Parastomal hernia (PSH) is one of the most frequent long-term complications following abdominoperineal resection (APR) for rectal cancer. The optimal colostomy route to minimize PSH remains controversial. This study aimed to compare PSH risk between extraperitoneal colostomy (EPC) and transperitoneal colostomy (TPC) after laparoscopic APR. A retrospective cohort study was conducted including patients who underwent laparoscopic APR for rectal cancer between 2014 and 2017. Patients were categorized according to colostomy route (EPC vs. TPC). The primary endpoint was PSH, and secondary endpoints included other short- and long-term stoma-related complications and perioperative outcomes. Propensity score matching (1:3) was applied to balance baseline characteristics. Risk factors for PSH were further analyzed using logistic regression. A total of 464 patients were included. After matching, 102 patients in the EPC group and 243 in the TPC group were analyzed. Perioperative outcomes and overall stoma-related complication rates were comparable between groups. However, PSH occurred less frequently in the EPC group than in the TPC group (10/102 [9.8

Purpose Natural orifice specimen extraction surgery (NOSES) has emerged as a minimally invasive technique in colorectal cancer treatment, offering improved postoperative recovery and cosmetic outcomes. Building upon previous editions, this third edition guideline aims to update and refine technical classifications, indications, and procedural standards based on the latest evidence and accumulated clinical experience. Methods This guideline was jointly developed by the Colorectal Cancer Committee of the China Anti-Cancer Association and the International Alliance of NOSES, incorporating recent multicenter data, consensus discussions, and advancements in laparoscopic and robotic techniques. This updated guideline was developed through an expert consensus–based revision process informed by comprehensive literature review and available multicenter clinical evidence, and was finalized after iterative discussion and approval by the guideline steering committee. Results This edition provides targeted updates from the previous version, including refined recommendations on preoperative assessment and acknowledgment of robotic assistance. Adjustments to surgical classifications, indications, and procedural descriptions have also been made to enhance clarity and clinical applicability. Conclusion This updated guideline provides a structured and practical reference for colorectal NOSES procedures, supporting wider adoption and continued surgical advancement.

BACKGROUND:Parastomal hernia (PSH) is a frequent complication of abdominoperineal resection (APR), yet large-scale studies characterizing its long-term incidence and tools for individualized risk stratification remain lacking. To determine the long-term incidence, independent risk factors, and develop a clinical prediction model for PSH after APR in rectal cancer patients. METHODS:We conducted a retrospective cohort study of 836 patients with rectal adenocarcinoma who underwent APR and permanent end colostomy at a high-volume tertiary center (2014-2018). PSH was diagnosed according to the European Hernia Society criteria. Independent risk factors were identified using Cox regression, and a nomogram was developed to predict 1- to 5-year PSH probabilities. Model discrimination was assessed using time-dependent AUC. RESULTS:During a median follow-up period of 85 months, 207 patients (24.8%) developed PSH, with a cumulative incidence of 26.2% at 5 years. Independent risk factors included female sex (HR = 2.28, 95% CI: 1.73-3.01), age ≥ 60 years (HR = 5.17, 95% CI: 3.72-7.18), BMI ≥ 24 kg/m2 (HR = 2.10, 95% CI: 1.57-2.80), and transperitoneal stoma route (HR = 4.11, 95% CI: 2.63-6.41; all P < 0.001). The nomogram demonstrated strong discrimination with 1-, 2-, 3-, 4-, and 5-year AUCs of 0.65, 0.70, 0.76, 0.80, and 0.83, respectively. CONCLUSION:This study provides evidence on PSH incidence and risk factors, introducing a nomogram for personalized risk stratification. The nomogram allows clinicians to identify high-risk patients and tailor preventive strategies, such as extraperitoneal stoma creation or prophylactic mesh placement, to reduce PSH burden.

Randomized controlled trials have revealed that abdominoperineal resection leads to inferior oncological outcomes compared with low anterior resection, especially regarding local recurrence rates (LRRs). While neoadjuvant chemoradiotherapy can lower LRRs, it is linked to potential short- and long-term radiation-induced adverse effects. Consequently, meticulous patient selection for neoadjuvant chemoradiotherapy is imperative to balance benefits and risks. This research encompassed individuals with rectal cancer (RC) who underwent abdominoperineal resection (APR) from January 2006 to December 2017. The cohort was categorized into two cohorts on the basis of tumor location: the anterior cohort and the nonanterior cohort. Propensity score matching (PSM) was employed to mitigate selection bias, and this resulted in 767 patients in both cohorts. The primary endpoint assessed was survival without local recurrence (LR). Of the 2025 cases examined, 1806 were deemed eligible for inclusion. In the entire cohort, the incidence of LR was 9.9

Background:The incidence of colorectal cancer (CRC) has been escalating, with a concurrent rise in early-onset colon cancer (EOCC). Despite this alarming trend, the prognosis of EOCC has been understudied. Our study aims to identify risk factors associated with EOCC and develop nomograms for predicting overall survival (OS) and cancer-specific survival (CSS), with the goal of choosing suitable therapy for various patient subgroups. Methods:Utilizing data from the Surveillance, Epidemiology, and End Results (SEER) database, we conducted a comprehensive analysis to elucidate risk factors in EOCC patients. We developed and validated nomograms to predict OS and CSS, stratifying patients into left-sided and right-sided groups and further categorizing them into distinct risk categories. After propensity score matching, we assessed therapeutic benefits of various interventions across subgroups. Results:We identified T stage, tumor histology, grade, size, N stage, carcinoembryonic antigen (CEA) levels, perineural invasion, tumor deposits, and race as independent risk factors for the left-sided group through univariate and multivariate Cox regression analyses. Those factors were integrated into the survival nomograms for this group. For the right-sided group, tumor histology, grade, N stage, CEA levels, perineural invasion, tumor deposits, radiation, and chemotherapy were identified as independent prognostic factors and were similarly incorporated into the survival nomograms. The concordance index (C-index) for our nomograms was significantly higher than that of the American Joint Committee on Cancer (AJCC) 7th edition staging system across all cohorts. Receiver operating characteristic (ROC) curve analysis demonstrated area under the curve (AUC) values of 0.72, 0.71, and 0.71 for 1-, 3-, and 5-year OS in the development cohort of the left-sided group, with comparable results in the validation cohort. The right-sided groups exhibited similarly favorable AUC outcomes. Calibration plots indicated a strong correlation between predicted and actual outcomes. Decision curve analysis (DCA) revealed the clinical utility of our nomograms to be superior to the AJCC 7th edition staging system. Analyses for CSS yielded analogous results. Kaplan-Meier curves highlighted significant differences in OS and CSS between low and high-risk groups. Notably, the right-sided groups derived greater benefits from adjuvant chemotherapy compared to the left-sided groups, whereas radiation therapy provided no discernible benefits across all subgroups. Conclusions:Our study provides a comprehensive prognostic evaluation of EOCC patients and uses nomograms for predicting OS and CSS in left-sided and right-sided groups. Subgroup analyses underscore the potential advantages of adjuvant chemotherapy in high-risk groups of both cohorts and the low-risk group of the right-sided cohort. These findings may inform the optimization of therapeutic strategies for EOCC patients.

Background:Locally advanced rectosigmoid junction cancer (LARSJC) presents unique challenges in prognosis and treatment due to its anatomical ambiguity between the colon and rectum. Current staging systems may not sufficiently capture the heterogeneity of LARSJC, highlighting a clinical need for more accurate prognostic tools to guide treatment decisions and improve patient outcomes. This study aimed to investigate risk factors and develop nomograms for LARSJC patients to improve clinical outcomes across diverse patient subgroups. Methods:We developed and validated nomograms to predict overall survival (OS) and cancer-specific survival (CSS) in LARSJC patients using data from the Surveillance, Epidemiology, and End Results (SEER) database (2010-2017). Patients with stage II and III LARSJC were included, excluding those with multiple primary cancers or incomplete data. Potential predictors, including age, sex, tumor stage, grade, size, carcinoembryonic antigen (CEA) levels, and perineural invasion, were assessed. OS and CSS were measured from diagnosis to death or last follow-up. The dataset was randomly split into a 7:3 ratio for training and validation. Predictive accuracy was assessed using C-index, receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results:T stage, N stage, poor tumor grade, larger tumor size, age, tumor histology, positive CEA level, tumor deposits, perineural invasion, chemotherapy, and therapy sequence were selected as independent risk factors by univariate and multivariate Cox regression analyses and included in the OS nomogram model. The C-index of the OS nomogram in the training set (0.74; 95% CI: 0.72-0.76) and testing set (0.75; 95% CI: 0.73-0.77) were significantly higher than that of the American Joint Committee on Cancer (AJCC) 7th staging system (0.63; 95% CI: 0.61-0.66). The ROC curve with the calculated area under the curve (AUC) in the development cohort was 0.790, 0.782, and 0.762 for 1-, 3-, and 5-year OS, respectively. The AUC in the validation cohort was 0.752, 0.742, and 0.703 for 1-, 3-, and 5-year OS, respectively. The calibration plots for both cohorts demonstrated good agreement between actual clinical observations and predicted outcomes for 1-, 3-, and 5-year OS. In the training cohort, DCA showed that the nomogram prediction model was more advantageous for clinical application than the AJCC 7th staging system. Kaplan-Meier curves in the low and high groups showed significant differences in OS. Similar results were observed for CSS. Conclusions:This study provided a comprehensive prognostic analysis of LARSJC patients, developing nomograms that may assist in personalizing treatment plans. Limitations included the retrospective nature of the study and potential missing data in the SEER database. Future researches should focus on validating these models in prospective studies and incorporating additional biomarkers to enhance prognostic accuracy. These findings could guide clinical decision-making, identifying high-risk patients for targeted interventions and improving overall patient management.

Background:The incidence of colorectal cancer (CRC) has been rising in recent years, with a concurrent increase in early-stage rectal cancer (ESRC) cases. This study aimed to investigate risk factors and developed nomograms to predict overall survival (OS) and cancer-specific survival (CSS) in ESRC patients in order to improve clinical outcomes across diverse patient subgroups. Methods:Risk factors were investigated in ESRC patients by analyzing data from the Surveillance, Epidemiology, and End Results (SEER) database. We developed and validated nomograms to predict OS and CSS after dividing patients into two risk groups. Then we assessed the potential benefits of various therapies across subgroups after propensity score-matching (PSM). Results:T stage, tumor grade, age, carcinoembryonic antigen (CEA) levels, tumor size, and surgical options emerged as independent risk factors through univariate and multivariate Cox regression analyses, contributing to the OS nomogram; while for CSS, the identified risk factors were tumor grade, age, elevated CEA levels and surgical options. The Concordance-index of the nomogram surpassed that of the American Joint Committee on Cancer (AJCC) 7th staging system, with values of 0.69 (C-index, 0.64-0.74) in the training set and 0.65 (C-index, 0.62-0.68) in the testing set. The receiver operating characteristic (ROC) analysis revealed area under the curve (AUC) values of 0.70, 0.70, and 0.67 for 1-, 3-, and 5-year OS in the development cohort, with comparable results in the validation cohort. Calibration plots demonstrated strong alignment between predicted and observed outcomes. Decision curve analysis (DCA) confirmed the nomogram's superior clinical utility relative to the AJCC 7th staging system, with similar findings for CSS. Kaplan-Meier curves illustrated significant differences in OS and CSS between low- and high-risk groups. Notably, radiation and chemotherapy conferred no benefit, while low-risk patients, especially younger individuals, may benefit from local resection. Conclusions:This study presents a comprehensive prognostic analysis of patients with ESRC and developed predictive nomograms for OS and CSS. Subgroup analyses highlight the potential benefits of local resection in younger patients with low risk.

In the context of surgical treatment for rectal cancer, the dentate line is acknowledged as a critical anatomical landmark. However, the prognostic implications of dentate line invasion (DLI) remain elusive and warrant further investigation. This study aims to evaluate and compare the outcomes of patients with rectal cancer who underwent abdominoperineal resection (APR), distinguishing between those with and without DLI. Between January 2006 and December 2017, this study enrolled 1854 patients with rectal cancer who underwent APR. The cohort was divided into two groups, namely the DLI group (n = 340) and the non-DLI group (n = 1514). The primary endpoints were distant relapse-free survival (DRFS) and local recurrence-free survival (LRFS). Univariate and multivariate analyses were conducted to assess the impact of DLI on DRFS, LRFS, overall survival (OS), and disease-free survival (DFS). The median follow-up duration for the patients was 92.9 months, with a 5-year OS rate of 92.0

Objectives To investigate the diagnostic performance of Node Reporting and Data System (Node-RADS) combined with computed tomography (CT) radiomics for assessing nonenlargement regional lymph nodes in gastric cancer (GC). Methods Preoperative CT images were retrospectively collected from 376 pathologically confirmed of gastric adenocarcinoma from January 2019 to December 2023, with 605 lymph nodes included for analysis. They were divided into training (n = 362) and validation (n = 243) sets. Radiomics features were extracted from venous-phase, and the radiomics score was obtained. Clinical information, CT parameters, and Node-RADS classification were collected. A combined model was built using machine-learning approach and tested in validation set using receiver operating characteristic curve analysis. Further validation was conducted in different subgroups of lymph node short-axis diameter (SD) range. Results Node-RADS score, SD, maximum diameter of thickness of tumor, and radiomics were identified as the most predictive factors. The results demonstrated that the integrated model combining SD, maximum diameter of thickness of tumor, Node-RADS, and radiomics outperformed the model excluding radiomics, yielding an area under the receiver operating characteristic curve of 0.82 compared with 0.79, with a statistically significant difference (P < 0.001). Subgroup analysis based on different SDs of lymph nodes also revealed enhanced diagnostic accuracy when incorporating the radiomics score for the 4- to 7.9-mm subgroups, all P < 0.05. However, for the 8- to 9.9-mm subgroup, the combination of the radiomics did not significantly improve the prediction, with an area under the receiver operating characteristic curve of 0.85 versus 0.85, P = 0.877. Conclusion The integration of radiomics scores with Node-RADS assessments significantly enhances the accuracy of lymph node metastasis evaluation for GC. This combined model is particularly effective for lymph nodes with smaller standard deviations, yielding a marked improvement in diagnostic precision. Clinical Relevance Statement The findings of this study indicate that a composite model, which incorporates Node-RADS, radiomics features, and conventional parameters, may serve as an effective method for the assessment of nonenlarged lymph nodes in GC.

Background Randomized studies have demonstrated that laparoscopic abdominoperineal resection is not inferior to open abdominoperineal resection for rectal cancer. Aims Evaluate the immediate and extended results of laparoscopic abdominoperineal resection versus open abdominoperineal resection for rectal cancer. Methods From January 2006 to December 2017, a total of 1852 patients with rectal cancer who had undergone abdominoperineal resection were enrolled in this investigation. The groups were matched in a 1:1 ratio using propensity score matching. The primary endpoints were overall survival and disease-free survival. The secondary endpoints were pathology and short-term postoperative outcomes. Results Compared to the open abdominoperineal resection group, the laparoscopic abdominoperineal resection group exhibited a higher rate of positive circumferential resection margins (P < 0.001) and fewer postoperative complications (P < 0.001). 5-year disease-free survival (P = 0.449) and overall survival rates (P = 0.664) were comparable. Age (P < 0.001), comorbidity (P = 0.040), (y)pT (P = 0.024), (y)pN (P < 0.001), lymphovascular invasion (P = 0.003) and positive circumferential resection margins (P = 0.014) were independent prognostic risks for overall survival. Conclusion The pathological outcomes of laparoscopic abdominoperineal resection are inferior compared to open abdominoperineal resection. However, they demonstrate comparable long-term oncological outcomes, and laparoscopic abdominoperineal resection offers certain short-term advantages over the open approach.

Abstract Objective The prevalence of early-onset colon cancer (EOCC) among individuals below the age of 50 has shown a marked upward trend in recent years. The embryology, clinical symptoms, incidence, molecular pathways, and oncologic outcomes differ between right-sided and left-sided colon cancers. However, the differences have not been fully researched in EOCC. Our study aims to develop and validate prognostic nomograms predicting overall survival (OS) and cancer-specific survival (CSS) for EOCC in different tumor locations based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods Using the SEER database, a total of 5,588 patients with EOCC were extracted and divided into development and validation cohorts in a random allocation ratio of 7:3 across three groups. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors influencing OS and CSS outcomes. These factors were then utilized to construct nomogram models. The prognostic capabilities of the three models were assessed through various evaluation metrics, including the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and validation cohorts respectively. Additionally, survival curves of the low- and high-risk groups were calculated using the Kaplan–Meier method together with the log-rank test. Results Significant differences in clinical features were observed between right-sided and left-sided EOCCs, particularly in terms of OS (52 months vs 54 months) as demonstrated by Kaplan–Meier curves. Transverse-sided EOCCs exhibited clinical characteristics similar to right-sided EOCCs, suggesting a potential shared tumor microenvironment and therapeutic considerations. Advanced stage, liver metastasis, poor grade, elevated pretreatment carcinoembryonic antigen (CEA) level, chemotherapy, and perineural invasion were identified as independent prognostic factors across all three tumor locations and were incorporated into the nomogram model. Nomograms were constructed to predict the probability of 3- and 5-year OS and CSS. The C-index and calibration plots showed that the established nomograms had good consistency between actual clinical observations and predicted outcomes. ROC curves with calculated area under the curve (AUC) values exceeded 0.8 for all three groups in both the development and validation cohorts, indicating robust predictive performance for OS and CSS. Furthermore, decision curve analysis (DCA) plots revealed a threshold probability range of 0.1 to 0.9, within which the nomogram model exhibited maximum benefit. Kaplan–Meier curves exhibited significant differences between the low- and high-risk groups in EOCC for all three tumor locations in OS and CSS, further validating the prognostic value of the nomogram models. Conclusions We successfully developed three precise nomogram models for EOCCs in different tumor locations, providing valuable support for clinicians in guiding clinical treatments and facilitating further prospective follow-up studies.

Abstract Objective Adjuvant chemoradiotherapy in early stage rectal cancer is still controversial. The purpose of this study was to access the survival benefits of chemoradiotherapy for overall survival (OS) and cancer-specific survival (CSS) in patients with early stage rectal cancer and find the optimal treatment for these patients. Methods The study analyzed data from patients diagnosed with T1-2N0M0 rectal cancer between 2010 and 2016, using the Surveillance, Epidemiology, and End Results (SEER) database. The researchers then divided the patients into low-risk and high-risk groups based on various prognostic factors. Kaplan-Meier analysis was employed to evaluate the impact of chemoradiotherapy on OS and CSS in these patient groups. Results The Kaplan-Meier analysis revealed that patients with T1 stage (T1N0M0) had better OS and CSS outcomes than the T2 stage (T2N0M0) groups. Furthermore, it was shown that both low-risk groups of T1 stage and T2 stage had better OS and CSS outcomes than the high-risk groups. No significant benefits was shown when adding chemoradiotherapy in T1 stage groups while it was observed significant improvements for OS and CSS in T2 stage groups. Furthermore, local excision alone in T1 stage groups and local excision with chemoradiotherapy in T2 stage shown no significant difference comparing to those treated with segmental resection. Conclusion In our study, we found that chemoradiotherapy was beneficial for T2N0M0 rectal cancer patients. What’s more, local excision alone was a feasible alternative for T1N0M0 rectal cancer patients and local excision with chemoradiotherapy was a promising alternative for T2N0M0 rectal cancer patients.

Abstract Objective The use of adjuvant chemoradiotherapy in the treatment of stage IIA (T3N0M0) rectosigmoid junction cancer remains a topic of debate. To address this issue, we conducted a study to evaluate the impact of chemoradiotherapy on cancer-specific survival (CSS) and overall survival (OS) in patients diagnosed with stage IIA rectosigmoid junction cancer patients. Methods The study analyzed data from patients diagnosed with stage IIA rectosigmoid junction cancer between 2010 and 2016, using the Surveillance, Epidemiology, and End Results (SEER) database. The researchers then divided the patients into low-risk and high-risk groups based on various prognostic factors. Kaplan-Meier analysis was employed to evaluate the impact of chemoradiotherapy on CSS and OS in these patient groups. Results Kaplan-Meier analysis revealed that chemotherapy was significantly beneficial for CSS in all patients with stage IIA rectosigmoid junction cancer, while it only had a significant impact on OS in the high-risk group. Furthermore, the addition of radiotherapy to chemotherapy didn’t demonstrate any significant improvement in OS or CSS in all patients with stage IIA rectosigmoid junction cancer. Conclusion In the treatment of IIA rectosigmoid junction cancer patients, chemotherapy is generally recommended. However, the addition of radiotherapy doesn’t appear to improve OS and CSS in these patients.

Background Clostridium butyricum (C. butyricum, CB) is a probiotic to modulate the intestinal disorders and CB supplement has been found to have a great impact on inflammation and cancer treatment. However, the effects and mechanisms of CB on colorectal cancer (CRC) are not clear. We performed this study to investigate the influence of CB on the progression of CRC and the potential mechanisms in vivo and in vitro. Methods We established azoxymethane (AOM)/dextran sulfate sodium salt (DSS) model mice (male, 6-week-old C57BL/6J) and divided them into the control (Ctrl) and CB groups at the end of the second DSS cycle. Mice in the CB group received treatment with CB [1×108 colony forming unit (CFU) in 100 µL phosphate buffered saline (PBS)] 3 times a week for 40 days by gavage administration. The apoptotic cells in tumor tissues were assessed by terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining. IL-6 and IL-10 were detected using enzyme linked immunosorbent assay (ELISA) assayes. Microbiota was analyzed through 16S rDNA sequencing. The location of CB was detected by the fluorescence in situ hybridization (FISH) assay. The function of CB on the proliferation of cell lines, HT-29 and CT-26, was examined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assayes. The expression of myeloid differentiation factor 88 (MyD88) and nuclear factor-kappa B (NF-κB) in cells and tissues was evaluated by real time quantitative PCR (RT-qPCR) and western blot. Results Mice in the CB group showed a lower incidence and total volume of CRC, more apoptotic cells in the tumor tissue, a lower level of IL-6, and a higher level of IL-10 compared with those in the Ctrl group. CB altered the composition of the gut microbiota and was enriched in the small intestine and tumor tissue. Moreover, CB restrained the proliferation and the expression of MyD88 and NF-κB in CRC cell lines and colon tissue. Conclusions CB restrained the progression of CRC, improved the inflammation of AOM/DSS mice, altered the composition of their gut microbiota, and regulated the expression of MyD88 and NF-κB. We concluded that CB plays its role in CRC via MyD88 and the NF-κB signaling pathway.

Background This study aimed to evaluate the impact of postoperative complications on long-term survival in patients with peritoneal metastasis (PM) arising from colorectal cancer (CRC) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Methods Patients with PM arising from CRC treated with CRS and HIPEC were systematically reviewed at the China National Cancer Center and Huanxing Cancer Hospital from June 2017 to June 2019. High-grade complications that occurred within 30 days were defined as grade 3 to 4 events according to the Common Terminology Criteria for Adverse Events (CTCAE) classification. Univariate and multivariable Cox regression models for overall survival were created. Predictors of high-grade postoperative complications were evaluated with univariate and multivariate logistic regression analyses. Results In all, 86 consecutive cases were included in this study. Forty-one patients (47.7%) developed postoperative complications, while 22 patients (25.6%) experienced high-grade complications. No mortality occurred during the postoperative period. The median survival of all patients was 25 months, and the estimated 3-year overall survival (OS) rate was 35.0%. In the multivariable Cox regression analysis, a high peritoneal carcinomatosis index (PCI) score (HR, 1.07, 95% CI, 1.01–1.14; P =0.015) and grade 3–4 postoperative complications (HR, 1.86, 95% CI, 1.22–3.51; P =0.044) correlated with worse overall survival. High estimated blood loss (OR, 1.01, 95% CI, 1.01–1.02; P < 0.001) was identified as an independent risk factor for developing high-grade complications. Conclusion Careful patient selection, high levels of technical skill and improved perioperative management are crucial to ensure patient survival benefits after CRS+HIPEC.

Purpose Cytoreductive surgery (CRS) added with hyperthermic intraperitoneal chemotherapy (HIPEC) can improve the survival rate of certain patients with peritoneal metastasis (PM). However, the perioperative safety and long-term survival of this intricate and possibly life-threatening procedure in elderly patients (≥65 years) remain controversial. Methods Patients with PM due to appendiceal or colorectal tumours who underwent CRS/HIPEC were evaluated systematically at the National Cancer Center of China and the Huanxing Cancer Hospital between June 2017 and June 2019. The recruited subjects were retrospectively categorized into elderly (age ≥65) and non-elderly (age<65) groups according to their age. Clinical and pathological features, postoperative outcomes, and prognoses were gathered and analysed. Results Both groups had similar overall morbidity (56.0% vs 38.7%, P=0.130) and grade 3/4 morbidity (28.0% vs 20.0%, P=0.403) after CRS/HIPEC. However, more patients in the elderly group suffered from ileus postoperatively (16.0% vs 2.6%, P=0.033). After a follow-up period of a median of 20 months, it was concluded that elderly patients had significantly worse 3-year overall survival (OS) than non-elderly patients (16.3% vs 51.4%, P=0.001). Independent prognostic factors were identified to be a high peritoneal carcinomatosis index (PCI) score (HR, 1.10, 95% CI, 1.04–1.16; P=0.001) and age ≥65 (HR, 2.42, 95% CI, 1.32–4.45; P=0.004) were independent prognostic factors through cox regression analysis. Conclusion CRS and HIPEC are related with an elevated prevalence of postoperative ileus but not with the overall morbidity or the grade 3/4 morbidity in elderly patients. However, since worse survival outcomes were observed more commonly in elderly patients compared to younger patients from CRS+HIPEC, this complex and potentially life-threatening procedure should be considered carefully in patients aged ≥65 years.

Abstract Background The impact of primary tumour location on the prognosis of patients with peritoneal metastasis (PM) arising from colorectal cancer (CRC) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rarely discussed, and the evidence is still limited. Methods Patients with PM arising from CRC treated with CRS and HIPEC at the China National Cancer Center and Huanxing Cancer Hospital between June 2017 and June 2019 were systematically reviewed. Clinical characteristics, pathological features, perioperative parameters, and prognostic data were collected and analysed. Results A total of 70 patients were divided into two groups according to either colonic or rectal origin (18 patients in the rectum group and 52 patients in the colon group). Patients with PM of a colonic origin were more likely to develop grade 3–4 postoperative complications after CRS+HIPEC (38.9% vs 19.2%, P = 0.094), but this difference was not statistically significant. Patients with colon cancer had a longer median overall survival (OS) than patients with rectal cancer (27.0 vs 15.0 months, P = 0.011). In the multivariate analysis, the independent prognostic factors of reduced OS were a rectal origin (HR 2.15, 95% CI 1.15–4.93, P = 0.035) and incomplete cytoreduction (HR 1.99, 95% CI 1.06–4.17, P = 0.047). Conclusion CRS is a complex and potentially life-threatening procedure, and we suggest that the indications for CRS+HIPEC in patients with PM of rectal origin be more restrictive and that clinicians approach these cases with caution.

*These authors contributed equally to this work Purpose: Cytoreductive surgery (CRS) added with hyperthermic intraperitoneal chemotherapy (HIPEC) can improve the survival rate of certain patients with peritoneal metastasis (PM). However, the perioperative safety and long-term survival of this intricate and possibly life-threatening procedure in elderly patients (≥65 years) remain controversial. Methods: Patients with PM due to appendiceal or colorectal tumours who underwent CRS/ HIPEC were evaluated systematically at the National Cancer Center of China and the Huanxing Cancer Hospital between June 2017 and June 2019. The recruited subjects were retrospectively categorized into elderly (age ≥65) and non-elderly (age<65) groups according to their age. Clinical and pathological features, postoperative outcomes, and prognoses were gathered and analysed. Results: Both groups had similar overall morbidity (56.0% vs 38.7%, P=0.130) and grade 3/ 4 morbidity (28.0% vs 20.0%, P=0.403) after CRS/HIPEC. However, more patients in the elderly group suffered from ileus postoperatively (16.0% vs 2.6%, P=0.033). After a followup period of a median of 20 months, it was concluded that elderly patients had significantly worse 3-year overall survival (OS) than non-elderly patients (16.3% vs 51.4%, P=0.001). Independent prognostic factors were identified to be a high peritoneal carcinomatosis index (PCI) score (HR, 1.10, 95% CI, 1.04–1.16; P=0.001) and age ≥65 (HR, 2.42, 95% CI, 1.32–4.45; P=0.004) were independent prognostic factors through cox regression analysis. Conclusion: CRS and HIPEC are related with an elevated prevalence of postoperative ileus but not with the overall morbidity or the grade 3/4 morbidity in elderly patients. However, since worse survival outcomes were observed more commonly in elderly patients compared to younger patients from CRS+HIPEC, this complex and potentially life-threatening procedure should be considered carefully in patients aged ≥65 years.

Background and purpose: Abdominal desmoid tumors (ADTs) are rare soft-tissue neoplasms that have a relatively high local recurrence rate. The purpose of the present study was to delineate the clinicopathologic features and explore the prognostic factors of ADTs. Methods: From January 2000 to January 2019, patients with ADTs who underwent macroscopically complete resection at the China National Cancer Center were included in the study. The clinicopathologic characteristics and follow-up data were carefully collected and reviewed. Prognostic factors such as age at presentation, sex, tumor location, tumor size and tumor proximity to nerves or vasculature were analyzed, and recurrence-free survival was analyzed with these factors. Results: A total of 113 patients with ADTs were assigned to the abdominal wall group (n = 66) or abdominal cavity group (n = 47) according to the tumor site. Abdominal wall DTs and intra-abdominal DTs demonstrated distinct clinicopathological features and prognoses. During a median 61-month follow-up period, twelve (10.2%) patients had local recurrence. According to the univariate and multivariate analyses, intra-abdominal tumors, large tumors, and positive margins were independent risk factors for poor prognosis. Conclusion: Compared with intra-abdominal DTs, abdominal wall DTs demonstrate different clinicopathological features and a better prognosis. Under the premise of ensuring negative margins during the first surgical procedure, patients with abdominal wall DTs can obtain satisfactory prognoses through radical resection.

Background Nowadays, colorectal cancer (CRC) is one of the most commonly diagnosed malignant tumors worldwide, the incidence rate of which is still increasing year by year. Herein, the objective of this study is to investigate whether CDC42EP3 has regulatory effects in CRC. Methods First, CDC42EP3 knockdown cell model based on HCT116 and RKO cell lines was successfully constructed, which was further used for constructing mouse xenotransplantation models. Importantly, effects of CDC42EP3 knockdown on proliferation, colony formation, apoptosis, and migration of CRC were accessed by MTT assay, EdU staining assay, colony formation assay, Flow cytometry, and Transwell assay. Results As the results, we showed that CDC42EP3 was significantly upregulated in CRC, and its high expression was associated with tumor progression. Furthermore, knockdown of CDC42EP3 could inhibit proliferation, colony formation and migration, and promote apoptosis of CRC cells in vitro. In vivo results further confirmed knockdown of CDC42EP3 attenuated tumor growth in CRC. Interestingly, the regulation of CRC by CDC42EP3 involved not only the change of a variety of apoptosis-related proteins, but also the regulation of downstream signaling pathway. Conclusion In conclusion, the role of CDC42EP3 in CRC was clarified and showed its potential as a target of innovative therapeutic approaches for CRC.