Journal of Gastrointestinal Surgery最新文献

Objectives: Colorectal cancer is the fourth most common cancer in the U.S., and early detection decreases mortality. We evaluated recent trends in colon cancer incidence and changes in rates of presentation with bowel obstruction before and during the COVID-19 pandemic.

Methods: Longitudinal study of U.S. Veterans from 2017-2023. The primary exposure was time-period: pre-pandemic (01/01/2017-02/29/2020) compared to pandemic (03/01/2020-10/31/2023). The primary outcome was new colon cancer diagnoses. We compared observed to expected diagnoses during the pandemic period. Malignant bowel obstruction at index diagnosis date, AJCC tumor stage, and tumor size at time of diagnosis were compared by period using standardized differences and bootstrapped confidence intervals.

Results: There were 22,256 new colon cancer diagnoses made in the VA: mean age 71±11 years old, 96% male, and 72% White. Comparing the pandemic to pre-pandemic periods, the proportion of tumors >4cm increased from 48.9% to 57.3% and the proportion with malignant bowel obstruction at presentation doubled from 2.7% to 5.3%. An estimated 619 cases were 'missed' during the pandemic: they were expected but not observed diagnoses. There were greater observed than expected large cancers, and fewer observed than expected small cancers during the pandemic according to forecast analyses.

Conclusions: Interruptions in care following the onset of the COVID-19 pandemic had measurable consequences among U.S. Veterans through the end of 2023. Among those diagnosed, median size was larger and more presented with bowel obstruction. This may be because decreased screening activity combined with lower healthcare utilization changed the distribution of cancer size at diagnosis to be larger - underlining the importance of encouraging engagement or re-engagement of Veterans in colorectal cancer screening.

Background: Patients post-gastroesophageal cancer surgery frequently present with clinical features of malabsorption and are often treated empirically with pancreatic enzyme replacement therapy (PERT). Primary aim was to objectify the presence of fat malabsorption in patients after gastroesophageal surgery and, secondary, to measure exocrine pancreatic function.

Methods: Eligible patients were those who underwent gastroesophageal cancer surgery (2017-2021), were at least six months post-operative, maintained an oral diet, and showed no evidence of recurrent disease. Treatment with PERT was ceased prior to this study. Fecal fat balance test (coefficient of fat absorption, CFA (%)) was used to measure absorption of fat. The CFA was determined by collecting feces over three days to measure daily fecal fat excretion (g/d), along with a four-day (weighted) nutritional diary, to establish the average daily fat intake (g/d). Fat malabsorption was defined as a CFA <85%. Exocrine pancreatic function was measured using fecal elastase-1 (FE-1).

Results: We included 90 patients (50 after esophagectomy with gastric tube reconstruction and 40 after (sub)total gastrectomy with Roux-en-Y reconstruction). Fecal analyses were conducted at a median of 17.5 months (IQR 11.3-29.8) post-surgery. A CFA <85% was found in 24% of patients after gastric tube reconstruction, accompanied by low levels of FE-1 in 33%. After Roux-en-Y reconstruction a CFA < 85% was present in 43%, of which 70% had low levels of FE-1.

Conclusion: Fat malabsorption is common after gastrectomy with Roux-en-Y reconstruction and after esophagectomy with gastric tube reconstruction, partly accompanied by reduced FE-1 levels. Clinicians should remain alert to malabsorption during follow-up and an empirical trial with PERT can be considered, although further studies are needed to evaluate its effects on absorption, symptoms, and quality of life.