Diseases of the Colon & Rectum最新文献

{"title":"Is Early, Post-Induction Restaging of Rectal Cancer Undergoing Total Neoadjuvant Therapy Associated With Ultimate Treatment Response?","authors":"William C Chapman, Emre Gorgun, Sumeyye Yilmaz, David R Rosen, Michael Valente, Josh Sommovilla, Arielle Kanters, Andrei Purysko, Alok Khorana, Smitha Krishnamurthi, Sudha Amarnath, Hermann Kessler, Scott Steele, David Liska","doi":"10.1097/DCR.0000000000003485","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003485","url":null,"abstract":"<p><strong>Background: </strong>Among rectal cancer patients treated with Total Neoadjuvant Therapy, it is unclear whether early, post-induction restaging is associated with final tumor response. If so, interim restaging may alter rectal cancer decision-making.</p><p><strong>Objective: </strong>To determine if post-induction restaging with endoscopy and magnetic resonance imaging is associated with final tumor response.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>US tertiary care institution accredited by the National Accreditation Program for Rectal Cancer.</p><p><strong>Patients: </strong>Biopsy-proven rectal cancer patients who underwent Total Neoadjuvant Therapy with interim (post-induction) restaging.</p><p><strong>Main outcome measures: </strong>Association between response assessment on post-induction restaging and final treatment response.</p><p><strong>Results: </strong>107 patients were analyzed. Patients with post-induction magnetic resonance tumor response grade 1 - 2 or complete endoscopic response were significantly more likely (odds ratio 5.4 [p < 0.01] and odds ratio 3.7 [p = 0.03], respectively) to ultimately achieve a final complete response. Likewise, the odds of a final incomplete response were significantly higher for patients with post-induction composite partial (odds ratio 4.1, p < 0.01) or minimal (odds ratio 12.0, p < 0.01) responses.</p><p><strong>Limitations: </strong>Retrospective analysis and lack of detailed subclassification of partial endoscopic response may have limited the conclusions of this data. Limited sample size may also have biased these conclusions.</p><p><strong>Conclusion: </strong>Tumor response to induction therapy is associated with ultimate treatment response to Total Neoadjuvant Therapy among complete or minimal responders; the significance of a partial interim response remains unclear. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Final Results of the GRECCAR-6 Trial on Waiting Period Following Neoadjuvant Radiochemotherapy for Locally Advanced Rectal Cancer: 5 Years of Follow-up.","authors":"Maxime K Collard, Laurent Mineur, Célia Nekrouf, Quentin Denost, Philippe Rouanet, Cécile de Chaisemartin, Aude Merdrignac, Mehrdad Jafari, Eddy Cotte, Jérôme Desrame, Gilles Manceau, Stéphane Benoist, Etienne Buscail, Mehdi Karoui, Yves Panis, Guillaume Piessen, Alain Saudemont, Michel Prudhomme, Frédérique Peschaud, Anne Dubois, Jérôme Loriau, Jean-Jacques Tuech, Emilie Duchalais, Renato Lupinacci, Nicolas Goasgen, Tabassome Simon, Yann Parc, Jérémie H Lefevre","doi":"10.1097/DCR.0000000000003477","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003477","url":null,"abstract":"<p><strong>Background: </strong>The potential oncological benefit of extending the waiting period between neoadjuvant radiochemotherapy and surgical resection for rectal cancer is debated.</p><p><strong>Objective: </strong>To evaluate the impact of prolonging this waiting period on the 5-year oncological prognosis and 2-year functional result of locally advanced rectal adenocarcinoma.</p><p><strong>Design: </strong>Phase III, multicenter, randomized, open-label, parallel-group, controlled trial.</p><p><strong>Settings: </strong>Patients were enrolled from 24 colorectal centers.</p><p><strong>Patients: </strong>Patients with non-metastatic mid or lower cT3-4 or TxN+ rectal adenocarcinoma who had received radio-chemotherapy (45 to 50 Gy with fluorouracil or capecitabine).</p><p><strong>Intervention: </strong>Patients were randomly assigned to undergo total mesorectal excision either 7 weeks (W7) or 11 weeks (W11) after radiochemotherapy.</p><p><strong>Main outcomes measures: </strong>Overall survival and disease-free survival at 5 years of follow-up and low anterior resection syndrome score assessed after 2 years of follow-up.</p><p><strong>Results: </strong>Among 265 patients enrolled, 133 were randomized in the 7-week group and 132 in the 11-week group. Twelve patients were excluded as they did not undergo resection. Among 253 patients analyzed, 5-year overall survival was not different between the two groups (81.6% in 7-week group versus 82.6% in 11-week group, p = 0.827), as well as for the 5-year disease-free survival (70.4% in 7-week group versus 69.5% in 11-week group, p = 0.856). No difference was observed between the two groups for distant recurrence (27.4% in 7-week group versus 25.7% in 11-week group, p = 0.777) or local recurrence (8.4% in 7-weeks group versus 10.2% in 11-week group, p = 0.543). Low anterior resection syndrome score was similar between the 7-week (25.0 IQR [15.0-34.0]) and 11-week groups (23.0 IQR[14.2-32.0], p = 0.743).</p><p><strong>Limitations: </strong>The response rate to the LARS questionnaire was only 52%.</p><p><strong>Conclusions: </strong>Extending the waiting period between radiochemotherapy and resection from 7 to 11 weeks does not modify the 5-year oncological prognosis in rectal cancer and the 2-year low anterior resection occurrence.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rectal Cancer Watch & Wait Management: Experience of 545 Patients from the U.S. Rectal Cancer Research Group.","authors":"Samuel H Lai, Maria Widmar, John R T Monson, Fergal J Fleming, Arden M Morris, Jon D Vogel","doi":"10.1097/DCR.0000000000003586","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003586","url":null,"abstract":"<p><strong>Background: </strong>The use of a watch and wait management strategy following a complete clinical response to neoadjuvant therapy for rectal cancer is increasing. However, insights into implementation, treatments, and outcomes, on a United States national level, are limited.</p><p><strong>Objective: </strong>To investigate and report on watch & wait management practices and outcomes in the US.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Multicenter.</p><p><strong>Patients: </strong>Stage II or III rectal cancer patients who underwent intentional watch & wait management between January 2015 and August 2022.</p><p><strong>Main outcome measures: </strong>Patient and tumor characteristics, neoadjuvant treatment and response, local cancer regrowth and metastasis, salvage surgery, overall and disease-specific survival.</p><p><strong>Results: </strong>Among 545 patients from 33 centers, follow-up was 21 months (range, 9-37). Total neoadjuvant therapy or other types of neoadjuvant were used in 395 (72%) and 150 (28%) of patients, respectively. Estimated 3-year local regrowth rate was 23.8% (95% CI: 19.1-29.4%). Patients with local regrowth had higher distant metastases incidence (14.2% vs. 3.5%, p < 0.001). Salvage surgery was performed in 74/84 (88%) patients with local regrowth and included rectal resection in 66 (89%), and local excision in 8 (11%). Of 64 salvage resections with known pathology results, 58 (91%) were margin-negative. Overall, 3-year overall survival was 94.8% (95% CI: 90.5 - 97.2%) and 3-year disease specific survival 96.2% (95% Cl 91.8 - 98.2%). Patients with and without local regrowth exhibited 3-year overall survival of 83.6% (95% Cl 68.4 - 91.9%), and 97.7% (95% CI: 93.3 - 99.2%), respectively.</p><p><strong>Limitations: </strong>Retrospective study.</p><p><strong>Conclusion: </strong>This multicenter study indicates that the watch & wait approach for locally advanced rectal cancer is feasible with acceptable outcomes across a variety of geographical regions and practice settings in the US. Local regrowth and distant metastasis rates were within published norms and salvage surgery proved effective. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complex Pelvic Fistulas in African Women: The Challenges and Opportunities of an Ongoing Epidemic.","authors":"Hillary Mabeya, Carolyn Aluku, Claud Crosby, Anna Spivak, Phantila Haruethaivijitchock, Arun Rojanasakul, Meena Dhir, Maher A Abbas","doi":"10.1097/DCR.0000000000003548","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003548","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Follow-up After an Initial Episode of Diverticulitis: A 13- Year Update.","authors":"Sarah N Anwar, Gabrielle E Dombek, Caroline Hayes, Maggie J McMahon, Cody Munroe, Jonathan S Abelson, Jason F Hall, David A Kleiman, Angela H Kuhnen, Peter W Marcello, Julia T Saraidaridis","doi":"10.1097/DCR.0000000000003587","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003587","url":null,"abstract":"<p><strong>Background: </strong>For patients with recurrent diverticulitis, the trigger to proceed to elective sigmoid colectomy is unclear. Current clinical practice guidelines suggest this is an individualized decision between surgeon and patient.</p><p><strong>Objective: </strong>To assess long-term risk of diverticulitis recurrence and determine predictors of recurrent disease.</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Tertiary care center.</p><p><strong>Patients: </strong>Consecutive patients with CT-proven diverticulitis who presented as inpatient or outpatient between 2002-2008.</p><p><strong>Interventions: </strong>Incidence of diverticulitis recurrence determined via chart review and questionnaire.</p><p><strong>Main outcome measures: </strong>Risk of recurrent diverticulitis or surgery for diverticulitis.</p><p><strong>Results: </strong>A total of 753 patients with first-time diverticulitis were identified. Patients were 61.5 years old (SD 15.3). Median follow-up was 13.2 years (IQR 3.8-18.3). There were 486 (64.5%) patients alive at time of follow-up. During initial presentation, 29 (3.9%) required IR drainage and 37 (4.9%) required emergency surgery. Forty-three (5.7%) underwent elective surgery after initial presentation, and 77 (10.2%) underwent surgery after more than 1 episode. Of those without surgery for first episode, 353 (52.4%) experienced recurrent disease with median time to recurrence of 2.9 years (IQR 0.83-8.5 years). On multivariate analysis, female sex (HR 1.28, p = 0.04), sigmoid disease (HR 1.35, p = 0.03), smoldering disease (HR 3.17, p < 0.01), length of involved segment >5 cm (HR 1.28, p = 0.04), and maximum fat stranding diameter >1.8 cm (HR 1.29, p = 0.03) were associated with disease recurrence. Kaplan Meier estimates of freedom from recurrence were 73.1% (69.6-76.3%) at 1 year, 47.9% (44.0-51.6%) at 5 years, and 34.6% (31.0-38.2%) at 10 years following initial presentation.</p><p><strong>Limitations: </strong>Retrospective design.</p><p><strong>Conclusions: </strong>After a single episode of diverticulitis, incidence of recurrence is more than 50% on long-term follow-up. Variables such as female sex, sigmoid disease, smoldering disease, length of involved segment greater than 5 cm, and maximum fat stranding diameter greater than 1.8 cm were associated with an increased risk of recurrence. These findings should be considered when counseling patients on decision to proceed with elective colectomy. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colon and Rectal Surgery Regional Society Meetings.","authors":"","doi":"10.1097/01.dcr.0001081296.85197.58","DOIUrl":"https://doi.org/10.1097/01.dcr.0001081296.85197.58","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"67 11","pages":"e1739-e1740"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kono-S Anastomosis Technique for Recurrent Crohn's Disease.","authors":"Maria A Casas, Nicholas S Murdoch Duncan, Agustin C Valinoti, Maximiliano E Bun, Nicolás A Rotholtz","doi":"10.1097/DCR.0000000000003436","DOIUrl":"10.1097/DCR.0000000000003436","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e1666"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Outcomes of Bascom Cleft Lift Versus Excision With Secondary Wound Healing for Pilonidal Sinus Disease: A Multicenter Retrospective Analysis.","authors":"Eleonora Anna Huurman, Jasper F de Kort, Christel A L de Raaff, Maarten Staarink, Sten P Willemsen, Robert M Smeenk, Boudewijn R Toorenvliet","doi":"10.1097/DCR.0000000000003402","DOIUrl":"10.1097/DCR.0000000000003402","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pilonidal sinus disease impacts a patient's quality of life. In the Netherlands, it is often treated with excision and secondary wound healing, which is associated with high recurrence rates and poor wound healing. The Bascom cleft lift, an alternative technique, has shown favorable healing times and recurrence rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The present study compares successful wound healing, time to healing, complications, and recurrence rate between excision with secondary wound healing and Bascom cleft lift.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This is a multicenter retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings: &lt;/strong&gt;Three institutions in the Rotterdam region of the Netherlands participated in the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Patients who underwent excision with secondary wound healing or Bascom cleft lift between July 2015 and August 2021 were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Primary end points included the rate of successful wound healing and the time to achieve healing. Secondary end points included postoperative complications and the recurrence rate within 12 months after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 272 patients, 128 underwent Bascom cleft lift and 144 patients underwent excision and secondary wound healing. Recurrent pilonidal sinus disease (47.7% vs 22.2%) and abscess history (53.1% vs 40.3%) were more common in the Bascom cleft lift group compared to excision with secondary wound healing. The median follow-up period at the outpatient clinic was 43 days. The wound healing rate was 84.4% after Bascom cleft lift versus 32.6% after excision and secondary wound healing ( p &lt; 0.001), with a median time to wound healing of 55 and 101 days, respectively ( p &lt; 0.001). Complications were 28.9% for Bascom cleft lift versus 13.2% for excision and secondary wound healing ( p = 0.003). The rate of recurrent disease was 6.3% after Bascom cleft lift and 11.8% after excision and secondary wound healing ( p = 0.113).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This study used a retrospective design, which makes it prone to selection bias and residual confounding. In addition, the short follow-up period adds to these limitations because a longer follow-up period may better identify true recurrence rates. The absence of collected patient satisfaction data, which is currently a common scientific issue, is also a deficiency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This retrospective study shows that Bascom cleft lift is superior to excision and secondary wound healing, given the higher percentage of patients with successful wound healing within a shorter time. See Video Abstract .&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados posoperatorios de la elevacin de la hendidura tipo bascom versus la escisin con cicatrizacin de la herida por segunda intensin para la enfermedad de seno pilonidal un anlisis retrospectivo multicntrico: &lt;/strong&gt;ANTECEDENTES:La enfermedad de seno pilonidal afecta la calidad de vida","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1458-1464"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11477847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Reporting on Anastomotic Leaks in Colorectal Cancer Trials: A Systematic Review.","authors":"Danique J I Heuvelings, Omar Mollema, Sander M J van Kuijk, Merel L Kimman, Marylise Boutros, Nader Francis, Nicole D Bouvy, Patricia Sylla","doi":"10.1097/DCR.0000000000003475","DOIUrl":"10.1097/DCR.0000000000003475","url":null,"abstract":"<p><strong>Background: </strong>Although attempts have been made in the past to establish consensus regarding the definitions and grading of the severity of colorectal anastomotic leakage, widespread adoption has remained limited.</p><p><strong>Objective: </strong>A systematic review of the literature was conducted to examine the various elements used to report and define anastomotic leakage in colorectal cancer resections.</p><p><strong>Data sources: </strong>A systematic review was conducted using the PubMed, Embase, and Cochrane Library Database.</p><p><strong>Study selection: </strong>All published randomized controlled trials, systematic reviews, and meta-analyses containing data related to adult patients undergoing colorectal cancer surgery and reporting anastomotic leakage as a primary or secondary outcome, with a definition of anastomotic leakage were included.</p><p><strong>Main outcome measures: </strong>Definitions of anastomotic leakage, clinical symptoms, radiological modalities and findings, findings at reoperation, and grading terminology or classifications for anastomotic leakage.</p><p><strong>Results: </strong>Of the 471 articles reporting anastomotic leakage as a primary or secondary outcome, a definition was reported in 95 studies (45 randomized controlled trials, 13 systematic reviews, and 37 meta-analyses) involving a total of 346,140 patients. Of these 95 articles, 68% reported clinical signs and symptoms of anastomotic leakage, 26% biochemical criteria, 63% radiological modalities, 62% radiological findings, and 13% findings at reintervention. Only 45% (n = 43) of included studies reported grading of anastomotic leakage severity or leak classification, and 41% (n = 39) included a time frame for reporting.</p><p><strong>Limitations: </strong>There was a high level of heterogeneity between the included studies.</p><p><strong>Conclusions: </strong>This evidence synthesis confirmed incomplete and inconsistent reporting of anastomotic leakage across the published colorectal cancer literature. There is a great need to develop and implement a consensus framework for defining, grading, and reporting anastomotic leakage.</p><p><strong>Registration: </strong>Prospectively registered at PROSPERO (ID 454660).</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1383-1401"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11477855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Metformin Treatment to Reduce Postoperative Hyperglycemia After Colon Cancer Surgery: A Randomized Clinical Trial.","authors":"Emilie Palmgren Colov Tauby, Rasmus D Bojesen, Camilla Grube, Rebecca E G Miedzianogora, Fatima Buzquurz, Tina Fransgaard, Filip K Knop, Ismail Gögenur","doi":"10.1097/DCR.0000000000003426","DOIUrl":"10.1097/DCR.0000000000003426","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Surgery induces a stress response, causing insulin resistance that may result in postoperative hyperglycemia, which is associated with increased incidence of complications, longer hospitalization, and greater mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study examined the effect of metformin treatment on the percentage of patients experiencing postoperative hyperglycemia after elective colon cancer surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This was a randomized, double-blind, placebo-controlled trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings: &lt;/strong&gt;The study was conducted at Slagelse Hospital in Slagelse, Denmark.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Patients without diabetes planned for elective surgery for colon cancer were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Patients received metformin (500 mg 3× per day) or placebo for 20 days before and 10 days after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Blood glucose levels were measured several times daily until the end of postoperative day 2. The main outcome measures were the percentage of patients who experienced at least 1 blood glucose measurement &gt;7.7 and 10 mmol/L, respectively. Rates of complications within 30 days of surgery and Quality of Recovery-15 scores were also recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 48 included patients, 21 patients (84.0%) in the placebo group and 18 patients (78.3%) in the metformin group had at least 1 blood glucose measurement &gt;7.7 mmol/L ( p = 0.72), and 13 patients (52.0%) in the placebo group had a measurement &gt;10.0 mmol/L versus 5 patients (21.7%) in the metformin group ( p = 0.04). No differences in complication rates or Quality of Recovery-15 scores were seen.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The number of patients in the study was too low to detect a possible difference in postoperative complications. Blood glucose was measured as spot measurements instead of continuous surveillance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In patients without diabetes, metformin significantly reduced the percentage of patients experiencing postoperative hyperglycemia, as defined as spot blood glucose measurements &gt;10 mmol/L after elective colon cancer surgery. See Video Abstract .&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Tratamiento perioperatorio con metformina para reducir la hiperglucemia posoperatoria despus de la ciruga de cncer de colon ensayo clnico aleatorizado: &lt;/strong&gt;ANTECEDENTES:La cirugía induce una respuesta de estrés que causa resistencia a la insulina que puede resultar en hiperglucemia posoperatoria. La hiperglucemia posoperatoria se asocia con una mayor incidencia de complicaciones, una hospitalización más prolongada y una mayor mortalidad.OBJETIVO:Este estudio examinó el efecto del tratamiento con metformina en el porcentaje de pacientes que experimentaron hiperglucemia posoperatoria después de una cirugía electiva de cáncer de colon.DISEÑO:Este fue un ensayo aleatorio, doble ciego y controlado con placebo.AJUSTES:El estudio se reali","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"67 11","pages":"1403-1412"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}