CACA guidelines for holistic integrative management of anal cancer （2024 Edition） fully refers to the latest researches at home and abroad， integrates experts’ opinions in relevant fields and forms an updated version.Compared to the previous edition， the diagnostic flowchart now includes HPV testing.In internal medicine treatment， patients without active autoimmune diseases may consider pembrolizumab and nivolumab as second-line therapies for recurrent or metastatic anal squamous cell carcinoma.Immune therapy has been added to the treatment flowchart for metastatic diseases.In the traditional Chinese medicine section，the phrase “clinical diagnosis and treatment should be offered based on syndrome differentiation” has been adjusted to “adopting the combination of treatment based on disease differentiation and treatment based on syndrome differentiation”， with the clinical value of traditional Chinese medicine treatment in perioperative，chemotherapy， radiotherapy， follow-up， and palliative treatment periods newly added.In the pathology diagnosis section， the phrase “invasive carcinoma may be misdiagnosed as high-grade intraepithelial neoplasia or intramucosal carcinoma” has been revised to “invasive carcinoma may be diagnosed as highgrade intraepithelial neoplasia”.Additionally， psychological assessment for patients has been added to the stoma management section.
Obstructive colorectal cancer is a common malignant bowel obstruction.Loop colostomy or colostomy following tumor resection may be the first choice for emergency surgery.The intestinal and systemic conditions of patients undergoing emergency surgery are often poor， and patients need to undergo multiple operations， which increase the surgical risk and economic burden and reduce the quality of life of patients.Poor intraoperative visual field may also affect the radical operation of emergency surgery.Transanal decompression tube （TDT） can rapidly decompress and drain the obstructed bowel， effectively relieve obstruction symptoms， and improve the success rate of primary radical resection.The TDT squeeze the tumor lightly， causing no spread of tumor cells， and is cheap， but the cavity of transanal decompression tube is small and easily blocked， and requires tedious flushing or regular replacement.Self-expanding metallic stents （SEMS） can relieve intestinal obstruction effectively， provide sufficient preoperative preparation time，complete preoperative examination， evaluate the tumor thoroughly， improve the patient’s nutritional status，and improve the patient’s tolerance to radical surgery， which might be used as an important treatment strategy choice for obstructive colorectal cancer.However， SEMS may squeeze the tumor， leading to the spread of tumor cells， increase the recurrence rate and metastasis rate， and reduce the survival rate.Moreover， intestinal wall edema still existed during the operation following SEMS， and the rate of ostomy after anastomosis was as high as 34%.We hypothesized that prolonging the interval between stent insertion and surgery to 2 months， with neoadjuvant chemotherapy administered during this interval （SEMS-neoadjuvant chemotherapy strategy）， would help improve outcomes.The SEMS-neoadjuvant chemotherapy strategy is a safe， effective，and well tolerated treatment approach with a high laparoscopic resection rate， low stoma formation rate and improvement in the overall survival for patients with left-sided colon cancer obstruction.The patient physical status is improved， the primary tumor is downstaged， and intestinal wall edema is relieved during the relatively longer interval between SEMS placement and surgery.The SEMS-neoadjuvant chemotherapy strategy may be one of the preferred therapeutic strategy for obstructive left colon cancer.
Colorectal cancer with obstruction represents a prevalent acute abdominal condition frequently encountered in clinical practice.The patient population is primarily elderly， often presenting with comorbidities and advanced disease stages.This demographic profile correlates with a heightened incidence of perioperative complications and mortality， complicating management strategies significantly.Current therapeutic interventions encompass stoma creation， one-stage tumor resection accompanied by anastomosis， placement of stents or intestinal obstruction catheters， endoscopic procedures， as well as the classic Hartmann’s procedure or three-stage operations.Each treatment modality carries distinct advantages and disadvantages； therefore， it is essential to integrate oncological considerations into the decision-making process.Consequently，clinicians are required to perform a thorough evaluation of the patient’s overall health status and disease stage while collaborating closely with experienced multidisciplinary teams （MDT） to formulate individualized treatment plans for each case.The primary objective remains focused on optimizing patient outcomes.
To evaluate the impact of self-expanding metallic stents （SEMS） combined with neoadjuvant chemotherapy on postoperative complications in patients with completely obstructive leftsided colon cancer， and to explore the management of stent-related complications.
Methods
This study retrospectively analyzed the clinical data of 93 patients with completely obstructive left-sided colon cancer who were treated at Beijing Chaoyang Hospital， Capital Medical University， from January 2012 to May 2023.According to the treatment plan， patients were divided into the stent group （44 cases） and the stentneoadjuvant group （49 cases）.The main observations were the postoperative stent-related complications rate （perforation， reobstruction， migration， and unresolved obstruction） and the management of stent-related complications.
Results
All patients were followed up.The incidence of early postoperative complications in the stent-neoadjuvant group was significantly lower than in the stent group （14.3% vs. 38.6%， P=0.007）.The stent-neoadjuvant group had better outcomes in terms of the proportion of laparoscopic surgery （85.7%vs. 61.4%， P=0.007）， postoperative hospital stay （10.88±5.60 days vs.13.30±5.82 days， P=0.044）， and ileostomy rate （10.6% vs. 28.6%，P=0.037）.There was no significant difference in the incidence of stentrelated complications between the two groups （14.3% vs. 13.6%， P=0.928）， including perforation （6.1% vs.6.8%， P=1.000）， reobstruction（6.1% vs. 4.5%， P=1.000）， migration（2.0% vs.0.0%， P=1.000）， and unresolved obstruction （0.0% vs. 2.3%， P=0.473）， respectively.A total of six cases （6.5%） of stent-related perforation occurred.Three cases （6.1%） in the stent-neoadjuvant group occurred 7， 8， and 13 days after stent placement，respectively.Three cases （6.8%） in the stent group occurred 4， 5， and 18 days after stent placement.Five cases（5.4%） of reobstruction were recorded.Three cases （6.1%） in the stent-neoadjuvant group occurred 69， 75 and 76 days after stent placement， while two cases （4.5%） in the stent group occurred 74， and 139 days after stent placement.One case （1.1%） of migration occurred in the stent-neoadjuvant group （2.0%）， ninety-three days after surgery.One case （1.1%） of unresolved obstruction occurred in the stent group （2.3%） 5 days after surgery.
Conclusion
Self-expanding metallic stents combined with neoadjuvant chemotherapy can improve surgical outcomes in patients with completely obstructive left-sided colon cancer without increasing the risk of stent-related complications.
To compare the efficacy and prognosis of neoadjuvant chemotherapy and elective surgery in the treatment of colorectal cancer induced intestinal obstruction after stent implantation.
Methods
The studies published from the establishment of the database to September 30， 2024，were searched from CNKI， Wanfang database， and VIP database.R studio software was used for data analysis.
Results
A total of 10 studies were included in this meta-analysis.Compared to direct surgery after intestinal stent implantation， elective surgery after intestinal stent implantation combined with neoadjuvant chemotherapy had significant higher laparoscopic surgeryrate（OR=2.96， 95%CI： 1.72～5.10）， diseasefree survival rates（OR=2.15， 95%CI： 1.24～3.72）， and overall survival （OR=1.92， 95%CI： 1.06～3.49） （P＜0.05）， and had significant lower ostomy rate（OR=0.28， 95%CI： 0.16～0.48）， post-operative complications rate（OR=0.41， 95%CI： 0.26～0.66）， local recurrence rate（OR=0.40， 95%CI： 0.20～0.82）， intraoperative blood loss（SMD=-1.24， 95%CI： -2.09～-0.40）， first postoperative exhaust time （SMD=-0.60， 95%CI： -1.00～-0.21） and length of stay after surgery （SMD=-1.12， 95%CI： -1.57～-0.67） （P＜0.05）.
Conclusion
Stent implantation combined with neoadjuvant chemotherapy is safer and more efficient than direct surgery after stent implantation combined with conventional treatment.
To investigate the effect of type 2 diabetes mellitus （T2DM） on tumor markers， clinicopathology and prognosis in patients with colorectal cancer.
Methods
The hospitalization information of patients with colorectal cancer who were hospitalized in the colorectal surgery department of Shanxi Cancer Hospital from January 2018 to December 2019 was collected.According to the inclusion criteria and whether they were combined with type 2 diabetes， they were divided into colorectal cancer combined with type 2 diabetes group （combined group） and simple colorectal cancer group （control group）.After 1：1 matching by propensity score matching method， a total of 96 pairs were matched.Serum tumor markers， mismatch repair protein deletion， high expression of Ki67， positive rate of p53 and long-term prognosis were compared between the two groups.
Results
There was significant difference in age between the two groups before matching （t=5.117， P＜0.05）.There was no significant difference in general data between the two groups after matching （P＞0.05）.The carcinoembryonic antigen （CEA）， CA19-9， CA242，CA724， CA50 and tissue polypeptide specific antigen （TPS） in the combined group were higher than those in the control group， and the differences were statistically significant （P＜0.05）.Compared with the control group， the combined group was prone to mismatch repair defects （χ2=0.245， P=0.805）， high expression of Ki67 （χ2=0.273， P=0.795）， and p53 mutation （χ2=2.602， P=0.142）， but the difference was not statistically significant （P＞0.05）.The 5-year survival rate of the combined group was significantly lower than that of the control group （52.27% vs. 75.51%， χ2=4.149， P=0.032）， the difference was statistically significant （P＜0.05）.
Conclusion
Type 2 diabetes mellitus significantly increases serum tumor markers and tumor proliferation activity in patients with colorectal cancer， and has a negative impact on the long-term prognosis of these patients.
To explore the effects of hyperthermia on myelosuppression，chemotherapy adverse reactions and quality of life scores in patients with adjuvant chemotherapy after colorectal cancer surgery.
Methods
According to the admission order and patient preference， fifty-two patients who had been diagnosed with colorectal cancer and accepted radical surgery in Department of Gastrointestinal Surgery，Affiliated Zhongshan Hospital of Dalian University from September 30， 2021 to December 31， 2023， were selected for our research.Among them， twenty-nine patients who had accepted postoperative adjuvant chemotherapy combined with deep hyperthermia were grouped into the experimental group， and the left 23 patients who had accepted the postoperative adjuvant chemotherapy only were grouped into the control group.The adjuvant chemotherapeutic regimen of both groups was XELOX regimen.The effects of deep hyperthermia on the adverse reactions after chemotherapy were explored by analyzing and comparing the occurrence of myelosuppression， adverse reactions and quality of life during treatment in the experimental group and the control group.
Results
In terms of myelosuppression， the incidence of moderate and severe platelet decline in experimental group was significantly lower than that in control group， the difference is significant （χ2=4.293， P＜0.05）.The incidence of moderate and severe neutrophil decline in experimental group was significantly lower than that in control group， the difference is significant （χ2=4.629， P＜0.05）.The incidence of moderate and severe elevation of bilirubin in experimental group was significantly lower than that in control group， the difference is significant （χ2=4.302， P＜0.05）.The incidence of moderate and severe elevation of alanine aminotransferase in experimental groups was significantly lower than that in control group， the difference is significant （χ2=7.719， P＜0.05）.In respect of the side effects of nausea and vomiting，the incidence of moderate to severe nausea and vomiting in experimental group was significantly lower than that in control group， with statistical significance （χ2=4.476， P＜0.05）.GIQLI scores in both groups were significantly higher after treatment than those before treatment， but the scores in experimental group were more significantly higher than those in control group， the difference is significant （t=15.914， P＜0.05）.
Conclusion
Deep hyperthermia can reduce the side effects of chemotherapy such as thrombocytopenia，neutropenia， liver function damage， nausea and vomiting in patients with adjuvant chemotherapy after colorectal cancer surgery.Deep hyperthermia can improve the quality of life of patients with postoperative adjuvant chemotherapy for colorectal cancer.
To investigate the feasibility， safety， and efficacy of cryotherapy for low rectal cancer.
Methods
A retrospective analysis was conducted on the clinical data of 85 patients with low rectal cancer who underwent cryotherapy at the Affiliated Hospital of Hunan Provincial Research Institute of Traditional Chinese Medicine from January 2018 to May 2024.These patients were not suitable for radical surgery or radiotherapy and chemotherapy due to various reasons.The objective was to evaluate the efficacy， symptom relief status， and complications of cryotherapy in different pathological stages.
Results
Cryotherapy has achieved remarkable effects in improving patients’ symptoms.Among the 85 patients included in the study， eighty presented with varying degrees of symptoms， and 68 of them experienced symptom relief after cryotherapy.The number of cryotherapy sessions required varied with the stage of rectal cancer.T1～2 stages typically required 1～2 sessions for complete local remission， while T3～4 stages mostly required 3～4 sessions to achieve clinical complete remission.A small number of tumors even did not achieve complete remission after 4 sessions.In terms of complications， among the 85 cases of cryotherapy for low rectal cancer， nine cases experienced bleeding， five cases had infections （including 1 case of perianal abscess）， and 70 cases developed varying degrees of edema.Except for the perianal abscess， which required incision and drainage， all other complications were relieved with symptomatic conservative treatment.
Conclusion
Cryotherapy for low rectal cancer is safe and reliable.It can significantly alleviate symptoms caused by rectal cancer and improve quality of life in the short term， representing another viable treatment option besides conventional treatment methods for low rectal cancer that is not suitable for radical surgery.
To analyze the expression characteristics of circular RNA（circRNA）in ulcerative colitis（UC） using high-throughput sequencing and bioinformatics techniques.
Methods
Eight diagnosed UC patients from the hospital were selected as the observation group， divided into an active phase group and a remission phase group based on their condition and colonoscopic mucosal findings，with 4 cases in each group.Additionally， four healthy individuals were included in the control group.CircRNA highthroughput sequencing was used to detect the expression profiles of circRNAs and messenger RNAs（mRNAs）in the colon tissues of the three groups.Online bioinformatics software was utilized to correlate the biological functions of differentially expressed circRNAs and the predicted target microRNAs（miRNAs） of circRNAs.
Results
The preprocessing analysis of high-throughput sequencing results indicated that the overall gene expression was consistent among the three sample groups.Clustering analysis of circRNAs and mRNAs data revealed significant differences in gene expression among the three sample groups.CircRNAs with a fold-change of ≥1.5 or ≤0.5 were screened.A total of 217 differentially expressed circRNAs were identified between active phase group and Control group， with 135 upregulated and 82 downregulated； 212 differentially expressed circRNAs between remission group and control group， with 98 upregulated and 114 downregulated； and 147 differentially expressed circRNAs between active phase group and remission group，with 95 upregulated and 52 downregulated.The differentially expressed circRNAs were significantly enriched in functions related to the immune system， inflammatory pathways， cell cycle， and signaling pathways.The intersection of miranda and RNAhybrid was used to predict 7 differential miRNA-circRNA target relationships related to immunity and inflammation， and the molecular regulatory mechanism of circRNAmiRNA-UC was analyzed.
Conclusion
There are differentially expressed circRNAs between the colon tissues of UC patients during active and remission phases and healthy individuals， which may participate in the pathogenic regulatory process of UC.
To explore the feasibility and safety of natural orifice specimen extraction surgery（NOSES） for colorectal neoplasm in primary hospital.
Methods
The clinicopathological data of 30 patients undergoing NOSES for sigmoid colon and rectal neoplasm in Taishan People’s Hospital from September 2023 to August 2024 were collected.The 30 patients were divided into three groups according to the tumor location.The specimens were extracted using three methods， namely， eversion resection technique，extraction resection technique， and resection extraction technique.The digestive tract reconstruction method adopted the end-to-end anastomosis， including double purse-string anastomosis， proximal single pursestring anastomosis， distal single purse-string anastomosis， and manual anastomosis.Observation indicators included surgical safety， tumor radicality， and intestinal function recovery.
Results
All 30 patients underwent NOSES successfully， without preventive stoma.There were statistically significant differences in the methods of specimen extraction among the three groups（P=0）， but no statistical difference in the endto-end anastomosis methods（P=0.509）.A total of 26 cases underwent double purse-string anastomosis.
Conclusion
The experience of using NOSES Ⅳ， NOSES ⅡA and NOSES ⅠC with double purse-string anastomosis as the pilot procedures and carrying out other procedures when necessary is feasible and safe in primary hospitals.
The incidence of rectal cancer is relatively high in China， and low anterior resection syndrome （LARS） is common.The LARS score can be utilized for rapid screening of LARS patients’ severity and provide treatment guidance.Despite its speed， effectiveness， and high sensitivity， the specificity of the LARS score has been a subject of controversy due to evolving diagnostic criteria and deepening research on LARS.Therefore， its content requires updating.LARS significantly impacts the postoperative quality of life for patients with rectal cancer， and there is currently a lack of accurate assessment and precise prediction tools for postoperative LARS.This article aims to review the development and application of the LARS score while summarizing existing controversies to aid in the development of new scoring tools.
Neutrophil extracellular traps （NETs） is a kind of reticular structure produced by neutrophils.More and more evidence suggests that it is closely associated with the progression， invasion，and migration of various cancers.Currently， the pathogenesis of colorectal cancer is unclear， and there is no previous systematic review of the role of NETs in the colorectum.This article comprehensively describes the biological characteristics of NETs and their intricate relationship with cancer， with a special focus on the specific mechanism of NETs in colorectal cancer， aiming to provide new perspectives and ideas for exploring the pathogenesis and developing novel therapeutic strategies for colorectal cancer.
