Effect of Denonvilliers’ fascia preservation versus resection during laparoscopic total mesorectal excision on postoperative urogenital function of male rectal cancer patients. Initial results of Chinese PUF-01 randomized clinical trial.

Leite RMA, Seo DJ, Gomez-Eslava B, Hossain S, Lesegretain A, de Souza AV et al.

JAMA Surg. ;157: 828-834.

This analysis of eight RCTs showed that the main outcomes were similar: successful treatment at 30 days, major adverse events. The non-operative group had a longer hospital stay and a higher rate of recurrent appendicitis (18 per cent).

Comment: Useful data to help clinicians use an individualised approach.

van der Kruijssen DEW, Elias SG, Vink GR, van Rooijen KL, Lam-Boer J, Mol L, et al for the CAIRO4 Working Group.
JAMA Surg 2021; 156: 1093-1101.

This study included 196 patients with metastatic colorectal cancer, and few or no symptoms from the primary. At 60 days, mortality rates were higher in those who had surgery as well as chemotherapy: 3 versus 11 per cent, P=0.03.

Comment: These results are of interest, but the real question is whether additional surgery provides a later benefit.

Prudhomme, M, Rullier E, Lakkis Z, Cotte E, Panis Y et al.
Ann Surg 2021; 274: 928-934.

There was no difference in the rates of stomal hernia after 24 months in this study that finally included 135 procedures: 31 per cent versus 28 per cent without mesh. There were no mesh infections.

Comment: It is interesting that there have been numerous RCTs, but with very variable results. This makes it difficult to conduct a systematic analysis, and to provide definitive recommendations.