March is Colorectal Cancer Awareness Month.
In recognition, we present seven of the most important colorectal cancer studies published in BJS and BJS Open over the past year. These articles highlight significant advancements in the understanding and management of colorectal cancer, covering topics such as surgical innovations, oncological outcomes, and prognostic markers. This collection showcases the latest research aimed at improving patient care and survival.
Explore these key contributions to the field and join us in raising awareness of colorectal cancer this March.
______
BJS highlights:
______
Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study
This nationwide cohort study analysed 14,154 patients with colorectal cancer who underwent curative surgery (2016–2019) to assess the prognostic impact of tumour deposit (TD) count. Using univariable and multivariable Cox regression analyses, the study found that an increasing TD count was associated with reduced 5-year overall survival (down to 49%) and a higher risk of distant metastasis (up to 54%). TD count remained an independent negative prognostic factor regardless of lymph node status or neoadjuvant treatment. The findings support integrating TD count into the TNM staging system to improve prognostic accuracy.
Read the paper.
______
Survival and safety after neoadjuvant chemotherapy or upfront surgery for locally advanced colon cancer: meta-analysis
This systematic review and meta-analysis included seven studies with 2,120 patients to assess the impact of neoadjuvant chemotherapy on oncological outcomes in locally advanced colon cancer. Neoadjuvant chemotherapy was associated with a significantly lower hazard of recurrence (HR 0.73) and death (HR 0.67), along with improved 5-year overall survival (79.9% vs. 72.6%) and disease-free survival (73.1% vs. 64.5%) compared to upfront surgery. No significant differences were observed in perioperative mortality or complications, but neoadjuvant chemotherapy reduced the risk of incomplete resection. These findings support its use as a beneficial treatment strategy in locally advanced colon cancer.
Read the paper.
______
Nationwide standardization of minimally invasive right hemicolectomy for colon cancer and development and validation of a video-based competency assessment tool (the Right study)
This study used the Delphi method to establish a national consensus on a standardized minimally invasive right hemicolectomy (MIRH) technique for colon cancer among 76 colorectal surgeons from 43 centres. After three rounds, consensus was reached on 23 of 24 statements, including key surgical principles such as low intra-abdominal pressure and intracorporeal anastomosis. A video-based competency assessment tool (CAT) was developed and validated, demonstrating excellent interrater reliability (ICC 0.923). These findings support the implementation of a standardized MIRH technique as part of a nationwide quality improvement initiative.
Read the paper.
______
Surgical stress response in robot-assisted versus laparoscopic surgery for colon cancer (SIRIRALS): randomized clinical trial
This double-blinded RCT compared robot-assisted and laparoscopic surgery for stage 1–3 colon cancer, assessing systemic stress response and clinical outcomes. Among 50 patients analysed, the laparoscopic group exhibited a significantly higher postoperative C-reactive protein response on day one (mean difference = 19.88 mg/L; P = 0.045), though no differences were observed on subsequent days. No significant differences were found in complications or patient-reported outcomes. These findings suggest that robot-assisted surgery may reduce the early postoperative inflammatory response in colon cancer surgery.
Read the paper.
______
BJS Open highlights:
______
Long-term follow-up of the conventional versus no-touch isolation technique for resection of primary colon cancer (JCOG1006): randomized clinical trial
This randomized clinical trial (JCOG1006) compared the no-touch isolation technique (NTIT) with conventional resection in patients with T3/T4 colon cancer. The 6-year follow-up demonstrated no significant difference in disease-free survival (70.3% vs. 69.4%), overall survival, or relapse-free survival between the two techniques. Despite earlier hypotheses that NTIT might reduce cancer spread, these results confirm that conventional surgery remains the standard for curative-intent colon cancer resection.
Read the paper.
______
Total mesorectal excision quality in rectal cancer surgery affects local recurrence rate but not distant recurrence and survival: population-based cohort study
This population-based cohort study analysed how the quality of total mesorectal excision (TME) influences recurrence and survival in rectal cancer surgery. While poor TME quality (muscularis propria resection) was associated with increased local recurrence risk (HR 2.73, P = 0.036), it had no significant impact on distant recurrence or overall survival. Key risk factors for lower-quality TME included low tumour location, female sex, minimally invasive surgery, and abdominoperineal resection.
Read the paper.
______
Estimation of the postoperative fatality window in colorectal cancer surgery
This nationwide Swedish cohort study examined postoperative mortality after colorectal cancer resection, using statistical modelling to determine the optimal time frame for assessing surgical outcomes. While 30-day and 90-day mortality rates were 1.43% and 2.60%, respectively, the study found that the postoperative fatality risk stabilizes around 24 days after surgery. This supports the use of the 30-day benchmark but suggests increased vigilance for older and high-risk patients.
Read the paper.
.png)
.jpg){kind=logo}
