The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

Aim The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Results Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. Conclusion One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Parental attitude in women with hyperprolactinemia: A controlled cross-sectional study; [Ailesel tutumun hiperprolaktinemi üzerine etkisi: Kesitsel kontrollü bir çalışma]

Objective: Prolactin hormone affects the brain, attitude and mood. Secretion of prolactin may be stimulated by environmental factors. The aim of this study was to demonstrate any possible effect of poor child-parent relationship on hyperprolactinemia. We hypothesize that women with hyperprolactinemia may have been subjected to poor child-parent relationship and neglect. Method: The present study was designed in a maternity hospital and included women with gynecologic complaints referred from the gynaecology outpatient clinic for serum prolactin assessments. An 85-item, self-rated EMBU Scale questionnaire (a scale for perceived parental attitude) was applied. Fifty women were enrolled over a period of 5 months. Results: Women with hyperprolactinemia (prolactin levels above 26 ng/ml) constituted the patient group (Group 1) (n=34) and those with normal serum prolactin levels (below 26 ng/ ml) served as the controls (Group 2) (n=16). The mean±SD levels of prolactin for group 1 and 2 were 57.25±38.7 ng/ml and 18.81±4.4 ng/ml, respectively. Group 1 patients believe that their parents did not show enough emotional warmth and had rejective behavior. Emotional warmth parameters of patients' mothers and fathers were significantly lower (p=0.002 and p=0.01, respectively) than those of the control group. We also found that the patients believed that their mothers and fathers both had rejective behaviors (p=0.008 and p= 0.009, respectively). Conclusion: Prolactin secretion is regulated by the dopaminergic system and since dopamine is responsible of pleasure and satisfaction sensations, the negative affection of both mothers and fathers in childhood may play a role in the etiology of chronic low-grade hyperprolactinemia in women. © TurkJBiochem.com