30-Second Takeaway
- Favor permanent synthetic mesh over biologic for parastomal hernia repair given lower 5-year recurrence without added mesh morbidity.
- In TNT-treated LARC, avoid shortening chemotherapy below about 18 weeks when feasible, given survival penalties with shorter courses.
- Use ctDNA and pathology, not imaging alone, to guide organ preservation and postoperative surveillance in rectal and MSI-H colorectal cancer.
Week ending February 28, 2026
Mesh choice, systemic therapy duration, and evolving biomarkers in colorectal practice
Synthetic mesh reduces 5-year parastomal hernia recurrence without added mesh morbidity
This post-hoc analysis followed 108 patients undergoing concomitant parastomal and open retromuscular ventral hernia repair randomized to biologic or synthetic mesh. At a median 5.9 years, parastomal hernia recurred in 37.5% with biologic versus 29.4% with synthetic mesh. Adjusted analysis showed synthetic mesh reduced recurrence risk by 35% (HR 0.65, 95% CI 0.44–0.96, P = 0.028). No new mesh-related complications occurred beyond 2 years, and reoperation numbers were similar between groups. Retromuscular Sugarbaker versus keyhole configuration did not significantly influence recurrence rate or recurrence-free survival.
At least 18 weeks of chemotherapy improves survival in LARC, mainly with TNT
This STELLAR trial post-hoc analysis examined 539 LARC patients receiving varying chemotherapy durations after neoadjuvant radiotherapy. Patients receiving ≥18 weeks of chemotherapy achieved the best outcomes, with 5-year OS 82.1% and DFS 66.0%. Versus no or 3–12 weeks of chemotherapy, ≥18 weeks significantly improved OS, and versus no chemotherapy it improved DFS (HR 0.621). In the TNT cohort, ≥18 weeks improved OS and DFS compared with 3–12 weeks, but not clearly versus 15 weeks. In the CRT cohort, the OS benefit of ≥18 weeks versus no chemotherapy disappeared when restricting to surgical patients. These findings caution against shortening chemotherapy below roughly 18 weeks in TNT-treated high-risk patients pending prospective confirmation.
Consensus framework for ICI-based perioperative and organ-preserving LARC management
This Chinese Society of Colorectal Surgery consensus standardizes immune checkpoint inhibitor use for locally advanced rectal cancer. It adopts internationally recognized dMMR/MSI detection criteria and stresses multidisciplinary decision-making before perioperative immunotherapy. The guidance offers graded recommendations on preoperative immunotherapy duration, postoperative adjuvant therapy, and indications for organ preservation or local resection. It details response evaluation and follow-up protocols tailored to ICI-based strategies to support safe nonoperative management. Perioperative safety processes for immunotherapy are refined, aiming for consistent, reproducible practice across centers.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.