Colorectal Surgery

Stage-specific survival in early-onset versus late-onset colorectal cancer is heterogeneous

This systematic review of 21 studies (n=332,451; 29,199 EOCRC) examined overall survival by TNM stage in early- versus late-onset CRC. Most studies reported favourable OS for early-onset disease overall, but the very youngest patients often had worse survival in stage II and III disease. Heterogeneity across studies prevented meta-analysis and precludes firm, stage-specific conclusions. Authors recommend large, granular datasets with detailed staging and histopathology to clarify age-by-stage survival differences. 1

Perioperative blood transfusion independently predicts worse overall survival after radical CRC resection

In a retrospective cohort of 1,777 CRC resections with propensity score matching (524 pairs), perioperative blood transfusion independently predicted worse 5-year OS (HR 1.44). Transfusion volume stratified outcomes: massive-volume transfusion (>4 units) carried the poorest survival (HR 1.61). Findings persisted after adjustment, supporting restrictive transfusion strategies, but the observational design cannot prove causality. Consider minimizing perioperative transfusion and limiting units when clinically feasible. 2

Post–total colectomy VTE risk and associated mortality in IBD patients

Population-based Danish cohort (n=5,303) found 30-day VTE risks of 0.6% for Crohn’s and 1.3% for ulcerative colitis after total colectomy. Strongest 30-day VTE predictors included older age, higher comorbidity, and corticosteroid use; some risks persisted to 31–90 days. VTE was associated with a 1-year mortality of 21.0% and a mortality hazard ratio of 7.65, indicating major downstream harm. Use these risk signals to identify high-risk patients and inform consideration of extended thromboprophylaxis studies. 3