The authors of the published version of this article missed to add the second affiliation of Mostafa Shalaby. The new affiliation is now added and presented correctly in this article. The remainder of the article remains unchanged.

[This corrects the article on p. 139 in vol. 32, PMID: 27626024.].

Background: Anastomotic leakage is one of the most serious complications after rectal cancer surgery. Method: A prospective multicenter interventional study to assess a newly described technique of creating the colorectal and coloanal anastomosis. The primary outcome was to access the safety and efficacy of this technique in the reduction of anastomotic leak. Result: Fifty-three patients with rectal cancer who underwent low or ultra-low anterior resection were included in the study. There were 35 males and 18 females, with a median age of 68 years (range = 49-89 years). The median tumor distance from the anal verge was 8 cm (range = 4-12 cm), and the median body mass index was 24 kg/m(2) (range = 20-35 kg/m(2)). Thirty patients underwent open, 16 laparoscopic, and 7 robotic surgeries. Multiple firing (2-charges) was required in 30 patients to obtain a complete rectal division. Forty-five patients had colorectal anastomosis, and 8 patients had coloanal anastomosis. The protective ileostomy was created in 40 patients at the time of initial surgery. There was no mortality in the first 30 days postoperatively, and only 10 (19%) patients developed complications. There were 3 anastomotic leakages (6%); 2 of them were subclinical with ileostomy created at initial operation and both were treated conservatively with transanal drainage and intravenous antibiotics. One patient required reoperation and ileostomy. The median length of hospital stay was 10 days (range = 4-20 days). Conclusion: Our technique is a safe and efficient method of creation of colorectal anastomosis. It is also a universal method that can be used in open, laparoscopic, and robotic surgeries.

[This corrects the article on p. 139 in vol. 32, PMID: 27626024.].

infections (p<0.001-0.02).The mean total direct hospital costs were significantly less for ERAS patients, at an average cost savings of $5,690 (p<0.001).The highest recorded total cost for the ERAS group was $25,290 which is notably less from the non-ERAS group, which was $74,770.The individual cost categories per patient was also significantly lower for ERAS patients compared to non-ERAS patients (p<0.001-0.02)(Table 1).Finally, the variability of cost within the ERAS group was less than non-ERAS, indicating higher costs and unpredictability in the non-ERAS group (p<0.001).Discussion: In conclusion, we have demonstrated that a dedicated ERAS protocol not only improves patient outcomes, but also results in significant hospital cost savings.Table 1.Cost comparisons between ERAS and Non-ERAS groups by department.Wilcoxon rank-sum tests with p-values adjusted for the false discovery rate (FDR).

Background and Objectives: Transanal minimally invasive surgery (TAMIS) has emerged as an alternative to transanal endoscopic microsurgery (TEM). The authors report their experience with TAMIS for the treatment of mid and high rectal tumors. Methods: From November 2011 through May 2016, 31 patients (21 females, 68%), with a median age of 65 years who underwent single-port TAMIS were prospectively enrolled. Mean distance from the anal verge of the rectal tumors was 9.5 cm. Seventeen patients presented with T1 cancer, 10 with large adenoma, 2 with gastrointestinal stromal tumor (GIST) and 2 with carcinoid tumor. Data concerning demographics, operative procedure and pathologic results were analyzed. Results: TAMIS was successfully completed in all cases. In 4 (13%) TAMIS was converted to standard Park's transanal technique. Median postoperative stay was 3 days. The overall complication rate was 9.6%, including 1 urinary tract infection, 1 subcutaneous emphysema, and 1 hemorrhoidal thrombosis. TAMIS allowed an R0 resection in 96.8% of cases (30/31 cases) and a single case of local recurrence after a large adenoma resection was encountered. Conclusion: TAMIS is a safe technique, with a short learning curve for laparoscopic surgeons already proficient in single-port procedures, and provides effective oncological outcomes compared to other techniques.

Anastomotic leak after gastrointestinal surgery is a severe complication associated with relevant short and long-term sequelae. Most of the anastomoses are currently performed with a surgical stapler that is required to have appropriate characteristics in order to guarantee good performances. The aim of our study was to evaluate, ex vivo, pressure resistance and tensile strength of anastomosis performed with different circular staplers available in the market. We studied 7 circular staplers of 3 different companies, 3 of them used for gastrointestinal anastomosis and 4 staplers for hemorrhoidal prolapse excision. A total of 350 anastomoses, 50 for each of the 7 staplers, were performed using healthy pig fresh intestine, then injected saline solution and recorded the leaking pressure. There were no statistically significant differences between the mean pressure necessary to induce an anastomotic leak in the various instruments (p>0.05). For studying tensile strength, we performed a total of 350 anastomoses with 7 different circular staplers on a special strong paper (Tyvek), and then recorded the maximal tensile force that could open the anastomosis. There were statistically significant differences between one brand stapler vs other 2 companies staplers about the strength necessary to open the staple line (p<0.05). In conclusion, we demonstrated that different circular staplers of three companies available in the market give comparable anastomotic pressure resistance but different tensile strengths. This is probably due to different technical characteristics.

BACKGROUND AND OBJECTIVES:Small-bowel obstruction (SBO) is a common surgical emergency that occurs in 9% of patients after abdominal surgery. Up to 73% are caused by peritoneal adhesions. The primary purpose of this study was to compare the rate of SBOs between patients who underwent laparoscopic (LPS) and those who had open (OPS) colorectal surgery. The secondary reasons were to evaluate the rate of adhesive SBO in a cohort of patients who underwent a range of colorectal resections and to assess risk factors for the development of SBO.METHOD:This was a retrospective observational cohort study. Data were analyzed from a prospectively collected database and cross checked with operating theater records and hospital patient management systems.RESULTS:During the study period, 707 patients underwent colorectal resection, 350 of whom (49.5%) were male. Median follow-up was 48.3 months. Of the patients included, 178 (25.2%) underwent LPS, whereas 529 (74.8%) had OPS. SBO occurred in 72 patients (10.2%): 20 (11.2%) in the LPS group and 52 (9.8%) in the OPS group [P = .16; hazards ratio (HR) 1.4 95% CI 0.82-2.48] within the study period. Conversion to an open procedure was associated with increased risk of SBO (P = .039; HR 2.82; 95% CI 0.78-8.51). Stoma formation was an independent risk factor for development of SBO (P = .049; HR, 0.63; 95% CI 0.39-1.03). The presence of an incisional hernia in the OPS group was associated with SBO (P = .0003; HR, 2.85; 95% CI 1.44-5.283). There was no difference in SBO between different types of procedures: right colon, left colon, and rectal surgery. Patients who developed early small-bowel obstruction (ESBO) were more often treated surgically compared to late SBO (P = .0001).CONCLUSION:The use of laparoscopy does not influence the rate of SBO, but conversion from laparoscopic to open surgery is associated with an increased risk of SBO. Stoma formation is associated with a 2-fold increase in SBO. Development of ESBO is highly associated with a need for further surgical intervention.

NK cell cytotoxicity is regulated by the types of the interaction between killer immunoglobulin-like receptors (KIRs) and human leukocyte antigen (HLA) class I ligands on target cells and the different binding affinity of the Fcγ receptor IIIA (CD16A) for IgG-coated tumor cells. Thus, it is conceivable that KIR and CD16A gene contents may contribute to the function of NK cells by modulating an immune response in the colorectal carcinoma (CRC) microenvironment. This hypothesis is supported by recent evidence suggesting that NK cells improve the clinical course of CRC patients by enhancing the anti-CRC effect of CD8 + T cells. This information provides the rationale to test the hypothesis whether the independent KIR segregation and specificity, as well as CD16A gene polymorphisms, have an impact on CRC.

Purpose The aim of this study is to investigate the impact of age on short-term outcomes after colorectal surgery in terms of the 30-day postoperative morbidity and mortality rates. Methods The subjects for the study were patients who had undergone colorectal surgery. Patients were divided into 2 groups according to age; groups A and B patients were ≥80 and <80 years old of age, respectively. Both groups were manually matched for body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index and procedure performed. Results A total of 200 patients, 91 men (45.5%) and 109 women (54.5%), were included in this retrospective study. These patients were equally divided into 2 groups. The mean ages were 85 years in group A (range, 80 to 104 years) and 55.3 years in group B (range, 13 to 79 years). The overall 30-day postoperative mortality rate was 1% of total 200 patients; both of these 2 patients were in group A. However, this observation had no statistical significance. No intraoperative complications were encountered in either group. The overall 30-day postoperative morbidity rate was 27% (54 of 200) for both groups. The 30-day postoperative morbidity rates in groups A and B were 28% (28 of 100) and 26% (26 of 100), respectively. However, these differences between the groups had no statistical significance importance. Conclusion Age alone should not be considered to be more of a contraindication or a worse predictor than other factors for the outcome after colorectal surgery on elderly patients.

Introduction: We previously reported results on 17 rectal cancer patients (pts) treated with neoadjuvant CisCape-RT (ESMO World GI 2011). We here present the final report of 52 patients treated with the CisCape-RT regimen. Methods: Fifty-two non-metastatic pts (male:female, 35:17 pts, median age 63 years, range 41-77), clinically staged with endoscopic ultrasound and chest/abdomen/pelvis CT scan as cT2cN1 (5 pts), cT3cN0 (18), cT3cN1 (21), cT3cN2 (4) or cT4cN1 (4), with histologically confirmed moderately (43 pts) or poorly (9) differentiated rectal adenocarcinoma (median distance from the anal verge 5 cm, range 2-13) were treated with standard pelvic radiotherapy (45 Gy/25 fractions) and concurrent capecitabine (825 mg/m2 twice daily days 1 through 14 and 22 through 35) plus cisplatin (40 mg/m2 once every three weeks). Results: radical surgery was performed in 92% of pts, median time elapsed from CRT commencement to surgery was 108 days (76-178), 3 pts underwent palliative surgery because of progression. Complete pathologic response (pCR) was documented in 9 pts (17%). Based on pre-treatment assessment, T and N down-staging were observed in 41% and 38% of pts, respectively. Primary tumour was down-sized in 14 pts (82%) with the median longest diameter reducing from 5.0 cm (range 1.6-16.0) before CRT to 2.0 cm (0-10.0) after CRT, two-tailed p = 0.001 (according to Wilcoxon test for paired samples). Grade 3-4 toxicities occurred in 35% of pts. Median progression-free and overall survival were not yet reached after a median follow-up of 30 months. Conclusion: Despite a good pCR rate, the high occurrence of grade 3-4 toxicities with CisCape-RT makes this regimen not suitable for larger phase III trials.

Increasing evidence suggests that HLA‐DRB1 alleles reduce or increase the risk of developing ulcerative colitis‐associated colorectal carcinoma (CRC) tumors. However, the role of HLA‐DRB1 locus on the susceptibility to develop CRC tumor, in the absence of a history of inflammatory bowel diseases (IBDs), is unclear. The aim of our study was to determine whether HLA‐DRB1 alleles are associated with IBD‐independent CRC tumor. HLA‐DRB1 allele polymorphisms were identified by sequence‐based typing method in 53 CRC patients and 57 sex‐ and age‐matched healthy Caucasian controls. Pearson's chi‐squared analysis with Yate's correction or Fisher's exact test with Bonferroni's correction, as appropriate, were used to compare the allele frequency (AF) differences of HLA‐DRB1 in patients and controls. A total of 29 HLA‐DRB1 alleles were recognized. A detailed study of these alleles allowed to identify DRB1*13:01 and DRB1*11:01 alleles that were significantly associated with an increased and reduced risk to develop CRC tumor, respectively. AF of DRB1*13:01, in CRC patients, was significantly higher than that of healthy controls, even following Bonferroni's correction (p = 0.029). In contrast, the presence of the DRB1*11:01 allele was negatively associated with CRC tumor as evidenced by the significantly lower AF in CRC patients than that of healthy controls (p = 0.005). However, following Bonferroni's correction, the AF of DRB*11:01 lost its statistical significance. These results suggest that HLA‐DRB1*13:01 allele could be a potential marker for predicting genetic susceptibility to CRC tumor. In contrast, the protective role of DRB1*11:01 remains unclear.

BACKGROUND:Tumor associated antigens are useful in colorectal cancer (CRC) management. The ribosomal P proteins (P0, P1, P2) play an important role in protein synthesis and tumor formation. The immunogenicity of the ribosomal P0 protein in head and neck, in breast and prostate cancer patients and the overexpression of the carboxyl-terminal P0 epitope (C-22 P0) in some tumors were reported.METHODS:Sera from 72 colorectal tumor patients (67 malignant and 5 benign tumors) were compared with 73 healthy donor sera for the presence of antibodies to CEA, EGFR, ErbB2 and ribosomal P proteins by western blotting or ELISA. Expression of the C-22 P0 epitope on tissues and colon cancer cells was determined by immunoperoxidase staining and indirect immunofluorescence/western blotting, respectively, employing MAb 2B2. Biological effects of MAb 2B2 on colon cancer cells were assessed by the Sulforhodamine B cell proliferation assay, trypan blue exclusion test and cleaved caspase-3 detection. Fisher's exact test was used to compare the number of auto-antibodies positive patients with healthy donors. Variation in the C-22 P0 expression, and in the number of apoptotic cells was evaluated by Student's t-test. Variation in cell survival and cell death was evaluated by Newman-Keuls test.RESULTS:No significant humoral response was observed to CEA, EGFR and ErbB2 in CRC patients. Conversely, 7 out of 67 CRC patient sera reacted to ribosomal P proteins. The prevalence of P proteins auto-antibodies in CRC patients was significant. Five patients showed restricted P0 immunoreactivity, while two patients reacted simultaneously to all P proteins. The C-22 P0 epitope was homogenously expressed both in malignant tumors and the adjacent mucosa, but the intensity of expression was higher in the tumor. Starved colon cancer cells showed a higher C-22 P0 epitope plasma membrane expression compared to control cells. MAb 2B2 inhibited colon cancer cell growth and induced cell death in a dose dependent manner.CONCLUSIONS:Our study shows a spontaneous humoral immune response to ribosomal P0 protein in CRC patients and the inhibition of in vitro cancer cell growth after C-22 P0 epitope targeting. The ribosomal P0 protein might be a useful immunological target in CRC patients.

Laparoscopic ventral mesh rectopexy (LVR) is gaining wider acceptance as the preferred procedure to correct internal as well as external rectal prolapse associated with obstructed defaecation syndrome and/or faecal incontinence. Very few reports exist on the use of biologic mesh for LVR. The aim of our study was to report the complication and recurrence rate of our first 100 cases of LVR for symptomatic internal rectal prolapse and/or rectocele using a porcine dermal collagen mesh.

Increasing evidence suggests that HLA‐DRB1 alleles reduce or increase the risk of developing ulcerative colitis‐associated colorectal carcinoma (CRC) tumors. However, the role of HLA‐DRB1 locus on the susceptibility to develop CRC tumor, in the absence of a history of inflammatory bowel diseases (IBDs), is unclear. The aim of our study was to determine whether HLA‐DRB1 alleles are associated with IBD‐independent CRC tumor. HLA‐DRB1 allele polymorphisms were identified by sequence‐based typing method in 53 CRC patients and 57 sex‐ and age‐matched healthy Caucasian controls. Pearson's chi‐squared analysis with Yate's correction or Fisher's exact test with Bonferroni's correction, as appropriate, were used to compare the allele frequency (AF) differences of HLA‐DRB1 in patients and controls. A total of 29 HLA‐DRB1 alleles were recognized. A detailed study of these alleles allowed to identify DRB1*13:01 and DRB1*11:01 alleles that were significantly associated with an increased and reduced risk to develop CRC tumor, respectively. AF of DRB1*13:01, in CRC patients, was significantly higher than that of healthy controls, even following Bonferroni's correction (p = 0.029). In contrast, the presence of the DRB1*11:01 allele was negatively associated with CRC tumor as evidenced by the significantly lower AF in CRC patients than that of healthy controls (p = 0.005). However, following Bonferroni's correction, the AF of DRB*11:01 lost its statistical significance. These results suggest that HLA‐DRB1*13:01 allele could be a potential marker for predicting genetic susceptibility to CRC tumor. In contrast, the protective role of DRB1*11:01 remains unclear.

Background: Pathological complete response (pCR) after neoadjuvant therapy of RC is recognized as a powerful favourable prognostic factor. We evaluated the potential for increasing pCR rate by adding a widely used radiosensitizer, cisplatin, to standard capecitabine-based chemoradiotherapy (CRT).Methods: 51 patients (pts) (male:female, 35:16, median age 63 years, range 41-77), clinically staged with endoscopic ultrasound and chest/abdomen/pelvis CT scan as Stage II (18 pts) or III (33 pts) with histologically confirmed moderately (43 pts) or poorly (8 pts) differentiated RC (median distance from the anal verge 5 cm, range 2-13) were treated with standard pelvic radiotherapy (45 Gy/25 fractions) and concurrent capecitabine (825 mg/m2 twice daily days 1 through 14 and 22 through 35) plus cisplatin (40 mg/m2 once every three weeks). Surgery was planned at 8-10 weeks after the end of CRT. 8 cycles of standard adjuvant FOLFOX4 was offered to all patients independently of pathological stage.Results: Radical abdominoperineal and anterior resection was performed in 36 and 12 pts, respectively, median time elapsed from CRT commencement to surgery was 108 days, 3 pts underwent palliative surgery. pCR (regression AJCC grade 0) was documented in 7 pts (14%), nearly complete response (AJCC grade 1) in 10 pts (20%). In the whole cohort, median disease-free (DFS) was not yet reached after a median follow-up of 30 months; however, there was a strong association between DFS and AJCC grade, with no relapse observed for AJCC grade 0-1 and a 4-year DFS rate of 78% and 22% for AJCC grade 2 and 3, respectively, HR 3.47 (95% CI 0.64-18.9), p 0.03. Among common clinical e biochemical variables, baseline hemoglobin (Hb) was significantly associated with pCR according to logistic regression analysis, with a 43% increased chance of pCR for 1-unit increase in Hb (OR = 0.57, p 0.049). A high frequency of Grade 3-4 toxicities, mainly diarrhoea, was observed (35% of pts). Adjuvant FOLFOX4 was completed in 52% of pts.Conclusions: Despite a good tumor AJCC regression rate, the high occurrence of grade 3-4 toxicities with CisCape CRT makes this regimen not suitable for larger phase III trials in all RC patients. However, baseline Hb may be a possible patient selection criteria for this intensive treatment strategy. Background: Pathological complete response (pCR) after neoadjuvant therapy of RC is recognized as a powerful favourable prognostic factor. We evaluated the potential for increasing pCR rate by adding a widely used radiosensitizer, cisplatin, to standard capecitabine-based chemoradiotherapy (CRT). Methods: 51 patients (pts) (male:female, 35:16, median age 63 years, range 41-77), clinically staged with endoscopic ultrasound and chest/abdomen/pelvis CT scan as Stage II (18 pts) or III (33 pts) with histologically confirmed moderately (43 pts) or poorly (8 pts) differentiated RC (median distance from the anal verge 5 cm, range 2-13) were treated with standard pelvic radiotherapy (45 Gy/25 fractions) and concurrent capecitabine (825 mg/m2 twice daily days 1 through 14 and 22 through 35) plus cisplatin (40 mg/m2 once every three weeks). Surgery was planned at 8-10 weeks after the end of CRT. 8 cycles of standard adjuvant FOLFOX4 was offered to all patients independently of pathological stage. Results: Radical abdominoperineal and anterior resection was performed in 36 and 12 pts, respectively, median time elapsed from CRT commencement to surgery was 108 days, 3 pts underwent palliative surgery. pCR (regression AJCC grade 0) was documented in 7 pts (14%), nearly complete response (AJCC grade 1) in 10 pts (20%). In the whole cohort, median disease-free (DFS) was not yet reached after a median follow-up of 30 months; however, there was a strong association between DFS and AJCC grade, with no relapse observed for AJCC grade 0-1 and a 4-year DFS rate of 78% and 22% for AJCC grade 2 and 3, respectively, HR 3.47 (95% CI 0.64-18.9), p 0.03. Among common clinical e biochemical variables, baseline hemoglobin (Hb) was significantly associated with pCR according to logistic regression analysis, with a 43% increased chance of pCR for 1-unit increase in Hb (OR = 0.57, p 0.049). A high frequency of Grade 3-4 toxicities, mainly diarrhoea, was observed (35% of pts). Adjuvant FOLFOX4 was completed in 52% of pts. Conclusions: Despite a good tumor AJCC regression rate, the high occurrence of grade 3-4 toxicities with CisCape CRT makes this regimen not suitable for larger phase III trials in all RC patients. However, baseline Hb may be a possible patient selection criteria for this intensive treatment strategy.