OPTIMAL DIAGNOSTIC ALGORITHM FOR COLORECTAL CANCER COMPLICATED BY ACUTE BOWEL OBSTRUCTION

AIM: to work out a diagnostic program that allows to individualize approach in preoperative care and surgery for patients with colorectal cancer complicated by acute obstruction.PATIENTS AND METHODS: the study included 442 patients with colorectal cancer complicated by acute obstruction, at whom were used special diagnostic methods for the purpose of precise diagnosis.RESULTS: the most informative and safe methods for the diagnosis of tumor obstruction were abdominal X-ray, CT scan, colonoscopy (CS), barium enema (BE) and abdominal ultrasound. These methods allow to prove bowel obstruction and its stage, to detect the tumor site, depth of invasion, distant metastases, to control the efficacy of decompression and to make prognosis of the outcome in 87.2-96.4% patients.CONCLUSION: the information obtained allows to plan individually the use of conservative, endoscopic and surgical methods of treatment for patients with colorectal cancer complicated by acute bowel obstruction.

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Modern aspects of surgical treatment of patients with adhesive small bowel obstruction

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov49895 ◽

2021 ◽

Vol 12 (4) ◽

pp. 47-54

Author(s):

Badri V. Sigua ◽

Vyacheslav P. Zemlyanoy ◽

Sergey V. Petrov ◽

Diyora H. Qalandarova

Keyword(s):

Small Intestine ◽

Surgical Treatment ◽

Small Bowel ◽

Mortality Rate ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Diagnostic Algorithm ◽

Diagnostic Methods ◽

Adhesive Small Bowel Obstruction ◽

Surgical Interventions

Despite the ongoing preventive measures aimed at reducing the formation of adhesions in the abdominal cavity with an increase in the number of surgical interventions on the abdominal organs, the number of patients admitted to surgical hospitals with adhesions of the small intestine is also increasing. It should be noted that annually about 12% of previously operated patients undergo treatment in surgical departments while the exceptional fact is that 5070% are patients with acute adhesive ileus of the small intestine and the mortality rate in this group ranges from 13 to 55%. In recent years the literature has been actively discussing the advantages of minimally invasive technologies in the treatment of adhesive small bowel obstruction since the use of traditional methods often leads to the development of complications with repeated (in 60% of cases) surgical interventions. The purpose of this study was the development and implementation of an improved therapeutic and diagnostic algorithm in patients with adhesive small bowel obstruction which made it possible to improve the results of treatment. A comparative analysis of 338 patients with adhesive small bowel obstruction who were treated in the surgical departments of the St. Elizabeth Hospital in St. Petersburg in the period from 2016-2019 was carried out. All the patients were divided into 2 groups: the main (I) group (2018-2019), which consisted of 198 patients who received the improved diagnostic and treatment algorithm as well as the comparison group (II) (2016-2017) which included 140 cases these are patients examined according to the standard protocol and operated on in the traditional way. Moreover, in 98 cases, it was possible to resolve acute adhesive small intestinal obstruction in a conservative way, and 240 patients underwent surgical treatment. The developed diagnostic algorithm is based on the consistent application of the most informative diagnostic methods. At the same time the indications and the sequence of their application were established which ultimately made it possible to shorten the preoperative time interval as well as to determine the optimal treatment strategy with the choice of the type of surgical treatment (laparotomy or laparoscopy). The proposed treatment and diagnostic algorithm allowed to reduce the complication rate from 46.5% (53) to 22.2% (28) (р 0,001), and the mortality rate from 14.9% (17) to 3.9% (5) (p 0,01).

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Serum ROBO4 and CLEC14A: preliminary evaluation as diagnostic and progression biomarkers in colorectal cancer patients

10.21203/rs.3.rs-142043/v2 ◽

2021 ◽

Author(s):

Łukasz Pietrzyk ◽

Kamil Torres

Keyword(s):

Colorectal Cancer ◽

Serum Concentration ◽

Cancer Patients ◽

Distant Metastases ◽

Tnm Stage ◽

Preliminary Evaluation ◽

Depth Of Invasion ◽

Clinical Value ◽

Serum Samples ◽

Before And After

Abstract Background: Colorectal cancer (CRC) is an important global burden, and the discovery of biomarkers for screening and monitoring is a current challenge. The present study aimed to determine the serum concentration of ROBO4 and CLEC14A in CRC patients and assess the clinical value of these diagnostic and progression biomarkers in CRC.Methods: Serum samples were collected from 32 patients with operable colorectal cancer and from 16 healthy individuals. Blood serum of CRC patients were tested at two time points (before and after surgery). Serum concentration of ROBO4 and CLEC14A were measured using ELISA tests.Results: The serum concentrations of ROBO4 and CLEC14A were significantly higher in CRC patients than non-cancer controls; the concentrations were already higher in TNM stage I + II CRC patients. The sensitivitiy and specificity of ROBO4 and CLEC14A in distiguishing cancer patients form controls ranged from 71.9–100% and from 84.5–100%, respectively. The serum ROBO4 concentration was associated with the TNM stage, depth of invasion, and lymph node and distant metastases. No significant relationship was observed between the CLEC14A concentration and the tumor site or the N and M stages. The level of ROBO4 was statistically lower 3 months after the surgery, compared to the level noted prior to the operation. The concentration of CLEC14A decreased in the postoperative period, compared to preoperative one; however, the decline was not statistically significant.Conclusion: Our preliminary study has provided evidence that ROOB4 and CLEC14A seem to be suitable biomarkers for clinical diagnostic purposes. However, ROOB4 appears to be more appropriate for assessment of CRC progression.

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FEATURES OF DIAGNOSIS AND TREATMENT OF ELDERLY AND SENILE PATIENTS WITH ADHESIVE SMALL BOWEL OBSTRUCTION

Успехи геронтологии ◽

10.34922/ae.2021.34.1.004 ◽

2021 ◽

pp. 33-38

Author(s):

Б.В. Сигуа ◽

В.П. Земляной ◽

С.В. Петров ◽

Д.Х. Каландарова ◽

А. Л. Ефимов

Keyword(s):

Small Bowel ◽

Mortality Rate ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Comparison Group ◽

Treatment Algorithm ◽

Diagnostic Algorithm ◽

Main Group ◽

Diagnostic Methods ◽

Adhesive Small Bowel Obstruction

Спаечная тонкокишечная непроходимость является часто встречающейся патологией с тенденцией к нарастанию, характеризуется сложным патогенетическим течением, с высоким процентным соотношением осложнений и летальных исходов. Среди форм кишечной непроходимости, обусловленных механическим препятствием, острая тонкокишечная непроходимость составляет 64,3-80 % с летальностью 5,1-8,4 % в структуре ургентных заболеваний. Сложность ранней диагностики наряду со стертой клинической картиной, тяжелым течением на отягощенном фоне у лиц пожилого и старческого возраста ведет к поиску новых оптимизированных лечебнодиагностических протоколов. Цель исследования - изучение характера течения спаечной тонкокишечной непроходимости у лиц пожилого и старческого возраста, установление информативности различных методов диагностики, определение показаний к выбору оптимального срока и метода лечения. Проведен сравнительный анализ по результатам лечения 191 пациента 60-90 лет и старше, получавших лечение в хирургических отделениях Елизаветинской больницы (Санкт-Петербург) в период 2016-2019 гг. Все пациенты были разделены на две группы: основную составили 106 пациентов (2018-2019 гг.), группу сравнения - 85 пациентов (2016-2017 гг.). Для всех пациентов основной группы использован усовершенствованный лечебно-диагностический алгоритм с применением оригинальной балльно-оценочной шкалы, который позволил оптимизировать диагностику и улучшить результаты лечения. Пациенты группы сравнения были обследованы в соответствии со стандартными протоколами, оперативное лечение осуществляли исключительно традиционными методами. Применение предложенного лечебно-диагностического алгоритма позволило увеличить вероятность консервативного разрешения острой спаечной тонкокишечной непроходимости с 20 % (17) до 33 % (35), снизить частоту послеоперационных осложнений с 60,2 % (41) до 25,3 % (18), р<0,01, а уровень летальности - с 23,5 % (16) до 7 % (5), р<0,05. Adhesive small bowel obstruction is a common pathology with a tendency to increase characterized by a complex pathogenetic course with a high percentage of complications and deaths. Among the forms of intestinal obstruction caused by mechanical obstacles acute small bowel obstruction ranges from 64,3 to 80 % with a mortality rate of 5,1 to 8,4 % in the structure of urgent diseases. The complexity of early diagnosis along with an erased clinical picture severe course against a burdened background as well as age - in elderly and senile people leads to the search for new optimized treatment and diagnostic protocols. The purpose of this study was to study the nature of the course of adhesive small bowel obstruction in elderly and senile people to establish the information content of various diagnostic methods to determine the indications for the choice of the optimal period and method of treatment. A comparative analysis of 191 patients aged 60 to 90 years and older who received treatment in the surgical departments of St. Elizabeth Hospital (St. Petersburg) in the period from 2016-2019 was carried out. All patients were divided into 2 groups: the main group consisted of 106 patients (2018-2019) the comparison group included 85 patients (2016-2017). All patients of the main group used an improved diagnostic and treatment algorithm with the use of an original point-assessment scale which made it possible to optimize diagnostics and improve treatment results. Patients in the comparison group were examined in accordance with standard protocols and surgical treatment was carried out exclusively by traditional methods. The use of the proposed therapeutic and diagnostic algorithm made it possible to increase the probability of conservative resolution of acute adhesive small bowel obstruction from 20 % (17) to 33 % (35) and to reduce the incidence of postoperative complications from 60,2 % (41) to 25,3 % (18), p<0,01, and the mortality rate from 23,5 % (16) to 7 % (5), p<0,05.

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Serum ROBO4 and CLEC14A: Preliminary Evaluation as Diagnostic and Progression Biomarkers in Colorectal Cancer Patients

10.21203/rs.3.rs-142043/v1 ◽

2021 ◽

Author(s):

Łukasz Pietrzyk ◽

Kamil Torres

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Distant Metastases ◽

Tnm Stage ◽

Preliminary Evaluation ◽

Depth Of Invasion ◽

Clinical Value ◽

Before And After ◽

Preliminary Study ◽

Colorectal Cancer Patients

Abstract Colorectal cancer (CRC) is an important global burden, and the discovery of biomarkers for screening and monitoring is a current challenge. The present study aimed to determine the serum concentration of ROBO4 and CLEC14A in CRC patients and assess the clinical value of these diagnostic and progression biomarkers in CRC. The ROBO4 and CLEC14A levels were measured using ELISA tests. Blood sera were tested in 32 CRC patients and 16 controls at two time points (before and after surgery). The serum concentrations of ROBO4 and CLEC14A were significantly higher in CRC patients than non-cancer controls; the concentrations were already higher in TNM stage I+II CRC patients. The sensitivitiy and specificity of ROBO4 and CLEC14A in distiguishing cancer patients form controls ranged from 71.9% to 100% and from 84.5% to 100%, respectively. The serum ROBO4 concentration was associated with the TNM stage, depth of invasion, and lymph node and distant metastases. No significant relationship was observed between the CLEC14A concentration and the tumor site or the N and M stages. The level of ROBO4 was statistically lower 3 months after the surgery, compared to the level noted prior to the operation. The concentration of CLEC14A decreased in the postoperative period, compared to preoperative one; however, the decline was not statistically significant. Our preliminary study has provided evidence that ROOB4 and CLEC14A seem to be suitable biomarkers for clinical diagnostic purposes. However, ROOB4 appears to be more appropriate for assessment of CRC progression.

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COMPARATIVE EVALUATION OF MULTIPARAMETRIC ENDORECTAL ULTRASOUND AND ENHANCED IMAGING COLONOSCOPY IN THE DIAGNOSIS OF EARLY COLORECTAL CANCER

Koloproktologia ◽

10.33878/2073-7556-2020-19-3-49-64 ◽

2020 ◽

Vol 19 (3) ◽

pp. 49-64

Author(s):

E. M. Bogdanova ◽

Yu. L. Trubacheva ◽

O. M. Yugai ◽

S. V. Chernyshov ◽

E. G. Rybakov ◽

...

Keyword(s):

Colorectal Cancer ◽

Statistical Significance ◽

Muscle Layer ◽

Endorectal Ultrasound ◽

Diagnostic Methods ◽

Early Colorectal Cancer ◽

Morphological Examination ◽

Optical Magnification ◽

The Difference ◽

Enhanced Imaging

AIM: to compare multiparametric endorectal ultrasound (ERUS) and enhanced imaging colonoscopy in the diagnosis of early colorectal cancer.PATIENTS AND METHODS: the study included 78 patients with epithelial rectal tumor. All the patients underwent multiparametric ERUS and colonoscopy with examination by narrow beam imaging (NBI) at optical magnification. All the patients were operated.RESULTS: a morphological examination removed specimens revealed adenomas in 48 cases, in 19 specimens – adenocarcinomas in situ and T1, and in 11 specimens – adenocarcinomas with invasion of the muscle layer or deeper. When calculating the accuracy indicators of diagnostic methods for groups of patients with adenoma, Tis-T1 adenocarcinoma, and T2-T3 adenocarcinoma, the difference in the sensitivity and specificity of the methods in none of the presented groups did not reach the level of statistical significance (p>0.05).ROC analysis showed that ultrasound has a prognostic value comparable to colonoscopy. The area difference was 0.013 (p=0.85).CONCLUSION: endoscopy and ultrasound have similar value in the diagnosis of malignant transformation of rectal adenomas.

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Nomogram based on homogeneous and heterogeneous associated factors for predicting distant metastases in patients with colorectal cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02140-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Tianwen Luo ◽

Yutong Wang ◽

Xuefeng Shan ◽

Ye Bai ◽

Chun Huang ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Lung Metastases ◽

Roc Curves ◽

Distant Metastases ◽

Good Prediction ◽

Operating Characteristics ◽

Good Prediction Performance ◽

Different Types ◽

Associated Risk Factors

Abstract Background The identification of the homogeneous and heterogeneous risk factors for different types of metastases in colorectal cancer (CRC) may shed light on the aetiology and help individualize prophylactic treatment. The present study characterized the incidence differences and identified the homogeneous and heterogeneous risk factors associated with distant metastases in CRC. Methods CRC patients registered in the SEER database between 2010 and 2016 were included in this study. Logistic regression was used to analyse homogeneous and heterogeneous risk factors for the occurrence of different types of metastases. Nomograms were constructed to predict the risk for developing metastases, and the performance was quantitatively assessed using the receiver operating characteristics (ROC) curve and calibration curve. Results A total of 204,595 eligible CRC patients were included in our study, and 17.07% of them had distant metastases. The overall incidences of liver metastases, lung metastases, bone metastases, and brain metastases were 15.34%, 5.22%, 1.26%, and 0.29%, respectively. The incidence of distant metastases differed by age, gender, and the original CRC sites. Poorly differentiated grade, more lymphatic metastasis, higher carcinoembryonic antigen (CEA), and different metastatic organs were all positively associated with four patterns of metastases. In contrast, age, sex, race, insurance status, position, and T stage were heterogeneously associated with metastases. The calibration and ROC curves exhibited good performance for predicting distant metastases. Conclusions The incidence of distant metastases in CRC exhibited distinct differences, and the patients had homogeneous and heterogeneous associated risk factors. Although limited risk factors were included in the present study, the established nomogram showed good prediction performance.

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472 Addressing the Quality of Hospital Care of Colorectal Cancer Patients Undergoing Surgery: What Did We Learn from the National Bowel Cancer Audit?

British Journal of Surgery ◽

10.1093/bjs/znab134.558 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

C Li ◽

S Z Y Ooi ◽

T Woo ◽

P H M Chan

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

External Validation ◽

Distant Metastases ◽

Management Plan ◽

Bowel Cancer ◽

Clinical Factors ◽

Quality Outcomes ◽

Colorectal Cancer Patients

Abstract Aim To identify the most relevant clinical factors in the National Bowel Cancer Audit (NBOCA) that contribute to the variation in the quality of care provided in different hospitals for colorectal cancer patients undergoing surgery. Method Data from 36,116 patients with colorectal cancer who had undergone surgery were retrospectively collected from the NBOCA and analysed from 145 and 146 hospitals over two years. A validated multiple linear regression was performed to compare the identified clinical factors with various quality outcomes. The quality outcomes defined in this study were the length of hospitalisation, 2-year mortality, readmission rate, 90-day mortality, and 18-month stoma rate. Results Four clinical factors (laparoscopy rate, abdominal-perineal-resection-of-rectum (APER), pre-operative radiotherapy and patients with distant metastases) were shown to have a significant (p < 0.05) impact on the length of hospitalisation and 18-month stoma rate. 18-month stoma rate was also significantly associated with 2-year mortality. External validation of the regression model demonstrated the Root-Mean-Square-Error of 0.811 and 4.62 for 18-month stoma rate and 2-year mortality respectively. Conclusions Hospitals should monitor the four clinical factors for patients with colorectal cancer during perioperative care. Clinicians should consider these factors along with the individual patients’ history when formulating a management plan for patients with colorectal cancer.

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Clostridioides difficile Infection, Still a Long Way to Go

Journal of Clinical Medicine ◽

10.3390/jcm10030389 ◽

2021 ◽

Vol 10 (3) ◽

pp. 389

Author(s):

Eleftheria Kampouri ◽

Antony Croxatto ◽

Guy Prod’hom ◽

Benoit Guery

Keyword(s):

Fecal Microbiota Transplantation ◽

Diagnostic Algorithm ◽

Fecal Microbiota ◽

Diagnostic Methods ◽

Special Focus ◽

Surveillance Systems ◽

Main Question ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

The Right

Clostridioides difficile is an increasingly common pathogen both within and outside the hospital and is responsible for a large clinical spectrum from asymptomatic carriage to complicated infection associated with a high mortality. While diagnostic methods have considerably progressed over the years, the optimal diagnostic algorithm is still debated and there is no single diagnostic test that can be used as a standalone test. More importantly, the heterogeneity in diagnostic practices between centers along with the lack of robust surveillance systems in all countries and an important degree of underdiagnosis due to lack of clinical suspicion in the community, hinder a more accurate evaluation of the burden of disease. Our improved understanding of the physiopathology of CDI has allowed some significant progress in the treatment of CDI, including a broader use of fidaxomicine, the use of fecal microbiota transplantation for multiples recurrences and newer approaches including antibodies, vaccines and new molecules, already developed or in the pipeline. However, the management of CDI recurrences and severe infections remain challenging and the main question remains: how to best target these often expensive treatments to the right population. In this review we discuss current diagnostic approaches, treatment and potential prevention strategies, with a special focus on recent advances in the field as well as areas of uncertainty and unmet needs and how to address them.

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