Endoscopic submucosal dissection offers effective long-term outcomes for T1 colorectal cancer, but high-risk patients may benefit from additional surgery. In a study of 383 T1 CRC patients, the 5-year local recurrence rate was 6.8% in high-risk follow-up patients vs. 0% in those who had surgery (p<0.001). Overall survival at 5 years was significantly lower for […]
Category: Intestine and Lower Gastrointestinal Tract
Impact on Urinary Function After Laparoscopic Surgery for Rectal Cancer
Short-term urinary dysfunction is common after laparoscopic surgery for low rectal cancer, especially in older patients and those undergoing abdominoperineal resection. 78 patients experienced short-term voiding dysfunction, linked to longer surgery duration. Patients aged over 75 had significantly worse urinary function post-surgery, with no recovery over time for those undergoing abdominoperineal resection. Surgeons should consider […]
Improved Technique for Chronic Anal Fissures
Probe-guided intersphincteric lateral internal sphincterotomy shows significant promise for treating chronic anal fissures, enhancing surgical precision and outcomes. Achieved 96.4% healing rate within 4 weeks in 165 cases, with only 2 recurrences. Complications remained low: no incontinence or keyhole deformities reported, and only 2.4% required drainage revision. This technique allows for effective management of complex […]
Surveillance strategies for colorectal cancer need improvement
A microsimulation model shows that surveillance for colorectal cancer recurrences yields suboptimal detection rates post-surgery. Over 5 years, recurrence rates were 9.5% for colon cancer and 38% for rectal cancer, with 82.5% and 85.5% detected, respectively. Detecting one recurrence requires 148 CEA tests, 37 CT scans, and 21 colonoscopies for colon cancer, versus 31 CEA […]
Tumor Debulking in Multiorgan Metastatic Colorectal Cancer Fails to Improve Survival
Combining tumor debulking with palliative chemotherapy in multiorgan metastatic colorectal cancer does not enhance patient survival. Median overall survival was 27.5 months for chemotherapy alone versus 30.0 months with tumor debulking (p=0.26). Serious adverse events were higher in the debulking group (53% vs 39%, p=0.006). Debulking should not become standard practice as it offers no […]
Effective Therapy Improves Outcomes in Advanced Rectal Cancer
Total neoadjuvant therapy (TNT) with short-course radiotherapy shows promise for locally advanced rectal cancer patients. After a median follow-up of 6.5 years, locoregional recurrence was just 5.9% and distant metastasis occurred in 24.7% of curatively treated patients. Patients with complete clinical responses had exceptional outcomes: 0% experienced locoregional recurrence and only 3.7% had distant metastasis. […]
High Concordance of cfDNA and Tumor Profiling in Appendiceal Cancer
This study shows that circulating tumor DNA (ctDNA) can accurately reflect the genetic profile of appendiceal cancer, which is crucial for surgical decision-making. ctDNA from plasma matched tumor genomic profiling with 98.4% concordance overall and 85.7% for actionable mutations. Key mutations found: KRAS (41%), GNAS (30%), TP53 (30%), and SMAD4 (29%). High-grade tumors are linked […]
Colorectal Cancer Liver Metastases Reveal Care Disparities
Surgical intervention for liver metastases in colorectal cancer is underutilized among disadvantaged groups, impacting outcomes. Only 18% of analyzed patients received hepatectomy or ablation, with non-Hispanic Black and Hispanic/Latino patients 17% less likely to undergo intervention. Patients at academic centers were 2.24 times more likely to receive surgical treatment than those at community programs. Higher […]
Circular Staplers Show No Leak Rate Advantage in Colorectal Surgery
Using powered circular staplers in left-sided colorectal anastomoses does not significantly reduce anastomotic leaks compared to manual staplers. Analysis of 9 studies with over 3,100 patients found no significant difference in leak rates (RR 0.56) or morbidity (RR 0.84). However, powered staplers showed a significantly lower rate of post-operative bleeding (RR 0.20, p < 0.001). […]
Endoscopic Closure vs. Surgery for Colonic Perforations
Endoscopic closure may be a viable first-line approach for select iatrogenic colonic perforations. No difference in treatment success between endoscopic closure and surgery (RR 1.00, 95% CI 0.94-1.06). Endoscopy was generally used for smaller, immediately recognized injuries, while surgery was preferred for larger, delayed presentations. In ideal candidates (perforations <2 cm with no peritonitis), endoscopy […]