30-Second Takeaway
- ESD is more cost-effective than TEM for early rectal tumors, with better excision quality and disease-free survival.
- Adenoma recurrence risk after polypectomy varies over time by histology, sex, and obesity, challenging uniform surveillance intervals.
- Long-term biennial FIT retains clinically relevant cancer yield, arguing against early cessation after negative rounds.
- In highly selected unresectable CRLM, HAIP plus conversion surgery can achieve survival approaching liver transplantation.
- Biomarker-informed adjuvant NSAIDs and ctDNA-guided anti-EGFR rechallenge modestly extend disease control without proven overall survival benefit.
Week ending February 7, 2026
Concise updates in rectal local therapy, colorectal screening, and metastatic CRC management
ESD is more cost-effective than TEM for early rectal tumors
In this multicenter comparative cohort of 213 ESD and 117 TEM procedures for early rectal tumors, ESD was more cost-effective at 1 year. At a €2500 willingness-to-pay per complete resection, ESD showed a significant incremental net monetary benefit of €1797. ESD achieved higher en bloc excision than TEM (99.0% vs 92.5%) with no significant differences in overall or major morbidity. Three-year disease-free survival favored ESD (94.3% vs 84.6%; adjusted HR 3.55), while overall survival and quality of life were similar.
Adenoma recurrence risk is strongly time-, histology-, sex-, and obesity-dependent
Among 59,667 patients after first colonoscopic polypectomy, 29.5% developed adenoma recurrence within 5 years. High-grade dysplasia conferred markedly elevated early recurrence risk (aHR 4.00), which attenuated in mid- and late follow-up. Villous histology showed a biphasic pattern with early risk elevation and reemergent risk beyond 10 years (late aHR 2.71). Obesity conferred persistent excess risk across all intervals, and women with high-risk adenomas had greater late-term recurrence risk than men.
Repeated biennial FIT remains productive; stopping after several negatives is premature
This biennial FIT program followed 2.81 million invitees across seven rounds, with 29.2% fully adherent and 46.2% never participating. First-round FIT produced the highest positivity, CRC and high-risk precursor PPVs, and CRC detection per 1000 participants. Beyond three rounds, positivity, PPVs, and detection stabilized at lower levels than in age-matched first-time screeners. Despite attenuation, CRC detection remained clinically relevant in adherent participants, arguing against early cessation after a series of negative FITs.
HAIP achieves transplant-comparable survival in a tiny subset of unresectable CRLM
Among 483 unresectable colorectal liver metastasis patients treated with HAIP, only 23 (4.8%) met modified liver transplant eligibility criteria. These patients were relatively young, heavily liver-involved, and had received at least first-line systemic chemotherapy before HAIP placement. HAIP chemotherapy converted 78% to resection after a median of 5 cycles, demonstrating strong downstaging potential. Median overall survival was 61 months, with 5-year survival of 53%, similar to a recent liver transplant randomized trial.
References
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Additional Reads
Optional additional studies from this edition.