Background: The "watch and wait" (W&W) strategy for rectal cancer offers organ preservation to patients achieving aclinical complete response (cCR) after neoadjuvant therapy. While oncologically safe, its adoption across the UK varies drastically due to non-standardised pathways, a lack of structured training, and clinician anxiety regarding local regrowth. With the rise of Total Neoadjuvant Treatment (TNT) and NICE-approved contact brachytherapy (Papillon), a shift toward "intentional" organ preservation is projected to exponentially increase service demands on multidisciplinary teams (MDTs). Aim: This protocol outlines the development of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) Position Statement. The initiative aims to mitigate MDT hesitation, standardise clinical pathways, and optimise the delivery of W&W care across the UK and Ireland. Methods: A 30-member multidisciplinary Task Force—comprising colorectal surgeons, oncologists, radiologists, trainees, andpatients—will undertake a rapid, single-round Delphi consensus process. The panel will evaluate approximately 30 statements spanning eight core domains, including response timing, endpoint definitions, service organisation, training, and follow-up. Consensus is defined as 70% or greater agreement, with any remaining disparities resolved via virtual nominal group meetings. Scope and Significance: The position statement focuses strictly on the clinical implementation of W&W following a cCR. Excluded from the scope are near-cCR management, salvage surgery, and trial frameworks. Scheduled for publication in mid-2026, this statement will provide a crucial framework to guide MDTs through an emerging clinical paradigm shift, with the aim of improving patient selection and resource allocation.

SpatialDecon derived immune cell counts aggregated by Region, KM grade and KRAS status with pairwise comparison between groups. Mann-Whitney test used to determine statistical significance between groups

BACKGROUND:Loss of skeletal muscle mass and systemic inflammation may offer prognostic value in patients with abdominal aortic aneurysm (AAA). The longitudinal progression of abnormal body composition parameters and their determinants is poorly reported. Statins are widely used medications that improve the prognosis of cardiovascular disease and interact with both muscle tissue and systemic inflammation. The present study aimed to describe the association between statin therapy and both pre-operative and longitudinal CT-derived body composition in patients undergoing elective intervention for AAA. METHODS:A total of 756 consecutive patients undergoing elective intervention for AAA at three centres were retrospectively recruited. Body composition analysis was performed on pre-operative and follow-up CTs at L3 to generate subcutaneous adipose tissue index, visceral adipose tissue index and skeletal muscle index and density (SMI and SMD). Systemic inflammation was assessed using the systemic inflammatory grade. RESULTS:A total of 756 patients (702 [93%] males, median [interquartile range, IQR] age 73.0 [11.0] years) were included, with a median (IQR) follow-up of 67.0 (32) months and 235 deaths during the follow-up period. There were 582 patients (77%) receiving statin therapy and 174 patients (23%) not receiving statin therapy. Follow-up CTs were available for 273 patients. From pre-operative to follow-up CTs, there was a decrease in median SMI (P < 0.001) and SMD (P < 0.001) and an increase in the comparative prevalences of low SMI (43% vs. 50%, P < 0.01) and low SMD (64% vs. 88%, P < 0.001). There were no differences in baseline clinicopathological characteristics, systemic inflammation or pre-operative CT-derived body composition parameters between patients with and without >10% loss of skeletal muscle mass. In patients with ≤10% loss of SMI, mean (95% confidence interval) survival was 91.6 (87.2-95.9) months versus 89.3 (80.4-98.2) months in patients with >10% loss of SMI (P = 0.58). Patients receiving statin therapy had a higher American Society of Anesthesiologists grade (P < 0.001), a higher body mass index (BMI) (P < 0.05) and a greater prevalence of normal pre-operative SMI (P < 0.001). CONCLUSIONS:In patients with AAA, skeletal muscle mass and density appear to progressively decline despite treatment of AAA, though specific determinants of this are uncertain, and statin use does not appear to predispose to either muscle loss or preservation. Statin therapy appears to be associated with a lower rate of pre-operative low skeletal muscle mass, despite greater comorbidity and BMI. Further investigation of the progressive changes in muscle mass and quality, statin therapy and systemic inflammation is warranted.

Abstract Background: Locally-advanced rectal cancer (LARC) is traditionally treated with neoadjuvant chemoradiotherapy before surgery, however, response heterogeneity necessitates the development of novel treatment combinations. Immune checkpoint blockade (ICB) with or without radiotherapy (RT) elicits clinical benefit in various solid tumors, yet ICB’s effectiveness so far is limited to colorectal tumors with microsatellite instability and the role of the tumor microenvironment (TME) is unclear. We present a novel orthotopic immunocompetent mouse model of LARC, where combinations of RT and ICB are tested to elucidate the role of TME in the response to treatment. Methods: Autochthonous murine tumor-derived organoids expressing common driver mutations (Apcfl/fl; KrasG12D/+; p53fl/fl; Tgfbr1fl/fl: ‘AKPT’) were orthotopically injected into syngeneic C57Bl/6 immunocompetent mice. Tumor response to RT-ICB was studied on timepoint and aging cohorts of mice with tumors growing in different TME settings: (a) in the rectal submucosa of wildtype mice, (b) subcutaneously in wildtype mice, and (c) in the rectal submucosa of mice lacking the iCCR locus (CCR1, CCR2, CCR3, and CCR5: ‘iCCRKO ’), which inhibits inflammatory monocyte recruitment into the TME. Radiation was delivered as 15Gy in 3# (Mon-Wed-Fri) using a Small Animal Radiation Research Platform on day 13 following tumor engraftment for the orthotopic models and on day 7 for the subcutaneous. PD-1 inhibition (PD-1i) was administered intraperitoneally (10mg/kg twice weekly) 3 days pre-RT until endpoint. Mice in the timepoint experiments were sampled 5 days following RT, while aging mice were sampled at clinical endpoint or 100 days, whichever came first. Results: RT and PD-1i offered significant survival extension and tumor control in the orthotopic wildtype setting (a). Transcriptomic characterization at 5 days revealed that untreated and irradiated tumors harbored a stroma-rich microenvironment, low in immune cells, which PD-1i partly reversed. This phenotypic ‘switch’ was also evident in an aging cohort, suggesting that RT + PD-1i have long-lasting effects on the stroma. In the subcutaneous setting (b), RT significantly increased tumor control but PD-1 blockade offered little additional advantage. Interestingly, subcutaneous AKPT tumors had significantly more CD8+ cells at baseline than orthotopic ones, highlighting the inherent immune permissiveness of the subcutaneous TME. Finally, tumors growing in the iCCRKO setting (c) were more radio-sensitive, leading to 3 instances of tumor clearance: one in the RT group and two in the RT + PD-1i. Conclusion: Our findings demonstrate the synergistic potential of RT and PD-1i to sensitize an inherently radio-resistant orthotopic mouse model of LARC. Tumor location and inflammatory monocytes emerged as key regulators of the immune response to RT-ICB, which could have important implications for LARC modeling. Importantly, we highlight that TME components can facilitate treatment resistance and give rise to targets that can be therapeutically exploited. Citation Format: Lydia Melissourgou-Syka, Michael A. Gillespie, Lily V.S. Hillson, Kathryn Gilroy, Katrina Stevenson, Susanti Susanti, Tamsin R.M. Lannagan, Eoghan Mulholland, Philip D. Dunne, Joanne Edwards, Sean M. O'Cathail, Colin W. Steele, Owen J. Sansom, Campbell S.D. Roxburgh.Investigating the role of the tumor microenvironment in the rectal cancer response to preclinical radio-immunotherapy combinations.[abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Targeted Therapies in Combination with Radiotherapy; 2025 Jan 26-29; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(2_Suppl):Abstract nr P022

Modern spatial proteomic methods, such as multiplex immunofluorescence (mIF) imaging, offer a data-rich view of spatial biology in intact tissues. However, interpreting its complexity is a major bottleneck, limiting its potential for biological discovery and clinical translation. Current computational methods often rely on segmentation-based approaches that discard crucial morphological information and are limited to testing pre-defined hypotheses. Here, we introduce a self-supervised learning (SSL) framework that enables hypothesis-agnostic, context-aware discovery of biomarkers directly from mIF images. Our approach extracts rich feature representations that capture holistic architectural patterns, which integrate cellular morphology, marker interactions, and microenvironmental context without human supervision. Applying this framework to over 7,000 mIF tissue images from over 1,800 patients in two distinct cancer types, we demonstrate superior prognostic performance over conventional segmentation analyses. The method autonomously identified previously unknown and potentially clinically actionable biological patterns. In lung adenocarcinoma, these include a Ki67-mediated immune evasion phenotype, a sub-cellular pattern of GLB1 expression which aligns with low-grade EGFR -driven tumours, and distinct modes of tumour-immune interaction in PD-L1+ patients. We also find a regulatory T-cell-mediated immunosupressive environment promoting tumour budding in colorectal carcinoma. Our work establishes SSL as a powerful, scalable, and unbiased platform to decode tissue ecosystems while being fully explainable without pre-defined hypotheses. This paradigm shift transforms high-plex imaging from a hypothesistesting tool into a hypothesis-generating engine that can accelerate the discovery of next-generation spatial biomarkers. ### Competing Interest Statement David Chang, John Le Quesne, and Ke Yuan are co-founders and shareholders of TileBio Ltd. Medical Research Council, https://ror.org/03x94j517, MR/W006804/1 Cancer Research UK, https://ror.org/054225q67, CTRQQR-2021\100006, CTRQQR-202\100006, A29801, A1920, EDDPGM-Nov21 100001, DRCMDP-Nov23 100010 Innovate UK, https://ror.org/05ar5fy68, 42497 NC3Rs DA3RT, APP51238 Prostate Cancer UK, https://ror.org/04dkv6329, MA-TIA22-001 Biotechnology and Biological Sciences Research Council, https://ror.org/00cwqg982, BB V016067 1 EU Horizon 2020, 101016851 Cancer Research UK, https://ror.org/054225q67, A31287

Primary colorectal cancer (CRC) is manageable with surgical and non-surgical therapies. However, high affinity for distant spread to the liver (CRLM) and lack of subsequent therapeutic options has maintained CRC as one of the most lethal malignant diseases worldwide. Tumors consist of malignant cells as well as a complex micro-environment (TME) of stromal and immune components, all of which have been implicated in disease severity and treatment resistance. Spatial transcriptomics (ST) is novel technology which allows molecular profiling of tissue while preserving tissue architecture. By studying matched CRC and CRLM with modern ST tools which allow scrutiny of the malignant cells and TME we aim to learn more about mechanisms of metastasis and why CRLM are resistant to treatment. 41 patients (29 untreated) underwent synchronous resection of CRC and CRLM within our institution between April 2002 and June 2010 (64% 5 year mortality). Paired CRC and CRLM from 4 patients underwent single-cell ST assessment on the Nanostring CosMx Spatial Molecular Imager (23 fields of view (FOV)). Paired CRC and CRLM from 4 patients underwent regional ST assessment (PanCk+, PanCk-, aSMA+ comprtments) on the Nanostring GeoMx Digital Spatial Profiler (116 FOV). Paired CRC and CRLM from 2 patients underwent regional ST assessment on the Visium 10X Genomics platform (4 FOV). Results/Conclusions: GeoMx offers entire slide visualization with bespoke and convenient FOV selection with reliable segmentation of TME components with whole transcriptome available. Visium 10X offers high resolution ST assessment of large pieces of tissue but slide preparation is difficult without specific tools. CosMx offers single-cell in-situ allowing the highest resolution with neighborhood and cellular interaction analysis possible but at lower plex and increased complexity. All technologies demonstrated differences between CRLM and their matched CRC. CRLM were generally more collagenous and chemokine rich. Furthermore, transcriptomic and morphological differences exist between CRLM from different patients. Specifically, CosMx demonstrated that epithelial cells and fibroblasts in CRC express MZTA compared to COL9A2, NEAT1 and IGF2 in CRLM. Neutrophils in CRLM under-express CXCL8. Desmoplastic CRLM were chemokine high whereas replacement CRLM over-expressed IGF2, DUSP5 and COL9A2. GeoMx identified MET and IL17 as potential drug targets in CRLM. These data suggest that CRLM evolve once metastasis is established and the immune response of the host to the metastasis is pivotal. Future therapeutic goals should emphasize personalized medicine and molecular staging of CRLM with specific targeted therapies. Colin Wood, Luke McNickle, Andrew Cameron, Ritupam Sarma, Vaidehi Pandya, Joao Da Silva Filho, Colin steele, John Cole, Joanne Edwards, Paul Horgan, Campbell Roxburgh. Multi-scale multi-omic assessment of matched synchronous colorectal cancer liver metastases using multiple spatial transcriptomic tools [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4586.

Supplementary details regarding methods and materials

Systemic inflammation has prognostic value in cancer and is considered aetiological of cachexia by the Global Leadership Initiative on Malnutrition (GLIM). Lactate dehydrogenase (LDH) also has recognized prognostic value. The present study aimed to evaluate the ability of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin, to identify cachexia and predict outcome in advanced lung cancer. Patients (n = 261) with serum LDH, CRP and albumin measurement receiving palliative radiotherapy for advanced lung cancer between 2009 and 2015 were identified. Subjects were stratified by LDH and LCAS. This was compared to GRIm and LIPI, two previously described LDH based prognostic scores, which do not incorporate CRP. On follow up there were 201 deaths. LDH and LCAS were associated with 1-year survival independent of ECOG-PS, MUST, weight loss, BMI, SMI, SMD, metastases, mGPS or NLR (all p < 0.001). On multivariate analysis LCAS (1.36, 1.13–1.63, p = 0.001), LIPI (1.50, 1.17–1.92, p = 0.02), metastases (1.53, 1.15–2.04, p = 0.004) and ECOG-PS (1.28, 1.04–1.57, p = 0.019) were independently associated with poorer overall survival. LCAS appears to identify cachexia and stratify survival. This may represent a useful aetiological criterion within the GLIM framework and a more powerful prognostic tool than the phenotypic criteria.

Aims To assess the impact of clinical factors on survival in patients undergoing pelvic exenteration (PE) with curative intent for locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC). Methods Retrospective analysis of consecutive patients undergoing PE between January 2008 and July 2021 at a tertiary referral centre. Baseline characteristics, comorbidities and neoadjuvant therapy were recorded. Influence of comorbidity was assessed using the validated Charlson comorbidity index and ASA performance status (ASA). Preoperative inflammation was quantified using clinically relevant values derived from haemoglobin concentration, serum albumin, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and modified Glasgow Prognostic Score (mGPS). Influence of each factor on overall survival (OS), disease free survival (DFS) and local recurrence free survival (LRFS) were assessed using Cox regression analysis. Results 388 of 506 resections met the inclusion criteria over this period. 256 PE for LARC and 132 PE for LRRC. Only mGPS ≥1 and ASA III were significant on multivariate analysis as negative prognostic markers for OS, DFS and LRFS in patients with LARC with Hazard ratios ranging from 1.94 to 3.82. For patients with LRRC ASA III was associated with reduced OS (p = 0.005) and LRFS (p = 0.039). Conclusions Despite broadly similar baseline clinical characteristics for LARC and LRRC there are significant differences in the effect of these factors upon long term outcomes. Key clinical factors that influence survival are readily identifiable and easy to measure preoperatively. These factors may help stratify and quantify the risk of recurrence in LARC; however, further prognostic clinical markers for LRRC remain to be fully elucidated.

Obesity (BMI > 30 kg/m2) is rapidly increasing worldwide with 26% of the UK population being obese and 38% being overweight. Obesity is intimately related to several life-limiting conditions including colorectal cancer (CRC). Obese patients have a higher degree of perioperative systemic inflammatory response (SIR) and an increased risk of perioperative complications. The aim of this current study was to investigate whether robotic-assisted surgery mitigates the effects of obesity in left sided CRC resections on the SIR and clinical outcomes. All patients undergoing left-sided colorectal cancer resections from May 2021 to May 2023 were, prospectively, entered into a database with patient characteristics and perioperative short-term outcomes recorded. CRP was considered a surrogate for SIR. The relationship between obesity and complications were examined using Chi Square for linear association, Kruskal-Wallis for continuous data and multivariate binary logistic regression model. 221 patients who underwent RAS for left-sided CRC were analysed. Obesity was associated with more comorbidity (ASA, p < 0.01) and SSI (p < 0.05) but not with age, sex, procedure or pathology. POD3 CRP < 150 mg/l was also associated with obesity (p < 0.01). In turn, greater comorbidity was associated with age (p < 0.001), site of resection (p < 0.05), SSI (p < 0.05), postoperative blood transfusion (p < 0.01) and LOS (p < 0.001). On multivariate analysis, only greater ASA (p < 0.05) and surgical procedure (p < 0.01) were associated with the development of an SSI independently. Greater comorbidity but not obesity was independently associated with postoperative SIR and clinical outcomes in patients undergoing RAS. These results support the use of RAS for left sided CRC resections, particularly in the obese.

Abstract Background In cancer cachexia the relationship between the tumour, its environment and the systemic inflammatory response is not clear. This study aims to examine this relationship in greater detail. Methods Host characteristics included the presence of a Systemic Inflammatory Response (SIR) as measured by Systemic Inflammatory Grade (SIG), sarcopenia (SMI) and myosteatosis (SMD) were measured. Categorical variables were analysed using χ2 test for linear-by-linear association, or χ2 test for 2 by 2 tables. Survival analysis was carried out using univariate and multivariate Cox regression. Results A total of 473 patients were included. Of these, 70.4% were over 65 years of age, 54.8% were male and 49.8% had an ASA grade of 1 or 2. Pathological examination showed that the majority of patients had a T3 (53.7%) or a T4 (34.0%) cancer and 73.0% had evidence of necrosis. A SIG score of 0 or 1 was present in 57.7% of patients. Tumour necrosis was associated with age (p < 0.01), tumour location (p < 0.01), T-stage (p < 0.001), margin involvement (p < 0.05), SIG (p < 0.001), SMI (p < 0.01), SMD (p < 0.05) and 5-year survival (p < 0.001). On multivariate survival analysis in patients with T3 cancers age (HR: 1.45 95% CI 1.13–1.86 p < 0.01), ASA grade (HR: 1.50 95% CI 1.15–1.95 p < 0.01) and SIG (HR: 1.28 95% CI 1.11–1.48 p < 0.001) remained independently associated with survival. Conclusion These results suggest that tumour necrosis and the subsequent SIR could result in profound changes in body composition and survival. Further pre-clinical and clinical work is required to prove causation.

Background:United Kingdom blood shortages necessitate better prediction of surgical blood requirement. We sought to assess the predictive accuracy of tools designed to identify those patients requiring blood transfusion within the perioperative period. Methods:We searched the Cochrane library, EMBASE, MEDLINE, ClinicalTrials.gov and WHO trials portal, 2000-July 2023. We included studies that developed and/or validated prediction tools for blood requirement during the early perioperative period (48 hours). Risk of bias was evaluated using the Prediction model Risk Of Bias Assessment Tool. We pooled area under receiver operating curve and calibration data via random effects meta-analysis. We evaluated certainty of evidence of any estimates using the Grading of Recommendations Assessment, Development and Evaluation framework. We used meta-regression to describe associations between included variables/tool characteristics with tool accuracy. Results:We included 50 papers, describing 67 unique prediction tools. Most tools were at high risk of bias, with limited external validation. Discrimination (area under receiver operating curve) of prognostic models ranged from 0.49 to 0.96. Only two surgery-specific tools, the McClusky Index (liver transplant surgery) and Papworth Bleeding Risk Score (cardiothoracic surgery), had sufficient data to enable pooling of discrimination measures. The McClusky Index's pooled area under receiver operating curve: 0.74 (95% CI 0.61 to 0.84) and Bleeding Risk Score's area under receiver operating curve: 0.68 (95% CI 0.49 to 0.82) were both rated 'very low' certainty by Grading of Recommendations Assessment, Development and Evaluation. Pooling calibration data was not possible for any prediction tools. Meta-regression suggested that fewer included variables, longer time from surgery and independent validation studies were all associated with lower accuracy. Limitations:There were insufficient studies to assess overall tool performance via meta-analysis in other surgical subgroups beyond cardiothoracic surgery and liver transplant. Our study population is also predominantly made up of elective surgeries which may make our results less generalisable to emergency settings. Future work:Implementation and cost-effectiveness studies are needed to evaluate how promising tools could be applied to clinical practice and the economic impact such tools could have upon the service. Conclusions:Despite the availability of multiple potential tools, available data suggest none are currently suitable for predicting blood transfusion in surgical practice. Our summary of the data comes with caveats around the quality of the included papers and the limited number of tools with more than one reported external validation. Funding:This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159933.

227 Background: Colorectal cancer (CRC) is surgically resectable and eminently screenable yet remains a lethal entity with high affinity to metastasise synchronously and metachronously. It has been proposed that cellular and extracellular components of the microenvironment contribute to metastatic potential. Dissociative profiling techniques such as bulk transcriptomic and single-cell RNA sequencing have contributed insight but limited therapeutic progress. Spatial transcriptomic (ST) assessment allows molecular profiling of tissue while preserving tissue architecture. Here we employ ST approaches to interrogate tumor compartments of primary resectable and matched synchronous CRC demonstrating stromal signatures with distinct collagen expression associated with outcome. Methods: 25 patients with primary resectable CRC and 4 patients with matched primary CRC and liver metastasis (CRLM) underwent single-cell spatial transcriptomics using the Nanostring CosMx Spatial Molecular Imager (SMI, 1000plex gene panel) (Discovery cohort). 71681 epithelial and 88806 stromal cells with intact spatial resolution were analysed. The spatial single-cell signatures were reconstituted in 89 patients using the Nanostring GeoMx Digital Spatial Profiler (Validation cohort). 3 GeoMx compartments were analysed: Epithelial (PanCK+); Stroma (aSMA+); Immune (PanCK-aSMA-). Results: CosMx demonstrated 2 distinct collagen signatures: COL1A1,COL1A2,COL3A1 associated with normal fibroblasts; COL9A2 associated with cancer-related stroma and lethal subtypes of epithelial cell. In the GeoMx validation cohort, 42 patients expressed the COL1A1 signature in the aSMA compartment and 47 did not (5 year recurrence free survival: 0.88 vs 0.49, p < 0.005) with different morphological patterns of each distinct aSMA group. In patients with favourable prognosis, chemokine high epithelial subtypes expressed CXCL5 and recruited COL9A2-, IL6+ neutrophils to the surrounding microenvironment. In contrast, epithelial cells in patients with poor prognosis expressed CXCL8 and recruited COL9A2+ neutrophils which were frequently in contact with SPP1+ macrophages. Conclusions: We have used ST approaches to interrogate cellular compartments of CRC demonstrating stromal subtypes that impact outcome. These insights could be used in the clinical setting to quantify COL9A2 expression in aSMA+ cells to prognosticate patients. Targeting of tumor collagen has been proposed to augment existing anti-cancer therapies and this work has demonstrated COL9A2 as a potential target in need of further investigation.

AIM:The ACPGBI has commissioned a taskforce to devise a strategy for integrating artificial intelligence (AI) into colorectal surgery. This report aims to (i) map current AI adoption amongst UK colorectal surgeons; (ii) evaluate knowledge, attitudes, perceptions and experience of AI technologies; and (iii) establish priority recommendations to drive innovation across the specialty. METHODS:A prospective 45-item questionnaire was circulated to the ACPGBI membership. Questionnaire findings were explored at a multidisciplinary round table of surgeons, allied professionals, computer scientists and lawyers. Strategic recommendations were then generated. RESULTS:122 members responded (75.4% consultants; 72.1% male; modal age 41-50 years). Although 43.5% used AI daily, only one third said they could explain key concepts within AI. 86.9% anticipated routine future-AI use, with documentation and imaging ranked highest. 88.5% endorsed formal AI training. Major obstacles were unclear regulation, cost, medicolegal liability and professional or patient distrust. The round table generated 17 recommendations across clinical, educational and research domains and a ten-point action plan, including the establishment of a Colorectal AI Committee and the creation of an open-source colorectal foundational data initiative. CONCLUSION:This taskforce report combines questionnaire insights from the ACPGBI membership and expert debate into 17 key recommendations and a ten-point action plan that will set the direction of future colorectal AI practice. The objective is to establish a framework through which colorectal surgical practice can be augmented by safe, trustworthy AI.

BACKGROUND:Cardio-pulmonary exercise testing (CPEX) is selectively used before intervention for abdominal aortic aneurysm (AAA). Sarcopenia, a chronic condition defined by reduced skeletal muscle function and volume, can be assessed radiologically by computed tomography (CT)-derived body composition analysis (CT-BC), and is associated with systemic inflammation. OBJECTIVE:The aim was to describe the association between CT-BC, CPEX, inflammation and survival in patients undergoing elective intervention for AAA. SETTING:Patients were recruited retrospectively from a single, secondary-care centre-operative database. Cases undergoing elective endovascular aneurysm repair (EVAR) and open surgical repair (OSR) between 31 March 2015 and 25 June 2020 were included. PATIENTS:There were 176 patients (130 EVAR, 46 OSR) available for analysis in the final study; median (interquartile range [IQR]) follow-up was 60.5 [27] months, and all completed a minimum of 2 years follow-up. MAIN OUTCOME MEASURES:Preoperative CPEX tests were recorded. CT sarcopenia score [CT-SS, range 0 to 2, calculated based on normal/low SMI (0/1) and normal/low SMD (0/1)] assessed radiological sarcopenia. Preoperative modified Glasgow Prognostic score (mGPS) was used to assess systemic inflammation. RESULTS:Mean [95% confidence interval (CI) survival in the CT-SS 0 vs. CT-SS 1 vs. CT-SS 2 subgroups was 80.1 (73.6 to 86.6) months vs. 70.3 (63.5 to 77.1) months vs. 63.8 (53.4 to 74.2) months] ( P = 0.01). CT-SS was not associated with CPEX results ( P > 0.05). Elevated CT-SS [hazard ratio (HR) 1.83, 95% CI, 1.16 to 2.89, P < 0.01] was independently associated with increased hazard of long-term mortality; however, CPEX results were not ( P > 0.05). CONCLUSION:CPEX test results were not consistently associated with body composition and did not have significant prognostic value in patients undergoing elective treatment for AAA.

Patient selection remains important in the management of symptomatic carotid stenoses. Sarcopenia and chronic inflammation confer an inferior long-term prognosis in atherosclerotic disease. The present study aims to describe the prognostic role of sarcopenia, assessed by computed tomography (CT)-derived body composition analysis and inflammation in patients undergoing carotid endarterectomy for symptomatic carotid stenosis.