Wen-Sy Tsai

The participant characteristics

Comparative performance of FIT and combined models. Comparison of performance of using FIT results only and combination of triple-marker models (FIT results + CD45neg EpCAMpos CTCs + CD45neg EpCAMneg cells) for differentiating the individuals with colorectal neoplasia from the normal subjects (76 individuals with colorectal neoplasia vs. 37 normal subjects) (*: statistical difference p < 0.05). Cut-off values for FIT results, CD45neg EpCAMpos CTCs, and CD45neg EpCAMneg cells were 100 ng/mL, 6 cells/7mL blood, and 300 cells/7mL blood, respectively.

Background:Colorectal neoplasia contributes substantially to morbidity and mortality worldwide. Although fecal immunochemical test (FIT) has been adopted as a screening method, its limitations (suboptimal adherence to follow-up colonoscopy among the FIT-positive population and missed diagnosis in the FIT-negative population) hamper its effectiveness in reducing colorectal cancer. To address these issues, a combination of FIT with circulating tumor cell (CTC) enumeration for colorectal neoplasia prediction and colorectal cancer risk evaluation was proposed.Methods:Participants (n = 113) underwent FIT, colonoscopy examination, and CTC enumeration. For the latter, CD45negEpCAMpos CTC and CD45negEpCAMneg cell counts were assayed. For statistical analysis, multivariable logistic regression and area under the ROC curve (AUROC) analyses were used.Results:For colorectal neoplasia prediction, a better performance (AUROC = 0.8371) was achieved when the variables (FIT results and CTC enumeration) were combined, which was significantly improved compared with that of the FIT result–only model (AUROC = 0.7555). For its further use for colorectal cancer risk assessment, among FIT-positive individuals, those with either ≥5 CD45negEpCAMpos CTCs or ≥300 CD45negEpCAMneg cells had significantly increased colorectal cancer risk. For the FIT-negative population, 80% of the FIT-negative colorectal cancer cases in this study could be detected if the thresholds were set at ≥2 CD45negEpCAMpos CTCs and ≥500 CD45negEpCAMneg cells. Its application could thus rescue missed diagnoses due to false-negative FIT results.Conclusions:The method was able to enhance the prediction of colorectal neoplasia. The assessment of colorectal cancer risk was also successfully demonstrated.Impact:The method is promising as a supportive method tackling the problems encountered in current FIT-based screening.

Background: Colorectal neoplasia contributes substantially to morbidity and mortality worldwide. Although fecal immunochemical test (FIT) has been adopted as a screening method, its limitations (suboptimal adherence to follow-up colonoscopy among the FIT-positive population and missed diagnosis in the FIT-negative population) hamper its effectiveness in reducing colorectal cancer. To address these issues, a combination of FIT with circulating tumor cell (CTC) enumeration for colorectal neoplasia prediction and colorectal cancer risk evaluation was proposed. Methods: Participants (n = 113) underwent FIT, colonoscopy examination, and CTC enumeration. For the latter, CD45negEpCAMpos CTC and CD45negEpCAMneg cell counts were assayed. For statistical analysis, multivariable logistic regression and area under the ROC curve (AUROC) analyses were used. Results: For colorectal neoplasia prediction, a better performance (AUROC = 0.8371) was achieved when the variables (FIT results and CTC enumeration) were combined, which was significantly improved compared with that of the FIT result–only model (AUROC = 0.7555). For its further use for colorectal cancer risk assessment, among FIT-positive individuals, those with either ≥5 CD45negEpCAMpos CTCs or ≥300 CD45negEpCAMneg cells had significantly increased colorectal cancer risk. For the FIT-negative population, 80% of the FIT-negative colorectal cancer cases in this study could be detected if the thresholds were set at ≥2 CD45negEpCAMpos CTCs and ≥500 CD45negEpCAMneg cells. Its application could thus rescue missed diagnoses due to false-negative FIT results. Conclusions: The method was able to enhance the prediction of colorectal neoplasia. The assessment of colorectal cancer risk was also successfully demonstrated. Impact: The method is promising as a supportive method tackling the problems encountered in current FIT-based screening.

Purpose Although minimally invasive colorectal surgery has been proven to have a shorter hospital stay and fewer short-term complications than open surgery, the advantages of laparoscopic surgery for colorectal cancer patients undergoing hemodialysis have not been validated. This study compared the outcomes of open and laparoscopic approaches in these patients. Materials and methods Between January 2007 and December 2020, we retrospectively analyzed the clinical data of 78 hemodialysis patients who underwent curative-intent, elective colorectal surgery. Patients were divided into two groups according to the surgical method: open and laparoscopic. Results Postoperative morbidity (p = 0.480) and mortality (p = 0.598) rates and length of hospital stay (28.8 vs. 27.5 days, p = 0.830) were similar between the groups. However, laparoscopic surgery patients had a shorter return to clear liquid, full liquid, or soft food time than open surgery patients (p < 0.001, p = 0.007, and p = 0.002, respectively). Disease-free survival and long-term cancer-specific survival rates were also similar between the two groups (p = 0.353 and p = 0.201, respectively). Multivariate analysis revealed that intraoperative blood transfusion was a risk factor for severe complications and mortality (OR 6.055; p = 0.046), and the odds ratio (OR) of laparoscopic surgery was not significantly greater than that of open surgery (OR = 0.537, p = 0.337). Conclusion Although laparoscopic surgery did not result in hemodialysis patients having a shorter postoperative hospital stay, our results suggest that the laparoscopic approach is as safe as open surgery for hemodialysis patients and may be beneficial for shortening the return time to food intake.

Background: Insufficient evidence exists to ascertain the long-term prognosis in patients with obesity undergoing laparoscopic surgery versus open surgery for colorectal cancer. Methods: Employing an institutional database from 2009 to 2019, we assessed individuals with a BMI of greater than or equal to 30 kg/m² who underwent surgery for primary stage I–III colorectal adenocarcinoma. The authors used propensity score-weighted analysis to compare short-term and oncologic outcomes between laparoscopic and open surgical approaches. Results: This study enrolled 473 patients (open vs. laparoscopic surgery: 220 vs. 253; median follow-up period, 60 months). The laparoscopy group showed a significantly longer operative time (252 vs. 212 min), a higher anastomotic-leakage rate (5.14% vs. 0.91%), and a greater proportion of Clavien–Dindo class greater than III complications (5.93% vs. 1.82%). The open group showed a higher wound infection rate (7.27% vs. 3.16%) and a higher readmission rate (6.36% vs. 2.37%). After propensity score weighting, laparoscopy was inferior to open surgery in terms of long-term overall survival (hazard ratio: 1.43), disease-free survival (1.39), and recurrence rate (21.1% vs. 14.5%). In the subgroup analysis, female patients, older individuals, stage III patients, patients with rectal cancer, and those who underwent surgery after 2014 showed inferior long-term outcomes after laparoscopy. Conclusions: Laparoscopic colorectal cancer surgery for patients with obesity requires significant caution. Despite good short-term outcomes, this procedure is associated with hidden risks and poor long-term prognoses. In female patients, older individuals, stage III patients, patients with rectal cancer, and those treated in the late surgery era subgroups, caution is advised when performing laparoscopic surgery.

Background: The primary treatment for non-metastatic rectal cancer is curative resection. However, sphincter-preserving surgery may lead to complications. This study aims to develop a predictive model for stoma non-closure in rectal cancer patients who underwent curative-intent low anterior resection. Methods: Consecutive patients diagnosed with non-metastatic rectal cancer between January 2005 and December 2017, who underwent low anterior resection, were retrospectively included in the Chang Gung Memorial Foundation Institutional Review Board. A comprehensive evaluation and analysis of potential risk factors linked to stoma non-closure were performed. Results: Out of 956 patients with temporary stomas, 10.3% (n = 103) experienced non-closure primarily due to cancer recurrence and anastomosis-related issues. Through multivariate analysis, several preoperative risk factors significantly associated with stoma non-closure were identified, including advanced age, anastomotic leakage, positive nodal status, high preoperative CEA levels, lower rectal cancer presence, margin involvement, and an eGFR below 30 mL/min/1.73m2. A risk assessment model achieved an AUC of 0.724, with a cutoff of 2.5, 84.5% sensitivity, and 51.4% specificity. Importantly, the non-closure rate could rise to 16.6% when more than two risk factors were present, starkly contrasting the 3.7% non-closure rate observed in cases with a risk score of 2 or below (p < 0.001). Conclusion: Prognostic risk factors associated with the non-closure of a temporary stoma include advanced age, symptomatic anastomotic leakage, nodal status, high CEA levels, margin involvement, and an eGFR below 30 mL/min/1.73m2. Hence, it is crucial for surgeons to evaluate these factors and provide patients with a comprehensive prognosis before undergoing surgical intervention.

Purpose The optimal timing of stoma closure during or after adjuvant chemotherapy for rectal cancer patients undergoing sphincter-preserving surgery remains unknown. This study aimed to investigate the influence of clinical and oncological outcomes depending on the timing of stoma closure. Methods Between January 2006 and December 2015, we enrolled 244 consecutive rectal cancer patients who underwent curative-intent sphincter-preserving surgery with diverting transverse colostomy and adjuvant chemotherapy. Patients with stoma closure during (During group) adjuvant chemotherapy were compared to those who had stoma closure after adjuvant chemotherapy (After group). Results Parastomal hernia occurred more frequently in the after group than in the during group. (10% vs. 2.9%, p = 0.028). Overall, no significant difference was observed in overall survival (OS) or disease-free survival (DFS) between the two groups (p = 0.911 for OS, p = 0.505 for DFS). However, an inferior OS occurred if reopen surgery was performed within 30 days of stoma closure in the during group, as compared with the after group (p = 0.004). In addition, a marginally poor DFS was observed in the group of patients who received further operations due to 30-day stoma closure complications compared to the other patients (p = 0.07). Conclusions For rectal cancer patients who underwent sphincter-preserving surgery, attention should be given to avoid 30-day major complications after stoma reversal because patients who require reoperation during adjuvant chemotherapy may have poor long-term survival.

The primary treatment for metastatic colorectal cancer (mCRC) consists of targeted therapy and chemotherapy to improve survival. A molecular target drug with an anti-epidermal growth factor receptor (EGFR) antagonist is recommended when the RAS and BRAF genes are normal. About 50–70% of patients using anti-EGFR antagonists will experience skin reactions. Some studies have shown that severe skin reactions caused by anti-EGFR antagonists may be linked to overall survival (OS) and progression-free survival (PFS), but the results are still uncertain. These data of mCRC patients who underwent anti-EGFR therapy between October 2017 and October 2018 were analyzed retrospectively. A total of 111 patients were included in this study. The survival results showed that gender, age, body mass index, primary tumor site, and recurrence did not significantly affect OS and PFS. However, the first-line anti-EGFR inhibitor treatment was significantly associated with OS (p < 0.001) and PFS (p < 0.001). There was no significant difference in the incidence of acne between males and females in grades 1 and 2, while males have a greater risk in grades 3 and 4 than females (20.3 vs. 4.8%; p-value = 0.041). Skin toxicity was not a predictor of anti-EGFR treatment response in this investigation.

Background/Aims: Exacerbating factors of ulcerative colitis (UC) are multiple and complex with individual influence. We aimed to evaluate the efficacy of disease control by searching and restricting inflammation trigger factors of UC relapse individually in daily clinical practice. Methods: Both patients with UC history or new diagnosis were asked to avoid dairy products at first doctor visit. Individual-reported potential trigger factors were restricted when UC flared up (Mayo endoscopy score ≥1) from remission status. The remission rate, duration to remission and medication were analyzed between the groups of factor restriction complete, incomplete and unknown. Results: The total remission rate was 91.7% of 108 patients with complete restriction of dairy product. The duration to remission of UC history group was significantly longer than that of new diagnosis group (88.5 days vs. 43.4 days, P=0.006) in patients with initial endoscopic score 2–3, but no difference in patients with score 1. After first remission, the inflammation trigger factors in 161 relapse episodes of 72 patients were multiple and personal. Milk/dairy products, herb medicine/Chinese tonic food and dietary supplement were the common factors, followed by psychological issues, non-dietary factors (smoking cessation, cosmetic products) and discontinuation of medication by patients themselves. Factor unknown accounted for 14.1% of patients. The benefits of factor complete restriction included shorter duration to remission (P<0.001), less steroid and biological agent use (P=0.022) when compared to incomplete restriction or factor unknown group. Conclusions: Restriction of dairy diet first then searching and restricting trigger factors personally if UC relapse can improve the disease control and downgrade the medication usage of UC patients in daily clinical practice.