Colorectal Surgery

Preoperative nutritional support significantly lowers early HAEC after Hirschsprung pull-through

In this multicenter RCT, 110 children undergoing pull-through for Hirschsprung disease were randomized to preoperative nutritional support or standard care. At 3 months, HAEC occurred in 7.3% with nutritional support versus 29.1% with standard care, an absolute risk reduction of 21.8%. No adverse events related to nutritional support were reported. These data support routine preoperative nutritional optimization pathways before pull-through to reduce early HAEC in pediatric Hirschsprung disease. 1

Tumor-informed serial ctDNA assays best detect colorectal cancer recurrence after surgery

This diagnostic meta-analysis compared tumor-informed and tumor-agnostic ctDNA assays for detecting recurrence after curative-intent colorectal cancer resection. With serial sampling, tumor-informed assays achieved higher sensitivity than tumor-agnostic assays (0.88 vs 0.59) without increasing false-positive rates. Landmark single-timepoint analyses showed no clear sensitivity advantage of tumor-informed over tumor-agnostic assays. These findings favor tumor-informed assays when longitudinal monitoring is feasible to guide adjuvant therapy and surveillance decisions. 2

cfDNA fragmentome plus tumor volume improves risk stratification in unresectable colorectal liver metastases

This CAIRO5 secondary analysis evaluated a cfDNA fragmentome score (DELFI-TF) and CT-based total tumor volume in unresectable, liver-limited colorectal metastases. Baseline tumor volume strongly correlated with DELFI-TF, but on-treatment DELFI-TF showed a larger relative decline than volume under systemic therapy. Baseline levels and early changes in both DELFI-TF and tumor volume independently predicted overall survival and improved prognostic discrimination when combined. DELFI-TF levels also predicted early recurrence after local therapy. These exploratory data suggest integrating cfDNA fragmentomics with imaging could refine timing and selection for liver-directed interventions. 3

Nationwide FIT screening in Sweden shows strong uptake and high neoplasia yield

Sweden’s new FIT-based colorectal cancer screening program invited 884,866 adults aged 60–74 over five years. Overall participation was 64.3%, with higher uptake in older individuals and women but lower in sparsely populated regions. FIT positivity was 2.7%, and 82% of FIT-positive participants underwent colonoscopy, slightly below guideline targets. Among colonoscopies, colorectal cancer detection was 6.6%, advanced adenoma or cancer 29.9%, and overall adenoma detection 49.7%. Bowel prep and caecal intubation quality were high and complication rates low, supporting FIT screening but signaling substantial ongoing colonoscopy demand. 4