Chemokines orchestrate many aspects of tumorigenic processes such as angiogenesis, apoptosis and metastatic spread, and related receptors are expressed on tumor cells as well as on inflammatory cells (e.g., tumor-infiltrating T cells, TILs) in the tumor microenvironment. Expressional changes of chemokines and their receptors in solid cancers are common and well known, especially in affecting colorectal cancer patient outcomes. Therefore, the aim of this current systematic review and meta-analysis was to classify chemokines as a prognostic biomarker in colorectal cancer patients. A systematic literature search was conducted in PubMed, CENTRAL and Web of Science. Information on the chemokine expression of 25 chemokines in colorectal cancer tissue and survival data of the patients were investigated. The hazard ratio of overall survival and disease-free survival with chemokine expression was examined. The risk of bias was analyzed using Quality in Prognosis Studies. Random effects meta-analysis was performed to determine the impact on overall respectively disease survival. For this purpose, the pooled hazard ratios (HR) and their 95% confidence intervals (CI) were used for calculation. Twenty-five chemokines were included, and the search revealed 5556 publications. A total of thirty-one publications were included in this systematic review and meta-analysis. Overexpression of chemokine receptor CXCR4 was associated with both a significantly reduced overall survival (HR = 2.70, 95%-CI: 1.57 to 4.66, p = 0.0003) as well as disease-free survival (HR = 2.68, 95%-CI: 1.41 to 5.08, p = 0.0026). All other chemokines showed either heterogeneous results or few studies were available. The overall risk of bias for CXCR4 was rated low. At the current level of evidence, this study demonstrates that CXCR4 overexpression in patients with colorectal cancer is associated with a significantly diminished overall as well as disease-free survival. Summed up, this systematic review and meta-analysis reveals CXCR4 as a promising prognostic biomarker. Nevertheless, more evidence is needed to evaluate CXCR4 and its antagonists serving as new therapeutic targets.

Purpose: Evidence-based medicine (EBM), precision medicine and interdisciplinarity are becoming increasingly important in medical education. The purposeful connection between EBM and interdisciplinary work is given in the context of a tumor board, since therapy decisions are discussed here in an interdisciplinary team based on current evidence-based guidelines. To date, there has been little focus on either topic. Therefore, we aimed to assess the existing knowledge and offered a practical exercise in terms of a tumor board simulation training for medical students during their surgical study semester. Methods: First, a knowledge test was performed in 4th year medical students (n = 149) addressing the topic of EBM following an evaluation questionnaire. Subsequently, a structured one hour- lecture was held. The students were divided into groups of up to ten and assigned with specific professional roles of tumor board members. Thereafter, students participated in a live simulated tumor board. At the end the same knowledge test and evaluation questionnaire were delivered (n = 163). Study was conducted at Heidelberg Medical University between 2023 and 2024. Results: A significant increase in knowledge was seen before versus after the course only in the primarily better students (p < 0.0001). Almost no difference in knowledge test was seen before and after the course pertaining all students (p = 0.205). Evaluation questionnaire displayed that 45% (n = 66) of the students had not dealt with the topic of EBM before the course. 98% (n = 146) of the students considered that interdisciplinary work in medical profession is very important. Conclusion: Including EBM and precision medicine in a practical way into the medical curriculum is necessarily needed. As only the best students seemed to benefit significantly, a more sustainable approach might be the implementation of a longitudinal precision medicine curriculum.

Introduction: At the beginning of medical school, anatomy courses usually take place on cadavers. Mostly several years of medical training without any further clinically applied anatomical lessons are following. Therefore, we decided to review and refresh students’ knowledge of anatomy with special regard to surgical clinical settings. Methods: An interdisciplinary surgical-based radiology seminar for final year students in their internship year and fourth year students during their surgical semester was performed starting with a surgical-radiological-anatomical knowledge exam. Afterwards, clinical cases were discussed in detail including for example videos from operations and corresponding radiological imaging by specialists from both surgery and radiology. At the end of the seminar, the same knowledge survey and an evaluation questionnaire were carried out. Results: Both final year students and fourth year students showed a significant increase regarding the knowledge questions after the interactive interdisciplinary seminar ( p 0.001). In addition, fourth year student’s post-seminar results were significantly higher than post-seminar results reached by final year students ( p 0.001). Ninety-seven percent of final year students perceived the seminar as useful preparation for the first year as a resident. Conclusion: In summary, this study demonstrates the value of implementing a clinically applied anatomy refresher into the medical curriculum to increase students’ knowledge and better prepare them for their residency.

Purpose: The optimal timing of protective ileostomy closure after rectal cancer surgery remains uncertain. This systematic review and meta-analysis compares early (EC) versus late closure (LC) and evaluates the associated risks and benefits. Methods: Medline, Web of Science, and CENTRAL were searched for RCTs published up to May 2025 that compared EC (≤ 30 days after creation) with LC (≥ 12 weeks after creation) following rectal cancer surgery. Results: Nine RCTs including 387 patients (EC: 195, LC: 192) were analyzed. We found no significant difference between the two groups regarding intraoperative blood loss, operation time, length of hospital stay, overall postoperative morbidity, major complications, anastomotic leakage, readmission, perioperative mortality, administration of adjuvant chemotherapy, occurrence of LARS, and quality of life. However, the EC group showed a tendency toward better functional outcomes in terms of shorter time to first passage of flatus ( p < 0.001). Additionally, one RCTs reported a significant, yet clinically irrelevant delay in initiation of adjuvant chemotherapy in the EC group ( p < 0.001). Two RCTs demonstrated a significant cost reduction in the EC group – lower costs of stoma bags over the treatment period ( p < 0.001) and lower total cost at 12 months following the initial rectal resection ( p < 0.001). Conclusion: EC can be considered a safe and feasible alternative to LC in carefully selected patients. However, caution is required in treating high-risk patients, and further research is necessary in order to identify potential risk factors that may predict unfavorable outcomes.