BACKGROUND Simultaneous resection of colorectal cancer liver metastases (CRLM) has been widely adopted; however, clinical efficacy still varies across different surgical approaches, and the best surgical strategy remains controversial. AIM To investigate the efficacy and safety of laparoscopic hybrid surgery (LHS) vs total open surgery (TOS) the in simultaneous resection of CRLM. METHODS This was an observational study conducted at a tertiary medical center, enrolling 266 patients who undergoing simultaneous resection of CRLM from January 2017 to June 2021. The surgical approach was selected by colorectal surgeons and hepatobiliary surgeons based on their experience with either TOS or LHS. The primary outcomes were the incidence of complications, and postoperative recovery related outcomes. The secondary outcomes were 5-year overall survival and disease-free survival. RESULTS This study ultimately enrolled 144 patients in the LHS group and 122 patients in the TOS group. The complication rate was significantly lower in the LHS group than in the TOS group (10.4% vs 20.5%, P = 0.022). Compared with the TOS group, patients in the LHS group had shorter postoperative hospital stay [8.00 (6.00, 10.00) days vs 9.00 (8.00, 12.00) days, P < 0.001], earlier resumption of liquid intake [3.00 (3.00, 3.00) days vs 4.00 (3.00, 4.00) days, P < 0.001], and less intraoperative blood loss [300.00 (200.00, 400.00) mL vs 500.00 (500.00, 700.00) mL, P < 0.001]. However, the LHS group was associated with a longer operative time [260.00 (236.00, 320.00) minutes vs 240.00 (195.00, 269.00) minutes, P < 0.001]. No significant differences were observed in overall survival (P = 0.464) or disease-free survival (P = 0.838). CONCLUSION Compared with TOS, LHS for simultaneous resection of CRLM results in faster postoperative recovery, lower complication rates, and similar survival outcomes.
BACKGROUND Neoadjuvant chemoradiotherapy is the standard treatment for locally advanced rectal cancer (LARC) and effectively reduces local recurrence; however, its survival benefit remains limited and radiotherapy is associated with substantial acute and long-term toxicities. Increasing evidence suggests that not all patients benefit equally from radiotherapy, particularly those without high-risk features such as cT4b disease, involved mesorectal fascia, or lateral lymph node metastasis. Meanwhile, immunotherapy alone shows limited efficacy in mismatch repair-proficient tumors. We hypothesized that combining chemotherapy with immunotherapy could provide a feasible radiotherapy-free neoadjuvant strategy for selected patients. AIM To evaluate the feasibility, efficacy, and safety of radiotherapy-free neoadjuvant sintilimab plus chemotherapy in resectable LARC. METHODS This multicenter, single-arm phase II trial enrolled patients with resectable LARC. Participants received 2-4 cycles of neoadjuvant sintilimab combined with XELOX, followed by total mesorectal excision. Patients with radiotherapy-mandating high-risk features were not the primary target population. Pathological response and safety were assessed. Multivariate logistic regression was used to explore predictors of major pathological response (MPR), and multiplex immunofluorescence was performed to evaluate tumor immune microenvironmental features. RESULTS A total of 41 patients underwent surgery, and all achieved R0 resection. The pathological complete response was observed in 11 patients (26.8%), and MPR was in 19 patients (46.3%). The objective response rates was 85.4%. T-stage and N-stage downstaging occurred in 41.5% of patients, with concurrent TN downstaging in 26.8%. Treatment-related adverse events were predominantly grade 1-2, with one case each of grade 3 immune-related rash and colitis. Multivariate analysis identified tumor size > 4 cm (odds ratio = 6.51, 95% confidence interval: 1.23-45.2; P = 0.036) and elevated baseline carcinoembryonic antigen (odds ratio = 0.12, 95% confidence interval: 0.01-0.73; P = 0.035) as independent negative predictors of MPR. Immunofluorescence analysis showed increased stromal CD8+ T-cell infiltration and reduced M2 macrophage polarization in responders. CONCLUSION Radiotherapy-free neoadjuvant sintilimab plus XELOX shows promising pathological responses and manageable toxicity in selected patients with LARC.
