Our study underlines the oncological safety of a transverse colectomy for mid-transverse colon cancer. Although TC tumors were associated with poorer histopathological features, survival rates were comparable.

Background and Objectives: Vascular invasion, in particular extramural venous invasion (EMVI), is a pathologic characteristic that has been extensively studied in rectal cancer but rarely in colon cancer. This study aims to evaluate its prognostic role in stage II-III colon cancer. Methods: All stage II-III colon cancer patients who underwent surgery between 2004–2015 were reviewed. We divided the study group into patients without invasion, with intramural invasion only (IMVI), EMVI only, and both IMVI/EMVI (n=923). Results: EMVI was associated with other high-risk features, including T4, N+ disease, lymphatic, and perineural invasion (P<0.001). EMVI+ patients had considerably higher rates of locoregional and distant recurrence and subsequently disease-specific mortality (stage-II: odds ratio (OR) 3.64, P=0.001, stage-III OR:1.94, P=0.009), whereas outcomes were comparable between IMVI and no vascular invasion (OR:1.21, P=0.764, OR:1.28, P=0.607, respectively). The adjusted hazard ratios for EMVI+ patients on disease-free survival, and disease-specific survival were 2.07 (P<0.001), 1.67 (P=0.027), respectively. Moreover, EMVI+ stage-II patients fared worse than EMVI– stage-III patients, even after adjusting for adjuvant chemotherapy. Conclusion: EMVI is a strong predictor for worse oncologic outcomes in stage II-III colon cancer patients, whereas IMVI is not. It is also associated with worse outcomes compared in patients with higher stage disease who are EMVI negative.

This SSI risk assessment factor provides a simple tool using readily available characteristics to stratify patients by SSI risk and identify patients at risk during their postoperative admission. Thereby, it can be used to potentially focus frequent monitoring and more aggressive preventive efforts on high-risk patients.

BACKGROUND: Perineural invasion is associated with adverse oncological outcomes in colorectal cancer. However, data regarding the prognostic and predictive impact in colon cancer are scarce. OBJECTIVE: This study aims to clarify the role of perineural invasion in patients with nonmetastatic colon cancer. DESIGN: This study is a retrospective review of a prospectively maintained database. SETTINGS: This study took place at a tertiary medical center. PATIENTS: Patients with stage I to III colon cancer who underwent elective surgery at our tertiary center between 2004 and 2015 (n = 1145) were included. MEAN OUTCOME MEASURES: The primary long-term outcomes include disease-free survival, disease-specific survival, and overall survival. Differences were determined by multivariate Cox regression models adjusted for stage and potential confounders. RESULTS: Perineural invasion was identified in 215 patients (18.8%) and associated with emergency procedures, male sex, and advanced disease. Histopathological features including lymphatic and extramural vascular invasion, poor differentiation, and infiltrating tumor borders were correlated with perineural invasion. Compared with patients with perineural invasion-negative tumors, patients who had perineural invasion-positive tumors had worse disease-free, overall, and disease-specific survival (all p < 0.001). Moreover, patients with perineural invasion-positive node-negative disease had worse overall survival than patients with perineural invasion-negative node-positive disease (p < 0.001). After adjustment, perineural invasion remained significantly associated with worse disease-free survival (HR, 1.45; 95% CI, 1.03–2.03; p = 0.033), worse overall survival (HR, 1.75; 95% CI, 1.33–2.31; p < 0.001), and worse disease-specific survival (HR, 1.52; 95% CI, 1.00–2.30; p = 0.048). However, we did not find a significant predictive response with adjuvant chemotherapy in perineural invasion-positive node-negative tumors (HR, 2.10; 95% CI, 0.80–5.51; p = 0.122). The predictive value was only demonstrated in stage III disease with a significant impaired overall survival in patients with perineural invasion-positive tumors who did not receive adjuvant therapy (HR, 0.23; 95% CI, 0.13–0.40; p < 0.001). LIMITATIONS: This study was limited by its retrospective design. CONCLUSION: Our study confirms the prognostic value of perineural invasion in stage I to II and III colon cancer. However, patients with node-negative disease and perineural invasion did not significantly benefit from adjuvant therapy. More information regarding postoperative treatment in node-negative perineural invasion-positive colon cancer is required. See Video Abstract at http://links.lww.com/DCR/A988. LA INVASIÓN PERINEURAL COMO FACTOR PRONÓSTICO NO PREDICTIVO EN EL CÁNCER DE COLON NO METASTÁSICO ANTECEDENTES: La invasión perineural se encuentra asociada a resultados oncológicos adversos en casos de cáncer colorrectal. Sin embargo, los datos sobre el impacto pronóstico y predictivo en caso de cáncer de colon son pocos. OBJETIVO: Definir el papel de la invasión perineural en pacientes con cáncer de colon no metastásico. DISEÑO: Revisión retrospectiva de una base de datos alimentada prospectivamente. AJUSTES: Centro hospitalario de atención terciaria. PACIENTES: Todos aquellos portadores de un cáncer de colon estadío I-III que se sometieron a cirugía electiva en nuestro centro entre 2004–2015 (n = 1145). PRINCIPALES RESULTADOS: Los resultados a largo plazo incluyeron la supervivencia sin enfermedad, la supervivencia específica de la enfermedad y la supervivencia general. Las diferencias se determinaron mediante modelos de regresión multivariantes de Cox, ajustados para el control de factores de confusión durante el análisis por estratificación. RESULTADOS: La invasión perineural fué identificada en 215 pacientes (18.8%) y se la asoció con procedimientos de emergencia, al género masculino y a la enfermedad avanzada. Las características histopatológicas que incluyeron la invasión vascular linfática y extramural, la diferenciación deficiente y los bordes tumorales infiltrantes se correlacionaron con la invasión perineural. Comparativamente con los tumores sin invasión perineural, los pacientes positivos a la invasión perineural tuvieron una peor supervivencia general, libre y específica de la enfermedad (todos p < 0.001). Asimismo, aquellos pacientes con invasion-perineural con ganglios negativos tuvieron una supervivencia global mucho peor que aquellos pacientes con ganglios positivos e invasión perineural negativa (p < 0.001). Después del ajuste, la invasión perineural se asoció significativamente con una peor supervivencia sin la enfermedad (HR, 1.45; IC 95%, 1.03–2.03; p = 0.033), supervivencia general (HR, 1.75; IC 95%, 1.33–2.31; p <0.001), así como con una peor supervivencia específica de la enfermedad (HR, 1.52; IC 95%, 1.00–2.30; p = 0.048). Sin embargo, no encontramos una respuesta predictiva significativa con quimioterapia adyuvante en los tumores acompañados de invasion-perineural con ganglios negativos (HR, 2.10; IC del 95%, 0.80–5.51; p = 0.122). El valor predictivo solo fué demostrado en aquellos casos de estadio III con un deterioro significativo de la supervivencia global en pacientes con tumores perineurales positivos a la invasión y que no recibieron tratamiento adyuvante (HR, 0.23; IC 95%, 0.13–0.40; p < 0.001). LIMITACIONES: Diseño retrospectivo. CONCLUSIÓN: Nuestros resultados confirman el valor pronóstico de la invasión perineural en el cáncer de colon estadios I-II y III. Sin embargo, los pacientes con enfermedad ganglionar negativa e invasión perineural no se beneficiaron significativamente de la terapia adyuvante. Se requiere más información sobre el tratamiento postoperatorio en el cáncer de colon positivo para la invasión perineural con ganglios negativos. Vea el Resumen del video en http://links.lww.com/DCR/A988.

No abstract

Small cohort studies demonstrated better oncologic outcomes for patients with pathologic complete response (PathCR) after neoadjuvant treatment for locally advanced rectal cancer. This study reviews long-term outcomes of a large cohort of clinically stage II/III rectal cancer patients who received neoadjuvant chemoradiation and surgery. This is a retrospective analysis of a single-center cohort, including all clinical stage II/III rectal cancer patients who received neoadjuvant chemoradiation and surgery between 2004 and 2014 (n = 271). Cox regressions were done to assess the influence of PathCR on recurrence-free survival (RFS) and overall survival (OS), adjusting for postoperative chemotherapy, clinical AJCC staging, comorbidity, and age where appropriate. PathCR patients had significantly lower distant recurrence rates (4 vs. 15.8%; P = 0.028) and lower disease-specific mortality rates (0 vs. 8.1%; P = 0.052), compared to patients with residual disease. PathCR was associated with longer RFS (HR, 5.6 [95% CI 1.3-23.1] P = 0.018) and longer OS (HR, 3.4 [1.31-10.0] P = 0.014) compared to having pathological residual disease. This large single-center study shows that patients with PathCR have significant longer RFS and OS than patients with residual disease on pathology after neoadjuvant chemoradiation.

No abstract

Introduction: Avoiding postoperative morbidity is essential in patients with advanced cancer. To further improve treatment in stage IV colorectal cancer, knowledge about risk factors which effect short‐ and long‐term outcomes is important. Methods: All stage IV colon and rectal cancer who underwent elective surgery between 2004 and 2015 were included (n = 345). We compared resectable colon and rectal patients, and unresectable colon and rectal cancer patients. Results: Median follow‐up duration was 22.2 (unresectable) and 56.7 months (resectable) with no difference in tumor location. Colon cancer patients were more often considered unresectable (P < .001). Rectal procedures were correlated with a higher morbidity rate and a longer surgical duration (P < .001). In the resectable cohort, obese patients, open procedures and prolonged surgery were independently associated with postoperative complications. Considering the palliative group, neoadjuvant treatment and age were correlated with worse outcomes. Morbidity was not associated with long‐term outcomes in the resectable cohort. However, unresectable patients who developed respiratory (hazard ratio [HR]: 7.53) or cardiac (HR: 3.75) complications and patients with an American Society of Anesthesiologists—score III to IV (HR: 1.51) had an impaired survival. Conclusion: Our results emphasize the need for an adequate preoperative assessment to identify patients at risk for postoperative complications and impaired survival.