The very last symposium on the final day of Virtually Vilnius, ‘CET – Colorectal cancer’, was hosted by Evangelos Xynos (Greece), ESCP’s new President. Evangelos welcomed a diverse range of excellent European speakers who are well known for their impact and expertise within the field.

Evangelos Xynos screenshot

Taking to the virtual stage first, Nick West (UK), discussed microsatellite instability for colorectal surgeons and the Deficient Mis-Match Repair (d-MMR) status which is accounted for in a distinct group of approximately 15% of sporadic colorectal cancers.

Nick presented relevant studies and expressed that all colorectal cancers should be tested for dMMR/MSI at diagnosis and how the information gathered will be used to inform prognosis as well as the response to adjuvant/neoadjuvant treatment, immunotherapy, and risk of lynch syndrome.

Next up, Toni Seppälä (Finland) presented an insightful session on ‘Cancer risk and surgical considerations in Lynch syndrome.’ Toni discussed a detailed rationale for ileosigmoid anastomosis after subtotal colectomy.

Eric Van Cutsem (Belgium) presented ‘Do we need more or less chemotherapy for colon cancer?’ which looked at new perspectives of chemotherapy for colon cancer. Eric discussed the FOXTROT trial (neo-adjuvant for the locally advanced disease) and IDEA trial – an evidence-based trial in the adjuvant setting which optimizes regimes and duration of treatment as well as the potential value in oncological outcomes of more radical surgery for colon cancer in terms of D3 lymphadenectomy.

Aleksei Petrov (Russia) then presented '"Quality" D2 versus D3 lymphadenectomy in colorectal cancer' which provided viewers with some fantastic analogies to take away and implement in their practice.

“Our borders are very arbitrary. Lymph nodes do not care about the lines we draw in our minds,” he said. Aleksei discussed the subjective extent of optimal lymph node dissection and stated that the line should be drawn using data collated in randomised controlled trials.

Lymph nodes map

‘Short-course RT for rectal cancer - a step towards TNT?’ was presented by Anna Martling (Sweden) which looked at the shift to less radiotherapy and more chemotherapy in the neo-adjuvant setting for locally advanced rectal cancer. Anna discussed the first results from the RAPIDO trial, as well as the Stockholm III trial.

George Chang (USA) then discussed the risk assessment of lateral lymph nodes and therapeutic implications in rectal cancer. The current controversies and evidence regarding management of lateral pelvic lymph node metastases from rectal cancer were discussed and George shared new recommendations for the evaluation and selection of patients for lateral pelvic lymph node dissection following multidisciplinary treatment.

Last and certainly not least, Diane Goere (France) presented ‘Cytoreduction with or without HIPEC for peritoneal carcinomatosis.’ Diane discussed the place of cytoreduction and the possible added value of hyperthermic intra-peritoneal chemotherapy (HIPEC) in peritoneal carcinomatosis from colorectal cancer.

Miguel Pera (Spain) and Gianluca Pellino (Italy) then hosted a panel discussion before recommencing with a standardised trainee video which detailed Open Low Anterior Resection which was shared by Ayhan Kuzu (Turkey).

Colorectal Cancer Presenters screenshot

The top colorectal cancer abstracts were then presented. Joana Simoes (UK) discussed the safety regarding a change in practice from minimally invasive to open gastrointestinal cancer surgery during the COVID-19 pandemic. She discussed an international cohort study which looked at the change in practice from minimally invasive to open surgery across multiple countries.

She stated no increased risk of pulmonary complications or mortality and stated that minimally invasive surgery should remain the choice of current care.

Following this, Kevin Talboom (Netherlands) presented ‘Highly selective diversion with pro-active leakage management after low anterior resection for rectal cancer is a safe strategy with potential benefits’ and Jordan Fletcher (UK) showcased accurate recreations of cadaveric pelvic specimens using a low cost single camera photogrammetry technique in his session on ‘Digital human project: 3D photogrammetry for human cadaveric pelvic specimens: an innovation in colorectal anatomical education.’

‘Influence of minimally invasive resection technique on sphincter preservation and short-term outcome in low rectal cancer in The Netherlands’ was then presented by Marieke Rutgers (Netherlands).

Marieke stated that TaTME is associated with the highest likelihood to avoid a permanent stoma followed by R-TME (15.4% increase in restorative procedures). “Patients with low rectal cancer in the Netherlands are more likely to get a restorative procedure with a trans-anal approach, compared to a laparoscopic or robotic procedure and highlighted short term oncological outcomes are comparable between the three minimally invasive techniques,” she said.

Sapho Roodbeen (Netherlands) then presented ‘Local recurrence and disease-free survival two years after transanal total mesorectal excision: results of the International TaTME Registry’ and Helene Juul Würtz (Denmark) presented ‘Anastomotic techniques and leakage rates in minimally invasive right hemicolectomy for cancer – a 4-year nationwide cohort from the Danish Colorectal Cancer Registry (DCCG).

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