Michał Mik, Łukasz Dziki, Radzisław Trzciński and Adam Dziki
The 30-day mortality is one of the factors reflecting the quality of treatment. All these efforts focused on decreasing 30-day mortality will directly improve quality of care.
The aim of the study was to identify risk factors of 30-day postoperative mortality in a cohort of patients operated on for colorectal cancer in one tertiary colorectal centre.
Material and methods. Patients operated on due to colorectal cancer (CRC) between 2008 and 2014 were included in the study. 30-day mortality was assessed as an endpoint of the retrospective study.
All records were collected from prospective database.
Results. 1744 patients were operated on due to CRC. The 30-day mortality was noted in 65 patients (3.5%). In multivariable analyses we revealed that spread disease and poor general condition at admission were risk factors of 30-day mortality: OR 2.35; 2.01-2.57 95%CI, p=0.03 and OR 2.18; 1.95-2.41 95% CI; p=0.01, respectively. Emergency surgery significantly increased the risk of 30-day mortality: OR 2.64; 2.45-2.87 95%CI; p=0.009. Low serum albumin concentration level and diabetes mellitus were additional risk factors for 30-day mortality, OR 1.65; 1.52-1.78 95%CI; p=0.01 and OR 1.67; 1.41-1.82 95%CI; p=0.03, respectively. Mortality was significantly higher after resection procedures than after only palliative operations: 4.21% vs 1.57%; p=0.002.
Conclusions. Emergent patients, patients with advanced disease and in poor general state have to be assessed by multidisciplinary team to prepare them to operation. Additionally to reduce the risk of 30-day mortality decision of extend of surgery should be made by experienced surgeons.
Alicja Klimczak, Bogumiła Mirosławska-Kempińska, Michał Mik and Adam Dziki
Alicja Klimczak, Michał Mik, Łukasz Dziki, Wojciech Seroka and Adam Dziki
Resections and Palliative Procedures in Patients Operated on for Colorectal Cancer in Poland in 2005-2008
The aim of the study was analysis of the number of resection and palliative procedures in patients operated on for colorectal cancer in Poland. We also analyzed the number of sphincter-sparing surgery in patients with rectal cancer.
Material and methods. Statistical data about surgical procedures performed in patients with colorectal cancer were obtained from the National Institute of Hygiene in Warsaw. The procedures were divided into palliations and resections. The analysis was performed for the period from 2005 to 2008. We analyzed the data including women and men.
Results. We observed an increase in the number of resections from 3381 to 3768 (85.6-88% of all treatments) (2005-2008) in patients with colon cancer. A similar regularity was observed in patients who underwent surgery for rectal cancer from 2335 to 2712, respectively (76.4 to 81.4% of all treatments). Similarly, the number of sphincter-sparing surgery over the course of the period has increased from 1502 to 1916 operations.
Conclusions. The increase in the percentage of resections and sphincter-sparing surgery may indicate the progress in the earlier detection of colorectal cancer. Another reason for this increase may be improving the level of education of surgeons due to the better availability of workshops and training. However, analysis is based on too short period of time and these conclusions cannot be regarded as final.
Anna Pietrzak, Michał Mik, Witold Bartnik, Adam Dziki and Piotr Krokowicz
Michał Mik, Kinga Rośniak, Piotr Narbutt, Łukasz Dziki, Marcin Tchórzewski, Radzisław Trzciński and Adam Dziki
The aim of the study was to identify clinical factors which could influence the results of overlapping sphincteroplasty.
Material and methods. Between 2003-2009 the group of 78 incontinent patients (59 women, mean age of 61±13 years), was operated on with anterior overlapping anal sphincteroplasty. Only patients with severe incontinence (>16 pts in Wexner scale) were included. Before surgery and in follow-up period anorectal ultrasound, manometry and incontinence assessment were performed and in follow-up period patients additionally fulfilled survey. The study was prospective. Follow up period was more than 36 months.
Results. In survey the excellent results related to 52 patients (66.7%), good in 15 (19.2%) and poor in 11 (14.1%). The squeeze pressure improved more significantly in men 33±11 cm H2O vs. 22±14 cm H2O; p=0.039. In patients <50 year squeeze pressure was significantly larger 32±10 cm H2O vs. 25±12 cm H2O; p=0.045. If the width of a defect within sphincter was less than 60°飀 the improvement in squeeze pressure was higher 33±9 cm H2O vs. 22±15 cm H2O; p=0.031. In Wexner scale male patients better responded to surgery than females 6.94±1.8 vs. 5.12±2.2, p=0.048; as well as patients with smaller scar <60° 6.51±1.4 vs. 4.28±2.3; p=0.042.
Conclusions. To succeed in sphincteroplasty the proper qualification to the procedure should be crucial. Clinical assessment prior to surgery with the use of all available non-surgical methods in patients suffer from severe symptoms can help to select optimal group who will benefit from surgery. Male patients may have to obtain better outcome and patients with smaller sphincter defect could likely have also better results from surgery.
Andrzej Sygut, Karolina Przybyłowska, Tomasz Ferenc, Łukasz Dziki, Michał Spychalski, Michał Mik and Adam Dziki
Experimental as well as clinical observations have demonstrated that the E-cadherin/catenin complex is a powerful inhibitor of invasion. Abrogation of this pathway is implicated in the carcinogenesis of several malignancies, especially colorectal cancer.
The aim of the study was to determine the CTNNA1 and the CTNNB1 mutations and its relationship to clinical and pathological features of sporadic colorectal cancer (CRC) in Polish patients.
Material and methods. Paired tumor and normal tissue samples from 110 sporadic CRC patients undergoing resective surgery were prospectively studied for the alpha catenin (CTNNA1) gene and beta catenin (CTNNB1)gene mutations by PCR/single strand conformation polymorphism (SSCP).
Results. The CTNNA1 gene alteration in exon 7 were detected in 4 samples and in exon 3 of CTNNB1 gene were found in 3 samples. There was a trend at the limit of statistical significance associating younger age at diagnosis (<50) with CTNNA1 and the CTNNB1 mutations. The mutation of CTNNB1 seemed to occur more frequently in the proximal colon than distal. The CRC patients with CTNNA1 mutation had a significantly increased lymph node metastasis. On the other hand, there was no correlation between mutations and the other clinical variables (e.g. sex, grade and depth of invasion).
Conclusion. Although we found a low frequency of mutations in the CTNNA1 and the CTNNB1 genes, but the analysis the relationship with clinical and pathological features of CRC patients may indicated an association of these mutations with the risk and progression of CRC.
Jacek Kabziński, Ireneusz Majsterek, Adam Dziki and Michał Mik
Participation of DNA repair systems in the pathogenesis of cancer has been a suspected phenomenon for a long time. Decreased efficiency in DNA repair translates to their ability to fix and consequently leads to mutations and the process of carcinogenesis. Linking individual polymorphisms of DNA repair systems with an increased risk of colorectal cancer will allow the classification of patients to high-risk groups and their placement under preventive program.
The aim of the study was to determine the effect of XPF gene polymorphism Ser835Ser on increasing the risk of colorectal cancer in the Polish population.
Material and methods. as the material blood collected from 146 patients diagnosed with colon cancer was used. The control group consisted of 149 healthy subjects. Genotyping was performed by Taq- Man method.
Results. The results indicate that genotype TCC/TCT is associated with an decreased risk of colorectal cancer (OR 0.574; CI 95% 0.335-0.984; p=0.043).
Conclusions. Based on these results, we conclude that the XPF gene polymorphism Ser835Ser may be associated with a decreased risk of colorectal cancer
Jacek Kabziński, Karolina Przybyłowska, Michał Mik, Andrzej Sygut, Łukasz Dziki, Adam Dziki and Ireneusz Majsterek
An Association of ARG399GLN Polymorphism of XRCC1 Gene with a Risk of Colorectal Cancer
Colorectal cancer is one of the most commonly diagnosed cancer and a leading cause of death from cancer. DNA repair defects have been associated with an individual susceptibility to cancer. Therefore, polymorphisms of DNA repair genes, including XRCC1 gene, are suspected to may increase the risk of colorectal cancer.
The aim of the study was to examine the association between Arg399Gln polymorphisms of XRCC1 gene and the occurrence of colorectal cancer. Research and understanding of the molecular basis of the formation of colorectal cancer will allow for typing of genetically loaded persons and qualifying them to a high-risk group.
Material and methods. In case-control study we genotyped 150 colorectal cancer patients and 170 healthy subjects from Polish population. Analysis was performed by PCR-restriction fragment length polymorphism (PCR-RFLP).
Results. We found that Gln/Gln genotype is associated with increased risk of colorectal cancer (OR 1.984; Cl 95% 1.070-3.677; p=0.029). We also found that Arg/Gln genotype is a risk factor for progression of tumor growth (OR 3.52; Cl 95% 1.157-10.707; p=0.023).
Conclusions. The current state of research suggests a link between Arg399Gln XRCC1 polymorphism and increased risk of colorectal cancer. Therefore, we conclude that the Arg399Gln polymorphism of XRCC1 gene may underlie at the molecular basis of the causes of colorectal cancer.
Katarzyna Malinowska, Michał Mik, Łukasz Dziki, Adam Dziki and Ireneusz Majsterek
Cancers are among the most feared diseases of modern civilization. In Poland, colorectal cancer is one of the tumors with the worst prognosis. The ability to cure is primarily dependent on the stage of the disease at the time of diagnosis.
The aim of the study was evaluate antioxidant response in patients with colorectal carcinoma.
Material and methods. Twenty patients (14 men and 6 women) aged 61.9± 11.1 years with colorectal cancer were included in the study. Twenty healthy subjects (4 men and 16 women) aged 64 ± 15.3 years formed the control group. The erythrocyte activities of antioxidant enzymes, superoxide dismutase (SOD), and glutathione peroxidase (GPx),
Results. A significant increase of GPx, and SOD (p < 0.05) were seen in patients compared to healthy controls.
Conclusion. The results indicate that the tested antioxidant enzyme activity of glutathione peroxidase and superoxide dismutase is increased in patients diagnosed with colorectal cancer compared to the control group.