Colorectal Surgery

Tumor size and stage determine rectal cancer cCR and watch-and-wait use

This single-center cohort included 148 evaluable rectal adenocarcinoma patients treated with neoadjuvant therapy from 2021 to 2025. Overall clinical complete response was 37.8%, and watch-and-wait was implemented in 28.4% of patients. Tumors <4 cm and clinical stage I–II achieved clinical complete response rates exceeding 55% across both short-course and long-course regimens. Larger tumors had substantially lower response rates, while distance from the anal verge was not consistently associated with response. With 26 months’ median follow-up in the watch-and-wait group, five recurrences occurred, including three local recurrences. 1

Cold techniques match hot EMR for 10–20 mm sessile serrated lesions

This multicenter randomized non-inferiority trial compared cold snare polypectomy, cold EMR, and hot EMR for 159 sessile serrated lesions 10–20 mm. Complete histologic resection rates were similar across groups: 90.6% with cold snare, 88.5% with cold EMR, and 87.0% with hot EMR. Cold snare achieved shallower vertical resection depth, which improved with submucosal injection, and shortened polypectomy and total procedure times. En bloc resection was lower with cold snare than hot EMR but improved when submucosal injection was used. These findings support cold techniques as effective alternatives to hot EMR for intermediate-size sessile serrated lesions. 2

Short-course RT plus immunotherapy leads neoadjuvant options for pMMR LARC

This network meta-analysis synthesized seven randomized trials including 1132 patients with pMMR locally advanced rectal cancer. Four strategies were compared: short-course radiotherapy alone, short-course radiotherapy plus immune checkpoint inhibitors, long-course chemoradiotherapy alone, and long-course chemoradiotherapy plus immunotherapy. Short-course radiotherapy plus immunotherapy ranked best for curative-intent response, significantly outperforming short-course radiotherapy alone and long-course chemoradiotherapy alone. The addition of immunotherapy did not significantly increase grade ≥3 treatment-related adverse events for either radiotherapy platform. Pathologic complete response rankings mirrored the composite response, supporting short-course radiotherapy as the preferred backbone for immunotherapy combinations. 3

CT severity scores stratify risk in ischemic colitis

This retrospective single-center study validated the Montpellier CT-based severity score in 174 patients with ischemic colitis. Severe disease, defined by early death, necrosis, surgery, or superior mesenteric artery stenting, occurred in 44% of cases. The original Montpellier score showed 68% sensitivity, 81% specificity, and an AUC of 0.78 for predicting severe ischemic colitis. A modified score incorporating decreased wall enhancement achieved 71% sensitivity, 80% specificity, and an AUC of 0.80. Right colon involvement and peritoneal effusion were additional CT predictors, supporting CT-based triage to surgery or intensive monitoring. 4