30-Second Takeaway
- Prefer U-EMR/EMR for complex benign polyps; reserve ESD for highest complete resection with acceptable safety.
- Use continuous small-bite fascial closure for elective midline laparotomy to cut long-term incisional hernia risk.
- In FIT-positive screening, colon capsule endoscopy still generates high colonoscopy re-investigation rates regardless of faecal haemoglobin level.
- For 3–5 cm CRLM, thermal ablation offers less morbidity but inferior local progression-free survival versus resection.
- Peri-operative ctDNA levels refine risk stratification after CRLM resection, potentially guiding peri-operative chemotherapy decisions.
Week ending April 4, 2026
Colorectal surgery grand rounds: optimizing resection techniques, closure, and oncologic pathways
Network meta-analysis ranks colorectal polypectomy techniques for efficacy and safety
This Bayesian network meta-analysis pooled 100 RCTs with 24,786 patients and 34,244 polyps across 13 polypectomy techniques. U-EMR and conventional EMR ranked highest for R0 and en bloc resection based on SUCRA probabilities. For complete resection, ESD performed best while maintaining a favorable bleeding safety profile. Cold forceps and CSP with submucosal injection were consistently least effective on efficacy outcomes. HS-EMR carried the highest bleeding risk, whereas CSP-based techniques were generally safest for perforation. Overall certainty of evidence was low to moderate, so rankings should inform but not dictate technique choice.
Thermal ablation versus resection for 3–5 cm colorectal liver metastases
This retrospective AmCORE registry study compared thermal ablation, surgical resection, and combined treatment for 3–5 cm CRLM in 320 patients with 448 metastases. Local tumor progression-free survival per tumor favored resection, with significantly higher progression after ablation despite multivariable adjustment. However, overall local control per tumor, overall survival, and distant progression-free survival did not significantly differ between treatment groups. Complication rates were significantly higher and hospital stay longer after resection compared with ablation. Ablation provided a shorter median stay and the option for repeat ablation, at the cost of more treatment-site recurrences.
Small-bite continuous closure halves long-term incisional hernia burden
This multicenter randomized trial followed 559 patients after elective midline laparotomy for up to 13 years. Continuous small-bite closure (5 mm × 5 mm) reduced cumulative incisional hernia incidence to 34% versus 49% with large bites, hazard ratio 0.61. Clinically important hernias (>20 mm) were also lower after small-bite closure, 17% versus 34%, hazard ratio 0.36. Hernias in the small-bite group were smaller at final follow-up, with similar hernia repair rates between groups. Patients with incisional hernias reported worse quality of life, underscoring the clinical impact of adopting small-bite closure. Given simplicity and cost neutrality, small-bite continuous closure should be considered standard for elective midline laparotomies.
FIT-based prioritised referral appears safe for CRC-specific survival
This retrospective study analyzed 126,984 symptomatic patients in a primary care FIT-prioritised lower GI pathway from 2019 to 2022. Colorectal cancer occurred in 1% of patients within three years, with 31% CRC-specific mortality over follow-up. On multivariable analysis, referral without FIT was associated with worse CRC-specific survival, hazard ratio 1.42, independent of TNM stage. Similarly, f-Hb ≥10 µg/g diagnosed outside cancer-prioritised pathways carried worse survival, hazard ratio 1.47. When referral and investigation followed f-Hb–guided cancer-prioritised pathways, CRC-specific survival was maintained, supporting current threshold-based triage.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.