Lateral pelvic lymph node dissection (LPLND) in the treatment of rectal cancer: current practice and evolving approaches in India.

Background: The introduction of total mesorectal excision improved locoregional control for rectal adenocarcinoma significantly. Standardisation of the technique of LPLND is lacking in literature.

Methods: We describe the current practices of case selection and technical details of lateral lymph node dissection in rectal cancer.

Simultaneous integrated boost intensity-modulated radiation therapy targeting clinically involved extramesorectal lymph nodes in locally advanced rectal cancer: A retrospective study.

Aim: Consensus is lacking regarding the management of extramesorectal lymph nodes (EMLN) in rectal cancer. Using simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT), we targeted involved EMLN and reserved lateral pelvic lymph nodal dissection (LPLND) for nonresponders. The primary aim of this work was to determine the proportion of patients who avoided LPLND and to establish the pathological EMLN positivity rate.

Evidence-Based De-Escalation of Radiotherapy in Locally Advanced Rectal Cancer.

Advancements in cancer care have significantly extended the life expectancy of rectal cancer patients and the impact of treatment-related toxicity on long-term quality of life has become a crucial factor in determining the most suitable type of neoadjuvant therapy, particularly for patients who are likely to undergo surgery. While radiotherapy has traditionally been regarded as the cornerstone for achieving improved local control in rectal cancer, it is accompanied by a range of associated complications, including bowel and bladder dysfunction, gonadal ablation, and Low Anterior Resection Syndrome. De-escalation of treatment is undoubtedly beneficial for many patients, and this approach should be tailored to consider their expectations while prioritizing patient care in decision-making.

The Hemodynamic Management and Postoperative Outcomes After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Prospective Observational Study.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has become standard treatment for peritoneal cancers and metastases, significantly enhancing survival rates. This study evaluated the relationship between tumor burden, hemodynamic management, and postoperative outcomes after CRS-HIPEC. This study included 203 patients undergoing CRS-HIPEC.

Inhibiting de novo lipogenesis identifies a therapeutic vulnerability in therapy-resistant colorectal cancer.

A significant clinical challenge in patients with colorectal cancer (CRC), which adversely impacts patient survival, is the development of therapy resistance leading to a relapse. Therapy resistance and relapse in CRC is associated with the formation of lipid droplets (LD) by stimulating de novo lipogenesis (DNL). However, the molecular mechanisms underlying the increase in DNL and the susceptibility to DNL-targeted therapies remain unclear.

Abdominoperineal Resection for T4 Low Rectal Cancer After Neoadjuvant Therapy-Are the Outcomes Acceptable?

Introduction: There is no clear consensus on using the response MRI as opposed to the pretreatment MRI for surgical planning in cT4 low rectal cancer. The objective of this study is to determine the safety of using response MRI in surgical planning for T4 rectal cancer.

Methods: This study is a retrospective review of a prospectively maintained database of abdominoperineal resections conducted at a single tertiary cancer center.

Unexpected peritoneal metastases diagnosed at the time of primary colon cancer resection: controversies regarding options for management.

Peritoneal metastases synchronously occurring in the patient with primary colon cancer causes that patient to be at high risk for subsequent disease progression within the abdomen and pelvis. If peritoneal metastases are preoperatively diagnosed, patients are likely to be treated with neoadjuvant chemotherapy with or without biological therapy prior to cytoreductive surgery (CRS). However, if one only considers patients with peritoneal metastases unexpectedly identified at the time of primary colon cancer resection, the optimal management strategy is neither standardized nor evidence based.

Tailored resection for persistent extramural vascular invasion in locally advanced rectal cancers.

Background: Extramural vascular invasion (EMVI) is a bad prognostic feature in rectal cancer and cancers that remain EMVI positive after neoadjuvant therapy are at high risk for having involved circumferential resection margins. Conventional total mesorectal excision (TME) resections are inadequate in such cases and often lead to positive margins.

Methods: We propose a technique for the surgical management of locally advanced tumours with persistent EMVI after neoadjuvant therapy.

Postoperative Morbidity and Factors Predicting the Development of Lymphoceles Following Lateral Pelvic Node Dissection for Rectal Cancer: A Cohort Study.

Purpose: Lateral pelvic node dissection (LPLND) is indicated in the surgical management of clinically significant pelvic lymphadenopathy associated with rectal malignancies. However, procedure-related morbidity, including the incidence and predisposing factors for lymphoceles arising in this setting have not been adequately evaluated.

Methods: This retrospective single-institution study included 183 patients with nonmetastatic, lateral node-positive rectal cancer undergoing total mesorectal excision with LPLND between June 2014 and May 2023 to determine the incidence and severity of postoperative complications using the Clavien-Dindo system, with logistic regression performed to model a relationship between lymphocele-development and potentially-predictive variables.

Patterns and Predictors of Recurrence After Curative Resection of Colorectal Liver Metastasis (CRLM).

Background: Our study aims to determine the predictors and patterns of relapses after curative colorectal liver metastasis (CRLM) resection.

Methods: A single-centre, retrospective study of CRLM patients operated between 2010 and 2022 was performed. The site of first recurrence was either hepatic (marginal (≤ 1 cm) or extramarginal), extrahepatic, or both.

Performance of Low-Dose Immunotherapy and Standard-Dose Immunotherapy in Microsatellite Instability-High Metastatic Colorectal Cancer: Real-World Data (CLouD-High Study).

Purpose: Standard-dose immune checkpoint inhibitors (SD-ICIs) are the standard of care as initial therapy in microsatellite instable-high (MSI-H) advanced/metastatic colorectal adenocarcinomas (mCRC), but there are preclinical data to suggest that low-dose ICIs (LD-ICI) might also have similar efficacy.

Materials And Methods: A retrospective study of patients with MSI-H mCRC receiving ICIs between June 2017 and January 2023 was conducted. The primary end point of the study was 12-month progression-free survival (PFS), which was computed using the Kaplan-Meier method.

Feasibility of Hepatic Artery Infusion Chemotherapy for Colorectal Liver Metastasis in an Indian Setting.

Hepatic artery infusion chemotherapy (HAIC) is a popular treatment modality for the treatment of colorectal liver metastasis (CRLM). The aim of this study was to determine the feasibility of HAIC for high-risk resected CRLM delivered using repeated femoral puncture and delivering 5-fluorouracil infusional chemotherapy along with systemic adjuvant chemotherapy. The present study is a retrospective review of a prospectively maintained database.

Minimally Invasive Simultaneous Colorectal and Liver Resection for Synchronous Colorectal Liver Metastasis-Short-Term Outcomes.

Surgical management of colorectal disease and liver metastatectomy can be staged or synchronous. A minimally invasive approach in synchronous resection in the selected group of patients may improve postoperative outcomes. The present study aimed to explore the safety and feasibility of simultaneous liver and colorectal resection for synchronous metastasis by a minimally invasive approach in terms of major morbidity and R0 resection rates.

The conundrum of total neoadjuvant therapy in rectal cancer.

Total neoadjuvant therapy (TNT) has fast become the paradigm in the management of rectal cancer. The widespread adoption of this approach across the world, not only for locally advanced cancers but even for cancers that otherwise would not merit chemotherapy, leads both to an increase in treatment-related toxicity for patients and burdens the healthcare services of the country. It is important to tailor treatment to each patient based not only on the tumour but, even more importantly, on the patient's expectations and goals.