Aged ; Colorectal Neoplasms ; physiopathology ; Humans ; Intestinal Neoplasms ; complications ; Stomach Neoplasms ; complications

PURPOSE: The purpose of this study is to compare postoperative complications for single-stage surgery after mechanical bowel preparation in patients who experienced obstruction and those who did not. METHODS: From 2000 to 2011, 1,224 patients underwent a single-stage operation for left colorectal cancer after bowel preparation. Nonobstruction (NOB) and obstruction (OB) colorectal cancer patients were 1,053 (86.0%) and 171 (14.0%), respectively. Postoperative morbidity and mortality were compared between groups. RESULTS: The OB group had poor preoperative conditions (age, white blood cell, hemoglobin, albumin level, and advanced tumor stage) compared with the NOB group (P < 0.05). Mean on-table lavage time for the OB group was 17.5 minutes (range, 14-60 minutes). Mean operation time for the OB group was statistically longer than that of the NOB group (OB: 210 minutes; range, 120-480 minutes vs. NOB: 180 minutes; range, 60-420 minutes; P < 0.001). Overall morbidity was similar between groups (NOB: 19.7% vs. OB: 23.4%, P = 0.259). Major morbidity was more common in the OB group than in the NOB group, but the difference was without significance (OB: 11.7% vs. NOB: 7.6%, P = 0.070). Postoperative death occurred in 16 patients (1.3%), and death in the OB group (n = 7) was significantly higher than it was in the NOB group (n = 9) (4.1% vs. 0.9%, P = 0.001). Twelve patients had surgical complications, which were the leading cause of postoperative death: postoperative bleeding in five patients and leakage in seven patients. CONCLUSION: Postoperative morbidity for a single-stage operation for obstructive left colorectal cancer is comparable to that for NOB, regardless of poor conditions of the patient.
Colorectal Neoplasms* ; Hemorrhage ; Humans ; Leukocytes ; Mortality ; Postoperative Complications* ; Therapeutic Irrigation

Accumulating evidence suggests that intestinal bacteria play an important role in the pathogenesis of colorectal cancer (CRC). Due to the complexity of the intestinal microbiome, identification of the specific causative microbial agents in CRC remains challenging, and the search for the causative microbial agents is intense. However, whether bacteria or their products can induce inflammation that results in tumorigenesis or directly causes CRC in humans is still not clear. This review will mainly focus on the progress of bacterial infection and CRC, and introduce the microbial contribution to the hallmarks of cancer. This article uses Salmonella and its chronic infection as an example to investigate a single pathogen and its role in the development of CRC, based on laboratory and epidemiological evidence. The bacterial infection leads to an altered intestinal microbiome. The review also discusses the dysfunction of the microbiome and the mechanism of host-microbial interactions, for example, bacterial virulence factors, key signaling pathways in the host, and microbial post-translational modifications in the tumorigenesis. Colonic carcinogenesis involves a progressive accumulation of mutations in a genetically susceptible host leading to cellular autonomy. Moving forward, more human data are needed to confirm the direct roles of bacterial infection in CRC development. Insights into the inhibiting infection will help to prevent cancer and develop strategies to restore the balance between host and microorganisms.
Bacterial Infections/complications* ; Carcinogenesis ; Colorectal Neoplasms/microbiology* ; Gastrointestinal Microbiome ; Humans

PURPOSE: A multidisciplinary program for early recovery after colorectal surgery has been developed continuously since 2000. The purpose of this study was to evaluate the effects of the standardized postoperative enhanced recovery program (SPERP) after a colorectal resection. METHODS: The patients undergoing laparoscopic colorectal resection for colorectal cancer were cared for by using the SPERP after surgery. The comparison group consisted of patients who had undergone similar surgery before establishment of the SPERP. The two groups were compared with respect to the patients' characteristics, operation methods, operation time, blood loss, amounts of intravenous fluid and intravenous antibiotics, complications, postoperative hospital stay, readmission rate, and reoperation rate. RESULTS: The number of patients being treated with the standardized postoperative recovery program, the standardized group (SG), was 63, and that of the traditional group (TG) was 61. Even though the day of oral feeding (1.02 vs. 2.67 days) was faster in the SG, the day of flatus and defecation was not different between two groups. The postoperative hospital stay in the SG (6.76 days) was significantly shorter than that in the TG (10.43 days). The total amount of intravenous fluid after surgery in the SG was 8,574.75 mL, compared with 19,568.22 mL in the TG. The duration of intravenous antibiotics was 2.69 days in the SG and 7.38 days in the TG (P=0.0001). The rates of complication (27.0% in SG vs. 39.3% in TG), reoperation (3.17% vs. 9.84%), and readmission (7.94% vs. 6.56%) did not increase after implementation of this program. CONCLUSION: The standardized postoperative recovery program reduced the amounts of postoperative intravenous fluid and antibiotics and the postoperative hospital stay without increasing either complications or the readmission rate. A prospective multi-center study of this program is needed.
Anti-Bacterial Agents ; Colorectal Neoplasms ; Colorectal Surgery ; Defecation ; Flatulence ; Humans ; Length of Stay ; Postoperative Complications ; Reoperation

PURPOSE: Laparoscopic surgery is used in elderly patients to maximize the benefits of improved postoperative recovery but this supposition lacks proper evidence. The aims of this study were to assess the safety and feasibility of laparoscopic colorectal surgery in elderly patients (group A, age > or =70 years, n=77) by a comparison with those in younger patients (group B, age < or =65 years, n=142), and to define the factors contributing to postoperative complications. METHODS: A retrospective analysis of 219 patients, who underwent elective laparoscopic colorectal cancer surgery between June 2006 and November 2010 at Kyung Hee University Hospital at Gangdong, was performed. The data included the patient's demographics, surgical and postoperative outcomes, including complications and recovery parameters. RESULTS: The mean ages of group A and B were 76 years and 56 years, respectively. Group A had more comorbid conditions than group B, as assessed by the Charlson comorbidity index score (group A 4.09 vs. group B 3.06, p<0.001). The postoperative recovery times were similar in the two groups. Intensive care unit (ICU) stays were more frequent in group A than group B (group A 44.2% vs. group B 6.3%, p<0.001). Postoperative complications were independently related to the long operation time (>200 minutes), ICU stay and rectal surgery. CONCLUSION: Laparoscopic colorectal surgery in elderly patients is safe and does not compromise the postoperative outcomes despite the comorbid conditions of the elderly patients.
Aged ; Colorectal Neoplasms ; Colorectal Surgery ; Comorbidity ; Demography ; Humans ; Intensive Care Units ; Laparoscopy ; Postoperative Complications ; Retrospective Studies

PURPOSE: Previous studies have demonstrated the prognostic impact of the prognostic nutritional index (PNI), a proposed indicator of immunonutritional statuses of surgical patients, on patients with various gastrointestinal cancers. Although the prognostic impact of the PNI on patients with colorectal cancer has been well established, its value has not been studied in patients treated with preoperative chemoradiation (pCRT). This study aimed to evaluate the prognostic impact of PNI on patients receiving pCRT for locally advanced rectal cancer (LARC). METHODS: Patients with LARC who underwent curative pCRT followed by surgical resection were enrolled. The PNI was measured in all patients before and after pCRT, and the difference in values was calculated as the PNI difference (dPNI). Patients were classified according to dPNI (<5, 5–10, and >10). Clinicopathologic parameters and long-term oncologic outcomes were assessed according to dPNI classification. RESULTS: No significant intergroup differences were observed in clinicopathologic parameters such as age, histologic grade, tumor location, tumor-node-metastasis stage, and postoperative complications. Approximately 53% of the patients had a mild dPNI (<5); only 15% had a high dPNI (>10). Univariate and multivariate analyses identified the dPNI as an independent prognostic factor for disease-free status (P < 0.01; hazard ratio [HR], 2.792; 95% confidence interval [CI], 1.577–4.942) and for cancer-specific survival (P = 0.012; HR, 2.469; 95%CI, 1.225–4.978). CONCLUSION: The dPNI is predictive of long-term outcomes in pCRT-treated patients with LARC. Further prospective studies should investigate whether immune-nutritional status correction during pCRT would improve oncologic outcomes.
Classification ; Colorectal Neoplasms ; Gastrointestinal Neoplasms ; Humans ; Multivariate Analysis ; Nutrition Assessment ; Postoperative Complications ; Prospective Studies ; Rectal Neoplasms*

Emerging evidence suggests that, along with dietary, genetic and environmental factors, gut microbiota plays a role in the progress of colorectal cancer. Dysbiosis of oral flora in patients with periodontitis affects the composition of microbial community in the gut, impairs gut barrier function, and induces a proinflammatory microenvironment, all of which contribute to the progression of colorectal cancer. In view of the influences by microbiota dysbiosis, this article reviews the role of periodontitis in affecting the occurrence and development of colorectal cancer.
Colorectal Neoplasms ; Dysbiosis/complications* ; Gastrointestinal Microbiome ; Humans ; Microbiota ; Periodontitis/complications* ; Tumor Microenvironment

To investigate the relationship between salt-inducible kinase 2 (SIK2) and lymph node metastasis in colorectal cancer patients complicated with chronic schistosomiasis. Tissue specimens were collected from 363 patients who were diagnosed as colorectal cancer by clinical and pathological examination in Wuhu Second People's Hospital from June 2015 to June 2020. Fifty-six patients were colorectal cancer complicated with schistosomiasis (CRC-S) and 307 patients were colorectal cancer not complicated with schistosomiasis (CRC-NS). The clinical and pathological data of the patients were analyzed to explore the relationship between chronic schistosomiasis and colorectal cancer. Immunohistochemistry and Western blotting were used to detect the distribution and expression of SIK2 in colorectal cancer specimens. The relationship between SIK2 and lymph node metastasis of CRC-S was analyzed. The rate of lymph node metastasis in CRC-S group was significantly higher than that in CRC-NS group (62.5% vs. 47.2%, <0.05). In CRC-S patients with lymph node metastasis, schistosome eggs were distributed mainly in tumor tissues (25/35, 71.4%), while in patients with CRC-S without lymph node metastasis, schistosome eggs were distributed mainly in paracancerous tissues (17/21, 81.0%) (14.243, <0.01). The SIK2 was mainly located in cytosol, and its expression in tumor tissues was higher than that in paracancerous tissues. Compared with CRC-NS patients, the expression of SIK2 in CRC-S patients was significantly increased; the expression of SIK2 in patients with lymph node metastasis was higher than that in patients without lymph node metastasis; and the expression of SIK2 in patients with schistosome eggs in cancer tissues was higher than that in patients with schistosome eggs in paracancerous tissues (all <0.01). Lymph node metastasis is more likely to be occurred in colorectal cancer patients with schistosomiasis, especially in those with schistosome eggs in tumor tissues. The expression of SIK2 may be correlated with chronic schistosomiasis, egg distribution and lymphatic metastasis.
Biomarkers, Tumor ; Colorectal Neoplasms/complications* ; Humans ; Immunohistochemistry ; Lymphatic Metastasis ; Neoplasm Staging ; Prognosis ; Schistosomiasis/complications*

Colorectal Neoplasms ; complications ; Humans ; Male ; Middle Aged ; Neck ; pathology ; Rectal Neoplasms ; complications ; Skin Neoplasms ; diagnosis ; pathology ; secondary ; Thorax ; pathology

PURPOSE: This study compared the perioperative and pathologic outcomes between an extralevator abdominoperineal resection (APR) in the prone position and a conventional APR. METHODS: Between September 2011 and March 2014, an extralevator APR in the prone position was performed on 13 patients with rectal cancer and a conventional APR on 26 such patients. Patients' demographics and perioperative and pathologic outcomes were obtained from the colorectal cancer database and electronic medical charts. RESULTS: Age and preoperative carcinoembryonic antigen (CEA) level were significantly different between the conventional and the extralevator APR in the prone position (median age, 65 years vs. 55 years [P = 0.001]; median preoperative CEA level, 4.94 ng/mL vs. 1.81 ng/mL [P = 0.011]). For perioperative outcomes, 1 (3.8%) intraoperative bowel perforation occurred in the conventional APR group and 2 (15.3%) in the extralevator APR group. In the conventional and extralevator APR groups, 12 (46.2%) and 6 patients (46.2%) had postoperative complications, and 8 (66.7%) and 2 patients (33.4%) had major complications (Clavien-Dindo III/IV), respectively. The circumferential resection margin involvement rate was higher in the extralevator APR group compared with the conventional APR group (3 of 13 [23.1%] vs. 3 of 26 [11.5%]). CONCLUSION: The extralevator APR in the prone position for patients with advanced low rectal cancer has no advantages in perioperative and pathologic outcomes over a conventional APR for such patients. However, through early experience with a new surgical technique, we identified various reasons for the lack of favorable outcomes and expect sufficient experience to produce better peri- or postoperative outcomes.
Carcinoembryonic Antigen ; Colorectal Neoplasms ; Demography ; Humans ; Postoperative Complications ; Prone Position* ; Rectal Neoplasms*