Colorectal Surgery

Probiotics may reduce chemo-related diarrhea and speed GI recovery after colorectal surgery

This systematic review of trials and meta-analyses through September 2025 found probiotic supplementation reduced clinically relevant chemotherapy-associated diarrhea, most consistently for severe diarrhea and select subgroups. Perioperative probiotics or synbiotics in colorectal surgery were associated with faster return of GI function, fewer postoperative infections, and shorter length of stay in pooled randomized evidence. No probiotic-strain invasive infections were reported in the included controlled studies, but rare serious events exist in broader literature. Heterogeneity in formulations, outcome definitions, and few large trials limit certainty; strain-specific, adequately powered RCTs are needed. 1

Delays >6 weeks to definitive therapy predict worse survival in early age-onset CRC

Population-based analysis of 112,672 Texas cancer registry patients found 11% had early age-onset CRC (age <50 years). Treatment delays >6 weeks from diagnosis to definitive therapy were associated with worse overall survival (adjusted HR ~1.29), independent of other factors. Higher Social Vulnerability Index and language barriers were also independently associated with delayed treatment and worse outcomes. Median overall survival for EOCRC exceeded follow-up, but delay remained prognostically significant on multivariable analysis. 2

ARS criteria: margin-negative resection is key in locoregionally recurrent rectal cancer

Multidisciplinary guideline and systematic review (116 trials) conclude the ability to achieve a margin-negative resection determines survival and local control in LRRC. Preoperative systemic therapy, radiation, or both can downsize tumors and improve chances of margin-negative resection. Treatment choice should be individualized by prior therapy and recurrence site, within a multidisciplinary framework. The panel did not recommend major practice changes but reinforced combined-modality planning to maximize resectability. 3