Iranian Journal of Colorectal Research
Volume:7 Issue: 2, Jun 2019

For most patients with colorectal cancer, laparoscopic surgery is considered the gold-standard approach as it features the advantages of minimally invasive surgery and is as oncologically safe as the conventional approach. However, during the past decades, there has been major controversy about the indications and feasibility of the laparoscopic approach for patients with colorectal neoplasm. In this paper, we review the evolution of laparoscopy in the treatment of colorectal cancer.

Peritonitis is a quite common surgical emergency. For this condition, many reports have shown that laparoscopic surgery is associated with lower morbidity and mortality. However, the laparoscopic approach to the management of peritonitis remains marginalized in low and middle-income countries (LMICs) due to financial and technical limitations. We conducted a seven-year prospective study on patients with acute generalized peritonitis in Yaoundé, Cameroon. Inclusion criteria were an age range of between 5 to 55 years, admission within 48 hours after the onset of symptoms, hemodynamic stability, and no major comorbidities. Excluded from this study were patients with colonic perforation, prior history of abdominal surgery, or primary and localized peritonitis after proper resuscitation. The patients included were managed via laparoscopy; operative and postoperative data were collected and analyzed. Some technical artifices were used to circumvent the lack of standard equipment. The study involved twenty-five patients with a mean age of 32.1 years. The etiology of peritonitis was identified as appendicitis in 20 cases, perforated duodenal ulcer in 2 cases, gastric ulcer perforation in 2 cases, and jejunal perforation in 1 case. In two cases (8%), the operation was converted to laparotomy. The postoperative course was uneventful in 21 cases (84%), whereas morbidity was seen in 4 cases (16%); no mortality was recorded. The mean length of hospital stay was 5.5 days. This study demonstrates that the laparoscopic management of acute generalized peritonitis in African LMICs is a feasible, safe, and effective surgical option in properly selected patients.

Occult rectal prolapse is a pathological condition that mainly affects women and is frequently associated with obstructed defecation. Numerous surgical procedures have been advocated for treating patients with obstructed defecation. In this study, we performed a retrospective analysis of the short-term surgical outcomes of combining internal mucosal resection with transverse perineal support in a single center with expertise in anorectal surgery. Resolution in obstruction symptoms was achieved with low morbidity. The use of sleeve resection of the rectal mucosa is a well-known and established procedure for occult rectal prolapse in obstructed defecation syndrome patients. Transverse perineal support operation has been recently adopted to correct defects of the perineum. In our preliminary experience, we report a combination in surgical techniques never described in the literature. Our preliminary results suggest that the technique is feasible, safe and reproducible. More patients and longer follow-up are required to be able to draw stronger conclusions.

Ulcerative colitis is a chronic inflammatory disease affecting mainly the colon and presenting with diarrhea, bloody defecation and abdominal pain. Although cardiac and/or pulmonary involvement has been reported in patients with ulcerative colitis, it rarely involves both the pleura and pericardium at the same time. Also, it is difficult to determine whether pulmonary or cardiac disease is secondary to the ulcerative colitis drugs or to the underlying disease process. Here we present a rare case of pleuropericardial effusion in a patient newly diagnosed with ulcerative colitis. In ulcerative colitis, the simultaneous involvement of the respiratory and cardiovascular systems is uncommon yet potentially dangerous.

Yes-associated protein (YAP1), the downstream effector of the Hippo pathway, plays important roles in the regulation of tissue reconstruction, stem cell proliferation, and development of different cancers. The regulation of YAP1 phosphorylation, YAP1 expression level, and its cellular localization have been considered in cancer development. There are different experimental evidences that indicate that YAP1 activation results in tumorigenesis, tumor progression, and metastasis. YAP1 is a transcription co-activator, and its dysregulation has been suggested in various cancers including colorectal cancer (CRC). The localization of YAP1 in the nucleus results in YAP1 interactions with different transcription factors to promote the expression of genes involved in cell proliferation, metastasis, and stem cell maintenance. However, a number of studies have been reported the tumor suppressor role of YAP1 in CRC. Therefore, a better understanding of the YAP1 regulation could be helpful for prevention, diagnosis, and treatment of CRC. In this review, we will discuss different roles of YAP1 in CRC progression through the regulatory roles of long non-coding RNAs (LncRNAs), microRNAs (miRNAs) and circular RNAs (CircRNAs) in YAP1 regulation.

Carcinoid tumors are the most common neuroendocrine tumors. In recent years, these tumors have had an increase in incidence, which is probably due to a higher number of them being incidentally found as a result of the rise of preventive medicine.

This study aimed to analyze a series of digestive carcinoid tumors detected by conventional endoscopy and/or echoendoscopy to evaluate the prevalence of those located in the colon and rectum, and subsequently make a comparison with data available in the literature.

In this retrospective, multicenter study (two centers), the clinical records of 100 white patients with more than 100 digestive carcinoid tumors (some multiple) diagnosed from 1994 to 2018 were reviewed.

The mean age of presentation was 52 years and 57% of the patients were men. The mean tumor size was 10 mm. The localization of the tumors was: stomach 43% (n = 43); duodenum 5% (n = 5); intestine 8% (n = 8); appendix 14% (n = 14); colon 4% (n = 4); rectum 19% (n = 19); pancreas 3% (n = 3); liver 2% (n = 2); gallbladder 1% (n = 1); primary tumor of unknown origin 1% (n = 1). Most multifocal tumors were in the stomach (20%; n = 20), followed by the duodenum (1%; n = 1) and intestine (1%; n = 1). Metastases and carcinoid syndrome were observed in 6% and 5% of the cases, respectively. General survival at the closure of the study was 80%.

Age and sex were similar to those described in the literature, while the colon and rectum represented 23% of all carcinoid tumors. There was a predominance of gastroduodenal and rectal carcinoid tumors, probably because the series analyzed was essentially endoscopic. In comparison with the literature, less cases of metastases or carcinoid syndrome were recorded and survival was greater, perhaps due to earlier diagnosis and treatment.

Preliminary testing of novel drugs for colorectal conditions must be performed on animal models, with invertebrate models desirable for practical reasons. The insect excretory organs, the Malpighian tubules, have been cited as models for human renal disease research because they differentially express several genes homologous to those differentially expressed in human kidneys. Their role in excretion and homeostasis suggests that they could be models for human colorectal disease. The insect Carausius morosus (Phasmatodea) has been a model organism for decades. Regarding its potential use as a colorectal disease model, it has an advantage over other insects in that excretion in Phasmatodea is split between two organs: Malpighian tubules and the Phasmatodea-specific “appendices of the midgut”.

To find homologues of human colon genes expressed in the excretory tissues of C. morosus for potential use in drug testing and other experiments requiring an animal model.

Pre-existing transcriptomics data for the excretory system of the C. morosus were examined to find genes homologous to those known to have elevated expression in the human colon. This was done with the goal of possibly determining the excretory tissues in which they are differentially expressed.

Exactly sixty transcripts from the excretory system transcriptome of C. morosus showed high sequence homology with human colon-specific genes, with a minimum e-value of 1e-50. Examples include solute carriers, myosin, bestrophin, carbonic anhydrase, and nitric oxide synthase. Several genes were identified with prognostic value for renal, pancreatic, endometrial, liver, skin, and urothelial cancers.

C. morosus can be used as model insect for human medical research applications, including colorectal drug testing.