Editorial: Newest challenges and advances in the treatment of colorectal disorders; from predictive biomarkers to minimally invasive techniques

Abstract

One study by Zheng et al. (2023) provides a detailed comparative analysis of laparoscopicassisted transanal natural orifice specimen extraction (NOSE) versus conventional laparoscopic surgery (CLS) for sigmoid and rectal cancer (1). Among 121 patients, NOSE was associated with a shorter total incision length, highlighting its cosmetic advantage. However, this benefit was offset by a longer operation time compared to CLS. Importantly, there were no significant differences in postoperative complications, such as bacterial culture positivity, intra-abdominal infections, or anastomotic leakage, nor were there differences in overall survival (OS) and disease-free survival (DFS) outcomes between the two groups. The findings suggest that while NOSE may be particularly suitable for patients who prioritize cosmetic outcomes, the extended operative duration warrants careful consideration in clinical decision-making.In another significant contribution, Hongan et al. conducted a systematic review and metaanalysis to assess the impact of adjuvant chemotherapy (ACT) on survival outcomes in nodenegative CRC patients, with a focus on the presence of perineural invasion (PNI) (2). Their analysis revealed that ACT significantly improved OS and DFS in patients with PNI, with hazard ratios (HR) of 0.52 and 0.53, respectively. However, ACT did not significantly affect DFS in patients without PNI. These findings underscore the potential of ACT as a particularly beneficial intervention for patients with PNI, while also suggesting that it may confer some survival advantage for those without PNI.Colorectal cancer (CRC) is characterized by significant genetic, anatomical, and transcriptional diversity. The tumor microenvironment (TME) plays a critical role in CRC prognosis and treatment outcomes. It consists of various cellular components like cancerassociated fibroblasts, tumor-associated macrophages, and regulatory T cells, as well as extracellular elements that contribute to therapeutic resistance through mechanisms such as fibrosis and enzymatic degradation. Given its influence on therapy efficacy, the TME presents a promising area for drug discovery, with ongoing research focused on targeting TME components to improve CRC treatment strategies (3).Colorectal cancer (CRC) with the BRAF V600E mutation is aggressive and resistant to conventional therapies, largely due to the enhanced MAPK pathway activation. Although MAPK inhibitors have shown limited clinical success, combining these inhibitors with immune checkpoint inhibitors (ICIs) offers promise, particularly for patients with microsatellite instability-high (MSI-H) tumors ( 4).The study by Jiang et al. ( 2023) investigated the relationship between collagen structure and the Immunoscore in the tumor microenvironment (TME) of CRC (5). Using multiphoton imaging, they developed a collagen signature from 327 stage I-III CRC patients, which was strongly correlated with the Immunoscore. A collagen nomogram was subsequently constructed, integrating the collagen signature with clinicopathological predictors. This nomogram demonstrated high predictive accuracy for prognosis, particularly in high-risk stage II and III patients, and was shown to be a valuable tool in identifying patients who might benefit most from adjuvant chemotherapy. This study highlights the potential of collagen structure as a biomarker for immunological activity within the TME, offering a novel approach to prognosis in CRC. 2023) focused on patients with pT4M0 colon adenocarcinoma (COAD), analyzing optimal treatment strategies using data from the SEER database (6). Their study, which included 8,843 patients, revealed that those who received surgery combined with postoperative adjuvant therapy had significantly better 3-year OS and cancer-specific survival (CSS) rates compared to those who underwent surgery alone. A nomogram was developed, incorporating variables such as age, race, N stage, serum CEA levels, tumor differentiation, and