Resection Of Colon Cancer Research Articles

A narrative review: complete mesocolic excision in right-sided colonic cancer resections—present paradigm and future directions

A narrative review: complete mesocolic excision in right-sided colonic cancer resections—present paradigm and future directions

Racial disparities in complications following elective colon cancer resection: Impact of laparoscopic versus robotic approaches

BackgroundWe sought to examine differences in outcomes for Black and White patients undergoing robotic or laparoscopic colectomy to assess the potential impact of technological advancement. MethodsWe queried the ACS-NSQIP database for elective robotic (RC) and laparoscopic (LC) colectomy for cancer from 2012 to 2020. Outcomes included 30-day mortality and complications. We analyzed the association between outcomes, operative approach, and race using multivariable logistic regression. ResultsWe identified 64,460 patients, 80.9% laparoscopic and 19.1% robotic. RC patients were most frequently younger, male, and White, with fewer comorbidities (P ​< ​0.001). After adjustment, there was no difference in mortality by approach or race. Black patients who underwent LC had higher complications (OR 1.10, 95% CI 1.03–1.08, P ​= ​0.005) than their White LC counterparts and RC patients. ConclusionsRobotic colectomy was associated with lower rates of complications in minority patients. Further investigation is required to identify the causal pathway that leads to our finding.

Predictive modeling based on tumor spectral CT parameters and clinical features for postoperative complications in patients undergoing colon resection for cancer

BackgroundColon cancer is a particularly prevalent malignancy that produces postoperative complications (POCs). However, limited imaging modality exists on the accurate diagnosis of POCs. The purpose of this study was therefore to construct a model combining tumor spectral CT parameters and clinical features to predict POCs before surgery in colon cancer.MethodsThis retrospective study included 85 patients who had preoperative abdominal spectral CT scans and underwent radical colon cancer resection at our institution. The patients were divided into two groups based on the absence (no complication/grade I) or presence (grades II–V) of POCs according to the Clavien-Dindo grading system. The visceral fat areas (VFA) of patients were semi-automatically outlined and calculated on L3-level CT images using ImageJ software. Clinical features and tumor spectral CT parameters were statistically compared between the two groups. A combined model of spectral CT parameters and clinical features was established by stepwise regression to predict POCs in colon cancer. The diagnostic performance of the model was evaluated using the receiver operating characteristic (ROC) curve, including area under the curve (AUC), sensitivity, and specificity.ResultsTwenty-seven patients with POCs and 58 patients without POCs were included in this study. MonoE40keV-VP and VFA were independent predictors of POCs. The combined model based on predictors yielded an AUC of 0.84 (95% CI: 0.74–0.91), with a sensitivity of 77.8% and specificity of 87.9%.ConclusionsThe model combining MonoE40keV-VP and VFA can predict POCs before surgery in colon cancer and provide a basis for individualized management plans.Critical relevance statementThe model combining MonoE40keV-VP and visceral fat area can predict postoperative complications before surgery in colon cancer and provide a basis for individualized management plans.Key points• Visceral fat area and MonoE40keV-VP were independent predictors of postoperative complications in colon cancer.• The combined model yielded a high AUC, sensitivity, and specificity in predicting postoperative complications.• The combined model was superior to the single visceral fat area or MonoE40keV-VP in predicting postoperative complications.Graphical

Deep learning to predict lymph node status on pre-operative staging CT in patients with colon cancer.

Lymph node (LN) metastases are an important determinant of survival in patients with colon cancer, but remain difficult to accurately diagnose on preoperative imaging. This study aimed to develop and evaluate a deep learning model to predict LN status on preoperative staging CT. In this ambispective diagnostic study, a deep learning model using a ResNet-50 framework was developed to predict LN status based on preoperative staging CT. Patients with a preoperative staging abdominopelvic CT whounderwent surgical resection for colon cancer were enrolled. Data were retrospectively collected from February 2007 to October 2019 and randomly separated into training, validation, and testing cohort 1. To prospectively test the deep learning model, data for testing cohort 2 was collected from October 2019 to July 2021. Diagnostic performance measures were assessed by the AUROC. A total of 1,201 patients (median [range] age, 72 [28-98 years]; 653 [54.4%] male) fulfilled the eligibility criteria and were included in the training (n = 401), validation (n = 100), testing cohort 1 (n = 500) and testing cohort 2 (n = 200). The deep learning model achieved an AUROC of 0.619 (95% CI 0.507-0.731) in the validation cohort. In testing cohort 1 and testing cohort 2, the AUROC was 0.542 (95% CI 0.489-0.595) and 0.486 (95% CI 0.403-0.568), respectively. A deep learning model based on a ResNet-50 framework does not predict LN status on preoperative staging CT in patients with colon cancer.

Secondary Localization of Colic Adenocarcinoma in the Abdominal Wall: About A Case

Parietal recurrences of colorectal cancer (CRC) are rare, and usually associated with intra-abdominal dissemination. Recurrences of colic ADK of the abdominal wall are isolated in about 10% of cases. Their natural history is poorly known but their occurrence may be late in the course of the disease. Parietal recurrences are painful and debilitating. When isolated, their curative resectability depends on their volume and the possibilities of parietal reconstruction. The aim of this study was to report the observation of a large metastatic mass of the abdominal wall, occurring 37 months after colonic resection for cancer of the right colon.

Time to recurrence and its relation to survival after recurrence in patients resected for stage III colon cancer

BackgroundIt is intuitively thought that early relapse is associated with poor survival after recurrence (SAR) in resected colon cancer (CC) patients, but this has never been formally studied. MethodsWe pooled data from stage III patients treated with oxaliplatin-based adjuvant therapy in two phase III trials, to analyse time to recurrence (TTR) and its relationship with SAR. TTR and SAR were also studied according to molecular status (mismatch repair (MMR), RAS, and BRAFV600E). Early relapsing patients were defined as patients having a TTR event within 12 months after starting adjuvant chemotherapy. Results4548 stage III CC patients were included in the present analysis. Deficient MMR (dMMR) CC patients experienced fewer recurrences than proficient (p)MMR CC patients (18.8% versus 27.6%) but had a significantly shorter median TTR (mTTR; 0.74 versus 1.40 years, p < 0.0001). In pMMR patients, BRAF and RAS mutations were also associated with earlier mTTR as compared to double wild-type (WT) patients (0.99 versus 1.38 versus 1.54 years, respectively, p < 0.0001). Early recurrence occurred in 397 patients and was associated with a median SAR (2.2 versus 3.3 years, p = 0.0007). However, this association was mainly due to pMMR/RAS and BRAFV600E mutated tumours and was not confirmed in dMMR and pMMR/double WT subgroups. ConclusionIn resected stage III CC treated with standard oxaliplatin-based adjuvant therapy, TTR varies between dMMR, pMMR/RAS, or BRAFV600E mutated and pMMR/double WT tumours. In addition, early relapse is associated with poor survival, mainly due to patients resected for a pMMR/RAS or BRAFV600E mutated tumour.

Colonic Resection, Stoma, or Self-expanding Metal Stents for Obstructive Left Colon Cancer: the CROSCO-1 study protocol.

Colorectal cancer (CRC) is one of the most common cancers worldwide. There are several causes of a mechanical left bowel obstructive but CRC accounts for approximately 50% of cases and in 10-30% of whom it is the presenting syndrome. In most cases, the left colon is involved. At present, the range of therapeutic alternatives in the management of obstructive left CRC in emergency conditions (primary resection vs. staged resection with applied self-expanding metallic stents) is broad, whereas internationally validated clinical recommendations in each condition are still lacking. This enormous variability affects the scientific evidence on both the immediate and long-term surgical and oncological outcomes. CROSCO-1 (Colonic Resection, Stoma or Self-expanding Metal Stents for Obstructive Left Colon Cancer) study is a national, multi-center, prospective observational study intending to compare the clinical results of all these therapeutic regimens in a cohort of patients treated for obstructive left-sided CRC. The primary aim of the CROSCO-1 study is the 1-year stoma rate of patients undergoing primary emergency surgical resection (Hartmann procedure or primary resection and anastomosis) compared with patients undergoing staged resection. Secondary outcomes are 30-day and 90-day major morbidity and mortality, 1-year quality of life and the timing of chemotherapy initiation in the two groups. Future CROSCO studies will follow in which, instead, we will evaluate the long-term oncological outcomes of the two treatment strategies. The results of a large prospective cohort study which will analyze what really happens in the common clinical practice of managing patients with obstructive left CRC will have the aim of understanding which is the best strategy in terms of surgical and oncological outcomes. Indeed, the CROSCO-1 study will analyze the early surgical outcomes for patients with obstructed left CRC. Future CROSCO studies will follow in which, instead, we will evaluate the long-term oncological outcomes of the two treatment strategies.

Lymph node metastases detection in Whole Slide Images using prototypical patterns and transformer-guided multiple instance learning

Abstract Background: The examination of lymph nodes (LNs) regarding metastases is vital for the staging of cancer patients, which is necessary for diagnosis and adequate treatment selection. Advancements in digital pathology, utilizing Whole-Slide Images (WSIs) and convolutional neural networks (CNNs), pose new opportunities to automate this procedure, thus reducing pathologists’ workload while simultaneously increasing the accuracy in metastases detection. Objective: To address the task of LN-metastases detection, the use of weakly supervised transformers are applied for the analysis of WSIs. Methods &amp; Materials: As WSIs are too large to be processed as a whole, they are divided into non-overlapping patches, which are converted to feature vectors using a CNN network, pre-trained on HE-stained colon cancer resections. A subset of these patches serves as input for a transformer to predict if a LN contains a metastasis. Hence, selecting a representative subset is an important part of the pipeline. Hereby, a prototype based clustering is employed and different sampling strategies are tested. Finally, the chosen feature vectors are fed into a transformer-based multiple instance learning (MIL) architecture, classifying the LNs into healthy/negative (that is, containing no metastases), or metastatic/positive (that is, containing metastases). The proposed model is trained only on the Camelyon16 training data (LNs from breast cancer patients), and evaluated on the Camelyon16 test set. Results: The trained model achieves accuracies of up to 92.3% on the test data (from breast LNs). While the model struggles with smaller metastases, high specificities of up to 96.9% can be accomplished. Additionally, the model is evaluated on LNs from a different primary tumor (colon), where accuracies between 62.3% and 95.9% could be obtained. Conclusion: The investigated transformer-model performs very good on LN data from the public LN breast data, but the domain transfer to LNs from the colon needs more research.

Early-stage sigmoid colon cancer resection followed by liver metastasis recurrence 1 year later and mesenteric recurrence more than 5 years later: a case report

BackgroundEarly-stage colorectal cancer (CRC) is often treated endoscopically, but additional surgical resection may be considered depending on pathological findings.Case presentationA 73-year-old man was found to have early-stage sigmoid colon cancer by colonoscopy during a medical examination, and endoscopic mucosal resection (EMR) was performed. The lesion was a 7-mm-sized sessile polyp, and the pathological diagnosis was well-differentiated tubular adenocarcinoma, pT1 (submucosal invasion of 400 μm), with no lymphovascular invasion, low budding grade, and negative horizontal and vertical margins. Therefore, the patient was observed without postoperative treatment. One year later, a computed tomography (CT) scan showed multiple liver metastases. After five courses of preoperative chemotherapy with folinic acid, 5-fluorouracil and oxaliplatin (FOLFOX) and panitumumab, liver metastases were reduced. The patient underwent extended right hepatic lobectomy. The pathological finding was well-to-moderately differentiated tubular adenocarcinoma, and immunohistochemistry findings were consistent with liver metastases from sigmoid colon cancer. Postoperatively, the patient received five courses adjuvant chemotherapy with FOLFOX. Although the patient had been recurrence-free for 5 years after liver resection, a CT scan revealed a nodular lesion in the sigmoid mesentery. Positron emission tomography (PET) showed abnormal accumulation in the same lesion. Therefore, the mesenteric nodules diagnosed as lymph metastasis and recurrence of sigmoid colon cancer and performed laparoscopic sigmoid colon resection with lymph node dissection. The pathological findings showed that the recurrent lesion in the mesentery formed a nodular infiltrate with venous, lymphatic, and neural invasion, but lymph node structures were not found, and it was assumed to be metastasis or recurrence due to lymphovascular invasion. The pathologic specimen of the sigmoid colon had no neoplastic lesions, which are considered to be a local recurrence on the mucosal surface. After sigmoid colectomy, adjuvant chemotherapy with CapeOX was conducted, and the patient has been recurrence-free for 13 months at present.ConclusionEven early-stage CRCs that have no pathological indications for additional resection have risks of metastases and recurrences, and we may need to consider that the criteria for additional resection should not be limited to pathological findings alone.

The topographical distribution of lymph node metastases in colon cancer resections

In accordance with international guidelines all lymph nodes in colon cancer specimens must be examined to obtain accurate staging. This study aimed to determine the topographical location of lymph node metastases and evaluate if a more limited sampling approach could be an alternative. Partial colectomies received at the Department of Pathology, Zealand University Hospital during a six-month period were included. At the macroscopic examination, each specimen was divided into three different segments: a segment containing the index tumor and the tumor-feeding artery, an oral and an anal segment. The number of lymph nodes and lymph node metastases were registered separately for each segment. Resections from 93 patients were included. Of 2466 lymph nodes, 1839 (74.6 %) were located in the tumor segment, 308 (12.5 %) in the oral, and 319 (12.9 %) in the anal segment, respectively. In 133 (5,4 %) lymph nodes a metastasis was present. Of these 129 (97.0 %) were located in the tumor segment, one (0.8 %) in the oral segment, and three (2.3 %) in the anal segment. No patients had metastasis in the oral or anal segments without metastases also being present in the tumor segment leading to consideration of the need for lymph node harvest of the complete specimen upon initial examination. As such, the segment containing the index tumor and tumor-feeding artery could be regarded as a sentinel segment indicating a potential need for lymph node dissection in the oral and anal segments.

Association of Minority-Serving Hospital Status with Post-Discharge Care Utilization and Expenditures in Gastrointestinal Cancer.

Disparities in utilization of post-discharge care and overall expenditures may relate to site of care and race/ethnicity. We sought to define the impact of minority-serving hospitals (MSHs) on postoperative outcomes, discharge disposition, and overall expenditures associated with an episode of surgical care. Patients who underwent resection for esophageal, colon, rectal, pancreatic, and liver cancer were identified from Medicare Standard Analytic Files (2013-2017). A MSH was defined as the top decile of facilities treating minority patients (Black and/or Hispanic). Theimpactof MSH on outcomes of interest was analyzed using multivariable logistic regression and generalized linear regression models. Textbook outcome (TO) was defined as no postoperative complications, no prolonged length of stay, and no 90-day mortality or readmission. Among 113,263 patients, only a small subset of patientsunderwent surgery at MSHs (n=4404, 3.9%). While 52.3% of patients achieved TO, rates were lower at MSHs (MSH: 47.2% vs. non-MSH: 52.5%; p<0.001). On multivariable analysis, receiving care at an MSH was associated with not achieving TO (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.76-0.87) and concomitantly higher odds of additional post-discharge care (OR 1.10, 95% CI 1.01-1.20). Patients treated at an MSH also had higher median post-discharge expenditures (MSH: $8400, interquartile range [IQR] $2300-$22,100 vs. non-MSH: $7000, IQR $2200-$17,900; p=0.002). In fact, MSHs remained associated with a 11.05% (9.78-12.33%) increase in index expenditures and a 16.68% (11.44-22.17%) increase in post-discharge expenditures. Patients undergoing surgery at a MSH were less likely to achieve a TO. Additionally, MSH status was associated with a higher likelihood of requiring post-discharge care and higher expenditures.

FTP2.11 Delay to elective colorectal cancer surgery

Abstract Aim To determine whether a delay to elective surgery of 12 weeks or more results in upstaging of colorectal cancer Method We looked retrospectively at all patients who had undergone elective colorectal cancer surgery over a 3-year period, from January 2020 - December 2022. We identified those patients who had delayed surgery. We defined delayed elective colorectal surgery as 12 weeks or more from the date of diagnosis. Patients who underwent endoscopic excision or those delayed due to neoadjuvant chemoradiotherapy were excluded from our study. TNM stage recorded by CT or MRI scan at the time of diagnosis and just before the delayed surgery were compared to determine if upstaging of the cancer had occurred. Result 406 patients underwent elective colon or rectal cancer resections from January 2020 to December 2022. After excluding those who had neoadjuvant chemoradiotherapy, the number of patients who had their surgery delayed by 12 weeks or more was 13. The median time delay was 16 weeks (12-30). All 13 patients had a staging scan at time of diagnosis, however only 7 out of the 13 had a re-staging scan prior to their delayed surgery. The pre-operative stages ranged from T0-T3, N0-N2, one patient had a single liver metastasis that resulted in a combined hemicolectomy and hepatectomy. None of the patients who were re-staged had a worse TNM stage. Conclusion In our cohort of patients, although a small total number, delaying elective cancer surgery by 12 weeks or more did not cause upstaging of their cancer.

ThTP7.5 An Assessment of Outcome in Patients with Anaemia (Iron Deficient and Non-Iron Deficient) Who Have Colon Cancer - Effect of treatment with Oral / IV Iron

Abstract Aim Treatment of iron deficiency anaemia in patients undergoing colon cancer resection improves outcome defined by length of stay (LOS), recurrence and requirements for blood transfusions. Method Retrospective analysis of patients with anaemia and colonic cancer between January 2018 - August 2019. Anaemia categorised as – Iron Deficiency Anaemia (IDA) and Non - Iron Deficiency Anaemia(non-IDA). IDA was defined as hypochromic microcytic anaemia. Patient demographics, tumour location, pre- and post-operative haemoglobin, LOS, recurrence, requirement for blood transfusions and treatment for anaemia were collected. Comparisons made between IDA and non-IDA groups in relation to treatment for anaemia with iron (oral/IV). Non-parametric statistical tests used (median, 2-way ANOVA, Kruskal-Wallis) with significance at P &amp;lt;0.05. Results 150 patients with colonic cancer identified: 77 in IDA group, 46 treated (42 oral, 4 iv iron). 11 in non- IDA group, 8 treated (oral iron). IDA oral and IV treatment versus non-IDA: Median age 74, 80 and 78 years (P = 0.814), Pre- and post op Hb IDA vs non-IDA: 107, 97; 109, 101 (P 0.007 significant), Requirement for blood transfusion (units) 0.77, 0.50;0.90 (P 0.596) Length of Stay (days) 6, 5; 7 (P 0.113), Tumour location: mean of right colon and transverse colon 24.33, 3.667 (P &amp;gt;0.1), and Recurrence P &amp;gt;0.1. Conclusion In our series, iron treatment does not influence recurrence, LOS, blood transfusion requirements. Tumour location is not significantly different between IDA and non-IDA groups. Patients treated with oral iron are seen to have a larger drop in haemoglobin post operatively than the other groups.

Age as a modifier of the effects of sarcopenia on survival among colon cancer patients after surgery.

Studies have been conducted to evaluate whether sarcopenia is a predictor for survival in patients with colon cancer postsurgery, but findings have been inconsistent, and effects of age were seldom evaluated. We recruited 133 patients with resectable colon cancer who underwent surgery between January 2014 and December 2017 at a teaching hospital to evaluate the effects of sarcopenia on survival, after adjusting for age and other potential predictors, including visceral adiposity (VA). Preoperative sarcopenia was associated with worse overall survival (OS: 62.3% vs. 83.8%, p = 0.04) and longer hospital stay (20.6 vs. 14.9 days, p < 0.01) while VA was not. Cox proportional hazards regressions showed that sarcopenia was associated with an adjusted hazard ratio (HR) of 2.91 (95% confidence interval [CI]: 1.08-7.86) after adjustment for other independent risk factors, but was not associated with disease free survival. In stratified analyses, we found that sarcopenia was an independent factor for worse OS (adjusted HR = 1.94; 95% CI: 1.11-3.38) among patients >70 years, but not among patients ≤70 years (HR = 0.48; 95% CI: 0.55-4.55). Age appeared to be a modifier of the effects of sarcopenia on OS among colon cancer patients postsurgery.

Macroscopic Evaluation of Colon Cancer Resection Specimens.

Colon cancer is a common disease internationally. Outcomes have not improved to the same degree as in rectal cancer, where the focus on total mesorectal excision and pathological feedback has significantly contributed to improved survival and reduced local recurrence. Colon cancer surgery shows significant variation around the world, with differences in mesocolic integrity, height of the vascular ligation and length of the bowel resected. This leads to variation in well-recognised quality measures like lymph node yield. Pathologists are able to assess all of these variables and are ideally placed to provide feedback to surgeons and the wider multidisciplinary team to improve surgical quality over time. With a move towards complete mesocolic excision with central vascular ligation to remove the primary tumour and all mechanisms of spread within an intact package, pathological feedback will be central to improving outcomes for patients with operable colon cancer. This review focusses on the key quality measures and the evidence that underpins them.

Identification and initial validation of maximal tumor area as a novel prognostic factor for overall and disease-free survival in patients with resectable colon cancer: a retrospective study.

The tumor area may be a potential prognostic indicator. The present study aimed to determine and validate the prognostic value of tumor area in curable colon cancer. This retrospective study included a training and validation cohorts of patients who underwent radical surgery for colon cancer. Independent prognostic factors for overall survival (OS) and disease-free survival (DFS) were identified using Cox proportional hazards regression models. The prognostic discrimination was evaluated using the integrated area under the receiver operating characteristic curves (iAUCs) for prognostic factors and models. The prognostic discrimination between tumor area and other individual factors was compared, along with the prognostic discrimination between the tumor-node-metastasis (TNM) staging system and other prognostic models. Two-sample Wilcoxon tests were carried out to identify significant differences between the two iAUCs. A two-sided P <0.05 was considered statistically significant. A total of 3051 colon cancer patients were included in the training cohort and 872 patients in the validation cohort. Tumor area, age, differentiation, T stage, and N stage were independent prognostic factors for both OS and DFS in the training cohort. Tumor area had a better OS and DFS prognostic discrimination characteristics than T stage, maximal tumor diameter, differentiation, tumor location, and number of retrieved lymph nodes. The novel prognostic model of T stage + N stage + tumor area (iAUC for OS, 0.714, P <0.001; iAUC for DFS, 0.694, P <0.001) showed a better prognostic discrimination than the TNM staging system (T stage + N stage; iAUC for OS, 0.664; iAUC for DFS, 0.658). Similar results were observed in an independent validation cohort. Tumor area was identified as an independent prognostic factor for both OS and DFS in curable colon cancer patients, and in cases with an adequate number of retrieved lymph nodes. The novel prognostic model of combining T stage, N stage, and tumor area may be an alternative to the current TNM staging system.

Influencing factors and nursing countermeasures of hypothermia in elder patients undergoing laparoscopic resection of colon cancer

Influencing factors and nursing countermeasures of hypothermia in elder patients undergoing laparoscopic resection of colon cancer

Membrane anatomy in right colon cancer: definition and identification of mesocolic completeness

Complete mesocolic excision (CME) and D3 resection of right colon cancer have been widely implemented, but the definition and identification of the completeness of the mesentery have not been fully agreed, especially the dorsal and medial borders. In this paper, we proposed the dorsal fascia of the colonic mesentery as the dorsal border of the mesocolon and the line connecting the roots of the ileocolic artery and the middle colic artery (ICA-MCA line) as the medial border of the CME by systematically studying the relationship between the mesentery and the mesenteric bed from the theory of membrane anatomy, combined with surgical experience and in-depth review of ontogenetic anatomy. We also proposed the visible "superior mesenteric vein notch" and "middle colic artery triangle" on surgical specimens as identifiers of mesocolic completeness.

Persistent high levels of carcinoembryonic antigen after tumor resection are associated with poorer survival outcomes in patients with resected colon cancer

BackgroundInterindividual survival and recurrence rates in cases of locoregional colon cancer following surgical resection are highly variable. The aim of the present study was to determine whether elevated pre-operative and post-operative CEA values are useful prognostic biomarkers for patients with stage I-III colon cancer who underwent surgery with curative intent.MethodsWe conducted a retrospective study in patients with histologically confirmed stage I-III primary colonic adenocarcinoma who underwent radical surgical resection at Mexico’s National Cancer Institute, between January 2008 and January 2020. We determined pre-operative and post-operative CEA and analyzed the association of scores with poorer survival outcomes in patients with resected colon cancer, considering overall survival (OS) and disease-free survival (DFS).ResultsWe included 640 patients with stage I-III colon cancer. Pre-operative CEA levels were in the normal range in 460 patients (group A) and above the reference value in the other 180. Of the latter, 134 presented normalized CEA levels after surgery, but 46 (group C) continued to show CEA levels above the reference values after surgery. Therefore, propensity score matching (PSM) was carried out to reduce the bias. Patients were adjusted at a 1:1:1 ratio with 46 in each group, to match the number in the smallest group. Median follow- up was 46.4 months (range, 4.9–147.4 months). Median DFS was significantly shorter in Group C: 55.5 months (95% CI 39.6–71.3) than in the other two groups [Group A: 77.1 months (95% CI 72.6–81.6). Group B: 75.7 months (95% CI 66.8–84.5) (p-value < 0.001)]. Overall survival was also significantly worse in group C [57.1 (95% CI 37.8–76.3) months] than in group A [82.8 (95% CI 78.6–86.9 months] and group B [87.1 (95% CI 79.6–94.5 months] (p-value = 0.002). To identify whether change in CEA levels operative and post-surgery was an independent prognostic factor for survival outcomes, a Cox proportional hazard model was applied. In multivariate analysis, change in CEA level was a statistically significant, independent prognostic factor for overall survival (p-value = 0.031).ConclusionsWhen assessed collectively, pre-operative and post-operative CEA values are useful biomarkers for predicting survival outcomes in patients with resected colon cancer. Prognoses are worse for patients with elevated pre-operative and post-surgical CEA values, but similar in patients with normal post-surgical values, regardless of their pre-surgery values.

Impact of preoperative chemotherapy on perioperative morbidity in combined resection of colon cancer and liver metastases

BackgroundPreoperative chemotherapy, or neoadjuvant therapy (NAC) can be used to improve resectability but can also have hepatotoxic effects on the future liver remnant. The purpose of this study was to investigate the impact of NAC on 30-day morbidity among patients undergoing a resection of primary colon cancer and synchronous liver metastases (sLM). MethodsThis was a retrospective study using the National Surgical Quality Improvement Program database (2012–2020). The association between NAC and 30-day overall morbidity, the primary outcome, was assessed. Subgroup analyses for low and high-risk procedures were performed. ResultsAmong 968 patients who underwent the combined resection, 571 (58.99%) received NAC. There was a lower rate of 30-day overall morbidity among patients who received NAC (34.50% vs. 41.56%, p = 0.026) and no difference in rates of postoperative liver failure, bile leak, need for invasive intervention for hepatic procedure, and anastomotic leak. On adjusted analyses, patients who received NAC had decreased odds of overall morbidity (OR 0.73, 95% CI 0.55–0.97, p = 0.031) compared to patients who did not receive NAC. On subgroup analyses, patients who received NAC prior to a low risk combined resection had lower rates of overall morbidity on both adjusted and unadjusted analyses. Among those undergoing high-risk combined resections, there was no difference in overall morbidity. Discussion and ConclusionPatients who are deemed to be candidates for preoperative chemotherapy can proceed with planned neoadjuvant chemotherapy prior to combined resection of primary colon cancer and sLM as preoperative neoadjuvant chemotherapy does not appear to be associated with increased postoperative morbidity.