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Anastomotic leak is a significant morbidity in colorectal surgeries. The risk factors for anastomotic leakage are multifactorial with vascularity of the bowel edge playing an important role. Indocyanine green (ICG) dye emits fluorescence and this principle is used to assess the bowel edge vascularity before anastomosis. The context of the study is that even though ICG dye has been used in colorectal cancer surgery for quite a while the evidence is not strong. Most of the data on the role of ICG dye in decreasing the anastomotic leak rate in colorectal cancer surgery comes from retrospective and few prospective trials. There are a few recently published randomized controlled trials (RCT) with contrasting outcomes in this regard. This study is a narrative review of randomized control trials and trial protocols published until 31st December 2023. PubMed, Embase, and Scopus were searched with the keywords ICG, AND Colorectal surgery, AND Anastomotic leak. Four completed RCTs were found and included in this review of all search results. Most of the included studies reported the beneficial effects of ICG on the incidence of anastomotic leak rate. To conclude, the role of ICG dye is not well established in reducing anastomotic leak rates following colorectal anastomosis, but there is growing evidence to support its use. [ABSTRACT FROM AUTHOR]

This review article examines the evidence-based management of colorectal cancers, focusing on topics characterized by ongoing debates and evolving evidence. To contribute to the scientific discourse, we intentionally exclude subjects with established guidelines, concentrating instead on areas where the current understanding is dynamic. Our analysis encompasses a thorough exploration of critical themes, including the evidence surrounding complete mesocolic excision and D3 lymphadenectomy in colon cancers. Additionally, we delve into the evolving landscape of perioperative chemotherapy in both colon and rectal cancers, considering its nuanced role in the context of contemporary treatment strategies. Advancements in surgical techniques are a pivotal aspect of our discussion, with an emphasis on the utilization of minimally invasive approaches such as laparoscopy and robotic surgery in both colon and rectal cancers, including advanced rectal cases. Moving beyond conventional radical procedures, we scrutinize the feasibility and implications of endoscopic resections for small tumors, explore the paradigm of organ preservation in locally advanced rectal cancers, and assess the utility of total neoadjuvant therapy in the current treatment landscape. Our final segment reviews pivotal trials that have significantly influenced the management of colorectal liver and peritoneal metastasis. [ABSTRACT FROM AUTHOR]

Background: Signet-ring cell colorectal carcinoma (SRCC) is an extremely aggressive yet uncommon histologic subtype of colorectal cancer (CRC) with an unknown etiology. There is a stark difference in the prevalence of signet cancers between Western countries and the Indian subcontinent; however, India itself is a vast and diverse country with variable cancer incidence. Objective: To study the spatial epidemiology of SRCC in India for identifying regions with high prevalence. Methods: This retrospective study included all patients diagnosed with colorectal adenocarcinoma at Tata Memorial Hospital, the largest colorectal cancer referral unit in India, between January 2020 and December 2022. Geocoding based on the location of the residence was done to map the incidences. Comparisons were performed between the proportion of signet cell and non-signet colorectal cancers. Results: A total of 4100 patients with colon or rectal adenocarcinomas were included, of which signet cell histology was found in 624 (15%) patients. SRCC accounted for the highest proportions of CRCs in the Central (19%) and Northern (19%) regions, and the lowest in the North-Eastern (10%) and Western (12%) regions of India (P < 0.001), with non-overlapping confidence intervals. Compared with patients with non-signet CRCs, those with SRCC more commonly had colon cancers (22% vs. 17%; P = 0.003) and belonged to a lower socioeconomic background (67% vs. 59%; P < 0.001). Conclusions: This study found that SRCCs accounted for a significant proportion of CRC cases in India, but there was no substantial disparity in distribution across regions. [ABSTRACT FROM AUTHOR]

Thus, the attributable harm by transposing the ovaries appears to be small in nonsignet ring cell cancers and in signet ring cancers it needs to be studied whether irradiating the ovaries would have prevented peritoneal and systemic recurrences. Keywords: fertility; ovarian transposition; radiation; rectal cancer EN fertility ovarian transposition radiation rectal cancer 1249 1250 2 10/31/22 20221001 NES 221001 Recently, our group published the results of laparoscopic ovarian transposition (LOT) in locally advanced rectal cancers (LARC) that required preoperative pelvic irradiation [1]. The majority of the failures, however, occurred in signet ring cell cancers (five of eight ovarian relapses); only one patient had isolated ovarian metastasis while the rest were accompanied by concomitant distant or peritoneal recurrences [1]. [Extracted from the article]

Interesting observations were reported in the article on mucinous tumours by Koeter et al., in which poor response to chemoradiation (CRT) and high rate of resections with a positive circumferential margin.1 We congratulate the authors on supplementing the literature currently available on the unsatisfactory treatment response of mucinous rectal cancers. Inclusion of signet ring cell cancers (that have distinctly worse prognosis compared to conventional adenocarcinomas) could have skewed the results towards higher local recurrences, inferior radiological response to CRT as well as an increase in R1 resections. Yet, these may have different histological correlates that include signet ring cell components (<50% signet cells) as well signet ring cell cancers. [Extracted from the article]

The first case demonstrates suspected RP nodes below the inferior mesenteric artery (IMA) in the inter-aortocaval region associated with an operable sigmoid cancer. I Dear Editor, i Retroperitoneal (RP) lymph node metastases from colorectal cancer (CRC) are rare, the reported incidence of isolated RP nodal disease being 1%-2% [1,2]. In patients with colorectal cancers, isolated synchronous RP nodes are considered as oligometastatic disease and treatment with curative intent is often undertaken. [Extracted from the article]