Aldo Rocca
Alfonso Reginelli3- 1Department of Medicine and Health Science “V. Tiberio”, University of Molise, Campobasso, Italy
- 2Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
- 3Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
- 4Hepatobiliary Unit, Department of Minimally Invasive General and Oncologic Surgery, Humanitas Gavazzeni University Hospital, Bergamo, Italy
- 5Department of Biomedical Sciences, Humanitas University, Milan, Italy
Editorial on the Research Topic
Colorectal cancer awareness month 2023: diagnosis, clinical course, and surgical management of metastatic colorectal cancer
Despite advances in medical care, Colorectal Cancer (CRC) is still a challenging health problem, representing the third most common cancer in terms of incidence and one of the leading causes of cancer-related mortality in the Western world (1).
Researchers are addressing various aspects of CRC, encompassing prevention, diagnosis, and treatment at different stages, from precancerous lesions to locally advanced and metastatic tumors (2–6). After pandemic era (7), advances in technology and cancer research are rapidly providing valuable and innovative insights for clinicians, researchers, and policymakers. Physicians must make clinical decisions among several options, pursuing a personalized approach for each patient in a continuously evolving scenario. Multidisciplinarity is the key, combining the expertise of medical oncologists, surgical oncologists, radiation oncologists, gastroenterologists, endoscopists, interventional radiologists, nuclear medicine physicians, pathologists, palliatives, and nurses in a patient-centered process (8–12). It is the only way to provide cutting-edge treatments, balancing benefits, risks, and costs in light of the latest evidence.
Following the considerations above, this editorial introduces a collection of articles entitled: “Colorectal Cancer Awareness Month 2023: Diagnosis, Clinical Course, and Surgical Management of Metastatic Colorectal Cancer,” which deeply explores the actual complexity of research and clinical practice for CRC patients.
In such a heterogeneous scenario, we have merged preclinical and clinical research on CRC, aiming to outline a single fil-rouge. Progress is driven by hyper-specialized research activity, but interconnection among different specialists is crucial for translating discoveries into clinical practice. Considering the latest innovations in each field, a multidisciplinary approach is essential to integrate them into the best clinical solution. For instance, medical and surgical oncologists strongly demand new biomarkers to guide their daily clinical decisions reliably (1, 13–15). The answer will likely be found by combining the results of genetic, radiomic, pathologic, and preclinical studies ongoing worldwide (16, 17). This is the spirit of the present Research Topic, in which the reader will navigate through the most recent advances and challenges in CRC research and treatment, always perceiving a unique aim: to build a multidisciplinary benchmark to answer clinical questions. Here are some of the most relevant insights from the published articles.
Schnitzer et al. analyzed the cost-effectiveness analysis of different imaging modalities for detecting colorectal liver metastases eligible for hepatic resection.
This study is critical for optimizing clinical outcomes and resource allocation, underscoring the importance of economic considerations in modern clinical reasoning (18–20).
At the same time, as reported by Zhang et al., the most recent laboratory researches, ranging from circulating biomarkers to single-cell RNA sequencing and bulk RNA transcriptome sequencing, pave the way to new approach to CRC, by unveiling heterogeneous immune landscape and identifying pivotal cell subpopulations associated with prognosis.
New biomarkers for CRC were also discussed. Lucarelli et al. proposed a potential role for the superior mesenteric vein ectasia in predicting liver metastases from rectal cancer, while Wang et al. suggested that serum mannose levels could predict the tumor N staging. A deeper knowledge of tumor biology is the basis for new therapeutic targets, which are crucial for developing personalized medicine approaches, and better prognostic models (21).
The term “Personalized medicine”, beside its therapeutic implication, also underscores the need for a patient-centered care. The patients and their relatives should be actively involved in the decision-making process and their feelings and behavior (o life-style) should be considered. According to the study by Gu et al., this remains an unmet need, with several patients not having a dominant role in clinical decision-making.
This issue is even more relevant in elderly patients: as reported by Huemer et al., patients aged 70 years or older with metastatic CRC can be effectively treated, but their comorbidities and specific physiological responses to treatment must be considered to find the right balance between efficacy and tolerability of interventions (22, 23). Ding et al. reported in a propensity score matching study the benefit of regional block techniques on postoperative high-grade complications in elderly patients with thoracic and abdominal cancers.
On the same line, the meta-analysis by Zeng et al. outlined the risk factors for lateral pelvic lymph node metastases in patients with low rectal cancer. The non-invasive stratification of risk for nodal metastases is essential to plan treatment and modulate aggressiveness of surgery. Finally, the increasing minimal invasiveness of therapeutic options enhances the access to treatment.
Shi et al., using a large database of over 25,000 patients, elucidated the indications for endoscopic treatment of T1N0 tumors, which offers a chance of cure even for frail patients.
In conclusion, this Research Topic aims to provide a deeper understanding of CRC, offering readers new perspectives on diagnosis, treatment, and patient management. The proposed papers strongly highlight the commitment of the medical and scientific community to improving the lives of patients affected by CRC through rigorous research and innovative solutions. While new complexities are continuously uncovered, the collected manuscripts provide invaluable contributions to shaping the future of CRC treatment.
In conclusion, this Research Topic aims to provide a deeper understanding of CRC, giving readers new perspectives concerning diagnosis, treatment, and patient management. From the proposed papers, it emerges with strength the commitment of the medical and scientific community to improve the lives of patients affected by CRC through rigorous research and innovative solutions. While new complexities are continuously uncovered, the collected manuscript give an invaluable contribution in shaping the near future of CRC treatment. As we continue to uncover the complexities of this disease, such contributions are invaluable in shaping the future of colorectal cancer care.
Author contributions
AR: Writing – original draft, Writing – review & editing. LV: Writing – original draft, Writing – review & editing. AR: Writing – review & editing.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
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References
1. Marcellinaro R, Spoletini D, Grieco M, Avella P, Cappuccio M, Troiano R, et al. Colorectal cancer: current updates and future perspectives. J Clin Med. (2023) 13. doi: 10.3390/jcm13010040
2. Tamura K, Nakamori M, Matsuda K, Hotta T, Nakamura M, Yokoyama S, et al. Elective colorectal cancer surgery in nonagenarians and postoperative outcomes. Updates Surg. (2023) 75:837–45. doi: 10.1007/s13304-023-01498-4
3. Zhang Q, Li B, Zhang S, Huang Q, Zhang M, Liu G. Prognostic impact of tumor size on patients with metastatic colorectal cancer: a large SEER-based retrospective cohort study. Updates Surg. (2023) 75:1135–47. doi: 10.1007/s13304-023-01533-4
4. Granata V, Faggioni L, Grassi R, Fusco R, Reginelli A, Rega D, et al. Structured reporting of computed tomography in the staging of colon cancer: a Delphi consensus proposal. Radiol Med. (2022) 127:21–9. doi: 10.1007/s11547-021-01418-9
5. Loffredo D, Marvaso A, Ceraso S, Cinelli N, Rocca A, Vitale M, et al. Minimal invasive surgery in treatment of liver metastases from colorectal carcinomas: case studies and survival rates. BMC Surg. (2013) 13 Suppl 2:S45. doi: 10.1186/1471-2482-13-S2-S45
6. Ceccarelli G, Rocca A, De Rosa M, Fontani A, Ermili F, Andolfi E, et al. Minimally invasive robotic-assisted combined colorectal and liver excision surgery: feasibility, safety and surgical technique in a pilot series. Updates Surg. (2021) 73:1015–22. doi: 10.1007/s13304-021-01009-3
7. Aldrighetti L, Boggi U, Falconi M, Giuliante F, Cipriani F, Ratti F, et al. Perspectives from Italy during the COVID-19 pandemic: nationwide survey-based focus on minimally invasive HPB surgery. Updates Surg. (2020) 72:241–7. doi: 10.1007/s13304-020-00815-5
8. Chiloiro G, Cusumano D, de Franco P, Lenkowicz J, Boldrini L, Carano D, et al. Does restaging MRI radiomics analysis improve pathological complete response prediction in rectal cancer patients? A prognostic model development. Radiol Med. (2022) 127:11–20. doi: 10.1007/s11547-021-01421-0
9. Tjhin Y, Kewlani B, Singh H, Pawa N. Artificial intelligence in colorectal multidisciplinary team meetings. What are the medicolegal implications? Colorectal Dis. (2024) 26(9):1749–52. doi: 10.1111/codi.17091
10. Rocca A, Porfidia C, Russo R, Tamburrino A, Avella P, Vaschetti R, et al. Neuraxial anesthesia in hepato-pancreatic-bilio surgery: a first western pilot study of 46 patients. Updates Surg. (2023) 75:1–11. doi: 10.1007/s13304-022-01437-9
11. Rocca A, Avella P, Scacchi A, Brunese MC, Cappuccio M, De Rosa M, et al. Robotic versus open resection for colorectal liver metastases in a “referral centre Hub&Spoke learning program”. A multicenter propensity score matching analysis of perioperative outcomes. Heliyon. (2024) 10:e24800. doi: 10.1016/j.heliyon.2024.e24800
12. Rocca A, Calise F, Marino G, Montagnani S, Cinelli M, Amato B, et al. Primary giant hepatic neuroendocrine carcinoma: a case report. Int J Surg. (2014) 12 Suppl 1:S218–21. doi: 10.1016/j.ijsu.2014.05.056
13. Marcellinaro R, Grieco M, Spoletini D, Troiano R, Avella P, Brachini G, et al. How to reduce the colorectal anastomotic leakage? The MIRACLe protocol experience in a cohort in a single high-volume centre. Updates Surg. (2023) 75:1559–67. doi: 10.1007/s13304-023-01588-3
14. Ma L, Li W, Liu N, Ding Z, Cai J, Zhang Y. Prothrombin time (PT) and CEA as prognostic predictive biomarkers for postoperative recurrence after curative resection in patients with stage I-III colorectal cancer: a retrospective cohort study. Updates Surg. (2022) 74:999–1009. doi: 10.1007/s13304-022-01268-8
15. Marte G, Scuderi V, Rocca A, Surfaro G, Migliaccio C, Ceriello A. Laparoscopic splenectomy: a single center experience. Unusual cases and expanded inclusion criteria for laparoscopic approach. Updates Surg. (2013) 65:115–9. doi: 10.1007/s13304-013-0197-0
16. Wang Q, Xu J, Wang A, Chen Y, Wang T, Chen D, et al. Systematic review of machine learning-based radiomics approach for predicting microsatellite instability status in colorectal cancer. Radiol Med. (2023) 128:136–48. doi: 10.1007/s11547-023-01593-x
17. Fiz F, Ragaini EM, Sirchia S, Masala C, Viganò S, Francone M, et al. Radiomic gradient in peritumoural tissue of liver metastases: A biomarker for clinical practice? Analysing density, entropy, and uniformity variations with distance from the tumour. Diagnost (Basel). (2024) 14. doi: 10.3390/diagnostics14141552
18. Fiz F, Viganò L, Gennaro N, Costa G, La Bella L, Boichuk A, et al. Radiomics of liver metastases: A systematic review. Cancers (Basel). (2020) 12. doi: 10.3390/cancers12102881
19. Viganò L, Jayakody Arachchige VS, Fiz F. Is precision medicine for colorectal liver metastases still a utopia? New perspectives by modern biomarkers, radiomics, and artificial intelligence. World J Gastroenterol. (2022) 28:608–23. doi: 10.3748/wjg.v28.i6.608
20. Brunese MC, Fantozzi MR, Fusco R, De Muzio F, Gabelloni M, Danti G, et al. Update on the applications of radiomics in diagnosis, staging, and recurrence of intrahepatic cholangiocarcinoma. Diagnostics (Basel). (2023) 13(8):1488. doi: 10.3390/diagnostics13081488
21. Andersen L, Kisistók J, Henriksen TV, Bramsen JB, Reinert T, Øgaard N, et al. Exploring the biology of ctDNA release in colorectal cancer. Eur J Cancer. (2024) 207:114186. doi: 10.1016/j.ejca.2024.114186
22. Komici K, Cappuccio M, Scacchi A, Vaschetti R, Delli Carpini G, Picerno V, et al. The prevalence and the impact of frailty in hepato-biliary pancreatic cancers: A systematic review and meta-analysis. J Clin Med. (2022) 11. doi: 10.3390/jcm11041116
Keywords: radiomic, precision surgery, colorectal cancer, prevention and diagnosis, treatment strategy
Citation: Rocca A, Reginelli A and Viganò L (2024) Editorial: Colorectal cancer awareness month 2023: diagnosis, clinical course, and surgical management of metastatic colorectal cancer. Front. Oncol. 14:1496480. doi: 10.3389/fonc.2024.1496480
Received: 14 September 2024; Accepted: 25 September 2024;
Published: 14 October 2024.
Edited and Reviewed by:
Francesco Giovinazzo, Saint Camillo Hospital, ItalyCopyright © 2024 Rocca, Reginelli and Viganò. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Aldo Rocca, aldo.rocca@unimol.it