This study aimed to assess factors associated with overall survival (OS) in patients with microsatellite stable (MSS) stage IV rectal cancer treated with immunotherapy. In this retrospective review of the NCDB (2015-2021), patients with MSS stage IV rectal adenocarcinoma were divided into immunotherapy and control groups, and propensity-score matched and compared. Multivariable Cox regression analysis was performed to assess the effect of immunotherapy and KRAS genotype on OS. Of 6489 included patients (64.6% males), immunotherapy was given to 47.9%. After matching for age, insurance type, liver metastases, surgery, radiation therapy, and chemotherapy, there were 2422 patients in each group. In the matched cohort, immunotherapy was associated with a similar median OS to the control group [31.8 (95% CI: 27.8-32.2) months vs 29.7 (95% CI: 27.8-32.2) months, P = 0.062]. Immunotherapy was not independently associated with improved OS (HR: 0.88, 95% CI: 0.69-1.14, P = 0.341) but was associated with longer median OS in black patients (25.8 vs 19.1 mo, P = 0.019), patients with bone metastases (22.1 vs 10.7, P < 0.001) and with KRAS mutation (27.4 vs 24.3 mo, P = 0.003). There was no survival benefit from immunotherapy when combined with radical resection, radiation therapy, or chemotherapy. In conclusion, immunotherapy was associated with a modest increase in OS of MSS stage IV rectal cancers, but not independently associated with improved survival. Black patients with bone metastases and KRAS mutations may have survival benefit from immunotherapy. Increased OS with immunotherapy was noted only in patients who did not have surgery, radiation, or chemotherapy. These results seem somewhat disappointing given the enthusiasm for immunotherapy.

Low anterior resection syndrome (LARS) is a common postoperative sequala affecting up to 70

Appendiceal adenocarcinoma is a rare malignancy with a high risk of peritoneal recurrence, especially in locally advanced stages. While intraoperative systemic chemotherapy (ISC) is standard for metastatic disease, its role in non-metastatic Stage II–III patients remains controversial. This study aimed to evaluate the survival benefit of ISC in this population. We conducted a retrospective cohort study using the National Cancer Database (2006–2022). Patients with clinical Stage II–III (T4, N0–2) appendiceal adenocarcinoma who underwent surgical resection were included. Overall survival (OS) was compared between patients who received ISC and controls using Kaplan-Meier statistics and multivariable Cox proportional hazard models. A total of 616 patients were identified, 130 (21.1

BACKGROUND:Diverticulitis is a common cause of acute abdominal conditions, often requiring urgent or elective surgical intervention. Both psoas muscle area (PMA) and bone mineral density (BMD) have been linked to postoperative outcomes, but their role in diverticulitis remains unclear. OBJECTIVES:To evaluate the relationship between PMA, BMD, and their combined effect on surgical outcomes in patients undergoing colectomy for diverticulitis. METHODS:In this retrospective, single-center study, we analyzed patients who underwent colectomy for diverticulitis. PMA and BMD were measured using preoperative computerized tomography. Statistical analysis assessed the association between postoperative outcomes and PMA, BMD, and their combined product (PMA × BMD). RESULTS:The cohort included 66 patients; median age 68.5 years (range 34-94); 41 (62.12%) females. Of the cases, 42 (63.63%) were urgent. Postoperative complications occurred in 38 patients (57.58%). Patients who developed major postoperative complications had lower PMA (1116.74 ± 716.31 mm² vs. 1948.01 ± 0.01 mm², P = 0.02). The area under the curve (AUC) for major postoperative complications was 0.94 for BMD. The AUC for postoperative ileus was 0.73, 0.69, and 0.76 for PMA, BMD, and PMA × BMD, respectively. The AUC for 30-day mortality was 0.66, 0.7, and 0.73. The AUC for ostomy reversal was 0.71, 0.71, and 0.76. CONCLUSIONS:PMA and BMD were associated with postoperative complications after colectomy for diverticulitis. Their combined assessment may improve predictive accuracy. Current evidence regarding the impact of body composition on surgical outcomes in diverticulitis remains limited and inconsistent. Further research is warranted.

BACKGROUND:Surgical site infection remains a common complication after colectomy. Mechanical bowel preparation and oral antibiotics are used to reduce infectious morbidity, but whether their benefit varies by BMI is unclear. OBJECTIVE:To evaluate the association between preoperative bowel-preparation regimen and 30-day postoperative outcomes after elective colectomy for nonmetastatic colon cancer, and to assess whether these associations vary across BMI. DESIGN:Retrospective cohort study. SETTINGS:American College of Surgeons National Surgical Quality Improvement Program-targeted colectomy database (2015-2023). PATIENTS:Adults undergoing elective colectomy for nonmetastatic colon cancer (N = 97,395). MAIN OUTCOME MEASURES:Thirty-day surgical site infection, anastomotic leak, and overall postoperative complication. RESULTS:In unadjusted analyses, surgical site infection occurred in 8.7% of patients with no bowel preparation and 5.0% with combined mechanical plus oral antibiotic bowel preparation. In adjusted modified Poisson models, all bowel-preparation regimens were associated with lower risk of 30-day postoperative complications versus no preparation (all p  < 0.001), with the lowest adjusted relative risk for combined preparation (any surgical site infection: 0.60; anastomotic leak 0.66; any complication: 0.70). In stratified analyses, combined preparation and oral antibiotics alone were superior to no preparation for both left- and right-sided resections, but mechanical preparation alone was not superior to no preparation for right-sided resections. Evidence of effect modification by BMI was limited (interaction p  = 0.09 for surgical site infection, p  = 0.26 for overall complications), including when stratified by resection site. LIMITATIONS:Observational design with potential residual confounding; registry data lacked preparation, adherence/quality, and granular institutional prevention practices; estimates were less precise at extreme BMI values. CONCLUSIONS:Bowel-preparation regimens containing oral antibiotics were associated with lower 30-day surgical site infection and complication risk across the BMI continuum. These findings suggest that the effectiveness of oral antibiotic-containing bowel preparation is preserved across BMI levels. See Video Abstract . RGIMEN DE PREPARACIN INTESTINAL PREOPERATORIA Y RESULTADOS POSTOPERATORIOS SEGN EL NDICE DE MASA CORPORAL EN LA COLECTOMA ELECTIVA POR CNCER DE COLON UN ESTUDIO DE COHORTE RETROSPECTIVO:ANTECEDENTES:La infección del sitio quirúrgico sigue siendo una complicación frecuente tras la colectomía. La preparación mecánica intestinal y los antibióticos orales se utilizan para reducir la morbilidad infecciosa, pero no está claro si su beneficio varía según el índice de masa corporal.OBJETIVO:Evaluar la asociación entre el régimen de preparación intestinal preoperatoria y los resultados postoperatorios a los 30 días tras una colectomía electiva por cáncer de colon no metastásico, y determinar si estas asociaciones varían según el índice de masa corporal.DISEÑO:Estudio de cohorte retrospectivo.ÁMBITO:Base de datos de colectomías dirigidas del Programa Nacional de Mejora de la Calidad Quirúrgica del Colegio Americano de Cirujanos, 2015-2023.PACIENTES:Adultos sometidos a colectomía electiva por cáncer de colon no metastásico (N = 97 395).PRINCIPALES MEDIDAS DE RESULTADO:Infección del sitio quirúrgico a los 30 días, fuga anastomótica y complicaciones postoperatorias generales.RESULTADOS:En los análisis no ajustados, la infección del sitio quirúrgico se presentó en el 8,7 % de los pacientes sin preparación intestinal y en el 5,0 % con preparación intestinal combinada mecánica más antibióticos orales. En los modelos de Poisson modificados ajustados, todos los regímenes de preparación intestinal se asociaron con un menor riesgo de complicaciones postoperatorias a los 30 días en comparación con la ausencia de preparación (p < 0,001 en todos los casos), con el menor riesgo relativo ajustado para la preparación combinada (cualquier infección del sitio quirúrgico: 0,60; fuga anastomótica: 0,66; cualquier complicación: 0,70). En los análisis estratificados, la preparación combinada y los antibióticos orales solos fueron superiores a la ausencia de preparación tanto para las resecciones del lado izquierdo como del derecho, pero la preparación mecánica sola no fue superior a la ausencia de preparación para las resecciones del lado derecho. La evidencia de modificación del efecto por el índice de masa corporal fue limitada (p de interacción = 0,09 para la infección del sitio quirúrgico, p = 0,26 para las complicaciones generales), incluso cuando se estratificó por sitio de resección.LIMITACIONES:Diseño observacional con posible confusión residual; Los datos del registro carecían de información sobre la adherencia/calidad de la preparación y las prácticas institucionales de prevención detalladas; las estimaciones fueron menos precisas en los valores extremos del índice de masa corporal (IMC).CONCLUSIONES:Los regímenes de preparación intestinal con antibióticos orales se asociaron con un menor riesgo de infección del sitio quirúrgico y complicaciones a los 30 días en todo el espectro del IMC. Estos hallazgos sugieren que la eficacia de la preparación intestinal con antibióticos orales se mantiene en todos los niveles de IMC. (AI-generated translation ).

Performance of International Medical Graduates (IMGs) compared to US Medical Graduates (USMGs) remains a key area of interest. This meta-analysis compared performance of IMGs and USMGs regarding surgical residency matching, research productivity, and postoperative outcomes. Systematic literature search of PubMed and Scopus was conducted up to December 2024. Data from eligible studies were synthesized to assess differences between IMGs and USMGs in matching, research, and postoperative outcomes. Random-effect meta-analyses were conducted, and risk of bias was assessed using the Newcastle–Ottawa Scale. A total of 22 studies, published from 2002 to 2024, were included. Neurosurgery (n = 8, 36.4

INTRODUCTION:Cancers of the rectosigmoid junction (RSJ) may pose a surgical challenge, given their unique anatomic location and behavior. The present study aimed to investigate the association between neoadjuvant chemoradiation therapy (nCRT) use and survival among patients with RSJ adenocarcinomas. METHODS:A retrospective analysis was conducted, including all patients in the Surveillance, Epidemiology, and End Results database (2000-2020) with stage II-III RSJ adenocarcinomas treated with radical resection, with and without nCRT. Patients who received and did not receive nCRT were equally matched for age, sex, disease stage, and marital status using the propensity-score method. The primary outcomes were 5-y overall survival (OS) and cancer-specific survival (CSS). Secondary outcomes included the receipt of adjuvant therapy and the number of harvested and positive lymph nodes. RESULTS:The study included 13,825 patients (56.7% males); nCRT was given to 1863 (13.5%) patients. After matching, 1790 patients were included in each group. Matched patients who received nCRT had similar 5-y OS (73.5% versus 71.6%, P = 0.837) and CSS (76.3% versus 77.1%, P = 0.552) to patients who did not receive neoadjuvant CRT. nCRT was not significantly associated with increased OS (hazard ratio: 0.86, 95% confidence interval: 0.73, 1.01, P = 0.073) or CSS (hazard ratio: 0.90, 95% confidence interval: 0.74, 1.10, P = 0.31) after adjusting for survival confounders. Stratified survival analyses of the unmatched cohort showed a survival benefit of nCRT in females, White patients, stage III disease, nonmucinous adenocarcinoma, tumors >5 cm, and elevated carcinoembryonic antigen. Matched patients who received nCRT less often received adjuvant chemotherapy (odds ratio [OR]: 0.44, P < 0.001) and adjuvant radiotherapy (OR: 0.14, P < 0.001) and had fewer harvested and positive lymph nodes. CONCLUSIONS:nCRT was not significantly associated with an increase in OS or CSS in rectosigmoid cancers. However, exploratory subgroup analyses found a potential survival benefit in White female patients with large stage III nonmucinous adenocarcinomas and carcinoembryonic antigen elevation.

BACKGROUND:We evaluated long-term outcomes of non-operative management (NOM) versus surgical management of acute uncomplicated appendicitis. METHODS:Systematic review of studies comparing NOM versus surgery with ≥2 years follow-up. Primary outcome was long-term failure rate. RESULTS:9/1635 studies were included (3 RCTs; 6 non-RCT studies), involving 3883 patients; 5 were in pediatric populations. Median follow-up was 33.6 (range 24-312) months. NOM pooled long-term failure rate was 38.9% (95% CI: 31.1%-46.7%), increasing to 44.4% (95% CI: 41.4%-47.4%) in RCTs. Pooled appendectomy rate after NOM was 36.3% (95% CI: 28.9%-43.7%). Incidence of appendiceal neoplasms was approximately 0.3%. Non-operative management had cost savings of €1535 (95% CI: -€1892 to -€1178) versus surgery. CONCLUSIONS:NOM of acute uncomplicated appendicitis was associated with high long-term failure rates and significant risk of subsequent appendectomy.

BACKGROUND:We assessed overall survival (OS) and cancer-specific-survival (CSS) of radical resection compared to local excision for stage 1 rectal cancer in very old patients (≥ 80 years). METHODS:This retrospective cohort study included patients aged ≥ 80 years who underwent surgery for stage 1 rectal cancer from the SEER database from 2000-2020. Patients were divided into radical resection and local excision groups, and were exact matched for T stage, tumor grade, and tumor size. The main outcome measures were OS and CSS. RESULTS:6379 patients ≥ 80 years underwent local or radical resection of stage 1 rectal cancer; 51.9% were female and 47% had T1 tumors. After matching, 1125 patients were included in each group. The median OS was longer in patients who underwent radical resection (60 months vs. 51 months, p = 0.009), yet there were no significant differences in CSS between the two groups. When stratified by the T stage, there was no benefit for radical resection in T1 tumors (p = 0.33). In multivariate analysis, radical resection and local excision had similar hazard of mortality (HR 1.03, 95%CI 0.76-1.38). CONCLUSION:Radical resection and local excision had similar CSS in very old patients with stage 1 rectal cancer. A personalized approach considering patient status and treatment goals should be used for each patient.

BACKGROUND:Older adults constitute a large proportion of patients with rectal cancer, yet rectal-specific comparative data on minimally invasive approaches remain limited. This study compared outcomes of laparoscopic versus robotic rectal resection in patients aged ≥65 years. METHODS:We performed a retrospective analysis of patients with stage I-III rectal adenocarcinoma from the U.S. National Cancer Database (NCDB) from 2010 to 2021. Patients undergoing laparoscopic or robotic-assisted surgery were identified and propensity-score matched for clinically relevant covariates. The primary outcome was conversion to open surgery. Secondary outcomes included short-term mortality, readmission, hospital stay, pathological outcomes, and 5-year overall survival (OS). RESULTS:Among 18,877 eligible patients, 4099 patients were matched in each group. Robotic surgery was more frequently performed for patients with stage III tumors (45.0% versus 36.9%), elevated carcinoembryonic antigen levels (60.2% versus 48.1%), and those who underwent abdominoperineal resection (25.2% versus 18.9%). After matching, robotic surgery was associated with a significantly lower conversion rate compared with laparoscopy (6.2% versus 14.9%; OR 0.38, 95% CI 0.33-0.44; P < .001). No significant differences were observed in 30-day mortality (1.2% versus 1.5%), 90-day mortality (2.5% versus 2.7%), unplanned 30-day readmission (7.3% versus 7.6%), or 5-year OS (70.5% versus 69.0%; P = .062). Median hospital stay was 5 days for both groups. Suboptimal lymph node yield (<12 nodes) was more frequent after laparoscopy (27.7% versus 24.1%; P < .001). CONCLUSION:In older adults with rectal cancer, robotic surgery was associated with significant reduction in conversion rates and potentially modestly improved lymph node harvest, while both approaches provided comparable safety and long-term oncologic outcomes.These findings must be considered in the context of the heterogenous definitions of conversion and the availability of the robotic platform and training in both robotic and laparoscopic technqiues.

BACKGROUND:The quality of mesorectal excision completeness is a key determinant of oncologic outcomes in rectal cancer; however, it is unclear how surgical margin status influences the survival impact of mesorectal excision quality. The present study aimed to assess the survival outcomes of incomplete total mesorectal excision (TME) in patients with locally advanced rectal cancer, according to surgical margin status. METHODS:Using a contemporary (2022-2023) cohort from the US National Cancer Database, adult patients with clinical stage II-III rectal adenocarcinoma who underwent proctectomy were included. Complete and near-complete TME were analyzed as a single group and compared with incomplete TME. Multivariable logistic regression was used to identify predictors of incomplete TME. Kaplan-Meier statistics and multivariable Cox proportional hazard analysis were used to assess 3-year overall survival (OS), stratified by margin, stage, and neoadjuvant chemoradiation therapy (nCRT). RESULTS:Among 4889 patients (61.6% males), 12.6% had an incomplete TME. Incomplete TME was associated with higher rates of positive CRM (37.5% vs. 11.1%) and positive margins (39.7% vs. 12.5%). Incomplete TME was associated with reduced 3-year OS (82.0% vs. 87.9%, p < 0.001). This survival decrement was more notable in patients with positive CRM (71.0% vs. 81.2%) than in patients with negative CRM (87.9% vs. 88.6%). The adverse survival effect of incomplete TME was strongest in patients who did not receive nCRT. Incomplete TME was not independently associated with reduced OS after adjustment for confounders (HR: 1.583, 95% CI: 0.892-2.807, p = 0.116). CONCLUSIONS:Incomplete TME was not independently associated with significantly reduced OS. However, it may have an adverse survival effect in patients with positive CRM or who did not receive nCRT. Margin status was found to be a critical modifier of the TME-survival relationship.

BACKGROUND:Palliative-intent therapies are a key component in the management of metastatic rectal cancer; however, contemporary national trends and disparities in their utilization remain incompletely characterized. METHODS:A retrospective cohort study was conducted using the National Cancer Database (NCDB) from 2012 to 2023. Adult patients with stage IV rectal adenocarcinoma were included. Palliative therapy was defined using the NCDB variable indicating treatment administered with non-curative intent. Temporal trends were evaluated overall and stratified by facility type and median household income. Multivariable logistic regression was performed to identify independent predictors of palliative therapy utilization. RESULTS:A total of 43 443 patients were included, of whom 8931 (20.6%) received palliative-intent therapy. Utilization increased significantly over time, from 16.2% in 2012 to 25.6% in 2023 (p < 0.001). Systemic therapy was the most frequently used modality and increased over time, while surgical palliation declined substantially. Immunotherapy use rose markedly in later years. Palliative therapy utilization increased across all facility types. Across all income strata, utilization also increased, with the most pronounced rise among patients from lower-income areas. On multivariable analysis, lower income (OR 1.82, 95% CI 1.21-2.74), brain metastases (OR 5.75, 95% CI 1.76-18.70), and immunotherapy use (OR 1.65, 95% CI 1.24-2.21) were independently associated with increased odds of receiving palliative therapy, whereas primary tumor resection was associated with reduced utilization (OR 0.45, 95% CI 0.32-0.61). CONCLUSION:In this large national cohort, palliative therapy utilization increased modestly over time, with a shift from surgical to systemic approaches. These patterns, observed across diverse healthcare settings and socioeconomic groups, reflect the evolving integration of palliative-intent treatment in the modern management of metastatic rectal cancer.

BACKGROUND:Resection with primary anastomosis (RPA) has emerged as an accepted alternative to Hartmann procedure for acute perforated diverticulitis with peritonitis, yet the need for routine diversion remains unclear. We compared the short-term outcomes of RPA with and without diversion in this setting. METHODS:We conducted a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2014-2021), including patients who underwent RPA for perforated diverticulitis. Patients who had or did not have a diverting stoma were propensity score matched for baseline characteristics. The primary outcomes were anastomotic leak and 30-day mortality; secondary outcomes included postoperative complications, readmission, length of stay, and operative time. A subgroup analysis was conducted in patients with preoperative sepsis. RESULTS:Among 1228 eligible patients, 387 patients were matched in each group. Omission of diversion was not associated with an increased risk of anastomotic leak (5.5% vs 4.1%; odds ratio [OR], 1.36; 95% CI, 0.60-3.10; P =.46) or 30-day mortality (3.4% vs 1.8%; OR, 1.89; 95% CI, 0.75-4.78; P =.18). In a subgroup analysis of patients with preoperative sepsis, diversion was associated with a lower rate of clinically significant anastomotic leaks (1.2% vs 5.9%; P =.039). Postoperative morbidity was similar between groups, with no significant differences in infectious, pulmonary, renal, cardiovascular, or thromboembolic complications. Diversion was associated with significantly higher 30-day readmission rates (23.3% vs 16.4%; OR, 1.55; 95% CI, 1.01-2.37; P =.044), longer operative times (159 vs 131 minutes; P <.001), and prolonged hospital stays (9 vs 8 days; P <.001). CONCLUSION:Based on evidence from observational data, RPA without a diverting stoma might not be associated with increased mortality or anastomotic leak in select patients with perforated diverticulitis. However, because several intraoperative factors that influence the decision to divert are not captured in NSQIP, residual confounding by indication remains possible; these findings should be interpreted with caution.

BACKGROUND:The National Comprehensive Cancer Network guidelines are based on randomized controlled trials that support treatment recommendations. The Fragility Index measures the minimum number of patient outcomes needed to alter or overturn a trial's statistical significance. In contrast, the Reverse Fragility Index indicates the minimum changes required to achieve significance in trials that initially show nonsignificant results. This study aimed to assess the robustness of randomized controlled trials cited in the National Comprehensive Cancer Network guidelines for gastric cancer, using both the Fragility Index and the Reverse Fragility Index. METHODS:We systematically reviewed randomized controlled trials referenced in the latest National Comprehensive Cancer Network guidelines for gastric cancer. The Fragility Index and Reverse Fragility Index were calculated for primary binary outcomes. Robustness was further assessed by comparing Fragility Index/Reverse Fragility Index values with the number of patients lost to follow-up. RESULTS:We analyzed 30 randomized controlled trials conducted between 1998 and 2021, which included 13,765 patients, with a median of 430 patients per study. Overall survival was the primary endpoint in 93.3% of the studies. Only 40% of the studies reported statistically significant results, with a median Fragility Index of 6 (interquartile range = 2-6). In contrast, among the studies that did not achieve statistical significance, the median Reverse Fragility Index was 8 (interquartile range = 3-17). Adjuvant chemotherapy had the highest Fragility Index at 20, followed by neoadjuvant chemoradiotherapy, with a Fragility Index of 8, and perioperative chemotherapy with a Fragility Index of 7. On the other hand, trials involving chemotherapy alone had the lowest Reverse Fragility Index of 27.5. Surgical studies averaged 9 patients lost to follow-up, exceeding their Fragility Index of 8, highlighting inconsistencies in study integrity and patient retention. CONCLUSION:The study indicates that the treatments recommended in the National Comprehensive Cancer Network guidelines for gastric cancer are often based on randomized controlled trials with nonsignificant primary outcomes and low Fragility Indices, raising concerns about the strength of the evidence.

BackgroundIt is difficult to predict which patients will have longer postoperative hospital stays after rectal cancer surgery. We aimed to determine the predictors of a long hospital stay following abdominoperineal resection (APR) for rectal cancer.MethodsRetrospective cohort analysis of patients diagnosed with rectal adenocarcinoma in the National Cancer Database between 2015 and 2019 with clinical stage I-IV cancers who underwent APR. Multiple linear regression analysis was conducted to determine the predictors of a long hospital stay. A statistical calculator was created to predict the in-hospital length of stay.Results7470 patients (63.2% males; mean age: 62.3 years) were included. Median hospital stay was 6 (IQR: 4-8) days. Black patients stayed nearly two days longer compared to other patients (1.9; 95% CI: 1.33-2.49, P < 0.001). Patients with a Charlson Deyo Score of 3 also had a longer length of stay (1.96, 95% CI: 1.02-2.91, P < .001). Robotic surgery was associated with shorter hospital stays (-0.7 days, 95% CI - 1.1, -0.4, P < .001), while conversion from minimally invasive to open surgery was associated with a longer hospital stay (1.1 days, 95% CI: 0.55-1.68, P < .001).ConclusionOlder age, black race, male sex, and severe comorbidities were associated with longer hospital stays, while minimally invasive surgery was associated with decreased length of stay.

BACKGROUND:Early stage anal squamous cell carcinoma may be treated with local excision but with considerable risk of recurrence. Adjuvant radiation therapy may be used to reduce recurrence and improve outcomes. This study aimed to assess outcomes of adjuvant radiation therapy after local excision of T1-2 N0 anal squamous cell carcinoma. METHODS:This study was a retrospective cohort analysis of patients with T1-2, N0, and M0 anal squamous cell carcinoma from the National Cancer Database (2010-2020) who underwent local excision with and without adjuvant radiation therapy. Patients were matched using 2:1 propensity-score matching. The primary outcome was 5-year overall survival. RESULTS:Five thousand sixty-five patients with anal squamous cell carcinoma (61.6% female; median age 60 years; 53% T1 stage and 47% T2 stage) were included; 3,366 patients (66.4%) received adjuvant radiation therapy. After matching for age, sex, race, Charlson score, T stage, tumor size and grade, facility type, and surgical margins, 868 patients were in the adjuvant radiation therapy group and 434 in the local excision group. Adjuvant radiation therapy was associated with improved overall survival (82.8% vs 74.9%; P < .001), which was more pronounced in patients with positive surgical margins (79.9% vs 67.2%; P = .003) than negative margins (84.6% vs 79.7%; P = .037). The survival benefit of adjuvant radiation therapy was specifically noted in patients ≥65 years (74.2% vs 53.9%; P < .001), women (85.8% vs 72.2%; P < .001), T2 (81.2% vs 67.5%; P = .001), and poorly differentiated (82% vs 72.8%; P = .001) tumors. Omitting adjuvant radiation therapy was associated with increased overall mortality (hazard ratio 1.4, 95% confidence interval 1.15-1.71; P < .001). CONCLUSION:Adjuvant radiation therapy after local excision of T1-2 and N0 anal squamous cell carcinoma was associated with a significant increase in overall survival. Increased survival was mainly noted in female patients ≥65 years with T2 moderately or poorly differentiated anal squamous cell carcinoma.

Small bowel neuroendocrine tumors (SBNET) are rare neoplasms that often present insidiously and may be associated with mesenteric fibrosis and advanced disease at diagnosis. While open surgery has traditionally been the standard of care, the role of laparoscopic resection in patients with complex SBNET remains under evaluation. We performed a retrospective analysis of all patients who underwent laparoscopic resection for SBNET at a tertiary referral center between 2002 and 2022. Clinical, operative, and oncologic data were extracted from a prospectively maintained database and reviewed for perioperative outcomes and long-term survival. Forty patients (mean age 62.2 years; 55% male) underwent laparoscopic resection, with a conversion rate of 7.5%. The ileum was the most common primary site (85%), and 75% of patients harbored a mesenteric mass. Postoperative morbidity was low (10%, all minor), with no perioperative mortality. The mean hospital stay was 7 days. Most tumors were low-grade (72.5% grade 1), yet 62.5% of patients presented with stage IV disease. With a mean follow-up of 7 years, overall survival reached 95 months, and progression-free survival 61 months. Age at surgery was the only independent predictor of outcome. Laparoscopic resection of SBNET is feasible and safe in selected patients, including those with advanced disease and mesenteric involvement, providing favorable long-term oncologic outcomes. These findings support the important role of minimally invasive surgery as part of the management of SBNET.

Pelvic exenteration (PE) entails an en bloc resection of locally advanced primary or recurrent rectal cancer. This study aimed to assess the short-term and survival outcomes of minimally invasive (MI)- and open PE. A retrospective cohort analysis of patients with stage III rectal adenocarcinoma treated with PE from the National Cancer Database (2010–2019) was conducted. Open and MI-PE were matched for baseline and treatment characteristics using 2:1 propensity score matching. Primary outcomes were 30- and 90-day mortality; secondary outcomes included 30-day readmission, hospital stay, surgical margins, lymph node yield, and overall survival (OS). PE was performed in 1010 (1.9

BACKGROUND:Current guidelines recommend selective adjuvant chemotherapy for stage II colon cancer with high-risk features. This study aimed to assess survival benefit of adjuvant chemotherapy in patients with stage II colon adenocarcinomas ≥5 cm without high-risk features. METHODS:The National Cancer Database was retrospectively reviewed (2010-2019) for all patients with pathologic stage II colonic adenocarcinomas ≥5 cm who underwent colectomy. Patients were divided into adjuvant and control groups that were propensity-score matched for baseline and treatment confounders. The primary outcome was 5-year overall survival (OS). RESULTS:Of 23,937 included patients, adjuvant chemotherapy was given to 2581 (10.8 %). Patient given adjuvant chemotherapy were younger, more often male, Black, had a Charlson score of 0 and private insurance, presented with left-sided cancers and microsatellite stable (MSS) tumors, and more frequently underwent segmental resections and open surgery. 796 patients in the adjuvant group were matched to 1592 patients in the control group. Adjuvant chemotherapy was associated with lower mortality (HR: 0.79; p = 0.022), however, it was not independently associated with improved OS when adjusted for other confounders (HR: 0.84; p = 0.157). The adjuvant group had significantly longer restricted mean OS than the control group (104.9 vs. 100.8 months; p = 0.007). The survival benefit was only noted in patients >50 years, female, White, with non-mucinous adenocarcinomas, MSS tumors, normal CEA levels, and had undergone open and emergency surgery. CONCLUSIONS:The study did not demonstrate a clear survival benefit from adjuvant chemotherapy in patients with stage II adenocarcinoma ≥5 cm. A possible potential survival benefit was observed only in a subgroup of patients.