Iranian Journal of Colorectal Research
Volume:11 Issue: 2, Jun 2023

Surgery for anal fistula and abscess is as old as mankind. More than 2000 years ago already procedures were performed and described in old manuscripts. In modern times anal fistula is still a big issue for colorectal surgeons. Only surgery has the ability to heal the patient. The cryptoglandular aetiology: in these glands a septic process starts and this leads to the formation of abscess and fistula. The abscess is the acute, the anal fistula the chronic manifestation of the same disease. Patients with recurrent abscess will have only relieve, when the underlying fistula has been dealt with. Most fistulas are superficial: fistulotomy results in a low recurrence rate and only minor problems concerning faecal continence. The complex fistulas are those, in which fistulotomy produces faecal incontinence. Therefor sphincter saving procedures have been developed. These techniques are described and the pros and cons are discussed. In Germany rectal advancement flap and fistulectomy with primary anal sphincter repair have found their place in the German guideline. In the last 30 years many new techniques have been developed, some are still being used, some are abandoned. Surgery for anal fistula is demanding: recurrence and faecal incontinence rates should be low. On the other hand: the more recurrences a patient had, the higher the chance of a new recurrence AND the higher the chance of faecal incontinence. Every new septic process in the anal region does not improve anal and pelvic floor function. The colorectal surgeon dealing with complex anal fistula should have more than one option to offer and discuss these with the patient.

In either men or women in the United States, colorectal cancer (also known as CRC) is the third largest cause of death from cancer-related causes. Screening programs that start at age 50 and have an average risk have been shown to lower the incidence and death of colorectal cancer in people older than 50 years of age. On the other hand, the incidence of colorectal cancer in people younger than 50 years of age (early onset colorectal cancer, or eoCRC) has recently and substantially increased.Epidemiologic studies of eoCRC suggest that the cancer is most prevalent in the distal colon and rectum, and that it is associated with a number of risk factors that can be modified, such as diabetes, obesity, diet, sedentary time, alcohol intake, and smoking. The data covering the potential risk factors of prior antibiotic exposure and alterations to the microbiome or direct carcinogen exposure are still in the process of being gathered. It's possible that a delay in diagnosis or more aggressive tumor biology led to the aggressive clinicopathologic characteristics of eoCRC that were observed at presentation. When matched for stage, the outcomes of patients with EoCRC are comparable to those of patients with loCRC; nevertheless, the overall mortality rate is higher due to a higher frequency of advanced illness at a younger presentation, which results in more life-years lost.

Bariatric surgery is the most effective treatment for morbid obesity, resulting in long-term weight loss and considerable improvements in coexisting conditions. We designed this study to histopathologic evaluation of resected stomachs after sleeve gastrectomy.

In this study, files of 827 patients who underwent sleeve gastrectomy between 2015 and 2018 in Shiraz were evaluated. In this retrospective cross-sectional study, the pathology findings of resected stomachs and other variables such as age, sex, preoperative BMI, and comorbid illnesses were evaluated.

Six hundred and fifty-three cases (78.9%) had chronic gastritis in some forms. Lymphoid follicle formation (in 197 cases), acute chronic gastritis (in 67cases), complete intestinal metaplasia (in 5 cases), hyperplastic polyp (in 5 cases), and gastrointestinal stromal tumor (GIST) (2 cases) were in the next positions respectively. Most the lymphoid follicle formation was reported in the context of gastritis. Two patients with GIST and one with submucosal lymphoma underwent more evaluation and proper treatment at that time.

The rate of other abnormal histopathologic findings of resected stomachs was about 88 % in our study. No malignancy was found in the current study but less than 15% of samples were totally normal. Because of the high rate of abnormal pathology in resected gastric specimens in this trial and the fact that gastric cancer is the most common gastrointestinal malignancy in Iran, it is recommended that all patients in our region who are candidates for sleeve gastrectomy should have an upper gastrointestinal endoscopy prior to surgery.

The autophagy and unfolded protein responses (UPR) are important pathways in colorectal tumorigenesis and drug resistance, which make them potential therapeutic targets for treatment of this cancer. As an ionophoric polyether antibiotic, salinomycin has anti-cancer effects and overcome drug resistance in cancer cells. Considering the low information on the molecular action mechanism of salinomycin in colorectal cancer, this study was designed to investigate the effect of this compound on autophagy and UPR pathways in colorectal cancer cells.

The in vitro cytotoxicity of salinomycin on CRC cell line HCT116 was determined using MTT assay by treating the cells with different concentrations of salinomycin for 24 and 48 h. The gene expression analysis of three main autophagy biomarkers Beclin1, LC3 and P62 and two UPR biomarkers, XBP-1s and CHOP was performed using quantitative real-time polymerase chain reaction (RT-PCR). Data were statistically analyzed with GraphPad Prism 8 software.

Salinomycin had cytotoxic effects on HCT116 cells in a time and dose dependent manner. The expression analysis of the UPR and autophagy related genes described the UPR activation at both 24 h and 48 h (increase of XBP-1s and CHOP), autophagy activation at 24 h (increase of Beclin 1, LC3II and decrease of P62) and autophagy flux inhibition at 48 h (increase of Beclin 1, LC3II and P62).

The anticancer activity of salinomycin against HCT116 cell line seems to be through triggering cell death by targeting UPR and autophagy pathways. Further studies are required to confirm our obtained results.

Helicobacter pylori is one of the most common microorganisms known in humans, and as a risk factor it can result in gastric cancer, therefore we decided to evaluate the serum level of PIVKA-II in patients with Helicobacter pylori (H. pylori) infection and normal group.

This study was performed on 90 patients (45 patients with H. pylori infection and 45 patients in the control group). After recording demographic information, serum level of PIVKA-II was measured in two groups by ELISA method.

The findings of our study showed no significant difference between the serum level of PIVKA-II in patients with H. pylori compared to those without infection (p = 0.08) but at the age of less than 40 years, the mean serum level of PIVKA-II in patients with H. pylori was significantly lower than the control group (p = 0.026), Also in men infected by H. pylori the mean serum level of PIVKA-II was significantly less than the control group. (p = 0.04)

The results of the present study indicate that the serum level of PIVKA-II in infected men as well as in people under 40 years of age with H. pylori infection, was significantly lower than the control group. Also, serum PIVKA-II levels in patients were significantly lower in men than women and in those under 40 years of age compared with those over 40 years of age.

A growing amount of data has indicated the possibility that tumor location may play a prognostic role in colon cancer. The present study set out to investigate the relation between the location of colon cancer (right side vs. left side) and the patient’s oncologic outcome.

In this study, 654 colon cancer patients who had been treated and followed-up at three tertiary hospitals between 2005 and 2014 were included. To determine the most important independent factors of oncologic outcomes, the Cox regression multivariate analysis model used to analyze the prognostic impact of the primary tumor location and other clinical-, pathologic-, and treatment-related factors.

In the univariate analysis, the prognostic factors for disease-free survival (DFS) were the primary tumor stage (< 0.001), node stage (<0.001), tumor grade (P = 0.013), surgical margin status (P = 0.001), lymphatic vascular invasion (LVI) (<0.001), and perineural invasion (PNI) (<0.001). Additionally, the prognostic factors for disease-free survival (OS) were the primary tumor stage (<0.001), node stage (<0.001), tumor grade (P = 0.036), presence of LVI (<0.001), presence of PNI (<0.001), and the mucinous type (P = 0.042). However, in the multivariate analysis, the presence of LVI, T3-4 lesions, tumor grade II-III, and an advanced disease stage remained independent prognostic factors for DFS as well as OS. However, the colon cancer location was not a prognostic factor in terms of DFS or OS.

We didn’t find tumor location as a significant prognostic factor for DFS and OS in colon cancer patients.