Colon Cancer Patients with Inflammatory Bowel Disease Do Not Necessarily Have Worse Outcomes
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Abstract, Academic Surgical Congress 2015: Introduction: Inflammatory bowel disease (IBD) is associated with a high risk of developing colon cancer. Its relationship with the eventual outcomes is less evident, although recent reports have indicated that comorbid IBD may be associated with worse survival. We therefore aimed to review characteristics of colon cancer associated with IBD in our population. Methods: We evaluated outcomes of a patient cohort operated on for colon cancer between 2004 through 2011 in a public tertiary care center in a state providing universal healthcare, focusing on comparing surgical pathological characteristics and long-term outcomes between IBD patients and the remainder of the population. Results: We included 1071 patients, of whom 38 (3.5%) had a concurrent diagnosis of IBD: 21 (2.0%) having Crohn’s, 16 (1.5%) having ulcerative colitis, and 1 patient with a mixed form. IBD patients were significantly younger (median age 59.5 vs. 67 years; P<0.001). These patients had a significantly higher rate of high-grade disease (33.3 vs. 19.4%; P=0.034) and borderline significantly higher rates of AJCC stage I disease (36.8 vs. 24.4%; P=0.06). In terms of outcomes however, no statistically significant differences were encountered between patients with or without IBD. Clinically significant but not statistically significant differences demonstrated lower rates of lymph-node metastasis (31.6 vs. 40.6%; P=0.27) and metastatic presentation (13.2 vs, 17%; P=0.54), as well as better outcomes in terms of metastatic recurrence (9.1 vs. 12.7%; P=0.55), and colon cancer mortality (26.3 vs. 35.6% P=0.27). Point estimates in multivariate analysis adjusted for age and staging where appropriate showed no changes in these trends. Conclusions: IBD patients who develop colon cancer appear to have relatively better staging and outcomes compared to non-IBD patients. These differences were present despite significantly higher-grade disease on presentation. More aggressive tumor characteristics in colon cancer patients with comorbid IBD fit the findings in earlier literature, while slightly better outcomes in IBD patients are an uncommon finding. This incongruence may potentially be explained by regular surveillance in patients with IBD, which may provide a protective effect through early detection of cancers. Differences with earlier reports in outcomes and staging could potentially be related to universal healthcare in our state, facilitating comprehensive IBD follow-up at our center. These findings suggest that under adequate and regular follow up, IBD patients are not necessarily inherently worse off when diagnosed with colon cancer.
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The present study was carried out to identify the role of malnutrition and its relationship for the development of cardiovascular disease (CVD) in chronic kidney disease (CKD) patients taking hemodialysis. We conducted an analytical study with 100 patients. It was carried out over one-year period, from February 25, 2017 to March 30, 2018. The inclusion criteria were the patients who have been on hemodialysis for at least past three months period and at least more than 18-year-old. All the patients were divided into two groups: first group of patients have both CVD and CKD and other group of patients have only CKD. Patients were subjected to biochemical and anthropometric parameters. Out of hundred patients, about 60 followed the inclusion and exclusion criteria. Eight women and 52 men with the age range from 18 to 80 years with 49±10.2years as mean age. We found that higher level of cholesterol, triglyceride, low protein intake and low energy conception in CKD alone patients is directly associated with malnutrition. The association between cholesterol levels and CKD would be altered by the presence of malnutrition. Low level of protein and total energy intake also confirms the presence of malnutrition in CKD patient developed the CVD.
Keywords: Malnutrition, hemodialysis patients, chronic kidney disease (CKD), cardiovascular disease (CVD)
The Mini-Gastric Bypass: Best Rx Diabetes
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
Running Head LITERATURE REVIEW 1LITERATURE REVIEW 5.docx
Running Head: LITERATURE REVIEW
1
LITERATURE REVIEW
5
Literature Review
Name: Liliana Faura
Course: NRS-490
Professor: Tish Dorman
Date: 1/12/2020
Introduction
The continued prevalence of type II diabetes has been blame d on sedentary lifestyle, but for a long time now, health experts have suggested dietary and lifestyle changes to reverse the trend, which may include but no limited to healthy eating and regular exercise. Scholars and clinicians have been evaluating the impact of the obesity on individuals and resources dedicated to curb the problem as not confined only to health impacts such as various types of diabetes and high-blood pressure, but also economic-wise. To shed more light on the issue of type II diabetes, this review compares the research questions, sample population, and limitation of various research studies regarding the topic of dietary and lifestyles changes for type 2 diabetic patients.
Comparison of Research Questions
According to Czupryniak et al (2010), the underlying question for the question is the impact of bariatric surgery on morbidly obese type II patients. However, as compared to Brun et al (2008), seek to answer the question of the targeted endurance training as weight reduction as well as fitness strategy on type II diabetic patients. Similarly, Umpierre (2011) seeks to determine the difference between physical activity exercise and structured exercise training on the regulation of glucose on type two patients. While prior scholars have dealt with lifestyles changes and surgery, Asemi et (2011) sought to answer the question of the impacts of “multispecies probiotic supplements on metabolic profiles, hs-CRP, and oxidative stress in diabetic patients.” While surgery is not a common way of managing weight for diabetic patients Picot et al (2012) echoes Czupryniak et al (2010) in trying to answer the question of the effectiveness of bariatric surgery as a way of managing weight on diabetic patients. Evidently, both lifestyle and dietary changes are some of the strategies used to manage complications associated with type II diabetes but there are other uncongenial ways such as bariatric surgery to manage weight in diabetic patients.
Comparison of Sample Populations
Picot et al (2012) searched 17 electronic sources, which is an according to the scholars, the meta-analysis was carried out strictly on studies that met criteria of the subject matter. Conversely Asemi et al (2013) randomly selected a sample size of 54 diabetic patients for their research. While the two studies use different reach methods, it is evident that quantitative research is more reliable in terms of sample size that qualitative research. Also, Brun and colleagues randomly selected 25 diabetic patients for their study, which pales only three (3) patients selected by Czupryniak and colleagues. Comparatively, Ninot et al (2011) randomly selected a total of 38 diabetic patients for their study, but the difference between this study and o ...
The biomarker of choice in association of dyslipidemia with osteoporosis: A c...
This case study describes a 55-year-old male patient who presented with pain in his lower limb and was diagnosed with both dyslipidemia and osteoporosis based on his medical history and laboratory tests. He had a family history of metabolic diseases and consumed excessive alcohol. His dyslipidemia was diagnosed based on genetic predisposition and lipid profile showing low HDL and high LDL levels. His osteoporosis was diagnosed a year and a half later when he fractured his femur during a walk and was found to have low bone mineral density. The conclusion is that low HDL and high LDL levels in the lipid profile are the biomarker of choice for associating dyslipidemia with osteoporosis as these
Prevalence of Chronic Kidney disease in Patients with Metabolic Syndrome in S...
Background and Objective: Chronic kidney disease (CKD) which is an increasingly important clinical and public health issue is associated with cardiovascular disease. Epidemiologic studies have also linked metabolic syndrome (MetS) with an increased risk of incident CKD. Therefore, the present study was designed retrospectively to find the prevalence and potential risk factors of CKD in patients with MetS in Saudi Arabia.
DM and Heart, What more can we do for patient heart.pdf
This document discusses diabetes and heart disease, providing an overview of several key points:
1) Diabetes significantly increases the risk of cardiovascular disease through mechanisms like accelerated atherosclerosis. It doubles the risk of coronary artery disease in men and triples it in women.
2) Intensive management of cardiovascular risk factors in diabetic patients, including glycemic control, blood pressure management, and lifestyle changes can significantly reduce cardiovascular events and mortality, as shown in studies like UKPDS, STENO-2, and Look AHEAD.
3) Current guidelines recommend a multifaceted treatment approach targeting glucose, lipid, and blood pressure control, along with lifestyle optimization and cardiovascular protective medications, to manage heart disease risk in diabetic
PIIS2212267214015895
This randomized controlled trial evaluated the effectiveness of two community-based weight loss strategies among 207 obese, low-income Latinos in the US over 24 months. The strategies included case management alone or with additional support from community health workers. Both interventions were compared to usual care. At 6 months, those receiving case management plus community health worker support lost more weight on average compared to the other groups. However, by 12 and 24 months the differences between groups narrowed and were no longer statistically significant. Men achieved greater weight loss than women in all groups at each time point. The study demonstrated that community health workers may help promote initial weight loss, especially among men, but not long-term weight maintenance.
3c diabetes.pdf
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The Case For a True Health Coalition
Simply applying knowledge we have reliably in hand, we could prevent fully 80% of all chronic disease and premature death in modernized and modernizing countries. Standing between us and that prize is an obstacle course of competing claims, false promises, and profit-driven, pop culture nonsense. The case will be made for True Health Coalition to rally diverse voices to the cause of using what we know, even as we pursue what we do not. The challenges, operations, and promise of the endeavor will be discussed.
John Rose: Systemic Factors and Access Issues Overview
This document summarizes research on systemic factors and access issues that contribute to disparities in surgical care. It reviews literature showing that factors like insurance status, procedure volume at hospitals, and delays in care affect outcomes for minorities and low-income patients. It also discusses gaps in understanding how interventions, social determinants, and vulnerable groups impact disparities. The document concludes by calling for more research on how policies, clinical programs, and management guidelines can help address disparities by improving access and communication between patients and providers.
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Effect of High-Grade Disease on Colon Cancer Outcomes
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5th Annual Early Age Onset Colorectal Cancer - Session V: Part II
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John Rose: Systemic Factors and Access Issues Overview
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More from Ramzi Amri
Risk Stratification in Stage II Colon Cancer Patients
Objective: AJCC Stage II colon cancer patients form a group where the choice to either undergo or forego adjuvant chemotherapy is far from evident and often remains controversial. This study analyzes several pathological characteristics in order to assess their predictive value for outcomes in stage II colon cancer.
Design: Retrospective review of a prospectively maintained, IRB-approved data repository.
Setting: Tertiary care center.
Patients: A series of 313 consecutive stage II patients treated surgically for colon cancer at our center (2004-2011) were included.
Main outcome measures: Mortality, disease-specific mortality and metastasis, including multivariable Cox regression adjusted for stage subdivisions (II-A/II-B/II-C) and potential confounders.
Results: Colon cancer-specific mortality was substage-independently increased in patients with baseline carcinoembryonic antigen (CEA) >5ng/L (HR=2.97;P=0.041), large vessel invasion (HR=3.93; P=0.002) and perineural invasion (HR=3.67; P=0.004). Overall mortality adjusted for substage, age and comorbidity was also significantly higher in patients with high-grade disease (HR=2.73; P<0.001)><0.001).>5ng/L (HR=2.37; P=0.046), large vessel invasion (HR=2.80; P=0.002), perineural invasion (HR=2.57; P=0.010), and extramural vascular invasion (EMVI) (HR=2.83; P=0.002). The number of high-risk features (0,1,2-3,4+) was associated with a clearly incremental increase in disease-specific mortality (P=0.008) and recurrence (P<0.001).>5ng/L, large vessel invasion, perineural invasion and EMVI are all independent risk factors for recurrence and disease-specific mortality in Stage II colon cancer patients. The number of factors present form risk strata that should be weighed heavily in decisions regarding adjuvant treatment.
Women Are Diagnosed With Colon Cancer Less Often Through Screening, Worsening...
Abstract, Academic Surgical Congress 2014:
See also:
Introductions
Disparities between men and women are omnipresent in many malignancies. In colon cancer, women usually fare slightly better. However, women also often tend to be underrepresented at screening initiatives. We hypothesized that the introduction of nationwide screening for colorectal cancer could have led to shifts in the status quo. We therefore assessed whether differences existed in terms of screening presentation at our center and whether this influenced staging and outcomes in our colon cancer population.
Methods
We included all patients over 50 without a previous history of colorectal cancer that have been treated surgically for colon cancer at our center from 2004 through 2011. Screening events included screening colonoscopies, as well as fecal occult blood tests. Chi-square statistics and relative risk (RR) computations assessed for the significance and magnitude of differences in screening rates between genders; as well as differences in several pathologic characteristics and death rates between women not diagnosed through screening and the remainder of the population.
Results
We included 919 patients, of whom 451 (49.1%) were female. Women were less likely to be diagnosed through screening (26.2% vs. 32.7%; RR: 0.8, 95%CI 0.66-0.98; P=0.037). Compared to the remainder of the population, women not diagnosed through screening were at significantly higher risk (all P<0.001) for having high-grade tumors (RR=1.61), lymph node metastasis (RR=1.37) and distant metastasis (RR= 1.65). This is reflected quite clearly in relative risk of death directly and uniquely attributable to colon cancer (RR: 1.65).
Conclusions
Female patients were less likely to be diagnosed with colon cancer through screening methods and subsequently were at risk for presenting with advanced disease and thus having higher mortality. This demonstrates the beneficial effect of diagnosis through screening, and shows that disparities in screening rates lead to disparities in outcomes.
Effect of Transition to Stapled Anastomosis on Anastomotic Leak Rates and Ope...
Abstract, Academic Surgical Congress 2014:
See also: http://www.ncbi.nlm.nih.gov/pubmed/25472748
Introduction
Stapled gastrointestinal anastomosis has gained wide adoption among the surgical community for its ease, speed, and its applicability in laparoscopic surgery. Over the last decade, anastomotic stapling grew to become the commonplace technique for colon cancer surgery at our center. This abstract assesses whether the increasing adoption of anastomotic stapling affected the rate of anastomotic leaks and duration of surgery.
Methods:
All patients operated on at our center for colon cancer from 2004 through 2011 were included. Rates of anastomotic leaks were compared between hand-sewn and stapled anastomosis, calculating relative risks and using Fischer's exact test and Chi-square tests to assess for significance. Univariate and multivariate linear regression compared durations of surgery, with estimates of difference were expressed in minutes through the unstandardized B-coefficient.
Results:
A total of 1071 patients were included. The number of stapled anastomoses grew significantly from 31.6% in 2004 to 70.8% in 2011 (p<0.001).><0.001) but eventually significantly shorter (138 vs. 162.2 P=0.005). This difference remained significant after adjustment for ASA classification, procedure type, presence of adhesions and operating surgeon (B=28.0 minutes; 95%CI 12.2,43.8; P=0.001).
Conclusion
Stapled anastomoses did not increase anastomotic leak rates. If anything, leak rates appeared slightly lower. In addition, stapled anastomoses significantly shortened operation duration. With the benefit of being a tool that facilitates minimally invasive surgery, it is a safe way to improve efficiency, reduce costs and promotes faster and better recovery.
Impact of Emergency Presentation on Colon Cancer Surgical Stay and Outcomes
Abstract, Academic Surgical Congress 2014:
Introduction:
Urgent presentation is an unequivocal poor prognostic factor in patients with colon cancer. This abstract assesses the magnitude of the negative effects associated with an emergency presentation in patients with surgically treated colon cancer.
Methods:
All patients diagnosed with colon cancer who underwent surgery at Massachusetts General Hospital from 2004 through 2011 were included. Emergency presentation is defined as presentation or referral to our center requiring immediate surgical treatment following diagnosis of colon cancer that was subsequently confirmed through pathology. We compared dichotomous outcomes among emergency and elective patients using the Chi-square test and a relative risk (RR) calculation, while linear regression was used for continuous outcomes, the unstandardized B regression coefficient was used as a point estimate of differences in time-related outcomes.
Results:
We included 1071 patients, of whom 97 were emergency admissions, 79 of which came from our Emergency department. Emergency patients required longer surgeries (median duration 141 vs. 124 minutes, P=0.026), had a median of three day longer length of stay (P<0.001),><0.001)><0.001),><0.001) rates.
Conclusions:
Emergency presentation is predictive for more advanced disease and far worse outcomes. Longer surgeries, stays, and higher readmission rates means these presentations will also lead to significantly higher healthcare costs. This is another strong argument for preventive care and screening colonoscopy.
Obesity, Outcomes and Quality of Care: BMI Increases the Risk of Wound-Relate...
Abstract, Academic Surgical Congress 2013:
See also paper: http://www.ncbi.nlm.nih.gov/pubmed/24139555
Introduction:
Hospitals and surgeons are constantly striving to improve their outcomes. SCIP measures and guidelines to improve the quality of care are now commonplace. However, factors that are beyond the control of the medical community play an important role in outcomes. The United States continues to struggle with obesity. Obesity increases resection difficulty and could be predictive of a complicated postoperative course. Body Mass Index (BMI) is a continuous numeric expression of body habitus and allows for a quantification of the effect of body habitus on postsurgical complications. The aim of this study is therefore to measure the effect of BMI on the risk of wound-related postoperative complications.
Methods:
851 patients were operated on for colonic adenocarcinoma at our tertiary care center between 2004 and 2011. Binomial logistic regression was used to assess for relationships between complications and incremental increases in BMI. We controlled in a separate univariate analysis for possibly significant predictive covariates, including age, gender, Charlson comorbidity score, approach, and intersurgeon variation.
Results:
After correction for statistically significant covariates, BMI proved to be a significant predictor of several wound-related complications. Using the same approach, all other major and minor complications within 30 days postoperatively did not show a significant relationship with BMI.
In wound-related complications, the risk increase was independent on whether the approach was laparoscopic or open. Figure 1 shows the p-values for each complication that was significantly related to BMI and the Odds Ratio for each increase of one BMI unit (1 kg/m2).
Conclusions:
Obesity has a direct effect on wound complications in both open and laparoscopic procedures. Furthermore, BMI-related risk of wound-related complications increases exponentially with increasing weight. This incremental effect illustrates how an increasingly obese US population relates to an independently growing risk of surgical complications. As the surgical community strives to improve the quality of care, patient controllable factors will clearly play an increasingly important role in cost containment and quality improvement.
Radial Margin Positivity as a Poor Prognostic Factor for Colon Cancer
This document summarizes a study examining the impact of radial margin positivity (RMP) in colon cancer surgery. The study found that RMP occurred in 5.6% of colon cancer resections and was associated with more advanced disease, poorer pathological features, and significantly worse long-term outcomes including higher rates of metastatic disease and death. Multivariate analysis showed RMP was an independent predictor of death from cancer even after accounting for other prognostic factors. While RMP had a relatively low occurrence, it carried profound clinical consequences by markedly worsening patient outcomes.
Poster: The impact of Screening Colonoscopy on Outcomes in Colon Cancer Surgery
Abstract, 92nd New England Surgical Society Annual Meeting:
Objective: Screening colonoscopy decreased overall rates of colorectal cancer in the United States. The NCI SEER database reported an annual percentage decrease in the incidence of colon cancer of 4.0% in 2002-2005 and 2.4% in 2005-2009.
In addition to removing benign lesions and preventing progression, screening colonoscopy theoretically identifies asymptomatic patients with early stage disease, potentially leading to higher survival rates. This study aims to assess this effect in surgically treated colon cancer patients.
Design: Retrospective review of prospectively maintained database.
Setting: Tertiary care center.
Patients: Patients operated for colonic adenocarcinoma (2006 -2011) at Massachusetts General Hospital, diagnosed through screening colonoscopy or after symptomatic presentation.
Main Outcome Measures: Post-operative staging, survival and disease-free interval.
Results: 597 patients were included. 460 patients were diagnosed after symptomatic presentation, 137 patients were diagnosed through screening.
Symptomatic patients had a significantly higher risk of having nodal disease (44.8% vs. 27%; Relative Risk 1.66; 95%CI 1.24-2.22; p<0.001)><0.001)><0.001)><0.001).
Conclusion: Patients with colon cancer identified on screening colonoscopy have significantly lower stage disease on presentation and significantly better outcomes than those with tumors identified because of symptoms.
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Risk Stratification in Stage II Colon Cancer Patients
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Women Are Diagnosed With Colon Cancer Less Often Through Screening, Worsening...
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Obesity, Outcomes and Quality of Care: BMI Increases the Risk of Wound-Relate...
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Radial Margin Positivity as a Poor Prognostic Factor for Colon Cancer
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Colon Cancer Patients with Inflammatory Bowel Disease Do Not Necessarily Have Worse Outcomes
- 1. Colon Cancer Patients with Inflammatory Bowel Disease Do Not Necessarily Have Worse Outcomes Ramzi Amri, MD1,2 Liliana G Bordeianou, MD, MPH1,2 Patricia Sylla, MD1,2 and David L Berger, MD 1,2 1 Massachusetts General Hospital, Division of General and Gastrointestinal Surgery. 2 Harvard Medical School, Department of Surgery. Disclosures: none 02/03/15 10th Annual Academic Surgical Congress, February 3-5 2015, Las Vegas, NV 07 - QuickShot: Clinical Research - Oncology
- 2. Introduction • Inflammatory bowel disease (IBD) carries a high risk of developing colon cancer.1 • Its relationship with the eventual outcomes is less evident. • Recent report2 confirmed early suspicions that IBD may be associated with worse survival.3 • Other reports did not identify differences.4 • We therefore reviewed characteristics of IBD- associated colon cancer in our population. 1. Triantafillidis JK, et al. Anticancer Res. 2009;29(7):2727–2737 2. Adams SV, et al. World J Gastroenterol. 2013;19(21):3241–3248. 3. Richards ME, et al. Ann Surg. 1989 Jun;209(6):764-73. 4. Delaunoit T, et al. Clin Gastroenterol Hepatol. 2006 Mar;4(3):335-42.
- 3. Methods • Included: • Surgical colon cancer patients at MGH 2004-2011 (n=1071) • Patients with IBD: 38 (3.5%) • Crohn’s: 21 (2.0%), UC: 16 (1.5%), 1 mixed form • Comparison: • Baseline pathology • Outcomes: survival, disease-free survival • Statistical analysis • Ordinal: χ2 , continuous: Mann Whitney U • Multivariate: Cox regression
- 4. Results
- 5. Conclusions • IBD patients who develop colon cancer appear to have relatively better staging and outcomes. • These differences were present despite significantly higher-grade disease on presentation. • More aggressive tumor characteristics in colon cancer patients with comorbid IBD fit findings in earlier literature. • Slightly better outcomes in IBD patients are an uncommon finding. • This incongruence may be explained by surveillance in IBD patients. Protective effect through early detection of cancers? Findings suggest that under adequate and regular follow up, IBD patients are not inherently worse off when diagnosed with colon cancer.
- 6. Questions?
- 7. Questions?