Randomized controlled trial of bisacodyl suppository versus placebo for postoperative ileus after elective colectomy for colon cancer

OBJECTIVE: To compare the use of bisacodyl suppository with placebo in resolving postoperative ileus after elective colectomy in a randomized controlled trial. METHODS: Twenty elective colectomy patients were randomized to receive either bisacodyl or placebo suppository on the third postoperative day. Outcomes included time to first defaecation, length of hospital stay, and postoperative complications. Participants and the primary investigator were unaware of the treatment assignment. RESULTS: All 10 participants in the bisacodyl group defaecated on the third postoperative day, while participants in the placebo group defaecated on days 3 (2/10), 4 (5/10) and 5 (3/10) (p < 0.001). The average lengths of hospital stay for the bisacodyl and placebo groups were 8.5 +/- 2.7 days and 10.4 +/- 5.3 days, respectively (p = 0.325). No significant complications occurred in either group. CONCLUSION: Bisacodyl suppository seems to be effective and safe in resolving postoperative ileus after elective colectomy in colon cancer patients.     

Androgenic pathway in triple negative invasive ductal tumors: Its correlation with tumor cell proliferation

Triple negative breast cancer (TNBC) is defined by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 negativity. Patients with TNBC frequently undergo an aggressive clinical course due to the unavailability of specific targeted therapies. Androgen receptor (AR) was reported to be expressed in up to 60% of TNBC cases but there have been controversies as to the roles of androgen signaling through AR in TNBC. Therefore, in this study, we analyzed the status of AR in combination with androgen synthesizing enzymes (5α‐reductase type 1 (5αR1) and 17β‐hydroxysteroid dehydrogenase type 5 (17βHSD5)] in order to further understand androgenic actions in TNBC. Androgen receptor, 5αR1, and 17βHSD5 were immunolocalized in a cohort of 203 TNBC patients from Thailand and Japan. We then correlated the findings with clinicopathological characteristics (age, stage, tumor diameter, lymph node invasion, metastatic spread, Ki‐67 labeling index, disease‐free survival, and overall survival) of the patients. Univariate analysis revealed that AR+/enzyme+ cases were associated with a significantly lower Ki‐67 labeling index than AR?/enzyme? samples. Multivariate analysis indicated the presence of significant positive correlations between AR and enzyme status in tumor cells, and between tumor diameter, lymph node invasion, and distant metastasis. Significant negative correlations were also detected between Ki‐67 labeling index and AR status (P = 0.04) or 5αR1 (P < 0.001). Cox proportional hazards analysis showed that Ki‐67 labeling index and stage were the only factors predicting disease‐free and overall survival of the patients, although univariate Kaplan–Meier analysis revealed AR/5αR1 negativity suggested a more adverse clinical course up to 80 months after surgery. These results suggest that the presence of androgen synthesizing pathways in addition to AR expression in tumor cells could confer a better clinical outcome through suppression of cell proliferation.     

Effectiveness and reliability of sentinel lymph node biopsy under local anesthesia for breast cancer

The objective of the present study was to determine the effectiveness and reliability of sentinel lymph node biopsy (SLNB) performed under local anesthesia (LA) for patients with breast cancer, by comparing the results with those obtained under general anesthesia (GA). Between January 2006 and February 2007, SLNB was performed under LA or GA in 37 and 94 patients with clinical Tis, T1, T2 or T3 N0 breast cancer, respectively. All underwent radiocolloid and blue dye injections to identify sentinel nodes. The sentinel node detection rate, the number of nodes harvested and the number of positive nodes were compared between the two groups. The sentinel node identification rates were similar for both groups. The number of sentinel and axillary nodes removed and number of positive nodes did not differ significantly between the two groups. SLNB performed under LA is an effective and reliable alternative to SLNB done under GA.