Browsing by Author "Dimitrijević, Ivan (59595303500)"

Aim To assess practical accuracy of revised Bethesda criteria (BGrev), pathological predictive model (MsPath), and histopathological parameters for detection of high-frequency of microsatellite instability (MSI-H) phenotype in patients with colorectal carcinoma (CRC). Method Tumors from 150 patients with CRC were analyzed for MSI using a fluorescence-based pentaplex polymerase chain reaction technique. For all patients, we evaluated age, sex, family history of cancer, localization, tumor differentiation, mucin production, lymphocytic infiltration (TIL), and Union for International Cancer Control stage. Patients were classified according to the BGrev, and the groups were compared. The utility of the BGrev, MsPath, and clinical and histopathological parameters for predicting microsatellite tumor status were assessed by univariate logistic regression analysis and by calculating the sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values. Results Fifteen out of 45 patients who met and 4 of 105 patients who did not meet the BGrev criteria had MSI-H CRC. Sensitivity, specificity, PPV, and NPV for BGrev were 78.9%, 77%, 30%, and 70%, respectively. MSI histology (the third BGrev criterion without age limit) was as sensitive as BGrev, but more specific. MsPath model was more sensitive than BGrev (86%), with similar specificity. Any BGrev criterion fulfillment, mucinous differentiation, and right-sided CRC were singled out as independent factors to identify MSI-H colorectal cancer. Conclusion The BGrev, MsPath model, and MSI histology are useful tools for selecting patients for MSI testing.

Introduction Functional results after low anterior resection for rectal cancer are an issue of increasing attention among colorectal surgeons and others interested in this subject. The consensus on ideal reconstruction type has not been achieved to date, although the number of papers on this subject has been published in recent years. Objective We conducted a prospective, parallel group study comparing latero-terminal with colonic J-pouch anastomosis in terms of defecatory function in patients undergoing stapled low colorectal/ coloanal anastomosis. Methods A total of 80 patients were included in this study with either latero-terminal or colonic J-pouch anastomosis. Defecatory function was evaluated using the modified version of MSKCC questionnaire 6, 12 and 24 months after the operation. Fecal continence was evaluated using the Wexner continence score. Results In both groups, trend towards improvement was registered in all measured variables in all three control intervals. This can apply to bowel frequency, urgency, night soiling, fragmentation and incomplete evacuation. However, the difference was not statistically significant, and when reviewing the trend of results we can note that in the J-pouch group steady state has not been reached even after 24 month control. Conclusion This trial did not reveal any significant differences in defecatory function 6, 12 and 24 months after low anterior resection (LAR) between patients with a latero-terminal anastomosis and those with colonic J-pouch anastomosis. Our results did not confirm superiority of colonic J-pouch over the lateroterminal anastomosis © 2015, Serbia Medical Society. All rights reserved.

Background/Aim. Colorectal cancer still presents a major health problem, with around 10% of patients in whom the tumor invades surrounding structures or organs. These patients are usually challenging even for an experienced colorectal surgical team. The decision for performing multivisceral resection (MVR) is often made intraoperatively, with no sufficient data on the tumor and patient condition. The percentage of perioperative morbidity and mortality is high and oncological outcome is often unfavorable.The aim of this study was to investigate the poor oncological outcome risk factors after MVR in the patients with colorectal carcinoma. Methods. This was a retrospective analysis of patients operated at the Department for Colorectal Surgery of the First Surgical Clinic, Clinical Centre of Serbia, Belgrade. The en bloc multivisceral resection for the primary adenocarcinoma of the colon and rectum was uniformly performed. Data were collected in prospectively designed database. Follow- up period was minimum 2 years. The patients were analyzed in terms of histopathological, demographical and follow- up data. Survival and time to recurrence were evaluated using the Kaplan-Meier method and the log-rank test. Results. Two hundred and thirteen patients were included in the study Their mean age was 59.9 ±12.0 years. The followup period was 33.8 ±29 months. Histopathology confirmed the true tumor infiltration of surrounding organ/structure in 126 (59.2%) patients. The R0 resection was confirmed in 173 (81.2%) patients. Five-year overall survival was 43.4%. Five-year survival for colon patients was 45.9% and in the rectal cancer group 40.9%. In the N0 group of patients, the overall survival in 5-year period was 66.7%. The N1 and N2 status proved the adverse effect on survival (overall 5-year survival 31.3% and 15.9%, respectively). The five-year local recurrence rate in the R0 group of patients was 17.7% and the percentage of distant metastases was 66.3%. Conclusion. The multivisceral resections are demanding procedures requiring a highly specialized surgical team and a high volume hospital. The oncological outcome of these procedures is still unfavorable. In the cases with the node positive disease, or the R1 resection, the perspective is poor. On the other hand, in the absence of these unfavorable factors, we can expect a good oncological outcome. More meticulous preoperative staging and aggressive preoperative treatment can further improve the results. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.