scholarly journals The Impact of Patient Characteristics and Tumor Biology on the Accuracy of Preoperative Staging of Colon Cancer in Denmark. A Nationwide Cohort Study

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4384
Author(s):  
Malene Roland V. Pedersen ◽  
Søren Rafael Rafaelsen ◽  
Jan Lindebjerg ◽  
Torben Frøstrup Hansen ◽  
Hans Bjarke Rahr
Keyword(s):  
Colon Cancer ◽  
Bowel Resection ◽  
Preoperative Staging ◽  
Clinical Staging ◽  
Resected Specimen ◽  
Common Disease ◽  
Curative Intent ◽  
Mmr Deficiency ◽  
The Impact ◽  
Histopathological Type

Background: Colon cancer is a common disease in western populations. The aim of this study was to assess the impact of mismatch repair (MMR) deficiency and other patient and tumor characteristics on the accuracy of preoperative staging by comparing histopathological T- and N-categories of the resected specimen with the preoperative clinical stage in a nationwide cohort of patients treated for colon cancer by elective bowel resection with curative intent. Methods: A register study of a cohort extracted from the Danish Colorectal Cancer Group (DCCG) database, which holds prospective data on all new cases of colon and rectum cancer in Denmark. Patients diagnosed with colon cancer and treated with an elective bowel resection with curative intent in the years 2016–2019 were analyzed. Results: A total of 6102 patients were included (n = 3161 (52%) men and n = 2941 (48%) women) with a median age of 72 years (range 23–97 years). MMR was deficient in 24% of the patients and proficient in 76%. MMR deficiency, tumor sidedness and histopathological type were significant predictors of the accuracy of preoperative staging of colon cancer in univariate and multivariate analysis. MMR status in particular showed a strong impact on the risk of overstaging. Conclusions: MMR deficiency, but also tumor sidedness and to some degree histopathological type, impacted the accuracy of preoperative staging of colon cancer. MMR status should be taken into consideration in everyday clinical staging.

Surgical management of liver metastasis

2018 ◽  
pp. 415-420
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Colon Cancer ◽  
Liver Metastasis ◽  
Surgical Management ◽  
Preoperative Staging ◽  
Treatment Algorithm ◽  
Metastatic Colon Cancer ◽  
Management Options ◽  
Curative Intent ◽  
Standard Practice ◽  
Team Meeting

The liver is the most common site for metastases. Perioperative investigations are explored and are critical to the decision as to whether liver metastases should be treated with curative intent. Careful preoperative staging and discussion at a multidisciplinary team meeting is standard practice in established units. This chapter examines surgical management options as well as the neoadjuvant therapies. It details a treatment algorithm for synchronous metastatic colon cancer. It explores newer techniques for improving resectability.

Stage-based variation in the impact of colon cancer surveillance.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3609-3609
Author(s):  
Lucy Gately ◽  
Christine Semira ◽  
Azim Jalali ◽  
Ian Faragher ◽  
Sumitra Ananda ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Recurrence Rate ◽  
Cancer Surveillance ◽  
Stage I ◽  
Stage At Diagnosis ◽  
Recurrence Rates ◽  
Curative Intent ◽  
Oligometastatic Disease ◽  
The Impact

3609 Background: Multiple meta-analyses have demonstrated that routine surveillance following curative intent colorectal cancer surgery improves overall survival. This benefit is largely driven by early detection and curative intent resection of oligometastatic disease. Intuitively, any surveillance benefit should be proportional to recurrence risk, leading some to question the value of surveillance for stage I patients where recurrence rates are low. However, the survival benefit of surveillance has not previously been reported by stage. Methods: We explored data from a multi-site cohort of colorectal cancer patients (pts) diagnosed from 1 January 2001 to 31 December 2016. Pts were followed according to standard protocols with a standardized comprehensive outcome data captured prospectively. Pts with a rectal primary or metastatic disease at presentation were excluded from the analysis. We examined the correlation of stage at diagnosis with tumor recurrence and subsequent outcomes. Results: Of 3608 colon cancer pts, 690 (19%) had stage 1, 1580 (44%) had stage 2, and 1338 (37%) had stage 3 disease. Median follow-up was 7.8 years. Stage at diagnosis impacted recurrence rate (4% stage I vs 12% stage II vs 28% stage III, p < .0001) but not median time to recurrence. Recurrence patterns varied with stage (e.g. distant nodal disease 5% vs 7% vs 16%, p = .003; liver metastases 90% vs 53% vs 42%, p = 0.001). In pts with recurrence, resection of oligometastatic disease varied significantly by stage (58% vs 42% vs 30%, p < .0001) as did post-resection 5 year survival (91% vs 66% vs 43%, p < 0.001). In pts with recurrence treated with palliative intent, stage at diagnosis also impacted post-recurrence 5 year survival (11% vs 7% vs 5%, p < 0.03). Conclusions: Colon cancer stage at diagnosis substantially impacts the proportion of pts able to undergo curative intent surgery for surveillance detected recurrent disease, potentially driven by stage specific metastatic patterns. Stage at diagnosis also has a significant impact on post-resection survival outcomes potentially driven by stage specific biology. Our data indicate a far greater survival impact of surveillance for stage I colon cancer than would be anticipated based on recurrence rate alone.

The impact of mismatch repair status to the preoperative staging of local colon cancer: Implications for clinical management.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 16-16
Author(s):  
Torben Hansen ◽  
Emilie Erbs ◽  
Natacha D. Trabjerg ◽  
Soeren Rafael Rafaelsen ◽  
Jan Lindebjerg ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Ct Scan ◽  
Mismatch Repair ◽  
Clinical Management ◽  
Preoperative Staging ◽  
Lymph Node Staging ◽  
Cancer Group ◽  
Preoperative Ct ◽  
Pn Stage ◽  
The Impact

16 Background: Computed tomography (CT) scan is standard in preoperative local staging of colon cancer. Tumours with a deficient mismatch repair (dMMR) system are characterised by unique clinical and pathophysiologic aspects that may impact on the accuracy of the preoperative CT staging. Methods: Data from the Danish Colorectal Cancer Group national clinical database addressing a cohort of patients operated for stage I-III colon cancer in 2010-15 was analysed. The analyses of MMR status had been conducted consecutively through means of immunohistochemistry. All CT scans were blindly assessed by a certified radiologist. Results: Data from 590 patients, operated at a specialised cancer centre were available for analyses. A dMMR phenotype was detected in 135 (22.9%) of the patients. The overall correlation of the clinical and pathological T-category was significant for both groups. There was inferior correlation between cN and pN (p > 0.05) in pMMR cancers with a higher degree of over-staging assessed by CT-scan, compared to a significant correlation between cN and pN stage in pMMR cancers (p < 0.01). Of the 91 dMMR tumours judged node-positive by the preoperative CT scan, 59 (64.8%) showed no sign of metastatic involvement at the postoperative assessment. Conclusions: The accuracy of preoperative CT lymph node staging in colon cancer seems to differ depending on MMR status and may impact the clinical management including the neoadjuvant setting.

scholarly journals The impact of mismatch repair status to the preoperative staging of colon cancer: implications for clinical management

2020 ◽  
Vol 9 (2) ◽  
pp. CRC20
Author(s):  
Emilie Erbs ◽  
Søren Rafael Rafaelsen ◽  
Jan Lindebjerg ◽  
Lars Henrik Jensen ◽  
Torben Frøstrup Hansen
Keyword(s):  
Colon Cancer ◽  
Mismatch Repair ◽  
Preoperative Staging ◽  
Lymph Node Staging ◽  
Clinical Database ◽  
National Clinical Database ◽  
Cancer Group ◽  
Metastatic Involvement ◽  
Mismatch Repair Status ◽  
The Impact

Aims: We sought to investigate if mismatch repair (MMR) status influences the preoperative staging of local colon cancer. Methods: Data from 590 patients in the Danish Colorectal Cancer Group national clinical database who were operated on for stage I-III colon cancer in 2010-15 were included. MMR status was determined by immunohistochemistry. Results: 22.9% had deficient(d) MMR tumors. Correlation of the clinical and pathological T-category was significant for both groups. The correlation of pre- and postoperative N-category was inferior (p >0.05) in dMMR cancers compared to a significant (p <0.01) correlation in proficient MMR cancers. 64.8% of dMMR tumors assessed node-positive demonstrated no sign of metastatic involvement at the postoperative assessment. Conclusion: MMR status seems to impact the accuracy of preoperative lymph node staging.

scholarly journals Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer

2021 ◽  
Author(s):  
Bjarte T. Andersen ◽  
Bojan V. Stimec ◽  
Bjørn Edwin ◽  
Airazat M. Kazaryan ◽  
Przemyslaw J. Maziarz ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Splenic Vein ◽  
Vascular Anatomy ◽  
Middle Colic Artery ◽  
Inferior Mesenteric Vein ◽  
Anatomical Landmarks ◽  
Colic Artery ◽  
Mesenteric Vein ◽  
Wide Range ◽  
The Impact

Abstract Background The impact of the position of the middle colic artery (MCA) bifurcation and the trajectory of the accessory MCA (aMCA) on adequate lymphadenectomy when operating colon cancer have as of yet not been described and/or analysed in the literature. The aim of this study was to determine the MCA bifurcation position to anatomical landmarks and to assess the trajectory of aMCA. Methods The colonic vascular anatomy was manually reconstructed in 3D from high-resolution CT datasets using Osirix MD and 3-matic Medical and analysed. CT datasets were exported as STL files and supplemented with 3D printed models when required. Results Thirty-two datasets were analysed. The MCA bifurcation was left to the superior mesenteric vein (SMV) in 4 (12.1%), in front of SMV in 17 (53.1%) and right to SMV in 11 (34.4%) models. Median distances from the MCA origin to bifurcation were 3.21 (1.18–15.60) cm. A longer MCA bifurcated over or right to SMV, while a shorter bifurcated left to SMV (r = 0.457, p = 0.009). The main MCA direction was towards right in 19 (59.4%) models. When initial directions included left, the bifurcation occurred left to or anterior to SMV in all models. When the initial directions included right, the bifurcation occurred anterior or right to SMV in all models. The aMCA was found in 10 (31.3%) models, following the inferior mesenteric vein (IMV) in 5 near the lower pancreatic border. The IMV confluence was into SMV in 18 (56.3%), splenic vein in 11 (34.4%) and jejunal vein in 3 (9.4%) models. Conclusion Awareness of the wide range of MCA bifurcation positions reported is crucial for the quality of lymphadenectomy performed. The aMCA occurs in 31.3% models and its trajectory is in proximity to the lower pancreatic border in one half of models, indicating that it needs to be considered when operating splenic flexure cancer.

The impact of magnetic resonance in the preoperative staging and the surgical planning for treating small bowel neoplasms

Surgery Today ◽  
2012 ◽  
Vol 43 (6) ◽  
pp. 613-619 ◽  
Author(s):  
Giuseppe Pappalardo ◽  
GianFranco Gualdi ◽  
Aldo Nunziale ◽  
Gabriele Masselli ◽  
Irene Floriani ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Small Bowel ◽  
Surgical Planning ◽  
Preoperative Staging ◽  
Small Bowel Neoplasms ◽  
The Impact

scholarly journals Loss of HER2 Positivity after Trastuzumab in HER2-Positive Gastric Cancer: Is Change in HER2 Status Significantly Frequent?

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Yu Ishimine ◽  
Akira Goto ◽  
Yoshito Watanabe ◽  
Hidetaka Yajima ◽  
Suguru Nakagaki ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gastric Cancer ◽  
Residual Tumor ◽  
Her2 Status ◽  
Resected Specimen ◽  
Her2 Positive ◽  
Curative Intent ◽  
Course Of Disease ◽  
Trastuzumab Therapy ◽  
Her2 Positivity

Trastuzumab has recently been introduced as a treatment for HER2-positive metastatic and/or unresectable gastric cancer (MUGC); however, compared with breast cancer, some issues concerning HER2 and trastuzumab therapy for gastric cancer remain unclear. A 74-year-old woman received trastuzumab-containing chemotherapy for HER2-positive MUGC. She had a marked response to 8 months of chemotherapy, and gastrectomy and hepatic metastasectomy with curative intent were performed. The resected specimen showed complete loss of HER2 positivity in the residual tumor. For MUGC, a change in HER2 status during the course of the disease with or without chemotherapy has rarely been reported. However, in breast cancer, a significant frequency of change in HER2 status during the course of disease has been reported, and reevaluation of HER2 positivity in metastatic/recurrent sites is recommended. The choice of trastuzumab for MUGC is currently based on the HER2 status of the primary tumor at the time of initial diagnosis, without reassessment of HER2 status during the course of disease and/or in metastatic/recurrent sites, on the assumption that HER2 status is stable. However, our case casts doubt on the stability of HER2 in gastric cancer.

scholarly journals Cyst(e)ine in nutrition formulation promotes colon cancer growth and chemoresistance by activating mTORC1 and scavenging ROS

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Jiao Wu ◽  
Sai-Ching Jim Yeung ◽  
Sicheng Liu ◽  
Aiham Qdaisat ◽  
Dewei Jiang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Weight Loss ◽  
Cancer Patients ◽  
Cancer Cell ◽  
Cancer Progression ◽  
Colorectal Cancer Patient ◽  
Nutrition Support ◽  
Immunodeficient Mice ◽  
The Impact

AbstractWeight loss and cachexia are common problems in colorectal cancer patients; thus, parenteral and enteral nutrition support play important roles in cancer care. However, the impact of nonessential amino acid components of nutritional intake on cancer progression has not been fully studied. In this study, we discovered that gastrointestinal cancer patients who received cysteine as part of the parenteral nutrition had shorter overall survival (P < 0.001) than those who did not. Cystine indeed robustly promotes colon cancer cell growth in vitro and in immunodeficient mice, predominately by inhibiting SESN2 transcription via the GCN2-ATF4 axis, resulting in mTORC1 activation. mTORC1 inhibitors Rapamycin and Everolimus block cystine-induced cancer cell proliferation. In addition, cystine confers resistance to oxaliplatin and irinotecan chemotherapy by quenching chemotherapy-induced reactive oxygen species via synthesizing glutathione. We demonstrated that dietary deprivation of cystine suppressed colon cancer xenograft growth without weight loss in mice and boosted the antitumor effect of oxaliplatin. These findings indicate that cyst(e)ine, as part of supplemental nutrition, plays an important role in colorectal cancer and manipulation of cyst(e)ine content in nutritional formulations may optimize colorectal cancer patient survival.

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