Colorectal Surgery

Neoadjuvant CAPOX does not improve DFS in locally advanced colon cancer

This Scandinavian phase III trial randomized 248 patients with CT-staged locally advanced colon cancer to upfront surgery or 3 cycles of neoadjuvant CAPOX. Three-year disease-free survival was similar: 87% with upfront surgery versus 83% with neoadjuvant chemotherapy (P = .36). Neoadjuvant CAPOX was feasible and safe, produced tumor downstaging, and reduced the proportion meeting criteria for adjuvant chemotherapy. Postoperative complications, adverse events, and quality of life were comparable, indicating no clear perioperative downside to neoadjuvant treatment. 1

Minimally invasive colectomy markedly lowers 1-year mortality versus open surgery

This English target trial emulation included 21,931 patients undergoing elective resection for stage I–III colon cancer in 2021–2022. Minimally invasive resection was attempted in 83% and completed in 74%, but frail, comorbid, deprived, and higher-stage patients were less likely to receive it. Observed 1-year mortality was 7.7% after open resection versus 2.9% after completed minimally invasive surgery. The emulated trial estimated MIS would reduce 1-year mortality from 6.8% to 3.0%, with greatest absolute benefit in very elderly and frail patients. 2

Thermal ablation rivals hepatectomy for solitary colorectal liver metastases ≤5 cm

This multicenter target trial emulation compared thermal ablation and hepatectomy in 1,334 patients with solitary colorectal liver metastases ≤5 cm. After propensity matching, median progression-free survival was similar for thermal ablation and hepatectomy (1.81 vs 1.95 years; HR 0.94; P = .41). Median overall survival was also comparable (7.22 vs 8.09 years; HR 0.89; P = .30), with similar 5-year PFS and OS rates. Thermal ablation significantly reduced Clavien-Dindo III–IV complications (2.1% vs 5.0%), hospital stay (3 vs 10 days), and treatment costs. 3

Darvadstrocel adds no benefit over optimized surgery for complex perianal Crohn’s fistulas

ADMIRE CD II randomized 568 adults with complex perianal Crohn’s fistulas to darvadstrocel or placebo, all receiving curettage and closure of internal openings. At week 24, combined remission occurred in 48.8% with darvadstrocel versus 46.3% with placebo (difference 2.4%; 95% CI -5.8 to 10.6; P = .571). Key secondary endpoints, including clinical remission and time to remission, also showed no significant differences between groups. Treatment-emergent adverse events were frequent but similar between arms, and no new safety concerns emerged. 4