Dong-Guk Park

Given the increasing staffing shortages that often necessitate noncolorectal surgeons performing emergency colorectal procedures, this study aims to evaluate the effect of surgeon subspecialty on short-term postoperative outcomes in patients undergoing emergency Hartmann procedure and whether strengthening residency training in Hartmann procedure could improve surgical outcomes. This retrospective study included 141 patients who underwent emergency Hartmann procedure at a single tertiary center between January 2010 and December 2021. Patients were categorized into colorectal and noncolorectal groups. The clinical characteristics, operative details, and outcomes were compared. Complications were classified using the Clavien-Dindo classification. Logistic regression analysis was used to identify complications and mortality. The noncolorectal group showed higher age (75 years vs. 69 years, P=0.038), hypertension prevalence (58.4% vs. 40.4%, P=0.039), and physiological instability (C-reactive protein >6.0 mg/dL: 55.1% vs. 36.5%, P=0.034; lactate: 1.90 mmol/L vs. 0.80 mmol/L, P<0.001). Complications were lower in the colorectal group (68.5% vs. 36.5%, P<0.001), with fewer major complications (Clavien-Dindo grade ≥III, 51.7% vs. 15.4%). The colorectal group had a lower mortality rate (25.8% vs. 3.8%, P=0.001). In the multivariate analysis, surgery performed by noncolorectal surgeons remained a significant independent risk factor for complications (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.27-6.89; P=0.012) and mortality (OR, 15.53; 95% CI, 2.11-114.18; P=0.006) even after adjusting for age, diagnosis, American Society of Anesthesiologists physical status, C-reactive protein levels, and time to surgery. Emergency Hartmann procedure for acute conditions yielded better short-term outcomes when performed by colorectal surgeons. These findings suggest that surgeon subspecialty is a critical determinant of survival, independent of patient severity or surgical timing. Improving surgical residency training in Hartmann procedure may enhance outcomes when noncolorectal surgeons must perform it due to staffing constraints.

Background: Cytoreductive surgery (CRS) combined with intraperitoneal chemotherapy (IPC) is an established treatment for select patients with colorectal peritoneal metastases. However, the impact of evolving treatment strategies and accumulating institutional experience on oncological outcomes remains poorly understood. This study aimed to characterise temporal changes in treatment approaches over a decade at a single high-volume centre and evaluate their association with outcomes by comparing early and later patient cohorts. Methods: A total of 160 patients who underwent CRS with IPC for colorectal peritoneal metastases between 2011 and 2019 were retrospectively analysed and categorised into early (2011–2013, n = 42) and late (2014–2019, n = 118) cohorts. Overall survival (OS) and disease-free survival (DFS) were compared between the groups. Prognostic factors were assessed using Cox proportional hazard regression models. Results: The later cohort demonstrated significantly improved OS compared to the early cohort (median OS, 25.1 vs. 13.8 months; 5-year OS, 25.9% vs. 11.9%; log-rank p = 0.015). DFS showed a non-significant trend toward improvement (p = 0.176). In the multivariate analysis, cohort period (HR 0.63, p = 0.029), completeness of cytoreduction (HR 4.51, p < 0.001), tumour location, preoperative CEA level, and receipt of preoperative systemic chemotherapy were independently associated with OS. Conclusions: These findings suggest that accumulated institutional experience and changes in treatment strategies may be associated with improved OS in patients undergoing CRS with IPC for colorectal peritoneal metastases.

BACKGROUND Peritoneal metastasis occurs in about 20% of patients with colorectal cancer (CRC) and is associated with a 5-year survival rate of only 6%. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy reportedly improves survival in selected patients. Achieving complete cytoreduction, indicated by a low completeness of cytoreduction (CCR) score, is a key factor in extending survival. Here, we present a case in which multimodal therapy yielded long-term survival in a patient, even though she had a CCR score of 3. CASE SUMMARY A 61-year-old female with CRC and extensive peritoneal metastases presented with abdominal distention. Cytoreductive surgery was not completed due to the extent of the disease (CCR score: 3). The patient underwent palliative omentectomy, followed by hyperthermic intraperitoneal chemotherapy with mitomycin C, and early postoperative intraperitoneal chemotherapy. She subsequently received systemic chemotherapy, which was terminated after 19 cycles and two dose reductions due to side effects. She was in good health without distant metastases or peritoneal recurrence at the 6-year follow-up. CONCLUSION Aggressive multimodal treatment may yield long-term survival and quality of life improvement in patients with advanced disease, even with high CCR scores.

Jo JW, et al. Ann Surg Treat Res. 2025 Jan;108(1):12-19. https://doi.org/10.4174/astr.2025.108.1.12

The route of oncolytic virotherapy is pivotal for immunotherapeutic efficacy in advanced cancers. In this preclinical study, an oncolytic reovirus (RC402) is orally administered to induce antitumor immunity. Oral reovirus treatment shows no gross toxicities and effectively suppresses multifocal tumor lesions. Orally administered reovirus interacts with the host immune system in the Peyer’s patch of the terminal ileum, increases IgA⁺ antibody-secreting cells in the lamina propria through MAdCAM-1⁺ blood vessels, and reshapes the gut microbiome. Oral reovirus promotes antigen presentation, type I/II interferons, and T cell activation within distant tumors, but does not reach or directly infect tumor cells beyond the gastrointestinal tract. In contrast to intratumoral reovirus injection, the presence of the gut microbiome, Batf3⁺ dendritic cells, type I interferons, and CD8⁺ T cells are indispensable for orally administered reovirus-induced antitumor immunity. Oral reovirus treatment is most effective when combined with αPD-1(L1) and/or αCTLA-4, leading to complete colon tumor regression and protective immune memory. Collectively, oral reovirus virotherapy is a feasible and effective immunotherapeutic strategy in preclinical studies.

A 61-year-old man presented with abdominal distension without any symptoms. On colonoscopy and computed tomography findings, it was clinically diagnosed as peritoneal metastasis of sigmoid colon cancer, and diagnostic laparoscopy was performed. Only the peritoneum was partially resected, and the pathology was signet ring cell carcinoma with predominantly local mucinous carcinoma component. However, the patient complained of persistent symptoms and, despite the progress of chemotherapy, the peritoneal dissemination worsened, and additional cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) was performed. Mixed adenoneuroendocrine carcinomas (MANECs) were reported in the appendix with perforated visceral peritoneum. After additional chemotherapy, the patient was discharged. Patients with advanced MANEC with peritoneal spreading may benefit from aggressive treatment by cytoreduction surgery with HIPEC, followed by intravenous chemotherapy.

Myxoma virus (MyxV) is a rabbit-specific poxvirus. However, its ability to selectively target tumor cells has established it as a safe and effective anticancer therapy. To strengthen its preclinical efficacy, transgenes that can prolong cancer cell infection and enhance anti-tumor effector functions are currently being investigated. We engineered MyxV armed with CD47, to turn on a ‘do not eat me’ signal within infected cells with actively replicating viruses, and with IFN-γ to further activate host immune anticancer responses. Tumor suppressive activities were significantly enhanced by the dual-armed MyxV_CD47/IFN-γ compared to parental MyxV or single-armed MyxV_CD47 or MyxV_IFN-γ. In addition, significant increases in IFN-γ+ CD8+T-cells and CD4+ T-cells populations within tumor-infiltrating lymphocytes (TIL) were observed after MyxV_CD47/IFN-γ treatment. Notably, all groups treated with MyxV showed a marked reduction in Foxp3+ CD4+ regulatory T-cells (Tregs) within TIL. We also show that MyxV infection induces PD-L1 up-regulation in cancer cells, and combinational treatment of MyxV with anti-mouse PD-L1 antibodies (αPD-L1) further controlled tumor burden and increased survival in the syngeneic melanoma model B16F10. Our data demonstrate that a CD47 and IFNγ dual-armed MyxV is an effective oncolytic viral immunotherapeutic. These findings strongly support further preclinical investigations to develop next-generation MyxV-based immunotherapy approaches.

Background Among cancer metastases by primary colorectal cancer (CRC), peritoneal metastasis is the second most common metastatic lesion after liver metastasis. In treating metastatic CRC, it is very important to differentiate targeted-therapy and chemotherapy according to the characteristics of each lesion because the genetic variation of the primary and metastatic lesions are different. However, there are few studies of genetic characteristics on peritoneal metastasis caused by primary CRC, so molecular-level studies are continuously required. Objective We propose an appropriate peritoneal metastasis treatment policy by identifying the genetic characteristics between primary CRC and synchronous peritoneal metastatic lesions. Methods Primary CRC and synchronous peritoneal metastasis samples were analyzed in pairs from six patients using Comprehensive Cancer Panel (409 cancer-related genes, Thermo Fisher Scientific, USA) and next-generation sequencing (NGS). Results The mutations were commonly found on the KMT2C and THBS1 genes in both primary CRC and peritoneal metastasis. The PDE4DIP gene was mutated in all cases except for on a sample of peritoneal metastasis. As a result of analysis using the mutation database, we confirmed that the gene mutations of primary CRC and the peritoneal metastasis derived from it showed the same tendency, although we did not accompany the gene expression level or epigenetic study. Conclusion It is thought that the treatment policy through molecular genetic testing of primary CRC can also be applied to peritoneal metastasis treatment. Our study is expected to be the basis for further peritoneal metastasis research.

A water-soluble variant of the artemisinin called artesunate, approved as an antimalarial agent, can induce cell death on various cancer cell types. We studied the mechanism of cell death of artesunate on HCT116 colorectal cancer cells. We treated HCT116 colon cancer cells with artesunate, holo-transferrin, deferoxamine mesylate, ferrostatin, necrostatin-1, and YM155. We observed the growth inhibition of artesunate on HCT116 colon cancer cells by morphologic findings. Inhibition of cell growth was assessed by MTT (3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide) assay and long-term growth inhibition by colony-forming assay. Apoptosis was investigated by flow cytometry and Western blot analysis. Artesunate inhibited the proliferation of HCT116 colon cancer cells effectively. Co-treatment with YM155, a specific survivin inhibitor, enhanced the artesunate-induced cell death. Co-treatment with the iron-chelating agent deferoxamine rescued artesunate induced cell death and increased long-term cell survival and proliferation. In this study, we demonstrated that artesunate-induced cytotoxicity in HCT116 colon cancer cells by suppressing the expression of survivin and partially by ferroptosis. Our findings suggest that the co-treatment artesunate with YM155 can induce more potent cell death on HCT116 colon cancer cells and shows new insight for the treatment of colorectal cancer patients.