Total neoadjuvant therapy (TNT) has become a cornerstone in the treatment of locally advanced rectal cancer, improving systemic control and increasing the potential for organ preservation. However, current trials and guidelines continue to treat rectal cancer as a homogeneous entity, overlooking the significant anatomic and therapeutic differences between mid- and low-rectal tumors. This uniform approach fails to reflect the impact of tumor location on both oncologic outcomes and functional consequences. Low-rectal cancers-defined as tumors located < 1 cm from the anal ring-pose distinct anatomic and functional challenges. These include more complex lymphatic drainage, higher risks of positive margins, and greater impact on continence. By contrast, mid-rectal tumors are generally more amenable to standard resection with preserved function and may benefit from treatment deintensification, particularly regarding radiotherapy. Drawing on data from over 80 studies and clinical trials, this review argues that mid- and low-rectal cancers should be considered distinct clinical entities requiring tailored treatment strategies. We examine evidence supporting radiotherapy de-escalation for mid-rectal tumors and intensified TNT for low-rectal tumors when organ and sphincter preservation is essential. Adopting a location-specific, patient-centered approach can better align treatment intensity with oncologic risk and individual functional priorities, ultimately improving both outcomes and quality of life.

BACKGROUND & AIMS:For the local excision of early rectal tumors (ERTs), the relative effectiveness of endoscopic submucosal dissection (ESD) vs transanal endoscopic microsurgery (TEM) is subject to debate. The comparisons are limited to retrospective, single-center studies lacking a health economic assessment. METHODS:A cost-effectiveness analysis was conducted alongside a nonrandomized, 2-arm, comparative, multicenter study. The main inclusion criterion was an ERT (adenomas, in situ and usT1N0 carcinomas) that could be resected with ESD or TEM, depending on the center. The primary effectiveness criterion was complete resection. A health care system perspective and a 1-year horizon were adopted for the cost evaluation. The results of the analysis were adjusted for baseline covariates: age, sex, body mass index, American Society of Anesthesiologists score, histology, and previous pelvic surgery. RESULTS:A total of 213 ESD and 117 TEM procedures were analyzed. At 1 year and with a willingness to pay of €2500 for complete resection, the incremental net monetary benefit of ESD was significant (€1797; 95% confidence interval, €861-€3,032; P < .001). ESD was more cost-effective for decision thresholds ranging from €0 to €6000. In terms of secondary outcomes, the en bloc excision rate favored ESD (99.0% vs 92.5%, P < .01). There were no significant between-group differences in overall and major morbidity. At 3 years, a cost-utility analysis did not reveal between-group differences in health-related quality of life, and the overall survival rates were similar. However, the disease-free survival rate was higher after ESD (94.3% vs 84.6% for TEM; adjusted hazard ratio, 3.55; 95% confidence interval, 1.64-7.75; P < .001). CONCLUSIONS:For ERT, ESD was more cost-effective and offered higher-quality excision and lower recurrence rates than TEM. (ClinicalTrials.gov, Number: NCT02885142).

BACKGROUND:Organ preservation strategies, including watch and wait and local excision, are increasingly adopted in rectal cancer management. Total neoadjuvant therapy improves complete response rates, potentially expanding organ preservation indications. OBJECTIVE:This study aims to evaluate the real-world implementation of organ preservation strategies and short-term oncologic outcomes in patients with nonmetastatic mid- and low-rectal cancer in France. DESIGN:Prospective, multicenter, observational cohort study. SETTINGS:Twenty-seven French Groupe de RECherche sur le CAncer ColoRectal centers were included. PATIENTS:Patients with biopsy-proven, nonmetastatic rectal adenocarcinoma (<12 cm from anal verge) treated with neoadjuvant therapy managed with organ preservation intent across 27 French Groupe de RECherche sur le CAncer ColoRectal centers (October 2022-March 2023) were included. Patients were categorized into selective (early stage) or opportunistic (advanced stage) strategies and managed with either watch and wait or local excision. MAIN OUTCOME MEASURES:The main outcome measures were rates of organ preservation, watch and wait versus local excision use, and oncologic outcomes at 1 and 2 years, including overall survival, disease-free survival, local recurrence-free survival, total mesorectal excision-free survival, and distant metastasis. RESULTS:Of the 457 patients, 117 (26%) underwent organ preservation, more frequently with the selective strategy (51% vs 18.1%; p < 0.001). Watch and wait was the predominant organ preservation method (78% vs 22%) and was used similarly across both groups ( p = 0.728). Total neoadjuvant therapy was the most common neoadjuvant regimen (67%), predominantly via induction chemotherapy (56%). Overall 2-year survival exceeded 95% across groups. No significant differences were found between watch and wait and local excision in disease-free survival, local recurrence-free survival, or total mesorectal excision-free survival. Local regrowth occurred in 14 watch and wait patients and in 3 patients after local excision, mostly within the first year, with salvage surgery successfully performed. Distant metastases were more frequent in patients treated under the opportunistic strategy. LIMITATIONS:The short follow-up period limits the assessment of long-term outcomes and late recurrences. CONCLUSIONS:In this nationwide French cohort, organ preservation strategies-supported by total neoadjuvant therapy-were feasible and safe across tumor stages. Both watch and wait and local excision demonstrated comparable short-term oncologic outcomes, supporting their roles as viable options within individualized, response-adapted treatment pathways. See Video Abstract . PRESERVACIN DE RGANOS EN EL TRATAMIENTO DEL CNCER DE RECTO UNA PERSPECTIVA PROSPECTIVA DEL ESTUDIO GRECCAR:ANTECEDENTES:Las estrategias de preservación de órganos, incluyendo la observación y espera y la escisión local, se adoptan cada vez más en el manejo del cáncer de recto. La terapia neoadyuvante total mejora las tasas de respuesta completa, lo que podría ampliar las indicaciones de preservación de órganos.OBJETIVO:Evaluar la implementación en la práctica clínica de las estrategias de preservación de órganos y los resultados oncológicos a corto plazo en pacientes con cáncer de recto medio e inferior no metastásico en Francia.DISEÑO:Estudio de cohorte prospectivo, multicéntrico y observacional.ÁMBITO:Se incluyeron veintisiete centros GRECCAR franceses.PACIENTES:Se incluyeron pacientes con adenocarcinoma de recto no metastásico confirmado por biopsia (<12 cm del margen anal) tratados con terapia neoadyuvante con intención de preservar el órgano en 27 centros GRECCAR franceses (octubre de 2022 a marzo de 2023). Los pacientes se clasificaron en estrategias selectivas (estadio temprano) u oportunistas (estadio avanzado) y se manejaron con observación y espera o escisión local. Principales medidas de resultado: Tasas de preservación de órganos, observación y espera frente a escisión local, y resultados oncológicos a 1 y 2 años, incluyendo supervivencia global, supervivencia libre de enfermedad, supervivencia libre de recurrencia local, supervivencia libre de escisión total del mesorrecto y metástasis a distancia.RESULTADOS:De los 457 pacientes, 117 (26%) se sometieron a preservación de órganos, con mayor frecuencia mediante la estrategia selectiva (51% frente a 18,1%; p < 0,001). La observación y espera fue el método predominante de preservación de órganos (78% frente a 22%), utilizado de forma similar en ambos grupos (p = 0,728). La terapia neoadyuvante total fue el régimen neoadyuvante más común (67%), predominantemente mediante quimioterapia de inducción (56%). La supervivencia global a los 2 años superó el 95% en ambos grupos. No se observaron diferencias significativas entre la observación y espera y la escisión local en la supervivencia libre de enfermedad, la supervivencia libre de recurrencia local ni la supervivencia libre de escisión total del mesorrecto. Se observó recidiva local en 14 pacientes del grupo de observación y espera, y en 3 tras la escisión local, principalmente durante el primer año, realizándose con éxito una cirugía de rescate. Las metástasis a distancia fueron más frecuentes en los pacientes tratados con la estrategia oportunista.LIMITACIONES:El corto periodo de seguimiento limita la evaluación de los resultados a largo plazo y las recidivas tardías.CONCLUSIONES:En esta cohorte francesa a nivel nacional, las estrategias de preservación de órganos -apoyadas por terapia neoadyuvante total- resultaron factibles y seguras en todos los estadios tumorales. Tanto la observación y espera como la escisión local demostraron resultados oncológicos a corto plazo comparables, lo que respalda su papel como opciones viables dentro de las vías de tratamiento individualizadas y adaptadas a la respuesta. (AI-generated translation ).

AIM:Neoadjuvant treatment for rectal cancer has evolved markedly with the growing adoption of total neoadjuvant therapy (TNT), organ-preservation strategies and selective omission of radiotherapy. Recent trials support risk-based personalization, but its application in real-world settings remains poorly documented. The aim was to describe current neoadjuvant treatment practices for mid-low rectal cancer in French expert centres and identify tumour- and patient-related factors influencing decisions. METHOD:This observational study included patients with non-metastatic rectal adenocarcinoma ≤10 cm from the anal verge, discussed in tumour boards (October 2022 to March 2023) across GRECCAR centres. Tumours were classified as early, intermediate-risk or locally advanced rectal cancer (LARC). Neoadjuvant treatments were analysed according to tumour extension, location and age. RESULTS:Among 463 patients from 27 centres, the most frequent regimen was induction chemotherapy, mainly FOLFIRINOX, followed by long-course chemoradiotherapy (CRT) (65%). This approach was used in 51%, 66% and 71% of patients in the early, intermediate-risk and LARC groups, respectively (p = 0.0060). TNT was more frequently administered for low- than mid-rectal cancers, especially in LARC (86% vs. 71%, p = 0.016). In patients >75 years, CRT + consolidation chemotherapy and radiotherapy alone were proportionally more frequent. Among the early rectal cancers, those treated with induction chemotherapy + CRT had more advanced features than those treated with CRT alone (cT3: 80% vs. 43%, cN+: 62% vs. 10%, tumour size: 3.4 vs. 2.3 cm; all p < 0.001). CONCLUSION:TNT with induction chemotherapy is the predominant neoadjuvant approach in French expert centres. Tumour classification, location and patient age significantly influence treatment choices, reflecting a shift towards personalized context-specific care.

Esophageal cancer is a global burden, and multiple international societies exist to address the issue in international collaboration. This study aims to analyze the characteristics of esophageal cancer and robot-assisted minimally invasive esophagectomy (RAMIE) across geographic areas. We performed a retrospective analysis of the Upper GI International Robotic Association (UGIRA) international database from January 2016 to April 2024. Forty centers worldwide that were known to perform RAMIE were involved in establishing this consortium. The patient characteristics, surgical techniques, and short-term outcomes of RAMIE were compared by each regional area (Europe, Asia, North America, and South America). A total of 3,916 RAMIE cases were registered in the UGIRA database (2,643 in Europe, 1,130 in Asia, 111 in North America, and 32 in South America). The median age was 66 years, and 80.5% of patients were male. Notably, Asia had a high prevalence of squamous cell carcinoma (91.2%) and predominant use of the McKeown approach (94.9%). BMI was lower in Asia, whereas comorbidities were more common in Western countries across all types. The use of neoadjuvant chemotherapy and radiation was lower in Asia (48.2% and 20.8 %, respectively). Postoperative complications also differed by region; pneumonia was most common in Europe and South America, cardiopulmonary complications in North America, and recurrent nerve injury in Asia. In conclusion, regional differences were observed in baseline characteristics, treatment approaches, and complication patterns in patients treated by RAMIE for esophageal cancer. Recognizing these variations is essential for fostering mutual understanding and advancing the field through international collaboration.

AIM:Lymph node metastases occur in 10%-15% of high-risk T1 rectal tumours. Total mesorectal excision remains the standard treatment, whereas chemoradiotherapy is reserved for patients with frailty. Indocyanine green (ICG)-guided lymphadenectomy may represent an organ-preserving alternative for patients at high risk of node metastasis. METHODS:From May 2021 to July 2025, 11 patients underwent curative transanal excision surgery for early-stage low rectal cancer that was classified as high-risk pT1 adenocarcinoma. ICG (1 mg) was injected submucosally to label all lymph nodes irrespective of their metastatic status. ICG-guided robotic-assisted mesorectal lymphadenectomy was performed with the Firefly Imaging System (INTUITIVE©). RESULTS:Initially, ICG was injected intraoperatively (n = 2 patients). However, due to unsuccessful mapping in the second patient, ICG was then administered the day before surgery in all subsequent patients, resulting in successful visualisation and excision. Lymphatic drainage was not along the superior rectal artery in two patients. Lymphadenectomy was mainly performed along the superior rectal artery to its bifurcation into the right and left rectal arteries in the mid-rectum. The median number of excised lymph nodes was 16.7 (range: 9-29). Lymph node invasion was detected in one patient who then received adjuvant chemotherapy. The median hospital stay was 2 days, without complications. After 36 months of follow-up (range: 12-60), all patients were alive without disease progression or functional impairment. CONCLUSION:In patients with early T1 rectal tumours, ICG-guided robotic-assisted mesorectal lymphadenectomy seems to be technically feasible. These preliminary results, feasibility and oncological safety need to be confirmed in a prospective multicentre trial.

BACKGROUND:Bladder drainage is systematically used in rectal cancer surgery in male patients, even in the era of enhanced recovery after surgery (ERAS). However, little data is available on risk factors for urinary tract infection (UTI). Identifying the risk factors associated with UTI within 4 days of male rectal cancer surgery in an ERAS program could support more individualized decision-making. METHODS:We used data from the GRECCAR 10 randomized clinical trial, a comparison of outcomes of transurethral catheterization (TUC) or suprapubic catheterization (SPC). 240 patients were randomized, 209 retained in the study (TUC n = 99; SPC n = 109). Univariate and multivariate logistic regression post-hoc study analyses were performed to assess association between potential predictive factors and UTI within 30 days after surgery. RESULTS:Out of 208 patients (median age 64.5 years), 19 (9.1%) had UTI, 26 (12.5%) had bacteriuria and 145 (69.7%) had pyuria. Univariate analysis identified age ≥ 65 years (OR = 3.08 [1.07-8.89]; p = 0.038), hypertension (OR = 3.65 [1.23-10.84]; p = 0.020) and ASA score ≥ 3 (OR = 4.15 [1.53-11.2]; p = 0.005) as risk factors for UTI until POD4. Multivariate analysis identified ASA score ≥ 3 with a risk of UTI. CONCLUSION:Regarding male rectal cancer surgery, our study shows that nearly 1 in 10 patients had UTI within 4 days. An ASA score ≥ 3 is an independent risk factor linked to UTI. Identifying this risk factor for UTI is necessary to advise patients, support a tailored decision-making process, and prevent these complications.

Work-related determinants of return to work (RTW) after breast cancer (BC) have been poorly studied. We analysed data from 2095 patients with primary BC enrolled in the French multi-center prospective cohort CANTO between 2012 and 2018. We investigated the association between administrative, physical and psychosocial working conditions and RTW two years after diagnosis using Poisson regression with robust variance. All models were adjusted for age, education, having a partner or children, and clinical variables at diagnosis. Analyses stratified by education (up to/higher than high school) and by chemotherapy were conducted. Multiple imputations were performed. Having no weekly rest period of 48 consecutive hours (RR = 1.36 95

Introduction: Telementoring could increase the quality, reduce the time, and increase cost efficiency of the proctoring program for robot-assisted minimally invasive esophagectomy (RAMIE). However, feasibility is unclear as no studies assessed telementoring for RAMIE. Methods: The feasibility of telementoring was assessed during the thoracic part of RAMIE procedures in three high-volume centers. RAMIEs were performed by trained surgeons, proctored by two experts. The primary outcome was the impact of the technology on conveying and understanding instructions. Results: Between December 2021 and December 2022, nine RAMIE procedures were proctored using telementoring. Overall quality of the telementoring technique was scored good to excellent (median score: good). The vast majority of the 24 proctor instructions were conveyed and understood fluently (n = 21, 96%). Most proctor instructions were aimed at improving surgical exposure (n = 9, 38%). The major point of criticism was the use of the audio as the communication through the headset of the performing surgeon was not accessible by the complete team. Discussion: Telementoring is deemed feasible for proctoring trained RAMIE surgeons after onsite proctoring. Technical improvements with regard to audio technology are warranted for broad implementation, especially in earlier training settings. The role of telementoring in the training pathway of learning surgeons needs clinical validation.

Background: Robot-assisted total mesorectal excision has been proposed as an alternative to laparoscopic TME for rectal cancer. However, its short-term outcomes and long-term oncological efficacy remain debated, especially in Western populations. This study evaluates the short-term clinical and long-term oncological outcomes of robot-assisted total mesorectal excision performed by experienced surgeons in high-volume European centres. Methods: This multicentre, international, retrospective cohort study included 1390 patients from the EUREKA collaborative dataset who underwent robot-assisted total mesorectal excision for rectal cancer between January 2013 and January 2022. All surgeries were performed by expert surgeons beyond the learning curve. Data were analysed for patient demographics, perioperative outcomes, pathological findings, and three-year survival metrics. Kaplan–Meier analysis was used to evaluate overall and disease-free survival. Results: Of 1390 patients, 60.6% underwent restorative low anterior resection. Conversion to open surgery occurred in 3.7%, and postoperative complications were reported in 28.7%. Anastomotic leakage occurred in 14.7% of patients who underwent restorative low anterior resection. The median operative time was 223 min. R0 resection was achieved in 94.7%, and circumferential resection margin positivity was 5.5%. Three-year overall survival was 90.1%, disease-free survival was 88.6%, and local recurrence was 2.9%. Conclusions: Robot-assisted total mesorectal excision performed by experienced surgeons in high-volume European centres is safe, with low conversion rates, acceptable complication rates, and favourable oncological outcomes. These findings underscore the potential of robot-assisted total mesorectal excision as a standard approach for rectal cancer in specialised settings.

The optimal technique for intrathoracic esophagogastric anastomosis in esophagectomy remains undetermined. This study evaluates different anastomotic techniques in robot-assisted minimally invasive esophagectomy (RAMIE) and their impact on anastomotic leakage rates. This observational, retrospective, comparative cohort study analyzed data obtained from the Upper GI International Robotic Association (UGIRA) Esophageal Registry. All consecutive patients with a histologically proven esophageal malignancy who underwent RAMIE with intrathoracic esophagogastrostomy were included. The anastomotic technique was performed based on the clinical judgement and expertise of each individual surgeon. For comparison, the four most common techniques were included: circular end-to-side, linear side-to-side, handsewn end-to-side, and handsewn end-to-end. The primary endpoint of this study was the occurrence of anastomotic leakage, defined by the Esophagectomy Complications Consensus Group as a full-thickness gastrointestinal defect involving the esophagus, anastomosis, staple line, or conduit, regardless of its presentation or method of identification. Between 2016 and September 2023, 1518 patients were included. Univariable analysis demonstrated that the linear stapled side-to-side anastomosis was associated with the lowest anastomotic leakage rate (14.0

AIM:Alteration of bowel function after delayed coloanal anastomosis (DCAA) might be a limitation to its utilization. Our aim was to assess the long-term bowel function of DCAA in a large multicentric cohort. METHOD:All patients who underwent DCAA interventions at 29 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included. Low anterior resection syndrome (LARS) score or confection of a stoma due to poor bowel function was assessed in eligible patients. Good bowel function was defined by the preservation of bowel continuity with no LARS or a minor LARS. RESULTS:Among the 385 eligible patients to assess long-term bowel continuity, 63% (n = 243) responded to the questionnaire or had a definitive stoma because of poor bowel function. After a median follow-up of 32 months, good bowel function was reported by 60% (n = 146) of patients (with no LARS 36% and minor LARS 24%), whereas 40% of patients (n = 146) had a poor bowel function including major LARS (36%) and definitive stoma due to poor bowel function (4%). No variables tested were predictive of a poor bowel function after DCAA, including a history of pelvic radiotherapy (P = 0.722), salvage DCAA after failure of a previous anastomosis (P = 0.755), presence of a diverting stoma (P = 0.556), occurrence of an anastomotic leakage (P = 0.416) and time interval from the DCAA to the bowel function assessment (P = 0.350). CONCLUSIONS:No LARS or minor LARS was reached for 60% of patients after DCAA. Less than 5% of patients received a definitive stoma due to a poor bowel function.

Background Positive circumferential resection margin (CRM) after total mesorectal excision (TME) is associated with higher local and systemic recurrence rates, affecting overall survival in patients with rectal cancer. Although risk factors for positive CRM have been identified for open, laparoscopic, and transanal TME, these may differ for robot-assisted total mesorectal excision (R-TME). This study aimed to assess the incidence of positive CRM following R-TME and identify the associated preoperative risk factors. Method An international multicentre retrospective study included patients receiving R-TME between January 2013 and January 2022 in centres based in the Netherlands, UK, and France. Endpoints were the incidence of and predictive factors for positive CRM. Univariable and multivariable logistic regression analyses were performed, and factors associated with positive CRM were then assessed by formulating a predictive model. Results A total of 1390 patients underwent R-TME, and the incidence of positive CRM was 6.0% (n = 83). Multivariable analysis revealed significant associations between positive CRM and cT4 tumours (OR 2.27), involved mesorectal fascia on staging magnetic resonance imaging at diagnosis (OR 1.89), and non-sphincter-saving surgery (OR 2.22). The predictive model exhibited satisfactory discrimination (area under the receiver-operating characteristic curve > 0.7) and predicted a 26% risk of positive CRM when all identified risk factors were present. Conclusion Preoperative tumour- and procedure-related factors, rather than patient-related factors, are associated with CRM involvement after R-TME. The proposed predictive model allows preoperative calculation of the risk of positive CRM, offering valuable insights for optimizing patient selection and tailoring treatment approaches to enhance oncological outcomes.

BACKGROUND:Data registries lack a definitive classification system that distinguishes different locations of colon cancer from one another. OBJECTIVE:To establish an international consensus on the definition of primary colon cancer segment locations. DESIGN:Between December 2022 and June 2023, the Delphi survey study was conducted to seek opinions from relevant international experts and eventually develop a consensus definition of each colon cancer segment. SETTING:Three-round online-based Delphi survey study. INTERVENTIONS:The online survey included 17 questions. In the first 2 rounds, participating experts were asked to rank each statement on a scale of 1 (least relevant) to 9 (most relevant). Consensus statements and definitions were revised according to the results for statements obtaining a consensus score of 7 to 9. During the third round and online meeting, definitions and statements that reached a moderate or high consensus (above 4 for more than 70% of participants) were included. MAIN OUTCOME MEASURES:The primary goal of our project was focused on precisely localizing the specific segment affected by primary colon cancer rather than identifying surgical treatment or type of resection needed for a particular segment. RESULTS:The first round included 331 experts; 301 (91%) completed the second round and 295 (98%) completed the final round. Experts strongly supported the use of a "10-cm rule" to describe colon cancer sites at the flexures and anatomical landmarks for other segments. Regarding the definition of rectosigmoid cancer, experts from United States and Europe reached a high consensus that the term rectosigmoid as a colon cancer location must be abolished in contrast to experts from Asia. The description of overlapping segments of cancers achieved a consensus of 64%. LIMITATIONS:Subjective decisions are based on individual expert clinical experience. CONCLUSIONS:This Delphi survey, the first internationally conducted consensus study, achieved a remarkable level of consensus among a panel of global experts. Ambiguity still exists regarding overlapping lesions. See Video Abstract . ESTANDARIZACIN DE LA DEFINICIN DE CADA SEGMENTO DE CNCER DE COLON CONSENSO DELPHI SOBRE LA TOMA DE DECISIONES CLNICAS PARA RESULTADOS ONCOLGICOS:ANTECEDENTES:Las bases de datos carecen de un sistema de clasificación definitivo que distinga las diferentes localizaciones del cáncer de colon.OBJETIVO:Establecer un consenso internacional sobre la definición de las localizaciones de los segmentos del cáncer de colon priamrio.DISEÑO:Entre diciembre de 2022 y junio de 2023, se realizó un estudio Delphi para recabar la opinión de expertos internacionales relevantes y, finalmente, desarrollar una definición consensuada de cada segmento del cáncer de colon.ESCENARIO:Estudio Delphi en línea de 3 rondas.INTERVENCIONES:La encuesta en línea incluyó 17 preguntas. En las dos primeras rondas, se pidió a los expertos participantes que calificaran cada afirmación en una escala del 1 al 9 (9 es la más relevante). Las afirmaciones y definiciones de consenso se revisaron según los resultados, obteniendo una puntuación de consenso de 7 a 9. Durante la tercera ronda y la reunión en línea, se incluyeron las definiciones y afirmaciones que alcanzaron un consenso moderado o alto (superior a 4 en más del 70 % de los participantes).MEDIDA PRINCIPALES DE RESULTADOS:El objetivo principal de nuestro proyecto se centró en localizar con precisión el segmento específico afectado por el cáncer de colon primario, en lugar de identificar el tratamiento quirúrgico o el tipo de resección necesario para un segmento en particular.RESULTADOS:La primera ronda incluyó a 331 expertos, 301 (91%) completaron la segunda ronda y 295 (98%) completaron la ronda final. Los expertos apoyaron firmemente el uso de una "regla de 10 cm" para describir las localizaciones del cáncer de colon en las flexuras y puntos de referencia anatómicos para otros segmentos. En cuanto a la definición de cáncer rectosigmoideo, expertos de América y Europa alcanzaron un alto consenso en la necesidad de abolir el término "rectosigmoide" como localización del cáncer de colon, a diferencia de los expertos de Asia. La descripción de los cánceres en segmentos que se superponen a alcanzó un consenso del 64%.LIMITACIONES:Las decisiones subjetivas se basan en la experiencia clínica individual de cada experto.CONCLUSIONES:Esta encuesta Delphi, el primer estudio de consenso realizado a nivel internacional, alcanzó un notable nivel de consenso entre un panel de expertos globales. Todavía existe ambigüedad en cuanto a las lesiones superpuestas. (Traducción-Dr. Jorge Silva Velazco ).

Background/Objectives: Rectal cancer is a major global health issue with high morbidity and mortality rates. Local recurrence (LR) significantly impacts patient outcomes, decreasing survival rates and often necessitating extensive secondary treatments. While robot-assisted total mesorectal excision (R-TME) is becoming a preferred method for rectal cancer surgery due to its improved precision and visualisation, long-term data on LR and predictors of recurrence remain limited. This study aims to determine the 3-year LR rate following R-TME and to identify predictors of recurrence to enhance patient selection and the personalisation of treatment. Methods: This retrospective international multicentre cohort study included 1039 consecutive rectal cancer patients who underwent R-TME between 2013 and 2020, with a minimum of 3 years of follow-up. Data from tertiary colorectal centres in the United Kingdom, the Netherlands, Spain, France, Italy, and Belgium were analysed. Potential predictors of LR were identified using backward elimination, and four machine learning models were evaluated for predicting LR. Results: The 3-year LR rate was 3.8%. Significant predictors of LR included advanced clinical M-staging, length of the hospital stay, postoperative ileus, postoperative complications, pathological N-staging, the completeness of resection, and the resection margin distance. The eXtreme Gradient Boosting model performed best for LR prediction, with a final accuracy of 77.1% and an AUC of 0.76. Conclusions: R-TME in high-volume centres achieves low 3-year LR rates, suggesting that robot-assisted surgery offers oncological safety and advantages in rectal cancer management. This study underscores the importance of surgical precision, patient selection, and standardised perioperative care, supporting further investment in robotic training to improve long-term patient outcomes.

The gut microbiota is increasingly recognized as a key factor in rectal carcinogenesis. This review synthesizes current clinical and preclinical evidence linking specific microbial signatures, such as Fusobacterium nucleatum, Duodenibacillus massiliensis and colibactin-producing Escherichia coli (CoPEC) to chemoradiotherapy (CRT) treatment efficacy and resistance. Microbiota-driven mechanisms include immune modulation, inflammation, and drug metabolism. We highlight emerging microbial biomarkers and therapeutic strategies such as antibiotics, probiotics, and fecal microbiota transplantation. Integrating microbiome profiling into clinical workflows could refine patient stratification and enhance CRT efficacy in rectal cancer. Ongoing clinical trials aim to validate these associations and establish robust microbial biomarkers for CRT response prediction in rectal cancer.

BACKGROUND:While total mesorectal excision is the gold standard for rectal cancer, the optimal surgical approach to achieve adequate oncological outcomes remains controversial. This network meta-analysis aims to compare the histopathological outcomes of robotic (R-RR), transanal (Ta-RR), laparoscopic (L-RR), and open (O-RR) resections for rectal cancer. MATERIALS AND METHODS:MEDLINE, Embase, and the Cochrane Library were screened from inception to June 2024. Of the 4186 articles screened, 27 RCTs were selected. Pairwise comparisons and Bayesian network meta-analyses applying random effects models were performed. RESULTS:The 27 RCTs included a total of 8696 patients. Bayesian pairwise meta-analysis revealed significantly lower odds of non-complete mesorectal excision with Ta-RR (Odds Ratio, OR, 0.60; 95%CI, 0.33, 0.92; P = .02; I2:11.7 %) and R-RR (OR, 0.68; 95%CI, 0.46, 0.94; P = .02; I2:41.7 %) compared with laparoscopy. Moreover, lower odds of positive CRMs were observed in the Ta-RR group than in the L-RR group (OR, 0.36; 95%CI, 0.13, 0.91; P = .02; I2:43.9 %). The R-RR was associated with more lymph nodes harvested compared with L-RR (Mean Difference, MD, 1.24; 95%CI, 0.10, 2.52; P = .03; I2:77.3 %). Conversely, Ta-RR was associated with a significantly lower number of lymph nodes harvested compared with all other approaches. SUCRA plots revealed that Ta-RR had the highest probability of being the best approach to achieve a complete mesorectal excision and negative CRM, followed by R-RR, which ranked the best in lymph nodes retrieved. CONCLUSION:When comparing the effectiveness of the available surgical approaches for rectal cancer resection, Ta-RR and R-RR are associated with better histopathological outcomes than L-RR.