Summaries for patients. Relationships between the amount of colon cancer surgery a hospital performs and patient outcomes.
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Adenocarcinoma↗
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Association of hospital procedure volume and outcomes in patients with colon cancer at high risk for recurrence.
BACKGROUND: Studies that use registry data have demonstrated superior long-term overall survival after curative surgical resection of colon cancer at hospitals where the volume of such surgeries is high. However, because such administrative data lack information on cancer recurrence, the true nature of this relation remains uncertain. OBJECTIVE: To determine whether hospital procedure volume predicts long-term outcomes of colon cancer surgery. DESIGN: Nested cohort study within a randomized clinical trial. SETTING: Intergroup 0089 national adjuvant colon cancer study conducted between 1988 and 1992. PATIENTS: 3161 patients with high-risk stage II and stage III colon cancer. MEASUREMENTS: Overall survival and recurrence-free survival, by hospital procedure volume as defined by Medicare claims data. RESULTS: With a median follow-up of 9.4 years, 5-year overall survival significantly differed across tertiles of hospital procedure volume (63.8% for patients who had resection at low-volume hospitals compared with 67.3% at high-volume hospitals; P = 0.04). After adjustment for other predictors of colon cancer outcome, the hazard ratio for overall mortality in patients treated at low-volume centers was 1.16 (95% CI, 1.03 to 1.32). However, the risk for cancer recurrence was not associated with hospital procedure volume. Five-year recurrence-free survival was 63.9% for patients who had resection at low-volume hospitals compared with 63.0% at high-volume hospitals (adjusted hazard ratio, 1.03 [CI, 0.89 to 1.18]). These findings did not materially change after stratification by other potential demographic and clinical predictors of outcome. CONCLUSIONS: According to prospectively recorded data from a large clinical trial, patients whose colon cancer was resected at low-volume hospitals experienced a higher risk for long-term mortality; however, this increased mortality was not attributable to differences in colon cancer recurrences.
Adenocarcinoma↗
[Secondary neoplasms in upper respiratory and digestive tracts].
Patients enduring cancer of the upper respiratory tract present greater risk of developing a second neoplasm, either synchronous or metasynchronously. Possible causes of this major risk are studied, giving a special attention to the role released for the treatment done in the primary neoplasm, in the later appearance of the second one.
Digestive System Neoplasms↗
Gastrointestinal malignant lymphomas in Macedonia.
The gastrointestinal tract including oral cavity is the most common location of extranodal lymphomas. In this retrospective study, the histomorphological, immunohistochemical and clinical features of 21 Macedonian cases with diagnosed malignant lymphomas were investigated. The series included 15 males and 6 females, mean age 44 (4-78) years. The most common locations were hard palate (n = 7), gastric site (n = 5), small intestinal wall (n = 2), large intestinal wall (n = 5), and lingual root (n = 2). All cases were B cell lymphomas, 23.8% of them low grade B cell lymphoma of mucosa associated lymphoid tissue, 4.7% mantle cell lymphoma, 47.6% diffuse large cell lymphoma, and 23.8% Burkitt type lymphoma. There was no T cell lymphoma. Most of the cases were positive for CD20 and CD79a. Monoclonality was confirmed by light chain restriction, except for nine cases where it failed due to poor tissue preservation. The fact that eight cases were in the clinically advanced third and fourth stage implied a conclusion that not only primary non-Hodgkin's lymphomas but also secondary lesions could invade the gastrointestinal tract. Immunohistochemical staining was helpful in differentiation between benign and malignant infiltration in low grade lymphomas, and in distinguishing diffuse large cell lymphomas from undifferentiated epithelial neoplasms.
Adolescent↗
Experimental evidence does not support use of the "no-touch" isolation technique in colorectal cancer.
PURPOSE: The benefits of the "no-touch" isolation technique usually performed to prevent the circulation of tumor cells are not evident. The aim of this study was to determine whether conventional surgical procedures for treatment of colon cancer could provoke the circulation of tumor cells detected by a genetic technology. METHODS: Sixteen patients undergoing resection for colorectal cancer and two patients with irresectable tumors were studied. No patient showed liver or lung metastasis. With specific primers for carcinoembryonic antigen, we used reverse transcriptase-polymerase chain reaction to analyze tumor biopsy specimens and blood samples obtained from the antecubital vein before and after surgery and from the main drainage vein of the tumor when the tumor had been extracted. Peritoneal fluid was also collected in irrecsectable cases. RESULTS: Amplification of cDNA with carcinoembryonic antigen-specific primers was achieved with all tumor biopsies and samples of peritoneal fluid. In two patients carcinoembryonic antigen reverse transcriptase-polymerase chain reaction products were detected in antecubital vein blood before surgery and in one of them also after surgery. Only in one patient (Dukes C) were carcinoembryonic antigen reverse transcriptase-polymerase chain reaction products detected from the main drainage vein of the tumor. In serial dilution experiments we determined that the limit of detection of this method was ten tumor cells in 2 ml of blood. CONCLUSION: Our data suggest that the use of no-touch isolation techniques in colorectal cancer is not justified, based on lack of evidence indicating the detachment of cells from the tumor at surgery.
Adult↗
Presence of villin, a tissue-specific cytoskeletal protein, in sera of patients and an initial clinical evaluation of its value for the diagnosis and follow-up of colorectal cancers.
Villin is an actin-binding protein found in a few normal adult epithelia, namely epithelial cells in the digestive and urogenital tracts. Moreover, villin production is maintained in malignant cells. We assumed that cell lysis and necrosis of solid tumors producing villin might result in villin release into blood. We analyzed the villin content of sera from 788 patients and controls using an enzyme-linked immunosorbent assay. Patients and controls were classified into healthy donors, patients with benign diseases of the gastrointestinal tract, patients with colorectal cancers, and patients with malignant nondigestive diseases. In the panel of sera analyzed, the sensitivity of the assay for colorectal cancers was 50.5%, and its overall specificity for malignant digestive tumors was 94.5%. Results were statistically analyzed comparing each group of sera with each other. We conclude that the presence of villin is indicative of a pathological state in the gastrointestinal tract (P less than 0.001). Finally, we followed villin levels after tumor resections (60 patients). We found that the villin level in sera remains low in remissions but is raised in recurrences. We suggest that the villin assay may have clinical utility as a diagnostic adjunct for adenocarcinoma of the gastrointestinal tract. It may also have some value in monitoring patients with advancing colorectal carcinomas after resection of these tumors.
Adult↗
[Value of mucin histochemistry in the normal and pathological digestive tract].
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Anal Canal↗
Effects of X-irradiation on N-methyl-N-nitrosourea-induced multi-organ carcinogenesis in rats.
The effects of X-irradiation on N-methyl-N-nitrosourea (MNU)-induced multi-organ carcinogenesis were examined in both sexes of ACI/N rats. At 6 weeks of age, rats in groups 1 (25 males, 25 females) and 3 (24 males, 23 females) received a single i.p. injection of MNU (25 mg/kg body weight), while those in groups 2 (25 males, 26 females) and 4 (25 males, 25 females) were administered the carcinogen at a dose of 50 mg/kg body weight. At 10 weeks of age, groups 3 and 4 were X-irradiated at a dose of 3 Gy. Group 5 (24 males, 24 females) received X-irradiation alone. Group 6 (21 males, 21 females) served as an untreated control. As a result, neoplasms developed mainly in the digestive tract, kidney, uterus, and hematopoietic organ in groups 1-5. The incidences of adenocarcinoma in small and large intestines of male rats of group 4 (50 mg/kg MNU and X-irradiation) (small intestine: 48%, large intestine: 32%) were significantly higher than those of group 2 (50 mg/kg MNU) (small intestine: 17%, P < 0.05; large intestine: 8%, P < 0.05), and also the frequency of adenocarcinoma in the large intestine of males of group 3 (25 mg/kg MNU and X-irradiation) (22%) was significantly greater than that of group 1 (25 mg/kg MNU) (0%, P < 0.05). These results indicated that X-irradiation enhanced the development of intestinal neoplasms induced by MNU in male ACI/N rats.
Adenocarcinoma↗
[Pathologic-anatomic diagnosis of endocrine neoplasms: new trends and applications].
The pathologic-anatomical diagnosis of endocrine diseases mainly relies on established techniques of histology and cytology. Additional immunhistochemical tests an the expression analysis may lead to a higher specificity of the morphological diagnosis. For thyroid tumours so-called high-throughput methods have been established in clinical routine successfully. Calcitonin screening tests can be performed routinely in patients with or without an increased risk of familiar dominance. For the neuroendocrine neoplasms of the pancreas and the gastrointestinal tract a new WHO classification has been established.
Biomarkers, Tumor↗
A phase II and pharmacokinetic study of 6S-leucovorin plus 5-fluorouracil in patient with colorectal carcinoma.
Leucovorin (LV) is commonly used as a modulator of 5-fluorouracil (5-FU) cytotoxicity. In patient with colon cancer, the addition of LV to 5-FU improves response rates, and in some trials has improved survival in advanced disease and in the adjuvant setting. Leucovorin is generally administered as a racemic mixture, but the isomers differ substantially in pharmacokinetics and biological activity, with 6S-LV the predominant active component. The current study was undertaken to determine the effect of 6R on the pharmacokinetics of 6S-LV, and to characterize the toxicity and antitumor effect of 5-FU when administered with 6S-LV to patients with advanced colorectal carcinoma. Thirty patients were treated with weekly 5-FU plus high dose 6S-LV. To determine the effects of 6R-LV on the pharmacokinetics of S6-LV, 20 patients were randomly assigned to receive either 250 mg/m2 6S-LV or 500 mg/m2 6R,S-LV as a 2 hour IV infusion on day -2, and the other preparation on day -1, with pharmacokinetics measured each day. The presence of 6R-LV had no effect on the AUC, Clp, Cmax, or terminal phase t1/2 of 6S-LV. The overall response rate was 40% (C.I. 23-60%). The most frequent toxicities were gastrointestinal. In this small cohort, scheduled and delivered dose intensity was positively associated with response (p = 0.05). These results show that there is no pharmacokinetic advantage to the use of 6S-LV rather than 6R,S-LV as a modulator of 5-FU.
Adult↗
Complications of hepatic artery infusion: a review of 4580 reported cases.
PURPOSE: The resurgence of hepatic artery infusion (HAI) for the treatment of colorectal liver metastases has been dampened by concern over its complications. We have reviewed the incidence and frequency of complications associated with HAI and discussed the factors associated with these complications. METHODS: A PUBMED search was conducted from 1950-2001 using various combinations of these keywords: hepatic arterial infusion, colorectal carcinoma, complications, and trials. The main inclusion criterion was the reporting of HAI complications. The main exclusion criterion was duplicated patients. Extracted data included chemotherapeutic agents, catheter technique, drug toxicities, and catheter related complications. Relative risks and 95% confidence intervals were calculated. RESULTS: We reviewed 437 articles/abstracts and included 101 studies. 4580 patients with 4582 toxicities and complications were reported. The mortality rate was 1%. The most common toxicities were: GI symptoms 22%, chemical hepatitis 19%, and bone marrow toxicity 8%. 5-fluorouracil (5-FU) HAI had statistically significant risk for GI symptoms and bone marrow toxicity. Floxuridine (FUDR) HAI had statistically significant risk for chemical hepatitis, sclerosing cholangitis, and biliary toxicity. The most common catheter complications were: hepatic artery occlusion 6%, catheter thrombosis 5%, and catheter displacement 7%. CONCLUSIONS: This literature review of the complications of HAI confirms a low mortality associated with HAI. Sclerosing cholangitis and chemical hepatitis are associated with the use of FUDR, while the use of 5-FU is associated with bone marrow toxicity. Our observations support the development of hepatic cytoprotective agents and other effective anti-tumor agents to improve the results and morbidity of HAI for colorectal liver metastases.
Antimetabolites, Antineoplastic↗
[A FOLLOW-UP OF DISEASES AFTER STOMACH RESECTION IN ULCER (BILLROTH II)].
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Bronchial Neoplasms↗
T lymphocytes bearing histamine receptors in patients with digestive neoplasm.
The inverse relationship between allergic diseases, particularly bronchial asthma, and cancer has been much debated these past years. This inverse relationship may be due to different levels of blood and tissue histamine, and its effect on lymphocytes with H2 receptors. A clinical study was performed on circulating histamine-bearing T cells and on in vivo and in vitro immune response to PPD and histamine in patients with a newly diagnosed digestive neoplasm and in patients with allergic bronchial asthma. The mean percentage of T lymphocytes with histamine receptors was significantly decreased in patients with digestive neoplasm and with allergic bronchial asthma as compared to healthy controls.
Adolescent↗
Reoperation as a quality indicator in colorectal surgery: a population-based analysis.
OBJECTIVE: To describe unplanned procedures following colorectal cancer surgery that might be used as intermediate outcome measures, and to determine their association with mortality and length of stay. SUMMARY BACKGROUND: Variation in the quality of surgical care, especially for common illnesses like colorectal cancer, has received increasing attention. Nonfatal complications resulting in procedural interventions are likely to play a role in poor outcomes but have not been well explored. METHODS: Cohort analysis of 26,638 stage I to III colorectal cancer patients in the 1992 to 1996 SEER-Medicare database. INDEPENDENT VARIABLES: sociodemographics, tumor characteristics, comorbidity, and acuity. PRIMARY OUTCOME: postoperative procedural intervention. ANALYSIS: Logistic regression identified patient characteristics predicting postoperative procedures and the adjusted risk of 30-day mortality and prolonged hospitalization among patients with postoperative procedures. RESULTS: A total of 5.8% of patients required postoperative intervention. Patient characteristics had little impact on the frequency of postoperative procedures, except for acute medical conditions, including bowel perforation (relative risk [RR] = 3.0, 95% confidence interval [CI] = 2.5-3.6), obstruction (RR = 1.6; 95% CI = 1.4-1.8), and emergent admission (RR = 1.3; 95% CI = 1.1-1.4). After a postoperative procedure, patients were more likely to experience early mortality (RR = 2.4; 95% CI = 2.1-2.9) and prolonged hospitalization (RR = 2.2; 95% CI = 2.1-2.4). The most common interventions were performed for abdominal infection (31.7%; RR mortality = 2.9; 95% CI = 2.3-3.7), wound complications (21.1%; RR mortality = 0.7; 95% CI = 0.4-1.3), and organ injury (18.7%; RR mortality = 1.6; 95% CI = 1.1-2.3). CONCLUSIONS: Postoperative complications requiring additional procedures among colorectal cancer patients correlate with established measures of surgical quality. Prospective tracking of postoperative procedures as complication markers may facilitate outcome studies and quality improvement programs.
Aged↗
Modified gastrointestinal reconstruction after pancreaticoduodenal resection with particular reference to the prevention of postoperative biliary and pancreatic fistulas.
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Aged↗
[Impact of glutamine of gut permeability and clinical prognosis on the aging patients undergoing gastric-intestinal operation].
OBJECTIVE: To evaluate the impact of parenteral nutrition supplemented glutamine on aging patients undergoing gastric-intestinal operation. METHODS: 30 patients above 60 years old undergoing gastric-intestinal operation, a randomized double-blind protocol was designed, divided into two groups, received impact isocaloric parenteral nutrition. The study group received alanyl-glutamine [0.5 g/(kg.d)]. To observe plasma amino acids profile, nitrogen balance, intestinal permeability and clinical prognosis, examine clinical chemistry variables and observe the adverse reactions in order to find out its safety. RESULTS: The patients in both groups were comparable prior to the operation. The plasma glutamine level of study group is higher than the control group, it's cumulative nitrogen balance values were prior to the control group, L/M ratio was lower than the control group. The complications related to infection was observed more in the control group. No adverse reaction was observed in both groups. CONCLUSIONS: Ala-Gln-supplemented PN improved nitrogen balance and maintained intestinal permeability, reduced complications.
Aged↗
[Expression of hepatocyte growth factor and its receptor, C-Met in human digestive tissues and different gastric and colonic cancer cell lines].
OBJECTIVES AND METHODS: Hepatocyte growth factor (HGF) and its receptor c-Met exert mitogene and motogene activities in digestive tissues. The aim of the study was a) to detect and localize these proteins in adult human digestive mucosae, liver and pancreas, using western immunoblotting and immunohistochemistry with anti-HGF and c-Met antibodies and b) to identify the receptor in three digestive cancer cell lines. RESULTS: HGF and c-Met were detected by the two techniques used in esophagus, fundus, antrum, duodenum, cecum, colon and rectum where they were localized in epithelial and sometimes lamina propria cells. HGF and c-Met were also present in hepatocytes, and c-Met in pancreatic endocrine cells. c-Met was identified in human gastric HGT-1 and rat colon DHD/K12 cancer cells. HGF (40 ng/mL) scattered colonies formed by these cells as well as human T84 colon cancer cells. CONCLUSIONS: Our findings demonstrate the presence of HGF and c-Met in all human digestive tissues and are compatible with the implication of HGF in metastatic processes of digestive cancers.
Adult↗
Elective surgery for colorectal cancer in a defined Swedish population.
AIMS: The aim of this study was to describe variability in compliance to clinical guidelines in colorectal cancer surgery related to hospital structure. METHODS: All patients registered in the databases of the Regional Oncologic Centre, operated upon electively for colon cancer between the start of the register in 1997 until 2000 (n=1771) and for rectal cancer between the start of the register in 1995 until 2000 (n=1841) were selected for analysis. RESULTS: There was no difference in 5-year survival rate between colon and rectal cancer (mean follow-up 2.6 and 3.0 years, respectively; p=0.22). There was a significant difference in frequency of preoperative liver scan depending on hospital category with an increase in colon cancer from 39 to 46% (p=0.02) and in rectal cancer from 42 to 64% (p<0.001). For colon cancer there was no difference, according to hospital category, in quotient sigmoid and high anterior resection to left-sided resection. Furthermore, high anterior resection was more common at university and general district hospitals (8%) compared with district hospitals (4%) (p=0.01). Sphincter-saving surgery was more common at university hospitals and district general hospitals than at district hospitals (low anterior/abdomino-perineal resection quotients 2.3, 2.4 and 1.6, respectively; p<0.001). CONCLUSIONS: Population-based audit forms an appropriate and valuable basis for quality assurance projects. In addition to describing compliance to guidelines and pointing to process steps that can be improved, such investigations may also indicate changes due to scientific development. Linked to case-costing data, such results may form an important basis for decisions about modifications in health care.
Adenocarcinoma↗