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GI Surgery – Colorectal

RCT: Nivolumab Plus Ipilimumab Extends Progression-Free Survival in MSI-H or dMMR Metastatic Colorectal Cancer

4 Dec, 2024 | 11:51h | UTC

Background: Patients with microsatellite-instability–high (MSI-H) or mismatch-repair–deficient (dMMR) metastatic colorectal cancer typically experience poor outcomes with standard chemotherapy. Previous nonrandomized studies suggested that combining nivolumab with ipilimumab may offer clinical benefits in this population.

Objective: To evaluate the efficacy and safety of nivolumab plus ipilimumab compared with chemotherapy in patients with MSI-H or dMMR metastatic colorectal cancer who had not received prior systemic treatment for metastatic disease.

Methods: In this phase 3, open-label, randomized trial, 303 patients with unresectable or metastatic MSI-H or dMMR colorectal cancer were assigned in a 2:2:1 ratio to receive nivolumab plus ipilimumab, nivolumab alone, or chemotherapy with or without targeted therapies. The primary endpoint assessed in this interim analysis was progression-free survival (PFS) of nivolumab plus ipilimumab versus chemotherapy in patients with centrally confirmed MSI-H or dMMR status.

Results: At a median follow-up of 31.5 months, nivolumab plus ipilimumab significantly improved PFS compared to chemotherapy (P<0.001). The 24-month PFS was 72% (95% CI, 64–79) with nivolumab plus ipilimumab versus 14% (95% CI, 6–25) with chemotherapy. The restricted mean survival time at 24 months was 10.6 months longer with the combination therapy. Grade 3 or 4 treatment-related adverse events occurred in 23% of patients receiving nivolumab plus ipilimumab and 48% of those receiving chemotherapy.

Conclusions: First-line treatment with nivolumab plus ipilimumab significantly prolonged progression-free survival compared to chemotherapy in patients with MSI-H or dMMR metastatic colorectal cancer, with a lower incidence of high-grade treatment-related adverse events.

Implications for Practice: The combination of nivolumab and ipilimumab may represent a new standard of care for first-line treatment in MSI-H or dMMR metastatic colorectal cancer. However, clinicians should weigh the benefits against potential immune-related adverse events, and long-term survival benefits remain to be fully established.

Study Strengths and Limitations: Strengths include the randomized, phase 3 design and central confirmation of MSI-H or dMMR status. Limitations involve the open-label design, potential bias in patient-reported outcomes, underrepresentation of certain populations, and immature overall survival data.

Future Research: Further studies are needed to compare nivolumab plus ipilimumab directly with nivolumab monotherapy and to assess long-term overall survival benefits and quality of life in diverse patient populations.

Reference: Andre T, et al. Nivolumab plus Ipilimumab in Microsatellite-Instability–High Metastatic Colorectal Cancer. New England Journal of Medicine. 2024;391(21):2014–2026. DOI: http://doi.org/10.1056/NEJMoa2402141

 

RCT: Comparing Perioperative Chemotherapy Alone to Perioperative Chemotherapy Plus Preoperative Chemoradiotherapy in Resectable Gastric Cancer

14 Sep, 2024 | 18:23h | UTC

Background:

In the management of resectable gastric cancer, perioperative chemotherapy—chemotherapy administered both before (neoadjuvant) and after (adjuvant) surgery—is the standard of care in many Western countries. This approach is based on trials like MAGIC and FLOT4-AIO, which demonstrated improved survival with perioperative chemotherapy compared to surgery alone.

Preoperative chemoradiotherapy (the combination of chemotherapy and radiotherapy before surgery) has shown benefits in other gastrointestinal cancers, such as esophageal cancer, by downstaging tumors and potentially improving surgical outcomes. However, its efficacy in gastric cancer, especially when added to perioperative chemotherapy, has not been well-established.

Objective:

To determine whether adding preoperative chemoradiotherapy to standard perioperative chemotherapy improves overall survival compared to perioperative chemotherapy alone in patients with resectable gastric and gastroesophageal junction adenocarcinoma.

Methods:

  • Study Design: International, phase 3, randomized controlled trial (TOPGEAR).
  • Participants: 574 patients with resectable adenocarcinoma of the stomach or gastroesophageal junction (Siewert type II or III), clinical stage T3 or T4, and considered suitable for curative surgery.
  • Interventions:

    1. Perioperative Chemotherapy Group (Control Group):

    • Definition of Perioperative Chemotherapy: Chemotherapy administered both before (preoperative/neoadjuvant) and after (postoperative/adjuvant) surgery.
    • Chemotherapy Regimens:
      • Before 2017: Patients received three cycles before surgery and three cycles after surgery of either:
        • ECF: Epirubicin, Cisplatin, and continuous-infusion Fluorouracil.
        • ECX: Epirubicin, Cisplatin, and Capecitabine (an oral prodrug of fluorouracil).
      • After 2017 Amendment: Patients received four cycles before surgery and four cycles after surgery of:
        • FLOT: Fluorouracil, Leucovorin, Oxaliplatin, and Docetaxel.

    2. Perioperative Chemotherapy Plus Preoperative Chemoradiotherapy Group (Experimental Group):

    • Modifications to Chemotherapy:
      • Received one less cycle of preoperative chemotherapy compared to the control group to accommodate the addition of radiotherapy.
      • Postoperative chemotherapy was the same as in the control group.
    • Preoperative Chemoradiotherapy:
      • Chemoradiotherapy Definition: Concurrent administration of chemotherapy and radiotherapy before surgery.
      • Radiotherapy Regimen:
        • Total dose of 45 Gy, delivered in 25 fractions over 5 weeks (1.8 Gy per fraction, 5 days per week).
        • Target Area: Entire stomach, any perigastric tumor extension, and regional lymph nodes.
      • Concurrent Chemotherapy During Radiotherapy:
        • Continuous infusion of Fluorouracil (200 mg/m² per day) 7 days a week during radiotherapy.
        • Alternatively, Capecitabine (825 mg/m² twice daily on days 1–5 of each radiotherapy week) could be used.
  • Surgical Procedure:
    • Surgery was performed 4–6 weeks after completion of preoperative therapy.
    • Recommended surgery included total gastrectomy, subtotal distal gastrectomy, or esophagogastrectomy with D2 lymphadenectomy (removal of additional lymph node stations beyond the immediate perigastric nodes).

Endpoints:

  • Primary Endpoint: Overall survival (time from randomization to death from any cause).
  • Secondary Endpoints: Progression-free survival, pathological complete response rate (no residual tumor in the resected specimen), treatment-related toxic effects, and quality of life.

Results:

  • Pathological Findings:
    • Pathological Complete Response Rate:
      • Higher in the experimental group (preoperative chemoradiotherapy) at 17% compared to 8% in the control group.
    • Tumor Downstaging:
      • More patients in the experimental group had their tumors downstaged to a lower T category and had fewer involved lymph nodes.
  • Survival Outcomes:
    • Overall Survival:
      • Median Overall Survival:
        • Experimental Group: 46 months.
        • Control Group: 49 months.
      • Hazard Ratio for Death: 1.05 (95% CI, 0.83–1.31), indicating no significant difference between the groups.
    • Progression-Free Survival:
      • Median progression-free survival was similar between the groups (31 months vs. 32 months).
  • Treatment Adherence:
    • Preoperative Therapy Completion:
      • High completion rates in both groups for preoperative chemotherapy.
      • Slightly lower in the experimental group due to the addition of radiotherapy.
    • Postoperative Chemotherapy Completion:
      • Lower completion rates overall, with fewer patients in the experimental group completing postoperative chemotherapy (48% vs. 59%).
  • Adverse Events:
    • Similar rates of grade 3 or higher toxic effects in both groups.
    • No significant differences in surgical complications or postoperative mortality.

Conclusion:

Adding preoperative chemoradiotherapy to standard perioperative chemotherapy did not improve overall survival or progression-free survival in patients with resectable gastric and gastroesophageal junction adenocarcinoma, despite achieving higher pathological complete response rates and increased tumor downstaging. These findings suggest that the routine addition of preoperative chemoradiotherapy to perioperative chemotherapy does not confer additional survival benefits and should not change the current standard of care.

Clinical Implications:

  • Standard Treatment Remains Perioperative Chemotherapy:
    • Perioperative chemotherapy alone continues to be the standard approach for resectable gastric cancer.
    • Regimens like FLOT are preferred due to their demonstrated efficacy.
  • Role of Radiotherapy:
    • Routine use of preoperative radiotherapy in addition to chemotherapy is not supported by this trial’s findings.
    • Radiotherapy may still have a role in specific clinical scenarios, but not as a standard addition to perioperative chemotherapy.
  • Future Directions:
    • Further research may focus on identifying subgroups of patients who might benefit from chemoradiotherapy.
    • Biomarker-driven approaches and personalized treatment strategies could optimize outcomes.

Reference: Leong, T., et al. (2024). Preoperative Chemoradiotherapy for Resectable Gastric Cancer. The New England Journal of Medicine.  DOI: http://doi.org/10.1056/NEJMoa2405195

 

RCT: More Extensive Lymph Node Removal Does Not Improve Outcomes in Right-Sided Colon Cancer Surgery

7 Sep, 2024 | 09:56h | UTC

Study Design and Population: This multicenter, open-label, randomized controlled trial (RELARC) evaluated the efficacy of complete mesocolic excision (CME) versus D2 lymphadenectomy for right-sided colon cancer. Conducted across 17 hospitals in China, the study enrolled 1,072 patients with stage T2-T4aNanyM0 or TanyN+M0 disease. Participants were randomized (1:1) to undergo either CME or D2 dissection, and the primary outcome was 3-year disease-free survival (DFS), with 3-year overall survival (OS) as the main secondary outcome.

Main Findings: Among 995 analyzed patients, no significant differences were observed between CME and D2 groups in 3-year DFS (86.1% vs. 81.9%, HR 0.74, P = 0.06) or 3-year OS (94.7% vs. 92.6%, HR 0.70, P = 0.17). While CME trended toward better DFS, the results were not statistically significant.

Implications for Practice: Given the lack of significant survival benefit, the trial supports D2 dissection as the standard surgical approach for right-sided colon cancer. CME may be reserved for cases with evident mesocolic lymph node involvement.

Reference: Lu, J. et al. (2024). Extent of lymphadenectomy for surgical management of right-sided colon cancer: the randomized phase III RELARC trial. Journal of Clinical Oncology. http://doi.org/10.1200/JCO.24.00393

 

Cohort Study: Short-Course Radiotherapy with CAPOX Shows Favorable Outcomes in High-Risk Locally Advanced Rectal Cancer

7 Sep, 2024 | 09:38h | UTC

Study Design and Population: This Swedish nationwide cohort study examined total neoadjuvant treatment (TNT) for 273 patients with high-risk locally advanced rectal cancer (LARC) using short-course radiotherapy (5×5 Gy) followed by four cycles of CAPOX chemotherapy. Patients were treated between July 2016 and June 2020 across 16 hospitals, with 189 additional patients treated off-study. The study aimed to evaluate the complete response (CR) rate, comparing outcomes with the RAPIDO trial.

Main Findings: The CR rate, including both pathological complete response (pCR) and clinical complete response (cCR), was 24% (LARCT-US group) and 23% (AdmL group), comparable to the RAPIDO trial’s results. Locoregional recurrences were low (6% and 5%, respectively) after 3 years. Neurotoxicity was lower than in RAPIDO, and overall, the treatment was well tolerated. Notably, two fewer chemotherapy cycles did not compromise the CR rate.

Implications for Practice: While the study demonstrates promising outcomes using short-course radiotherapy and four CAPOX cycles for locally advanced rectal cancer (LARC), these findings are based on an observational study, which inherently limits the ability to draw definitive causal conclusions. Despite this, the real-world data suggests that a shorter chemotherapy regimen may be both feasible and effective. Further randomized trials are needed to confirm these results and assess long-term outcomes. Clinicians should cautiously apply this regimen, considering both the evidence and individual patient factors.

Reference: Glimelius, B. et al. (2024). Total Neoadjuvant Treatment Using Short-Course Radiotherapy and Four CAPOX Cycles in Locally Advanced Rectal Cancer with High-Risk Criteria for Recurrence: A Swedish Nationwide Cohort Study (LARCT-US). eClinicalMedicine. http://doi.org/10.1016/j.eclinm.2024.102771

 

RCT: Cold Snare EMR Reduces Major Adverse Events but Increases Residual Adenoma in Large Nonpedunculated Colorectal Polyps – Gastroenterology

25 Aug, 2024 | 11:45h | UTC

Study Design and Population: This multicentric randomized controlled trial (RCT) involved 19 centers in Germany and included 363 patients with 396 large nonpedunculated colorectal polyps (≥20 mm). Participants were randomly assigned to undergo either cold snare endoscopic mucosal resection (EMR) or the traditional hot snare EMR. The study aimed to compare the safety and effectiveness of cold versus hot snare EMR.

Main Findings: Cold snare EMR significantly reduced the incidence of major adverse events (AEs), with a major AE rate of 1.0% compared to 7.9% in the hot snare group. This included significant reductions in perforation and postendoscopic bleeding rates. However, cold snare EMR was associated with a higher rate of residual adenoma at follow-up, with 23.7% of cases compared to 13.8% in the hot snare group. The increased rate of residual adenoma was particularly noted in larger lesions (≥4 cm) and those with high-grade dysplasia.

Implications for Practice: Cold snare EMR offers a safer alternative to hot snare EMR for resecting large nonpedunculated colorectal polyps, particularly in terms of reducing major AEs. However, the higher rate of residual adenoma indicates that cold snare EMR should be used selectively, especially for smaller polyps or less likely to have advanced histology. Further research is needed to refine lesion selection criteria and to explore technical modifications that could improve the efficacy of cold snare EMR.

Reference: Steinbrück, I., et al. (2024). Cold Versus Hot Snare Endoscopic Resection of Large Nonpedunculated Colorectal Polyps: Randomized Controlled German CHRONICLE Trial. Gastroenterology, 167(4), 764–777. http://doi.org/10.1053/j.gastro.2024.05.013

 

FDA grants approval for Colosense, a noninvasive stool RNA-based test for colorectal cancer screening

11 May, 2024 | 17:48h | UTC

Geneoscopy, Inc. announced that the U.S. Food and Drug Administration (FDA) has approved ColoSense™, a noninvasive stool RNA-based test for colorectal cancer (CRC) screening in adults aged 45 and older who are at average risk for CRC.

 

Test Performance and Specifications:

– Sensitivity and Specificity: In the CRC-PREVENT trial, ColoSense demonstrated a sensitivity of 93% for detecting colorectal cancer and 45% sensitivity for detecting advanced adenomas (AA).

– Technology: ColoSense employs a multi-target stool RNA (mt-sRNA) approach, detecting colorectal neoplasia-associated RNA markers and occult hemoglobin. This method is designed to overcome variability in test performance that can occur with age-related changes in other biomarkers.

– Breakthrough Device Designation: The test has been designated as a Breakthrough Device by the FDA, acknowledging its potential to offer more effective diagnosis compared to existing methods.

– Accessibility: ColoSense is intended to facilitate increased screening uptake by providing a noninvasive alternative to traditional colonoscopy, particularly among populations reticent about invasive procedures.

 

Clinical Application:

– Screening Recommendations: Approved for individuals at typical average risk for CRC, ColoSense aligns with updated screening guidelines that recommend starting CRC screening at age 45.

– Role in Screening Strategy: ColoSense is indicated for use as a screening tool but is not intended to replace diagnostic or surveillance colonoscopy in individuals at high risk for CRC.

 

Geneoscopy is working towards a commercial launch of ColoSense in collaboration with Labcorp (NYSE: LH), aiming to make the test available by late 2024 or early 2025. (link to news release)

 

Cohort Study: Extending colonoscopy intervals to 15 years seems feasible in after a negative initial test in individuals without family history of CRC – JAMA Oncol

6 May, 2024 | 06:25h | UTC

This cohort study analyzed Swedish register-based data, examining colorectal cancer (CRC) diagnoses and CRC-specific mortality. The study included 110,074 individuals with a negative first colonoscopy (exposed group) and 1,981,332 matched controls, from 1990 to 2018. Participants were aged 45 to 69 at initial screening and were followed for up to 29 years.

During the follow-up, 484 new CRC cases and 112 CRC-specific deaths occurred in the exposed group. The study found significantly lower risks of CRC and CRC-specific death in the exposed group compared to controls over 15 years. The data suggest extending the screening interval from 10 to 15 years could miss only 2 CRC cases and prevent 1 CRC-specific death per 1,000 individuals while potentially reducing unnecessary colonoscopies.

The findings suggest that for individuals with no family history of CRC and a negative initial screening, the standard 10-year colonoscopy interval could safely be extended to 15 years. This adjustment could decrease the number of invasive procedures without significantly impacting cancer incidence and mortality, optimizing resource allocation and reducing patient burden.

 

Reference (link to abstract – $ for full-text):

Qunfeng Liang et al. (2024). Longer Interval Between First Colonoscopy With Negative Findings for Colorectal Cancer and Repeat Colonoscopy. JAMA Oncol., Published online May 2, 2024. DOI: 10.1001/jamaoncol.2024.0827.

 

Clinical validation of a cell-free DNA test for colorectal cancer screening: sensitivity and specificity analysis

20 Mar, 2024 | 19:16h | UTC

Study Design and Population: This study conducted a clinical validation of a cell-free DNA (cfDNA) blood-based test to screen for colorectal cancer in a cohort of 10,258 individuals, 7,861 of whom met the eligibility criteria and were evaluable. The research aimed to assess the test’s performance by comparing its sensitivity for detecting colorectal cancer and its specificity for identifying advanced neoplasia (including colorectal cancer or advanced precancerous lesions) against the outcomes of screening colonoscopy, a standard procedure.

Main Findings: The cfDNA test demonstrated a sensitivity of 83.1% for detecting colorectal cancer, with stage-specific sensitivities of 87.5% for stages I-III cancers. However, its sensitivity for identifying advanced precancerous lesions was notably lower at 13.2%. On the specificity front, the test showed an 89.6% ability to correctly identify individuals without any advanced colorectal neoplasia and had an overall specificity of 89.9% for those with a negative colonoscopy result, indicating no presence of colorectal cancer, advanced precancerous lesions, or non-advanced precancerous lesions.

Implications for Practice: The cfDNA blood-based test presents a promising tool for colorectal cancer screening, boasting substantial sensitivity for colorectal cancer detection and high specificity for advanced neoplasia. Its non-invasive nature could potentially enhance screening adherence, facilitating earlier cancer detection and possibly reducing colorectal cancer-related mortality. However, the test’s low sensitivity for advanced precancerous lesions suggests a need for further research and development to improve early detection capabilities.

Reference: Chung, D.C. et al. A Cell-free DNA Blood-Based Test for Colorectal Cancer Screening. Journal Name, Volume(Issue), Pages. Access the study here: [Link]

RCT: Effectiveness of mechanical and oral antibiotic bowel preparation in reducing postoperative complications in elective rectal resection

20 Mar, 2024 | 18:18h | UTC

Study Design and Population

This double-blind, placebo-controlled randomized clinical trial was conducted at three university hospitals in Finland, involving 565 patients aged 18 years and older undergoing elective rectal resection with primary anastomosis for tumors 15 cm or less from the anal verge, as determined by magnetic resonance imaging. Participants were allocated in a 1:1 ratio to either the mechanical and oral antibiotic bowel preparation (MOABP) group, receiving neomycin and metronidazole orally, or to the mechanical bowel preparation (MBP) plus placebo group, with all interventions occurring the day before surgery alongside standard preoperative intravenous antibiotics.

Main Findings

The study found that patients in the MOABP group experienced significantly fewer postoperative complications, with a median Comprehensive Complication Index significantly lower than that of the MBP plus placebo group. Additionally, the MOABP group showed reduced rates of surgical site infections (SSIs) and anastomotic dehiscence compared to the control group, demonstrating a clear benefit in postoperative outcomes.

Implications for Practice

The results of this trial suggest that incorporating oral antibiotics with mechanical bowel preparation prior to elective rectal resection significantly reduces postoperative complications, including SSIs and anastomotic dehiscence. Therefore, MOABP should be adopted as the standard regimen for patients undergoing these procedures to improve postoperative outcomes and reduce the burden of complications. This evidence underscores the importance of updating surgical protocols to include this preparation strategy.

Reference

Laura Koskenvuo et al. (2024). Randomized Clinical Trial: Effectiveness of Mechanical and Oral Antibiotic Bowel Preparation in Reducing Postoperative Complications in Elective Rectal Resection. JAMA Surg, Published online March 20, 2024. DOI: 10.1001/jamasurg.2024.0184. Access the study here: [Link]

Prospective Study: Enhanced detection of colorectal cancer and precancerous lesions with next-generation stool DNA testing

20 Mar, 2024 | 17:41h | UTC

Study Design and Population:

This prospective study evaluated the efficacy of a next-generation multitarget stool DNA test for colorectal cancer screening in asymptomatic adults aged 40 and older. The study encompassed 20,176 participants undergoing screening colonoscopy to determine the test’s sensitivity and specificity in detecting colorectal cancer and advanced neoplasia, including advanced precancerous lesions.

Main Findings:

The next-generation stool DNA test demonstrated a sensitivity of 93.9% for detecting colorectal cancer and a specificity of 90.6% for advanced neoplasia, significantly outperforming the fecal immunochemical test (FIT) in sensitivity for both colorectal cancer and advanced precancerous lesions. However, the test showed slightly lower specificity for advanced neoplasia compared to FIT. No adverse events were reported, indicating the test’s safety for screening purposes.

Implications for Practice:

The findings suggest that the next-generation multitarget stool DNA test offers a superior option for colorectal cancer screening, with significantly higher sensitivity for detecting cancer and advanced precancerous lesions than the currently available FIT. This advance in non-invasive screening technology could lead to earlier detection and treatment of colorectal cancer, potentially improving patient outcomes. Further research may focus on optimizing the balance between sensitivity and specificity to enhance the clinical utility of stool DNA testing.

Reference:

Imperiale, T. F.et al, & BLUE-C Study Investigators (2024). Next-Generation Multitarget Stool DNA Test for Colorectal Cancer Screening. N Engl J Med, 390(11), 984-993. DOI: 10.1056/NEJMoa2310336.

Cohort Study | Moderate to heavy drinking linked to increased risk of early-onset colorectal cancer

9 Aug, 2023 | 15:27h | UTC

Sex and Tumor-Site Differences in the Association of Alcohol Intake With the Risk of Early-Onset Colorectal Cancer – Journal of Clinical Oncology

Commentary: Association of Alcohol Intake With Risk of Early-Onset Colorectal Cancer – The ASCO Post

 

Commentary on Twitter

 

ACP Guidance | Asymptomatic CRC screening advised from age 50 with fecal occult blood test every 2 years or colonoscopy every 10 years

3 Aug, 2023 | 13:48h | UTC

Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians – Annals of Internal Medicine

News Release: ACP issues updated guidance for colorectal cancer screening of asymptomatic adults – American College of Physicians

Commentary: Start screening for colorectal cancer at age 50 years, ACP suggests – ACP Internist

Summary for Patients: Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults – Annals of Internal Medicine

 

Large bowel obstruction | ED presentation, evaluation, and management

19 Jul, 2023 | 14:17h | UTC

Large bowel obstruction: ED presentation, evaluation, and management – emDocs

 

Consensus Paper | Colorectal neuroendocrine tumors

30 Jun, 2023 | 14:45h | UTC

European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours – Journal of Neuroendocrinology

 

Guidance on fecal immunochemical testing to help diagnose colorectal cancer among symptomatic patients in primary care

29 Jun, 2023 | 13:59h | UTC

Guidance on faecal immunochemical testing (FIT) to help diagnose colorectal cancer among symptomatic patients in primary care – British Journal of General Practice

Related: Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG) – Gut

 

SR | Supportive care interventions for managing gastrointestinal symptoms following treatment for colorectal cancer

22 Jun, 2023 | 14:49h | UTC

Supportive care interventions for managing gastrointestinal symptoms following treatment for colorectal cancer: a systematic review – Journal of Cancer Survivorship

 

RCT | Hemostatic powder provides better control of gastrointestinal tumor bleeding than standard endoscopic treatment

20 Jun, 2023 | 12:39h | UTC

Hemostatic powder vs. standard endoscopic treatment for gastrointestinal tumor bleeding: A multicenter randomized trial – Gastroenterology (link to abstract – $ for full-text)

 

Position Statement | Curriculum for training in endoscopic mucosal resection in the colon

19 Jun, 2023 | 13:42h | UTC

Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Endoscopy

 

M-A | Preoperative IV plus oral antibiotics reduce surgical site infections in elective colorectal surgery

14 Jun, 2023 | 14:31h | UTC

Mechanical bowel preparation and antibiotics in elective colorectal surgery: network meta-analysis – BJS Open

Related:

SR | Mechanical plus oral antibiotic bowel preparation may prevent complications in elective colorectal surgery

M-A: Strategies for antibiotic administration for bowel preparation among patients undergoing elective colorectal surgery – “the addition of oral antibiotics to intravenous antibiotics was associated with a reduction in the incidence of incisional surgical site infection by more than 50%”.

Meta-Analysis: Effects of Mechanical Bowel Preparation and Oral Antibiotics Before Elective Colorectal Surgery

 

Commentary on Twitter

 

RCT | Preoperative FOLFOX noninferior to chemoradiotherapy in locally advanced rectal cancer

7 Jun, 2023 | 14:06h | UTC

Preoperative Treatment of Locally Advanced Rectal Cancer – New England Journal of Medicine (link to abstract – $ for full-text)

Related Publication: Patient-Reported Outcomes During and After Treatment for Locally Advanced Rectal Cancer in the PROSPECT Trial (Alliance N1048) – Journal of Clinical Oncology

Commentary: Radiation May Be Safely Omitted in Select Patients With Locally Advanced Rectal Cancer – The ASCO Post

 

Commentary on Twitter

 

Cohort Study | Overweight or obesity in early and middle adulthood linked to higher gastrointestinal cancer risk

5 Jun, 2023 | 13:34h | UTC

Analysis of Body Mass Index in Early and Middle Adulthood and Estimated Risk of Gastrointestinal Cancer – JAMA Network Open

Editorial: Obesity and Gastrointestinal Cancer: A Life Course Perspective – JAMA Network Open

Commentary: Association Between Overweight/Obesity and Risk of Gastrointestinal Cancer – The ASCO Post

 

WSES consensus guidelines on sigmoid volvulus management

5 Jun, 2023 | 13:19h | UTC

WSES consensus guidelines on sigmoid volvulus management – World Journal of Emergency Surgery

 

SR | Systematic review finds 16.4-36.18 severe bleedings, 7.62-8.5 perforations per 10,000 colonoscopies

1 Jun, 2023 | 12:15h | UTC

An Estimate of Severe Harms Due to Screening Colonoscopy: A Systematic Review – The Journal of the American Board of Family Medicine

 

M-A | Prehabilitation may enhance functional capacity in pre- and postoperative colorectal cancer patients

30 May, 2023 | 11:50h | UTC

Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery – Cochrane Library

Summary: Preparing a patient with bowel cancer for surgery with multiple interventions – Cochrane Library

 

AGA/ACG Guideline | Pharmacological management of chronic idiopathic constipation

22 May, 2023 | 13:53h | UTC

American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation – American Journal of Gastroenterology

 

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