Hans H. Wasmuth

Identification of serum microRNA profiles in colon cancer.

Background:microRNAs (miRNAs) exist in blood in an apparently stable form. We have explored whether serum miRNAs can be used as non-invasive early biomarkers of colon cancer.Methods:Serum samples from 30 patients with colon cancer stage IV and 10 healthy controls were examined for the expression of 375 cancer-relevant miRNAs. Based on the miRNA profile in this study, 34 selected miRNAs were measured in serum from 40 patients with stage I–II colon cancer and from 10 additional controls.Results:Twenty miRNAs were differentially expressed in serum from stage IV patients compared with controls (P<0.01). Unsupervised clustering revealed four subgroups; one corresponding mostly to the control group and the three others to the patient groups. Of the 34 miRNAs measured in the follow-up study of stage I–II patients, 21 showed concordant expression between stage IV and stage I–II patient. Based on the profiles of these 21 miRNAs, a supervised linear regression analysis (Partial Least Squares Regression) was performed. Using this model we correctly assigned stage I–II colon cancer patients based on miRNA profiles of stage IV patients.Conclusion:Serum miRNA expression profiling may be utilised in early detection of colon cancer.

Durability of Ileal Pouch–anal Anastomosis and Continent Ileostomy

PURPOSE This study was designed to evaluate pouch durability and salvage in patients undergoing continent ileostomy and ileal pouch-anal anastomosis. METHODS Three hundred seventeen patients undergoing ileal pouch-anal anastomosis and 63 undergoing continent ileostomy were evaluated in a prospective observational study. Median observation time was 10.6 (range, 1-23) years for patients who underwent ileal pouch-anal anastomosis and 14 (1-24) years for those who underwent continent ileostomy. RESULTS Twenty-three pelvic pouches failed (8%), and six continent ileostomies (10%) were excised (difference not significant). Estimated failure rates at 20 years were 11.4% (CI, +/-4.8) for ileal pouch-anal anastomosis and 11.6% (CI, +/-8,2) for continent ileostomy (P = 0.8). Sixty-five patients who had received an ileal pouch-anal anastomosis (21%) and 21 of those who had a continent ileostomy (30%) had one or more salvage procedures. Estimated salvage rates at 20 years were 31% vs. 38%, respectively (P = 0.06). The crude success rates of functioning ileal pouch-anal anastomosis and continent ileostomy were 92.8% and 90.5%, respectively. CONCLUSION Success rates after ileal pouch-anal anastomosis and continent ileostomy are high. Their rates of failure are similar. Salvage procedures are substantial with both procedures. Complications and failure after continent ileostomy are not inferior to those after ileal pouch-anal anastomosis. Continent ileostomy remains an option in patients for whom ileal pouch-anal anastomosis is unsuitable.PURPOSE: The Surgisis® AFP™ anal fistula plug is a bioabsorbable xenograft designed to assist in the closure of anorectal fistulas. Its efficacy was studied in a series of patients at King Khalid University Hospital, in Riyadh, Saudi Arabia. METHODS: Patients with chronic and/or complicated anorectal fistulas were prospectively studied. Diagnoses were made by clinical, radiographic, or endoscopic criteria. The number of fistula tracts (based on the number of primary openings) and the duration of draining setons was recorded. Under general anesthesia, patients underwent identification and irrigation of the fistula tracts using hydrogen peroxide. The anal fistula plug was used to occlude the primary opening for each high anal/anorectal fistula not amenable to fistulotomy. The plug was securely sutured into place at the primary opening using absorbable suture. RESULTS: Twenty-two consecutive patients were prospectively enrolled. In total, 23 fistula tracts were treated. Three anorectal fistulas failed to close early in the study, but two failures were attributed to technical error. Both patients refused to undergo a second procedure. The third failure occurred because of recurrent Crohn’s disease. After a mean follow-up of 12 months, 19 of the 23 fistula tracts remained successfully closed, for an overall success rate of 83%. There was no relationship between closure of the fistula and the presence of draining setons. CONCLUSIONS: In our experience, closure of cryptoglandular anorectal fistula tracts using the Surgisis® AFP™ anal fistula plug is safe and successful in 83% of fistula tracts at 12 months of follow-up.

Awareness of heredity in colorectal cancer patients is insufficient among clinicians: a Norwegian population‐based study

Objective  The assessment of family history and medical data is crucial in identifying families with Lynch syndrome (LS). Among consecutive colorectal cancer (CRC) patients, we aimed at identifying all patients with a hereditary predisposition, and to study a possible discrepancy with assessments made by the responsible clinicians.

Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993–2010

Background. The Norwegian Rectal Cancer Project was initated in 1993 with the aims of improving surgery, decreasing local recurrence rates, improving survival, and establishing a national rectal cancer registry. Here we present results from the Norwegian Colorectal Cancer Registry (NCCR) from 1993 to 2010. Material and methods. A total of 15 193 patients were diagnosed with rectal cancer in Norway 1993–2010, and were registered with clinical data regarding diagnosis, treatment, locoregional recurrences and distant metastases. Of these, 10 796 with non-metastatic disease underwent tumour resection. The results were stratified into five time periods, and the treatment outcomes were compared. Recurrence rates are presented for the 9785 patients who underwent curative major resection (R0/R1). Results. Among all 15 193 patients, relative five-year survival increased from 54.1% in 1993–1997 to 63.4% in 2007–2010 (p < 0.001). Among the 10 796 patients with stage I–III disease who underwent tumour resection, from 1993–1997 to 2007–2010, relative five-year survival improved from 71.2% to 80.6% (p < 0.001). An increasing proportion of these patients underwent surgery at large-volume hospitals; and 30- and 100-day mortality rates, respectively, decreased from 3.0% to 1.4% (p < 0.001) and from 5.1% to 3.0% (p < 0.011). Use of preoperative chemoradiotherapy increased from 6.5% in 1993 to 39.0% in 2010 (p < 0.001). Estimated local recurrence rate after major resection (R0/R1) decreased from 14.5% in 1993–1997 to 5.0% in 2007–2009 (p < 0.001), and distant recurrence rate decreased from 26.0% to 20.2% (p < 0.001). Conclusion. Long-term outcomes from a national population-based rectal cancer registry are presented. Improvements in rectal cancer treatment have led to decreased recurrence rates of 5% and increased survival on a national level.

Performance of clinical guidelines compared with molecular tumour screening methods in identifying possible Lynch syndrome among colorectal cancer patients: a Norwegian population-based study

Background:The aim of this study was to assess the performance of the Revised Bethesda Guidelines (RBG) and the accuracy of the Amsterdam II criteria (AM II) in identifying possible Lynch syndrome (LS) compared with the results of molecular tumour testing.Methods:Tumours from 336 unselected colorectal cancer patients were analysed by three molecular tests (namely microsatellite instability (MSI), BRAF mutation and methylation of mismatch-repair genes), and patients were classified according to the RBG and AM II criteria.Results:A total of 87 (25.9%) patients fulfilled the RBG for molecular tumour analyses (MSI and/or immunohistochemistry), and the AM II identified 8 (2.4%) patients as having possible LS. Molecular tests identified 12 tumours (3.6%) as probable LS. The RBG identified 6 of the 12 patients (sensitivity 50%), whereas 5 of the 8 patients who fulfilled the AM II criteria were not likely to be LS, based on molecular tests (predictive value of positive test, 38%).Interpretation:Assuming a fairly high accuracy of molecular testing, the performance of the RBG in identifying patients with possible LS was poor, and the AM II criteria falsely identified a large proportion as having possible LS. This favours the use of molecular testing in the diagnosis of possible LS.

Impact of perioperative chemotherapy on oncological outcomes after gastric cancer surgery

Perioperative chemotherapy has become standard care for resectable gastric cancer. However, available evidence is based on a limited number of trials, and the outcomes in routine clinical practice and in unselected patients are scarcely reported.

Long-term surgical load in patients with ileal pouch-anal anastomosis

Aim  To evaluate surgical workload and complications in patients who had undergone restorative proctocolectomy, through long‐term follow‐up in one single institution.

Surgical load and long-term outcome for patients with Kock continent ileostomy

Objective  The aim of the study was to evaluate the results of Kock continent ileostomy (CI) during the same period when ileal pouch–anal anastomosis was the preferred operation for patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP).

Long-term function after ileal pouch-anal anastomosis –Function does not deteriorate with time

Aim  There are conflicting reports regarding long term function after ileal pouch‐anal anastomosis (IPAA). The aim of the present prospective study was to investigate the influence of duration as an independent factor on long‐term function results.

The outcome and the frequency of pathological complete response after neoadjuvant radiotherapy in curative resections for advanced rectal cancer: a population-based study.

Pathological complete response (ypCR) after neoadjuvant treatment for rectal cancer is associated with favourable survival and a low rate of local recurrence. The aim of the study was to assess the incidence of ypCR among patients with advanced rectal cancer treated with neoadjuvant chemoradiotherapy and curative resection and to explore factors associated with survival.