To identify baseline rectal MRI characteristics that may serve as predictive factors for recurrence in patients with rectal adenocarcinoma after surgical resection.

This retrospective, single-center study included 269 consecutive patients (median age, 55 years [interquartile range, 47-65]; 144 men and 125 women) diagnosed with rectal cancer from January 2015-December 2017 who underwent baseline rectal MRI followed by surgical resection. MRI characteristics were collected from rectal MRI synoptic reports. Recurrence-free survival was defined as the time between surgical resection and recurrence (local recurrence and/or metastatic disease) or death. Statistical analysis included Cox proportional hazards to determine associations between baseline rectal MRI/clinical characteristics and recurrence.

The median recurrence-free survival in the study sample was 6.4 years. Baseline rectal MRI characteristics associated with recurrence at univariable analysis were: age > 55 years (P = 0.044), low rectal tumor location (P = 0.04), craniocaudal length ≥ 5.0 cm (P = 0.007), anal canal involvement (P = 0.011), presence of suspicious total mesorectal excision (TME) lymph nodes > 0.5 cm (P = 0.03), mesorectal fascia involvement (P = 0.04), T3 stage (P = 0.024), T4 stage (P = 0.008), and M1 stage (P = 0.024). At multivariable analysis, only age > 55 years (P = 0.012) and the presence of suspicious TME lymph nodes > 0.5 cm (P = 0.049) remained associated with recurrence.

Advanced age and the presence of suspicious TME adenopathy > 0.5 cm on baseline rectal MRI are associated with higher risk of recurrent disease in patients with resected rectal cancer.

Response to preoperative chemoradiation (CRT) is an important indicator of the possibility of lateral pelvic lymph node (LPN) metastasis. However, the effect of LPN dissection (LPND) in good responders to CRT remains unclear. This study aimed to identify the optimal treatment strategy for patients with rectal cancer who respond well to preoperative CRT.

This multi-institutional retrospective study evaluated patients with locally advanced rectal cancer and clinically suspected LPN metastases who underwent total mesorectal excision with LPND after CRT. The patients were divided into two groups based on the largest lymph node diameter post-CRT (cutoff: 5 mm): good (n = 38) and poor responders (n = 53).

LPN metastasis was significantly higher in poor responders (18 patients, 34.0 %) than in good responders (5 patients, 13.2 %) (p = 0.024). All 5 patients in the good responder group had low rectal cancer (i.e., tumors located within 5 cm from the anal verge (AV)). Low rectal cancer was the only significant predictor for LPN metastasis in good responders (p = 0.004). However, LPN size before and after CRT did not predict LPN metastasis in this group (p = 0.947 and 0.910, respectively). When LPND was indicated for all poor responders and for good responders with tumors located ≤5 cm from the AV, the sensitivity for LPN metastasis diagnosis was 100 %.

Among rectal cancer patients with good response to preoperative CRT, pathological LPN metastasis occurs in 13.2 %, and tumor height is a significant risk factor for LPN metastasis. LPND might be considered for low rectal tumors, regardless of preoperative CRT response.

The lateral pelvic cavity is an anatomically tricky site to access using a linear approach; therefore, robot-assisted lateral lymph node dissection (LLND) may be superior over existing laparoscopic procedures. In this study, we aimed to compare the short- and long-term outcomes of robot-assisted LLND (R-LLND) versus laparoscopic LLND (L-LLND) for locally advanced low rectal cancer and explore the potential advantages of robot-assisted surgery.

This single-center, retrospective cohort study included patients aged ≥ 18 years who underwent minimally invasive total mesorectal excision (TME) plus LLND for low rectal adenocarcinoma. Patients were divided into L-LLND and R-LLND groups. The short- and long-term outcomes of the procedures were compared.

There were 41 patients in the L-LLND group and 21 in the R-LLND group. The incidence of postoperative complications was significantly lower in the R-LLND group (49% vs. 19%, p = 0.029), especially urinary retention (29% vs. 5%, p = 0.046). The median postoperative hospital stay was significantly shorter in the R-LLND group (22 vs. 15 days, p < 0.001). The 3-year relapse-free survival rates in the L-LLND and R-LLND groups were 75.3% (95% confidence interval [CI]: 58.9-85.9) and 65.7% (95% CI: 30.7-86.1), respectively. No significant differences were observed in long-term survival outcomes.

Patients with locally advanced rectal cancer who underwent TME plus R-LLND had a significantly lower incidence of postoperative complications and a significantly shorter postoperative hospital stay compared to those who underwent TME plus L-LLND. The long-term outcomes were comparable, and no oncological concerns associated with R-LLND were observed.

Rectal cancer (RC) is one of the most common malignant tumors of the digestive system and has an alarmingly high incidence and mortality rate globally. Compared to conventional imaging examinations, radiomics can extract quantitative features that reflect tumor heterogeneity and mine data from medical images. In this review, we discuss the potential value of multimodal MRI-based radiomics in the diagnosis and treatment of RC, with a special emphasis on the role of peritumoral tissue characteristics in clinical decision-making. Existing studies have shown that a radiomics model integrating intratumoral and peritumoral characteristics has good application prospects in RC staging evaluation, efficacy prediction, metastasis monitoring, recurrence early warning, and prognosis judgment. At the same time, this paper also objectively analyzes the existing methodological limitations in this field, including insufficient data standardization, inadequate model validation, limited sample size and poor reproducibility of results. By combining existing evidence, this review aimed to enhance the attention of clinicians and radiologists on the characteristics of peritumoral tissues and promote the translational application of radiomics technology in the individualized treatment of RC.

Few studies have investigated quality of life (QoL) improvements in patients with colorectal cancer or the benefits of digital healthcare interventions. This randomized controlled trial assessed the impact of mobile applications on postoperative QoL in patients scheduled for curative surgery for colorectal cancer. Patients were randomized into three intervention groups (each using a different mobile application for postoperative lifestyle management) and a control group. QoL was evaluated using the European Quality of Life-5 Dimensions (EQ-5D), with physical and metabolic parameters and fat/muscle areas measured preoperatively, and every six months postoperatively. At six months, no significant differences in the EQ-5D scores from baseline were observed across groups. Intervention Group C showed a significant increase in skeletal muscle area compared to the control group (P = 0.046). Overall, mobile application use had a minimal effect on postoperative health-related QoL, warranting further research on their efficacy and compliance rates. Trial registration: CRIS.nih.go.kr: KCT0005447. Registration date: June 23, 2020.

Predicting response to neoadjuvant therapy in locally advanced rectal cancer (LARC) is challenging. Organ preservation strategies can be offered to patients with complete clinical response. We aim to evaluate MRI-derived radiomics models in predicting complete pathological response (pCR).

Search included MEDLINE, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) for studies published before 1st February 2024. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) and Radiomics Quality Score (RQS) tools were used to assess quality of included study. The research protocol was registered in PROSPERO (CRD42024512865). We calculated pooled area under the receiver operating characteristic curve (AUC) using a random-effects model. To compare AUC between subgroups the Hanley & McNeil test was performed.

Forty-four eligible studies (12,714 patients) were identified for inclusion in the systematic review. We selected thirty-five studies including 10,543 patients for meta-analysis. The pooled AUC for MRI radiomics predicted pCR in LARC was 0.87 (95% CI 0.84-0.89). In the subgroup analysis 3 T MRI field intensity had higher pooled AUC 0.9 (95% CI 0.87-0.94) than 1.5 T pooled AUC 0.82 (95% CI 0.80-0.83) p < 0.001. Asian ethnicity had higher pooled AUC 0.9 (95% CI 0.87-0.93) than non-Asian pooled AUC 0.8 (95% CI 0.75-0.84) p < 0.001.

We have demonstrated that 3 T MRI field intensity provides a superior predictive performance. The role of ethnicity on radiomics features needs to be explored in future studies. Further research in the field of MRI radiomics is important as accurate prediction for pCR can lead to organ preservation strategy in LARC.

Although the oncological benefits of thoracic duct (TD) resection have been reported, recent research has questioned its impact on survival. With advancements in minimally invasive esophagectomy (MIE) and a deeper understanding of the microanatomy, standardizing techniques for TD resection/preservation have become increasingly important. We demonstrated a minimally invasive surgical procedure for esophagectomy, with and without TD resection, in patients who received neoadjuvant chemotherapy.

This multicenter, retrospective cohort study evaluated patients with cT1-3 thoracic esophageal cancer who underwent thoracoscopic McKeown esophagectomy after neoadjuvant chemotherapy at two Japanese cancer centers between 2012 and 2019. The effects of TD preservation and resection were compared using propensity score-matching. Short- and long-term outcomes were analyzed.

We showed the standard procedure for TD resection and preservation and demonstrated that recognizing membrane structures is crucial for precise resection of the esophagus and regional lymph nodes. After matching, 255 patients in each group were analyzed. The TD resection group showed no significant differences in short-term outcomes, complication rates, or thoracic lymph node harvest compared to the TD preservation group. Both groups had similar 5-year overall and recurrence-free survival rates, with no significant differences in recurrence patterns.

In the context of modern esophageal carcinoma treatment, in which MIE and neoadjuvant chemotherapy are standard practices, the impact of TD resection on prognosis is limited. Recognizing membrane structures is crucial for accurate esophagectomy using the MIE approach.

Treatment of locally recurrent rectal cancer (LRRC) is still challenging because of inhomogeneous patient cohorts regarding previous treatments as well as different recurrence patterns and locations. The aim of this study was to investigate the treatments and surgical approaches tailored to them.

We included all patients who were treated for LRRC without distant metastasis at the University Medical Center Mannheim, Germany, between 2010 and 2021. We collected data from our electronic clinical data management system regarding the initial diagnosis and treatment, as well as the locations and treatment of the recurrent tumor.

We identified a total of 666 patients who were curatively treated for rectal cancer of whom 36 patients (5.4%) developed LRRC without distant recurrence. Most patients (26/36) had a tailored therapy regimen that included surgery with or without perioperative radiation and/or chemotherapy. The most common site of local relapse was around the former colorectal anastomosis (15/36, 41.7%). The operative procedures ranged from anterior resection to multi-organ resection and exenteration. A complete resection (R0) could be achieved in twelve patients (12/22. 54.5%). The 3- and 5-year overall survival rates were 79% and 72%, respectively.

Most local recurrences occur at the anastomotic site and are mostly eligible for curative surgical therapy with good long-term survival.

This study aims to examine why we encounter a pathological circumferential resection margin (pCRM)-positive specimen whose preoperative MRI indicates negative mesorectal fascia involvement in middle to low rectal cancer.

Forty-four consecutive patients included in this study had c(yc)T1-3 primary rectal adenocarcinoma without mesorectal fascia involvement and underwent laparoscopic total mesorectal excision (TME) with curative intent in the Department of Gastrointestinal Surgery of Kansai Medical University Hospital from January 2014 to April 2018. We adopted three checkpoints to investigate the misleading point causing positive pCRM (≤ 1 mm). (1) c(yc)CRM diagnosis by two radiologists with more than 20 and 15 years of experience in rectal cancer MRI diagnosis. (2) The specimen was assessed using the TME score presented by Nagtegaal. (3) We compared the standard sectioning according to UK guidelines (group A; n = 26) with the specimen MRI image navigation-based section (group B; n = 18) in terms of estimation of pCRM by c(yc)CRM.

We achieved a "complete" resection specimen in all cases. A simple correlation coefficient in group B revealed a significant correlation between c(yc)CRM and pCRM (r = 0.663, p = 0.00513); this correlation was not significant in group A (r = 0.261, p = 0.19824). However, tests for differences between linear regression coefficients in groups A and B showed no significant differences (p = 0.12596). There were five cases of pCRM ≤ 1 mm: three in group A and two in group B. An anterior lesion caused pCRM ≤ 1 mm in three cases; the tumor deposits or extramural vascular invasion caused the other cases.

The cause of misleading pCRM was the inaccurate preoperative MRI diagnosis of c(yc)CRM.

In advanced epithelial ovarian cancer (AEOC), debulking surgery with posterior pelvic exenteration (PPE) is performed in 35-70 % of the patients to achieve no macroscopic residual disease. This study aims to evaluate the incidence of mesorectal involvement and its prognostic role in AEOC patients undergoing PPE.

This prospective study analyzes data from a cohort of AEOC patients who underwent primary debulking surgery (PDS) or interval debulking surgery (IDS) with PPE at the Léon Bérard Cancer Center in Lyon between 2018 and 2022.

73 patients underwent debulking surgery with PPE during the study period. 27 (34 %) underwent PPE during PDS and 46 (66 %) during IDS. 23 patients (31.5 %) had only serosal involvement, 19 (26 %) had bowel involvement up to the muscularis propria, and 7 (9.6 %) had up to the mucosa. Mesorectal involvement was observed in 40 cases (54.7 %) and was significantly associated with positive MLNs and higher liver recurrence rates. Hepatic metastases had an early onset (months, 9.8 vs 28.8; p = 0.0001) and were correlated with poorer OS (months, 20.9 vs 51.5) compared to recurrences in other sites. The persistence of positive mesorectum after neoadjuvant chemotherapy in the IDS group seemed to be linked to poor OS (NR vs 42.7 months).

Debulking surgery with PPE in AEOC patients is often needed. Total mesorectal excision should be performed in AEOC to achieve no residual disease because positive mesorectum after neoadjuvant chemotherapy seemed to be linked with poor OS, with early onset and increased incidence of liver metastasis.

Previous studies have demonstrated the advantages of short-term histopathological outcomes and complications associated with transanal total mesorectal excision (TME) compared with laparoscopic TME. However, the long-term oncological outcomes of transanal TME remain ambiguous. This study aims to compare 3-year disease-free survival of transanal TME with laparoscopic TME.

To evaluate 3-year disease-free survival between transanal TME and laparoscopic TME in patients with rectal cancer.

This randomized, open-label, noninferiority, phase 3 clinical trial was performed in 16 different centers in China. Between April 2016 and June 2021, a total of 1115 patients with clinical stage I to III mid-low rectal cancer were enrolled. The last date of participant follow-up was in June 2024.

Participants were randomly assigned in a 1:1 ratio before their surgical procedure to undergo either transanal TME (n = 558) or laparoscopic TME (n = 557).

The primary end point was 3-year disease-free survival, with a noninferiority margin of -10% for the comparison between transanal TME and laparoscopic TME. Secondary outcomes included 3-year overall survival and 3-year local recurrence.

In the primary analysis set, the median patient age was 60 years. A total of 692 male and 397 female patients were included in the analysis. Three-year disease-free survival was 82.1% (97.5% CI, 78.4%-85.8%) for the transanal TME group and 79.4% (97.5% CI, 75.6%-83.4%) for the laparoscopic TME group, with a difference of 2.7% (97.5% CI, -3.0% to 8.1%). The lower tail of a 2-tailed 97.5% CI for the group difference in 3-year disease-free survival was above the noninferiority margin of -10 percentage points. Furthermore, the 3-year local recurrence was 3.6% (95% CI, 2.0%-5.1%) for transanal TME and 4.4% (95% CI, 2.6%-6.1%) for laparoscopic TME. Three-year overall survival was 92.6% (95% CI, 90.4%-94.8%) for transanal TME and 90.7% (95% CI, 88.3%-93.2%) for laparoscopic TME.

In patients with mid-low rectal cancer, 3-year disease-free survival for transanal TME was noninferior to that of laparoscopic TME.

ClinicalTrials.gov Identifier: NCT02966483.

Background/Objectives: Robotic-assisted surgery is an attractive and promising option with unique advantages in rectal cancer surgery, but the optimal surgical approach is still debatable. Therefore, we aimed to compare the short- and long-term outcomes of the robotic-assisted approach with the laparoscopic-assisted and open approaches. Methods: A single referral center in Israel retrospectively reviewed all patients that underwent an elective rectal resection for primary non-metastatic rectal cancer between 2010 and 2020. The cohort was separated into three groups according to the surgical approach: robotic, laparoscopic, or open. Results: The cohort included 526 patients with a median age of 64 years (range 31-89), of whom 103 patients were in the robotic group, 144 in the open group, and 279 patients in the laparoscopic group. The robotic group had significantly more lower rectal tumors (24.3% versus 12.7% and 6%, respectively, p < 0.001), more locally advanced tumors (65.6% versus 51.2% and 50.2%, respectively, p = 0.004), and higher rates of neoadjuvant radiotherapy (70.9% versus 54.2% and 39.5%, respectively, p < 0.001). Conversion to an open laparotomy was more common in the laparoscopy group (23.1% versus 6.8%, respectively, p = 0.001). The open approach had higher rates of intraoperative complications (23.2% compared with 10.7% and 13.5% in the robotic and laparoscopic groups, respectively, p = 0.011), longer hospital stays (10 days compared with 7 and 8 days, respectively, p < 0.001), and higher rates of postoperative complications (76% compared with 68.9% and 59.1%, respectively, p = 0.002). The groups were similar in the number of harvested lymph nodes (14) and the incidence of positive resection margins (2.1%). The 5-year overall survival in the robotic group was 92.3% compared with 90.5% and 88.3% in the laparoscopic and open groups, respectively (p = 0.12). The 5-year disease-free survival in the robotic group was 68% compared with 71% and 63%, respectively (p = 0.2). Conclusions: The robotic, laparoscopic, and open approaches had similar histopathological outcomes and long-term oncological outcomes. The open approach was associated with higher rates of perioperative morbidity. These findings suggest that the robotic approach is safe and effective in rectal cancer surgery.

To develop scoring systems to predict the need for selective lateral lymph node dissection (LLND) alongside total mesorectal excision (TME) in patients with locally advanced low rectal cancer after neoadjuvant chemoradiotherapy (nCRT), focusing on lateral local recurrence (LLR) and lateral lymph node (LLN) metastasis.

This retrospective study included 607 patients with mrT3/T4 rectal cancer located within 8 cm of the anal verge who underwent nCRT and TME. A development group was used to develop a scoring system predicting the necessity of LLND using logistic regression analysis, incorporating primary tumor and LLN features observed on rectal MRI. External validation was performed in an independent group of 144 patients. We also analyzed risk factors for recurrence and residual LLNs after LLND.

Model 1 included pretreatment LLN size and extramural venous invasion (EMVI). Model 2 incorporated pretreatment internal iliac and obturator lymph node sizes, EMVI, and nonresponsive LLN on restaging MRI. Model 3 focused solely on nonresponsive LLN on restaging MRI. In the development group, Models 1 and 2 exhibited better performance (area under the curve (AUC) = 0.92 and 0.90, respectively) than Model 3 (AUC = 0.79), consistent with the validation group. Among patients who underwent LLND, the distal internal iliac compartment had more residual lymph nodes than other compartments (p = 0.02).

Scoring systems utilizing LLN features and EMVI on MRI might aid in decision-making for selective LLND following nCRT in locally advanced low rectal cancer.

Question The criteria for when additional lateral lymph node dissection (LLND) may benefit in locally advanced low rectal cancer have not yet been definitively established. Findings Scoring systems (Model 1, 2) based on preoperative MRI utilize lateral lymph node (LLN) size and extramural venous invasion to predict the necessity of LLND. Clinical relevance The selective LLND along with total mesorectal excision aids in managing LLN metastasis and lateral local recurrence in locally advanced low rectal cancer after neoadjuvant chemoradiotherapy. The imaging-based scoring systems may guide clinical decision-making for selective LLND.

In preoperative staging for patients with a ductal adenocarcinoma of the pancreatic head (PDAC), resectability is anatomically characterized by the possible clearance of the medial vascular grove. Borderline resectable PDAC patients who retain an increased risk of infiltration to the portomesenteric system and/or arterial vasculate are candidates for neoadjuvant therapy. However, redefined pathological analysis revealed the dorsal resection margin to be similar at risk for R1 resection. Mesopancreatic excision (MPE) aims to secure the integrity of the dorsal and ventral resection margins. The existence of the mesopancreas (MP) is inevitable, since the pancreas is of a secondary retroperitoneal nature and the dorsal as well as ventral fascial coverings define the peripancreatic compartment anatomy. It remains unknown if the MP area is only infiltrated in high-risk PDAC patients or if MPE during pancreatoduodenectomy should be employed for localized PDAC patients as well.

Patients who underwent upfront pancreatoduodenectomy were included. CRM evaluation and analysis of the MP was standardized in all patients. Patients were sub-grouped by the infiltration status of the vascular groove (localized disease: LOC). In LOC patients there was evidently no cancerous infiltration into the medial vascular groove (true + primary resectable).

Two hundred eighty-four consecutive patients who underwent pancreatoduodenectomy were included (169 LOC patients). In LOC patients the MP infiltration rate remained high but was significantly lower when compared to advanced PDAC patients (MP + 69.2% vs. 83.5%, p = 0.005). In LOC patients, CRM resection status of the dorsal resection status remained significantly affected by the MP infiltration status (R0CRM- 80.5% vs. 62.8%, p = 0.019).

These important findings clearly show underestimated tumor extensions into the mesopancreas even in localized, primary resectable PDAC patients who are currently amenable for upfront resection. Synergistically to total mesorectal or mesocolic excision, which is applied to all stages of colorectal disease, MPE is justified in primary resectable patients as well. Therefore, MPE should be employed in all PDAC patients. Since the infiltration status of the mesopancreas was a significant factor for incomplete resection in primary resectable PDAC patients, neoadjuvant treatment options for must be discussed.

As part of an organ sparing strategy, a surgical local excision may be performed in patients with early-stage rectal cancer or following neoadjuvant (chemo)radiotherapy. In selected cases, a completion total mesorectal excision may be recommended which can be more complex because of the preceding local excision. A transanal approach to perform completion total mesorectal excision may offer an advantage through the better visualization of the surgical field in the distal rectum and less forceful retraction for exposure. However, the oncologic safety and technical feasibility of this approach have yet to be demonstrated in these patients. Therefore, the aim of this study was to evaluate the oncological and technical safety of completion transanal total mesorectal excision following a local excision in patients with rectal cancer.

Patients from the prospective International Transanal Total Mesorectal Excision Registry who underwent a surgical local excision prior to completion transanal total mesorectal excision were retrospectively analyzed.

In total, 189 patients were included of which 22% received neoadjuvant radiotherapy. In 94% of the patients, a low anterior resection was performed. A primary anastomosis was constructed in 91% (n = 171/189) of the patients, with the majority also receiving a defunctioning stoma (84%, n = 144/171), of which 69% (n = 100/144) were reversed. Within 30 days, 7% developed an anastomotic leakage. The two-year local recurrence rate was 5% (n = 5/104) with an estimated rate of 3% (95% CI 0-7%). Two-year disease-free survival was 85% (n = 88/104) and overall survival was 95% (n = 99/104).

Transanal completion total mesorectal excision following local excision for rectal cancer is oncologically safe, with low complication rates and high restorative rates.

Approximately 7% of patients with rectal cancer experience local recurrence within 5 years of curative surgery. A positive circumferential resection margin (CRM) is among the most significant risk factors. Other reported risk factors include histopathologic type, anastomotic leakage, positive distal margins, and more recently, the anterior localization of the tumor. In this retrospective cohort study, we aimed to assess risk factors for local recurrence in our institution, with a focus on tumor localization as an independent negative predictive factor.

From 2007 to 2018, all patients with stage II or III rectal cancer were included in this study. Patients underwent neoadjuvant chemoradiotherapy followed by surgical resection with total mesorectal excision. The tumor's anterior or posterior localization was assessed by preoperative endosonography or magnetic resonance imaging. Risk factors for local recurrence were assessed using univariate and multivariate regression analyses.

A total of 128 patients were included. The 3-year and 5-year local recurrence rates were 4.7% and 7%, respectively. In univariate and multivariate analyses, the histologic type of a poorly differentiated tumor (P=0.001) and a positive CRM (P=0.001) were correlated with local recurrence. Tumor localization (anterior or posterior) was not identified as a statistically significant factor associated with local recurrence.

Positive CRM and a poorly differentiated tumor histological subtype were found to be independent risk factors for local recurrence. In contrast to previous findings, anterior localization was not identified as an independent risk factor for local recurrence in our patient cohort.

Rectal eversion (RE) is a natural orifice specimen extraction (NOSE) method that allows anus-sparing resection in very low rectal tumors. This study aims to share the long-term results of RE in laparoscopic rectal resection performed with double stapling anastomosis.

A single-center retrospective cohort study was conducted for patients who underwent laparoscopic low anterior resection with RE. Age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, type of surgery, distance of the tumor to the dentate line, specimen extraction site, cancer stage, preoperative chemoradiotherapy, postoperative complications, and postoperative clinical follow-up findings were recorded. Incontinence was assessed using the Wexner score (WS). Low anterior resection syndrome (LARS) is determined by the LARS score. A 7-point Likert scale was used to evaluate the satisfaction of the patients.

A total of 17 patients underwent resection by RE for rectal tumors. Of the 11 patients included in the study, 4 were female and 7 were male. The mean age was 66.09±15.04 years. The mean follow-up was 64.18±16.83 months. The mean tumor diameter was 3.1 cm (range: 0.9 to 7.2 cm). The mean distance of the tumor from the dentate line was 2.7 cm (range: 1.2 to 5.6 cm). No anastomotic leak was observed in any patient. One patient had an anastomotic stenosis and was treated with balloon dilatation. The median LARS score was 16 (range 0 to 32) and 64% of the patients had no LARS. Two patients had minor LARS and 2 patients had major LARS. The median Wexner score was 3.5 (range 0 to 14). The median Likert scale was 7 (range 5 to 7). It was found that 55% of the patients were extremely satisfied, 18% were satisfied, and 27% were slightly satisfied with their surgery. There were no dissatisfied patients.

RE is a safe NOSE technique in laparoscopic double stapling anastomosis for rectal resection. There is a high level of long-term patient satisfaction with anus-sparing procedures via RE, even in the presence of various symptoms.

The standard treatment for locally advanced rectal cancer involves neoadjuvant chemoradiation followed by total mesorectal excision surgery. A subset of patients achieves pathologic complete response (pCR), representing the optimal treatment outcome. This study compares the long-term oncological outcomes of patients who achieved pCR with those who attained clinical complete response (cCR) after total neoadjuvant therapy, managed using a watch-and-wait approach.

This study retrospectively evaluated patients with mid-low locally advanced rectal cancer who underwent neoadjuvant treatment from January 1, 2005, to May 1, 2023. The pCR and cCR groups were compared based on demographic, clinical, histopathological, and long-term survival outcomes.

The median follow-up times were 54 months (range, 7-83 months) for the cCR group (n=73), 96 months (range, 7-215 months) for the pCR group (n=63), and 72 months (range, 4-212 months) for the pathological incomplete clinical response (pICR) group (n=627). In the cCR group, 15 patients (20.5%) experienced local regrowth, and 5 (6.8%) developed distant metastasis (DM). The pCR group had no cases of local recurrence, but 3 patients (4.8%) developed DM. Among the pICR patients, 58 (9.2%) experienced local recurrence, and 92 (14.6%) had DM. Five-year disease-free survival rates were 90.0% for cCR, 92.0% for pCR, and 69.5% for pICR (P=0.022). Five-year overall survival rates were 93.1% for cCR, 92.0% for pCR, and 78.1% for pICR. There were no significant differences in outcomes between the cCR and pCR groups (P=0.810); however, the pICR group exhibited poorer outcomes (P=0.002).

This study shows no significant long-term oncological differences between patients who exhibited cCR and those who experienced pCR.

Rectal cancer surgery remains a significant technical challenge. The development and implementation of a new technology offer hope for more accurate and precise surgery. To evaluate whether single-port robotic (SPr) technology helps achieve this goal, an international SPr registry was established. This study reported short-term clinical and oncologic outcomes from an international SPr registry for rectal cancer.

A review of a prospective international registry of SPr technology approved for colorectal surgery with an investigational design exemption was conducted. Patients with rectal adenocarcinoma who had resection for curative intent using the SPr platform between November 2018 and September 2022 were included. Frequency statistics described patient and tumor characteristics and intraoperative, oncologic, and clinical outcome variables. The main outcome measure was the quality of the total mesorectal excision (TME) specimen. The secondary outcome measures were intraoperative conversion and 30-day postoperative morbidity and mortality.

A total of 113 SPr procedures for rectal cancer were performed at 2 centers by 4 colorectal surgeons. Of note, 9 local excisions were excluded, leaving 104 cases analyzed. The cohort consisted of 53 men (50.96%), had a mean age of 60.00 years (SD, 11.29), and had a body mass index of 25.80 kg/m2 (SD, 6.18). The most common T stage was 3 (55 [52.8%]), followed by 2 (19 [18.26%]). More than 60% of patients had preoperative neoadjuvant chemoradiation. The mean tumor distance from the anorectal ring was 2.90 cm (SD, 2.62), and the mean tumor size was 4.52 cm (SD, 1.82). The procedures performed included transanal abdominal transanal/transanal TME (52 [46%]), low anterior resection (49 [43.3%]), and abdominoperineal resection (3 [2.7%]). The mean operating time was 168.0 min (SD, 56.9). There were no intraoperative complications and 2 (1.9%) conversions to laparoscopy. There was a median of 2 incisions, with a mean size of 2.30 cm (SD, 1.31). The TME specimens were complete in 101 cases (97.1%) and near complete in 3 cases (2.9%). The R1 rate was 3.8%, with 3 positive distal margins and 1 positive circumferential margin. Postoperatively, there were 15 total complications, of which 4 were major complications and 11 were minor complications. There were 2 readmissions (ileus and small bowel obstruction). There were no mortalities.

This early international experience with the SPr procedure showed that it is a safe and effective technique for distal rectal cancers, with excellent specimen quality. The complication and conversion rates observed with other techniques and platforms used in rectal cancer surgery were not demonstrated. An international registry was used to better understand the opportunities and limitations of SPr technology in rectal cancer surgery as the technology is adopted and applied more widely. Although structured training and controlled trials will be required to develop best practices and define the use of the SPr technology, initial international registry data are encouraging.

Early recurrence (ER) following surgery for rectal cancer is a significant factor impacting patient survival rates. Tsai et al identified age, preoperative neoadjuvant therapy, length of hospital stay, tumour location, and pathological stage as factors influencing the risk of ER. Postoperative monitoring for ER should encompass a thorough medical history review, physical examination, tumour marker testing, and imaging studies. Additionally, noninvasive circulating tumour cell DNA testing can be utilized to predict ER. Treatment strategies may involve radical surgery, radiation therapy, chemotherapy, and immunotherapy. Through a comprehensive analysis of risk factors, the optimization of monitoring methods, and the development of personalized treatment strategies, it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.

Organ preservation (OP) strategies are gaining interest in improving the quality of life in the management of rectal cancer, particularly for tumors located in the distal or middle rectum. The optimal OP protocol is still not standardized and relies on randomized trials. This review summarizes past and ongoing studies on OP protocols for adenocarcinoma of the distal and middle rectum.

We searched for articles and abstracts on randomized clinical trials investigating OP approaches for rectal cancer, including data presented at the LUCARRE Congress held in Nice on November 25, 2023, covering ongoing and recently published trials on rectal preservation.

Our review's findings are presented in four tables: the first evaluates key trials with overall survival (OS) as the primary endpoint; the second provides an overview of past Phase III trials; the third reviews Phase II/III trials that specifically focus on local excisions (LE); and finally, the fourth summarizes ongoing trials. Each table is accompanied by detailed comments elucidating the significance and implications of the presented data, alongside a review of current guidelines.

We highlight the growing interest in OP strategies for rectal cancer management to enhance patients' quality of life. Despite the lack of international consensus on the optimal OP protocol, past and ongoing randomized trials provide valuable findings into the evolving management strategies of rectal cancer treatment. The presented data supports the role of randomized phase III trials to provide evidence for a change in clinical practice.

Metastatic lateral pelvic lymph node (LPN) in rectal cancer has a significant clinical impact on the prognosis and treatment strategies. But there are still debates regarding prediction of lateral pelvic lymph node metastasis and its oncological impact. This review explores the evidence for predicting lateral pelvic lymph node metastasis and survival in locally advanced rectal cancer. Until now many studies have reported that magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) are considered as essential tools for predicting metastatic LPN, with MRI-based size criteria, particularly the short-axis diameter of LPN. But several studies have reported that the addition of tumor location or artificial intelligence (AI) can further enhance diagnostic accuracy. Western practices focus more on neoadjuvant chemoradiation (nCRT), while Eastern countries focus more on lateral pelvic lymph node dissection (LPND). LPND has been shown to reduce lateral local recurrence (LLR) rates compared to total mesorectal excision (TME) alone, particularly in patients with enlarged LPNs, but its impact on overall survival is uncertain. The decision to perform LPND should be individualized according to LPN size and response to nCRT; and through selective LPND based on those criteria, patients could achieve a balance between the benefit of local control and the risk of surgical complications from LPND, such as sexual and urinary dysfunction.

At the end of the past century, the introduction of Total Mesorectal Excision (TME), preceded by either short-course radiotherapy (SCRT) or chemoradiation (CRT), established the new standard of care for locally advanced rectal cancer (LARC). Recently, significant advancements were achieved for both dMMR/MSI and pMMR/MSS LARC patients. For the 2-3% of dMMR/MSI LARCs, ablative immunotherapy emerged as a curative approach, offering the possibility of avoiding chemotherapy (CT), radiotherapy, and surgery altogether. In pMMR/MSS LARCs, the intensification of preoperative treatments with Total Neoadjuvant Treatment (TNT) afforded three outcomes: (a) a reduction of distant metastases, positively impacting on survival endpoints, (b) a significant increase of complete clinical response (cCR) rate, paving the way for non-operative management (NOM), and (c) the selective omission of radiotherapy following induction CT. The choice of the most appropriate therapeutic strategy can only be made through the shared decision-making process between physician and patient based on risk stratification and patient preferences.

Objectives: Despite optimal local control obtained with neoadjuvant chemoradiotherapy (CRT), data on overall survival (OS) and disease-free survival (DFS) of local advanced rectal cancer patients are still equivocal. This meta-analysis aimed to estimate the pathological complete response (pCR), regression rate, DFS, and OS probabilities of rectal cancer patients treated with a second chemotherapy drug added to fluoropyrimidine and long-term radiotherapy. Methods: Computerized bibliographic searches of MEDLINE, PUBMED, Web of Science and the Cochrane Central Register of Controlled Trials databases (1970-2023) were supplemented with hand searches of reference lists. Studies were included if they were randomised controlled trials (RCTs) comparing intensified chemotherapy with CRT to preoperative CRT and if they had patients with resectable, histologically proven rectal adenocarcinoma without metastases. Results: Eighteen RCTs (7695 patients) were analysed. Data on population, intervention, and outcomes were extracted from each RCT, following the intention-to-treat method, by three independent observers and combined using the DerSimonian and Laird methods. A chemotherapy with two drug and long-term radiotherapy CRT, compared to preoperative CRT (fluoropyrimidine and long-term radiotherapy), significantly increases the rate of pathological complete response (OR 1.37 (95% CI, 1.16-1.63) p = 0.0003) and the regression rate (OR 1.57 (95% CI, 1.16-2.14) p < 0.00001). Furthermore, it increases DFS (HR 0.87 (95% CI, 0.79 to 0.95) p = 0.002 and OS HR 0.84 (95% CI, 0.74 to 0.95) p = 0.007). The risk of severe adverse events (≥G3) is increased OR 1.96 (95% CI 1.35-2.85), p = 0.0005. Conclusions: In patients with resectable rectal cancer, intensified chemotherapy can reduce by 13% the risk of disease progression and by 16% the risk of death.

This study aims to evaluate the clinical efficacy and functional outcomes of DA Vinci (Xi)-assisted surgery compared to conventional laparoscopic surgery for middle and low rectal cancer, focusing on oncologic cure and functional preservation.

Between December 2020 and June 2021, 102 patients with middle and low rectal cancer (tumour lower margin ≤10 cm) were enrolled at the affiliated Hospital of Xuzhou Medical University. Participants were divided into two groups: robot-assisted (n = 51) and laparoscopy-assisted (n = 51). Each group underwent a radical resection using their assigned method. Clinical and functional outcomes were analysed post-surgery.

Preoperative data did not differ significantly between groups (P > 0.05). All surgeries were successfully completed without conversion to open surgery. The robotic group experienced significantly less intraoperative blood loss (55.2 ± 29.8 mL vs. 109.5 ± 58.5 mL) and faster recovery in gastrointestinal function (35.1 ± 9.4 h vs. 40.7 ± 1.9 h), diet recovery (2.1 ± 0.8 days vs. 2.9 ± 0.4 days), and catheter removal (2.9 ± 2.7 days vs. 5.3 ± 2.1 days). The robotic group also dissected more lymph nodes (23 ± 6 vs. 15 ± 4). However, they had longer operative times (239.8 ± 29.6 min vs. 141.1 ± 18.5 min) and higher hospital costs. Satisfaction levels regarding defecation, voiding, and sexual functions were notably higher in the robotic group.

No significant differences in surgical safety or immediate postoperative outcomes were observed between robotic and laparoscopic approaches. However, robotic surgery demonstrated superior lymph node dissection, anal function preservation, and gastrointestinal recovery, enhancing overall functional outcomes.

While total mesorectal excision is the gold standard for rectal cancer, the optimal surgical approach to achieve adequate oncological outcomes remains controversial. This network meta-analysis aims to compare the histopathological outcomes of robotic (R-RR), transanal (Ta-RR), laparoscopic (L-RR), and open (O-RR) resections for rectal cancer.

MEDLINE, Embase, and the Cochrane Library were screened from inception to June 2024. Of the 4186 articles screened, 27 RCTs were selected. Pairwise comparisons and Bayesian network meta-analyses applying random effects models were performed.

The 27 RCTs included a total of 8696 patients. Bayesian pairwise meta-analysis revealed significantly lower odds of non-complete mesorectal excision with Ta-RR (Odds Ratio, OR, 0.60; 95%CI, 0.33, 0.92; P = .02; I2:11.7 %) and R-RR (OR, 0.68; 95%CI, 0.46, 0.94; P = .02; I2:41.7 %) compared with laparoscopy. Moreover, lower odds of positive CRMs were observed in the Ta-RR group than in the L-RR group (OR, 0.36; 95%CI, 0.13, 0.91; P = .02; I2:43.9 %). The R-RR was associated with more lymph nodes harvested compared with L-RR (Mean Difference, MD, 1.24; 95%CI, 0.10, 2.52; P = .03; I2:77.3 %). Conversely, Ta-RR was associated with a significantly lower number of lymph nodes harvested compared with all other approaches. SUCRA plots revealed that Ta-RR had the highest probability of being the best approach to achieve a complete mesorectal excision and negative CRM, followed by R-RR, which ranked the best in lymph nodes retrieved.

When comparing the effectiveness of the available surgical approaches for rectal cancer resection, Ta-RR and R-RR are associated with better histopathological outcomes than L-RR.

To some extent, the robotic technique does offer certain benefits in rectal cancer surgery than laparoscopic one, while remains a topic of ongoing debate for rectal cancer patients who have undergone neoadjuvant chemoradiotherapy (NCRT).

Potential studies published until January 2024 were obtained from Web of Science, Cochrane Library, Embase, and PubMed. Dichotomous and continuous variables were expressed as odds ratios (ORs) or weighted mean differences (WMDs) with 95% CIs, respectively. A random effects model was used if the I2 statistic >50%; otherwise, a fixed effects model was used.

Eleven studies involving 1079 patients were analysed. The robotic-assisted group had an 0.4 cm shorter distance from the anal verge (95% CI: -0.680 to -0.114, P =0.006) and 1.94 times higher complete total mesorectal excision (TME) rate (OR=1.936, 95% CI: 1.061-3.532, P =0.031). However, the operation time in the robotic-assisted group was 54 min longer (95% CI: 20.489-87.037, P =0.002) than the laparoscopic group. In addition, the robotic-assisted group had a lower open conversion rate (OR=0.324, 95% CI: 0.129-0.816, P =0.017) and a shorter length of hospital stay (WMD=-1.127, 95% CI: -2.071 to -0.184, P =0.019).

Robot-assisted surgery offered several advantages over laparoscopic surgery for locally advanced mid-low rectal cancer following NCRT in terms of resection of lower tumours with improved TME completeness, lower open conversion rate, and shorter hospital stay, despite the longer operative time.

Surveillance of rectal cancer recurrence in patients with negative pretreatment carcinoembryonic antigen (CEA) is challenging. This study aimed to develop the magnetic resonance imaging (MRI)-based radiomics models to predict rectal cancer recurrence in CEA-negative patients.

This retrospective multicenter study consecutively enrolled rectal cancer patients with negative pretreatment CEA diagnosed between November 2012 and November 2018 from three medical centers. Radiomics features were extracted from the volume of interest on T2-weighted and diffusion-weighted images. Inter-class correlation coefficient (ICC) analysis, univariate Cox and least absolute shrinkage and selection operator (LASSO) Cox regression were then used to select features and construct a radiomics signature (RS). Multivariable Cox regression analysis was applied to develop two prediction models for disease-free survival (DFS) by incorporating the RS and independent clinicopathological predictors. The Kaplan-Meier method stratified tumor recurrence risk, and model performance was assessed using the Harrell concordance index (C-index).

A total of 600 rectal cancer patients were assigned to the development cohort (n = 358), internal test cohort (n = 120) and external test cohort (n = 122). The combination of ICC, univariate and LASSO Cox regression resulted in the selection of 25 radiomics features that comprise the RS. The RS can significantly stratify high-risk and low-risk patients (development: HR = 6.63, internal test: HR = 4.76, external test: HR = 4.62, all p < 0.05) and achieved good predictive performance (C-index = 0.720-0.758). The All-Clin+Rad model constructed by integrating RS and clinicopathological predictors showed superior performance with a C-index of 0.775 (95 % confidence interval [CI], 0.723-0.827), 0.739 (95 %CI, 0.654-0.823), and 0.822 (95 %CI, 0.720-0.924) in the development, internal test, and external test cohorts, respectively.

The radiomics signature notably enhanced the prediction of tumor recurrence in rectal cancer patients with negative pretreatment CEA, assisting clinicians in making personalized follow-up plans.

The use of robotic surgery is increasing significantly. Specific training is fundamental to achieve high quality and better oncological outcomes. This work defines key exposure techniques in robotic total mesorectal excision (TME). Based on a modular approach, macro- and microtractions for exposure in every step of a robotic TME are identified and described. The aim is to develop a step-by-step technical guide of the exposure techniques for a robotic TME.

Twenty-five videos of robotic rectal resections performed at Champalimaud Foundation (Lisbon, Portugal) with the Da Vinci™ Xi robotic platform were examined. Robotic TME was divided into modules and steps. Modules are essential phases of the procedure. Steps are exposure moments of each module. Tractions are classified as macro- and microtractions. Macrotraction is the grasping of a structure to expose an area of dissection. Microtraction consists in the dynamic grip of tissue to optimize macrotraction in a defined area of dissection.

The procedure videos reviewed showed homogeneity concerning surgical methodology. Eight modules are outlined: abdominal cavity inspection and exposure, approach to and ligation of the inferior mesenteric vessels, medial to lateral dissection of the mesocolon, lateral colon mobilization, splenic flexure takedown, proctectomy with TME, rectal transection, and anastomosis. Each module was divided into steps, with a total of 45 steps for the entire procedure. This manuscript characterizes macrotraction and microtraction fine-tuning, detailing the large-scale macrotractions and the precision of microtractions at each step.

Tissue exposure techniques in robotic TME are key to precise dissection. This modular guide provides a functional system to reproduce this procedure safely; the addition of the exposure techniques could serve as a training method for robotic rectal cancer surgery.

The debate regarding the two possible roles of lymphadenectomy in surgical oncology, prognostic or therapeutic, is still ongoing. Furthermore, the use of lymphadenectomy as a proxy for the quality of the surgical procedure is another feature of discussion. Nevertheless, this reckoning depends on patient conditions, aggressiveness of the tumor, the surgeon, and the pathologist, and then it is not an absolute surrogate for the surgical quality. The international guidelines recommend a minimum of 12 lymph nodes harvested for pathological examination in colorectal cancer (CRC) surgery. There is a growing literature on reporting better survival when the lymph node yield is high, even when these nodes are negative for malignancy. On the other hand, there are studies reporting no survival benefit with high lymph node yield in stage I-II of CRC. Herein we review the roles of the lymphadenectomy in CRC, and discuss the results of studies on lymph node harvesting.

This manuscript focused on the surgical challenge of urinary and sexual dysfunction after rectal cancer surgery based on the interesting results demonstrated by the observational study of Chen et al, which was published in the World Journal of Gastrointestinal Surgery. Urinary dysfunction occurs in one-third of patients treated for rectal cancer. Surgical nerve damage is the main cause of urinary dysfunction. Radiotherapy seems to exacerbate sexual dysfunction. The role of Denonvilliers' fascia preservation vs resection when performing total mesorectal excision (TME), the impact of robotic and transanal TME, alternatives to open and laparoscopic TME, as well as intraoperative pelvic neuromonitoring are discussed in this report. In conclusion, exact knowledge of the highly complex pelvic neuroanatomy and the use of novel surgical techniques can lead to a reduction in urinary and sexual dysfunction after rectal cancer surgery.

Rectal cancer robotic surgery is becoming more and more common, but evidence for predicting surgical difficulty is scarce. Our goal was to look at the elements that influence the complexity of robot-assisted total mesorectal excision (R-TME) in the medical care of middle and low rectal cancer as well as to establish and validate a predictive model on the basis of these factors. Within this multicenter retrospective investigation, 166 consecutive patients receiving R-TME between January 2021 and December 2022 with middle and low rectal cancer were included and categorized according to the median operation time. A nomogram was created to forecast the procedure's complexity after variables that could affect its difficulty were found using logistic regression analysis. Using R software, a total of 166 patients were randomly split into two groups: a test group (48 patients) and a training group (118 patients) at a ratio of 7 to 3. The median operation time of all patients was 207.5 min; patients whose operation time was ≥ 207.5 min were allocated to the difficult surgery group (83 patients), and patients whose operation time was < 207.5 min were allocated to the nondifficult surgery group. Multivariate analysis revealed that body mass index (BMI), the gap between the tumor and the anal verge and the posterior rectal mesenteric thickness were independent predictors of surgical duration. A clinical predictive model was created and assessed employing the above independent predictors. The results of the receiver operating characteristic (ROC) analysis revealed the adequate discriminative ability of the predictive model. Our study revealed that it is feasible to predict surgical difficulty by obtaining clinical and magnetic resonance parameters for imaging (the gap between the anal verge and the tumour, and posterior mesorectal thickness), and these predictions could be useful in making clinical decisions.

The management of locally advanced rectal cancer has changed drastically in the last few decades due to improved surgical techniques, development of multimodal treatment approaches and the introduction of a watch and wait (WW) strategy. For patients with a complete response to neoadjuvant treatment, WW offers an opportunity to avoid the morbidity associated with total mesorectal excision in favor of organ preservation. Despite growing interest in WW, prospective data on the safety and efficacy of nonoperative management are limited. Challenges remain in optimizing multimodal treatment regimens to maximize tumor regression and in improving the accuracy of patient selection for WW. This review summarizes the history of treatment for rectal cancer and the development of a WW strategy. It also provides an overview of clinical considerations for patients interested in nonoperative management, including restaging strategies, WW selection criteria, surveillance protocols and long-term oncologic outcomes.

The aim of this work is to report actual overall survival (AOS) at 5 and 10 years after multimodal treatment for locally recurrent rectal or sigmoid cancer (LRRC) and the importance of local re-recurrence (reLRRC) and distant metastases for AOS.

All patients resected for LRRC at a single centre between years 1990 and 2007 were included. Resections were based on images taken after neoadjuvant treatment. Patients were prospectively followed up for 5 years. After a minimum of 10 years, the records of referring hospitals were analysed.

A total of 224 patients underwent resection. At 5 and 10 years 33% and 17%, respectively, had survived. Median survival was 38 months [interquartile range (IQR) 62 months]. Patients with complete resections had 5- and 10-year survival of 56% and 28%, respectively, versus 22% and 11% for those with microscopic remaining tumour; none with macroscopic remains survived beyond 4 years. Median survival was 71 months (IQR 106 months), 33 months (IQR 35 months) and 15 months (IQR 17 months), respectively. With a median survival of 123 months (IQR 80 months), the 54 patients without recurrence had 5- and 10-year survival of 69% and 59%, respectively. The independent predictor of survival was R-stage. Of the 197 patients who had radical resection, 83 developed reLRRC and 108 distant metastases. ReLRRC appeared at a median of 18 months (IQR 21 months) and distant metastases at 12 months (IQR 21 months). Lung metastases were the most common form of distant disease.

More than 5 years postoperatively the mortality from cancer was substantial. Most metastases appeared not to be secondary to reLRRC. Planning surgery from pretreatment images might reduce reLRRC.

Colorectal cancer (CRC) is a neoplasm with a high prevalence worldwide, with a multimodal treatment that includes a combination of chemotherapy, radiotherapy, and surgery in locally advanced stages with acceptable pathological complete response (pCR) rates, this has improved with the introduction of total neoadjuvant therapy (TNT) reaching pCR rates up to 37% in compare with classic neoadjuvant treatment (NAT) where pCR rates of around 20-25% are achieved. However, the patient population that benefits most from this therapy has not been determined, and there is a lack of biomarkers that can predict the course of the disease. Multiple biomarkers have been studied, ranging from hematological and molecular markers by imaging technique and combinations of them, with contradictory results that prevent their use in routine clinical practice. In this review, we evaluate the most robust prognostic biomarkers to be used in clinical practice, highlighting their advantages and disadvantages and emphasizing biomarker combinations and their predictive value.

Objective: The aim of our study was to assess the learning curve of robotic assisted low anterior resection with diverting loop ileostomy (LARDLI) for low and mid rectal cancer performed by novice in robotic-assisted surgery colorectal surgeon in a public hospital with limited access to the robotic platform. Methods: A retrospective analysis of all low and mid rectal cancer robotic-assisted operations was conducted. All procedures were performed by a single surgeon with a once per week access to the Da Vinci® Si™ Surgical System, Intuitive Surgical Inc. Demographic, clinical, and pathological data were reviewed. The cumulative sum (CUSUM) analysis was utilized to analyze learning curve for operative time. Results: A total of 107 consecutive patients who underwent LARDLI for lower and mid rectal cancer between November 2011 and July 2020 were included in the analysis. The median patients' age was 65 (range, 32-85) years, 72% were males (n = 77), and 91% (n = 97) received neoadjuvant therapy. Median operative time was 295.5 (range, 180-551) minutes. The conversion rate was 3.7% (n = 4). Median length of hospital stay was 6 (range, 1-41) days. There were 35 (32.7%) postoperative complications, of these 7 (6.5%) were major complications (≥Grade 3, according to the Clavien-Dindo classification). There was only one intraoperative complication (.9%). CUSUM analysis showed that the learning curve was 49 cases to achieve a plateau. Conclusions: The learning curve of robotic assisted low anterior resection for lower and mid rectal cancer for a novice in robotic surgery colorectal surgeon with limited access to the robotic platform is 49 cases. Surgeon and operative team dedication, alongside sufficient hospital support, may lower the number of cases of the learning curve.

The present study aimed to compare the effectiveness of two abbreviated magnetic resonance imaging (MRI) protocols in assessing the response to neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. Data from the examinations of 62 patients with rectal cancer who underwent neoadjuvant CRT and standard contrast-enhanced rectal MRI were retrospectively evaluated. Standard contrast-enhanced T2-weighted imaging (T2-WI), post-contrast T1-weighted imaging (T1-WI) and diffusion-weighted imaging (DWI) MRI, as well as two abbreviated protocols derived from these images, namely protocol AB1 (T2-WI and DWI) and protocol AB2 (post-contrast fat-suppressed (FS) T1-WI and DWI), were assessed. Measurements of lesion length and width, lymph node short-axis length, tumor staging, circumferential resection margin (CRM), presence of extramural venous invasion (EMVI), luminal mucin accumulation (MAIN), mucinous response, mesorectal fascia (MRF) involvement, and MRI-based tumor regression grade (mrTRG) were obtained. The reliability and compatibility of the AB1 and AB2 protocols in the evaluation of tumor response were analyzed. The imaging performed according to the AB1 and AB2 protocols revealed significant decreases in lesion length, width and lymph node size after CRT. These protocols also showed reductions in lymph node positivity, CRM, MRF, EMVI.Furthermore, both protocols were found to be reliable in determining lesion length and width. Additionally, compliance was observed between the protocols in determining lymph node size and positivity, CRM involvement, and EMVI after CRT. In conclusion, the use of abbreviated MRI protocols, specifically T2-WI with DWI sequences or post-contrast FS T1-WI with DWI sequences, is effective for evaluating tumor response in patients with rectal cancer following neoadjuvant CRT. The AB protocols examined in this study yielded similar results in terms of lesion length and width, lymph node positivity, CRM involvement, EMVI, MAIN, and MRF involvement.

Complete mesocolic excision (CME) is widely adopted for its assumed superior oncological outcome. However, it's unclear if all right-sided colon cancer patients benefit from CME. The aim of this systematic review is to investigate whether CME contributes to postoperative outcomes and to determine the surgical indications for CME.

We searched eligible articles about CME versus non-CME procedures for right-sided colon cancer in the OVID Medline, Embase, and Cochrane CENTRAL databases, and a meta-analysis was conducted.

Twenty-two articles and seven abstracts involving 8088 patients were included in this study. Among them, 3803 underwent CME and 4285 non-CME procedures. The analysis showed that CME was favoured for three-year disease-free survival (DFS) and overall survival (OS), for local, systemic, and total recurrence, and for hospital stay durations. However, increased vascular injury and longer surgery time were observed in CME. Regarding the three-year OS, the superiority of CME was observed only in Stage III. Additionally, no significant differences were observed between CME and non-CME groups regarding overall complications, 30-day readmission rates, reoperation, or postoperative mortality rates.

CME for right-sided colon cancer should be considered, particularly in Stage III patients, to contribute to improved oncological outcomes. However, careful attention must be paid to the increased risk of vascular injury.