Background: Postoperative infectious complications (ICs) after surgery for colorectal cancer (CRC) increase in-hospital deaths and decrease long-term survival. However, the methodology for IC preoperative and intraoperative risk assessment has not yet been established. We aimed to construct a risk model for IC after surgery for CRC. Methods: Between January 2016 and June 2020, a total of 593 patients who underwent curative surgery for CRC in Chengdu Second People’s Hospital were enrolled. Preoperative and intraoperative factors were obtained retrospectively. The least absolute shrinkage and selection operator (LASSO) method was used to screen out risk factors for IC. Then, based on the results of LASSO regression analysis, multivariable logistic regression analysis was performed to establish the prediction model. Bootstraps with 300 resamples were performed for internal validation. The performance of the model was evaluated with its calibration and discrimination. The clinical usefulness was assessed by decision curve analysis (DCA). Results: A total of 95 (16.0%) patients developed ICs after surgery for CRC. Chronic pulmonary diseases, diabetes mellitus, preoperative and/or intraoperative blood transfusion, and longer operation time were independent risk factors for IC. A prediction model was constructed based on these factors. The concordance index (C-index) of the model was 0.761. The calibration curve of the model suggested great agreement. DCA showed that the model was clinically useful. Conclusion: Several risk factors for IC after surgery for CRC were identified. A prediction model generated by these risk factors may help in identifying patients who may benefit from perioperative optimization.

Background: The clinicopathological and molecular characteristics of early-onset colorectal cancer (EOCRC) are unclear. In this study, we compared the clinicopathological features, biomarkers, and prognoses between EOCRC and late-onset colorectal cancer (LOCRC). Methods: A search was conducted on PubMed, Web of Science, Embase, and Cochrane Library from inception to May 2024. The key outcomes were clinicopathological features, prevalence of molecular biomarker alterations, and 5-year overall survival (OS), with pooled odds ratios (ORs) and hazard ratios (HRs), along with their corresponding 95% confidence intervals (CIs), calculated for each outcome. Results: Forty studies were included in the final analysis. EOCRC exhibited distal colon and rectum localization (OR: 0.59; 95% CI: 0.55–0.62; P < 0.001), was poorly differentiated (OR: 0.56; 95% CI: 0.52–0.60; P = 0.01), tended to be more mucinous or signet-ring cell carcinoma (OR: 0.56; 95% CI: 0.52–0.60; P < 0.001), and was associated with advanced stages (OR: 1.49; 95% CI: 1.30–1.71; P < 0.001), lymph node metastasis (LNM) (OR: 0.56; 95% CI: 0.53–0.60; P < 0.001), and distant metastasis (OR: 1.29; 95% CI: 1.04–1.60; P = 0.02). EOCRC exhibited higher TP53 mutation rates (OR: 1.33; 95% CI: 1.13–1.58; P < 0.001), MSI-H status (OR: 1.45; 95% CI: 1.10–1.92; P = 0.01), but lower PIK3CA mutation rates (OR: 0.93; 95% CI: 0.88–0.99; P = 0.03). EOCRC and LOCRC had similar 5-year OS rates (HR: 1.01; 95% CI: 0.79–1.30; P = 0.92). Although no significant difference was observed in the APC, BRAF, KRAS, NRAS, SM4D4, and MMR, subgroup analyses revealed that BRAF ( P = 0.01), KRAS mutations ( P < 0.001), and DNA hypermethylation ( P = 0.01) were less prevalent among westerners. Conclusion: EOCRC often presents with more aggressive and metastatic features due to its frequent diagnosis at advanced stages. TP53 mutations and the MSI-H status are prevalent in EOCRC. EOCRC’s prognosis is often comparable to LOCRC. Radical and tailored treatment strategies should be developed to improve the survival outcomes in advanced and metastatic EOCRC.

BACKGROUND: There is a dispute regarding the necessity of infrapyloric lymph node dissection in right hemicolectomy for hepatic flexure colon cancer. OBJECTIVE: To evaluate the risk factors for infrapyloric lymph node metastasis and the prognostic role of infrapyloric lymph node dissection in patients with hepatic flexure colon cancer and identify the population of patients who would benefit from infrapyloric lymph node dissection. DESIGN: Retrospective multicenter propensity score matching study to minimize heterogeneity between 2 groups. SETTINGS: This study was conducted at 3 medical centers. PATIENTS: A total of 531 patients who underwent curative resection for hepatic flexure colon cancer were included. MAIN OUTCOME MEASURES: The primary outcome measure was the metastasis rate of infrapyloric lymph nodes, whereas secondary outcome measure included overall survival. Logistic regression analysis was used to identify risk factors, and Kaplan-Meier analysis was used to evaluate survival outcomes. RESULTS: The metastasis rate of infrapyloric lymph nodes among patients undergoing infrapyloric lymph node dissection was 11.8% (26/221). Cox multivariate analysis confirmed that infrapyloric lymph node dissection was an independent prognostic factor after propensity score matching (HR 0.60; 95% CI, 0.38–0.84; p = 0.007). A proposed flowchart for infrapyloric lymph node dissection based on preoperative factors was created. Based on the proposed flowchart, 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 identified as the high-priority infrapyloric lymph node 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 node dissection had better survival outcomes than those not undergoing infrapyloric lymph node dissection (p = 0.005). LIMITATIONS: This study is limited by its retrospective nature. CONCLUSIONS: This study suggests that infrapyloric lymph node dissection should be performed in specific patients with hepatic flexure colon cancer. See Video Abstract. EL VALOR DE LA DISECCIÓN DE LOS GANGLIOS LINFÁTICOS INFRA PILÓRICOS EN LA HEMICOLECTOMÍA DERECHA PARA EL CÁNCER DE COLON DEL ANGULO HEPÁTICO: UN ANÁLISIS MULTICÉNTRICO BASADO EN EL EMPAREJAMIENTO POR PUNTAJE DE PROPENSIÓN: ANTECEDENTES: Existe controversia sobre la necesidad de la disección de los ganglios linfáticos infra pilóricos en la hemicolectomía derecha por cáncer de colon del ángulo hepático. OBJETIVO: Evaluar los factores de riesgo de metástasis de los ganglios linfáticos infra pilóricos y el papel pronóstico de la disección de los ganglios linfáticos infra pilóricos en pacientes con cáncer de colon del ángulo hepático e identificar la población que se beneficiaría de la disección de los ganglios linfáticos infra pilóricos. DISEÑO: Estudio retrospectivo multicéntrico de emparejamiento por puntaje de propensión para minimizar la heterogeneidad entre dos grupos. AJUSTE: Estudio realizando en tres centros médicos. PACIENTES: Un total de 531 pacientes sometidos a una resección curativa por cáncer de colon del ángulo hepático. PRINCIPALES MEDIDAS DE RESULTADO: Se utilizó un análisis logístico para evaluar los factores de riesgo de metástasis de los ganglios linfáticos infra pilóricos y se utilizó el análisis de Kaplan-Meier para evaluar la supervivencia general. RESULTADOS: La tasa de metástasis de los ganglios linfáticos infra pilóricos entre los pacientes sometidos a disección de ganglios linfáticos infra pilóricos fue del 11,8 % (26/221). El análisis multivariable de Cox confirmó que la disección de ganglios linfáticos infra pilóricos era un factor pronóstico independiente después de la comparación por puntuación de propensión (cociente de riesgos instantáneos 0,60; IC del 95 %, 0,38 a 0,84; p = 0,007). Se creó un diagrama de flujo propuesto para la disección de ganglios linfáticos infra pilóricos basado en factores preoperatorios. Con base en el diagrama de flujo propuesto, los pacientes con un nivel de CEA sérico preoperatorio ≤5,0 ng/ml, cN+ y un tamaño tumoral ≥5 cm, y los pacientes con un nivel de CEA sérico preoperatorio >5,0 ng/ml se definieron como grupo de disección de ganglios linfáticos infra pilóricos de alta prioridad. La tasa de metástasis de los ganglios linfáticos infra pilóricos en el grupo de alta prioridad fue del 16,0 % (20/125). En el grupo de alta prioridad, los pacientes sometidos a disección de ganglios linfáticos infra pilóricos tuvieron mejores resultados de supervivencia que aquellos que no se sometieron a disección de ganglios linfáticos infra pilóricos (p = 0,005). LIMITACIONES: Estudio limitado por su naturaleza retrospectiva. CONCLUSIONES: El estudio sugiere que la disección de ganglios linfáticos infra pilóricos se debe realizar en pacientes específicos con cáncer de colon del ángulo hepático. (Traducción: Dr. Fidel Ruiz Healy)

Anastomotic leakage (AL) is a serious complication of low anterior resection (LAR) of rectal cancer. While ileostomy is the most commonly used method for AL alleviation, it has associated risks of permanent stoma and stoma-related complications, and also requires additional surgery. The aim of this study was to explore the use of a novel technique to protect the anastomosis after LAR. Sixty-five patients were randomly assigned to an LAR combined with degradable stent group ( n = 32) or an LAR combined with ileostomy group ( n = 33). The study was conducted between January 2023 and December 2024. Demographic information, laboratory findings, surgical results, and tumor characteristics were recorded. One case of anastomotic stricture (3%) and four cases of intestinal obstruction (12.5%) were observed in the LAR + degradable stent group, and two cases of intestinal obstruction (6%) occurred in the LAR + ileostomy group. No complications, such as abscesses, bleeding, bowel perforation, and anastomotic leakage, were observed in either group. There was no difference in short-term postoperative complications between patients treated with degradable stent or ileostomy, suggesting that the potential of degradable stents as a novel method of preventing anastomotic leakage after low anterior resection of rectal cancer.

Background: Laparoscopic rectal resection may cause various surgical complications including perineal hernia and adhesive small-bowel obstruction. Pelvic peritoneum reconstruction (PPR) could prevent those complications. The aim of the study is to evaluate the short-term clinical, technical and safety outcomes of PPR using the barbed suture in laparoscopic rectal resection. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. Between January 2014 and December 2019, a total of 402 patients who underwent curative surgery for rectal cancer in Chengdu Second People’s Hospital were enrolled in the study. Among them, 216 patients who underwent laparoscopic rectal resection with PPR were allocated into the experimental group, and 186 patients who underwent laparoscopic rectal resection without PPR were allocated into control group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. The data were represented by X ± s. t-test and X² test were used for counting data. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion We hypothesized that pelvic peritoneum reconstruction with barbed suture could improve the efficiency of intracorporeal closure of the pelvic cavity after in laparoscopic rectal resection, which can significantly reduce postoperative perineal-related complications. Further, we expect that use of the barbed sutures will reduce intra-operative stress on the endoscopic surgeon.

Objective: This study aimed to evaluate the safety and short-term outcomes of pelvic peritoneum reconstruction with barbed sutures in laparoscopic rectal resection for rectal cancer. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. The clinicopathological data of 402 patients with rectal cancer admitted to our department hospital from January to December 2019 were collected. There was total of 402 patients, including 218 males and 174 females, with an average age of 68 years. Among them, 216 patients who underwent laparoscopic rectal resection with pelvic peritoneum reconstruction (PPR) were allocated into the PPR group, and 186 patients who underwent conventional laparoscopic rectal resection were allocated into a non-PPR group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion pelvic peritoneum reconstruction with barbed suture in laparoscopic rectal resection is safe and feasible for the treatment of rectal cancer, which can significantly reduce postoperative perineal-related complications.