Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Surgical treatment of varicocele [Il trattamento chirurgico del varicocele.]

The correlation between varicocele and infertility has been established for many years. Authors expose their twelve years experience on surgical treatment of varicocele. 213 cases have been treated: 105 had infertility associated to varicocele and a microsurgical treatment has been performed. A high legature of spermatic vein has been applied to 108 patients with normal spermiogram (the last 6 by laparoscopic technique). In the case in which there is alteration of the spermiogram the microsurgical treatment seems more efficient for the sperm quality because it is more valuable in eliminating the venous stasis, and the operation Belgrano 1 seems to be the best compared to the others. Correlating the treatment efficiency to the simplicity of the application and to the treatment expense and reduced morbility we think it is advisable to treat the spermatic vein with laparoscopic ligature in patients with normal fertility indexes, even on the basis of our recent experience. Physiopathology, economic reasons and efficacy have been demonstrated

Surgical treatment of varicocele [Il trattamento chirurgico del varicocele.]

The correlation between varicocele and infertility has been established for many years. Authors expose their twelve years experience on surgical treatment of varicocele. 213 cases have been treated: 105 had infertility associated to varicocele and a microsurgical treatment has been performed. A high legature of spermatic vein has been applied to 108 patients with normal spermiogram (the last 6 by laparoscopic technique). In the case in which there is alteration of the spermiogram the microsurgical treatment seems more efficient for the sperm quality because it is more valuable in eliminating the venous stasis, and the operation Belgrano 1 seems to be the best compared to the others. Correlating the treatment efficiency to the simplicity of the application and to the treatment expense and reduced morbility we think it is advisable to treat the spermatic vein with laparoscopic ligature in patients with normal fertility indexes, even on the basis of our recent experience. Physiopathology, economic reasons and efficacy have been demonstrated

Frequency and pattern of endoscopic recurrence in Crohn's disease patients with ileocolonic resection using a laparoscopic versus laparotomic approach: A prospective longitudinal study

[No abstract available