Surgical Oncology

NeoCol: Neoadjuvant CAPOX Safe but DFS-Neutral in Locally Advanced Colon Cancer

In the phase III NeoCol trial, 248 patients with CT-staged locally advanced colon cancer were randomized to upfront surgery or 3 cycles of neoadjuvant CAPOX. Three-year DFS was similar: 87% with upfront surgery vs 83% with neoadjuvant CAPOX, confirming no DFS benefit from preoperative chemotherapy. Neoadjuvant CAPOX downstaged tumors and reduced the proportion meeting criteria for adjuvant chemotherapy, without increasing complications or impairing quality of life. Exploratory analysis suggested MMR-deficient tumors fared better with upfront surgery, arguing against routine neoadjuvant CAPOX in this subgroup. These results support reserving neoadjuvant chemotherapy for selected indications rather than standard care in resectable locally advanced colon cancer. 1

Thermal Ablation Rivals Hepatectomy for Solitary Colorectal Liver Metastasis ≤5 cm

This multicenter target trial emulation included 1,334 patients with solitary colorectal liver metastases ≤5 cm treated with thermal ablation or hepatectomy across 21 hospitals. After propensity matching (437 pairs), PFS and OS were comparable, with overlapping 5-year survival between thermal ablation and hepatectomy. Thermal ablation reduced major complications, shortened median hospital stay from 10 to 3 days, and halved treatment costs. Comparable oncologic outcomes held across subgroups, including tumor size and clinical risk scores. The authors propose thermal ablation as a first-line local therapy alternative to hepatectomy for appropriately selected solitary colorectal liver metastases. 2

Nationwide Emulated Trial: MIS Colon Resection Lowers One-Year Mortality

Linking English cancer and hospital records, investigators analyzed 21,931 patients with stage I–III colon cancer undergoing elective resection in 2021–2022. MIS was completed in 16,271 patients, while 5,660 underwent open surgery; deprivation, frailty, comorbidity, and higher stage reduced MIS use. Observed one-year mortality was 2.9% after completed MIS vs 7.7% after open resection. In the emulated trial, MIS reduced modeled one-year mortality from 6.8% to 3.0%, with largest absolute benefit in very elderly, frail, and comorbid patients. High-risk patients, who stood to benefit most, were paradoxically least likely to receive MIS, highlighting an actionable equity and access gap. 3

North American taTME Trial Shows Strong 3-Year Oncologic Outcomes and Sphincter Preservation

This North American phase II multicenter trial followed 100 patients undergoing taTME for stage I–III rectal adenocarcinoma, with median tumor height 5.8 cm from the anal verge. At a median 50.9-month follow-up, estimated 3-year OS, cancer-specific survival, and DFS were 93.7%, 96.6%, and 84.6%, respectively. Locoregional recurrence was rare, occurring in only two patients, while most recurrences were distant and involved lung or liver. Late complications occurred in 32 patients, including 21 severe events, though late anastomotic problems were infrequent and rarely required reoperation. At three years, 97% of diverted patients were stoma-free, demonstrating high sphincter preservation and durable functional reconstruction in experienced centers. 4