Background Anastomotic leakage (AL) is a serious complication of colorectal surgery, associated with re-intervention, prolonged hospitalization, and impaired long-term outcomes. Although patient- and procedure-related risk factors are well established, the impact of perioperative conditions, thermal management, fluid balance, intraoperative blood loss, and vasopressor-supported hemodynamics remains incompletely defined, with heterogeneous and confounded evidence. Methods In this retrospective single-center cohort study, 672 colorectal procedures with primary anastomosis at the University Hospital Erlangen (2013-2018) were analyzed. The primary endpoint was anastomotic leakage within 30 days, defined by clinical and/or radiologic evidence requiring intervention. Examined variables included age, sex, body mass index (BMI), ASA class, surgical urgency, operative duration, minimum intraoperative core temperature, estimated blood loss (>500 mL), total crystalloid volume (>3500 mL), and intraoperative norepinephrine administration. Associations with anastomotic leakage were evaluated using univariable and exploratory multivariable logistic regression. Results Anastomotic leakage (AL) occurred in 20/672 procedures (3.0%) and was associated with a markedly longer hospital stay (41.5 [IQR 31.3-60.3] vs. 11 [IQR 9.0-17.0] days; p < 0.001). In an exploratory multivariable logistic regression, ASA class III/IV (OR 3.8, 95% CI 1.3-11.3; p = 0.016) and operative duration ≥300 min (OR 3.6, 95% CI 1.2-13.6; p = 0.025) were independently associated with leakage. In contrast, intraoperative hypothermia (<35.5°C), estimated blood loss (>500 mL), and any norepinephrine use showed unadjusted associations with AL but were not independently associated after adjustment. Conclusion High ASA class (III/IV) and prolonged operative duration were the only independent risk factors for anastomotic leakage in this study. Intraoperative exposure variables such as hypothermia, estimated blood loss, and any norepinephrine use were not independently associated after adjustment.

The aim of the present study was to identify risk factors associated with postoperative morbidity and mortality in patients undergoing isolated left pancreatectomy and those undergoing left pancreatic resection as part of a multivisceral resection. We performed a retrospective analysis of 296 adult patients who underwent elective left pancreatectomy from 2005 to 2022 at the University Hospital Erlangen. Patient demographics, pre- and intraoperative findings, along with postoperative outcomes, were collected and tested as predictive factors for various short-term postoperative parameters. Isolated left pancreatectomy (LP) was performed in 173 patients, while 123 patients underwent left pancreatectomy as part of a multivisceral resection (multivisceral LP). Multivisceral LP was associated with a higher rate of major morbidity (27% vs. 17%, p = 0.043) and mortality (7% vs. 2%, p = 0.046) compared to LP. Independent risk factors for major morbidity included the need for intraoperative blood transfusion and oncological lymphadenectomy in the LP group and longer operative time in the multivisceral LP group. CR-POPF was associated with the indication for surgery in the LP group. Independent risk factors for re-surgery included intraoperative blood transfusion in the LP group and ASA III or IV in the multivisceral LP group. Cardiovascular diseases were associated with higher mortality in the LP group, while COPD was the only risk factor for mortality in the multivisceral LP group. Multivisceral left pancreatectomy is associated with worse outcomes compared to isolated left pancreatectomy. In both groups, relevant risk factors predict postoperative complications. Patients with these identified risk factors should receive close monitoring during the postoperative course to anticipate outcomes with an increased risk of complications.

Low anterior resection (LAR) and abdominoperineal resection (APR) are the two main surgical procedures after preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer. APR is associated with poorer prognosis; however existing data do not consider intensified CRT (5-Fluorouracil (5-FU)/Oxaliplatin + radiation) protocols. Clinicopathological data of patients treated with APR and LAR from the CAO/ARO/AIO-04 trial were analysed in terms of prognostic parameters and quality of life (QoL). Based on higher response rate after intensified CRT, subgroup analyses were performed. Data from n = 1173 patients were assessed. APR after preoperative CRT was associated with a significantly worse overall survival (p = 0.0056), disease-free survival (p < 0.0001) and local recurrence rate (p = 0.0047). Clinicopathological data including clinical T stage (p < 0.000001), grading (p = 0.0038), postoperative lymph node (LN) positivity (p = 0.013), and number of positive LN (p = 0.0049) significantly differed between procedures and showed higher values in APR patients. The quality of total mesorectal excision (TME) was significantly better (p < 0.0001) and complete resection rates were higher (p = 0.0022) in LAR compared to APR patients. Subgroup analyses showed worse LR rates in APR patients after standard CRT (5-FU mono and radiation) but not after intensified CRT. After 3 years, role functioning (p = 0.019) and physical functioning (p = 0.001) had a slightly poorer outcome in APR patients. The poorer prognosis of patients undergoing APR for locally advanced rectal cancer may be explained by clinicopathological characteristics. Intensified CRT may compensate for the higher risk of LR after APR in patients with worse TME quality. QoL in APR patients was comparable to LAR patients.

Pancreatic cancer is a malignant tumor of the digestive system. It is highly aggressive, easily metastasizes, and extremely difficult to treat. This study aimed to analyze the genes that might regulate pancreatic cancer migration to provide an essential basis for the prognostic assessment of pancreatic cancer and individualized treatment. A CRISPR knockout library directed against 915 murine genes was transfected into TB 32047 cell line to screen which gene loss promoted cell migration. Next-generation sequencing and PinAPL.py- analysis was performed to identify candidate genes. We then assessed the effect of serine/threonine kinase 11 (STK11) knockout on pancreatic cancer by wound-healing assay, chick agnosia (CAM) assay, and orthotopic mouse pancreatic cancer model. We performed RNA sequence and Western blotting for mechanistic studies to identify and verify the pathways. After accelerated Transwell migration screening, STK11 was identified as one of the top candidate genes. Further experiments showed that targeted knockout of STK11 promoted the cell migration and increased liver metastasis in mice. Mechanistic analyses revealed that STK11 knockout influences blood vessel morphogenesis and is closely associated with the enhanced expression of phosphodiesterases (PDEs), especially PDE4D, PDE4B, and PDE10A. PDE4 inhibitor Roflumilast inhibited STK11-KO cell migration and tumor size, further demonstrating that PDEs are essential for STK11-deficient cell migration. Our findings support the adoption of therapeutic strategies, including Roflumilast, for patients with STK11-mutated pancreatic cancer in order to improve treatment efficacy and ultimately prolong survival.

ZusammenfassungDie wichtigste Komplikation nach Pankreatoduodenektomie ist die klinisch relevante Pankreasfistel. Um die Rate an Komplikationen zu senken, ist eine routinierte und standardisierte Operationstechnik zur Anlage der Pankreatojejunostomie notwendig.Die Pankreatoduodenektomie ist im multimodalen Setting der Goldstandard zur Behandlung des lokal begrenzten Pankreaskopfkarzinoms und weiterer Pathologien. Das robotische Verfahren bietet als innovatives minimalinvasives Verfahren Vorteile bez. Morbidität und Ergonomie.Nach der Resektionsphase folgt die Rekonstruktion beginnend mit der Pankreatojejunostomie. Die aktuell meistverbreitete robotische Technik ist die Anastomose nach Blumgart: Dabei wird eine äußere Naht transpankreatisch zwischen Jejunalwand und dem gesamten Pankreasparenchym in ventrodorsaler Ausrichtung angelegt, die Spannungs- und Scherkräfte verteilt. Die innere Naht wird durch eine Duct-to-Mucosa-Naht des Pankreasganges mit einer kleinen Jejujunostomie erreicht. In diesem Manuskript werden verschiedene Varianten dieser Rekonstruktion in robotischer Technik gezeigt.Hinsichtlich der wissenschaftlichen Evidenz zeigt keine Anastomosenvariante einen Vorteil. Das Outcome ist abhängig von der Expertise des Operateurs, entsprechend sollte diejenige Anastomosentechnik angewendet werden, für die am meisten Erfahrung verfügbar ist. Die in diesem Beitrag gezeigten Variationen sollen für Anwender den Fokus auf wichtige Details legen sowie Tipps und Tricks zur Durchführung geben.

Perturbation of cell polarity is a hallmark of pancreatic ductal adenocarcinoma (PDAC) progression. Scribble (SCRIB) is a well-characterized polarity regulator that has diverse roles in the pathogenesis of human neoplasms. To investigate the impact of SCRIB deficiency in PDAC development and progression, Scrib expression was genetically ablated in well-established mouse models of PDAC. Scrib loss in combination with KrasG12D did not influence development of pancreatic intraepithelial neoplasms in mice. However, Scrib deletion cooperated with KrasG12D and concomitant Trp53 heterozygous deletion to promote invasive PDAC and metastatic dissemination, leading to reduced overall survival. Immunohistochemical and transcriptome analyses revealed that Scrib-null tumors display a pronounced reduction of collagen content and an abundance of cancer-associated fibroblasts (CAF). Mechanistically, IL1α levels were reduced in Scrib-deficient tumors, and Scrib knockdown downregulated IL1α in mouse PDAC organoids (mPDO), which impaired CAF activation. Furthermore, Scrib loss increased YAP activation in mPDOs and established PDAC cell lines, enhancing cell survival. Clinically, SCRIB expression was decreased in human PDAC, and SCRIB mislocalization was associated with poorer patient outcome. These results indicate that SCRIB deficiency enhances cancer cell survival and remodels the tumor microenvironment to accelerate PDAC development and progression, establishing the tumor suppressor function of SCRIB in advanced pancreatic cancer.  Significance: SCRIB loss promotes invasive pancreatic cancer development via both cell-autonomous and non-cell-autonomous processes and is associated with poorer outcomes, denoting SCRIB as a tumor suppressor and potential biomarker for the prediction of recurrence.

Zusammenfassung Einleitung Zystische Pankreasneoplasien haben aufgrund ihrer hohen Pravalenz einen relevanten Stellenwert im klinischen Alltag eingenommen. Nur ein kleiner Teil der diagnostizierten Pankreaszysten erfordert eine chirurgische Therapie. Ist eine Resektion indiziert, so hangt die Wahl des passenden Operationsverfahrens von der Art, dem Ausma ss und der Lage der zystischen Pankreasneoplasie ab. Indikationen Zystische Pankreasneoplasien: Fall 1: Seitengang-IPMN im Pankreaskopf; Fall 2: muzinos-zystische Neoplasie (MCN) im Pankreasschwanz; Fall 3: solide pseudopapillare Neoplasie (SPN) im Pankreasschwanz; Fall 4: Mixed-Type-IPMN im Pankreaskorpus. Prozeduren Minimalinvasive Resektionstechniken bei zystischen Pankreasneoplasien: Fall 1: roboterassistierte Enukleation; Fall 2: laparoskopische Pankreaslinksresektion; Fall 3: roboterassistierte milzerhaltende Pankreasschwanzresektion; Fall 4: roboterassistierte Pankreassegmentresektion. Schlussfolgerung Die Heterogenitat zystischer Pankreasneoplasien erfordert eine individualisierte Wahl des Operationsverfahrens, das bevorzugt minimalinvasiv und organerhaltend durchgefuhrt werden sollte.

The vasculature is a key player and regulatory component in the multicellular microenvironment of solid tumors and, consequently, a therapeutic target. In colorectal carcinoma (CRC), antiangiogenic treatment was approved almost 20 years ago, but there are still no valid predictors of response. In addition, treatment resistance has become a problem. Vascular heterogeneity and plasticity due to species-, organ-, and milieu-dependent phenotypic and functional differences of blood vascular cells reduced the hope of being able to apply a standard approach of antiangiogenic therapy to all patients. In addition, the pathological vasculature in CRC is characterized by heterogeneous perfusion, impaired barrier function, immunosuppressive endothelial cell anergy, and metabolic competition-induced microenvironmental stress. Only recently, angiocrine proteins have been identified that are specifically released from vascular cells and can regulate tumor initiation and progression in an autocrine and paracrine manner. In this review, we summarize the history and current strategies for applying antiangiogenic treatment and discuss the associated challenges and opportunities, including normalizing the tumor vasculature, modulating milieu-dependent vascular heterogeneity, and targeting functions of angiocrine proteins. These new strategies could open perspectives for future vascular-targeted and patient-tailored therapy selection in CRC.

Zystische Pankreasraumforderungen stellen eine anspruchsvolle heterogene Entität mit potenziell malignem Transformationsrisiko dar. Die Diagnostik umfasst insbesondere die Anamnese mit Erfassung relevanter klinischer Informationen sowie die Durchführung einer hochauflösenden Bildgebung, bevorzugt mittels Magnetresonanztomographie (MRT) mit MR-Cholangiopankreatikographie und/oder Endosonographie. Eine Differenzierung der einzelnen Zystenentitäten sowie das Erkennen von Risikozeichen sind entscheidend für eine angemessene Therapieentscheidung. Nur ein kleiner Teil aller zystischen Pankreasneoplasien bedürfen einer chirurgischen Therapie. Zystische Pankreasraumforderungen mit relevantem Malignitätsrisiko (Hauptgang-IPMN[intraduktale papillär-muzinöse Neoplasie], muzinös-zystische Neoplasie, solide pseudopapilläre Neoplasie, generell zystische Pankreasläsionen mit Risikofaktoren unabhängig der Entität) sollten reseziert werden, während bei Seitengang-IPMN ein individualisiertes Vorgehen erforderlich ist und serös-zystische Neoplasien sowie dysontogenetische Zysten keinerlei Behandlung bedürfen. Bei der Resektion zystischer Pankreastumoren sollten parenchymsparende und minimal-invasive Resektionsverfahren wann immer möglich bevorzugt werden. Etwa 10

Pancreatic cystic lesions represent a challenging heterogeneous entity with a potential risk of malignant transformation. The diagnostics include in particular medical history taking with collection of relevant clinical information and high-resolution imaging, preferably using magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) and/or endoscopic ultrasonography. A differentiation between different cystic entities and identification of risk factors are crucial for making appropriate treatment decisions. Only a small proportion of pancreatic cystic neoplasms require surgery. Pancreatic cystic lesions with a relevant risk of malignancy, such as main duct intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), solid pseudopapillary neoplasms (SPN) and general cystic pancreatic lesions with risk factors regardless of the entity, should be resected, whereas an individualized approach is required for branch duct IPMN and serous cystic neoplasms (SCN) and dysontogenetic cysts require no treatment. Parenchyma-sparing and minimally invasive resection techniques should be preferred whenever possible for resecting pancreatic cystic tumors. Approximately 10% of patients develop recurrences over time.

Background/Objectives: This study aimed to determine the risk factors associated with postoperative major morbidity, anastomotic/suture leakage, re-surgery and mortality in patients undergoing emergency surgery for colonic perforation. Methods: A total of 204 adult patients treated surgically for colonic perforation from 2016 to 2021 at the University Hospital Erlangen were included in a retrospective analysis. Patient demographics and pre-, intra- and postoperative parameters were obtained and evaluated among various outcome groups (in-hospital major morbidity, anastomotic/suture leakage, re-surgery and 90-day mortality). Results: Postoperative in-hospital major morbidity, anastomotic/suture leakage, need of re-surgery and 90-day mortality occurred in 45%, 12%, 25% and 12% of the included patients, respectively. Independent risk factors for in-hospital major morbidity were identified and included the presence of any comorbidity, a significantly reduced preoperative general condition, the localization of perforation in the right hemicolon and the need for an intraoperative blood transfusion. The only independent risk factor for anastomotic/suture leakage was the presence of any comorbidity, whereas no independent risk factors for re-surgery were found. An age > 65 years, a significantly reduced preoperative general condition and the need for an intraoperative blood transfusion were independent risk factors for 90-day mortality. Conclusions: Our study identified risk factors impacting postoperative outcomes in patients undergoing emergency surgery for colonic perforation. These patients should receive enhanced postoperative care and may benefit from individualized and targeted therapeutic approaches.

BackgroundPancreatic ductal adenocarcinoma (PDAC) is one of the deadliest forms of cancer and peritoneal dissemination is one major cause for this poor prognosis. Exosomes have emerged as promising biomarkers for gastrointestinal cancers and can be found in all kinds of bodily fluids, also in peritoneal fluid (PF). This is a unique sample due to its closeness to gastrointestinal malignancies. The receptor tyrosine kinase-like orphan receptor 1 (ROR1) has been identified as a potential biomarker in human cancers and represents a promising target for an immunotherapy approach, which could be considered for future treatment strategies. Here we prospectively analyzed the exosomal surface protein ROR1 (exo-ROR1) in PF in localized PDAC patients (PER-) on the one hand and peritoneal disseminated tumor stages (PER+) on the other hand followed by the correlation of exo-ROR1 with clinical-pathological parameters.MethodsExosomes were isolated from PF and plasma samples of non-cancerous (NC) (n = 15), chronic pancreatitis (CP) (n = 4), localized PDAC (PER-) (n = 18) and peritoneal disseminated PDAC (PER+) (n = 9) patients and the surface protein ROR1 was detected via FACS analysis. Additionally, soluble ROR1 in PF was analyzed. ROR1 expression in tissue was investigated using western blots (WB), qPCR, and immunohistochemistry (IHC). Exosome isolation was proven by Nano Tracking Analysis (NTA), WB, Transmission electron microscopy (TEM), and BCA protein assay. The results were correlated with clinical data and survival analysis was performed.ResultsPDAC (PER+) patients have the highest exo-ROR1 values in PF and can be discriminated from NC (p <0.0001), PDAC (PER-) (p <0.0001), and CP (p = 0.0112). PDAC (PER-) can be discriminated from NC (p = 0.0003). In plasma, exo-ROR1 is not able to distinguish between the groups. While there is no expression of ROR1 in the exocrine pancreatic tissue, PDAC and peritoneal metastasis show expression of ROR1. High exo-ROR1 expression in PF is associated with lower overall survival (p = 0.0482).ConclusionWith exo-ROR1 in PF we found a promising diagnostic and prognostic biomarker possibly discriminating between NC, PDAC (PER-) and PDAC (PER+) and might shed light on future diagnostic and therapeutic concepts in PDAC.

Zusammenfassung Die Pankreassegmentresektion weist bei symptomatischen benignen oder prämalignen Läsionen des Pankreaskorpus bzw. -schwanzes, die sich nicht für eine Enukleation eignen, eine ausgezeichnete Alternative zur Pankreaslinksresektion auf. Der Hauptvorteil dieser Technik liegt in der Schonung von Pankreasparenchym, was mit einer niedrigeren Rate an postoperativem Diabetes mellitus assoziiert ist. Auf der Gegenseite erfordert die Pankreassegmentresektion eine komplexere Rekonstruktion, was wiederum mit einer erhöhten Morbidität einhergeht. Insulinom im Pankreaskorpus. Roboterassistierte Pankreassegmentresektion mit Pankreatikojejunostomie in modifizierter Blumgart-Technik. Die Pankreassegmentresektion stellt ein aufgrund einer limitierten Anzahl an Indikationen insgesamt seltenes und zudem anspruchsvolles Resektionsverfahren am Pankreas dar, besitzt aber aufgrund der funktionellen Vorteile eindeutig ihren Stellenwert in der modernen Pankreaschirurgie. Bei entsprechender Indikation und technischer Durchführbarkeit sollte die Pankreassegmentresektion einer alternativen Pankreaslinksresektion vorgezogen und wann immer möglich minimalinvasiv durchgeführt werden.

BACKGROUND:The aim of this study was to investigate the patterns of recurrence and their associated risk factors in patients who underwent resection for pancreatic carcinoma. METHODS:This retrospective study included 272 patients, who underwent Ro/R1-resection of PDAC from 2005 to 2020 at the University Hospital Erlangen. Risk factors for different recurrence patterns and the prognostic value of recurrence pattern on the overall survival after recurrence were evaluated. RESULTS:61 % of the patients experienced recurrence, mostly within the first 12 postoperative months (62 %) and in the form of metastases (87 %). The median overall survival from recurrence was 9.2 months. The preoperative absence of diabetes and the presence of lymph node metastasis were independent risk factors for recurrence and a preoperative CA19-9 exceeding 97 U/ml for early recurrence. Additionally, lymph node metastases were associated with a higher risk of metastatic recurrence. Early recurrence, but not the site of recurrence, was identified as an independent prognostic factor for worse overall survival from recurrence. CONCLUSION:The occurrence of recurrence and especially of early and metastatic recurrence are associated with a worse overall survival. Patients lacking preoperative diabetes, having high preoperative CA19-9 values and lymph node metastases are particularly at risk for (early) recurrence.

Background: Total neoadjuvant therapy (TNT) has been used for patients with locally advanced rectal cancer. The optimal sequence of chemoradiotherapy (CRT) and chemotherapy (CT) is a matter of debate. Methods: We performed a pooled analysis of the CAO/ARO/AIO-12 and OPRA multicenter, randomized phase 2 trials to identify patient subsets that could benefit from one TNT sequence over the other regarding disease-free survival (DFS). Patients with stage II/III rectal cancer were randomized to CRT (50.4-54 Gy) with either induction (INCT-CRT) or consolidation CT (CRT-CNCT) with fluorouracil, leucovorin, oxaliplatin (CAO/ARO/AIO12 and OPRA) or capecitabine and oxaliplatin (OPRA) followed by mandatory total mesorectal excision (TME) (CAO/ARO/AIO-12) or selective watch-and-wait surveillance (OPRA). 311 and 324 patients were recruited from June 15, 2015 to January 31, 2018; and from April 12, 2014 to March 30, 2020 in the two trials, respectively. Pretreatment clinical and tumor characteristics included were age, sex, ECOG, cT-category, cN-category, clinical UICC stage, location from anal verge, and tumor grade. Findings: In total, 628 eligible patients were included in the pooled analysis (CAO/ARO/AIO-12, n = 304; OPRA, n = 324). Of those, 313 were randomly assigned to the INCT-CRT group, and 315 to the CRT-CNCT group.Median follow-up was 43 months (IQR, 35-49) months in the CAO/ARO/AIO-12 trial and 61,2 months (IQR, 42-68,4) in the OPRA trial. Pooled analysis of baseline clinical and tumor characteristics did not identify any subgroups of patients that would benefit by the one TNT sequence over the other with regard to DFS. Interpretation: To our knowledge, this is the first pooled analysis of two randomized trials after direct head-to- head comparison of both TNT sequences. Both trials reported higher rates of complete response with CRTCNCT, and this should be considered the preferred TNT sequence if organ preservation is a priority.

BACKGROUND AND AIMS:Inflammatory bowel diseases (IBD) are characterized by mucosal inflammation and sequential fibrosis formation, but the exact role of the hyperactive NLRP3 inflammasome in these processes is unclear. Thus, we studied the expression and function of the NLRP3 inflammasome in the context of inflammation and fibrosis in IBD. METHODS:We analysed intestinal NLRP3 expression in mucosal immune cells and fibroblasts from IBD patients and NLRP3-associated gene expression via single-cell RNA sequencing and microarray analyses. Furthermore, cytokine secretion of NLRP3 inhibitor treated blood and mucosal cells, as well as proliferation, collagen production, and cell death of NLRP3 inhibitor treated intestinal fibroblasts from IBD patients were studied. RESULTS:We found increased NLRP3 expression in the inflamed mucosa of IBD patients and NLRP3 inhibition led to reduced IL-1β and IL-18 production in blood cells and diminished the bioactive form of mucosal IL-1β. Single cell analysis identified overlapping expression patterns of NLRP3 and IL-1β in classically activated intestinal macrophages and we also detected NLRP3 expression in CD163+ macrophages. In addition, NLRP3 expression was also found in intestinal fibroblasts from IBD patients. Inhibition of NLRP3 led to reduced proliferation of intestinal fibroblasts, which was associated with a marked decrease in production of collagen type I and type VI in IBD patients. Moreover, NLRP3 inhibition in intestinal fibroblasts induced autophagy, a cellular process involved in collagen degradation. CONCLUSIONS:In the presented study, we demonstrate that inhibiting NLRP3 might pave the way for novel therapeutic approaches in IBD, especially to prevent the severe complication of intestinal fibrosis formation.

Patients with right-sided metastatic colon carcinoma have a significantly worse prognosis than those with left-sided colorectal cancer (CRC), regardless of treatment. The aim of the prospective IVOPAK II study was to implement an interdisciplinary guideline-conform personalized CRC palliative therapy of metastatic colorectal carcinoma and to improve the overall survival (OS) by multidisciplinary approach via secondary metastatic resection. We present the efficacy data of first-line treatment and the benefit of interdisciplinary collaboration of right-sided metastatic colon carcinoma patients: n = 25. RAS mutation: n = 20 (80%): received systemic first-line treatment: FOLFIRI plus bevacizumab. All-RAS-wildtype: n = 5 (20%): received systemic first-line treatment: FOLFIRI plus cetuximab. Last date evaluation: 31 January 2024. Median age: 59.6 years (range 42–71), men/women: 14/11. Eastern Cooperative Oncology Group (ECOG) index: 0/1/2 : 11/10/4. Evaluable for response: n = 25. Complete response: n = 0, partial response: n = 14 (56%), stable disease: n = 8 (32%), progressive disease: n = 3 (12%), early tumor shrinkage: n = 13 (52%), estimates progression-free survival: 13 months (95% CI 8–17 months), estimated OS: 48 months (95% CI 25–71 months), median follow-up: 26 months (1–61 months), no evidence of disease: n = 4 (16%). A chemotherapy doublette regimen with FOLFIRI plus a biological as first-line treatment shows promising efficacy and secondary metastatic resection after interdisciplinary discussion was associated with a survival benefit in right-sided metastatic colon carcinoma.