Fascin expression in colorectal carcinomas

PURPOSE: The purpose of this study was to investigate the significance of fascin expression in colorectal carcinoma. METHODS: This is a retrospective study of 167 consecutive, well-documented cases of primary colorectal adenocarcinoma for which archival material of surgical specimens from primary tumor resections were available. We chose a representative tissue sample block and examined fascin expression by immunohistochemistry using a primary antibody against "fascin". We calculated the "immunohistochemical score (IHS)" of fascin for each case, which was calculated from the multiplication of scores for the percentage of stained cells and the staining intensity. RESULTS: Fascin immunoreactivity was observed in 59 (35.3%) of all cases with strong reactivity in 24 (14.4%), moderate reactivity in 25 (14.9%) and weak reactivity in 10 (6.0%) cases. Strong/moderate immunoreactivities were mostly observed in invasive fronts of the tumors or in both invasive and other areas. Fascin immunoreactivity scores were significantly higher in tumors with lymph node metastasis (p:0.002) and advanced stage presentation (p:0.007). There was no relation between fascin expression and age, gender, depth of invasion, distant metastasis or histological grade (p>0.05). There was a higher and statistically significant correlation between fascin immunoreactivity in the invasive borders of tumors and lymph node metastasis (r:0.747, p:0.005). In stage III/IV tumors, two-year survival was 92.2% in tumors without fascin immunoreactivity, and only 60.0% in tumors with a fascin IHS>10 (p:0.003). CONCLUSION: These findings suggest that fascin is heterogeneously expressed in approximately one third of colorectal carcinomas with a significant association with lymph node metastasis, tumor stage and location. Moreover, these results indicate that fascin may have a role in the lymph node metastasis of colorectal carcinoma

Small Bowel Transection as a Rare Complication of Lumbar Disc Surgery: Report of a Case.

Small bowel injury resulting from the perforation of anterior longitudinal ligament during lumbar disc surgery is very rare, with prompt diagnosis being difficult. In the present study, we present a case of intestinal transection and discuss technical methods to prevent this complication with a review of literature. A 34-year-old woman, who had a history of lumbar disc surgery one day before, presented with abdominal pain. On physical examination, rebound tenderness and muscular rigidity were obtained, with emergency abdominal computed tomography confirming the diagnosis of perforation by showing free air and free fluid. The patient underwent laparoscopic exploration; the small bowel was found transected 60 cm proximally to the ileocecal valve. Since there were no signs of generalized peritonitis, the abdomen was irrigated with sterile saline, and side-to-side ileal anastomosis was performed. Her postoperative course was uneventful and she was discharged on the postoperative fifth day. Although bowel perforation after discectomy rarely occurs, it might be very fatal unless a prompt diagnosis is achieved. Especially, an early postoperative course can mask the symptoms and signs. Therefore, general surgeons should be aware of such a complication after lumbar disc surgery, and spine surgeons must be more cautious while they are using retractors in the intervertebral space. [Arch Clin Exp Surg 2015; 4(4.000): 222-225

Prognostic factors affecting overall survival in right colon cancer

Background: The prognosis of patients who have carcinoma of the colon is dependent on several factors that are clinical, pathological, and biological. Adequate lymph node staging in patients with colon cancer is important for determining prognosis and planning further treatment. We aimed to determine what factors might predict survival in patients with right colon cancer. Methods: Between 2007 and 2014, consecutive patients undergoing operation for adenocarcinoma of the right-sided colon were enrolled in this study. The following factors were analyzed with the Cox regression model: age, gender, localization of the tumor, recurrence, pTNM stage, removed and invaded lymph node status (MLN) and survival rate. Multivariate models were used to assess the adjusted effects and to explore the interaction between survival and other factors. Results: A total of 56 (38,1%) men and 91 (61,9%) women, mean age being 61,8 ± 15,9 years, were included. The mean survival time was 46,5 ± 43,2 months. The mean LN number was 18,8 ± 9,44; MLN number was 2,66 ± 5,13. Age, total LN, MLN number and postoperative stage were significant in the univariate analysis for survival. Independent predictors of survival in multivariate analysis were age (p=0,019), postoperative stage (p=0,039), and MLN (p=0,003). Conclusions: LN metastasis is a prognostic feature in patients by means of colon cancer. It could not be changed independent of a number of prognostic factors, such as age, but LN number was dependent on operation in right colon cancer surgery. LN yields have been linked to improved survival and its determination is reliant on both the surgeon and the pathologist. [Arch Clin Exp Surg 2017; 6(1.000): 17-32

BRAF Inhibitors for BRAF V600E Mutant Colorectal Cancers: Literature Survey and Case Report.

The main method of fighting against colon cancer is targeted treatment. BRAF inhibitors, which are accepted as standard treatment for V600E mutant malign melanomas, are the newest approach for targeted treatment of V600E mutant colorectal cancers. In this case report, we share our experience about the use of BRAF inhibitor vemurafenib on a V600E mutant metastatic right colon adenocarcinoma patient. A 59-year-old male with only lung multiple metastatic V600E mutant right colon cancer presented to our clinic. The patient was evaluated and FOLFOX + bevacizumab treatment was initiated, which was then continued with vemurafenib. A remarkable response was achieved with vemurafenib treatment in which the drug resistance occurred approximately in the sixth month. Even though the patient benefited majorly from vemurafenib, he died on the 20th month of the diagnosis. The expected overall survival for metastatic V600E mutant colon adenocarcinoma patients is 4.7 months. BRAF inhibitors provide new treatment alternatives for V600E mutant colorectal cancers, with prolonged overall survival. BRAF inhibitors in combination with MEK inhibitors are reported as feasible treatment to overcome BRAF inhibitor drug resistance on which phase studies are still in progress. To conclude, BRAF inhibitors alone or in combination with other drugs provide a chance for curing BRAF V600E mutant colorectal cancer patients

Factors affecting operative morbidity and long-term outcomes in patients undergoing surgery for presacral tumours: a multicentric cohort study from the Turkish Collaborative Group for Quality Improvement in Colorectal and Pelvic Surgery

Aim: Data regarding the operative management of presacral tumours present various dilemmas due to their rarity and heterogeneous nature. The aim of this study was to evaluate the management strategy, factors associated with operative morbidity and long-term postoperative outcomes in a large group of patients undergoing surgery for presacral tumours. Method: This study was designed as a multicentre retrospective cohort study. Records of patients who underwent surgery for presacral tumours at 10 tertiary colorectal centres between 1996 and 2017 were evaluated. Results: One hundred and twenty seven patients (44 men) with a mean age of 46 years and body mass index of 27 kg/m2 were included. Fifty eight per cent of the patients had low sacral lesions (below S3). The operative approaches were transabdominal (17%), transsacral (65%) and abdominosacral (17%). The postoperative morbidity was 19%. Thirty per cent of the patients had a malignant tumour. Longer duration of symptoms (p = 0.001), higher American Society of Anesthesiologists score (p = 0.01), abdominosacral operations (p = 0.0001) and presacral tumours located above S3 (p = 0.004) were associated with an increased risk of postoperative morbidity. Overall long-term postoperative recurrence and mortality were 6% and 5%, respectively, within a 3-year mean follow-up period in patients with presacral malignant tumours. Conclusion: Reduced physical condition, omission of symptoms prior to surgery, combined resections and high sacral tumours are the risk factors associated with postoperative complications in patients undergoing surgery for presacral tumours. Meticulous planning of the operation and intensified perioperative care may improve the outcomes in high-risk patients