS 83.8% for AA and 82.2% for AB (p = 0.53), and the five-year local recurrence was 6.3% for AA and 5.8% for AB (p = 0.71). We confirmed improved compliance to neoadjuvant CT in this study. Although there is no statistical difference in ypT0N0 rate, local recurrence, and DFS between the two arms, a trend towards favourable oncological outcomes is observed. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The tumor stage represents the single most important prognostic factor for colorectal cancer (CRC), although more accurate prognostics remain much needed. Previously, we identified CA125 as an independent significant prognostic factor, which we have further validated along with CEA, CA19-9, and CA242 in a large cohort of CRC patients. METHODS: Using enzyme-linked immunosorbent assays, we analyzed preoperative serum samples in 322 CRC patients operated on between 1998 and 2003. RESULTS: Using the Spearman's rho model, we calculated the correlation between our previous findings on MUC16 and CA125, for which the correlation coefficient was 0.808 (p < 0.001). The Cox regression analysis of the linear and logarithmic values of CEA, CA125, CA242, and CA19-9 identified only CA125 (hazard ratio [HR] 1.03; 95% confidence interval [95% CI] 1.02−1.04; p < 0.001) as significant when using the linear values. Survival among CRC patients with a high CA125 level was poor compared with CRC patients with a low CA125 level (HR 2.48; 95% CI 1.68–3.65; p < 0.001). In subgroup analyses, patients with high CA125 levels and aged ≤67 or >67, with stage I–II or III–IV, and both colon and rectal cancer exhibited poor prognoses. In the multivariate analysis, we used clinical pathological variables in the model, where age, gender, and stage served as the background characteristics. We dichotomized CA125 using the Youden maximal cutoff point, and the median values for CEA, CA19-9, and CA242. CA125 emerged as the only marker remaining significant and independent together with stage, location, and age (HR 1.91; 95% CI 1.24–2.95; p 0.003). CONCLUSIONS: CA125 represents a significant and independent prognostic factor in CRC patients, superior to CEA. Furthermore, CA242 served as a better prognostic marker than both CEA and CA19-9. We recommend including both CA125 and CA242 in prognostic clinical trials among CRC patients. [ABSTRACT FROM AUTHOR]

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Objective: Mutation in KRAS gene is one of the most common genetic changes among patients with colorectal cancer (CRC), which is observed in 30-45% of cases. This study aims to estimate the prevalence of this mutation among patients with primary or metastatic CRC. Patients and Methods: Eligible studies were identified during a comprehensive electronic search, applying inclusion/exclusion criteria and quality assessment. Stata version 11 software was used for data analysis. The heterogeneity between the results of the primary studies was assessed using Cochrane and I-square indices. Random effect model was applied for combining the primary estimates. Point and pooled estimates (with 95% confidence intervals) were presented by forest plots. Investigating the factors associated with heterogeneity was carried out using meta-regression models. The publication bias was traced by Egger test. Results: Combining the results of 164 eligible studies, the total prevalence of KRAS gene mutation among primary tumor samples was estimated as of 33.14% (95% confidence interval: 30.08- 36.20). The corresponding figure for metastatic cancer was estimated as of 36.20 % (95% confidence interval: 33.96- 38.44). Prevalence of this mutation among patients with primary CRC in EMRO, EURO, PAHO, SEARO and WAPRO was 30.23%, 35.12%, 31.83%, 33.17% and 32.64%, respectively. Corresponding rates for mutation among metastatic cases were 42.20%, 38.46%, 36.06%, 42.80%, 33.05%, respectively. In addition, the total prevalence of KRAS gene mutation in codons 12 and 13 was estimated as 76.69% and 28.49%, respectively. Conclusions: More than one-third of patients with CRC carried KRAS gene mutation particularly in the metastatic tumors. The rate of mutation was the same in different WHO regions.

Amaç: Bu çalışmada lokal ileri rektum kanserli hastalarda neoadjuvan kemoradyoterapi öncesi basit uygulanabilir, en temel parametrelerden birisi olan hemoglobin (Hb) seviyesi ile genel sağkalım arasındaki ilişkiyi araştırmayı amaçladık.Gereç ve Yöntem: Neoadjuvan kemoradyoterapi tedavisi sonrasında cerrahi uygulanan 123 lokal ileri rektum kanseri tanılı hasta retrospektif olarak çalışmamızda değerlendirildi. Tüm hastaların tedavi öncesi Hb değerleri bağımsız değişken olarak kaydedildi. Birincil amacımız tedavi Hb seviyesinin genel sağkalıma etkisi olarak belirlendi. Bulgular: Çalışmanın ortalama izlem süresi 40,3 ay (1,4-92ay) olarak tespit edildi. Yapılan ROC analizine göre Hb’nin cut-off değeri 12.5g/dl (AUC=0,673, %95 0.564-0.781) bulundu. Grup Hb’nin cut-off değerine göre normal-Hb (nHb; Hb>12) ve düşük-Hb (dHb≤12) iki gruba ayrıldığında nHb olan grupta Hb’ni düşük olan gruba göre genel sağkalım istatistiksel olarak daha uzun saptandı. Çok değişkenli analizde de p değeri anlamlılığını korudu.Sonuç: Neoadjuvan kemoradyoterapi tedavisi planlanan lokal ileri rektum kanseri tanılı hastalarda tedavi öncesi Hb değerinin bağımsız bir prognostik faktör olduğu düşünüldü.