This letter comments on a recent study comparing two-row and three-row circular staplers in colorectal cancer surgery. We highlight methodological limitations related to the use of historical controls, evolving perioperative practices, and limited event numbers, which may confound the observed reduction in anastomotic leakage. Current evidence does not conclusively support the superiority of triple-row staplers, underscoring the need for prospective studies using standardized modern protocols.

BACKGROUND:Anorectal incontinence is a major health issue due to its economic burden and impact on quality of life. Its true prevalence remains under-estimated and a matter of debate. Our aim was to evaluate the prevalence of anal incontinence among the collaborators of a tertiary hospital. METHODS:An anonymous survey was distributed to all collaborators of a tertiary hospital using a standardized electronic questionnaire, incorporating Jorge-Wexner and LARS scores and items covering different definitions of anorectal incontinence, along with demographic characteristics and specific medical history. RESULTS:Among 14,270 collaborators, 2535 filled the questionnaire. This sample was comparable to the total hospital staff concerning age, gender and occupation. Anorectal incontinence (defined by a Jorge-Wexner score ≥ 3) was present in 20.9% of participants. However, only 2.3% fulfilled the strict Rome IV criteria for faecal incontinence. The presence of anorectal incontinence was higher in women (16.2% vs. 4.7%, p = 0.001), but the Rome IV criteria were comparable. In women, vaginal delivery was not associated with anal incontinence in univariate and multivariate analyses or with Rome IV criteria after adjustment. Diabetes was markedly associated with the presence of Rome IV criteria (OR: 3.3, 95% CI: 1.09-10.08, p = 0.035). History of proctological procedure was also substantially associated with anorectal incontinence and Rome IV criteria (OR: 4, 95% CI: 1.86-8.6, p < 0.001). CONCLUSION:Prevalence of anal incontinence was higher than expected in an active population, and in this medically sensitized working cohort, traditional obstetric factors appeared less strongly associated with anorectal incontinence than anticipated, suggesting a more complex risk profile.

In laparoscopic right hemicolectomy (lapRHC) for colorectal cancer, intra-corporeal anastomosis (ICA) has been associated with faster recovery and lower incidence of incisional hernia (IH) compared with extra-corporeal anastomosis (ECA). However, due to technical constraints, ICA is not widely adopted, and ECA remains the standard approach. Robotic surgery, with enhanced dexterity and suturing capability, facilitates ICA and may therefore improve short-term outcomes and reduce IH incidence. We designed a monocentric, double-blind randomized controlled trial to compare robotic right hemicolectomy (robRHC) with D2 lymphadenectomy, ICA, and off-midline extraction (fully minimally invasive) versus lapRHC with D2 lymphadenectomy, ECA, and midline extraction (standard of care). The primary endpoint is bowel recovery, assessed by time to first passage of stool. Secondary endpoints include perioperative safety (morbidity, mortality, resection margins, lymph node yield), length of stay, IH incidence, and patient-reported esthetic and quality-of-life outcomes. Based on a hypothesized 1-day reduction in bowel recovery, a total of 70 patients will be randomized. The trial complies with the Declaration of Helsinki, ICH-GCP, and Swiss regulatory standards. It has been approved by the local ethics committee (CCER 2024 − 00975) and registered in ClinicalTrials.gov (NCT06067620, 09.05.2024).

INTRODUCTION:The incidence of colorectal cancer in adults younger than 50 years has increased, but the trends of incidence in Switzerland has not been yet described. We assessed long-term incidence, stage distribution, and survival of early-onset colorectal cancer (EOCRC) in Switzerland. MATERIALS AND METHODS:We conducted a nationwide, population-based study including all patients aged 20 years or older who were diagnosed with a first colorectal adenocarcinoma between 1980 and 2021, based on data from the National Cancer Dataset provided from the National Agency for Cancer Registration (NACR). Age-standardized incidence rates per 100'000 person-years were calculated using the 1976 European Standard Population. Temporal trends were assessed using joinpoint regression, expressed as annual percent change (APC). Stage distribution was analysed for 2010-21, when harmonized TNM data were available. Five-year net survival was estimated using the Pohar-Perme estimator. RESULTS:Among 96'410 patients, 5'928 (6.1%) were below 50 years old. Rectal cancers comprised 31.8% of EOCRC, versus 22.9% in those aged ≥ 75 years, whereas proximal colon cancers were less common (30.5% vs 42.7%, respectively). From 2010 to 2021, 27.7% of EOCRC were UICC stage IV, compared with 22.1% at ages 50-74 and 19.4% at ≥ 75. EOCRC incidence rose steadily (men: APC +0.46% [95% CI 0.17-0.76]; women: +0.49% [0.17-0.81]), driven by rectal cancers in both sexes and proximal colon cancers in young women. In contrast, incidence declined in older adults after the mid-2000s. Five-year net survival improved and reached a peak of 76.9% in 2010 for young men and 78.2% in 2007 for young women. DISCUSSION:EOCRC incidence in Switzerland has risen continuously, with advanced stage at diagnosis and heterogeneous survival gains, underscoring the need for adapted prevention, awareness, and screening strategies.

Surgical techniques for right hemicolectomy (RHC) show considerable heterogeneity. To identify potential areas for improvement and standardization, the objective of this survey was to evaluate and report current practices and preferences among surgeons for performing RHC for colorectal cancer. An international online survey consisting of 31 questions was distributed to general surgeons worldwide to assess their preferred techniques for performing RHC. A total of 368 surgeons from 48 countries responded. Among them, 47% reported performing at least 90% of RHC laparoscopically, while 40% used a robotic approach. The most common dissection technique was a medial-to-lateral vessel-first approach, used by 82.3% of respondents. During laparoscopic procedures, 51.6% of surgeons performed extracorporeal anastomosis, whereas 82.9% of those using a robotic approach favored intracorporeal anastomosis. Fluorescence angiography was routinely used by 39.9% of respondents. The Pfannenstiel incision was the most frequently selected extraction site (46.5%) especially if intracorporeal anastomosis was performed (81.8%). The preferred technique for performing RHC includes a laparoscopic approach with intracorporeal lymph node dissection and extracorporeal anastomosis. Most RHC procedures therefore remain laparoscopy-assisted rather than fully minimally invasive. Robotic surgery appears to facilitate a fully minimally invasive approach including intracorporeal anastomosis.

In 2025, digestive surgery is evolving with the integration of pharmacology and immunotherapy. In severe obesity, surgery remains the most durable option, while GLP-1 and GLP-1/GIP agonists provide an effective complement but require long-term treatment. In liver cancer, immunotherapy expands access to curative surgery through improved tumor control. For locally advanced colon cancer, neoadjuvant chemotherapy and MMR status guide decisions, with immunotherapy becoming key in dMMR cases. These advances highlight the importance of coordinated care and the central role of general practitioners.

Background/Objectives: Treatment of locally advanced rectal cancer (LARC) very often requires a neoadjuvant multimodal approach. Neoadjuvant treatment (NAT) encompasses treatments like chemoradiotherapy (CRT), short-course radiotherapy (SCRT), radiotherapy (RT) or a combination of either of these two with additional induction or consolidation chemotherapy, namely total neoadjuvant treatment (TNT). In case of complete radiological and clinical response, the non-operative watch-and-wait strategy can be adopted in selected patients. This strategy is impacted by a regrowth rate of approximately 30%. Predicting biomarkers of tumor response to NAT could improve guidance of clinicians during clinical decision making, improving treatment outcomes and decreasing unnecessary treatment exposure. To this day, there is no validated biomarker to predict tumor response to any NAT strategies in clinical use. Most research focused on CRT neglects the study of other regimens. Methods: We conducted a narrative literature review which aimed at summarizing the status of biomarkers predicting tumor response to NAT other than CRT in LARC. Results: Two hundred and fourteen articles were identified. After screening, twenty-one full-text articles were included. Statistically significant markers associated with improved tumor response pre-treatment were as follows: low circulating CEA levels; BCL-2 expression; high cellular expression of Ku70, MIB-1(Ki-67) and EGFR; low cellular expression of VEGF, hPEBP4 and nuclear β-catenin; the absence of TP53, SMAD4, KRAS and LRP1B mutations; the presence of the G-allel of LCS-6; and MRI features such as the conventional biexponential fitting pseudodiffusion (Dp) mean value and standard deviation (SD), the variable projection Dp mean value and lymph node characteristics (short axis, smooth contour, homogeneity and Zhang et al. radiomic score). In the interval post-treatment and before surgery, significant markers were as follows: a reduction in the median value of circulating free DNA, higher presence of monocytic myeloid-derived suppressor cells, lower presence of CTLA4+ or PD1+ regulatory T cells and standardized index of shape changes on MRI. Conclusions: Responders to neoadjuvant SCRT and RT tended to have a tumor microenvironment with an immune–active phenotype, whereas responders to TNT tended to have a less active tumor profile. Although some biomarkers hold great promise, scarce publications, inconsistent results, low statistical power, and low reproducibility prevent them from reliably predicting tumor response following NAT.

OBJECTIVE:Anastomotic leak occurs in 8.1% of right colectomies and up to 17.1% of low anterior resections. Fluorescence angiography has gained acceptance in recent years as a method for assessing anastomosis vascularization, a key element implicated in anastomotic leak. Our objective was to perform a systematic review and meta-analysis of randomized controlled trials on the effect of fluorescence angiography on anastomotic leak and postoperative morbidity. METHODS:A systematic review was performed on Medline, Embase and CENTRAL according to the PRISMA statement until 16 March 2025. Randomized controlled trials in English that compared fluorescence angiography with standard care were considered eligible. Articles were screened, bias was detected, data were extracted, pooled and analysed. RESULTS:Among 477 identified studies, 401 were retained for screening but only eight were included in the quantitative analysis (3999 patients). Fluorescence angiography was significantly protective against anastomotic leak, with an odds ratio of 0.64 (95% CI: 0.39-0.98, I2: 0%, p < 0.0001) and a reduction in risk of 4 percentage points (95% CI: -0.05 to 0.02, I2: 0%, p < 0.0001). When analysis was restricted to colorectal anastomosis, the effect of fluorescence angiography on anastomotic leak was maintained (OR 0.59, 95% CI 0.44-0.79, I2: 0%, p < 0.0005). However, fluorescence angiography did not reduce postoperative morbidity compared with the control group. CONCLUSION:High-quality evidence shows that fluorescence angiography reduces the rate of anastomotic leak in colorectal surgery with a decrease in the incidence of 4 percentage points.

Modern surgical guidance in laparoscopic colon cancer procedures could be enhanced by visualizing lymphatic flow during surgery, already helping surgeons in determining the precise extent of digestive resection and could be useful in lymphadenectomy. Related to oncological procedure, lymphadenectomy is mandatory to assess the extension of the disease. To explore this approach, the objective of this review is to examine the use of indocyanine green fluorescence imaging for real-time in vivo identification of lymphatic flow and especially sentinel nodes in patients undergoing elective surgery for colorectal cancer. A systematic review was conducted to identify relevant studies on sentinel node mapping using indocyanine green (ICG) in colorectal cancer surgery. A comprehensive search was performed in electronic databases including PubMed, Embase, and Cochrane Library from inception to December 2024. The search strategy incorporated relevant keywords and MeSH terms, combining variations of “colorectal neoplasms,” “sentinel lymph node,” “indocyanine green,” and related terms. The search was limited to articles published in English language. A total of 405 studies were identified across all databases. After screening, 45 full-text articles were assessed for eligibility, and 12 studies were ultimately included in the systematic review. ICG-FI has not yet demonstrated superiority over the standard blue dye technique. Moreover, a notable heterogeneity exists among the reported studies concerning ICG dosage, injection methods and the definition of positive LN status for sensitivity calculations, making direct comparisons challenging. Despite the potential shown with other surgical oncological resections, ICG-FI requires further investigation and standardization in protocols and indications to fully harness its capabilities for SLN detection in CRC, especially metastatic nodes. Larger patient populations should be considered in future research to comprehensively assess its efficacy. This systematic review highlights the heterogeneity and limitations of current evidence regarding ICG-FI for SLN detection in colorectal cancer. While preliminary results are encouraging, further well-designed prospective trials are required before routine clinical implementation can be recommended.

Current treatments for locally advanced rectal cancer (LARC) include preoperative radiotherapy, chemotherapy and chemoradiotherapy followed by total mesorectal excision (TME), which can severely impact quality of life. Recently, anti-PD1 immunotherapy in microsatellite instability high (MSI-H) LARC has shown 100% clinical complete responses, allowing patients to avoid surgery with minimal toxicity. This review assesses the safety, toxicity, pathological impact, and long-term benefits of incorporating immunotherapy into the neoadjuvant treatment of microsatellite stable (MSS) and MSI-H LARC. This systematic review, conducted following PRISMA guidelines, investigates neoadjuvant immunotherapy in LARC. Data on study characteristics, treatment protocols, and outcomes were extracted. Quality assessment was conducted by using the Methodological Index for nonrandomized studies (MINORS) and the RoB2 tool. Patients were categorized into MSI-H, MSS, and unknown microsatellite status cohorts. We found twelve published studies including 547 patients. In the MSS cohort, postneoadjuvant surgery rates ranged from 57.6% to 100%, with a watch-and-wait approach adopted in up to 27.1% of cases. For MSI-H patients, surgery and watch-and-wait rates varied widely (0%-100%), reflecting heterogeneity in management. R0 resection rates were high across cohorts (70%-100% MSS, 80%-100% MSI-H). Pathological complete response (pCR) rates were 25% to 50% in MSS and 50% to 60% in MSI-H cohorts. Grade 3-4 adverse events ranged from 3.9% to 45.2% (MSS), 0% to 60% (MSI-H), with immune-related events generally below 10%. The role of immunotherapy in MSS rectal cancer remains unclear; phase III trials and translational research are needed urgently for guidance.

Anal squamous cell carcinoma (ASCC) is a rare malignancy with an increasing incidence despite advancements in treatment. The primary treatment for localized ASCC is radiochemotherapy (RCT), which achieves high rates of tumor regression in most cases, but up to 30% of patients experience recurrence or persistent disease. Salvage surgery, such as an abdominoperineal resection (APR), is often used for recurrent disease but is associated with significant morbidity and limited oncological outcomes. Patients with small T1 tumors may also benefit from primary local excision. For patients with metastatic or unresectable recurrent ASCC, chemotherapy, particularly carboplatin and paclitaxel, remains the standard treatment. New therapeutic strategies, including immune checkpoint inhibitors like pembrolizumab, are showing promise, particularly in PD-L1-positive tumors. Clinical trials have suggested that immunotherapy offers a potential alternative for patients for whom conventional treatments have failed, though the overall response rates remain modest. Re-radiation and intraoperative radiotherapy combined with salvage surgery may improve the outcomes for select patients, though the data are still limited. The management of recurrent or persistent ASCC requires a personalized approach, incorporating both established and emerging therapies to optimize patient outcomes. Further research is needed to refine these treatment strategies.

INTRODUCTION:The effect of appendectomy on the development of Crohn's disease (CD) is a matter of debate. The aim of this systematic review and meta-analysis was to gather the latest published data to determine whether patients with a history of appendectomy have an increased risk of developing CD or not. METHODS:MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for case-control and cohort studies assessing the risk of developing CD after appendectomy. The pooled adjusted and not adjusted odds ratio (OR) with 95% confidence intervals (CIs) were calculated for case-control studies. Heterogeneity was assessed. Studies were ranked using the Newcastle-Ottawa Scale (NOS) and were all of good quality. RESULTS:Fourteen case-control studies and 6 cohort studies were included. Meta-analysis of case-control studies (33,243 patients) of raw OR shows a positive association between appendectomy and CD (OR: 1.51, 95% CI: 0.97-2.36, I2 = 87%), which was not statistically significant (p = 0.069). The meta-analysis of adjusted OR shows that appendectomy represents a statistically significant risk factor for the development of CD (OR: 1.86, 95% CI: 1.01-3.45, p = 0.047, I2 = 89%). CONCLUSION:Appendectomy appears to be a risk factor for the development of CD. However, the discrepant results obtained by meta-analysis of unadjusted OR, the heterogeneity between studies, and the lack of precision of the magnitude of the association mandate confirmation by a large epidemiological study.