Faculty Bibliography

INTRODUCTION: The aim of this study was to evaluate 30-day postoperative morbidity in patients undergoing colectomy for cecal volvulus. METHODS: Patients who underwent surgery for cecal volvulus between 2012 and 2015 were identified from the American College of Surgeons-NSQIP by using current procedural terminology codes and ICD-9 code. Demographics, perioperative, and operative factors were assessed and compared between 2 groups, which were classified according to the presence or absence of postoperative morbidity. RESULTS: A total of 591 patients were identified with a mean age of 61.8 (range 18-89) of which 74% were female. Forty-three percent of patients had postoperative complications and 3% of patients died within 30 days of surgery. Most common postoperative complication was ileus (23%) followed by transfusion (10%) and superficial surgical site infection (8%). Mean length of stay was 8.5 days >=days and 9% of patients were readmitted within 30 days of surgery. African American (AA) race (odds ratio [OR]: 2.3, p=0.03), preoperative septic status (OR: 1.8, p=0.04) and wound class of 3-4 (OR: 1.9, p=0.01) were associated with 30-day postoperative morbidity. Length of stay (5.7+/- 2.6 vs 12.2+/- 10, p<0.0001) was longer and readmission rates (11 (3.2) vs 44 (17.1), p<0.0001) were higher among the patents with postoperative morbidity. CONCLUSIONS: Thirty-day postoperative morbidity in patients who underwent colectomy for cecal volvulus is high with a longer length of stay. Severity of infection seems strictly related to postoperative morbidity and individualized patient care can be designed based on the extent of infection in these patients

The expression of Cancer/Testis (CT) antigens in some tumors and restricted expression in normal tissue make CT antigens attractive vaccine targets. We evaluated the expression of MAGE-A3, PLAC1, GAGE, and CTAG2 in a series of colorectal cancers (CRC). CT mRNA expression was determined via quantitative PCR on paired tumors and normal tissue samples from 82 CRC patients. In addition, plasma antibody titers specific to MAGE-A3, PLAC1, GAGE, and CTAG2 were determined via ELISA. Tissue expression of MAGE-A3 was assessed via a standard IHC protocol. The Student's t-test was used for statistical analysis (significance p < 0.05). Tumor expression of MAGE-A3, CTAG2, and GAGE was compared to the levels of expression in testis. The percentage of samples that had a tumor vs. testis expression ratio above 0.1% was: MAGE-A3 (28%) and CTAG2 (17%) but no tumor presented GAGE expression levels above 0.1%. The expression levels of PLAC1 in tumors were compared to the levels in placenta, and in 12.8% of the samples analyzed, these levels were above 0.1%. Sero-reactivity specific for MAGE-A genes and PLAC1 was noted in 2.4% and 2.6% of patients, respectively. MAGE-A3 and PLAC1 may hold promise as vaccine targets for CRC. Further study is warranted.

BACKGROUND: Angiopoetin- (Ang-) 1 inhibits and Ang-2 promotes VEGF-mediated angiogenesis via binding to endothelial cell-bound Tie-2 receptor (Tie-2). After minimally invasive colorectal resection (MICR), Ang-1 levels decrease and Ang-2 levels increase, which may stimulate angiogenesis in wounds and residual tumor foci. Soluble Tie-2 (sTie-2) modulates the effects of free Ang-1 and Ang-2 by binding to them. This study assessed perioperative MICR plasma sTie-2 levels. METHODS: Blood samples were taken preoperatively (PreOp) and on postoperative days (POD) 1 and 3 from 50 cancer and 53 benign disease MICR patients. In a subgroup, a fourth sample was taken between POD7 and POD13 and bundled as a single time point. sTie-2 levels (ng/ml) were determined via ELISA. The mean and SD were determined at each time point. The t test used for analysis. RESULTS: PreOp plasma sTie-2 levels were significantly higher in the benign group (27.6 +/- 10.2) than in the cancer group (22.9 +/- 7.9). A significant drop from PreOp occurred in sTie-2 levels in the cancer group on POD1 (20.0 +/- 7.4) and POD3 (21.0 +/- 6.6) and in the benign group on POD1 (24.8 +/- 9.1). The benign group's POD3 and the cancer group's POD7-13 sTie-2 levels were statistically similar to the PreOp levels while the benign group's POD7-13 level was significantly higher. CONCLUSION: PreOp sTie-2 levels were significantly lower in cancer patients. MICR is associated with a significant short-lived decrease in plasma sTie-2 levels in cancer patients on POD1 and 3, which may briefly inhibit VEGF-mediated angiogenesis. The benign group's early results were similar.

BACKGROUND: Epidermal growth factor (EGF) stimulates tumor growth directly via tumor cell EGF receptors or indirectly via its proangiogenic effects. This study's purpose was to determine the impact of minimally invasive colorectal resection (MICR) on postoperative (postop) plasma EGF levels in the colorectal cancer (CRC) and benign disease settings and to see if preoperative (PreOp) EGF levels are altered in cancer patients. METHODS: MICR patients with benign pathology (n = 40) and CRC (n = 48) had blood samples taken PreOp and on postoperative days (POD) 1 and 3. In some patients, late samples were taken between POD7 and POD60; these were bundled into 7-day blocks and considered as single time points. EGF levels were determined by enzyme-linked immunosorbent assay (ELISA) and results were reported as mean +/- SD after logarithmic transformation. The Student t test was used (p < 0.008 after Bonferroni correction). RESULTS: The cancer and benign groups were comparable except for age. The mean PreOp CRC plasma EGF level (122.9 +/- 75.9 pg/ml) was significantly higher than that of the benign group (85.3 +/- 38.5 pg/ml) (p = 0.015). The cancer group's EGF levels were significantly decreased on POD1 and POD3 and for the POD31-55 time point (mean EGF level = 63.1 +/- 42.2 (n = 10). The benign group's POD3 and POD7-14 EGF levels were significantly lower than the PreOp level; later levels returned toward baseline. Small late sample size limited analysis. CONCLUSION: Plasma EGF levels are significantly higher in cancer patients. MICR is associated with a significant decrease in EGF levels early postop in both cancer and benign settings. Unlike the benign group, EGF blood levels in cancer patients remain low during the second postop month. A larger study with more late samples is needed to verify these results. EGF may have value as a tumor marker.