Rectal Cancer Research Articles

Correlation Between Grade of Clinical Response to Neoadjuvant Therapy for Rectal Cancer and Oncologic Outcomes in the Era of Watch-and-Wait

Background: The watch-and-wait strategy provides an opportunity to pursue non-operative management in rectal cancer patients with clinical complete response after neoadjuvant therapy. The management of those with near complete response remains controversial. Objective: We assessed the oncologic outcomes of patients managed by watch-and-wait versus total mesorectal excision according to clinical response to neoadjuvant therapy. Design: Retrospective cohort study. Settings: Comprehensive cancer center in New York. Patients: Patients with rectal adenocarcinoma diagnosed between January 2006 to December 2020. Interventions: A watch-and-wait strategy of active surveillance was offered to patients if they achieved clinical complete response. Salvage surgery was utilized for watch-and-wait patients with local regrowth. Patients with an incomplete response underwent total mesorectal excision Main Outcome Measures: Local regrowth rate, organ preservation rate, disease-free survival and overall survival. Results: Patients with rectal adenocarcinoma (n = 1230) were divided into 3 response cohorts—incomplete (n = 646), near-complete (n = 189) and complete (n = 395). Eighty-one (43%) patients in the near-complete group and 351 (89%) patients in the complete group entered watch-and-wait. Three-year local regrowth rates were 40% and 24% in the near-complete and complete response cohorts, respectively. The 5-year organ preservation rate was 53% in near-complete responders, and 73% in complete responders. Five-year disease-free survival increased with greater clinical response to neoadjuvant therapy with intermediate outcomes noted for patients with a near-complete (73%) compared to complete (82%) or incomplete response (68%). Overall survival at 5 years was similar between the three cohorts (complete 90%, near-complete 86%, and incomplete 85%). Limitations: Retrospective nature. Conclusion: Greater clinical response to neoadjuvant therapy is associated with improved oncologic outcomes. Near-complete responders may avoid surgery and still achieve high organ preservation rates yet experience greater local regrowth rates than clinical complete response patients. Ongoing prospective trials integrating watch-and-wait after complete response as determined by uniform criteria will bolster the work to help treating physicians better select patients who qualify for active surveillance. See Video Abstract.

Features of Lateral Pelvic Lymph Nodes Associated With Pathological Involvement After Total Neoadjuvant Therapy in Patients Undergoing Lateral Pelvic Lymph Node Dissection

BACKGROUND: There is a lack of consensus regarding treating involved lateral pelvic lymph nodes in rectal cancer. OBJECTIVE: This study aimed to evaluate the clinical and magnetic resonance imaging-based factors associated with pathological lateral pelvic lymph node metastasis in patients undergoing total neoadjuvant therapy and lateral pelvic lymph node dissection. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at a single comprehensive cancer center. PATIENTS: A total of 107 patients with advanced low rectal cancer with pretreatment enlarged lateral pelvic lymph nodes (≥7 mm in long-axis) undergoing total neoadjuvant therapy with long-course chemoradiotherapy, followed by total mesorectal excision and lateral pelvic lymph node dissection, were enrolled. MAIN OUTCOME MEASURES: Pathological lateral pelvic lymph node metastasis and survival. RESULTS: Among 107 patients, 48 had a short-axis lateral node diameter <7 mm at baseline, while 59 had ≥7 mm. The ≥7 mm group showed significantly higher rates of pathological lateral pelvic lymph node metastasis (44.1% vs. 2.1%; p < 0.0001). In this group, pathological lateral pelvic lymph node metastasis was independently associated with pre-treatment malignant features and post-treatment short-axis diameter ≥4 mm. Five-year relapse-free survival was significantly lower in patients with post-treatment lateral node diameter ≥ 4 mm than those with <4 mm (71.1% vs. 86.2%, p = 0.0364). Patients with pathological lateral pelvic lymph node metastasis had significantly lower overall survival, relapse-free survival, and local recurrence-free survival rates. LIMITATIONS: Selection bias exists in a retrospective analysis. CONCLUSIONS: Pathological lateral pelvic lymph node metastasis is rare in patients with pre-treatment short-axis diameter <7 mm. In patients with pre-treatment short-axis diameter ≥7 mm, pre-treatment malignant features and post-treatment short-axis diameter are both associated with pathological lateral pelvic lymph node metastasis. These factors should be considered when deciding whether to proceed with lateral pelvic lymph node dissection after total neoadjuvant therapy. See Video Abstract.

Tumor microenvironment remodeling after neoadjuvant chemoradiotherapy in local advanced rectal cancer revealed by single-cell RNA sequencing

Tumor microenvironment remodeling after neoadjuvant chemoradiotherapy in local advanced rectal cancer revealed by single-cell RNA sequencing

Exploring the correlation between Tom1L1 and the efficacy of neoadjuvant chemotherapy for locally progressive mid-low rectal cancer.

To investigate the specificity of Target of Myb1-Like1 (Tom1L1) expression in colorectal adenocarcinoma tissues and analyze the predictive value of Tom1L1 in the efficacy of neoadjuvant chemotherapy for patients with rectal adenocarcinoma. The cancerous tissues and paracancerous normal tissues of 102 patients diagnosed with colorectal adenocarcinoma without treatment were selected; quantitative polymerase chain reaction (qPCR), Western blot and immunohistochemistry (IHC) were adopted to validate the expression level of Tom1L1 in the two groups. Furthermore, 34 patients with locally progressive mid-low rectal adenocarcinoma, who were treated with neoadjuvant Xelox chemotherapy prior to the operation, IHC was adopted to detect the expression of Tom1L1 protein in patients before and after neoadjuvant chemotherapy and to analyze the relationship between the expression level of Tom1L1 and the sensitivity of neoadjuvant therapy. The results of qPCR, Western blot and IHC showed that the expression of Tom1L1 in colorectal adenocarcinoma tissues was significantly higher than that in paracancerous normal tissues, with a statistically significant difference (P < 0.01); Neoadjuvant chemotherapy was significantly more effective in patients with low expression of Tom1L1 protein than in those with high expression of Tom1L1 protein, with a statistically significant difference (P < 0.05). Tom1L1 is highly expressed in colorectal adenocarcinoma tissues; neoadjuvant Xelox chemotherapy can have an impact on Tom1L1 expression in progressive rectal cancer; patients with locally progressive mid-low rectal adenocarcinoma who have low Tom1L1 expression are more sensitive to neoadjuvant chemotherapy.

Safe implementation of minimally invasive surgery in a specialized colorectal cancer unit.

In the past 30 years, minimally invasive surgery (MIS) has made remarkable progress and has become the standard of care in colorectal cancer treatment. The implementation of new techniques or platforms is, therefore, a challenge for surgical teams. This study aims to analyze the experience in the implementation of minimally invasive surgery in the colorectal unit in a specialized colorectal cancer center. We will report and compare the clinical outcomes of the patients submitted to the different surgical approaches, reflecting the importance of surgical training in the laparoscopic and robotic field for the reduction of surgical complications and improve short-term outcomes. This study involved a retrospective analysis of data collected from a prospectively maintained database at the colorectal unit of Champalimaud Foundation between 2012 and 2023. Data were collected as part of routine clinical documentation and included variables on patient's demographics, staging, short-term outcomes, and follow-up. A total of 661 patients treated at the Champalimaud Foundation between 2012 and 2023 were included, of which 389 (59%) had colon and 272 (41%) rectal cancer. Most of the patients underwent elective surgery, with a minimally invasive approach performed in 91% of cases. A complete resection (R0) was achieved in 95.1% (619) of the procedures with a pathology report staging 64.5% (409) of tumors as pT3-4. Eleven percent (70) of patients had complications classified as Clavien-Dindo (CD) ≥ 3. This study supports the safety of the implementation of minimally invasive surgery in colorectal cancer care, with improvement in postoperative outcomes and surgical quality, supporting the importance of surgical training and specialized teams.

Risk factors of the low anterior resection syndrome (LARS) after ileostomy reversal in rectal cancer patient.

This study is aimed at identifying risk factors of Low Anterior Resection Syndrome following ileostomy reversal in rectal cancer patients who had undergone preventive ileostomy. This retrospective analysis was conducted on a cohort of 605 patients treated at the Fourth Hospital of Hebei Medical University between January 2018 and December 2021. These patients were grouped based on LARS score, and Clinical and follow-up data were collected to conduct univariate analyses of potential factors influencing LARS occurrence based on variable type. Variables with statistical significance were included in a logistic regression model to analyze potential influences on the occurrence of LARS. Univariate and Multivariate logistic regression analysis showed that N2 stage (OR = 2.290 95%CI: 1.076-4.873, P = 0.031), chemoradiotherapy (OR = 2.271, 95%CI: 1.246-4.138, P = 0.007), and anastomosis height (OR = 0.836, 95%CI: 0.717-0.975, P = 0.022) were independent influences on the occurrence of LARS. In model 3 (adjusting for all covariates), the relationship between anastomotic height and patient LARS status showed a negative correlation. In subgroup analyses, there were significant differences in the effect of anastomotic height on LARS in subgroups with different hemoglobin concentrations. A high occurrence rate of LARS is observed in rectal cancer patients with preventive ileostomy reversal. N2 stage, history of chemoradiotherapy, and anastomotic height are independent influence factors for the occurrence of major LARS after ileostomy reversal.

Rectal Cancer and Lateral Lymph Node Staging: Interobserver Agreement and Success in Predicting Locoregional Recurrence

Objectives: To evaluate the agreement among radiologists in the evaluation of rectal cancer staging and restaging (after neoadjuvant therapy) and assess whether locoregional recurrence can be predicted with this information. Materials and Methods: Pre-neoadjuvant and after-neoadjuvant therapy magnetic resonance imaging (MRI) examinations of 239 patients diagnosed with locally advanced rectal cancer were retrospectively reviewed by three radiologists. The agreement between the MRI findings (localization of tumor involvement, tumor coverage pattern, external sphincter involvement, mucin content of the mass and lymph node, changes in the peritoneum, MRI T stage, distance between tumor and MRF, submucosal sign, classification of locoregional lymph node, and EMVI) was discussed at the September 2023 meeting of the Society of Abdominal Radiology (SAR) and the interobserver and histopathological findings were examined. The patients were evaluated according to locoregional rectal cancer and lateral lymph node (LLN) staging, and re-staging was performed using MRI images after neoadjuvant treatment. The ability of the locoregional and LLN staging system to predict locoregional recurrence was evaluated. Results: Among the parameters examined, for the MRI T stage and distance between the tumor and the MRF, a moderate agreement (kappa values: 0.61–0.80) was obtained, while for all other parameters, the interobserver agreement was notably high (kappa values 0.81–1.00). LLNs during the restaging with an OR of 2.1 (95% CI = 0.33–4.87, p = 0.004) and a distance between the tumor and the MRF of less than 1 mm with an OR of 2.1 (95% CI = 1.12–3.94, p = 0.023) affected locoregional recurrence. A multivariable Cox regression test revealed that the restaging of lymph nodes among the relevant parameters had an impact on locoregional recurrence, with an OR of 1.6 (95% CI = 0.32–1.82, p = 0.047). With the LLN staging system, an increase in stage was observed in 37 patients (15.5%), and locoregional recurrence was detected in 33 of them (89.2%) (p &lt; 0.001). Conclusions: LLN staging is not only successful in predicting locoregional recurrence among MRI parameters but is also associated with a very high level of interobserver agreement. The presence of positive LLN in the restaging phase is one of the most valuable MRI parameters for poor prognosis.

Comparison of robotic assisted and laparoscopic radical resection for rectal cancer with or without left colic artery preservation.

The preservation of the left colic artery (LCA) during rectal cancer resection remains a topic of controversy, and there is a notable absence of robust evidence regarding the outcomes associated with LCA preservation. And the advantages of robotic-assisted laparoscopy (RAL) surgery in rectal resection remain uncertain. The objective of this study was to assess the influence of LCA preservation surgery and RAL surgery on intraoperative and postoperative complications of rectal cancer resection. Patients who underwent laparoscopic (LSC) or RAL with or without LCA preservation resection for rectal cancer between April 2020 and May 2023 were retrospectively assessed. The patients were categorized into two groups: low ligation (LL) which with preservation of LCA and high ligation (HL) which without preservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was operative findings, operative morbidity, and postoperative genitourinary function. A total of 612 patients were eligible for this study, and propensity score matching yielded 139 patients in each group. The blood loss of the LL group was significantly less than that of the HL group (54.42 ± 12.99 mL vs. 65.71 ± 7.37 mL, p<0.001). The urinary catheter withdrawal time in the LL group was significantly shorter than that in the HL group (4.87 ± 2.04 d vs. 6.06 ± 2.43d, p<0.001). Anastomotic leakage in the LL group was significantly lower than that in HL group (1.44% vs. 7.91%, p = 0.011). The rate of urinary dysfunction and sexual dysfunction in LL group is both significantly lower than HL group. Blood loss and number of harvested lymph nodes (LNs) of both RAL subgroups in LL and HL groups were significantly more than that in LSC subgroups. The anastomotic leakage in the RAL subgroup of HL group was significantly lower than that in LSC subgroup (0% vs. 14.89%, p = 0.018). LCA preservation surgery for rectal cancer may help reduce the blood loss, urinary catheter withdrawal time, the rate of anastomotic leakage and ileus, and postoperative genitourinary function outcomes. RAL can reduce the probability of blood loss and improve harvest LNs in patients with rectal cancer.

Impact of Multidisciplinary Team Management on Survival and Recurrence in Stage I–III Colorectal Cancer: A Population-Based Study in Northern Italy

This study aimed to assess whether multidisciplinary team (MDT) management improves outcomes in patients with stage I–III colorectal cancer (CRC) compared to non-MDT care. This study included 460 CRC patients diagnosed from 2017 to 2018 in a northern Italian province, of whom 300 (65%) were managed by MDT. MDT patients were younger, more frequently had rectal cancers, were diagnosed at earlier stages, and were more likely to undergo surgery and chemotherapy. Disease-free survival (DFS) and overall survival (OS) were significantly better in the MDT group. The recurrence rate was 8.5%, with no significant differences between MDT and non-MDT patients, although MDT patients exhibited lower recurrence rates for early-stage tumors. A multivariable analysis showed that DFS and OS were adversely affected by older age, advanced stage, and lack of MDT management. Kaplan–Meier estimates demonstrated a 3-year DFS of 78% in the MDT group versus 65% in the non-MDT group, as well as an OS of 83% versus 69%, respectively. The MDT approach was associated with improved treatment adherence and better management of recurrences. While limited by a small sample size, this population-based study highlights the beneficial impact of MDT care on CRC outcomes. Further research with extended follow-up is warranted to confirm these findings.

Serum zonulin and colorectal cancer risk.

Intestinal permeability has been related to colorectal cancer (CRC) development. Zonulin, a protein able to regulate tight junction function and intestinal permeability, emerges as a promising marker to elucidate the contribution of bacterial translocation in CRC. An Italian case-control study included 77 CRC cases, 72 intestinal adenoma and 76 healthy controls (for a total of 148 tumor-free subjects), aged 20-85. Serum zonulin levels were quantified by ELISA kit and blood 16S rRNA gene copies by DNA extraction and polymerase chain reaction. We applied logistic regression models adjusted for center, sex, age and education. There was a positive association between zonulin and CRC risk. The odds ratio (OR) of CRC for the highest versus lowest tertile of zonulin as compared to tumor-free subjects was 2.36 (95% confidence interval, 1.14-4.86). The ORs were similar in colon and rectal cancers. The OR of colon cancer for the highest versus lowest levels of both zonulin and 16S rRNA gene copies was 4.55.Circulating levels of zonulin were higher in CRC patients compared to tumor-free controls supporting the hypothesis of an interplay of gut barrier dysfunction and bacterial translocation in colorectal carcinogenesis. Zonulin may interact with 16S rRNA gene copies and serve as a further biomarker in the evaluation of CRC diagnosis.

Nomograms Predicting Survival, Recurrence and Beneficiary Identification of Adjuvant Chemotherapy in Treatment-naïve Patients with Rectal Cancer who Underwent Upfront Curative Resection: A multi-institutional study

Objective: To create and validate nomograms predicting overall survival and recurrence in treatment-naïve rectal cancer (RC) patients who underwent upfront surgery. Background: Although multidisciplinary treatment is standard for locally advanced RC, understanding surgical efficacy is important for determining indications for perioperative adjuvant therapy. Methods: RC patients who underwent upfront surgery at the Japanese Society for Cancer of the Colon and Rectum institutions were analyzed. A training cohort (n = 1925) of treatment-naïve patients who underwent surgery between 2007 and 2008 was analyzed to construct prognostic models predicting postoperative survival and recurrence. Discrimination and calibration were performed using an external validation cohort (n = 2957; Japanese colorectal cancer registry, procedures in 2005–2006). Effects of adjuvant chemotherapy on survival were evaluated based on nomogram prediction and Surveillance, Epidemiology, and End Results (SEER) data (n = 10,482; upfront surgery for RC in 2010–2015). Results: In the training cohort, age predicted survival, venous invasion predicted recurrence, and sex, tumor location, histological type, preoperative carcinoembryonic antigen, invasion depth, lymphatic invasion, positive radial margin, and numbers of metastatic nodes and examined nodes predicted both. Internal and external validated Harrell’s C-index values were respectively 0.77 and 0.75 for survival and 0.75 and 0.74 for recurrence. RC patients who underwent upfront surgery in the SEER database were stratified into 3 risk levels by nomogram score. Adjuvant chemotherapy did not improve 5-year survival in low-risk patients, but did so for middle-risk (62.4% vs 76.8%) and high-risk (39.4% vs 63.5%) patients. Conclusion: These nomograms could predict survival and recurrence after upfront curative resection of RC and identify cases expected to benefit more from adjuvant chemotherapy.

Watch-and-Wait Approach Following Neoadjuvant Chemo-Radiotherapy for Locally Advanced Rectal Cancer: A Retrospective Single-Center Cohort Study.

The watch-and-wait (WW) strategy in patients after complete clinical response (cCR) following chemoradiotherapy for locally advanced rectal cancer (LARC) offers the option of organ preservation. The aim of this study was to assess the oncological outcomes of WW patients treated and followed up in a German referral cancer center. In this retrospective study, we analyzed the clinical records of consecutive patients with LARC who underwent neoadjuvant radiotherapy/chemoradiotherapy at our institution between January 2020 and December 2023 and received non-operative management after cCR. A total of 30 patients undergoing WW for LARC were included. After a median follow-up of 17 months (SD = 10 months), local regrowth occurred in four patients (4/30, 13.3%), and one patient (1/30, 3.3%) developed distant metastasis. No predictor for tumor regrowth could be identified based on radiological findings at diagnosis, including cT4 and/or cN2, involvement of the mesorectal fascia, extramural vascular invasion or infiltration of the anal sphincter/levator. All patients with local regrowth were successfully surgically treated (R0 resection). Nonoperative management for patients with cCR after neoadjuvant therapy for LARC proved to be safe. R0 resection was successfully achieved in all patients who underwent salvage surgery.

HPB O02 - On-site hepatobiliary surgery capability independently predicts treatment pathway completion in metastatic rectal cancer: A nationwide observational study of 15,727 patients

Abstract Background Stage IV rectal cancer carries a 10% 5-year survival rate (Jemal et al., 2005). Curative-intent management requires treatment of both the primary and metastatic disease. This study aimed to identify patterns in stage IV rectal cancer treatment pathway at population level across the UK, and to identify predictors of treatment pathway completion. Method Patient demographics and treatment data were extracted from the UK Colorectal Cancer Intelligence Hub’s CORECT-R repository, national chemotherapy (SACT), radiotherapy datasets (RTDS), and Hospital Episode Statistics (HES) data. Treatment pathway completion was defined as receipt of intervention to the primary tumour, in addition to metastasis-directed therapy, or the combination alongside chemotherapy. Multivariable logistic regression analysis was performed to identify independent predictors of treatment completion. Results A total of 15,727 patients with stage IV rectal cancer diagnosed between 2010-19 were identified. There was significant variation in proportion of patients with complete treatment between MDTs. Multivariable analyses showed that lack of on-site HPB surgery capability was the only predictor of failure to complete treatment (OR 1.22, 95%CI:1.07-1.38, p&amp;lt;0.01). Conclusion Across the UK, there is variation in Stage IV rectal cancer patients completing treatment for both their primary and metastatic disease. Further work is needed to determine whether differences in treatment pathways stem from variation in access to specialist services between cancer alliances or whether they are due to differences in MDT decision making.

Transarterial Chemoembolization in Locally Advanced Rectal Cancer: A Systematic Review

Background: Locally advanced rectal cancer (LARC) presents a significant treatment challenge. Transarterial chemoembolization (TACE) has emerged as a potential adjunctive treatment, offering targeted delivery of chemotherapeutic agents to the tumor site, minimizing systemic exposure. This systematic review aims to assess the current literature on this novel technique and evaluate the safety and efficacy profile of TACE in treating this complex cohort of patients. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, EMBASE, and Cochrane Library, to identify studies evaluating TACE in LARC. Inclusion criteria encompassed clinical trials, cohort studies, and case series reporting on outcomes such as tumor response rate, overall survival (OS), progression-free survival (PFS), and treatment-related adverse events. Results: A total of eight studies involving 543 patients met the inclusion criteria. The studies varied in design, with five prospective and three retrospective studies. A higher prevalence of male participants (68.7%) was noted, with a median age of 60.3 years. The studies primarily evaluated the efficacy and safety of TACE in LARC treatment. Pathological response rates, tumor reduction, and survival outcomes varied across studies, with TACE showing promise in reducing tumor size, improving survival, and controlling metastasis. Major complications were rare, reported in 6.0% of cases. Conclusions: TACE is a promising therapeutic option for patients with LARC, demonstrating favorable tumor response rates and manageable toxicity profiles. Further large-scale, randomized controlled trials are warranted to confirm these findings and better define the role of TACE in the multimodal treatment of LARC.

Cost of Care Related to Radiation Treatment in Locally Advanced Rectal Cancer: Short Course Radiation Therapy vs Long Course Chemoradiation

Cost of Care Related to Radiation Treatment in Locally Advanced Rectal Cancer: Short Course Radiation Therapy vs Long Course Chemoradiation

Endoscopic intermuscular dissection: insights from China on minimally invasive treatment for early rectal cancer.

Endoscopic intermuscular dissection: insights from China on minimally invasive treatment for early rectal cancer.

Abundance of Tumor-Infiltrating B Cells in Human Epithelial Malignancies

Cancer is a major global health problem. The type of malignant neoplasm and the potency of the immune response against tumors are two of the key factors influencing the outcome of the disease. The degree of tumor infiltration by lymphocytes plays an important role in antitumor response development, generally correlating with a favorable prognosis of treatment for certain cancers. We analyzed the abundance of tumor-infiltrating B cells (TIBs) in solid tumors of different cancers. TIBs were shown to be more abundant in colon and sigmoid colon cancer samples compared with cecal, rectal, and kidney cancer samples. The median and interquartile range of the TIB fraction were 11.5% and 4–20% in colon cancer, 6% and 3–11% in sigmoid colon cancer, 2.7% and 0.7–3.7% in cecal cancer, 2.5% and 0.9–3.6% in rectal cancer, 1.4% and 1.0–2.3% in kidney cancer, and 3.0% and 1.8–12% in lung cancer, respectively. However, there were no significant differences in the abundance of TIBs among samples at different stages of the cancer. Hence, investigation of the B cell response in colon cancer is of particular interest, since increased quantities of TIBs may indicate the existence of immunogenic tumor markers or the cell-cell interactions involved in disease progression. We believe that studying the diversity of TIBs in colon cancer will increaseour understanding of the mechanisms of the disease, contributing to the identification of new molecular targets for targeted oncotherapy.

Evaluation of Volumetric Magnetic Resonance Imaging in Determining the Indication for Total Neoadjuvant Therapy in Rectal Cancer.

This study aims to evaluate the relationship between volumetric measurements of residual tumor via magnetic resonance imaging (MRI) and pathologic complete response (pCR) in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (nCRT). Patients with locally advanced rectal cancer who had pelvic MRI for clinical staging and completed nCRT followed by radical resection were included. Two experienced radiologists measured tumor volume on MRI obtained before and after nCRT. We compared the pre- and post-CRT tumor volume and measured tumor volume reduction rates. The median value of tumor volume reduction rate in all patients was 64.7% (min-max - 81.1-98.1%). When the relationship between tumor volume and tumor regression grade (TRG) after nCRT was assessed, it was found that 18 of 21 (86%) patients with a good response (TRG 1) had a post-CRT tumor volume of ≤ 8 cm3 (p = 0.001). While 9 of 10 patients with pCR after nCRT had a tumor volume of ≤ 8 cm3, one patient had pCR despite having a tumor volume greater than 8 cm3 (p = 0.015). The correlation between post-nCRT residual tumor volume and pCR underscores the potential of volumetric MRI as a predictive tool in tailoring rectal cancer treatment. For patients with residual tumor volumes greater than 8 cm3, extending neoadjuvant chemotherapy as part of TNT may enhance the likelihood of achieving pCR. This approach advocates for a more personalized treatment strategy, potentially optimizing outcomes for rectal cancer patients.

Utilizing C-Reactive Protein (CRP) and CRP Ratios for Early Detection of Postoperative Complications Following Rectal Cancer Surgery

Background: Surgical treatment for rectal cancer may cause complications that exacerbate the condition, lengthen hospital stays, and raise healthcare costs. Rectal cancer surgery complications can be detected immediately with postoperative C-reactive protein (CRP) monitoring. Elevated levels of CRP indicate the presence of inflammation and can serve as a predictive factor for future outcomes. Methods: A retrospective cohort analysis was performed on 67 rectal cancer surgery patients. Prior to and after surgery, CRP levels were measured on days 1–3 and 4–7. Postoperative complications were linked to CRP, surgical approach (open, laparoscopic, conversion), and patient characteristics. This study included t-tests, chi-square tests, Mann–Whitney U tests, ANOVA, Pearson and Spearman correlation analyses, and logistic regression. Results: There was a significant correlation between high levels of CRP on postoperative days 4–7 and the development of problems (p &lt; 0.001). The ratios of CRP/albumin and CRP/platelet were highly predictive of problems over this period (p = 0.000033). Patients who encountered problems had a notably greater estimated blood loss (p = 0.0086). Logistic regression analysis demonstrated a statistically significant relationship between higher Charlson Comorbidity Index (CCI) scores and an elevated probability of experiencing problems (p = 0.0078). Moreover, patients who underwent laparoscopic surgery but had to be converted to an open method saw a notably greater incidence of complications (p = 0.0022). From a financial standpoint, the average cost per patient with complications was EUR 1128.75, resulting in a total cost of EUR 44,021.25 for all 39 patients. Conversely, patients who did not experience any difficulties had a cost of EUR 731.25 per patient, resulting in a total of EUR 20,475.00 for all 28 patients. Conclusions: Regularly monitoring CRP, particularly between days 4 and 7 following surgery for rectal cancer, can promptly identify any complications. Monitoring CRP levels and promptly managing any abnormalities can enhance surgical outcomes and reduce healthcare costs.

Summary of Professor HUANG Jinchang's experience of electroacupuncture at Baliao acupoints for low anterior resection syndrome of rectal cancer

This paper introduces Professor HUANG Jinchang's experience in treating low anterior resection syndrome (LARS) of rectal cancer. Based on the clinical experience in treating fecal incontinence after rectal cancer surgery, Professor HUANG Jinchang proposes that the primary pathogenesis of LARS is spleen-kidney yang deficiency with internal obstruction of damp turbidity. The treatment approach should focus on strengthening the spleen, warming the kidney, and eliminating turbidity. The Baliao acupoints are specifically selected to eliminate turbidity, promote yang , facilitate the qi flow of the viscera, and regulate the opening and closing of the anus. Emphasis is placed on deep needling at the Baliao acupoints, with flexible acupoint selection based on accompanying symptoms. Additionally, moxibustion and bloodletting cupping are used to restore regular bowel movements and improve the quality of life for patients who have undergone anus-preserving surgery for rectal cancer.