Prophylactic Sublay Mesh Placement During Stoma Closure to Prevent Incisional Hernias: a Pilot Study

Introduction: There are many methods to prevent hernia following stoma closure; however, there is a lack of evidence of the efficacy of prophylactic sublay synthetic mesh placement. This study aimed to investigate the safety of sublay mesh placement during stoma closure. Methods: Patients with rectal cancer who underwent stoma closure with prophylactic sublay mesh placement following low anterior resection at N.N. Blokhin Cancer Research Center between June and July 2023 were included in this pilot study. The inclusion criteria were age 18-75, TNM stage I-III, and written informed consent. The exclusion criteria included patients with synchronous and metachronous cancers, human immunodeficiency virus, an Eastern Cooperative Oncology Group score of >2, and those undergoing chemotherapy. The sublay mesh placement technique was used, with the endpoints being surgical site infection rate at 30 days, operative time, mesh placement time, and postoperative morbidity (Clavien-Dindo classification). Results: Ten patients were included in the study. Among them, one patient (10%) had a postoperative surgical site infection, which did not require mesh removal. There was no other morbidity. The median operative time was 105.5 min, whereas the median mesh placement time was 25.5 min. Conclusion: A low surgical site infection rate makes it possible to consider preventive sublay mesh placement during stoma closure. We initiated a prospective randomized clinical trial after this pilot study (ClinicalTrials.gov, NCT05939687)

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection:an international, multi-centre, prospective audit

Introduction: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30–0.92, P = 0.02) but MBP was not (OR 0.92, 0.63–1.36, P = 0.69) compared to NBP. Conclusion: This non-randomised study adds ‘real-world’, contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice

Evaluating the incidence of pathological complete response in current international rectal cancer practice

The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as 'fair' only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively).The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials

EXTRAMURAL VENOUS INVASION AS A FACTOR OF DISTANT METASTASIS IN PATIENTS WITH LOCALLY ADVANCED RECTAL CANCER

Aim: In this article extramural venous invasion (EMVI) in patients with locally advanced rectal cancer (LARC) is evaluated as a risk factor of distant metastasis. Materials and methods: This study is based on experience made in proctological department of N.N. Blokhin National Medical Research Center of Oncology. Retrospective analysis was performed on a group of 230 patients with LARC with stage mrT3(CRM+)/T4N0-2M0. All patients underwent long course of chemoradiotherapy with capecetabine, then 2-4 courses of chemotherapy CapOx were conducted in induction and/or consolidation scheme. Results: There were no critical differences in the effect of EMVI (+) on the development of reccurences in comparison with the EMVI (-) group (p&gt;0.05). Along with that EMVI(+) patients were significantly associated with distant metastasis (43 patients - 27,4%) then in EMVI(-) group (2 - 2,74%) (p&lt;0,05). The positive mr-EMVI result was more likely to be present in patients with T4 then in T3 group (p&lt;0,05). A positive EMVI status was 81,4% in patients with the III stage, which is significant higher than in patients with II stage - 55,7% (p&lt;0,05). 3-year recurrent-free survival of patients with EMVI(+) was 64%, compared with the group of patients with EMVI (-) - 93%, which was a significant difference (HR 0.03; 95% CI, 0.08-0.19 p&lt;0.001). Conclusion: The definition of extramural vascular invasion indicates a poor prognosis and could be used for treatment planning of neoadjuvant chemoradiation and adjuvant chemotherapy.</jats:p

THE FEASIBILITY OF COMBINED TREATMENT OF COMPLICATED LOCALLY ADVANCED AND RECURRENT RECTAL CANCER. CASE-CONTROL STUDY

INTRODUCTION: The goal of the study was to assess the feasibility of combined treatment in patients with a complicated course of locally advanced and recurrent colorectal cancer. METHODS: A case-control study was conducted. The study group included patients with locally advanced or recurrent rectal cancer complicated by external, rectovesical, rectovaginal fistulas and/or peritumoral abscesses received neoadjuvant chemoradiation (CRT). Patients without complications comparable to the study group by sex, age, ECOG status, cT value, and the nature of the tumor (primary/recurrent) treated with neoadjuvant CRT were selected in the control group. The primary end points of the study were CRT toxicity (NCI-CTC v.4.0) and postoperative complications (Clavien-Dindo). The secondary endpoints of the study were the pathologic complete response rate 2-year progression-free survival. RESULTS: 21 patients were included in both groups. In the study group the following complications were noted: external fistula (n = 7), rectovaginal fistula (n = 6), rectovesical fistula (n = 4), paraproctitis (n = 4), peritumoral abscess (n = 13), 16 patients (76%) required additional treatment prior the CRT: preventive colostomy (n = 14), antibacterial therapy (n = 5). Grade 3 toxicity was observed in 2 (9,52%) patients and in the study group (p = 1). Postoperative mortality was not registered in both groups. Postoperative grade III and higher complications in the study group were observed in 1 (5,2%) patient and in 3 patients (15,7) in the comtrol group (p = 0.129). 19 patients underwent surgery in each group, R0-resection was achieved in 17 patients in the study group and 19 in the control group. Pathological complete response was registered in 1 (5,2%) patient in the study group and in 4 patients in the control group (21,5%) (p = 0,14). Median progression-free survival was not achieved in both groups. CONCLUSION: the combined treatment of complicated locally advanced and recurrent rectal cancer after appropriate planning and concomitant symptomatic therapy does not increase the toxicity profile and postoperative complications rate.</jats:p

Blood Plasma Metabolome Profiling at Different Stages of Renal Cell Carcinoma

Early diagnostics significantly improves the survival of patients with renal cell carcinoma (RCC), which is the prevailing type of adult kidney cancer. However, the absence of clinically obvious symptoms and effective screening strategies at the early stages result to disease progression and survival rate reducing. The study was focused on revealing of potential low molecular biomarkers for early-stage RCC. The untargeted direct injection mass spectrometry-based metabolite profiling of blood plasma samples from 51 non-cancer volunteers (control) and 78 patients with different RCC subtypes and stages (early stages of clear cell RCC (ccRCC), papillary RCC (pRCC), chromophobe RCC (chrRCC) and advanced stages of ccRCC) was performed. Comparative analysis of the blood plasma metabolites between the control and cancer groups provided the detection of metabolites associated with different tumor stages. The designed model based on the revealed metabolites demonstrated high diagnostic power and accuracy. Overall, using the metabolomics approach the study revealed the metabolites demonstrating a high value for design of plasma-based test to improve early ccRCC diagnosis.</jats:p

Blood Plasma Metabolome Profiling at Different Stages of Renal Cell Carcinoma

Early diagnostics significantly improves the survival of patients with renal cell carcinoma (RCC), which is the prevailing type of adult kidney cancer. However, the absence of clinically obvious symptoms and effective screening strategies at the early stages result to disease progression and survival rate reducing. The study was focused on revealing of potential low molecular biomarkers for early-stage RCC. The untargeted direct injection mass spectrometry-based metabolite profiling of blood plasma samples from 51 non-cancer volunteers (control) and 78 patients with different RCC subtypes and stages (early stages of clear cell RCC (ccRCC), papillary RCC (pRCC), chromophobe RCC (chrRCC) and advanced stages of ccRCC) was performed. Comparative analysis of the blood plasma metabolites between the control and cancer groups provided the detection of metabolites associated with different tumor stages. The designed model based on the revealed metabolites demonstrated high diagnostic power and accuracy. Overall, using the metabolomics approach the study revealed the metabolites demonstrating a high value for design of plasma-based test to improve early ccRCC diagnosis