Journal of Surgical Oncology最新文献

Background

We assessed causes of death in patients with early-onset colorectal cancer (EOCRC) and factors associated with non-CRC-related deaths.

Methods

SEER database was screened between 2000 and 2020 for patients with EOCRC. Causes of death were classified into CRC-related and non-CRC-related, and stratified by demographics, disease location, and stage. The main study outcome was the cause of death in EOCRC.

Results

A total of 67 353 patients (53.9% male) had EOCRC. In total, 13.2% of 25 441 deaths were unrelated to CRC. The most common cause of non-CRC-related deaths was medical conditions (36.1%), mainly heart disease (16.6%). CRC was more often the cause of death in patients aged < 30 years, female, and stages III and IV disease; whereras medical conditions accounted for more deaths in patients aged 40–50 years, males, and Black. Other primary cancers were more often the cause of death in patients aged 45–50 years, female patients, and Asian patients. Death due to causes other than CRC was significantly more likely when surgery for CRC was performed (OR: 2.35; p = 0.028) and when CRC was one of multiple primary cancers (OR: 3.7; p < 0.001).

Conclusions

Most common causes of non-CRC-related deaths were medical conditions and other primary cancers accounting for more deaths in patients aged 40–50 years, males, Black and Asian patients, and with early-stage CRC.

Background

Total mesorectal excision (TME) is the standard surgical treatment for rectal cancer. Transanal local excision (TLE) after neoadjuvant chemoradiotherapy (nCRT) is an organ-preserving option, avoiding morbidity of TME. This study compared TLE versus TME following nCRT.

Methods

We searched Medline, PubMed, Embase, Web of Science, Scopus, Cochrane databases, Google Scholar, and CINHAL to 30 April 2025. Eligible studies were adults with nonmetastatic mid or low rectal cancer treated with nCRT followed by TLE or TME. Outcomes included local recurrence, disease free survival (DFS), overall survival (OS), and postoperative complications. Risk of bias was assessed using Cochrane RoB 2 for randomized trials and Newcastle-Ottawa Scale (NOS) for cohorts.

Results

Nineteen studies were included. TLE was associated with higher local recurrence in cohorts (RR = 1.823; 95% CI = 1.222–2.720; p = 0.003), but no difference in RCTs (RR = 1.248; 95% CI = 0.618–2.518; p = 0.537). DFS (HR = 1.121; p = 0.174) and OS (HR = 1.032; p = 0.830) did not differ. Postoperative morbidity was lower after TLE (RR = 0.429; p = 0.005).

Conclusion

Strengths include robust search, study quality and number of patients, while heterogeneity in nCRT protocol, follow up, and complication reporting are limitations. Higher recurrence in TLE in cohorts but not in RCTs suggests safety of TLE when strict selection criteria are applied.

Registration: PROSPERO CRD420251076513.

Objective

Endoscopic submucosal dissection (ESD) is increasingly preferred as an alternative to surgery and as an organ-preserving method for the treatment of rectal lesions. However, its impact on bowel function—particularly the development of low anterior resection syndrome (LARS)—remains poorly understood. This study aimed to evaluate the incidence of LARS following rectal ESD and to identify associated clinical and pathological factors.

Methods

Data from 118 patients who underwent rectal ESD between January 2018 and December 2024 were retrospectively analyzed. Demographic characteristics, lesion location and size, histopathological findings, and LARS scores were recorded. All procedures were performed by the same experienced colorectal surgeon. For functional assessment, patients were contacted by telephone, and the LARS score was administered.

Results

Of the patients included in the study, 60.9% were male, with a mean age of 68.2 ± 11.0 years. In total, 93.2% of lesions were located in the rectum, while 6.8% were located in the anal canal or anorectal junction. The mean lesion size was 5.04 ± 3.19 cm. Lymphovascular invasion was detected in four patients. Minor LARS was observed in 3.4% (n = 4) of cases, and no cases of major LARS were identified. All patients with LARS had adenomas located in the lower rectum containing high-grade dysplasia.

Conclusion

The incidence of LARS after rectal ESD is low and limited to minor symptoms. Lesion location, size, and dysplasia grade may influence LARS development. These findings support ESD as a functionally safe treatment approach. Further validation in larger, prospective studies is warranted.

Trial Registration

This study was a retrospective observational analysis.