Objective:To evaluate the clinical features and risk factors of anastomotic leakage (AL) in patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (nCRT) followed by laparoscopic radical resection and proctocol ostomy.Method:Clinicla data of LARC patients receiving neoadjuvant chemoradiotherapy followed by laparoscopic radical resection and proctocol ostomy admitted to Peking Union Medical College Hospital between Jan 2019 and Oct 2023 was enrolled. According to the occurrence of AL, patients were divided into AL group and non-AL group.Results:After propersity matching score(PSM), there were 40 patients (33.4%) and 80 patients (66.6%) in the AL and non-AL group, respectively. The first-onset symptoms of AL were abnormal character and color of the drainage (23 cases, 57.5%) and fever (14 cases, 35.0%). About 82.5% of the AL were graded as B,and all 36 patients (90.0%) were managed consveratively by fully drainage anti-infection therapy. Logistic regression analysis indicated that tumor circumferential range more than 1/2 cycle ( OR=5.95, 95% CI:2.12-1.67, P=0.004), male ( OR=4.28, 95% CI:1.22-15.00, P=0.023) and high-ligation of Inferior mesenteric artery ( OR=8.08, 95% CI:1.86-37.78, P=0.006) were independent risk factors of AL. Conclusions:In this series, grade-B AL ranks the top of the incidence, and all were cured by conservative therapy. Special attention should be paid to those patients with the characteristics of male, tumor circumferential range more than 1/2 cycle, and high-ligation of inferior mesenteric artery.

Background and Purpose:Neoadjuvant immunotherapy currently significantly enhances treatment efficacy for locally advanced rectal cancer(LARC);However,clinical management of immune-related adverse events(irAEs)lacks robust evidence.This study aimed to investigate the characteristics,clinical management strategies,and outcomes of irAEs during neoadjuvant immunotherapy for rectal cancer,providing a basis for optimizing irAEs monitoring and intervention.Methods:We retrospectively analyzed clinical data from LARC patients who developed irAEs after receiving neoadjuvant immunotherapy at Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,between July 2022 and June 2024.Types of irAEs,severity,time of onset,management strategies,and outcomes were recorded.All patients underwent regular follow-up for at least 6 months.This study has been approved by Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(ethical approval number:I-24PJ0024).Descriptive statistics were used to summarize irAEs patterns and management approaches.Results:A total of 41 irAE episodes occurred among the 30 patients.Mild irAEs(Grade 1-2)accounted for 78.0%(32/41),while severe irAEs(Grade 3-4)constituted 22.0%(9/41).Five patients(16.7%)permanently discontinued treatment due to severe toxicity.Endocrine toxicities were most frequent(36.6%,15/41),primarily characterized by progression from hyperthyroidism to hypothyroidism;75.0%required thyroid hormone replacement therapy.One case of delayed-onset adrenal insufficiency was alleviated with glucocorticoid(GC)therapy.Among hepatotoxicities(19.5%,8/41),62.5%were Grade 3 injury,and 37.5%required GC intervention;two patients experienced recurrence during adjuvant chemotherapy.Three cases of severe myositis occurred,accompanied by asymptomatic myocardial injury(evidenced by markedly elevated creatine kinase and concurrent changes in cardiac biomarkers),all requiring high-dose GC pulse therapy combined with intravenous immunoglobulin or immunosuppressants(recovery period:2-4 months).Nine dermatological reactions were managed with topical therapy.Two gastrointestinal events occurred,including one Grade 3 diarrhea treated with GCs.The overall GC usage rate was 31.7%(13/41),with 76.9%administered for Grade≥3 irAEs.Conclusion:irAEs during neoadjuvant immunotherapy for LARC are predominantly mild-to-moderate and manageable with supportive care.However,some patients develop severe(Grade 3-4)irAEs requiring multidisciplinary management.GC usage is concentrated in higher-grade irAEs,with severe myositis and cardiac involvement necessitating intensive immunosuppressive therapy despite their rarity.Recurrence of irAEs during adjuvant chemotherapy in a minority of patients underscores the necessity for early recognition,graded intervention,and comprehensive management throughout the entire treatment cycle.

Objective:To analyze the types and characteristics of post-operative complications in colorectal cancer patients aged over 85 years undergoing laparoscopic surgery, and to summarize peri-operative management strategies.Methods:This was an observational study. Inclusion criteria: pathologically confirmed adenocarcinoma; tumor located in ileocecum, ascending colon, transverse colon, descending colon, sigmoid colon, or rectum; undergoing laparoscopic radical resection for colorectal cancer; complete clinical data. Exclusion criteria included distant metastasis, synchronous resection of multiple primary cancers, simultaneous liver metastasis surgery, and follow-up duration <1 month. A retrospective analysis was conducted on 191 patients of colorectal cancer patients aged over 85 years who underwent laparoscopic radical surgery in the General Surgery Department at Peking Union Medical College Hospital from January 2019 to January 2024. Among 191 patients, 107 patients (56.0%) had colon cancer and 84 (44.0%) rectal cancer. All patients received "home-based prehabilitation" and post-operative "enhanced recovery after surgery" protocols. Patient characteristics, peri-operative complication types, treatments, and outcomes were analyzed.Results:Post-operative complications occurred in 97 patients (50.8%), including 53 colon cancer patients (54.6%) and 44 rectal cancer patients (45.4%). Comorbidities existed in 88 patients (90.7%), with 93 patients (95.9%) classified as ASA II-III pre-operatively and 86 (88.7%) having nutritional risks. Surgical procedures included Dixon procedure (38 patients, 39.2%), right hemicolectomy (33 patients, 34.0%), sigmoidectomy (10 patients, 10.3%), and 17 patients (17.5%) received prophylactic stomas. Complication types comprised non-anastomotic infections (38 patients, 19.9%), intestinal flora disorder (26 patients, 13.6%), anastomotic/wound/stoma-related complications (16 patients, 8.4%), thrombotic/hemorrhagic events (6 patients, 3.1%), and others (11 patients, 5.8%). By Clavien-Dindo classification: Grade I (12 patients, 6.3%), Grade II (69 patients, 36.1%), Grade III (12 patients, 6.3%), and Grade IV (4 patients, 2.1%). Except for 5 patients (2.6%) requiring unplanned re-operation, all complications resolved with conservative treatment. The median duration of post-operative hospitalization was 9.5 days (7–13).Conclusion:Non-anastomotic infections and intestinal flora disorder constitute predominant complications after laparoscopic surgery in colorectal cancer patients aged over 85 years, mostly manageable with conservative treatment. Strengthened peri-operative management incorporating pre-operative prehabilitation and post-operative enhanced recovery after surgery protocols is crucial for patients aged over 85 years.

Background and Purpose:Neoadjuvant immunotherapy currently significantly enhances treatment efficacy for locally advanced rectal cancer(LARC);However,clinical management of immune-related adverse events(irAEs)lacks robust evidence.This study aimed to investigate the characteristics,clinical management strategies,and outcomes of irAEs during neoadjuvant immunotherapy for rectal cancer,providing a basis for optimizing irAEs monitoring and intervention.Methods:We retrospectively analyzed clinical data from LARC patients who developed irAEs after receiving neoadjuvant immunotherapy at Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,between July 2022 and June 2024.Types of irAEs,severity,time of onset,management strategies,and outcomes were recorded.All patients underwent regular follow-up for at least 6 months.This study has been approved by Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(ethical approval number:I-24PJ0024).Descriptive statistics were used to summarize irAEs patterns and management approaches.Results:A total of 41 irAE episodes occurred among the 30 patients.Mild irAEs(Grade 1-2)accounted for 78.0%(32/41),while severe irAEs(Grade 3-4)constituted 22.0%(9/41).Five patients(16.7%)permanently discontinued treatment due to severe toxicity.Endocrine toxicities were most frequent(36.6%,15/41),primarily characterized by progression from hyperthyroidism to hypothyroidism;75.0%required thyroid hormone replacement therapy.One case of delayed-onset adrenal insufficiency was alleviated with glucocorticoid(GC)therapy.Among hepatotoxicities(19.5%,8/41),62.5%were Grade 3 injury,and 37.5%required GC intervention;two patients experienced recurrence during adjuvant chemotherapy.Three cases of severe myositis occurred,accompanied by asymptomatic myocardial injury(evidenced by markedly elevated creatine kinase and concurrent changes in cardiac biomarkers),all requiring high-dose GC pulse therapy combined with intravenous immunoglobulin or immunosuppressants(recovery period:2-4 months).Nine dermatological reactions were managed with topical therapy.Two gastrointestinal events occurred,including one Grade 3 diarrhea treated with GCs.The overall GC usage rate was 31.7%(13/41),with 76.9%administered for Grade≥3 irAEs.Conclusion:irAEs during neoadjuvant immunotherapy for LARC are predominantly mild-to-moderate and manageable with supportive care.However,some patients develop severe(Grade 3-4)irAEs requiring multidisciplinary management.GC usage is concentrated in higher-grade irAEs,with severe myositis and cardiac involvement necessitating intensive immunosuppressive therapy despite their rarity.Recurrence of irAEs during adjuvant chemotherapy in a minority of patients underscores the necessity for early recognition,graded intervention,and comprehensive management throughout the entire treatment cycle.

Objective:To analyze the types and characteristics of post-operative complications in colorectal cancer patients aged over 85 years undergoing laparoscopic surgery, and to summarize peri-operative management strategies.Methods:This was an observational study. Inclusion criteria: pathologically confirmed adenocarcinoma; tumor located in ileocecum, ascending colon, transverse colon, descending colon, sigmoid colon, or rectum; undergoing laparoscopic radical resection for colorectal cancer; complete clinical data. Exclusion criteria included distant metastasis, synchronous resection of multiple primary cancers, simultaneous liver metastasis surgery, and follow-up duration <1 month. A retrospective analysis was conducted on 191 patients of colorectal cancer patients aged over 85 years who underwent laparoscopic radical surgery in the General Surgery Department at Peking Union Medical College Hospital from January 2019 to January 2024. Among 191 patients, 107 patients (56.0%) had colon cancer and 84 (44.0%) rectal cancer. All patients received "home-based prehabilitation" and post-operative "enhanced recovery after surgery" protocols. Patient characteristics, peri-operative complication types, treatments, and outcomes were analyzed.Results:Post-operative complications occurred in 97 patients (50.8%), including 53 colon cancer patients (54.6%) and 44 rectal cancer patients (45.4%). Comorbidities existed in 88 patients (90.7%), with 93 patients (95.9%) classified as ASA II-III pre-operatively and 86 (88.7%) having nutritional risks. Surgical procedures included Dixon procedure (38 patients, 39.2%), right hemicolectomy (33 patients, 34.0%), sigmoidectomy (10 patients, 10.3%), and 17 patients (17.5%) received prophylactic stomas. Complication types comprised non-anastomotic infections (38 patients, 19.9%), intestinal flora disorder (26 patients, 13.6%), anastomotic/wound/stoma-related complications (16 patients, 8.4%), thrombotic/hemorrhagic events (6 patients, 3.1%), and others (11 patients, 5.8%). By Clavien-Dindo classification: Grade I (12 patients, 6.3%), Grade II (69 patients, 36.1%), Grade III (12 patients, 6.3%), and Grade IV (4 patients, 2.1%). Except for 5 patients (2.6%) requiring unplanned re-operation, all complications resolved with conservative treatment. The median duration of post-operative hospitalization was 9.5 days (7–13).Conclusion:Non-anastomotic infections and intestinal flora disorder constitute predominant complications after laparoscopic surgery in colorectal cancer patients aged over 85 years, mostly manageable with conservative treatment. Strengthened peri-operative management incorporating pre-operative prehabilitation and post-operative enhanced recovery after surgery protocols is crucial for patients aged over 85 years.

Objective:To evaluate the clinical features and risk factors of anastomotic leakage (AL) in patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (nCRT) followed by laparoscopic radical resection and proctocol ostomy.Method:Clinicla data of LARC patients receiving neoadjuvant chemoradiotherapy followed by laparoscopic radical resection and proctocol ostomy admitted to Peking Union Medical College Hospital between Jan 2019 and Oct 2023 was enrolled. According to the occurrence of AL, patients were divided into AL group and non-AL group.Results:After propersity matching score(PSM), there were 40 patients (33.4%) and 80 patients (66.6%) in the AL and non-AL group, respectively. The first-onset symptoms of AL were abnormal character and color of the drainage (23 cases, 57.5%) and fever (14 cases, 35.0%). About 82.5% of the AL were graded as B,and all 36 patients (90.0%) were managed consveratively by fully drainage anti-infection therapy. Logistic regression analysis indicated that tumor circumferential range more than 1/2 cycle ( OR=5.95, 95% CI:2.12-1.67, P=0.004), male ( OR=4.28, 95% CI:1.22-15.00, P=0.023) and high-ligation of Inferior mesenteric artery ( OR=8.08, 95% CI:1.86-37.78, P=0.006) were independent risk factors of AL. Conclusions:In this series, grade-B AL ranks the top of the incidence, and all were cured by conservative therapy. Special attention should be paid to those patients with the characteristics of male, tumor circumferential range more than 1/2 cycle, and high-ligation of inferior mesenteric artery.

Objective:To investigate the clinical characteristics of brain metastases after radical surgery for locally advanced rectal cancer (LARC).Methods:The clinical characteristics of LARC with brain metastases treated in the Department of General Surgery, Peking Union Medical College Hospital from 2013 to 2023 were retrospectively analyzed. The inclusion criteria were rectal adenocarcinoma within 15 cm of the anal verge and having undergone radical surgery, and the exclusion criterion was primary malignant tumor of the brain. The main outcomes were overall survival (OS), disease-free survival (DFS), and disease-specific overall survival (determined as the interval between occurrence of brain metastasis to death from any causes). The Kaplan–Meier method was used for survival analysis.Results:We identified 4500 patients with LARC, 20 (0.4%) of whom had brain metastases. The mean age of patients with brain metastases was 63.8±9.3 years. They comprised five women and 15 men. The brain was the first site of metastasis in four patients (20%) whereas 18 patients had heterochronous extracranial metastases before brain metastasis. Two patients also had multi-organ metastases. The most common manifestations of brain metastases were dizziness and headache (five patients, 25%), sudden onset of limb weakness (four, 20%), sudden speech impairment (two, 10%), and polyopia (two, 10%). The metastases were diagnosed during follow-up in three patients (15%). Four of the patients were asymptomatic (20%). Treatment approaches included surgical resection (six patients, 30%), chemoradiotherapy (nine, 45%), and palliative (five, 25%). The median follow-up time was 45.5 (4–112) months until October 2023. 1y-OS, 3y-OS, and 5y-OS were 95.0%, 62.9%, and 43.3%, respectively. 1y-DFS, 3y-DFS, and 5y-DFS were 55.0%, 25.0%, and 5.0%, respectively. With brain metastasis as the starting point, the median duration of survival was 16 (10.2–21.8) months.Conclusion:The incidence of brain metastasis is relatively low in patients with LARC, who often have multiple synchronous extracranial metastases. Brain metastases lack specific manifestations and more often occur in male patients. Surgical intervention or combined radiotherapy and chemotherapy may improve disease-specific survival to a certain extent. However, the overall prognosis remains poor.

Objective:To investigate the clinical characteristics of brain metastases after radical surgery for locally advanced rectal cancer (LARC).Methods:The clinical characteristics of LARC with brain metastases treated in the Department of General Surgery, Peking Union Medical College Hospital from 2013 to 2023 were retrospectively analyzed. The inclusion criteria were rectal adenocarcinoma within 15 cm of the anal verge and having undergone radical surgery, and the exclusion criterion was primary malignant tumor of the brain. The main outcomes were overall survival (OS), disease-free survival (DFS), and disease-specific overall survival (determined as the interval between occurrence of brain metastasis to death from any causes). The Kaplan–Meier method was used for survival analysis.Results:We identified 4500 patients with LARC, 20 (0.4%) of whom had brain metastases. The mean age of patients with brain metastases was 63.8±9.3 years. They comprised five women and 15 men. The brain was the first site of metastasis in four patients (20%) whereas 18 patients had heterochronous extracranial metastases before brain metastasis. Two patients also had multi-organ metastases. The most common manifestations of brain metastases were dizziness and headache (five patients, 25%), sudden onset of limb weakness (four, 20%), sudden speech impairment (two, 10%), and polyopia (two, 10%). The metastases were diagnosed during follow-up in three patients (15%). Four of the patients were asymptomatic (20%). Treatment approaches included surgical resection (six patients, 30%), chemoradiotherapy (nine, 45%), and palliative (five, 25%). The median follow-up time was 45.5 (4–112) months until October 2023. 1y-OS, 3y-OS, and 5y-OS were 95.0%, 62.9%, and 43.3%, respectively. 1y-DFS, 3y-DFS, and 5y-DFS were 55.0%, 25.0%, and 5.0%, respectively. With brain metastasis as the starting point, the median duration of survival was 16 (10.2–21.8) months.Conclusion:The incidence of brain metastasis is relatively low in patients with LARC, who often have multiple synchronous extracranial metastases. Brain metastases lack specific manifestations and more often occur in male patients. Surgical intervention or combined radiotherapy and chemotherapy may improve disease-specific survival to a certain extent. However, the overall prognosis remains poor.

Objective:To investigate the influencing factors for permanent protective stoma in locally advanced rectal cancer (LARC) patients after neoadjuvant chemoradiotherapy (nCRT) and radical resection.Methods:The retrospective case-control study was conducted. The clinicopatho-logical data of 216 patients with LARC who were admitted to Peking Union Medical College Hospital from June 2019 to May 2022 were collected. There were 144 males and 72 females, aged 60(53,68)years. All patients underwent nCRT followed by radical resection and protective stoma. Observation indicators: (1) permanent protective stoma and anastomotic complications after nCRT and radical resection; (2) influencing factors for permanent protective stoma after nCRT and radical resection; (3) influencing factors for anastomotic complications after nCRT and radical resection. Comparison of measurement data with normal distribution between groups was performed using the independent sample t test. Comparison of measurement data with skewed distribution between groups was performed using the Mann-Whitney U rank sum test. Comparison of count data between groups was performed using the chi-square test or Fisher exact probability. Univariate analysis was conducted using appropriate statistical methods based on the data type. Factors with P<0.15 in univariate analysis were included in binary Logistic regression for multivariate analysis using a forward stepwise method based on maximum likelihood estimation. Results:(1) Permanent protective stoma and anastomotic complications after nCRT and radical resection. All the 216 patients were followed up of 40(23,51)months. Of the 216 patients, 36 cases developed permanent protective stoma, of which 24 cases could not have stoma reversal based on preoperative evaluation, while 12 cases required re-colostomy with transverse colostomy after complications from reversal surgery. Of the 216 patients, 25 cases deve-loped anastomotic-related complications. (2) Influencing factors for permanent protective stoma after nCRT and radical resection. Results of multivariate analysis showed that anastomotic-related complication was an independent risk factor for permanent protective stoma in LARC patients after nCRT and radical resection ( odd ratio=17.503, 95% confidence interval as 6.097-50.244, P<0.05). (3) Influencing factors for anastomotic complications after nCRT and radical resection. Results of multivariate analysis showed that age ≤50 years, low body mass index, prolonged operation time were all independent risk factors for anastomotic-related complications in LARC patients after nCRT and radical resection( odd ratio=0.385, 0.770, 1.105, 95% confidence interval as 0.151-0.979, 0.654-0.907, 1.007-1.023, P<0.05). Conclusions:Anastomotic-related complication is an independent risk factor for permanent protective stoma in LARC patients after nCRT and radical resection. Age ≤50 years, low body mass index, prolonged operation time are independent risk factors for anastomotic-related complications in LARC after nCRT and radical resection.

Objective:To investigate the influencing factors for permanent protective stoma in locally advanced rectal cancer (LARC) patients after neoadjuvant chemoradiotherapy (nCRT) and radical resection.Methods:The retrospective case-control study was conducted. The clinicopatho-logical data of 216 patients with LARC who were admitted to Peking Union Medical College Hospital from June 2019 to May 2022 were collected. There were 144 males and 72 females, aged 60(53,68)years. All patients underwent nCRT followed by radical resection and protective stoma. Observation indicators: (1) permanent protective stoma and anastomotic complications after nCRT and radical resection; (2) influencing factors for permanent protective stoma after nCRT and radical resection; (3) influencing factors for anastomotic complications after nCRT and radical resection. Comparison of measurement data with normal distribution between groups was performed using the independent sample t test. Comparison of measurement data with skewed distribution between groups was performed using the Mann-Whitney U rank sum test. Comparison of count data between groups was performed using the chi-square test or Fisher exact probability. Univariate analysis was conducted using appropriate statistical methods based on the data type. Factors with P<0.15 in univariate analysis were included in binary Logistic regression for multivariate analysis using a forward stepwise method based on maximum likelihood estimation. Results:(1) Permanent protective stoma and anastomotic complications after nCRT and radical resection. All the 216 patients were followed up of 40(23,51)months. Of the 216 patients, 36 cases developed permanent protective stoma, of which 24 cases could not have stoma reversal based on preoperative evaluation, while 12 cases required re-colostomy with transverse colostomy after complications from reversal surgery. Of the 216 patients, 25 cases deve-loped anastomotic-related complications. (2) Influencing factors for permanent protective stoma after nCRT and radical resection. Results of multivariate analysis showed that anastomotic-related complication was an independent risk factor for permanent protective stoma in LARC patients after nCRT and radical resection ( odd ratio=17.503, 95% confidence interval as 6.097-50.244, P<0.05). (3) Influencing factors for anastomotic complications after nCRT and radical resection. Results of multivariate analysis showed that age ≤50 years, low body mass index, prolonged operation time were all independent risk factors for anastomotic-related complications in LARC patients after nCRT and radical resection( odd ratio=0.385, 0.770, 1.105, 95% confidence interval as 0.151-0.979, 0.654-0.907, 1.007-1.023, P<0.05). Conclusions:Anastomotic-related complication is an independent risk factor for permanent protective stoma in LARC patients after nCRT and radical resection. Age ≤50 years, low body mass index, prolonged operation time are independent risk factors for anastomotic-related complications in LARC after nCRT and radical resection.