Molecular and phenotypic profiling of colorectal cancer patients in West Africa reveals biological insights

Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is vital to addressing the regions rising burden of disease. Tissue from unselected Nigerian patients was analyzed with a multigene, next-generation sequencing assay. The rate of microsatellite instability is significantly higher among Nigerian CRC patients (28.1%) than patients from The Cancer Genome Atlas (TCGA, 14.2%) and Memorial Sloan Kettering Cancer Center (MSKCC, 8.5%, P < 0.001). In microsatellite-stable cases, tumors from Nigerian patients are less likely to have APC mutations (39.1% vs. 76.0% MSKCC P < 0.001) and WNT pathway alterations (47.8% vs. 81.9% MSKCC, P < 0.001); whereas RAS pathway alteration is more prevalent (76.1% vs. 59.6%, P = 0.03). Nigerian CRC patients are also younger and more likely to present with rectal disease (50.8% vs. 33.7% MSKCC, P < 0.001). The findings suggest a unique biology of CRC in Nigeria, which emphasizes the need for regional data to guide diagnostic and treatment approaches for patients in West Africa.

A REVIEW OF JALUKAVACHARANA (LEECH THERAPY) IN THE MANAGEMENT OF THROMBOSED HAEMORRHOIDS - CASE REPORTS

Haemorrhoids are dilated veins within the anal canal in the subepithelial region formed by radicles of superior, middle and inferior rectal veins. It is a common ano-rectal disease. Thrombosed hemorrhoid is a painful swelling in the anal tissues caused by a clot in one or more small veins in the anal canal. According to modern science, there are many operative and non-operative procedures for the management of haemorrhoids. Most of the operative pro- cedures are not patient friendly, cause high economic burden and associated with complications like pain, bleeding and recurrence. Acharya Vagbhata defines Arsas (haemorrhoids) as an abnormal growth which obstructs the anal canal and troubles continuously like an enemy. Shalyatantra deals with Sastra karma (surgical procedures), Anusas- tra karma (parasurgical procedures) and conservative management in the different types of diseases. Jaluka is con- sidered as best among Anusastra. Acharya Vagbhata indicates Jalukavacharana in haemorrhoids when they are hard and swollen. The present article deals with Jalukavacharana in two patients having thrombosed haemorrhoids attended in outpatient department of VPSV Ayurveda College Kottakkal. Application of Jaluka (leech) provided improvement in features like pain, edema, tenderness and discoloration of mass. Keywords: Thrombosed haemorrhoids, Arsha, Raktamokshana, Jalukavacharana.

A CLINICAL STUDY OF GUGGULU- SHIGRU KSHAR SUTRA IN BHAGANDARA (LOW LEVEL FISTULA)

Among all the notorious diseases Bhagandara is one such ano-rectal disease which have callous nature. The pain, inconvenience and constant discomfort hinder the natural routine of an individual and create problems for them. A revolutionary treatment approach to this disease is Kshar Sutra therapy. But it is the need of time to make more efficient Kshar Sutra by doing further research on them. Therefore, a research work was performed in Gurukul Campus of UTTARAKHAND AYURVED UNIVERSITY Haridwar, entitled ‘A clinical study of Guggulu-Shigru Kshar Sutra in the management of Bhagandara (Low level fistula)’. It is a single blind controlled study where 30 patients who fit in the inclusion criteria were randomly selected for the study. The Guggulu-Shigru Kshar Sutra was used to treat their anal fistulas and was changed on 7th day, 14th day, 21st day and so on till the end of the treatment. The present study has shown some very beneficial results in Unit Cutting Time (U.C.T.), pain, discharges, itching and burning sensation. Keywords Bhagandara, Gurukul Campus, Low level fistula, Guggulu-Shigru Kshar Sutra, U.C.T.,

Randomized controlled clinical trial to study the efficacy of Priyangvaadi Gana Siddha tail in the management of Parikartika w.s.r. to fissure-in-ano-An Ayurvedic management protocol

Sushruta explained about Guda-Roga, i.e. Ano Rectal Disease in Shalya Tantra. It includes no. of disease out of them one is Parikartika," i.e. Fissure – in – Ano. Lifestyle diseases are mainly caused by improper work pattern, stressful life, improper diet intake and improper sleep habits. These causative factors produce indigestion which leads to various lifestyle disorders, specially anorectal disorders like piles, fissure in ano, fistula in ano etc., constitute a significant group. Priyangvaadi Gana siddha tail in the management of Parikartika. The present study is designed as a Randomized, single-blind parallel in which 60 patients will be enrolled. Priyangvaadi Gana Siddha Taila Pichu and Yastimadhu tail Pichu will be given for basti twice a day. Assessment will be done 0th, 7th day, 14thday, and 28th day. The changes are expected to be observed in subjective parameters such as pain bleeding per rectum with itching as well as with objective parameters such as Parikartika Healing. The study is expecting the nonsurgical management of fissure in ano with respect to the impact of Priyangvaadi Gana Siddha tail pichu and Yastimadhu tail Pichu. The research is expecting to be a baseline and benchmark of the prospective studies in Acute Fissure in ano (Parikartika).

Metachronous advanced neoplasia after submucosal invasive colorectal cancer resection

Little is known about the incidence of metachronous advanced neoplasia (AN) following resection of submucosal invasive colorectal cancer (SM-CRC). Here, we aimed to assess the occurrence of metachronous AN following SM-CRC resection. We retrospectively reviewed consecutive patients who underwent SM-CRC resection at an academic medical center between 2005 and 2013. Among 343 patients, 250 (72.9%) underwent surgical resection or endoscopic resection followed by surgical resection and 93 (27.1%) underwent only endoscopic resection. During a median follow-up period of 61.5 months, the overall incidence of metachronous AN was 7.6%, and the cumulative incidence at 5 years was 6.1%. The cumulative incidence was significantly higher in the endoscopic resection group than in surgical resection group, in patients with colonic disease than in those with rectal disease, and in patients with synchronous AN than in those without. Multivariate analysis revealed that synchronous AN was the only significant risk factor for metachronous AN (HR 4.35; 95% CI 1.88–10.1). These findings imply that depending on synchronous AN, a surveillance protocol following SM-CRC resection can be changed for better detection of metachronous AN.

Effect of Ashwini Mudra as an adjuvant on pain in post-operative cases of ano-rectal diseases - An Ayurvedic management protocol

Ano-rectal disorders refer to the illness of the anal canal and rectum. Fissure in ano, Fistula in ano and haemorrhoids are among the most common ano-rectal conditions. In these cases, symptoms like pain, itching, burning, bleeding and swelling can significantly affect a patient's lifestyle. In Today’s Era, for pain management in post-operative cases of ano-rectal diseases, yoga plays an important role in pain management. Yoga is a way of living that aim towards a healthy mind in a healthy body. Ashwini mudra is a tantric practice used to generate and move prana (life force energy) upward along the spine, via the main energy channel of the subtle body known as sushumna nadi. The practice involves contracting the anal sphincter in a rhythmic way, thereby generating and containing intense energy within the lower body before pumping it upwards As the ano-rectal disease require long term conservative treatment and also surgical intervention. Due to this patients are suffering for long term problems. To minimize the side effects of medicine in post-operative cases, certain measures are needed. Yoga is a way of living that aims towards a healthy mind in a healthy body. Sushruta and Vagbhata have described that the total length of Guda is 4½ Angula only. Vagbhata had also told measurement of Guda as Atmapanitala (palm of hand) Ashwini mudra is very easy to perform and can be done during any time and by any age group.

Use of the End to End Anastomotic Stapler From Above for Difficult Pelvic Surgery for Distal Rectal Disease

Introduction Transabdominal utilization (TAU) of the end to end anastomotic (EEA) stapler in low anterior resection (LAR) for rectal cancer is an excellent alternative to the most widely performed techhnique. Methods We performed a retrospective analysis of a prospectively maintained database which obtained data on 104 patients with rectal disease who underwent EEA-assisted LAR with TAU. Records of all patients were used to evaluate demographics, complications, tumor location, margin status, postoperative complications, clinical sphincter function, adjuvant or neoadjuvant treatment, disease stage, and survival. Results Of the 104 patients, 48% were women with a mean age of 64 years (range 34-85 years). The average tumor location was 8 cm above the dentate line, and the mean tumor distance from the distal margin was 1.9 cm. All distal margins in cases for patients with rectal cancer were negative. Hospital length of stay averaged 8.7 days (6-15 days). There were no anastomotic complications (leaks, bleeding, or obstruction), and there were no leaks at the separate colotomy site. All patients have had normal postoperative sphincter function. Conclusion Transabdominal utilization of the EEA stapler in LAR for colorectal carcinoma is an alternative to the conventional approach and may be advantageous in avoidance of the lithotomy position with potential nerve injury, risk of deep venous thrombosis, and stapler-induced sphincter trauma.

The Use of Enhanced Technologies in Robotic Surgery and Its Impact on Outcomes in Rectal Cancer: A Systematic Review

The main advantage of the robotic approach is the surgical precision that the technology offers. It is particularly useful in rectal cancer as this is a technically challenging procedure. The technological advantage of the robot leads to better postoperative outcomes. Apart from the 3D vision and endowrist instrumentation in comparison to laparoscopy, the options of using fluorescence imaging, endowrist stapler, and table motion have revolutionised the way of performing an anterior resection. Thus, the true benefit of these advances will be the quality of the surgery, which leads to better postoperative outcomes. This article focuses on the current status of applications of new modalities and technology development in robotic rectal surgery. A systematic literature search was performed using PubMed, MEDLINE, and cochrane database. The studies included were considered based on the following (1) articles written in English, (2) full text is available, (3) whether the topic is related to the use of novel technologies during robotic rectal surgery, and (4) sample: adult patients and malignant rectal disease. The primary end point was to analyse the current use of technological advances in robotic rectal surgery. Only a few studies are currently available on the use of these different technologies in robotic colorectal surgery. Many of these reports describe promising results, although with short-term outcomes. The use of technologies in robotic colorectal surgery is safe and feasible and can be used together to improve short-term outcomes. Intraoperative fluorescence angiography has demonstrated to reduce the rate of anastomotic leak, whereas the robotic stapler and the table motion simplify anatomic resection.

Minimally invasive approach to low-velocity penetrating extraperitoneal rectal trauma

Unlike intraperitoneal colorectal injuries, the standard of care for extraperitoneal rectal trauma includes a diverting colostomy due to relative inaccessibility of these injuries for primary repair. New technologies to enhance access to the extraperitoneal rectum have gained increasing use in benign and malignant rectal disease. We present two cases of low-velocity penetrating extraperitoneal rectal trauma. In both cases, a transanal minimally invasive surgery (TAMIS) approach was used to access, and primarily repair, full-thickness rectal lacerations. These patients were successfully managed without a colostomy and without complication. TAMIS enables access to distal rectal injuries, facilitating primary repair and bringing the management of extraperitoneal rectal injuries in line with intraperitoneal injuries, with the potential to avoid fecal diversion.

Colorectal Cancer in the Young: Epidemiology, Prevention, Management

Colorectal cancer (CRC) incidence rates in the United States overall have declined since the mid-1980s because of changing patterns in risk factors (e.g., decreased smoking) and increases in screening. However, this progress is increasingly confined to older adults. CRC occurrence has been on the rise in patients younger than age 50, often referred to as early-onset disease, since the mid-1990s. Young patients are more often diagnosed at an advanced stage and with rectal disease than their older counterparts, and they have numerous other unique challenges across the cancer management continuum. For example, young patients are less likely than older patients to have a usual source of health care; often need a more complex treatment protocol to preserve fertility and sexual function; are at higher risk of long-term and late effects, including subsequent primary malignancies; and more often suffer medical financial hardship. Diagnosis is often delayed because of provider- and patient-related factors, and clinicians must have a high index of suspicion if young patients present with rectal bleeding or changes in bowel habits. Educating primary care providers and the larger population on the increasing incidence and characteristic symptoms is paramount. Morbidity can further be averted by increasing awareness of the criteria for early screening, which include a family history of CRC or polyps and a genetic predisposition.