Implementation of Psychosocial Intervention StomieCare for Patients with Rectal Cancer Treated by Rectal Excision and Temporary Stoma: A Pilot Study of Feasibility, Acceptability and Efficacy

L’objectif de cette étude est d’évaluer la faisabilité, l’acceptabilité et l’efficacité d’une intervention psychosociale en individuel (appelée StomieCare) auprès de patients atteints d’un cancer du rectum et traités par chirurgie avec stomie temporaire. Cette intervention, en trois séances individuelles, comprend des discussions thématiques autour de problèmes communs relatifs à la maladie et/ou la stomie comme l’impact du cancer et de ces traitements sur la qualité de vie, l’estime de soi, d’apport d’informations et d’apprentissage de techniques (résolution de problème et restructuration cognitive). Trente-sept patients atteints d’un cancer du rectum et traités par chirurgie avec stomie temporaire ont été recrutés et randomisés soit dans le groupe contrôle (prise en charge traditionnelle, n = 20) soit dans le groupe intervention (prise en charge traditionnelle et StomieCare, n = 17). Une semaine avant l’opération (T1) et trois mois après le rétablissement de continuité (T2), tous les patients ont rempli la HADS pour évaluer l’anxiété et la dépression, la BIS pour l’image du corps, l’ESS pour la honte liée à l’image du corps et la FACT-C pour la qualité de vie. Des analyses statistiques intergroupes et intragroupes ont été réalisées. Les critères de faisabilité et d’acceptabilité sont satisfaisants. A T2, les scores de dépression du groupe contrôle sont significativement plus élevés que ceux du groupe intervention. A T2, et uniquement pour le groupe contrôle, il y a une altération significative des scores de qualité de vie, dépression et image du corps. Aucune différence significative n’est observée pour le groupe intervention. L’anxiété diminue entre T1 et T2 de manière significative uniquement pour le groupe contrôle. Pour conclure, StomieCare semble être une intervention faisable et acceptable à visée préventive de la symptomatologie dépressive.Objective: This study aims to evaluate the feasibility, acceptability, and efficacy of StomieCare for rectal cancer patients undergoing surgery with a temporary stoma. StomieCare (three individual sessions) comprises thematic discussions, information and education, and teaching problem-solving and cognitive restructuring. Methods: Thirty-seven rectal cancer participants treated by surgery and temporary stoma were recruited and randomized to control (routine care approach, n = 20) and intervention (routine care and StomieCare, n = 17) groups. Outcomes were psychological distress (anxiety and depression, HADS), body image (BIS, ESS), and quality of life (FACT-C), at one week before surgery (T1) and 3 months after stoma closure (T2). Interand intragroup statistical analyses were performed. Results: This study demonstrated that StomieCare is feasible and acceptable. At T2, depression scores were higher for controls than for the intervention group. The mean scores for quality of life, depression, and body image decreased in the control group but remained stable in the intervention group. Anxiety scores significantly decreased between T1 and T2 only for the control group. Conclusion: StomieCare is a feasible and acceptable intervention for the prevention of depressive symptomatology

The effect of body weight on altered expression of nuclear receptors and cyclooxygenase-2 in human colorectal cancers

<p>Abstract</p> <p>Background</p> <p>Epidemiological studies on risk factors for colorectal cancer (CRC) have mainly focused on diet, and being overweight is now recognized to contribute significantly to CRC risk. Overweight and obesity are defined as an excess of adipose tissue mass and are associated with disorders in lipid metabolism. Peroxisome proliferator-activated receptors (PPARs) and retinoid-activated receptors (RARs and RXRs) are important modulators of lipid metabolism and cellular homeostasis. Alterations in expression and activity of these ligand-activated transcription factors might be involved in obesity-associated diseases, which include CRC. Cyclooxygenase-2 (COX-2) also plays a critical role in lipid metabolism and alterations in COX-2 expression have already been associated with unfavourable clinical outcomes in epithelial tumors. The objective of this study is to examine the hypothesis questioning the relationship between alterations in the expression of nuclear receptors and COX-2 and the weight status among male subjects with CRC.</p> <p>Method</p> <p>The mRNA expression of the different nuclear receptor subtypes and of COX-2 was measured in 20 resected samples of CRC and paired non-tumor tissues. The association between expression patterns and weight status defined as a body mass index (BMI) was statistically analyzed.</p> <p>Results</p> <p>No changes were observed in PPARγ mRNA expression while the expression of PPARδ, retinoid-activated receptors and COX-2 were significantly increased in cancer tissues compared to normal colon mucosa (<it>P </it>≤ 0.001). The weight status appeared to be an independent factor, although we detected an increased level of COX-2 expression in the normal mucosa from overweight patients (BMI ≥ 25) compared to subjects with healthy BMI (<it>P </it>= 0.002).</p> <p>Conclusion</p> <p>Our findings show that alterations in the pattern of nuclear receptor expression observed in CRC do not appear to be correlated with patient weight status. However, the analysis of COX-2 expression in normal colon mucosa from subjects with a high BMI suggests that COX-2 deregulation might be driven by excess weight during the colon carcinogenesis process.</p

The CARTS study: Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery

Contains fulltext : 96401.pdf (publisher's version ) (Open Access

Radiochimiothérapie préopératoire et traitement conservateur des cancers du bas rectum

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Colorectal tissue engineering: prerequisites, current status and perspectives

International audienceGastrointestinal tissue engineering has emerged over the past 20 years and was often focused on esophagus, stomach or small intestine, whereas bioengineering researches of colorectal tissue are scarce. However, some promising results have been obtained in animal models. Refinements should be performed in scaffold and cell source selection to allow smooth muscle layer regeneration. Indeed, synthetic and natural polymers such as small intestinal submucosa and collagen sponge seeded with organoid units or smooth muscle cells did not allow smooth muscle regeneration. Mesenchymal stem cells derived from adipose tissue seeded on composite scaffold could represent an interesting way to achieve this goal. This article reviews potential indications, current status and perspectives of tissue engineering in the area of colorectal surgery

Tailored Treatment Strategy for Locally Advanced Rectal Carcinoma Based on the Tumor Response to Induction Chemotherapy

International audienc

An International Multicenter Prospective Study Evaluating the Long-term Oncological Impact of Adjuvant Chemotherapy in ypN+ Rectal Cancer

Objective: To assess the oncological benefit of adjuvant chemotherapy (AC) in node positive (ypN+) rectal cancer after neoadjuvant chemoradiotherapy and radical surgery. Background: The evidence for AC after total mesorectal excision for locally advanced rectal cancer is conflicting and the net survival benefit is debated. Methods: An international multicenter comparative cohort study was performed comparing oncological outcomes in tertiary rectal cancer centers from the Netherlands and France. Patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by total mesorectal excision surgery and with positive lymph nodes on histologic examination (ypN+) were included for analysis. Kaplan-Meier curves were generated to compare disease-free (DFS) and overall survival in AC and non-AC groups. Results: Of 1265 patients screened, a total of 239 rectal cancer patients with ypN+ disease were included. Demographic and clinical characteristics were similar in both groups. Higher systemic recurrence rates were observed in the non-AC group compared with those who received AC [32.0% (n=40) vs 17.5% (n=11), respectively, P=0.034]. DFS at 1 and 5 years postoperatively were significantly better in the AC group (92% vs 80% at 1 year; 72% vs 51% at 5 years, P=0.024), whereas no difference in overall survival was observed. Conclusions: In this multicenter comparative cohort study, we identified an oncological benefit of AC in both systemic recurrence and DFS in ypN+ rectal cancer patients. From this data, systemic chemotherapy continues to confer oncological benefit in locally advanced ypN+ rectal cancer

Colorectal tissue engineering: A comparative study between porcine small intestinal submucosa (SIS) and chitosan hydrogel patches

Objective. Tissue engineering may provide new operative tools for colorectal surgery in elective indications. The aim of this study was to define a suitable bioscaffold for colorectal tissue engineering.Methods. We compared 2 bioscaffolds with in vitro and in vivo experiments: porcine small intestinal submucosa (SIS) versus chitosan hydrogel matrix. We assessed nontoxicity of the scaffold in vitro by using human adipose-derived stem cells (hADSC). In vivo, a 1 X 2-cm colonic wall defect was created in 16 rabbits. Animals were divided randomly into 2 groups according to the graft used, SIS or chitosan hydrogel. Graft area was explanted at 4 and 8 weeks. The end points of in vivo experiments were technical feasibility, behavior of the scaffold, in situ putative inflammatory effect, and the quality of tissue regeneration, in particular smooth muscle layer regeneration.Results. In vitro, hADSC attachment and proliferation occurred on both scaffolds without a substantial difference. After proliferation, hADSCs kept their mesenchymal stem cell characteristics. In vivo, one animal died in each group. Eight weeks after implantation, the chitosan scaffold allowed better wound healing compared with the SIS scaffold, with more effective control of inflammatory activity and an integral regeneration of the colonic wall including the smooth muscle cell layer.Conclusion. The outcomes of in vitro experiments did not differ greatly between the 2 groups. Macroscopic and histologic findings, however, revealed better wound healing of the colonic wall in the chitosan group suggesting that the chitosan hydrogel could serve as a better scaffold for colorectal tissue engineering