Although neoadjuvant chemoradiotherapy treatment followed by surgical resection is the recommended treatment for locally advanced rectal cancer (LARC), response rates remain poor. In proficient mismatch repair (pMMR) rectal cancer, combination (vs. monotherapy) immunotherapy has begun to show promise. This study involved 87 LARC patients undergoing short-course radiotherapy (SCRT), followed by CAPOX (capecitabine and oxaliplatin), in combination with the immune checkpoint inhibitor tislelizumab. Following neoadjuvant therapy, 81 patients underwent surgery, achieving an R0 resection rate of 98.7%. Pathological complete response (pCR) was observed in 41 patients (50.6%), with responders (patients with tumor regression grade TRG 0/TRG 1 or complete clinic response) constituting 69% (60/87). Grade 3 adverse events occurred in 11.5% of participants, and there was one case of grade 4 myasthenia gravis. Imaging Mass Cytometry (IMC) analysis demonstrated higher infiltration of M1 macrophages were in responders. Spatial analysis further identified significant aggregation of PD-L1+ myofibroblastic cancer-associated fibroblasts (MyoCAFs), a unique cell population, within a 10 µm radius to tumor cells, in non-responders; and dynamic analysis showed that post-treatment PD-L1+ MyoCAFs continued to increase in the non-responder group, who also had more exhausted CD8+T cells, possibly explaining their worse response. Our study affirms the efficacy and safety of neoadjuvant SCRT combined with immunochemotherapy in LARC, highlighting the importance of assessing the spatial distribution of immune cells in the tumor microenvironment (TME) for predicting treatment responses. ClinicalTrials.gov registration: NCT05515796.

This video vignette illustrates the application of the da Vinci Xi® robotic platform for robotic left colectomy and intracorporeal overlap anastomosis in a 51-year-old patient diagnosed with sigmoid-descending colon junction cancer. Emphasizing the advantages of robotic surgery in colorectal procedures, the video showcases a complete mesocolic excision, involving steps such as medial-to-lateral dissection, mobilization of the splenic flexure, ligation of the left colic and sigmoid arteries, and resection of an abdominal wall nodule. The presentation highlights the surgical precision and efficiency achieved, including minimal blood loss and no complications, with an operation time of 190 min. The postoperative outcome was favorable, with the patient discharged on the eighth day and subsequent management involving chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) for stage pT4bN1aM1c moderately differentiated adenocarcinoma. This case underscores the enhanced capabilities of robotic platforms in complex colorectal surgeries, particularly in achieving cytoreductive surgery (CRS) and ensuring anastomosis safety with improved R0 resection rates.

ObjectiveDuring the past decade, the concept of complete mesocolic excision (CME) has been developed in an attempt to minimize recurrence for right-sided colon cancer. This study aims to compare outcomes of robotic versus laparoscopic right hemicolectomy with CME for right-sided colon cancer.MethodsWe performed a retrospective multicenter propensity score matching study. From July 2016 to July 2021, 382 consecutive patients from different Chinese surgical departments were available for inclusion out of an initial cohort of 412, who underwent robotic or laparoscopic right hemicolectomy with CME. Data of all patients were retrospectively collected and reviewed. Of these, 149 cases were performed by a robotic approach, while the other 233 cases were done by laparoscopy. Propensity score matching was applied at a ratio of 1:1 to compare perioperative, pathologic, and oncologic outcomes between the robotic and the laparoscopic groups (n = 142).ResultsBefore propensity score matching, there were no statistical differences regarding the sex, history of abdominal surgery, body mass index (BMI), American Joint Committee on Cancer (AJCC) staging system, tumor location, and center between groups (p > 0.05), while a significant difference was observed regarding age (p = 0.029). After matching, two comparable groups of 142 cases were obtained with equivalent patient characteristics (p > 0.05). Blood loss, time to oral intake, return of bowel function, length of stay, and complications were not different between groups (p > 0.05). The robotic group showed a significantly lower conversion rate (0% vs. 4.2%, p = 0.03), but a longer operative time (200.9 min vs. 182.3 min, p < 0.001) and a higher total hospital cost (85,016 RMB vs. 58,266 RMB, p < 0.001) compared with the laparoscopic group. The number of harvested lymph nodes was comparable (20.4 vs. 20.5, p = 0.861). Incidence of complications, mortality, and pathologic outcomes were similar between groups (p > 0.05). The 2-year disease-free survival rates were 84.9% and 87.1% (p = 0.679), and the overall survival rates between groups were 83.8% and 80.7% (p = 0.943).ConclusionDespite the limitations of a retrospective analysis, the outcomes of robotic right hemicolectomy with CME were comparable to the laparoscopic procedures with fewer conversions to open surgery. More clinical advantages of the robotic surgery system need to be further confirmed by well-conducted randomized clinical trials with large cohorts of patients.

Purpose: To investigate the role of miR-449b-5p in gastric cancer (GC) metabolism. Methods: Human GC samples and their corresponding normal tissues were used in this study. Cell survival ability was evaluated using a commercial MTT kit. Glucose uptake, lactate production and ATP content were assessed using commercial kits. The expression levels of miRNAs were assessed by stem-loop reverse transcription-polymerase chain reaction (RT-PCR). Results: MiR-449b-5p expression decreased in both GC tissues and cells. When the cells with low level of miR-449b-5p were transfected with miR-449b-5p mimics, glycolysis was inhibited (p < 0.05). Lactate dehydrogenase A (LDHA) was predicted as a target gene of miR-449b-5p and verified using luciferase reporter assay. MiR-449b-5p expression was up-regulated in GC cells (p < 0.05). Furthermore, miR- 449b-5p expression was related to long overall survival time in patients with GC. Conclusion: The findings demonstrate that miR-449b-5p reverses the glycolytic state of GC cells by targeting LDHA expression, and thus, it can potentially be developed for the treatment of gastric cancer.

Background Whether or not to preserving left colic artery(LCA) in anterior resection for rectal cancer and its effect on anastomotic leakage are remains controversial. The aim of this study was to investigate the clinical outcomes of preserving the LCA during anterior resection for rectal cancer. We further explored branching types of the inferior mesenteric artery(IMA) based on the three-dimensional computed tomography reconstruction images. Methods Between January 2017 and October 2019, patients who underwent anterior resection for rectal cancer were allocated to preservation LCA or non-preservation LCA. Evaluation parameters including intraoperative conditions, pathological outcomes, postoperative complications, and short-term results. Furthermore, preoperative three-dimensional computer tomography reconstruction were performed to assess types of IMA. Results 160 patients with rectal cancer were enrolled in this study, 56 were arranged to preservation LCA and 104 to non-preservation LCA. The incidence of anastomotic leakage and overall early complications were significantly(P<0.05) decreased in the preservation LCA group. The reoperation rate of the preservation LCA group (1.8%) was lower than that of the non-preservation LCA group (10.6%), but the difference was not statistically significant (P>0.05). The two groups did not significantly(P>0.05) differ in blood loss, intraoperative complications, total number of harvested lymph nodes, and number of positive lymph nodes. The three-dimensional computer tomography reconstruction images of 108 patients with rectal cancer were evaluated, the IMA was divided into four types, of which 53(49.1%) were type I, 24 (22.2%) were type II, 18 (16.7%) were type III, and 13 (12%) were type IV. Conclusions The preservation of LCA in anterior resection for rectal cancer could help reducing the incidence of anastomotic leakage, overall early complications and without increasing other known risks. The three-dimensional computer tomography reconstruction technique was useful for evaluating the IMA types to facilitate make intraoperative surgical decisions and preservation of LCA during rectal cancer surgery.

BACKGROUND:Although total or subtotal colectomy for slow-transit constipation (STC) has been proven to be a definite treatment, the associated defecation function and quality of life (QOL) are rarely studied.AIM:To evaluate the effectiveness of surgery for STC regarding defecation function and QOL.METHODS:From March 2013 to September 2017, 30 patients undergoing surgery for STC in our department were analyzed. Preoperative, intra-operative, and postoperative 3-mo, 6-mo, 1-year, and 2-year follow-up details were recorded. Defecation function was assessed by bowel movements, abdominal pain, bloating, straining, laxative, enema use, diarrhea, and the Wexner constipation and incontinence scales. QOL was evaluated using the gastrointestinal QOL index and the 36-item short form survey.RESULTS:The majority of patients (93.1%, 27/29) stated that they benefited from the operation at the 2-year follow-up. At each time point of the follow-up, the number of bowel movements per week significantly increased compared with that of the preoperative conditions (P < 0.05). Similarly, compared with the preoperative values, a marked decline was observed in bloating, straining, laxative, and enema use at each time point of the follow-up (P < 0.05). Postoperative diarrhea could be controlled effectively and notably improved at the 2-year follow-up. The Wexner incontinence scores at 6-mo, 1-year, and 2-year were notably lower than those at the 3-mo follow-up (P < 0.05). Compared with those of the preoperative findings, the Wexner constipation scores significantly decreased following surgery (P < 0.05). Thus, it was reasonable to find that the gastrointestinal QOL index scores clearly increase (P < 0.05) and that the 36-item short form survey results displayed considerable improvements in six spheres (role physical, role emotional, physical pain, vitality, mental health, and general health) following surgery.CONCLUSION:Total or subtotal colectomy for STC is not only effective in alleviating constipation-related symptoms but also in enhancing patients' QOL.