Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

COLPOCYSTODEFECOGRAPHY IN OBSTRUCTED DEFECATION: IS IT REALLY USEFUL TO THE SURGEON? (CORRELATING CLINICAL AND RADIOLOGICAL FINDINGS IN SURGERY FOR OBSTRUCTED DEFECATION.

Objective Colpocystodefecography images the pelvic floor with the dynamics of defecation, but various authors claim that it overestimates clinical findings. The aim of this study was to evaluate the pre- and postoperative consistency between clinical and colpocystodefecographic findings in patients undergoing surgery for obstructed defecation. Method Between June 2001 and September 2003, 20 patients underwent transvaginal posterior colpoperineorrhaphy and rectal mucosal prolapsectomy with one circular stapler for symptomatic rectocele and concomitant anorectal prolapse. They were prospectively evaluated both before surgery by designed questionnaire on constipation and incontinence, proctological, gynaecological and urological examinations, colpocystodefecography and anorectal manometry, and after operation at 6 months by questionnaire and a proctological check-up. The mean follow-up was 30 months (24-48 months). Results At 6 months the questionnaire revealed a major response in terms of symptoms. The proctological visit confirmed the absence of rectocele in 19 (95%) patients, while the anorectal prolapse had completely disappeared in 17 (85%) patients. Postoperative colpocystodefecography demonstrated a general reduction in the dimensions of the rectocele, which had completely disappeared in five (25%) patients; 40% of the patients had a persistent anorectal prolapse. Conclusion Preoperative data analysis showed a statistically significant correlation between clinical and radiological findings. Postoperatively the global clinical assessment correlated well with patient satisfaction, while there was evidence of a statistically significant difference between the radiological and clinical findings. Routine postoperative use of colpocystodefecography is unjustified unless there is clinical evidence of surgical failure

Prospective randomized study on perioperative enteral immunonutrition in laparoscopic colorectal surgery

Background: Perioperative nutrition for patients undergoing colon surgery seems to be effective in reducing catabolism and improving immunologic parameters. A relatively low-fiber and highly absorbable diet may facilitate the intestinal cleansing and loop relaxation fundamental for laparoscopic surgery with a lower dose of iso-osmotic laxative. Methods: From 1 February 2004 to 30 July 2005, 28 patients referred to our unit with colon disease (neoplasms and diverticular disease) amenable to laparoscopic surgery were prospectively randomized into two groups of 14 patients each. For 6 days preoperatively, the patients in group I were given 750 ml/day of a diet enriched with arginine. omega-3 fatty acids.. and ribonucleic acid (RNA) associated with low-fiber foods. They had I day of intestinal preparation with 31 of iso-osmotic laxative. On postoperative day 2, they were fed orally with the same diet. The patients in group 2 preoperatively received a low-fiber diet. They had 2 days of preparation with iso-osmotic laxative (3 l/day). On postoperative day 3, oral nutrition was restored. Intraoperatively, we evaluated loop relaxation and intestinal cleanliness. Clinical trends were monitored in both groups, as well as adverse reactions to early nutrition. The nutritional (albumin, prealbumin) and immunologic (lymphocyte subpopulations, immunoglobulins) biohumoral parameters were evaluated at the first visit, on the day before surgery, on postoperative day 7, and 1 month after surgery. Results: The two groups did not differ in terms of age, gender, distribution of disease, or baseline anthropometric, biohumoral, or immunologic parameters. There was a significant increase in CD4 lymphocytes on the day before surgery as compared with baseline parameters (p < 0.05) in group 1, but not in group 2. There was no statistically significant difference between the two groups in intestinal loop relaxation or cleanliness or in postoperative infectious complications. Conclusions: Perioperative immunonutrition proved to be safe and useful in increasing the perioperative immunologic cell response. It may contribute toward improving the preparation and relaxation of the intestinal loops despite the shorter intestinal preparation

Fatty acid signature analysis confirms foraging resources of a globally endangered Mediterranean seabird species: calibration test and application to the wild

Tissue fatty acid signatures (FAS) can complement traditional methods of studying seabird diets. Although plasma lipid FAS are known to indicate dietary changes qualitatively, here we test whether they can be used to determine the proportions of different dietary items in a quantitative manner.2. Captive herring gulls (Larus argentatus) were fed North Atlantic plaice Pleuronectes platessa (demersal species made available to wild seabirds by fisheries) and herring Clupea harengus (pelagic fish often found naturally in their diet) with different mixing ratios (0%, 10%, 20% and 50% herring).3. Major fatty acids did not indicate diet, but several minor components in plasma, for example, 14 : 0, 18 : 3n-3, 18 : 4n-3 and C20-22 monounsaturated fatty acids (MUFA), showed good correlations with diet composition. Different fatty acids were incorporated from diet into plasma lipids with different calibration coefficients.4. Together with dose-dependent but inefficient (low calibration coefficient) transfer of 22 : 1n-11 (a major fatty acid of herring) to the plasma FAS of the gulls, the percentages of potential chain shortening products of 22 : 1n-11, that is, 20 : 1n-11, 18 : 1n-11 and 16 : 1n-11 increased with increasing proportion of herring in the diet. Notably, the dietary supply of these fatty acids itself did not change. Thus the metabolic products of certain dietary fatty acids can reflect the amount of their dietary precursors in a quantitative way.5. Despite the fact that many major fatty acids in FAS of seabird plasma are greatly modified by endogenous metabolism, several minor components of FAS (in this experiment 14 : 0, branched chain 17 : 0, 18 : 1n-7, 18 : 3n-3, 18 : 4n-3, C20-22 MUFA with their chain shortening products, and 22 : 4n-6) that can be accurately and reliably quantified by gas chromatography, vary proportionally to diet composition, allowing their use for monitoring temporal and spatial differences in seabird diet