Application value of pre-cutting endoscopic mucosal resection in treatment of colorectal laterally spreading tumors

To investigate whether robotic surgery (RS) decreases the risk of circumferential resection margin (CRM) positivity compared with conventional laparoscopic surgery (LS) in patients with rectal cancer (RC) undergoing mesorectal excision (ME). 

Robotic surgery is associated with a decreased risk of circumferential resection margin positivity compared with conventional laparoscopic surgery in patients with rectal cancer undergoing mesorectal excision: A systematic review and meta-analysis

Introduction: There is a lack of information on the role of neoadjuvant chemotherapy in upper rectal cancer. The aim of our research was to investigate the role of neoadjuvant chemotherapy in upper rectal cancer treatment.Materials and methods: We conducted a retrospective cohort multicenter study to analyze the medical records of patients with upper rectal cancer from 2007 to 2020 obtained from the archive of Research Institute FSBI «N. N. Blokhin Cancer Research Center» of the Ministry of Health of Russia, A. N. Ryzhikh National Medical Research Centre for Coloproctology, Stavropol regional Clinical oncological Dispensary and Kaliningrad oncological Center. All patients were divided into 2 groups: group 1 included patients who underwent neoadjuvant chemotherapy with CAPOX as the first treatment step, and group 2 included patients who underwent upfront surgery. Primary endpoint was 3‑year disease-free survival (DFS) rate. We also estimated the pathological complete response (pCR) rate, treatment toxicity, postoperative morbidity rate (Clavien – Dindo), degree of tumor regression, local recurrence rate, distant metastases rate, 3‑year overall survival (OS) and the neoadjuvant chemotherapy completion rate.Results: 118 patients were included in the neoadjuvant chemotherapy group and 103 patients — in the surgery group. Study groups were well balanced and comparable for gender, the ASA status and the tumor differentiation grade. More patients in the neoadjuvant chemotherapy group had clinically positive lymph nodes (p = 0.002). Median follow-up period was 36 months. There were no significant differences in 3‑year OS and DFS. The local recurrence rate was 3.9 % in the surgery group versus 0 % in the neoadjuvant chemotherapy group (p = 0.046). There were no significant differences between study groups in the distant metastases rate (p = 0.293). Sixteen (13.6 %) patients had a pCR after neoadjuvant chemotherapy. The neoadjuvant chemotherapy completion rate was 91.5 %. The hematological toxicity grade 3–4 was observed in 3.3 % (4 patients), the non-hematological toxicity grade 3–4 in 3.3 % (4 patients).Conclusion: NACT has an acceptable toxicity profile, does not impede oncological treatment results, and can be used in a selected group of patients for early systemic control.

Preliminary results of surgical treatment and neoadjuvant chemotherapy in upper rectal cancer

The prognosis of colorectal cancer has continuously improved in recent years thanks to continuous progress in both the therapeutic and diagnostic fields. The specific objective of this study is to contribute to the diagnostic field through the evaluation of the correlation between superior hemorrhoidal vein (SHV) ectasia detected on computed tomography (CT) and Tumor (T), Node (N), and distant metastasis (M) examination and mesorectal fascia (MRF) invasion in the preoperative staging of rectal cancer.Between January 2018 and April 2022, 46 patients with histopathological diagnosis of rectal cancer were retrospectively enrolled, and the diameter of the SHV was evaluated by CT examination. The cutoff value for SHV diameter used is 3.7 mm. The diameter was measured at the level of S2 during portal venous phase after 4× image zoom to reduce the interobserver variability. The parameters evaluated were tumor location, detection of MRF infiltration (defined as the distance < 1 mm between the tumor margins and the fascia), SHV diameter, detection of mesorectal perilesional lymph nodes, and detection of metastasis.A total of 67.39% (31/46) of patients had SHV ectasia. All patients with MRF infiltration (4/46, 7.14%) presented SHV ectasia (average diameter of 4.4 mm), and SHV was significantly related with the development of liver metastases at the moment of primary staging and during follow-up.SHV ectasia may be related to metastasis and MRF involvement; therefore, it could become a tool for preoperative staging of rectal cancer.

The role of superior hemorrhoidal vein ectasia in the preoperative staging of rectal cancer

Introduction: The triplet FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan) may be considered aneffective option in the neoadjuvant setting for metastatic colon cancer (mCRC). To investigate potential molecularcriteria for treatment response, we evaluate the transcriptome of paired primary colon tumors and livermetastases.Method: Two sets of quadruple-matched specimens (primary colon tumor, liver metastasis, normal colon andliver tissues) from five patients with resectable mCRC before and after neoadjuvant FOLFOXIRI were selected forRNA sequencing (RNA-seq).Results: RNA-seq data showed that liver metastases exhibited a higher number of differentially expressed genes(DEGs) than colon tumors (FDR &lt; 0.05, 301 vs. 62, respectively). Up-regulation of IL1RN, MTCO1P12, RN7SL1,ALDH1A1, DUSP1, COX1, and FOS may be associated with colon tumor sensitivity to FOLFOXIRI. HBB, GADD45B,DUSP1, FOSB, HBA2, TSC22D3, TAGLN, PER1, CSRP1, CCN2, NAMPT, ZBTB16, SERPINE1, ISG20, SRGN, ATF3, IL7R,IFITM2, and KLF2 may potentially be involved in the partial liver metastasis response. EPS8L2 was the only genehighly expressed in pre-treatment liver tissue of the complete responder patient compared to others (|Log2FC|= 3.84, FDR &lt; 0.05).Conclusion: Data obtained indicate transcriptional discordance between the primary tumors and liver metastasesduring neoadjuvant FOLFOXIRI, with the pattern of DEGs involved in their response being distinct. The EPS8L2transcript could be regarded as a candidate biomarker of liver complete response; however, prognostic conclusionscannot be drawn from this cohort. 

Transcriptome biomarkers of colon cancer liver metastasis response to neoadjuvant triplet chemotherapy: a case series

Chemoradiotherapy (CRT) remains the standard treatment for locally advanced rectal cancer (LARC). This phase 2 clinical trial was designed to evaluate the efficacy and safety of neoadjuvant triplet chemotherapy with mFOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin, and irinotecan) in LARC.The patients with LARC (the lower edge more than 5 cm from the anal verge) received up to 5 cycles of mFOLFOXIRI. MRI was performed to assess the baseline and postchemotherapy TN stage. Radical resection was performed within 4-6 weeks from the last dose of chemotherapy if the tumor shrank or remained stable. Adjuvant chemotherapy with mFOLFOX6 or XELOX was recommended. Postoperative radiation was planned for R1 resection, ypT4b, ypN2 and a positive CRM. The primary endpoint was the pathological complete response (pCR) rate.From February 2016 to March 2019, 50 patients were enrolled. Forty-eight (96%) were clinically node-positive, 28 (56.5%) with MRF invasion and 39 (78.4%) were EMVI positive. The median cycle of neoadjuvant mFOLFOXIRI chemotherapy was 5 (range,1-5). A total of 46/50 (92%) patients underwent total mesorectal excision (TME) surgery, all with R0 resection. The pCR rate was 4.3% (2/46). Twenty-three of 46 (50%) patients with cN + achieved a pathological node-negative status. The proportions of pathologically positive CRM and EMVI were 2.2% and 34.7%, respectively. Adjuvant radiotherapy was given to 14/46 (30.4%) patients. The most common Grade 3 or > toxicities included neutrocytopenia (50%), leukopenia (14%) and diarrhea (12%) during the neoadjuvant chemotherapy period. Clinically meaningful postoperative complications included pneumonia (n = 1), pelvic infection (n = 1) and anastomotic fistula (n = 1). With a median follow-up time of 51.2 months, local recurrences and distant metastases were confirmed in 3 (6.5%) and 9 (19.6%) of cases, respectively. The 3-year disease free survival (DFS) and overall survival (OS)rates were 75.8% and 86.8%.Neoadjuvant chemotherapy with mFOLFOXIRI yielded a significant down-staging effect and seemed to be effective in eliminating EMVI and transforming the positive MRF to negative in LARC. The survival results are promising. The long-term follow-up showed promising DFS and OS rates accompanied by a favorable safety profile.ClinicalTrials.gov identifier: NCT03443661, 23/02/2018. 

/pdf/neoadjuvant-chemotherapy-with-modified-folfoxiri-for-locally-20m8io1u.pdf

Neoadjuvant chemotherapy with modified FOLFOXIRI for locally advanced rectal cancer to transform effectively EMVI and MRF from positive to negative: results of a long-term single center phase 2 clinical trial

Objective
To explore influencing factors for complete resection and operation time of endoscopic submucosal dissection(ESD) for colorectal tumors.


Methods
This retrospective study included 95 consecutive colorectal tumors in 88 patients whose pathological diagnosis was adenoma and carcinoma, treated with ESD at the Department of Endoscopy of the First Hospital of Jilin University from January 2013 to December 2014. Multiple logistic regression analysis was conducted on the factors related to complete resection and operation time.


Results
Average tumor size was 28.7±14.1 mm(range, 8-80 mm), and the average procedure time was 80.72±63.90 min. The rate of complete resection was 92.6%(88/95), and the rate of incomplete resection was 7.4%(7/95). Multivariate logistic regression analysis revealed that fibrosis (P=0.012, OR=52.473, 95%CI: 2.571-1 140.438) contributed to incomplete resection. Fibrosis (P=0.001, OR=0.045, 95%CI: 0.007-0.289), tumor size (P=0.035, OR=0.170, 95%CI: 0.033-0.884), granular-type laterally spreading tumor(P=0.013, OR=34.432, 95%CI: 2.138-554.476), non-granular-type laterally spreading tumor(P=0.044, OR=31.715, 95%CI: 1.093-919.904) were independent factors for extending operation time of colorectal ESD.


Conclusion
The severer fibrosis can induce higher rate of incomplete resection. The more severe fibrosis is, the larger tumor size is, and the longer operation time is.


Key words: 
Tumor; Colon; Rectum; Endoscopic submucosal dissection; Complete resection; Operative time

Influencing factors for complete resection and operation time in endoscopic submucosal dissection for colorectal tumors

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Neoadjuvant chemotherapy with modified FOLFOXIRI for locally advanced rectal cancer to transform effectively EMVI and MRF from positive to negative: results of a long-term single center phase 2 clinical trial

Influencing factors for complete resection and operation time in endoscopic submucosal dissection for colorectal tumors