Joon Ho Jang

Colorectal cancer in patients under 50 years of age: A retrospective analysis of two institutions' experience

AIM To investigate the epidemiological characteristics of colorectal cancer (CRC) in patients under 50 years of age across two institutions. METHODS Records of patients under age 50 years of age who had CRC surgery over a 16 year period were assessed at two institutions. The following documents where reviewed: admission notes, operative notes, and discharge summaries. The main study variables included: age, presenting symptoms, family history, tumor location, operation, stage/differentiation of disease, and post operative complications. Stage of disease was classified according to the American Joint Committee on Cancer TNM staging system: tumor depth; node status; and metastases. RESULTS CRC was found in 180 patients under age 50 years (87 females, 93 males; mean age 41.4 ± 6.2 years). Young patients accounted for 11.2% of cases during a 6 year period for which the full data set was available. Eight percent had a 1(st) degree and 12% a 2(nd) degree family CRC history. Almost all patients (94%) were symptomatic at diagnosis; common symptoms included: bleeding (59%), obstruction (9%), and abdominal/rectal pain (35%). Evaluation was often delayed and bleeding frequently attributed to hemorrhoids. Advanced stage CRC (Stage 3 or 4) was noted in 53% of patients. Most tumors were distal to the splenic flexure (77%) and 39% involved the rectum. Most patients (95%) had segmental resections; 6 patients had subtotal/total colectomy. Poorly differentiated tumors were noted in 12% and mucinous lesions in 19% of patients of which most had Stage 3 or 4 disease. Twenty-two patients (13%) developed recurrence and/or progression of disease to date. Three patients (ages 42, 42 and 49 years) went on to develop metachronous primary colon cancers within 3 to 4 years of their initial resection. CONCLUSION CRC was common in young patients with no family history. Young patients with symptoms merit a timely evaluation to avoid presentation with late stage CRC.

Laparoscopic-Facilitated Endoscopic Submucosal Dissection, Mucosal Resection, and Partial Circumferential (“Wedge”) Colon Wall Resection for Benign Colorectal Neoplasms That Come to Surgery

Background. Large polyps that come to surgery are removed via colectomy (CR). Alternatives are MIS-facilitated endoscopic submucosal dissection/endoscopic mucosal resection (ESD/EMR) or wedge resection (WR). This study presents the results of 26 polyp patients who had minimally invasive surgery (MIS)-monitored ESD/EMR, WR, or if necessary, standard CR. Methods. The authors used a retrospective review of 1 surgeon’s experience. ESD/EMR was the first choice, WR was the second, and CR was the last resort. Results. Polyp locations were as follows: right/transverse, 16 (62%); rectum, 7 (27%); and left/sigmoid, 3 (12%). ESD/EMR was successful in 13 patients and WR in 4; 9 patients required CR. Median flatus times were as follows: ESD/EMR, 1 day; WR, 2 days; and CR, 3 days (ESD/EMR vs CR, P = .01). Median length of stay was as follows: ESD/EMR, 3 days; WR, 5 days; and CR, 5 days (ESD/EMR vs CR, P = .0037). There were no leaks or abscesses. Carcinoma was found in 3 patients. Postoperatively, 2 ESD/EMR patients had residual polyp fully removed via a scope. Conclusions. ESD/EMR and WR appear to be safe but techniques are evolving. Larger studies are needed.

Plasma monocyte chemotactic protein-1 remains elevated after minimally invasive colorectal cancer resection

AIM To investigate plasma Monocyte Chemotactic Protein-1 levels preoperatively in colorectal cancer (CRC) and benign patients and postoperatively after CRC resection. METHODS A plasma bank was screened for minimally invasive colorectal cancer resection (MICR) for CRC and benign disease (BEN) patients for whom preoperative, early postoperative, and 1 or more late postoperative samples (postoperative day 7-27) were available. Monocyte chemotactic protein-1 (MCP-1) levels (pg/mL) were determined via enzyme linked immuno-absorbent assay. RESULTS One hundred and two CRC and 86 BEN patients were studied. The CRC patients median preoperative MCP-1 level (283.1, CI: 256.0, 294.3) was higher than the BEN group level (227.5, CI: 200.2, 245.2; P = 0.0004). Vs CRC preoperative levels, elevated MCP-1 plasma levels were found on postoperative day 1 (446.3, CI: 418.0, 520.1), postoperative day 3 (342.7, CI: 320.4, 377.4), postoperative day 7-13 (326.5, CI: 299.4, 354.1), postoperative day 14-20 (361.6, CI: 287.8, 407.9), and postoperative day 21-27 (318.1, CI: 287.2, 371.6; P < 0.001 for all). CONCLUSION Preoperative MCP-1 levels were higher in CRC patients (vs BEN). After MICR for CRC, MCP-1 levels were elevated for 1 mo and may promote angiogenesis, cancer recurrence and metastasis.

Plasma Levels of Prostaglandin E2 (PGE2), A Protein With Proangiogenic Effects, Are Elevated in Colorectal Cancer Patients

S A T A b st ra ct s and passive absorption) was much less in 10 mM than the 100 mM glucose solutions (mean±SEM, 2.8±2.0 vs 14.8±3.7 μmol/30 cm/min, respectively; n=6 rats in each; p<0.001). Importantly, stereospecific carrier-mediated uptake increased from 1.9±1.3 to 13.9±2.8 μmol/min (p<0.001), while passive (non-stereospecific) uptake increased, as expected by much less, from 0.7±2.0 to 1.3±1.9 μmol/30 cm/min (p<0.001). In separate experiments (n=6 rats each) carrier-mediated glucose absorption in 10 and 100 mM glucose solutions was decreased by phlorizin (SGLT1 inhibitor) from 2.5±0.2 to 0.6±0.1μmol (p<0.02) and 9.4±2.3 to 2.0±0.9 μmol (p<0.01), respectively, and by phloretin (GLUT2 inhibitor) from 2.4±0.3 to 1.7±0.2 μmol (p<0.02) and 10.0±1.2 to 4.4±1.0 μmol/min, respectively (p<0.03) (Fig.1). The relative contribution of GLUT2 to glucose absorption was 27% at 10 mM but more than double, 56%, at 100 mM (p<0.01). SUMMARY: Augmented, carrier-mediated glucose absorption at infusions of 100 mM glucose appears mediated by GLUT2 (SGLT1 Km≈3-6 mM and would be saturated at≥20 mM glucose solutions). The marked inhibition of glucose absorption at 100 mM glucose by SGLT1 inhibition (phlorizin) implicates SGLT1 activity as being necessary in this GLUT2-mediated process. There is a GLUT2-mediated component of glucose absorption (~27%) even at 10 mM glucose. CONCLUSION: A small amount of GLUT2 is present apically in the enterocyte (constitutively expressed), but when exposed to high luminal concentrations of glucose, the enterocyte changes its phenotype by recruiting GLUT2 apically (within minutesthus mediated through a non-genomic, posttranslational mechanism) to markedly augment glucose absorption. This early postprandial process represents a form of “acute phenotypic adaptation”.

Tu1749 Colorectal Cancer in Patients Under 50 Years of Age: Frequent and More Often Advanced?

S A T A b st ra ct s body mass index (BMI), previous abdominal surgeries, and comorbidities including chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), hypertension, diabetes mellitus (DM), chronic kidney disease (CKD), and nicotine dependence. Our goal was to determine significant differences between the two groups with regard to postoperative pain, wound infection, hernia formation, postoperative ileus, septic complications, length of hospital stay, readmission rate, time interval for postoperative chemotherapy if indicated, symptom distress score (SDS), Visick grade, Quality of life Index (QLI) and cosmetic score. Results: The two groups were comparable for all categories. Follow up was available on all patients (100%). At a mean follow-up of 25.23 months (range 6-53, there was no difference between postoperative pain between the two groups on postoperative day one, postoperative day two or greater than 2 weeks (p= .571),(p= .861),(p= .688), respectively. The NOSE group had no postoperative hernia formation or wound infections compared to the LARH group which had 10% hernia formation rate and 5% wound infection rate, however the difference was not significant (p= .439)and(p=.267), respectively. There was no difference between groups in postoperative ileus (p=.192), septic complications (p=1.000), length of hospital stay (p=.243), readmission rate (p=.394), time interval for postoperative chemotherapy (p=.645), SDS (p=.446), Visick grade (p=.176) or QLI (p=.175). The NOSE group, however, have statically significant better cosmetic scores (p.018). Conclusion: NOSE is comparable LARH with regard to short and long term postoperative outcomes. NOSE is associated with better cosmetic outcome.