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Predictive Factors of Conversion in Laparoscopic Colorectal Cancer Resection

ABSTRACT: Background Laparoscopic resection is the treatment of choice for colorectal cancer. Rates of conversion to open surgery range between 7% and 30% and controversy exists as to the effect of this on oncologic outcomes. The objective of this study was to analyze what factors are predictive of conversion and what effect they have on oncologic outcomes. Material & Methods From a prospective database of patients undergoing laparoscopic surgery between 2000 and 2018 a uni- and multivariate analyses were made of demographic, pathological and surgical variables together with complementary treatments comparing purely laparoscopic resection with conversions to open surgery. Overall and disease-free survival were compared using the Kaplan-Meier method.

DISEASE(S): Colorectal Neoplasm,Colorectal Neoplasms,Laparoscopy

PROVIDER: 2354718 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Unbiased proteomics of human cerebrospinal fluid (CSF) has been used successfully to identify biomarkers of Amyotrophic Lateral Sclerosis (ALS). However, high abundance proteins mask the presence of lower abundance proteins that may hold valuable diagnostic and prognostic use. Developments in mass spectrometry proteomic data acquisition methods therefore hold promise for improved protein depth and more sensitive biomarker discovery. In this study, mass spectrometry with library-free data-independent acquisition (DIA) was used to compare the CSF proteome of 40 people with ALS, 15 healthy controls and 8 people with mimicking conditions. Qthen quantified protein groups were subsequently correlated with clinical variables. Univariate analysis identified 7 proteins significantly upregulated in ALS vs healthy controls, and 9 with altered abundance in ALS vs mimicking conditions (FDR <0.1). Elevated Chitotriosidase 1 (CHIT1) was common to both comparisons and showed strong correlation with disease progression rate (Pearson r =0.41, FDR-adjusted p = 0.035), but no association with survival (Pearson correlation and Kaplan-Meier survival analysis). Ubiquitin carboxyl-terminal hydrolase isozyme L1 (UCHL1; upregulated in ALS vs healthy controls) showed a stronger correlation with disease progression rate (Pearson r = 0.53, FDR-adjusted p = 0.003) and significant association with survival in Kaplan Meier analysis (log rank p = 0.013) but no independent effect in proportional hazards models. Weighted correlation network analysis was then used to identify functionally relevant modules of proteins. One module, enriched for inflammatory functions, was strongly associated with age at disease onset (Pearson r = 0.58, FDR-adjusted p = 0.005) and survival (Hazard Ratio 1.78, FDR = 0.065), and a second module, enriched for endoplasmic reticulum proteins, negatively correlated with disease progression rate (r = -0.42, FDR-adjusted p =0.109). This study confirms that UCHL1 is strongly associated with disease progression and survival, and highlights potential of inflammatory and endoplasmic reticulum proteins to provide prognostic biomarker potential.

Project description:Sacrocolpopexy has been dubbed the “gold standard” repair for apical pelvic organ prolapse (POP). This study sought to determine a genetic cause for sacrocolpopexy failure by comparing genotypes from 10 women who suffered from early POP reoccurance after sacrocolpopexy surgery, versus 40 randomly selected women with long term success after the same procedure. We objectively defined early overt failure after robotic-assisted laparoscopic sacrocolpopexy as having a pelvic organ prolapse quantification system examination (POP-Q) of stage III or IV occurring in more than one compartment within six months after surgery. All medical records identified during this process were then reviewed by a panel of urogynecology attendings and fellows to select patients who were truly clinical outliers. By this method we identified 10 patients (cases) who experienced early overt surgical failure. We also randomly selected 40 controls from our research database which includes greater than 500 patients who underwent robotic-assisted laparoscopic sacrocolpopexy during the same time period and had been objectively and subjectively assessed for ≥ 12 months with surgical success at ≥ 12 months that did not undergo prolapse re-operation or re-treatment. Demographics and peri-operative details were compared between cases and controls. Exclusion criteria for controls included use of other graft material besides polypropylene mesh, prior surgery for prolapse involving graft material, and conversion to laparotomy. DNA from the 10 cases and 40 controls was isolated from buccal swabs and genotyped on a single nucleotide polymorphism (SNP) array that contains 250,000 markers (NspI 250K SNP array, Affymetrix, Santa Clara, CA). All women in this study identified as Caucasian. All subjects provided written informed consent to study participation and data release. This was a case-control study approved by the Institutional Review Board at the Atlantic Health System in Morristown New Jersey (R11-10-004).

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Predictive Factors of Conversion in Laparoscopic Colorectal Cancer Resection

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