Colorectal Surgery

Updated ESGAR MRI guidance sharpens primary rectal cancer staging for surgery

This ESGAR consensus updates MRI acquisition, interpretation, and reporting for primary rectal cancer staging. Key changes include using the sigmoid take-off to distinguish rectal from sigmoid tumors and redefining mesorectal fascia involvement as ≤1 mm, including irregular nodes and EMVI. Nodal staging adopts a patient-level cN category with updated morphologic criteria and a ≥7 mm threshold for suspicious lateral nodes. The guideline recommends limited diffusion-weighted imaging for baseline staging, emphasizing high-quality T2-weighted sequences instead. 1

ESGAR restaging MRI consensus standardizes post-neoadjuvant rectal cancer assessment

This guideline provides updated MRI recommendations for restaging rectal cancer after neoadjuvant treatment. It details assessment of post-treatment fibrosis, ycMRF status, and ycEMVI to guide resection margins and surgical strategy. The document outlines MRI criteria for selecting candidates for organ preservation, including watch-and-wait and local excision, and recommends standardized tumor regression grading. Specific guidance is given for mucinous tumors and nodal response classification (ycN category). 2

Long-term FIT adherence retains clinically relevant cancer detection despite lower positivity

This organized screening study followed 2.81 million individuals through up to seven biennial FIT rounds. In both all invitees and adherent participants, the first round had the highest FIT positivity, PPVs, and CRC detection rates. After three rounds, outcomes stabilized at lower levels but remained clinically meaningful for CRC and advanced precursors. Detection in late rounds was substantially lower than in same-age first-time screeners, reflecting prior neoplasia removal and risk selection. 3

Tumor location and PCI predict peritoneal recurrence after CRS/HIPEC

Among 133 patients undergoing CC-0 CRS/HIPEC for colorectal peritoneal metastases, 48.1% developed peritoneal surface recurrence. Recurrent patients had higher baseline peritoneal cancer index (PCI), and each one-point PCI increase among those who recurred advanced relapse by about 2.4 weeks. Right- and sigmoid-colon primaries independently predicted peritoneal recurrence versus other locations after adjusting for PCI. Tumor stage, histology, HIPEC agent, and KRAS/BRAF/SMAD4 status were not associated with recurrence risk. 4