Colorectal Surgery

Early-onset T1 colorectal cancer nearly doubles odds of lymph-node metastasis

Meta-analysis of 29,132 surgically treated T1 CRC patients found LNM in 19.2% of patients <50 versus 11.1% ≥50. Pooled odds ratio for lymph-node metastasis in early-onset disease was 1.94 (95% CI 1.75–2.15). Multivariable analyses in included studies generally supported younger age as an independent predictor of LNM. Interpretation limited by serious confounding in three component studies, so absolute estimates require caution. 1

Neoadjuvant CAPOX/FOLFOX improves downstaging and R0 resection rates in LACC (phase II)

Randomized phase II trial (n=120) showed NAC produced a 65.4% tumor volume reduction and higher tumor regression grade rates. R0 resection was achieved in all patients receiving NAC, with reduced lymphatic invasion and tumor budding versus upfront surgery. NAC completion was 94.2% and perioperative morbidity did not increase. The trial was phase II with early termination; DFS at 2 years favored NAC but was not statistically significant. 2

Author specialty influences conclusions in nonrandomized prostatectomy versus radiation studies

Review of 105 nonrandomized comparative studies found 42% favored surgery, 14% favored radiation, and 44% showed no conclusive difference. Multivariate analysis linked urology author specialty and use of national databases with conclusions favoring surgery. Association persisted after excluding studies limited to biochemical endpoints. Findings highlight specialty-related bias in observational comparisons and the need for multidisciplinary interpretation. 3