Search

Perianal tuberculosis (TB) is an extremely rare form of mycobacterial infection, in which the anal mucocutaneous junction becomes infected by autoinoculation from an active draining gastrointestinal tract infection. The case of a 73-year-old immunocompetent male patient, who came in with a refractory perianal ulcer is presented. The patient had no history of TB and his lab tests for TB were all negative. A chest X-ray showed streak and nodular opacities in both upper lungs. The ulcer was biopsied twice and a diagnosis of TB was finally rendered by histological examination with confirmatory Polymerase chain reaction (PCR). The lesion was finally cured by intensive anti-TB treatment. Perianal TB needs to be excluded in patients with a refractory perianal ulcer, including immunocompetent cases without TB history. Biopsies and microbiological tests should be performed for any suspicious lesion and repeated if there is high clinical concern. ---Continue

Objective: To analyze whether the European Organisation for Treatment and Research of Cancer (EORTC) Quality of Life Questionnaires (QLQ-C30 and QLQ-CR29) complement the low anterior resection of rectum syndrome (LARS) score in evaluating the quality of life of patients who underwent laparoscopic or robotic rectal cancer surgery. Methods: Initially, 335 patients who underwent laparoscopic or robotic rectal cancer surgery were randomly selected at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from June 2013 to September 2020. All the patients took the questionnaires of LARS score, QLQ-C30 and QLQ-CR29. Totally, questionnaires filled out by 224 patients were qualified after screening. Patients were divided into three groups according to LARS score: No LARS group (score 0–20), minor LARS group (score 21–29) and major LARS group (score 30–42). The scores of QLQ-C30 as well as QLQ-CR29 among the three groups were compared. Results: Major, minor and no LARS groups had 140 cases, 40 cases and 44 cases respectively. In the scales of QLQ-C30, significant differences were discovered in global quality of life, physical function, role function, emotional function, cognitive function, social function, fatigue, pain, dyspnea, sleep disturbance, constipation and diarrhea between the no and major LARS groups (p

134 Background: Chemoradiation is the standard neoadjuvant treatment for locally advanced rectal cancer. Microsatellite stable (MSS)/ mismatch repair proficient (pMMR) rectal cancer rarely responds to immune checkpoint inhibitor monotherapy, but combination with chemoradiation may improve sensitivity of MSS/pMMR tumors by inducing immune-stimulatory effects. Therefore, we aimed to investigate the efficacy and safety of patients treated with neoadjuvant preoperative short-course radiation followed by envafolimab plus CAPEOX for MSS/pMMR locally advanced rectal cancer. Methods: This is an open-label, single-center, phase ¢ò study. Patients (pts) with locally advanced rectal adenocarcinoma with MSS/pMMR were eligible. MMR protein expression was tested by immunohistochemistry (IHC) £¬and MSI status was confirmed by NGS (next generation sequencing). All pts included in this study underwent neoadjuvant short-course radiation (total dose of 5¡Á5Gy) in the first week after enrollment, then followed by 6 cycles of envafolimab (anti-PD-L1 inhibitor,150mg, d1, subcutaneous injection, QW) plus 2 cycles of CAPEOX in the next six weeks, and subsequently underwent total mesorectal excision (TME) in the ninth week. The primary endpoint is pathological complete response rate. Secondary endpoints include tumor regression grade (TRG), 3 year disease free survival, overall survival, toxicity, and quality of life (QoL). Results: This study intends to recruit 32 pts, and a total of 21 pts were enrolled from January 2022 to September 2022. Overall median age was 67 (42-79) years. 12 pts completed study designed treatment protocol (envafolimab plus CAPOX) followed with TME procedures, and 9 pts are still undergoing neoadjuvant treatment. All 12 pts achieved major partial response (MPR) evaluated by diffusion-weighted magnetic resonance imaging (DW-MRI), and 8 pts (8/12,76.6%) achieved pCR. During neoadjuvant treatment period, 20 pts (20/21, 95.2%) presented with treatment-related AEs (TRAEs) of any grade, 18 pts (18/21, 85.7%) had grade 1-2 and one each pts had grade 3 and 4 thrombocytopenia (2/21, 9.5%). The most common TRAEs were sensation of rectal tenesmus. Conclusions: Neoadjuvant preoperative short-course radiation followed by envafolimab plus CAPEOX in MSS/pMMR locally advanced rectal cancer achieved a promising pathologic response. Meanwhile, this combination neoadjuvant therapy is safe and worthy of application to clinical practice. (Funded by Sir Run Run Shaw Hospital Zhejiang University School of Medicine.) Clinical trial information: NCT05216653 .

Aim: This study aimed to compare clinical and oncological outcomes of robot-assisted and laparoscopic surgery for rectal cancer. Materials and Methods: We searched PubMed/Medline, Embase, the Cochrane Library, Yahoo, and Google Scholar databases for relevant articles published up to 2017. Studies based on comparability between robot-assisted and laparoscopic surgery for rectal cancer were designated. Clinical outcomes included operative time, conversion to open surgery, estimated blood loss (EBL), bowel function recovery time, length of hospital stay (LOS), anastomosis leak, and postoperative complications. Oncological outcomes comprised the number of lymph nodes extracted, the positive circumferential margin (PCRM), and the distal resection margin (DRM) Results: Twenty studies were designated totaling 5496 patients, comprising a robot-assisted surgery patient group (n = 2168, 39.4%) and a laparoscopic surgery patient group (n = 3328, 60.6%). The robot-assisted surgery group was associated with longer operative time (odds ratio [OR] 0.48, 95% confidence interval [CI]; 0.14, 0.82), lower conversion to open surgery rate (OR 0.55, 95% CI; 0.44, 0.69), shorter LOS (OR − 0.15, 95% CI; −0.30, 0.00), faster bowel function recovery (OR − 0.38, 95% CI; −0.74, −0.02), and lower postoperative complications (OR 0.79, 95% CI; 0.65, 0.97). EBL, anastomosis leak rate, and oncological outcomes including the number of lymph nodes extracted, the DRM, and the PCRM showed no significant differences between groups. Conclusion: Robot-assisted surgery for rectal cancer showed longer operative time, lower conversion, faster bowel function recovery rates, and shorter hospital stay, and similar oncological outcomes compared to laparoscopic surgery.

Background Bcl-XL, a mitochondria membrane protein, is overexpressed in colorectal cancers and promotes cell survival. We have previously shown that the adenovector expressing small hairpin (sh)RNA targeting Bcl-XL could induce significantly apoptosis in colon cancer cells. In the present study, we aimed to further detect the anti-cancer effect of adenovector expressing the shRNA targeting Bcl-XL (Ad/Bcl-XL shRNA) on rectal cancer xenografts that were derived from patient tumors. Methods We first established three rectal cancer xenografts. These xenografts were subsequently treated with Ad/Bcl-XL shRNA alone or in combination with 5-fluouracil (5-Fu). Finally, the inhibition of tumor growth, survival time and induction of apoptosis were analyzed. Results The results obtained demonstrated that Ad/Bcl-XL shRNA could effectively suppress the tumor growth of all three rectal cancer xenografts and prolong their survival time. After being combined with 5-Fu, the suppressing effect of Ad/Bcl-XL shRNA was enhanced further. In addition, the data also showed that Ad/Bcl-XL shRNA combined with 5-Fu could significantly increase the apoptotic ratio in the rectal cancer xenograft. Conclusions These data indicate that Ad/Bcl-XL shRNA with or without 5-Fu has effective anti-tumor effects on the patient tumor-derived rectal cancer xenografts, suggesting that it could be a potential strategy for rectal cancer therapy. Copyright © 2012 John Wiley & Sons, Ltd.

Early diagnosis plays a decisive role in the outcome of colorectal cancer (CRC) therapy. The ex vivo culture of fresh CRC tissues and paired normal colorectal tissues provides a feasible way to explore potential serum biomarkers for CRC early detection under near-physiological conditions. In the present work, we applied a lectin affinity based approach to enrich and increase the detection number of secreted proteins in the conditioned media of cultured tissues. The captured proteins were then analyzed by the proteomic strategy of one-dimensional gel electrophoresis coupled to liquid chromatography-tandem mass spectrometry. By quantification with label-free spectral counting, we found 123 differentially expressed secreted proteins (DESPs) with 68 DESPs up-regulated in CRC tissues. EFEMP2, one of the top 10 up-regulated DESPs, was further validated by immunohistochemistry at tissue level and enzyme-linked immunosorbent assay at serum level. We found the expression level of EFEMP2 was dramatically increased in CRC patients, even at the early stage. Moreover, the diagnostic accuracy of EFEMP2 was superior to the established CRC biomarker carcinoembryonic antigen evidenced by the area under the receiver operating characteristic curve for the two biomarkers were 0.923 and 0.728, respectively. These results indicated EFEMP2 is a promising serum biomarker for CRC early detection.

Bcl-XL, a mitochondria membrane protein, is overexpressed in colorectal cancers and promotes cell survival. We have previously shown that the adenovector expressing small hairpin (sh)RNA targeting Bcl-XL could induce significantly apoptosis in colon cancer cells. In the present study, we aimed to further detect the anti-cancer effect of adenovector expressing the shRNA targeting Bcl-XL (Ad/Bcl-XL shRNA) on rectal cancer xenografts that were derived from patient tumors.We first established three rectal cancer xenografts. These xenografts were subsequently treated with Ad/Bcl-XL shRNA alone or in combination with 5-fluouracil (5-Fu). Finally, the inhibition of tumor growth, survival time and induction of apoptosis were analyzed.The results obtained demonstrated that Ad/Bcl-XL shRNA could effectively suppress the tumor growth of all three rectal cancer xenografts and prolong their survival time. After being combined with 5-Fu, the suppressing effect of Ad/Bcl-XL shRNA was enhanced further. In addition, the data also showed that Ad/Bcl-XL shRNA combined with 5-Fu could significantly increase the apoptotic ratio in the rectal cancer xenograft.These data indicate that Ad/Bcl-XL shRNA with or without 5-Fu has effective anti-tumor effects on the patient tumor-derived rectal cancer xenografts, suggesting that it could be a potential strategy for rectal cancer therapy.