30-Second Takeaway
- Extensive multiorgan debulking for mCRC did not improve survival and increased serious adverse events versus chemotherapy alone.
- Short-course radiotherapy plus PD-1 blockade yields the highest complete-response rates in pMMR rectal cancer without more high-grade toxicity.
- Baseline rectal tumor size and stage strongly determine cCR and watch-and-wait feasibility in routine practice.
Week ending March 21, 2026
Colorectal surgery grand rounds: current evidence in metastatic care, rectal organ preservation, IBD surgery, and screening
Extensive debulking plus chemotherapy does not improve survival in multiorgan mCRC (ORCHESTRA)
In ORCHESTRA, adults with multiorgan metastatic colorectal cancer eligible for >80% debulking received induction oxaliplatin-based chemotherapy, then were randomized to chemotherapy alone or additional debulking. Median overall survival was similar with chemotherapy alone vs chemotherapy plus debulking (27.5 vs 30.0 months; adjusted HR 0.88; 95% CI 0.70-1.10). Progression-free survival was nearly identical (10.4 vs 10.5 months; adjusted HR 0.83; 95% CI 0.67-1.02). Serious adverse events occurred more often with debulking than chemotherapy alone (53% vs 39%; P = .006).
SCRT plus checkpoint blockade ranks best for curative-intent response in pMMR LARC
This network meta-analysis pooled seven randomized trials (1132 patients) of pMMR locally advanced rectal cancer treated with SCRT- or LCRT-based neoadjuvant regimens with or without immune checkpoint inhibitors. For curative-intent response (pCR or cCR with watch-and-wait), SCRT + ICI ranked highest (SUCRA 98.5%). SCRT + ICI significantly outperformed SCRT alone (RR 1.82; 95% CI 1.27-2.60) and LCRT alone (RR 2.23; 95% CI 1.33-3.76). Adding ICIs to either platform did not significantly increase grade ≥3 treatment-related adverse events, and toxicity rates were similar between SCRT + ICI and LCRT + ICI.
Tumor size and stage drive cCR and watch-and-wait eligibility in real-world rectal cancer
This single-center retrospective cohort included 148 evaluable rectal adenocarcinoma patients treated with neoadjuvant therapy between 2021 and 2025. Clinical complete response occurred in 56 patients (37.8%), and watch-and-wait was implemented in 42 (28.4%). Stage I-II tumors smaller than 4 cm on baseline MRI had cCR rates exceeding 55%, whereas tumors 4 cm or larger responded substantially less often. cCRs were observed with both SCRT plus chemotherapy and long-course chemoradiotherapy in small, early-stage tumors, regardless of distance from the anal verge. With 26 months median follow-up in the watch-and-wait group, five recurrences occurred, including three local recurrences.
Post-ileocecal resection Crohn behavior is predominantly B1, independent of preoperative phenotype
This retrospective cohort followed 297 adults who underwent ileocecal resection for Crohn disease between 1990 and 2020 for a median of 14 years. At surgery, 20% had B1, 54% B2, and 25% B3 disease behavior. At last follow-up, 73% had B1, 23% B2, and 4% B3 behavior, with only 3% of B3 patients redeveloping B3 disease. Reprogression to stricturing or penetrating disease was independent of preoperative phenotype (P = .90).
References
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Additional Reads
Optional additional studies from this edition.