Background Previous studies have examined the relationship between colorectal tumor distribution and metastasis, but the tumor luminal location and associative risk factors promoting tumor growth remain unknown.Methods In this study, we mapped the luminal distribution of human colonic adenomas/adenocarcinomas and their association with various physiologic parameters.Results We identified a mesenteric predominance for colonic adenomas and adenocarcinomas.Conclusion The findings of this study raise the possibility of novel mechanistic pathways in the development of adenomas and subsequent transformation into adenocarcinomas.

BACKGROUND:A significant proportion of colonic polyps are unsuitable for endoscopic removal. A combined endoscopic and laparoscopic approach is an alternative to conventional polypectomy or resection. In this review, we set out to determine whether avoiding segmental resection for benign colonic polyps was a viable option through combined endolaparoscopic surgery (CELS). We examined the methods and classification criteria different centers employed in their reporting. Finally, we determined whether CELS and procedures methodically similar should be considered as the standard of care today. METHODS:A systematic review was performed reporting the outcomes of CELS for benign colorectal polyps. Main outcomes measured included operating time, length of hospital stay and postoperative complications. The CELS data from reports with a larger number of polyps examined were compared to data from representative EMR, ESD and laparoscopic colectomy literature. RESULTS:Eighteen eligible studies with 532 patients were included. We identified three different CELS techniques: EMR, ESD and full-thickness excision. The operative time for CELS reported in 12 studies varied from 45 to 205 min. The successful endoscopic resection rate ranged from 58 to 100%. Conversion to open surgery was reported in <5%. The length of hospital stay varied from 0 to 7 days. Overall postoperative complications ranged from 0 to 18%. The reports of CELS with more than 20 polyps presented 74-91% successful rate. In comparison with laparoscopic group, CELS groups showed shorter operation time (92-145 vs 125-199 min) and length of hospital stay (1-1.5 vs 4-11 days). CONCLUSIONS:CELS and similar procedures are viable options for intestinal polyps removal. Moving forward, we suggest methods to standardize CELS procedure reporting. The reported outcomes of CELS indicate that it should be seen as a viable alternative to segmental resection when endoscopic methods alone do not suffice.

Large bowel obstruction (LBO) secondary to malignancy is an urgent or emergent surgical condition. Despite recent advances in alternative therapies, surgery remains the primary evidence-based curative, palliative, or temporizing treatment option. Acute presentations of malignant LBO are likely to be associated with advanced age, multiple comorbidities, advanced disease stage, and a poor prognosis. Immediate management should focus on prompt diagnosis, resuscitation, and treatment to relieve the obstruction. The modern operating room should be thought of as the arena where the highest probability for optimal outcomes is achieved. This article outlines the evolving role of malignant LBO surgery, and how newer approaches to operative treatment may improve clinical outcomes.