Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Woodchuck hepatitis virus core gene deletions and proliferative responses of peripheral blood mononuclear cells stimulated by an immunodominant epitope: a viral immune escape in the woodchuck model of chronic hepatitis B?

Marmota monax and its natural infection by woodchuck hepatitis virus (WHV) could be used as a predictive model for evaluating mechanisms of viral persistence during chronic hepatitis B virus (HBV) infection. The aim of this study was to investigate the presence of viral variants in the core gene of chronically WHV-infected woodchucks that showed two different patterns of peripheral blood mononuclear cells’ (PBMCs’) responses after stimulation with a specific WHV core peptide. Sequences’ analysis of the WHV core region from eight WHV chronically infected woodchucks have been performed after in vitro stimulation with an immunodominant epitope of the WHV core protein (amino acids [aa] 96-110). Following this stimulation, positive PBMC responses at each point of follow-up were observed for four animals (group A), and weak immune responses at one or a few points of follow-up were observed for the remaining four animals (group B). The WHV core gene sequences contained amino acid deletions (aa 84-126, aa 84-113) in three of four group A animals and in none of group B animals. In the group A animals, the same deletions were observed in liver specimens and in two of four tumor specimens. Hepatocellular carcinoma (HCC) was diagnosed in all group A animals and in one group B animal. In conclusion, internal deletions in the core region correlated with a sustained PBMC response to the immunogenic peptide (96- 110) of the core protein. A possible role of this relationship in hepatocarcinogenesis could be hypothesized; however, this needs to be investigated in patients with chronic HBV infection. The evaluation of virus-specific T-cell responses and T-cell epitopes that are possibly related to the mechanisms of viral evasion should be further investigated in order to design combined antiviral and immune approaches to control chronic HBV infection

MEDICAL AND SURGICAL TREATMENT OF CHRONIC ANAL FISSURE: PROSPECTIVE LONG-TERM RESULTS

Background: we previously assessed the efficacy of different medical and surgical treatments for chronic anal fissure (CAF). In this prospective audit we present longer-term results of this study in a larger series.Patients and Methods: From 01/04 to 09/08, 294 patients with typical CAF were enrolled. All patients were treated with 0.2% nitroglycerin ointment (GTN) or anal dilators (DIL) for 8 weeks. Those patients in which no improvement in symptoms was observed after 8 weeks were crossed to the other treatment (GTN or DIL) or switched to a combination of the two. Persisting symptoms after 12 weeks or recurrence were indications for either botulinum toxin injection into the internal sphincter and fissurectomy (BTX) or LIS. Primary end-point was fissure healing at last follow-up. Secondary end-points were symptomatic improvement, need for lateral internal sphincterotomy (LIS), and side effects. Differences between treatment groups were evaluated by chi square test. Results: patients' demographics, fissure characteristics and treatment results are resumed in Table 1. Mean follow-up was 36±17 months. Recurrence rate after 12 weeks treatment was similar between GTN and DIL (11.5% vs 9.3%). Overall fissure healing after medical treatment was 69.7% without significant differences between GTN (57.2%), DIL (66.9%) or a combination of the two (59.5%). Side effects (GTN) or severe discomfort (DIL) were observed in 13.2% of the patients. Thirty patients were treated with BTX and 64 underwent LIS (including BTX failures). At the end of the follow-up healing rates were 83.3% after BTX and 100% after LIS. No morbidity or postoperative incontinence were observed in both surgical groups.Conclusions: This study confirms that LIS is far more effective than medical treatments for CAF. However, BTX injection/fissurectomy as first line treatment may significantly increase the healing rate while avoiding any risk of incontinence. Table 1: patients' demographics, fissure characteristics and treatment results. GTN DIL GTN/DIL BTX/Fissurectomy LIS Number 173 121 42 30 64 Mean Age (years) 41 43 43 38 45 Sex (M/F) 80/93 52/69 28/14 11/19 27/32 Fissure position Ant 19 18 8 2 15 Post 145 97 32 26 47 Both/other 9 6 2 2 2 Single treatment (12 weeks) success N/% 95/173 (54.9%) 75/121 (61%) NA NA NA Recurrence 11/95 (11.5%) 7/75 (9.3%) NA NA NA After cross-over healing N/% 20/50 (40%) 16/32 (50%) 17/42 (40.4%) NA NA Recurrence 5/20 (25%) 3/16 (18.7%) 4/17 (23.5%) NA NA Overall success N/% 99/173 (57.2%) 81/121 (66.9%) 25/42 (59.5%) 25/30 (83.3%) 64/64 (100%) NA= not applicabl

Histotype influences emergency presentation and prognosis in colon cancer surgery

Aim: To investigate whether differences in histotype in colon cancer correlate with clinical presentation and if they might influence oncological outcomes and survival. Methods: Data regarding colon cancer patients operated both electively or in emergency between 2009 and 2014 were retrospectively collected from a prospectively maintained database and analyzed for the purpose of this study. Rectal cancer was excluded from this analysis. Statistical univariate and multivariate analyses were performed to investigate possible significant variables influencing clinical presentation, as well as oncological outcomes and survival. Results: Data from 219 patients undergoing colo-rectal resection for cancer of the colon only were retrieved. One hundred seventy-four patients had an elective procedure and forty-five had an emergency colectomy. Emergency presentation was more likely to occur in mucinous (p<0.05) and signet-ring cell (p<0.01) tumors. No definitive differences in 5-year overall (44.7% vs. 60.6%, p=0.078) and disease free survival (51.2% vs. 64.4%, p=0.09) were found between the two groups as a whole, but the T3 emergency patients showed worse prognosis than the elective (p<0.03). Lymph-node invasion, laparoscopy, histology, and blood transfusions were independent variables found to influence survival. Distribution assessed for pTNM stage showed T3 cancers were more common in emergency (p<0.01). Conclusions and discussion: Mucinous and signet-ring cell tumors are related to emergency presentation, pT3 stage, poorest outcomes and survival. Disease-free survival in patients who had emergency surgery for T3 colon cancer seems related to the histotype

MEDICAL AND SURGICAL TREATMENT OF CHRONIC ANAL FISSURE: PROSPECTIVE LONG-TERM RESULTS

Background: we previously assessed the efficacy of different medical and surgical treatments for chronic anal fissure (CAF). In this prospective audit we present longer-term results of this study in a larger series.Patients and Methods: From 01/04 to 09/08, 294 patients with typical CAF were enrolled. All patients were treated with 0.2% nitroglycerin ointment (GTN) or anal dilators (DIL) for 8 weeks. Those patients in which no improvement in symptoms was observed after 8 weeks were crossed to the other treatment (GTN or DIL) or switched to a combination of the two. Persisting symptoms after 12 weeks or recurrence were indications for either botulinum toxin injection into the internal sphincter and fissurectomy (BTX) or LIS. Primary end-point was fissure healing at last follow-up. Secondary end-points were symptomatic improvement, need for lateral internal sphincterotomy (LIS), and side effects. Differences between treatment groups were evaluated by chi square test. Results: patients' demographics, fissure characteristics and treatment results are resumed in Table 1. Mean follow-up was 36±17 months. Recurrence rate after 12 weeks treatment was similar between GTN and DIL (11.5% vs 9.3%). Overall fissure healing after medical treatment was 69.7% without significant differences between GTN (57.2%), DIL (66.9%) or a combination of the two (59.5%). Side effects (GTN) or severe discomfort (DIL) were observed in 13.2% of the patients. Thirty patients were treated with BTX and 64 underwent LIS (including BTX failures). At the end of the follow-up healing rates were 83.3% after BTX and 100% after LIS. No morbidity or postoperative incontinence were observed in both surgical groups.Conclusions: This study confirms that LIS is far more effective than medical treatments for CAF. However, BTX injection/fissurectomy as first line treatment may significantly increase the healing rate while avoiding any risk of incontinence. Table 1: patients' demographics, fissure characteristics and treatment results. GTN DIL GTN/DIL BTX/Fissurectomy LIS Number 173 121 42 30 64 Mean Age (years) 41 43 43 38 45 Sex (M/F) 80/93 52/69 28/14 11/19 27/32 Fissure position Ant 19 18 8 2 15 Post 145 97 32 26 47 Both/other 9 6 2 2 2 Single treatment (12 weeks) success N/% 95/173 (54.9%) 75/121 (61%) NA NA NA Recurrence 11/95 (11.5%) 7/75 (9.3%) NA NA NA After cross-over healing N/% 20/50 (40%) 16/32 (50%) 17/42 (40.4%) NA NA Recurrence 5/20 (25%) 3/16 (18.7%) 4/17 (23.5%) NA NA Overall success N/% 99/173 (57.2%) 81/121 (66.9%) 25/42 (59.5%) 25/30 (83.3%) 64/64 (100%) NA= not applicabl

Minimal open access ileocolic resection in complicated Crohn’s disease of the terminal ileum

The objective of this study was to evaluate the possibility to undertake an ileocolic resection in complex Crohn’s disease using a minimal open abdominal access using standard laparoscopic instruments. The incision was carried out over the previous McBurney scar, with a mean length of 6 cm. Seventy-two patients with complicated Crohn’s disease underwent IC resection in the considered period; 12 patients had a McBurney scar due to a previous appendectomy and represented the group of study. Feasibility and safety of the procedure were evaluated. Clinical data and outcome were compared with a control arm of 15 patients who had a standard laparoscopic IC resection, pooled out from our database among those who had a McBurney incision as service incision. Mean operative time and postoperative stay were significantly shorter in the study group. Blood loss and operative costs were also lower in the study group but did not reach statistical significance. Minimal open access ileocolic resection (MOAIR) through a small McBurney incision seems safe and feasible in complex Crohn’s disease. Some advantages over standard laparoscopic surgery could be found in surgical outcomes and costs