Resection Of Colon Cancer Research Articles

Preoperative botensilimab (BOT) with or without balstilimab (BAL) for patients with resectable locally advanced pMMR or dMMR colon cancer: Results from the UNICORN trial by GONO.

158 Background: Standard treatment for patients (pts) with localized colon cancer (CC) is surgery and adjuvant chemotherapy where indicated. Neoadjuvant strategies allow for earlier exposure to systemic therapy, potentially leading to tumor downstaging, micro-metastases eradication, improved survival, and may pave the way for non-operative management (NOM). BOT, a novel Fc-enhanced multifunctional anti-CTLA-4 antibody plus BAL, an anti-PD-1 antibody, have demonstrated activity in proficient mismatch repair (pMMR) CC pts with durable responses in metastatic CC and unprecedented rates of pathological complete response (pCR) in the localized setting. Methods: UNICORN is a window-of-opportunity, multicohort, umbrella platform phase II trial enrolling non-metastatic, radiologically staged rT3-4 N0-2, resectable CC pts to be treated with a short course preoperative targeted treatment according to a prespecified molecular profile assessed by immunohistochemistry and next-generation sequencing on tumor biopsy. Pts with pMMR or deficient (dMMR) tumors received intravenous (IV) BOT at 1 mg/kg on day 1 (cohorts 4 or 6) or IV BOT 1 mg/kg on day 1 and BAL 3 mg/kg on days 1 and 15 (cohorts 5 or 7, enrolled after 4 and 6) and underwent radical surgery on day 35 ± 5. Pathological response (pR), major response (pMR) and pCR rates were defined as ≤ 50%, ≤10% and 0% residual viable tumor. The primary endpoint was centrally assessed pMR rate in each cohort. According to a Fleming 1-stage design, choosing β=80% and α=5%, 14 pts were enrolled in each cohort and the treatment was judged promising if ≥5/14 pMRs were observed. Results: All 56 enrolled pts completed preoperative treatment and underwent surgery. Timely surgery was performed in most pts (98%), except 1 who underwent surgery with a delay < 4 weeks due to treatment-related hyperthyroidism. Among pts with pMMR disease, activity was limited for BOT monotherapy (pMR 0%, pR 43%). With BOT + BAL, pCR was 29%, pMR 36% and pR 71%. Among those with dMMR status, BOT led to pCR, pMR and pR in 29%, 36% and 64% pts, respectively. Notably, BOT + BAL led to pCR and pMR in 93% and 100% pts. Adverse events (AEs) of any grade occurred in 28/56 pts (50%), and 22 (39%) were deemed immune-related. Serious AEs occurred in 9 pts (16%) and were treatment-related in 3 pts (5%). Conclusions: The primary endpoint was met in all cohorts except for BOT monotherapy in pts with pMMR status. Despite limited sample size, the activity of 1 neoadjuvant cycle with BOT + BAL favorably compares to ipilimumab/nivolumab in both pMMR and dMMR subgroups. pCR rate was remarkable in pMMR and the highest ever reported in dMMR pts, paving the way to NOM studies irrespective of MMR status. Clinical trial information: EU-CT 2022-501308-90-00 . Molecular status n° Treatment pCR, n (%) pMR, n (%) pR, n (%) pMMR 14 BOT 0 (0) 0 (0) 6 (43) 14 BOT/BAL 4 (29) 5 (36) 10 (71) dMMR 14 BOT 4 (29) 5 (36) 9 (64) 14 BOT/BAL 13 (93) 14 (100) 14 (100)

NRG-GI008: Colon adjuvant chemotherapy based on evaluation of residual disease (CIRCULATE-North America).

TPS310 Background: Currently, there are no biomarkers validated prospectively in randomized studies for resected colon cancer (CC) to determine need for adjuvant chemotherapy (AC). However, circulating tumor DNA (ctDNA) represents a highly specific and sensitive approach (especially with serial monitoring) for identifying minimal/molecular residual disease (MRD) post-surgery in CC patients (pts), and may outperform traditional clinical and pathological features in prognosticating risk for recurrence. CC pts who do not have detectable ctDNA (ctDNA-) are at a much lower risk of recurrence and may be spared the toxicities associated with AC. Furthermore, for CC pts with detectable ctDNA (ctDNA+) who are at a very high risk of recurrence, the optimal AC regimen has not been established. We hypothesize that for pts whose CC has been resected, ctDNA status may be used to risk-stratify for making decisions about AC. Methods: In this prospective phase II/III trial, up to 1,912 pts with resected stage IIB, IIC, and III CC will be enrolled. Based on the post-operative ctDNA status using personalized and tumor-informed assay (Signatera, bespoke assay), those who are ctDNA- (Cohort A) will be randomized to immediate AC with fluoropyrimidine (FP)+oxaliplatin (Ox) for 3-6 mos per established guidelines v serial ctDNA monitoring. Patients who are ctDNA+ post-operatively, or with serial monitoring (Cohort B), will be randomized to FP+Ox v more intensive AC with addition of irinotecan (I) for 6 mos. One cycle of chemotherapy is allowed while awaiting ctDNA testing results for cohort assignment. The primary endpoints for Cohort A are time to ctDNA+ status (phase II) and disease-free survival (DFS) (phase III) in the immediate v delayed AC arms. The primary endpoint for Cohort B is DFS in the FP+Ox v FP+Ox+I arms for both phase II and phase III portions of the trial. Secondary endpoints include prevalence of detectable ctDNA post-operatively, time-to-event outcomes (overall survival and time to recurrence) by ctDNA status, and the assessment of compliance to adjuvant therapy. Biospecimens including archival tumor tissue, as well as post-operative plus serial matched/normal blood samples, will be collected for exploratory correlative research. Active enrollment across the NCTN started in June 2022 with CCTG sites joining in August 2023. Current accrual (as of 9-20-2024): 500/1,912. Clinical trial information: NCT05174169 .

Surgical Approach and Variation in Long-Term Survival Following Colorectal Cancer Surgery Using Instrumental Variable Analysis

Objective: The study aimed to determine whether increased use of minimally invasive surgical approaches, compared with open, improves long-term survival after colon and rectal cancer resections. Background: Existing prospective and observational data comparing surgical approach for colon and rectal cancer are limited by selection bias, necessitating better approaches for causal inference to understand the relationship between surgical approach and long-term survival. Methods: We included colon and rectal cancer patients who underwent colon or rectal resection from the American College of Surgeons National Cancer Database between 2011 and 2018. Using an instrumental variable (IV) approach, we accounted for measured and unmeasured differences between patients undergoing colon or rectal cancer resection based on operative approach – robotic, laparoscopic, or open. The IV used in this study was rate of robotic-assisted colon and rectal cancer surgery within 81 different hospital regions based on US Census region and rurality during the 12 months before each patient’s operation. Proportional hazard modeling was used to estimate risk-adjusted mortality rates. Results: There were 326,406 colon and 96,979 rectal cancer patients included in this study. The risk-adjusted 5-year cumulative incidence of mortality for colon and rectal cancer was highest for patients who underwent open approaches (35.73 [95% confidence interval {CI}: 35.37–36.1] and 39.27 [95% CI: 28.44–30.13], respectively), compared with lower mortality for those undergoing laparoscopic (28.91 [95% CI: 28.55–29.27] and 22.93 [95% CI: 22.11–23.78], respectively) and robotic approaches (26.39 [95% CI: 24.51–28.42] and 19.77 [95% CI: 17.32–22.43], respectively). Growth in utilization of minimally invasive approaches outpaced improvements in long-term survival. Conclusions: Patients undergoing minimally invasive surgical approaches for colon and rectal cancer had improved long-term survival. However, long-term survival changes did not correlate with the large expansion of minimally invasive approaches, which suggests that growing these approaches is not a viable strategy to improve long-term patient outcomes.

Impact of surgical specialization on long-term survival after emergent colon cancer resections.

The impact of surgical specialization on long-term survival in patients undergoing emergent colon cancer resections remains unclear. A retrospective analysis was conducted on all patients who underwent emergent colon cancer resections at a secondary care hospital between 2010 and 2020. The most senior surgeon performing the procedures was classified as colorectal surgeon (CS) or non-colorectal surgeon (NCS). NCS was further divided into acute care surgeons (ACSs) or general surgeons (GSs). Overall survival (OS) and cancer-free survival (CFS) were compared in patients operated by surgeons with different specializations. A total of 235 emergent resections were performed during the study period, of which 99 (42%) were performed by CS and 136 (58%) by NCS. In adjusted Cox regression analyses, OS and CFS were similar in patients operated on by CS and NCS (hazard ratio (HR) for OS: 1.02 (0.72-1.496), p = 0.899 and HR for CFS: 0.91 (0.61-1.397), p = 0.660). Similarly, OS and CFS were equivalent in patients operated by ACS and CS (HR for OS: 1.10 (0.75-1.62), p = 0.629 and HR for CFS: 1.24 (0.80-1.92), p = 0.343). However, patients operated by GS had significantly shorter OS and CFS (HR for OS: 1.78 (1.05-3.00), p = 0.031 and HR for CFS: 1.83 (1.02-3.26), p = 0.041) compared with those operated by ACS and CS. Long-term survival after emergent colon cancer resections was similar in patients operated on by CS and NCS, and the subgroup of ACS, indicating equivalent comparable surgical quality. The less favorable poorer survival observed for patients operated on by GS may possibly be due to less frequent exposure to colorectal and emergent surgery.

Preoperative CT lymph node size as a predictor of nodal metastasis in resectable Colon cancer: a retrospective study of 694 patients

PurposeThis study aimed to investigate the efficacy of measuring lymph node size on preoperative CT imaging to predict pathological lymph node metastasis in patients with colon cancer to enhance diagnostic accuracy and improve treatment planning by establishing more reliable assessment methods for lymph node metastasis.MethodsWe retrospectively analyzed 1,056 patients who underwent colorectal resection at our institution between January 2004 and March 2020. From this cohort, 694 patients with resectable colon cancer were included in the study. We analyzed the relationship between lymph node size on preoperative CT imaging and lymph node metastasis identified on postoperative pathological examination.ResultsThe optimal cutoff values for the maximum long diameter and short diameter of regional lymph nodes on preoperative CT were identified as 6.5 mm and 5.5 mm, respectively, with an AUC of 0.7794 and 0.7755, respectively. Notably, the predictive accuracy varied by tumor location. Higher cutoff values were observed in the right-sided colon (maximum long diameter: 7.7 mm, maximum short diameter: 5.9 mm) compared to the left-sided colon (maximum long diameter: 5.8 mm, maximum short diameter: 5.2 mm).ConclusionLymph node size on preoperative CT is a significant predictor of pathological lymph node metastasis in colon cancer. Notably, the optimal cutoff values for predicting lymph node metastasis vary depending on the specific region within the colon.

Robotic-Assisted Colon Cancer Surgery: Faster Recovery and Less Pain Compared to Laparoscopy in a Retrospective Propensity-Matched Study.

Background and Objective: Colorectal cancer (CRC) is the third most common cancer worldwide, with colon cancer accounting for approximately 60% of all CRC cases. Surgery remains the primary and most effective treatment. Robotic-assisted surgery (RAS) has emerged as a promising approach for colon cancer resection. This retrospective study compares RAS and laparoscopic-assisted surgery (LSS) for stage I-III colon cancer resections at a single medical center in East Asia. Methods: Between 1 January 2018, and 29 February 2024, patients undergoing colectomy were classified into right-side and left-side colectomies. Propensity score matching was conducted based on age group, gender, ASA score, and BMI to ensure comparability between groups. After matching, there were 50 RAS and 200 LSS cases for right colectomy (RC), and 129 RAS and 258 LSS cases for left colectomy (LC). Perioperative outcomes were compared between the two surgical approaches. The primary outcomes were recovery milestones, while secondary outcomes included complications and postoperative pain scores. Results: RAS demonstrated faster recovery milestones compared to LSS (hospital stay: 6.5 vs. 10.2 days, p = 0.005 for RC; 5.5 vs. 8.2 days, p < 0.001 for LC). RAS also resulted in lower rates of ileus (14% vs. 26%, p = 0.064 for RC; 6.2% vs. 15.9%, p = 0.007 for LC) and higher lymph node yields (31.4 vs. 26.8, p = 0.028 for RC; 25.8 vs. 23.9, p = 0.066 for LC). Major complication rates showed no significant difference between RAS and LSS (4.0% vs. 7.0%, p = 0.746 for RC; 4.7% vs. 3.1%, p = 0.563 for LC). Patients in the RAS group experienced earlier diuretic phases and reported significantly lower postoperative pain scores (3.0 vs. 4.1, p = 0.011 for RC; 2.9 vs. 4.1, p < 0.001 for LC). Conclusions: Robotic-assisted surgery is associated with faster recovery, lower rates of ileus (LC), higher lymph node yield (RC) and reduced postoperative pain compared to laparoscopic-assisted surgery for colon cancer resection.

Segmental versus Extended Resection for Colon Cancer in Lynch's Syndrome

Segmental versus Extended Resection for Colon Cancer in Lynch's Syndrome

Association of chronic kidney disease with acute clinical outcomes and hospitalization costs of cancer resection.

Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been noted to face increased cancer incidence. Yet, the impact of concomitant renal dysfunction on acute outcomes following elective surgery for cancer remains to be elucidated. All adult hospitalizations entailing elective resection for lung, esophageal, gastric, pancreatic, hepatic, or colon cancer were identified in the 2016-2020 National Inpatient Sample. Based on stage of renal dysfunction, CKD patients were sub-classified as CKD1-3, CKD4-5, or ESRD (others: Non-CKD). Multivariable regression models were developed to assess the association of comorbid CKD/ESRD with in-hospital mortality, perioperative complications, and resource utilization. Of ~515,145 patients, 32,195 (6.2%) had CKD (5.1% CKD1-3, 0.7% CKD4-5, 0.5% ESRD). The incidence of CKD among patients undergoing cancer resection increased from 5.3% in 2016 to 7.3% in 2020 (P<0.001). Following risk adjustment, CKD1-3 and CKD4-5 remained linked with similar likelihood of mortality and hospitalization costs, but greater need for blood transfusion (CKD1-3 AOR 1.21, CI 1.09-1.35; CKD4-5 AOR 1.73 CI 1.38-2.18). CKD4-5 was also associated with greater odds of infection (AOR 1.88, CI 1.34-2.62) and respiratory sequelae (AOR 1.36, CI 1.05-1.77). Further, ESRD was linked with greater odds of in-hospital mortality (AOR 2.74, CI 1.69-4.45), infection (AOR 2.31, CI 1.62-3.30) and respiratory complications (AOR 1.72, CI 1.31-2.26), as well as greater resource utilization, relative to Non-CKD. Comorbid renal dysfunction was linked with inferior clinical and financial outcomes following elective cancer resection. Future work is needed to develop optimal management strategies and recovery pathways for this complex cohort.

Ischemic ulcers do not significantly impact endoscopic recurrence score in Crohn's disease: A multicenter comparative study after right-side colectomy.

Postoperative recurrence (POR) occurs in up to 70% of patients with Crohn's disease (CD). The Rutgeerts score (RS) system may overestimate the prevalence of "real" anastomotic recurrence. Hence, we aimed to compare the prevalence of anastomotic POR in CD and the presence of ulcers at anastomotic sites in patients with right-side resection for colonic cancer (CC). We retrospectively selected CD and CC patients with right-side resection and anti-peristaltic stapled L-L anastomosis from 5 tertiary referral centers. All patients underwent endoscopy within 8 months of surgery. POR was scored according to the modified RS. We directly compared the prevalence of isolated anastomotic ulcers in CD (Rutgeerts i2A) and CC patients. We enrolled 221 CD patients and 72 CC subjects. POR was recorded in 127 CD patients (57%). Endoscopy detected anastomotic ulcers in two of the 72 CC patients (3%), one (1.4%) being early local recurrence. The presence of isolated ulcerations was significantly higher in CD patients compared to CC (19% vs 3%; p < 0.01;OR 6.3). The prevalence of anastomotic (presumed ischemic) ulcers in CC patients is very low, but if shifted into the POR of CD, this is not representative of a real diagnostic matter. Prospective, multicenter, and direct comparative studies are needed to confirm our results.

Comparison of Oncological Outcomes After Curative Resection for Right-side Colon Cancer and Left-side Colon Cancer: a Retrospective Observational Study

Comparison of Oncological Outcomes After Curative Resection for Right-side Colon Cancer and Left-side Colon Cancer: a Retrospective Observational Study

Postoperative outcomes of pancreatoduodenaectomy with colon resection

AIM: to assess early results of pancreatoduodenalectomy with colon resection for cancer.PATIENTS AND METHODS: a retrospective cohort two-center controlled study included 927 patients. The first group included 95 patients after рancreatoduodenalectomy with colon resection. The second group included 832 patients who underwent рancreatoduodenalectomy without resection of adjacent organs. The first group was divided into two subgroups: the first subgroup is patients with malignant neoplasms of the colon — 42, the second subgroup is patients with malignant neoplasms of other sites — 53.RESULTS: the group of patients with рancreatoduodenalectomy and colon resection was significantly more often assessed according to the ECOG 2–3 and ASA 3 (52/95 (54.7%) vs 63/669 (9.4%), p &lt; 0.001 and 25/95 (26.3%) vs 104/669 (15.5%), respectively). The postoperative morbidity rate, as well as their class according to Clavien-Dindo, was homogeneous in both groups. The postoperative mortality rate was higher in the group of рancreatoduodenalectomy with colon resection (13/42 (31.0%) vs 49/832 (5.9%), p = 0.004). When comparing with subgroups, the postoperative mortality rate was comparable between patients after рancreatoduodenalectomy with colon resection for colon cancer and рancreatoduodenalectomy without resection of adjacent organs (3/42 (7.1%) vs 49 / 832 (5.9%), р = 0.7), and was significantly higher in the рancreatoduodenalectomy with colon resection (10/53 (18.9%) vs 49/832 (5,9%), р &lt; 0.001).CONCLUSION: patients in the рancreatoduodenalectomy with colon resection group are clinically more severe, and the operation itself is accompanied by a high rate of postoperative morbidity, but a comparable with рancreatoduodenalectomy in a standard volume, without resection of adjacent organs. Рancreatoduodenalectomy with colon resection for colon cancer is also associated with a comparable rate of postoperative mortality with standard рancreatoduodenalectomy, while рancreatoduodenalectomy with colon resection for cancer of other locations is characterized by a significantly higher level of postoperative mortality.

The Value of Infrapyloric Lymph Nodes Dissection in Right Hemicolectomy for Hepatic Flexure Colon Cancer: A Multicenter Analysis Based on Propensity Score Matching.

There is dispute regarding the necessity of infrapyloric lymph nodes dissection in right hemicolectomy for hepatic flexure colon cancer. To evaluate the risk factors for infrapyloric lymph nodes metastasis and prognostic role of infrapyloric lymph nodes dissection in patients with hepatic flexure colon cancer and identify the population who would benefit from infrapyloric lymph nodes dissection. Retrospective multi-center propensity score matching study to minimize heterogenity between 2 groups. This study was conducted at three medical centers. A total of 531 patients who underwent curative resection for hepatic flexure colon cancer were included. Logistic analysis was used to evaluate risk factors for infrapyloric lymph nodes metastasis and Kaplan-Meier analysis was used to evaluate overall survival. The metastasis rate of infrapyloric lymph nodes among patients undergoing infrapyloric lymph nodes dissection was 11.8% (26/221). Cox multivariate analysis confirmed that infrapyloric lymph nodes dissection was an independent prognostic factor after propensity score matching (hazard ratio 0.60, 95% CI, 0.38 to 0.84; p = 0.007). A proposed flow chart for infrapyloric lymph nodes dissection based on preoperative factors was created. Based on the proposed flow chart, patients with preoperative serum CEA level ≤5.0 ng/ml, cN+, and tumor size ≥5 cm, and patients with preoperative serum CEA level >5.0 ng/ml were defined as high-priority infrapyloric lymph nodes dissection group. The metastasis rate of infrapyloric lymph nodes in the high-priority group was 16.0% (20/125). In the high-priority group, patients undergoing infrapyloric lymph nodes dissection had better survival outcomes than those not undergoing infrapyloric lymph nodes dissection (p = 0.005). This study is limited by its retrospective nature. This study suggests that infrapyloric lymph nodes dissection should be performed in specific patients with hepatic flexure colon cancer. See Video Abstract.

Trajectory Analysis of Healthcare Use Before and after Gastrointestinal Cancer Surgery.

Frailty correlates with worse postoperative outcomes and higher surgical cost, but the long-term impact on healthcare use remains ill-defined. We sought to evaluate patterns of healthcare use pre- and postsurgery among patients with gastrointestinal cancer and characterize the association with frailty. Data on patients who underwent surgical resection for liver, biliary, pancreatic, colon and rectal cancer were obtained from the SEER-Medicare database from 2005 to 2020. Frailty was assessed using the claims-based frailty index. Group-based trajectory modeling identified clusters of patients with discrete patterns of healthcare use. Multivariable regression was performed to predict cluster membership based on preoperative factors, including frailty. Among 66,684 beneficiaries, 4 distinct use trajectories based on data from 12 months before and after surgical resection were identified. After a surge in use during the month of surgical resection, most patients reverted to presurgery baseline use (low: 6,588, 9.9%; moderate: 17,627, 26.4%; and high: 29,850, 44.8%). However, a notable trajectory involving 12,619 (18.9%) patients was identified, wherein surgical resection precipitated a transition from a "low" presurgery use state to a "high" use state postsurgery. Frail patients were more likely to be among those individuals who transitioned to high users (low: 4.2% vs transition: 12.6% vs high: 7.5%; p < 0.001). On multivariable analysis incorporating preoperative variables, frailty was associated with high group trajectory membership (ref: least and moderate; highest: odds ratio 4.90, 95% CI 4.49 to 5.35; p < 0.001). Patients with gastrointestinal cancer demonstrated distinct clusters of healthcare use after surgical resection. Preoperative predictive models may help differentiate different healthcare use trajectories to help tailor care for patients in the postoperative period.

CtDNA/MRD Testing for Colon Cancer: A Work in Progress or Ready for Prime-Time Standard of Care?

In patients with surgically resectable colon cancer (CC), clinicopathologic characteristics translate into cancer staging and predict recurrence risk. Adjuvant chemotherapy reduces the risk of recurrence and is offered to high-risk patients. However, some patients are inevitably overtreated or undertreated; better risk stratification is necessary to improve outcomes after surgery. Circulating tumor DNA (ctDNA)-based minimum residual disease (MRD) assays sequence plasma cell-free DNA for tumor DNA to predict the presence of otherwise subclinical malignancy. Studies have demonstrated that detectable ctDNA after surgery for CC predicts a high rate of recurrence and improves prognostication. Recent clinical trials show promise for using ctDNA to guide therapy, in particular standard-risk stage II CC. Large, randomized studies evaluating ctDNA-guided adjuvant chemotherapy versus standard of care in stage III CC are ongoing. Current data are insufficient to recommend routine use of ctDNA to guide adjuvant chemotherapy in resectable stage III CC.

Long-term outcomes following the resection of screen-detected right-sided colon cancer.

The relative outcomes following the resection of screen-detected right-sided colon cancer compared to symptomatic cases are unknown. In this study, short and long-term outcomes after right-sided colectomy in screen-detected colon cancer are compared with symptomatic cases, both emergency and elective. A prospective observational cohort study of patients, including both screen-detected and symptomatic patients (elective and emergency resections), undergoing right-sided colectomy for colon cancer (2010-2020) in a tertiary care unit was conducted. Each patient was followed up for long-term recurrence and survival. A total of 909 patients (median age, 70; IQR, 58-82; male, 52%) were included (151 patients (16.6%) screen-detected; 598 (65.8%) elective and 160 (17.6%) emergency). Screen-detected patients were more likely to haveT1 or T2 lesions compared to elective and emergency groups (T1: 14.6% vs. 3.8% vs. 0.6% p<0.001; T2: 16.6% vs. 8.9% vs. 3.1% p<0.001), but were less likely to have T3 or T4 lesions (p<0.001), respectively. Rates of N0 were higher in the screen-detected group (68.9% vs. 63.5% vs. 41.9%, respectively; p<0.001). 98% of the screen-detected group achieved R0 resection compared to 93.3% of elective and 79.4% of emergency patients (p<0.001). At 5-years following resection, overall survival for the screen-detected, elective, and emergency groups were 85.4%, 75.4%, and 53.1%, respectively (p<0.001). Recurrence at 5-year post-resection were 8%, 15.1%, and 22.5% for the screen-detected, elective, and emergency groups, respectively (p<0.001). When considering right-sided colon cancer alone, screen-detected cancers have a lower long-term recurrence rate, lower rates of postoperative complication, and superior survival compared to symptomatic groups following resection.

Oncologic outcomes and trends in each colon cancer location and stages over the last two decades: insights from the SEER registry.

The main purpose of the study is to comprehensively evaluate population-level survival disparities stage-by-stage, according to specific anatomical colon segments, and based on prognosis as defined by lymph nodes among patients who have undergone curative resection for non-metastatic colon cancer. The study was conducted from the Surveillance Epidemiology and End Result (SEER) program from the USA. Patients who underwent surgery for colon adenocarcinoma between 2000 and 2019 were identified. Demographics and clinical and pathologic factors were compared amongst each other according to different colon segments, stages, and time periods. A total of 482,672 patients were identified and 195,105 of them met the inclusion criteria. Patients with proximal cancers were significantly older, more likely to be female, had a higher number of lymph nodes, and node positivity (p < 0.001). During the study period, an almost 10% improvement in overall survival rate was observed at 3 and 5years for each colon site and stage (p < 0.05). The study's findings revealed a notable improvement in overall and cancer-specific survival rates across all colon segments and stages in patients who underwent curative treatment for non-metastatic primary colon cancer from a nationwide database.

Phase II trial evaluating the long-term efficacy and peripheral sensory neuropathy of capecitabine plus oxaliplatin (XELOX) as adjuvant therapy in Japanese patients with operated stage III colon cancer

Adjuvant oxaliplatin plus capecitabine (XELOX) therapy is recommended for patients with curatively resected colon cancer. However, prospective data on its practical application in Japanese patients are limited. Therefore, we aimed to conduct a long-term clinical evaluation of the efficacy and safety of adjuvant XELOX in patients with curatively resected stage III colon cancer (MCSCO-1024). This prospective, multi-center, open-label, single-arm, phase II study enrolled patients with curatively resected stage III colon cancer. The treatment protocol consisted of a 120-minute intravenous infusion of oxaliplatin (130 mg/m2) on day 1 and two divided doses oral capecitabine (2000 mg/m2/day) for 14 days in a 3-week cycle, totaling eight cycles (24 weeks). The primary endpoint was 3-year disease-free survival (DFS), and the secondary endpoints were 5-year overall survival and long-term prognosis of peripheral sensory neuropathy. A total of 196 patients were enrolled between November 2011 and August 2014 (34 months). The 3-year DFS rate was 73%, and the 5-year overall survival rate was 87%. The overall incidence of peripheral sensory neuropathy was 17%, with a 1% rate of grade 3 neuropathy after 5 years. Adjuvant XELOX demonstrated utility and safety in the clinical management of Japanese patients with stage III colon cancer.

Risk of metachronous peritoneal metastases after surgery for obstructive colon cancer: Multivariate analysis from a series of 1,085 patients

BackgroundData in the literature suggest that obstruction is an independent predictor of poor prognosis in colon cancer. Of all possible sites of recurrence, peritoneal metastases are associated with worse survival. Our aim was to report the incidence of metachronous peritoneal metastases from a cohort of patients undergoing resection of obstructive colon cancer with curative intent and to identify predictive factors for metachronous peritoneal metastases. MethodsFrom 2000 to 2015, a total of 2,325 patients were treated for obstructive colon cancer in French surgical centers, members of the French National Surgical Association (AFC). Patients with palliative management, synchronous metastatic disease, and with postoperative mortality were excluded. A multivariate analysis was performed to determine independent predictive factors of metachronous peritoneal metastases. ResultsThe cohort included 1,085 patients. The median follow-up was 21.5 months. Metachronous peritoneal metastases occurred in 12% of patients and were diagnosed after a median interval of 13.5 months. The cumulative 3-year metachronous peritoneal metastasis rate was 10.9%. Three-year overall survival was 85% for patients who did not develop recurrence, 71% for those who develop recurrence without peritoneal metastases, and 56% for those with metachronous peritoneal metastases (P < .0001). In multivariate analysis, 3 variables were identified as independent risk factors for metachronous peritoneal metastases: pT4 stage (odds ratio: 1.98; 95% confidence interval: 1.17–3.36; P = .011), pN2 stage (odds ratio: 2.57; 95% confidence interval: 1.89–4.45; P = .0007), and fewer than 12 lymph nodes examined (odds ratio: 2.01; 95% confidence interval: 1.08–3.74; P = .028). ConclusionThis study showed a significant risk of metachronous peritoneal metastases after curative-intent resection of obstructive colon cancer. The awareness of factors predisposing to metachronous peritoneal metastases could improve the treatment strategy of these patients.

Long-term follow-up of the conventional versus no-touch isolation technique for resection of primary colon cancer (JCOG1006): randomized clinical trial.

The Japan Clinical Oncology Group (JCOG) 1006 was a phase III trial of patients with clinical T3/T4 colon cancer comparing the no-touch isolation technique ('No Touch') with the conventional technique ('Conventional'). The planned primary analysis at 3 years failed to confirm the superiority of the No Touch over the 'Conventional'. The present study aimed to compare the 'No Touch' and 'Conventional' using long-term (6-year) follow-up data. Patients aged 20-80 years who had a clinical classification of T3-4, N0-2, and M0 with histologically proven colon cancer were randomly assigned (1 : 1) to undergo open surgery using 'Conventional' or 'No Touch' techniques. The primary endpoint was disease-free survival. In total, 853 patients from 30 institutions were assigned to the 'Conventional' (427) or 'No Touch' (426) groups between June 2011 and November 2015. The 6-year disease-free survival was 70.3% and 69.4% for 'Conventional' and 'No Touch' arms respectively (HR 1.030; 95% c.i. 0.813 to 1.304; one-sided P = 0.60). The 6-year overall survival was 89.4% and 86.6% respectively (HR 1.276; 95% c.i. 0.902 to 1.807). The 6-year relapse-free survival was 78.9% and 75.0% respectively (HR 1.209; 95% c.i. 0.920 to 1.589). The 6-year liver relapse-free survival was 85.1% and 80.2% respectively (HR 1.311; 95% c.i. 0.961 to 1.787). Long-term follow-up data did not support the superiority of 'No Touch' over 'Conventional' technique in patients with stages II and III colon cancer. These study findings indicate that the conventional technique is still standard surgery for managing colon cancers. UMIN000004957.

Colon Cancer With Bladder Invasion: A Single Center Experience.

The aim of our study was to investigate the outcome of colon cancer with bladder invasion after surgical intervention. Between 2011 and 2022, a total of 41 patients diagnosed with colon cancer and bladder invasion underwent surgical procedures at Taichung Veterans General Hospital. The impact of various risk factors on overall survival (OS) was assessed using Kaplan-Meier analyses and Cox proportional hazards models. Among the enrolled patients, 21 underwent radical cystectomy, while 20 underwent partial cystectomy. Twelve had tumors located in the rectum, 19 in the sigmoid colon, and 10 in both the rectum and sigmoid colon. The median OS was 71.8 months in stage 2, 50.8 months in stage 3, and 11.2 months in stage 4 (p=0.061). Median OS was 71.8 months in patients with negative surgical margins and 10.5 months in those with positive surgical margins (p=0.003). In multivariate regression analysis, positive surgical margins [hazard ratio (HR)=3.64, 95% confidence interval (CI)=1.28-10.34, p=0.015] and emergency operations (HR=4.57, 95%CI=1.34-15.55, p=0.015) significantly impacted OS. Complete resection of colon cancer with bladder invasion can yield excellent oncologic outcomes. The decision between partial and radical cystectomy should balance surgical margin clearance and the preservation of quality of life. Both surgical margin involvement and emergency operations are independent risk factors for OS.