Evaluación de la recurrencia local y supervivencia a largo plazo en enfermos de cáncer de colon izquierdo obstructivo: endoprótesis puente a cirugía programada versus cirugía urgente

Introducción: La endoprótesis como puente a cirugía electiva en pacientes con cáncer de colon izquierdo obstructivo es una alternativa al tratamiento quirúrgico urgente. El objetivo del estudio es evaluar la recurrencia y la supervivencia a largo plazo en estos pacientes. Material y Métodos: Estudio retrospectivo de cohortes, donde se incluyeron los pacientes que acudieron a Urgencias, con un cuadro clínico de obstrucción intestinal por cáncer de colon izquierdo entre junio de 2006 y enero del 2014. Se trataron mediante endoprótesis puente a cirugía electiva o mediante cirugía urgente. El período de observación fue hasta septiembre del 2018. Las variables principales fueron supervivencia global, recidiva local y recidiva a distancia. Como objetivos secundarios, se estudiaron número de anastomosis primarias y de estomas, morbi-mortalidad asociada y estancia hospitalaria. Resultados: Fueron 53 pacientes los que pertenecieron al grupo endoprótesis y 40 pacientes al grupo cirugía. La recurrencia local sólo estuvo presente en 2 pacientes del grupo cirugía con una media de aparición 17,6 meses ± 2,7. La recidiva a distancia fue más frecuente en el grupo cirugía (34,2% versus 17,8%), aunque sin diferencias significativas. La supervivencia global (SG) no mostró diferencias significativas entre los grupos de tratamiento, siendo menor en el grupo endoprótesis (SG a los 5 años 60,4% versus 68,5%). Sin embargo, se encontraron diferencias significativas en mayor porcentaje de anastomosis primaria en el grupo endoprótesis (75% versus 52,5% p 0,02) y una menor proporción de estomas (27% versus 47,5% p 0,04). Las complicaciones postoperatorias y la mortalidad postoperatoria, aunque no mostraron diferencias significativas, fueron mayores en el grupo endoprótesis. La estancia hospitalaria tampoco mostró diferencias significativas. Conclusiones: Los resultados a largo plazo no mostraron diferencias significativas entre los dos grupos. Sin embargo, se observó una mejoría en la proporción de anastomosis primarias y estomas en el grupo endoprótesis de manera significativa

Familial component of early-onset colorectal cancer: opportunity for prevention

[Background]: Individuals with a non-syndromic family history of colorectal cancer are known to have an increased risk. There is an opportunity to prevent early-onset colorectal cancer (age less than 50 years) (EOCRC) in this population. The aim was to explore the proportion of EOCRC that is preventable due to family history of colorectal cancer. [Methods]: This was a retrospective multicentre European study of patients with non-hereditary EOCRC. The impact of the European Society of Gastrointestinal Endoscopy (ESGE), U.S. Multi-Society Task Force (USMSTF), and National Comprehensive Cancer Network (NCCN) guidelines on prevention and early diagnosis was compared. Colorectal cancer was defined as potentially preventable if surveillance colonoscopy would have been performed at least 5 years before the age of diagnosis of colorectal cancer, and diagnosed early if colonoscopy was undertaken between 1 and 4 years before the diagnosis. [Results]: Some 903 patients with EOCRC were included. Criteria for familial colorectal cancer risk in ESGE, USMSTF, and NCCN guidelines were met in 6.3, 9.4, and 30.4 per cent of patients respectively. Based on ESGE, USMSTF, and NCCN guidelines, colorectal cancer could potentially have been prevented in 41, 55, and 30.3 per cent of patients, and diagnosed earlier in 11, 14, and 21.1 per cent respectively. In ESGE guidelines, if surveillance had started 10 years before the youngest relative, there would be a significant increase in prevention (41 versus 55 per cent; P = 0.010). [Conclusion]: ESGE, USMSTF, and NCCN criteria for familial colorectal cancer were met in 6.3, 9.4, and 30.4 per cent of patients with EOCRC respectively. In these patients, early detection and/or prevention could be achieved in 52, 70, and 51.4 per cent respectively. Early and accurate identification of familial colorectal cancer risk and increase in the uptake of early colonoscopy are key to decreasing familial EOCRC.This study was funded by Instituto de Salud Carlos III through project PI20/0974 to J.P and PI19/01867 to F.B. (co-funded by European Regional Development Fund ‘A way to make Europe’); and Agència de Gestió d’Ajuts Universitaris i de Recerca (Generalitat de Catalunya, GRC 2017SGR653). Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas is funded by the Instituto de Salud Carlos III

Primary squamous cell carcinoma of the rectum: an atypical histology

Squamous cell carcinoma of the rectum is one of the differential diagnoses of rectal tumors. It represents a low incidence in the population. The etiopathogenesis and the biology of these tumors are unclear, for this reason the gold standard treatment is difficult to establish. We present a 47-years-old woman who had a squamous cell carcinoma in medium rectum. She was treated with radiation therapy and chemotherapy and the treatment was followed by surgical excision

Duodenal fistula after gastrectomy: retrospective study of 13 new cases

Introduction: Duodenal stump fistula (DSF) after gastrectomy has a low incidence but a high morbidity and mortality, and is therefore one of the most aggressive and feared complications of this procedure. Material and methods: We retrospectively evaluated all DSF occurred at our hospital after carrying out a gastrectomy for gastric cancer, between January 1997 and December 2014. We analyzed demographic, oncologic, and surgical variables, and the evolution in terms of morbidity, mortality and hospital stay. Results: In the period covered in this study, we performed 666 gastrectomies and observed DSF in 13 patients (1.95%). In 8 of the 13 patients (61.5%) surgery was the treatment of choice and in 5 cases (38.5%) conservative treatment was carried out. Postoperative mortality associated with DSF was 46.2% (6 cases). In the surgical group, 3 patients developed severe sepsis with multiple organ failure, 2 patients presented a major hematemesis which required endoscopic haemostasis, 1 patient had an evisceration and another presented a subphrenic abscess requiring percutaneous drainage. Six patients (75%) died despite surgery, with 3 deaths in the first 24 hours of postoperative care. The 2 patients who survived after the second surgical procedure had a hospital stay of 45 and 84 days respectively. In the conservative treatment group the cure rate was 100% with no significant complications and an average postoperative hospital stay of 39.5 days (range, 26-65 days). Conclusion: FMD is an unusual complication but it is associated with a high morbidity and mortality. In our experience, conservative management has shown better results compared with surgical treatment

Telomere Length as a New Risk Marker of Early-Onset Colorectal Cancer

Early-onset colorectal cancer (EOCRC; age younger than 50 years) incidence has been steadily increasing in recent decades worldwide. The need for new biomarkers for EOCRC prevention strategies is undeniable. In this study, we aimed to explore whether an aging factor, such as telomere length (TL), could be a useful tool in EOCRC screening. The absolute leukocyte TL from 87 microsatellite stable EOCRC patients and 109 healthy controls (HC) with the same range of age, was quantified by Real Time Quantitative PCR (RT-qPCR). Then, leukocyte whole-exome sequencing (WES) was performed to study the status of the genes involved in TL maintenance (hTERT, TERC, DKC1, TERF1, TERF2, TERF2IP, TINF2, ACD, and POT1) in 70 sporadic EOCRC cases from the original cohort. We observed that TL was significantly shorter in EOCRC patients than in healthy individuals (EOCRC mean: 122 kb vs. HC mean: 296 kb; p hTERT (rs79662648), POT1 (rs76436625, rs10263573, rs3815221, rs7794637, rs7784168, rs4383910, and rs7782354), TERF2 (rs251796 and rs344152214), and TERF2IP (rs7205764) genes and the risk of developing EOCRC. We consider that the measurement of germline TL and the status analysis of telomere maintenance related genes polymorphisms at early ages could be non-invasive methods that could facilitate the early identification of individuals at risk of developing EOCRC