Cancers

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12 pages, 5418 KiB

Open AccessArticle

Model Predicting Survival in Intermediate-Stage HCC Patients Reclassified for TACE Based on the 2022 BCLC Criteria

by Jihoon Kim, Jin-Hyoung Kim, Eunbyul Ko, Jeong-Yeon Kim, Byung Soo Im, Gun Ha Kim, Hee Ho Chu, Heung-Kyu Ko, Dong Il Gwon, Ji Hoon Shin and Ibrahim Alrashidi

Cancers 2025, 17(5), 894; https://doi.org/10.3390/cancers17050894 - 5 Mar 2025

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Abstract

Background/Objectives: The Barcelona Clinic Liver Cancer (BCLC) staging system for hepatocellular carcinoma (HCC) was updated in 2022 to refine patient stratification, particularly in patients with intermediate-stage (BCLC B) HCC. Although transarterial chemoembolization (TACE) remains a key treatment for these patients, there is [...] Read more.

Background/Objectives: The Barcelona Clinic Liver Cancer (BCLC) staging system for hepatocellular carcinoma (HCC) was updated in 2022 to refine patient stratification, particularly in patients with intermediate-stage (BCLC B) HCC. Although transarterial chemoembolization (TACE) remains a key treatment for these patients, there is no prognostic model for survival outcomes based on the pretreatment factors of patients who meet the updated 2022 BCLC indications for TACE. The aim of this study was to develop a pretreatment risk model predicting overall survival (OS) in patients with intermediate-stage HCC and reclassified as candidates for TACE according to the updated 2022 BCLC criteria. Methods: This retrospective study included 658 HCC patients treated with first-line TACE according to the updated BCLC 2022 guidelines. Pretreatment factors such as the Child–Pugh score, tumor burden (up-to-11 criteria), bilobar tumor involvement, and serum alpha-fetoprotein (AFP) levels were analyzed. Cox proportional hazards models were used to identify significant predictors of OS, with these factors subsequently incorporated into a risk prediction model. Results: Significant predictors of OS included Child–Pugh score ≥ 7, bilobar tumor involvement, beyond up-to-11 criteria, and AFP ≥ 400 ng/mL. A risk model was developed using these factors, stratifying patients into low-, intermediate-, and high-risk groups. The median OS in the low-, intermediate-, and high-risk groups was 53, 35, and 21 months, respectively. Conclusions: The proposed pretreatment risk prediction model may be useful for predicting OS and guiding TACE candidacy in intermediate-stage HCC patients based on the updated 2022 BCLC guidelines. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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13 pages, 1303 KiB

Open AccessArticle

Clinical Characteristics and Long-Term Prognosis of Colorectal Mucosa-Associated Lymphoid Tissue Lymphoma According to the Endoscopic Classification and Treatment Modality: A Multicenter Study

by Seung Min Hong, Dong Hoon Baek, Geun Am Song, Hong Sub Lee, Seung Bum Lee, Ra Ri Cha, Tae-Oh Kim, Jae Hyun Kim, Jong Hoon Lee and Busan Ulsan Gyeongnam Intestinal Study Group Society (BIGS)

Cancers 2025, 17(5), 750; https://doi.org/10.3390/cancers17050750 - 22 Feb 2025

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Abstract

Background/Objectives: The clinical characteristics of colorectal mucosa-associated lymphoid tissue (MALT) lymphoma remain poorly defined, and there is no standardized treatment for the disease. Therefore, we investigated the clinical characteristics of colorectal MALT lymphoma and its prognosis based on different treatment modalities. Methods [...] Read more.

Background/Objectives: The clinical characteristics of colorectal mucosa-associated lymphoid tissue (MALT) lymphoma remain poorly defined, and there is no standardized treatment for the disease. Therefore, we investigated the clinical characteristics of colorectal MALT lymphoma and its prognosis based on different treatment modalities. Methods: A retrospective analysis was performed on patients diagnosed with colorectal MALT lymphoma from 2003 to 2021 across six hospitals in Korea’s Busan–Ulsan–Gyeongnam area. Macroscopic findings classified all cases into polyposis type, mass-forming type, subepithelial lesion type, and inflammatory type. Results: Fifty-one patients were enrolled. The median age was 59 years, and 27 patients (52.9%) were male. Five patients (9.8%) were stage IV at initial diagnosis. As for the endoscopic type, the polyposis type was the most common (39.2%). There was no statistically significant difference in disease progression according to the endoscopic type (p = 0.813). Three cases of disease progression were confirmed in stage I after treatment, and one of them died due to disease progression. No disease progression was identified in other stages. According to the treatment modality, disease progression was identified in 1 of 16 patients who underwent endoscopic resection and 2 of 16 patients who underwent chemotherapy. There was no disease progression in the observation group. However, there was no statistically significant difference in disease progression according to treatment modality (p = 0.889). Conclusions: Colorectal MALT lymphoma showed good prognosis regardless of the initial stage, endoscopic type, or treatment modality. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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14 pages, 939 KiB

Open AccessArticle

Prognostic Significance of Lymph Node Ratio (LNR) in Gastric Cancer in Predicting Postoperative Complications and Survival: A Single-Center Study

by Michał Miciak, Krzysztof Jurkiewicz, Przemysław Dzierżek, Julia Rudno-Rudzińska and Wojciech Kielan

Cancers 2025, 17(5), 743; https://doi.org/10.3390/cancers17050743 - 22 Feb 2025

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Abstract

Background/Objectives: The Lymph Node Ratio (LNR) index is the proportion of lymph nodes with present metastases to lymph nodes removed and examined. This is an additionally established parameter for predicting the prognosis of gastric cancer patients. The most popular cancer classification, TNM, describes [...] Read more.

Background/Objectives: The Lymph Node Ratio (LNR) index is the proportion of lymph nodes with present metastases to lymph nodes removed and examined. This is an additionally established parameter for predicting the prognosis of gastric cancer patients. The most popular cancer classification, TNM, describes only the number of affected lymph nodes. It can result in a negative overestimation of the prognosis of patients with gastric cancer if the number of nodes examined is relatively limited. Methods: In this study, we retrospectively analyzed 194 patients diagnosed with gastric cancer operated on between 2017 and 2021 at the Clinical Department of Oncological Surgery, University Centre of General and Oncological Surgery of the University Clinical Hospital in Wroclaw. In total, 133 patients underwent gastrectomy with D2 lymphadenectomy and 61 remaining patients had the resection procedure abandoned due to an unresectable lesion. The LNR index was calculated based on histopathological examination, and postoperative complications were assessed using the Clavien–Dindo (C-D) scale. Statistical analysis was performed regarding the dependence of LNR on the following patient characteristics: sex, age, TNM features, tumor stage, tumor location, performed procedure, chemotherapy application, C-D complication rate, and survival rate. Results: The value of the LNR index significantly depends on TNM features (p < 0.05), clinical tumor stage (p < 0.05), and patient survival (p < 0.05), while no statistically significant relationship with C-D complication rate was demonstrated. Conclusions: The LNR index is a relevant parameter in predicting prognosis and survival time in gastric cancer patients, but future studies on larger and differentiated groups of patients could further confirm its usefulness in the development of guidelines. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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18 pages, 9209 KiB

Open AccessArticle

Integrin α3β1 Is Not Required for Onset of Dysplasia in Genetic Model of Colon Cancer but Promotes Motility of Colon Cancer Cells

by Kathryn E. Ottaviano, Sita Subbaram, Lei Wu, Kiley Stahl, Antoinette J. Mastrangelo, Hwajeong Lee and C. Michael DiPersio

Cancers 2025, 17(3), 371; https://doi.org/10.3390/cancers17030371 - 23 Jan 2025

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Abstract

Background/Objectives: The progression of colorectal cancer through clinically and histopathologically well-defined stages is driven by specific mutations that activate oncogenes or inactivate tumor-suppressor genes. In addition, pre-cancerous/cancer cells respond to cues from the tissue microenvironment that support tumorigenesis and progression, many of which [...] Read more.

Background/Objectives: The progression of colorectal cancer through clinically and histopathologically well-defined stages is driven by specific mutations that activate oncogenes or inactivate tumor-suppressor genes. In addition, pre-cancerous/cancer cells respond to cues from the tissue microenvironment that support tumorigenesis and progression, many of which are transmitted through integrin receptors for the extracellular matrix. Integrin α3β1 has pro-tumorigenic/pro-metastatic roles in many cancers, but it also has suppressive roles in some cancers or at specific stages of progression, indicating that its potential value as a therapeutic target cannot be extrapolated across cancer types or stages. In this study, we investigated roles for α3β1 in colorectal cancer using cellular and genetic models that represent different stages. Methods: We generated mice with colon-specific α3 knockout in a tamoxifen-inducible model of KRAS-mutated colorectal cancer to assess the effects of α3β1 ablation on early dysplasia. We also used siRNA to suppress α3β1 in human colorectal cancer cells, then assessed effects on motility and invasion in vitro. Results: Genetic deletion of α3β1 in the colon did not alter dysplasia in mice predisposed to KRAS-mutated colorectal cancer, and it was accompanied by an increase in the colocalization of α6 integrin with laminin-332 (a matrix ligand for both integrins), suggesting functional compensation. However, suppression of α3β1 caused an approximately 40% to 60% reduction in the motility/invasion of human colorectal cancer cells. Conclusions: Our findings that α3β1 is not required for pre-cancerous dysplasia but promotes colorectal cancer cell motility/invasion indicate an important role for pro-migratory functions of this integrin at later stages of progression when cells invade from the primary tumor, suggesting that strategies to target α3β1 in colorectal cancer should be aimed at distinct stages of disease progression. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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13 pages, 1660 KiB

Open AccessArticle

Ongoing Failure to Deliver Guideline-Concordant Care for Patients with Pancreatic Cancer

by Jonathan Ejie, Amir Ashraf Ganjouei, Sophia Hernandez, Jaeyun Jane Wang, Fernanda Romero-Hernandez, Laleh Foroutani, Kenzo Hirose, Eric Nakakura, Carlos Uriel Corvera, Adnan Alseidi and Mohamed Abdelgadir Adam

Cancers 2025, 17(2), 170; https://doi.org/10.3390/cancers17020170 - 7 Jan 2025

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Abstract

(1) Background: Comprehensive evaluation of guideline-concordant care (GCC) across all PDAC stages has yet to be thoroughly conducted. This study aimed to characterize treatment patterns and assess factors associated with receiving GCC among patients with pancreatic ductal adenocarcinoma (PDAC) in California. (2) Methods: [...] Read more.

(1) Background: Comprehensive evaluation of guideline-concordant care (GCC) across all PDAC stages has yet to be thoroughly conducted. This study aimed to characterize treatment patterns and assess factors associated with receiving GCC among patients with pancreatic ductal adenocarcinoma (PDAC) in California. (2) Methods: Data on adult patients with PDAC were extracted from the California Cancer Registry (2004–2020). GCC is defined according to the recommendations provided by the National Comprehensive Cancer Network. We used multivariable logistic regression to identify factors associated with receiving GCC. A Cox model was used to examine the association of GCC with overall survival. (3) Results: A total of 50,346 PDAC patients were included (stage 1: 10%; stage 2: 25%; stage 3: 11%; stage 4: 54%). Only 46.7% of all patients received GCC (stage 1: 20%; stage 2: 40%; stage 3: 69%; stage 4: 50%). Only 31% of stage 1 patients underwent surgery. Factors inversely associated with receiving GCC were Hispanic ethnicity (OR 0.78; p < 0.001), Black race (OR 0.74; p < 0.001), having no insurance (OR 0.40; p < 0.001]), and a Charlson–Deyo score of ≥2 (OR 0.68; p < 0.001). Adherence to GCC was associated with improved survival (Hazard Ratio 0.39; p < 0.001). Notably, patients with stage 1 PDAC who received GCC had a median survival of 47 months vs. 8 months for those who did not. (4) Conclusions: Although stage 1 PDAC patients have the greatest potential for survival with GCC, only 20% of patients received such treatment. Thus, it is crucial to identify and address the modifiable factors contributing to these suboptimal care patterns. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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10 pages, 1283 KiB

Open AccessArticle

Endoscopic and Histological Characteristics of Gastric Cancer Detected Long After Helicobacter pylori Eradication Therapy

by Ryo Abe, Shu Uchikoshi, Yohei Horikawa, Nobuya Mimori, Yuhei Kato, Yuta Tahata, Saki Fushimi, Masahiro Saito and Satsuki Takahashi

Cancers 2024, 16(24), 4153; https://doi.org/10.3390/cancers16244153 - 13 Dec 2024

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Abstract

Background/Objectives: Since 2013, eradication therapy for Helicobacter pylori gastritis (Hp-ET) has been covered by the National Health Insurance of Japan. Recently, the risk of post-eradication gastric cancer (pE-GC) has increased. pE-GC includes cancers that develop immediately and several years after Hp [...] Read more.

Background/Objectives: Since 2013, eradication therapy for Helicobacter pylori gastritis (Hp-ET) has been covered by the National Health Insurance of Japan. Recently, the risk of post-eradication gastric cancer (pE-GC) has increased. pE-GC includes cancers that develop immediately and several years after Hp-ET. Therefore, we aimed to clarify the endoscopic and histological characteristics of late types of pE-GCs. Method: One hundred patients with differentiated cancers detected after Hp-ET who underwent endoscopic submucosal dissection from 2015 to 2023 were compared. Patients were divided into two groups; the immediate group (n = 69), with cancer detected within 6 years, and the delayed group (n = 31), with cancer detected within >6 years after Hp-ET. The background mucosa and tumor mucosa were examined individually. The endoscopic findings were as follows: enlarged folds, map-like redness, intermediate zone irregularity, and the presence of a regular arrangement of collecting venules and a light blue crest (background); an irregular surface structure, an irregular vascular pattern, an irregular surface pattern, and a gastritis-like appearance (tumor). The histological findings were as follows: a low remnant rate of the fundic glands, intestinal metaplasia (IM), crypt enlargement, and neutrophil infiltration (background); mosaicism, the elongation of noncancer ducts, and an overlying non-neoplastic epithelium (tumor). Results: There was no significant difference regarding the background mucosa and tumor mucosa between the two groups. In the delayed group, the remnant rate of the fundic glands was 19.8 ± 15.6%, and IM was 87.1% (27/31). Further, 90.3% (28/31) of the patients exhibited persistent neutrophil infiltration. Conclusion: This study suggested that patients with a low remnant rate of the fundic gland and IM and persistent mucosal inflammation were at high risk for developing pE-GCs. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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11 pages, 3156 KiB

Open AccessArticle

Real-World Data of Patients with BRAF V600E-Mutated Metastatic Colorectal Cancer Treated with Trifluridine/Tipiracil

by Javier Ros, Jose Maria Ucha, Eduardo Garcia-Galea, Pablo Gomez, Giulia Martini, Francesca Balconi, Raquel Comas, Vicente Alonso, Marta Rodriguez, Iosune Baraibar, Francesc Salva, Nadia Saoudi, Adriana Alcaraz, Ariadna Garcia, Josep Tabernero and Elena Elez

Cancers 2024, 16(24), 4140; https://doi.org/10.3390/cancers16244140 - 12 Dec 2024

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Abstract

Background: For patients with refractory metastatic colorectal cancer (mCRC), trifluridine/tipiracil (FTD–TPI) has been associated with a significant improvement in overall survival (OS). However, data are lacking regarding the activity of FTD–TPI in patients with BRAF-mutated mCRC. Methods: This retrospective, multicenter, international cohort [...] Read more.

Background: For patients with refractory metastatic colorectal cancer (mCRC), trifluridine/tipiracil (FTD–TPI) has been associated with a significant improvement in overall survival (OS). However, data are lacking regarding the activity of FTD–TPI in patients with BRAF-mutated mCRC. Methods: This retrospective, multicenter, international cohort included patients with BRAF-mutated mCRC treated with FTD–TPI in a real-life setting in Spain and Italy. Survival analysis was performed using Kaplan–Meier methods and Cox proportional hazard models and according to established prognostic groups: good prognosis characteristics (GPC; < 3 metastatic sites and time from metastases to FTD–TPI ≥ 18 months) and poor prognosis characteristics (PPC; ≥ 3 metastatic sites or time from metastases to FTD–TPI < 18 months). Results: In the 26 patients included, the median age was 61 years, 13 (50%) were female, and 20 (77%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 1. Fourteen (56%) patients had right-sided tumors, six (23%) had microsatellite instability tumors, and thirteen (50%) had liver metastases. Median progression-free survival was 2.3 months (95% CI 2.0–3.2), and median OS (mOS) was 6.6 months (95% CI 4.4–12.0). mOS was 7.6 vs. 4.2 months (HR 1.64, 95% CI 0.65–4.10, p = 0.3) for GPC and PPC patients, respectively. Exploratory analyses identified ECOG as the only feature associated with survival. The most frequent grade 3–4 adverse events were neutropenia (8%), anemia (8%), and asthenia (4%). Conclusions: Patients with BRAF mutant mCRC achieved modest benefits with FTD–TPI; however, patients with GPC and ECOG 0 achieved longer OS compared with those with PPC or ECOG 1–2, thus warranting further exploration in prospective cohorts. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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16 pages, 1800 KiB

Open AccessArticle

Thermal Liquid Biopsy: A Promising Tool for the Differential Diagnosis of Pancreatic Cystic Lesions and Malignancy Detection

by Judith Millastre, Sonia Hermoso-Durán, María Ortiz de Solórzano, Nicolas Fraunhoffer, Guillermo García-Rayado, Sonia Vega, Luis Bujanda, Carlos Sostres, Ángel Lanas, Adrián Velázquez-Campoy and Olga Abian

Cancers 2024, 16(23), 4024; https://doi.org/10.3390/cancers16234024 - 30 Nov 2024

Cited by 1 | Viewed by 727

Abstract

Pancreatic cystic lesions (PCLs) are a heterogeneous group of lesions with increasing incidence, usually identified incidentally on imaging studies (multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), or endoscopic ultrasound (EUS)) [...] Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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12 pages, 649 KiB

Open AccessArticle

Should We Offer Universal Germline Genetic Testing to All Patients with Pancreatic Cancer? A Multicenter Study

by Joan Llach, Irina Luzko, Julie Earl, Emma Barreto, Mercedes Rodríguez-Garrote, Marc Lleixà, Cristina Herrera-Pariente, Guerau Fernández, Jenifer Munoz, Laia Bonjoch, Tamara Saurí, Fabio Ausania, Teresa Ocaña, Lorena Moreno, Elia Grau, Josep Oriola, Maria Isabel Alvarez-Mora, Marta Herreros-Villanueva, Sergi Castellví-Bel, Francesc Balaguer, Luis Bujanda and Leticia Moreira Show full author list Hide full author list

Cancers 2024, 16(22), 3779; https://doi.org/10.3390/cancers16223779 - 9 Nov 2024

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Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with a significant percentage of germline pathogenic variants (GPVs). Unlike in the United States, routine universal genetic testing is not performed in Europe. The aim of the study is to evaluate the diagnostic yield of germline [...] Read more.

Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with a significant percentage of germline pathogenic variants (GPVs). Unlike in the United States, routine universal genetic testing is not performed in Europe. The aim of the study is to evaluate the diagnostic yield of germline genetic testing in all patients with PDAC. Methods: Individuals with newly diagnosed PDAC from three Spanish hospitals were enrolled, regardless of family history. Thirteen known susceptibility genes for PDAC were studied using a multigene panel or whole-exome sequencing. Results: One hundred seventy-nine PDAC patients underwent genetic testing. Fourteen (7.8%) had a GPV or likely pathogenic variant In the genes studied: six in ATM, six in BRCA2, one in PALB2, and one in TP53. Of these, seven (50%) did not meet the clinical criteria for genetic study and would have been classified as sporadic PDAC. Presenting with a personal history of any other neoplasm was associated with some GPV, with an odds ratio (OR) of 3.5 (1.1–11.5). A family history of PDAC and breast cancer was also associated with some GPV, with oRs of 3.7 (1.08–13.6) and 8.5 (2.6–26.6), respectively. None of the patients over 60 years without a relevant family history of malignancies presented a GPV associated with PDAC. Conclusions: In our PDAC cohort, a noteworthy number of GPVs were identified, and half of these patients would have been classified as sporadic based solely on clinical criteria. Genetic testing should always be considered, particularly in patients under 60 years or those with a history of other malignancies, especially where economic resources need optimization. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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11 pages, 1619 KiB

Open AccessArticle

High Rates of Organ Preservation in Rectal Cancer with Papillon Contact X-ray Radiotherapy: Results from a Swiss Cohort

by Cristina Picardi, Francesca Caparrotti, Michael Montemurro, Daniel Christen, Nora-Brunner Schaub, Marie Fargier-Voiron, Laetitia Lestrade, Jeremy Meyer, Guillaume Meurette, Emilie Liot, Daniel Helbling, Jan Schmidt, Jean-Pierre Gutzwiller, Marco Bernardi, Oscar Matzinger and Frederic Ris

Cancers 2024, 16(13), 2318; https://doi.org/10.3390/cancers16132318 - 25 Jun 2024

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Abstract

Rectal cancer typically necessitates a combination of radiotherapy (RT), chemotherapy, and surgery. The associated functional disorders and reduction in quality of life have led to an increasing interest in organ preservation strategies. Response strongly correlates with RT dose, but dose escalation with external [...] Read more.

Rectal cancer typically necessitates a combination of radiotherapy (RT), chemotherapy, and surgery. The associated functional disorders and reduction in quality of life have led to an increasing interest in organ preservation strategies. Response strongly correlates with RT dose, but dose escalation with external beam remains limited even with modern external beam RT techniques because of toxicity of the surrounding tissues. This study reports on the use of Papillon, an endocavitary Radiotherapy device, in the treatment of rectal cancer. The device delivers low energy X-rays, allowing for safe dose escalation and better complete response rate. Between January 2015 and February 2024, 24 rectal cancer patients were treated with the addition of a boost delivered by Papillon to standard RT, with or without chemotherapy, in an upfront organ preservation strategy. After a median follow-up (FU) of 43 months, the organ preservation rate was 96% (23/24), and the local relapse rate was 8% (2/24). None of our patients developed grade 3 or more toxicities. Our results demonstrate that the addition of Papillon contact RT provides a high rate of local remission with sustained long-term organ preservation, offering a promising alternative to traditional surgical approaches in patients with rectal cancer. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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13 pages, 1708 KiB

Open AccessArticle

A Comparative Study of Postoperative Complications Associated with Distal Gastrectomy and Pylorus-Preserving Gastrectomy among Gastric Cancer Patients Based on Nationwide Survey Data and Propensity Score Weighting

by Sang-Ho Jeong, Miyeong Park, Kyung Won Seo, Rock Bum Kim, Jae-Seok Min and Information Committee of the Korean Gastric Cancer Association

Cancers 2024, 16(12), 2203; https://doi.org/10.3390/cancers16122203 - 12 Jun 2024

Cited by 1 | Viewed by 1093 | Correction

Abstract

Background/Objective. This study aimed to compare complication rates between pylorus-preserving gastrectomy (PPG) and distal gastrectomy (DG) using Korean nationwide survey data and propensity score weighting (PSW). PPG preserves gastric function but may lead to more postoperative complications than DG. Methods and Results. We [...] Read more.

Background/Objective. This study aimed to compare complication rates between pylorus-preserving gastrectomy (PPG) and distal gastrectomy (DG) using Korean nationwide survey data and propensity score weighting (PSW). PPG preserves gastric function but may lead to more postoperative complications than DG. Methods and Results. We analyzed 9424 gastric cancer patients who underwent either DG (n = 9183) or PPG (n = 241). PSW balanced variables such as age, sex, TNM stage, comorbidities, ASA score, and surgical approach. Before PSW, 87.8% of DG patients and 87.1% of PPG patients had no complications (p = 0.053). Severe complications (Clavien–Dindo IIIa or higher) were more frequent in PPG (6.6%) than in DG (3.8%) (p = 0.039). After PSW, overall complication rates (p = 0.960) and severe complication rates (p = 0.574) were similar between groups. Incidence rates of anastomotic stricture and leakage were higher in PPG (2.9% and 1.7%) compared to DG (0.6% and 0.5%) (p = 0.001 and 0.036) before PSW, but these differences were not significant after PSW (p = 0.999 and 0.123). Conclusion. The PSW-adjusted analysis indicates no significant difference in overall and severe complication rates between PPG and DG in gastric cancer patients. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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14 pages, 5892 KiB

Open AccessArticle

Prospective, Observational Study of Aflibercept Use in Combination with FOLFIRI in Patients with Metastatic Colorectal Cancer: A Real-World Effectiveness Study

by Agnieszka Durbajło, Marcin Świeżyński, Beata Ziemba, Danuta Starzyczny-Słota, Marzena Samborska-Plewicka, Anna Cencelewicz-Lesikow, Agata Chrzanowska-Kapica, Aneta Dobrzyńska-Rutkowska, Iwona Drab-Mazur, Monika Kulma-Kreft, Magdalena Sikora-Skrabaka, Elwira Matuszewska, Małgorzata Foszczyńska-Kłoda, Tomasz Lewandowski, Grzegorz Słomian, Krystyna Ostrowska-Cichocka, Ewa Chmielowska, Rafał Wiśniowski, Anna Twardosz, Katarzyna Wierzbicka, Leszek Rumianowski and Lucjan Wyrwicz Show full author list Hide full author list

Cancers 2024, 16(11), 1992; https://doi.org/10.3390/cancers16111992 - 24 May 2024

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Abstract

Background: This was an observational study prospectively evaluating the effectiveness and safety of aflibercept/FOLFIRI administered in second-line mCRC per the reimbursement criteria in Poland. Methods: Consecutive mCRC patients who progressed with first-line oxaliplatin-based chemotherapy received aflibercept (4 mg/kg IV) followed by FOLFIRI every [...] Read more.

Background: This was an observational study prospectively evaluating the effectiveness and safety of aflibercept/FOLFIRI administered in second-line mCRC per the reimbursement criteria in Poland. Methods: Consecutive mCRC patients who progressed with first-line oxaliplatin-based chemotherapy received aflibercept (4 mg/kg IV) followed by FOLFIRI every 2 weeks until progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS); overall survival (OS) and safety were the secondary endpoints. Results: A total of 93 patients were treated at 17 Polish sites. A median of 10 cycles was administered. Over a median treatment duration of 5.3 months, median PFS and median OS were 8.4 months [95% CI, 6.9–9.9] and 27.0 months [95% CI, 23.9–30.1], respectively. There was no significant impact of primary tumor location, metastatic site, or KRAS status on PFS and OS. Main grade ≥ 3 adverse events were neutropenia (16%), hypertension (8%), diarrhea (4%), and stomatitis (4%). Conclusions: The benefits/risks of Aflibercept plus FOLFIRI administered per the Polish reimbursement criteria in second-line treatment of mCRC after failure of a prior oxaliplatin-based regimen is confirmed. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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14 pages, 2546 KiB

Open AccessArticle

Effect of Neoadjuvant Chemotherapy on Tumor-Infiltrating Lymphocytes in Resectable Gastric Cancer: Analysis from a Western Academic Center

by Elliott J. Yee, Danielle Gilbert, Jeffrey Kaplan, Sachin Wani, Sunnie S. Kim, Martin D. McCarter and Camille L. Stewart

Cancers 2024, 16(7), 1428; https://doi.org/10.3390/cancers16071428 - 7 Apr 2024

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Abstract

Tumor-infiltrating lymphocytes (TILs) are an emerging biomarker predictive of response to immunotherapy across a spectrum of solid organ malignancies. The characterization of TILs in gastric cancer (GC) treated with contemporary, multiagent neoadjuvant chemotherapy (NAC) is understudied. In this retrospective investigation, we analyzed the [...] Read more.

Tumor-infiltrating lymphocytes (TILs) are an emerging biomarker predictive of response to immunotherapy across a spectrum of solid organ malignancies. The characterization of TILs in gastric cancer (GC) treated with contemporary, multiagent neoadjuvant chemotherapy (NAC) is understudied. In this retrospective investigation, we analyzed the degree of infiltration, phenotype, and spatial distribution of TILs via immunohistochemistry within resected GC specimens treated with or without NAC at a Western center. We hypothesized that NAC executes immunostimulatory roles, as evidenced by an increased number of anti-tumor TILs in the tumor microenvironment. We found significantly elevated levels of conventional and memory CD8+ T cells, as well as total TILs (CD4+, CD8+, T_reg, B cells), within chemotherapy-treated tumors compared with chemotherapy-naïve specimens. We also revealed important associations between survival and pathologic responses with enhanced TIL infiltration. Taken together, our findings advocate for an immunostimulatory role of chemotherapy and underscore the potential synergistic effect of combining chemotherapy with immunotherapy in resectable gastric cancer. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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17 pages, 2987 KiB

Open AccessArticle

HER2 and PD-L1 Expression in Gastric and Gastroesophageal Junction Cancer: Insights for Combinatorial Targeting Approaches

by Marta Baptista Freitas, Irene Gullo, Dina Leitão, Lúcia Águas, Carla Oliveira, António Polónia, Joana Gomes, Fátima Carneiro, Celso Albuquerque Reis and Henrique Oliveira Duarte

Cancers 2024, 16(6), 1227; https://doi.org/10.3390/cancers16061227 - 20 Mar 2024

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Abstract

Gastric and gastroesophageal junction adenocarcinomas (GA/GEJA) are associated with a poor prognosis, primarily due to late disease diagnosis. Human Epidermal Growth Factor Receptor 2 (HER2) overexpression and programmed death-ligand 1 (PD-L1) expression are important biomarkers for treatment selection in locally advanced unresectable and [...] Read more.

Gastric and gastroesophageal junction adenocarcinomas (GA/GEJA) are associated with a poor prognosis, primarily due to late disease diagnosis. Human Epidermal Growth Factor Receptor 2 (HER2) overexpression and programmed death-ligand 1 (PD-L1) expression are important biomarkers for treatment selection in locally advanced unresectable and metastatic GA/GEJA, and there is increasing interest in their role in earlier stages of disease. In this study, we aimed to evaluate HER2 and PD-L1 expression in a curative-intent GA/GEJA cohort to describe their expression patterns and analyze the association between HER2 expression and clinicopathological features. HER2 expression was evaluated in surgical and endoscopic submucosal dissection tumor samples, and PD-L1 was evaluated in HER2-positive cases. The clinical cohort included 107 patients, with 8.4% testing positive for HER2 (seven of whom also exhibited a PD-L1 combined positive score of ≥1. HER2 status was not significantly associated with survival outcomes. A pathologist-guided, region-specific analysis revealed that PD-L1 expression rarely overlaps with HER2-positive tumor areas. While the therapeutic implications of these observations remain unknown, these findings suggest that combination strategies targeting HER2 and PD-L1 might be directed toward distinct tumor subclones. The herein disclosed region-specific biomarker expression patterns may have important therapeutic and prognostic impacts, warranting further evaluation. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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12 pages, 447 KiB

Open AccessArticle

Preoperative Chronic Inflammation Is a Risk Factor for Postoperative Complications Independent of Body Composition in Gastric Cancer Patients Undergoing Radical Gastrectomy

by Ryota Matsui, Noriyuki Inaki, Toshikatsu Tsuji and Tetsu Fukunaga

Cancers 2024, 16(4), 833; https://doi.org/10.3390/cancers16040833 - 19 Feb 2024

Cited by 2 | Viewed by 1361

Abstract

The purpose of this study was to investigate the association between preoperative inflammation and postoperative complications in gastric cancer patients having elective gastrectomy. Participants in this study were those who underwent radical gastrectomy between April 2008 and June 2018 and were diagnosed with [...] Read more.

The purpose of this study was to investigate the association between preoperative inflammation and postoperative complications in gastric cancer patients having elective gastrectomy. Participants in this study were those who underwent radical gastrectomy between April 2008 and June 2018 and were diagnosed with stage I–III primary gastric cancer. Preoperative CRP values were used to divide the patients into two groups: the inflammation group comprised individuals having a CRP level of ≥0.5 mg/dL; the other was the non-inflammation group. The primary outcome was overall complications of Clavien–Dindo grade II or higher after surgery. Using propensity score matching to adjust for background, we compared the postoperative outcomes of the groups and conducted a multivariate analysis to identify risk variables for complications. Of 951 patients, 852 (89.6%) were in the non-inflammation group and 99 (10.4%) were in the inflammation group. After matching, both groups included 99 patients, and no significant differences in patient characteristics were observed between both groups. The inflammation group had a significantly greater total number of postoperative complications (p = 0.019). The multivariate analysis revealed that a preoperative CRP level of ≥0.5 mg/dL was an independent risk factor for total postoperative complications in all patients (odds ratio: 2.310, 95% confidence interval: 1.430–3.730, p < 0.001). In conclusion, in patients undergoing curative resection for gastric cancer, preoperative inflammation has been found to be an independent risk factor for overall complications after surgery. Patients with chronic inflammation require preoperative treatment to reduce inflammation because chronic inflammation is the greatest risk factor for postoperative complications. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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Review

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21 pages, 572 KiB

Open AccessReview

Biomarkers for the Evaluation of Immunotherapy in Patients with Cholangiocarcinoma

by Thaleia-Eleftheria Bousou, Panagiotis Sarantis, Ioanna A. Anastasiou, Eleni-Myrto Trifylli, Dimitris Liapopoulos, Dimitra Korakaki, Evangelos Koustas, Michalis Katsimpoulas and Michalis V. Karamouzis

Cancers 2025, 17(3), 555; https://doi.org/10.3390/cancers17030555 - 6 Feb 2025

Viewed by 629

Abstract

Cholangiocarcinoma is a rare primary liver cancer with poor prognosis, due to the advanced stage at the time of diagnosis and limited therapeutic options, with poor response. Chemotherapy remains the standard first-line treatment, but the advent of immunotherapy has recently induced promising results. [...] Read more.

Cholangiocarcinoma is a rare primary liver cancer with poor prognosis, due to the advanced stage at the time of diagnosis and limited therapeutic options, with poor response. Chemotherapy remains the standard first-line treatment, but the advent of immunotherapy has recently induced promising results. Given the fact that diagnosis frequency is increasing nowadays and the survival rate remains very low, it is crucial to recognize patients who are suitable for immunotherapy and will have the best response. Different types of biomarkers, such as interleukins, exosomes, mi-RNA, ctDNA, and gene mutations, have been studied for their feasibility, not only for the early diagnosis of biliary tract cancer but also for the determination of responsiveness in treatment. Less frequently, these studies focus on finding and observing biomarkers in patients who receive immunotherapy. This review aims to summarize current knowledge of existing/promising biomarkers in patients with unresectable or metastatic cholangiocarcinoma, treated with immunotherapy as monotherapy, or combined with chemotherapy. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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15 pages, 939 KiB

Open AccessReview

Evolution in the Surgical Management of Gastric Cancer Peritoneal Metastases

by Matthew Krell, Suedeh Ranjbar, Saige Gitlin, Diego R. Alvarez Vega, Rachel Wilson, Kenya Thrasher and Zachary J. Brown

Cancers 2025, 17(1), 100; https://doi.org/10.3390/cancers17010100 - 31 Dec 2024

Viewed by 861

Abstract

Despite therapeutic treatments and the growing utilization of multimodal therapies, gastric cancer (GC) remains a highly aggressive malignancy with high mortality worldwide. Much of the complexity in treating GC is due to the high incidence of peritoneal metastasis (PM), with mean overall survival [...] Read more.

Despite therapeutic treatments and the growing utilization of multimodal therapies, gastric cancer (GC) remains a highly aggressive malignancy with high mortality worldwide. Much of the complexity in treating GC is due to the high incidence of peritoneal metastasis (PM), with mean overall survival typically ranging from 4 to 10 months. With current systemic therapy, targeted therapies, and immunotherapies continuing to remain ineffective for GC/PM, there has been a significant growing interest in intraperitoneal (IP) therapies for the treatment of GC/PM. In this review, we summarize the development of PM and evolving treatment strategies for GC/PM. Furthermore, we explore the various advancements and outcomes of IP therapies, including heated intraperitoneal chemotherapy (HIPEC), neoadjuvant HIPEC, and pressurized intraperitoneal aerosolized chemotherapy (PIPAC). Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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17 pages, 364 KiB

Open AccessReview

Landscape of Biomarkers and Pathologic Response in Rectal Cancer: Where We Stand?

by Abrahams Ocanto, Macarena Teja, Francesco Amorelli, Felipe Couñago, Ariel Gomez Palacios, Diego Alcaraz and Ramón Cantero

Cancers 2024, 16(23), 4047; https://doi.org/10.3390/cancers16234047 - 2 Dec 2024

Viewed by 1057

Abstract

Colorectal cancer (CRC) is a neoplasm with a high prevalence worldwide, with a multimodal treatment that includes a combination of chemotherapy, radiotherapy, and surgery in locally advanced stages with acceptable pathological complete response (pCR) rates, this has improved with the introduction of total [...] Read more.

Colorectal cancer (CRC) is a neoplasm with a high prevalence worldwide, with a multimodal treatment that includes a combination of chemotherapy, radiotherapy, and surgery in locally advanced stages with acceptable pathological complete response (pCR) rates, this has improved with the introduction of total neoadjuvant therapy (TNT) reaching pCR rates up to 37% in compare with classic neoadjuvant treatment (NAT) where pCR rates of around 20–25% are achieved. However, the patient population that benefits most from this therapy has not been determined, and there is a lack of biomarkers that can predict the course of the disease. Multiple biomarkers have been studied, ranging from hematological and molecular markers by imaging technique and combinations of them, with contradictory results that prevent their use in routine clinical practice. In this review, we evaluate the most robust prognostic biomarkers to be used in clinical practice, highlighting their advantages and disadvantages and emphasizing biomarker combinations and their predictive value. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

24 pages, 724 KiB

Open AccessReview

Perioperative Treatment in Gastric Cancer: A Fast-Changing Field

by Mafalda Costa, Catarina Lopes Fernandes and Helena Magalhães

Cancers 2024, 16(23), 4036; https://doi.org/10.3390/cancers16234036 - 1 Dec 2024

Viewed by 1305

Abstract

Gastric cancer is the fifth most common cancer worldwide and its incidence is rising. Surgery is the only curative strategy and its association with perioperative chemotherapy is now standard treatment for most resectable tumors. Despite treatment advances, disease relapse is high, even in [...] Read more.

Gastric cancer is the fifth most common cancer worldwide and its incidence is rising. Surgery is the only curative strategy and its association with perioperative chemotherapy is now standard treatment for most resectable tumors. Despite treatment advances, disease relapse is high, even in early stages, and continued improvement in curative treatment is imperative. With deeper knowledge of gastric cancer heterogeneity, molecular subtypes, and the tumor immune microenvironment, new standard treatment strategies may emerge in the near future. This paper provides a comprehensive review of the current treatment landscape in resectable gastric cancer and future perspectives for the next decade regarding new agents such as targeted therapies, immunotherapy, antibody–drug conjugates, and the combination of multiple treatment modalities. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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25 pages, 1498 KiB

Open AccessReview

Current Applications and Future Directions of Circulating Tumor Cells in Colorectal Cancer Recurrence

by Kun-Yu Tsai, Po-Shuan Huang, Po-Yu Chu, Thi Ngoc Anh Nguyen, Hsin-Yuan Hung, Chia-Hsun Hsieh and Min-Hsien Wu

Cancers 2024, 16(13), 2316; https://doi.org/10.3390/cancers16132316 - 24 Jun 2024

Cited by 6 | Viewed by 2462

Abstract

The ability to predict or detect colorectal cancer (CRC) recurrence early after surgery enables physicians to apply appropriate treatment plans and different follow-up strategies to improve patient survival. Overall, 30–50% of CRC patients experience cancer recurrence after radical surgery, but current surveillance tools [...] Read more.

The ability to predict or detect colorectal cancer (CRC) recurrence early after surgery enables physicians to apply appropriate treatment plans and different follow-up strategies to improve patient survival. Overall, 30–50% of CRC patients experience cancer recurrence after radical surgery, but current surveillance tools have limitations in the precise and early detection of cancer recurrence. Circulating tumor cells (CTCs) are cancer cells that detach from the primary tumor and enter the bloodstream. These can provide real-time information on disease status. CTCs might become novel markers for predicting CRC recurrence and, more importantly, for making decisions about additional adjuvant chemotherapy. In this review, the clinical application of CTCs as a therapeutic marker for stage II CRC is described. It then discusses the utility of CTCs for monitoring cancer recurrence in advanced rectal cancer patients who undergo neoadjuvant chemoradiotherapy. Finally, it discusses the roles of CTC subtypes and CTCs combined with clinicopathological factors in establishing a multimarker model for predicting CRC recurrence. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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13 pages, 1286 KiB

Open AccessReview

Autoimmune Atrophic Gastritis: A Clinical Review

by Chiara Castellana, Leonardo Henry Eusebi, Elton Dajti, Veronica Iascone, Amanda Vestito, Pietro Fusaroli, Lorenzo Fuccio, Antonietta D’Errico and Rocco Maurizio Zagari

Cancers 2024, 16(7), 1310; https://doi.org/10.3390/cancers16071310 - 28 Mar 2024

Cited by 11 | Viewed by 11919

Abstract

Autoimmune atrophic gastritis (AAG) is a chronic condition characterized by the presence of atrophy in the oxyntic mucosa due to anti-parietal cell antibodies. This review provides a comprehensive and up-to-date overview of autoimmune atrophic gastritis, reporting recent evidence on epidemiology, pathogenesis, diagnosis, clinical [...] Read more.

Autoimmune atrophic gastritis (AAG) is a chronic condition characterized by the presence of atrophy in the oxyntic mucosa due to anti-parietal cell antibodies. This review provides a comprehensive and up-to-date overview of autoimmune atrophic gastritis, reporting recent evidence on epidemiology, pathogenesis, diagnosis, clinical presentation, risk of malignancies, and management. The prevalence of AAG has been estimated at between 0.3% and 2.7% in the general population. The diagnosis of AAG is based on a combination of the serologic profile and the histological examination of gastric biopsies. Patients with AAG are often asymptomatic but can also have dyspeptic or reflux symptoms. The atrophy of the oxyntic mucosa leads to iron and vitamin B12 malabsorption, which may result in anemia and neurological affections. Autoimmune atrophic gastritis is associated with an increased risk of type I neuroendocrine tumors (NETs) and gastric cancer, with an incidence rate of 2.8% and 0.5% per person/year, respectively. Management is directed to reinstate vitamins and iron and to prevent malignancies with endoscopic surveillance. In conclusion, atrophic autoimmune gastritis is an infrequent condition, often asymptomatic and misdiagnosed, that requires an early diagnosis for appropriate vitamin supplementation and endoscopic follow-up for the early diagnosis of NETs and gastric cancer. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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Other

Jump to: Research, Review

15 pages, 424 KiB

Open AccessSystematic Review

Neoadjuvant Treatment in Localized Pancreatic Cancer of the Elderly: A Systematic Review of the Current Literature

by Elena Orlandi, Stefano Vecchia, Elisa Anselmi, Ilaria Toscani, Massimo Guasconi, Gennaro Perrone, Chiara Citterio, Filippo Banchini and Mario Giuffrida

Cancers 2025, 17(5), 747; https://doi.org/10.3390/cancers17050747 - 22 Feb 2025

Viewed by 421

Abstract

Background/Objectives: Neoadjuvant therapy (NAT) improves surgical outcomes in pancreatic cancer, but its role in elderly patients remains unclear. Due to comorbidities and lower chemotherapy tolerance, assessing NAT’s benefits and risks in this population is essential. This systematic review assesses the impact of [...] Read more.

Background/Objectives: Neoadjuvant therapy (NAT) improves surgical outcomes in pancreatic cancer, but its role in elderly patients remains unclear. Due to comorbidities and lower chemotherapy tolerance, assessing NAT’s benefits and risks in this population is essential. This systematic review assesses the impact of NAT on overall survival (OS), surgical resection rates, and treatment-related toxicities(G3-4) in elderly patients with resectable, borderline, or locally advanced pancreatic cancer. Methods: A systematic search was conducted in PubMed, MEDLINE, EMBASE, Scopus, and Cochrane databases according to PRISMA guidelines. Studies reporting that NAT outcomes in elderly patients (≥70 years) were included. The Newcastle–Ottawa scale was used to assess study quality. Subgroup analyses compared NAT versus upfront surgery and outcomes in elderly versus younger patients. Results: Twelve studies (four prospective and eight retrospective) including 11,385 patients met the inclusion criteria. Among 9580 elderly patients, only 24% underwent NAT. NAT significantly improved R0 resection rates compared to upfront surgery (p < 0.001), and elderly patients receiving NAT had a median OS of 26.5 (range 15.7–39.1) months versus 20.3 months (range 11.5–23.8) of upfront surgery and versus 36.2 months (range 23.6–43.0) of NAT in young patients. Elderly patients experienced higher rates of major toxicities (17–57.5%). Personalized regimens, such as gemcitabine/nab-paclitaxel, were better tolerated than FOLFIRINOX. Conclusions: NAT is associated with improved survival and surgical outcomes in elderly pancreatic cancer patients, despite a higher risk of adverse events. Patient selection based on performance status rather than age alone is essential to optimize treatment benefits. Further prospective trials are needed to refine treatment approaches in this population. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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1 pages, 146 KiB

Open AccessCorrection

Correction: Jeong et al. A Comparative Study of Postoperative Complications Associated with Distal Gastrectomy and Pylorus-Preserving Gastrectomy among Gastric Cancer Patients Based on Nationwide Survey Data and Propensity Score Weighting. Cancers 2024, 16, 2203

by Sang-Ho Jeong, Miyeong Park, Kyung Won Seo, Rock Bum Kim, Jae-Seok Min and Information Committee of the Korean Gastric Cancer Association

Cancers 2024, 16(22), 3745; https://doi.org/10.3390/cancers16223745 - 6 Nov 2024

Viewed by 628

Abstract

Text Correction [...] Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

11 pages, 682 KiB

Open AccessSystematic Review

Robotic versus Laparoscopic Liver Resections for Colorectal Metastases: A Systematic Review and Meta-Analysis

by Kamil Safiejko, Michal Pedziwiatr, Michal Pruc, Radoslaw Tarkowski, Marcin Juchimiuk, Marian Domurat, Jacek Smereka, Khikmat Anvarov, Przemyslaw Sielicki, Krzysztof Kurek and Lukasz Szarpak

Cancers 2024, 16(8), 1596; https://doi.org/10.3390/cancers16081596 - 22 Apr 2024

Cited by 6 | Viewed by 2261

Abstract

Colorectal cancer is the third most common cancer worldwide, and the liver is the most common localization of metastatic disease. The incidence of minimally invasive liver surgery is increasing, and robotic surgery (RLR) is believed to overcome some limitations of a laparoscopic approach [...] Read more.

Colorectal cancer is the third most common cancer worldwide, and the liver is the most common localization of metastatic disease. The incidence of minimally invasive liver surgery is increasing, and robotic surgery (RLR) is believed to overcome some limitations of a laparoscopic approach (LRL). We performed a systematic review and meta-analysis of operative and short-term oncologic outcomes of the laparoscopic versus robotic-assisted liver resection for colorectal liver metastases. An online search of PubMed, Embase, Scopus, and the Cochrane databases was performed. Eight studies involving 3210 patients were considered eligible for the meta-analysis. In the LRL group, a higher conversion to open rate (12.4%) was observed compared to the RLR (6.7%; p = <0.001). 30-day mortality was 0.7% for the LRL group compared to 0.5% for the RLR group (p = 0.76). Mortality in longer periods among LLR and RLR amounted to 18.2% vs. 8.0% for 1-year mortality (p = 0.07), 34.1% vs. 26.7% for 2-year mortality (p = 0.13), and 52.3% vs. 48.3% for 3-year mortality (p = 0.46). The length of hospital stay was 5.6 ± 2.5 vs. 5.8 ± 2.1 days, respectively (p = 0.47). There were no significant differences between the incidence of individual complications in the LRL and RLR groups (p = 0.78). Laparoscopic or robotic approaches for colorectal liver metastases are comparable in terms of safety and effectiveness. There are significant advantages to robotic surgery, although there is still no long-term evidence concerning overall survival, and the number of patients operated on using RLR remains small. Full article

(This article belongs to the Special Issue Developments in the Management of Gastrointestinal Malignancies)

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