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The gastrointestinal tract is home to diverse and abundant microorganisms, collectively referred to as the microbiome. This ecosystem typically contains trillions of microbial cells that play an important role in regulation of human health. The microbiome has been implicated in host immunity, nutrient absorption, digestion, and metabolism. In recent years, researchers have shown that alteration of the microbiome is associated with disease development, such as obesity, inflammatory bowel disease, and cancer. This review discusses the five decades of research into the human microbiome and the development of colorectal cancer - the historical context including experiments that sparked interest, the explosion of research that has occurred in the last decade, and finally the future of testing and treatment., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Pancreatic tumors are frequently found in a geriatric population. Given that the median age of patients with pancreatic cancer is 70 years at diagnosis and the ubiquity of CT and MRI imaging has increased the detection of pancreas masses, pancreatic surgeons often find themselves operating on patients of advanced age. This study sought to evaluate the outcomes of pancreatic resection in an octogenarian population at a single institution with a dedicated surgical oncology team., Study Design: A retrospective chart review was performed for all patients undergoing pancreatic resection over a 13-year period at an academic community cancer center. Patient characteristics and operative outcomes were compared between patients aged 80 and older, and those younger than 80. Student t-tests, Fisher's exact test, and Kruskal-Wallis tests were used for univariate analyses., Results: Over the 13-year period, a total of 48 patients of 403 undergoing pancreatic resections were aged 80 or older. Of these 48 patients, 35 underwent pancreaticoduodenectomy (Whipple) and 13 underwent distal pancreatectomy. Patient characteristics including ASA classification were similar among the two age groups. The procedures themselves were equally complicated with similar operative times, transfusion requirements, estimated blood losses, and portal vein resections. The number and severity of complications such as delayed gastric emptying and pancreatic leak were not statistically different between the two groups. Additionally, the 30-day reoperation, readmission, and mortality rates were not statistically different. Outcomes at 90-days revealed an increased rate of readmission amongst octogenarians who underwent Whipple without an increase in rates of major complications. The total number of deaths in the octogenarian group was 3 (6.2%) vs. 6 (1.7%) in the non-octogenarian group (p = 0.080). The median length of stay was similar amongst the two age groups., Conclusions: At a large-volume academic community cancer center with a dedicated surgical oncology team, highly selected octogenarians can undergo pancreatic resection safely with outcomes that do not differ significantly from their younger counterparts., (Published by Elsevier Ltd.)

Background: Large University Hospitals are usually the referral centers for complex surgical procedures. However, the majority of cancer care takes place in the community hospital. The aim of this study was to analyze the morbidity, mortality and long-term survival of gastric cancer patients after the establishment of a multidisciplinary gastric cancer team in an academic community hospital., Methods: A retrospective review of medical records was performed for patients who presented with gastric cancer from 2005 to 2013. Thirty-day morbidity and mortality were assessed for patients who underwent gastrectomy with curative intent. Long-term survival was determined by Kaplan-Meier analysis., Results: Ninety-one patients underwent curative resection over an 8-year period. Eighty-seven patients (96%) had an R0 resection. Mean lymph node recovery was 20. Serious morbidity rate was reported in 10/91 (11%). Mortality in the series was 3/91 (3%). Five-year survival by stage was similar to AJCC reported survival., Conclusion: Complex surgical resections for gastric cancer can be safely performed at a high volume community cancer center with minimal morbidity and mortality., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The advent of sentinel lymph node biopsy changed the way the surgical community treated breast cancer. It also reduced the post operative morbidity for millions of patients. Now that sentinel lymph node biopsy has become the mainstay of treatment, new clinical questions have arisen and continued research is being done to answer these questions. This report details a brief history of sentinel lymph node biopsy and how it was applied in the treatment a breast cancer. This report also includes a review of the current literature regarding unique clinical scenarios involving sentinel lymph node biopsy in breast cancer including the ACOSOG Z011 trial., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Recent studies have lead to a renewed interest in cytoreductive surgery and intraperitoneal chemotherapy as a regional treatment modality for patients with peritoneal surface malignancies. There have been multiple phase III randomized trials that have shown a survival advantage with intraperitoneal chemotherapy in certain patients. More well designed phase III studies are needed to further define which groups of patients may benefit from cytoreductive surgery and intraperitoneal chemotherapy., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

In the last 250 years, the treatment of rectal cancer has changed dramatically. Once considered an incurable disease, combined modality therapy has improved mortality from 100% to less than 4% for locally advanced rectal cancer. This dramatic reduction paralleled surgical techniques based on a growing understanding of anatomy and disease pathology. In order to understand modern treatment, it is necessary to recognize the achievements of preceding surgeons., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Hepatic resection for colorectal metastases, limited to the liver, has become the standard of care, and currently remains the only potentially curative therapy. Numerous single institutional reports have demonstrated long-term survival and there are no other treatment options that have shown a survival plateau. However, curative resection is possible in less than 25% of those patients with disease limited to the liver, which translates into only 5-10% of the original group developing colorectal cancer. To increase the number of patients who could benefit from hepatic resection, the last decade has seen considerable effort being directed towards novel approaches to permit curative hepatic resection such as: neoadjuvant systemic and regional chemotherapy, pre-operative portal vein embolization for hypertrophy of future liver remnant, staged hepatic resection and radio frequency ablation combined with resection for addressing multiple bilobar metastases. This article reviews development of these innovative multidisciplinary modalities and the aggressive surgical approach that has been adopted to extend the frontiers of surgical therapy for colorectal hepatic metastases.

Thyroid nodules are present in 4-10% of the adult population. However, less than 1% of all cancers occur in the thyroid gland. Thyroid nodules are usually an incidental finding in a routine clinical or an ultrasound examination of the neck performed for some other reason. Differentiating a benign nodule, which may require no specific treatment, from a malignant nodule presents a diagnostic dilemma. An individualized approach to a patient with history, risk factors and fine needle cytology is warranted. Molecular markers and immunohistochemical studies done on thyroid nodule cytology may help in differentiating benign from malignant. This article presents a review of the literature for the diagnosis and management of the thyroid nodule.

Squamous cell carcinoma (SCC) of the anal canal is a rare condition with increasing incidence rates in the United States population in the past several decades. This review article provides a complete overview of the etiology, anatomy and the approach to the multidisciplinary management of the patient with anal SCC. Chemoradiation therapy for the treatment of SCC of the anal canal provides excellent disease control and survival while preserving anal sphincter function in the majority of patients. The surgeon plays a key role in the diagnosis and follow-up of this disease. Surgical salvage with APR for disease persistence or recurrence in carefully selected patients can result in reasonable 5-year survivals.

Conventional staging of colorectal cancer does not account for the marked variability in outcome that exists within each stage. Certain populations of patients with early recurrence, resistance to chemotherapy and decreased survival cannot be predicted utilizing common histopathologic criteria. As the molecular mechanisms underlying colorectal carcinogenesis are elucidated, putative molecular prognostic factors are identified. A comprehensive review of various molecular markers and their roles as prognostic factors in colorectal cancer is presented.

Colorectal cancer (CRC) is believed to carry a grim prognosis in young patients. A retrospective study of patients diagnosed with colorectal cancer at age 30 years or less between 1971 and 1994 was conducted. Statistical analyses were performed using non-parametric one way ANOVA tests and logistic regression models. Sixty-eight of the patients evaluated at our institution were suitable for this study. Risk factors were identified in 28% of patients. The median age at diagnosis was 27 years (range 14-30 years). Fifty-six patients (82%) were Stage III or IV at the time of diagnosis. Twenty-two of the 34 patients who underwent potentially curative surgery had recurring disease at a median of 12 months (range 1-43 months). At a median follow-up of 21.5 months, 54 patients had died from disease. At the time of death, abdominal carcinomatosis and distant disease were the most common patterns of failure. Stage of the primary tumour (P=0.0006) and recurrence (P=0.0001) were the only variables noted to be associated with survival. The stage of the primary tumour and whether the tumour recurred were each associated with survival in patients with colorectal cancer at age 30 years or less.

The lymph node clearing technique improves the detection of lymph nodes in colorectal cancer specimens. The purpose of this study was to determine the utility of mapping the lymph nodes cleared from rectal adenocarcinoma specimens by evaluating the possible relationship between the pattern of lymph node metastases to the site of the recurrent disease. A retrospective medical record review was performed in 40 patients with primary rectal adenocarcinoma. The specimens were analysed by lymph node clearing technique and mapped after surgery. The lymph nodes were mapped according to their location in the cleared specimens. Statistical analysis was performed using the chi 2-test. A total of 1290 lymph nodes were cleared in 40 specimens. Of these, 1126 (87%) lymph nodes were < or = 5 mm. One-hundred and ten (9%) lymph nodes were metastatic. Sixty-seven (61%) of these 110 lymph nodes were 5 mm or less in size. The majority of lymph nodes with or without metastases were in the pelvis, as opposed to an extrapelvic location (P = 0.0001). Eleven patients recurred. In nine of these patients the recurrence showed a direct relationship between the level of metastatic lymph node location (pelvic vs. extrapelvic) and the site of the recurrent disease (loco-regional or systemic, P = 0.05). The majority of lymph nodes, both normal and metastatic, cleared from specimens from rectal adenocarcinoma were < or = 5 mm in diameter. The lymph node mapping technique may help in predicting the site of recurrence.

We investigated the value of serum IgA-1 as a complementary tumour marker to carcinoembryonic antigen (CEA) in the monitoring of the postoperative follow-up of 19 patients with advanced colorectal carcinoma presenting with normal levels of CEA. Mean follow-up period was 14 months (range 2-72 months). Mean number of serum specimens was 5 (range 2-9). IgA-1 assay employed rabbit antihuman IgA for binding IgA-1 from patient's serum and peanut agglutinin to detect the IgA-1 O-glycosidic structure. Ten patients developed distant metastases while nine patients had locoregional recurrence. All 19 patients had generally persistent elevation of serum IgA-1 throughout the follow-up period while serum CEA levels were subsequently elevated in only 10 patients. IgA-1 predicted recurrence with an average lead time of 8 months (range 1-19 months). On the other hand, mean lag time for CEA was 12 months (range 6-50 months). The data indicate the clinical utility of serum IgA-1 as a potential complementary tumour marker to CEA in the monitoring of the postoperative course of this particular subset of colorectal cancer patients.

Fifty-three patients were treated for palliation with endoscopic neodymium yttrium aluminum garnet (Nd:YAG) laser for colorectal carcinoma at Roswell Park Cancer Institute. There were 25 females and 28 males. The mean age of the patients was 76 years. Thirty-eight tumours were primary and 15 recurrent. The level of the lesions from the anal verge ranged from 2 to 50 cm, with a mean of 10 cm. Eighty-four percent of the lesions were rectal carcinomas within 15 cm of the anal verge. Lesion length ranged from 1.5 to 12 cm with a mean of 5 cm. The number of laser treatments ranged from 1 to 17 with a mean of 3. The duration of treatments ranged from 25 to 90 min with a mean of 35 min. The mean number of joules per treatment was 5093. Eight patients (15%) developed complications. There were no mortalities. The success rate for treating bleeding, the most frequent presenting symptom, was 93%. The overall success rate of patients improved by laser treatment was 79%. Patients who were improved by therapy had a median survival of 18 months versus those not improved who had a median survival of 3 months (P = 0.01). The use of the Nd:YAG laser for palliative treatment of patients with colorectal carcinoma is safe, effective and associated with no mortality.

A retrospective review of the medical records of 30 patients with familial adenomatous polyposis who underwent oesophagogastroduodenoscopy was performed to evaluate the spectrum of gastroduodenal polyps. Twenty-five patients (83%) had gastroduodenal polyps. Eighteen patients (60%) had gastric polyps and 21 patients (70%) had duodenal polyps. Five patients (17%) had gastric and 20 patients (67%) had duodenal adenomatous polyps. Three patients (10%) died from an upper gastrointestinal tract adenocarcinoma. Three of nine patients with periampullary adenomas had a normal-appearing papilla of Vater. Since gastroduodenal polyps are common in familial adenomatous polyposis, oesophagogastroduodenoscopy should be performed at the time of diagnosis. Biopsy of polyps as well as biopsy of a normal-appearing papilla of Vater should be performed. Due to their malignant potential, if identified, gastroduodenal adenomatous polyps should be destroyed.