Cardiovascular morbidities in postoperative colorectal cancer patients

This retrospective observational study investigated the long-term prevalence of new-onset cardiovascular disease (CVD) and the predictive role of atherosclerotic plaque in the aorta and iliac arteries for CVD in postoperative colorectal cancer (CRC) patients who received surgical treatment between 2014 and 2015. CVD included coronary or cerebrovascular diseases which required treatment and new-onset CVD included peri-and postoperatively diagnosed CVDs or aggravated CVDs that required additional treatment during follow-up. Of the 2,875 patients included in this study, the prevalence of CVD was 8.9% (255/2875) and 141 (4.9%) developed new-onset CVD. Maximum arterial stenosis in the aorta or iliac arteries occurred in 40.8 +/- 18.6% of patients with new-onset CVD and 11.6 +/- 13.8% of patients without new-onset CVD (p < 0.001). The mean new-onset CVD-free survival time in patients with > 30% and < 30% stenoses were 52.5 [95% confidence intervals (CIs) 50.0-54.9] and 66.5 (95% CIs 66.2-66.8) months, respectively (p < 0.001). The area under the receiver operating characteristic curve of the maximal arterial stenosis for new-onset CVD was 0.911. These results suggest that CRC patients are at risk for developing new-onset CVD, which is associated with reduced survival. Atherosclerotic burden in the aorta or both iliac arteries may help predict future CVD events

Optimal postoperative surveillance strategies for stage III colorectal cancer

BACKGROUND Optimal surveillance strategies for stage III colorectal cancer (CRC) are lacking, and intensive surveillance has not conferred a significant survival benefit. AIM To examine the association between surveillance intensity and recurrence and survival rates in patients with stage III CRC. METHODS Data from patients with pathologic stage III CRC who underwent radical surgery between January 2005 and December 2012 at Asan Medical Center, Seoul, Korea were retrospectively reviewed. Surveillance consisted of abdominopelvic computed tomography (CT) every 6 mo and chest CT annually during the 5 year follow-up period, resulting in an average of three imaging studies per year. Patients who underwent more than the average number of imaging studies annually were categorized as high intensity (HI), and those with less than the average were categorized as low intensity (LI). RESULTS Among 1888 patients, 864 (45.8%) were in HI group. Age, sex, and location were not different between groups. HI group had more advanced T and N stage (P = 0.002, 0.010, each). Perineural invasion (PNI) was more identified in the HI group (21.4% vs 30.3%, P < 0.001). The mean overall survival (OS) and recurrence-free interval (RFI) was longer in the LI group (P < 0.001, each). Multivariate analysis indicated that surveillance intensity [odds ratio (OR) = 1.999; 95% confidence interval (CI): 1.680-2.377; P < 0.001], pathologic T stage (OR = 1.596; 95%CI: 1.197-2.127; P = 0.001), PNI (OR = 1.431; 95%CI: 1.192-1.719; P < 0.001), and circumferential resection margin (OR = 1.565; 95%CI: 1.083-2.262; P = 0.017) in rectal cancer were significantly associated with RFI. The mean post-recurrence survival (PRS) was longer in patients who received curative resection (P < 0.001). Curative resection rate of recurrence was not different between HI (29.3%) and LI (23.8%) groups (P = 0.160). PRS did not differ according to surveillance intensity (P = 0.802). CONCLUSION Frequent surveillance with CT scan do not improve OS in stage III CRC patients. We need to evaluate role of other surveillance method rather than frequent CT scans to detect recurrence for which curative treatment was possible because curative resection is the important to improve post-recurrence survival

Surgical options for perianal fistula in patients with Crohn's disease: A comparison of seton placement, fistulotomy, and stem cell therapy

Objective: This study was designed to assess the demographic characteristics of patients with Crohn's perianal fistula (CPF) who were treated at a tertiary referral institution. Surgical outcomes were compared in groups of patients who underwent seton placement, fistulotomy, and stem cell therapy. Methods: Patients who underwent surgery for CPF between 2015 and 2017 at Asan Medical Center, Seoul, Korea, were retrospectively evaluated. Patients were divided into groups who underwent seton place-ment, fistulotomy, and stem cell therapy. Their clinical variables and closure rates were compared. Results: This study included 156 patients who underwent a total of 209 operations. More than half of the operations consisted of seton placement (67%), followed by stem cell therapy (18%) and fistulotomy (15%) patients. Of the 209 fistulas, 153 (73%) were complex, with an overall closure rate of 38% during a median follow-up of 29 months. Closure rates following fistulotomy, stem cell therapy, and seton placement were 90%, 70%, and 18%. Seton placement was more significantly frequently used than the other procedures in patients with complex fistula and those with abscesses. Of the 79 fistulas that achieved complete closure, 11 (14%) recurred. The recurrence rates did not differ among the various techniques. Conclusion: Surgical treatment of CPF is dependent on lesion type. Seton placement was the primary draining procedure for complex fistulas and abscesses, resulting in low closure rates. Fistulotomy was the definite procedure for low type and simple fistula. Stem cell therapy showed high closure rates as definitive treatment, even for complex fistulas. (c) 2021 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/)

Optimal Postoperative Surveillance Strategies for Colorectal Cancer: A Retrospective Observational Study

Simple Summary Optimal surveillance strategies for colorectal cancer remain undetermined, with intensive surveillance not conferring significant survival benefits. This study aimed to assess whether surveillance intensity is associated with recurrence and survival in patients with colorectal cancer. This retrospective observational study showed that, although frequent postoperative surveillance did not improve overall survival or recurrence-free survival, surveillance improved post-recurrence survival. Analysis using a recurrence risk-prediction model showed that intensive surveillance improved both post-recurrence survival and overall survival in patients who were at high risk of recurrence. Thus, intensive surveillance does not improve overall survival and recurrence-free survival but can help improve post-recurrence survival by detecting early-stage recurrence or increasing the curative resection rate. This study aimed to assess whether surveillance intensity is associated with recurrence and survival in colorectal cancer (CRC) patients. Overall, 3794 patients with pathologic stage I-III CRC who underwent radical surgery between January 2012 and December 2014 were examined. Surveillance comprised abdominopelvic computed tomography (CT) every 6 months and chest CT annually for 5 years. Patients who underwent more than and less than an average of three imaging examinations annually were assigned to the high-intensity (HI) and low-intensity (LI) groups, respectively. Demographics were similar in both groups. T and N stages were higher and perineural and lymphovascular invasion were more frequent in the HI group (p < 0.001 each). The mean overall survival (OS) was similar for both groups; however, recurrence-free survival (RFS) was longer (p < 0.001) and post-recurrence survival (PRS) was shorter (p = 0.024) in the LI group. In the multivariate analysis, surveillance intensity was associated with RFS (p < 0.001) in contrast to PRS (p = 0.731). In patients with high recurrence risk predicted using the nomogram, OS was longer in the HI group (p < 0.001). A higher imaging frequency in patients at high risk of recurrence could be expected to lead to a slight increase in PRS but does not improve OS. Therefore, rather than increasing the number of CT scans in high-risk patients, other imaging modalities or innovative approaches, such as liquid biopsy, are required

Impact of the COVID-19 Pandemic on Surgical Treatment Patterns for Colorectal Cancer in a Tertiary Medical Facility in Korea

Simple Summary The COVID-19 pandemic is threatening to public health, including malignant disease. Fear of viral infection has influenced the diagnosis and treatment of colorectal cancer and may result in impairment of surgical and oncologic outcomes. Therefore, we need to analyze the influence of COVID-19 on surgical outcomes of colorectal cancer and provide guidance on proper diagnosis and treatment, including public messaging regarding appropriate healthcare. Because of their reluctance to visit the hospital due to concerns about contracting coronavirus disease 2019 (COVID-19), patients with colorectal cancer have been affected by delays in care during the pandemic. This study assessed the effects of the pandemic on the clinical characteristics and surgical treatment patterns of colorectal cancer patients at a tertiary medical facility in Korea. Patients who underwent colorectal cancer surgery at our institution between March and September 2020 were analyzed. Clinicopathological and treatment characteristics were compared with those of patients who underwent surgery in 2018 and 2019. The patients who did not undergo tumor resection (4.1% vs. 1.8%, p < 0.001) and who received neoadjuvant treatment (16.7% vs. 14.7%, p = 0.039) were significantly higher during the COVID period. The minimally invasive approach was performed less during the COVID period (81.2% vs. 88%, p < 0.001). More patients in the COVID period required combined resection of organs adjacent to the tumor (4.8% vs. 2.8%, p = 0.017). Surgical aggressiveness, as shown by the proportion of patients undergoing minimally invasive surgery and adjacent organ resection, was significantly influenced by the pandemic. In addition, resectability decreased during the COVID period. These characteristics will likely influence long-term oncological outcomes, indicating the need for long-term monitoring of this cohort