From organ preservation to selective surgery: How immunotherapy changes colorectal surgery?

Area of Science:

• Oncology
• Immunotherapy
• Colorectal Cancer Research

Background:

• Immunotherapy has significantly altered conventional colorectal cancer (CRC) treatment strategies.
• Immune checkpoint blockade is now a standard first-line therapy for metastatic CRC (mCRC) and shows promise in locally advanced CRC (LACRC).

Purpose of the Study:

• To review recent clinical trials demonstrating breakthroughs in immunotherapy for colorectal cancer.
• To highlight advancements in organ preservation for patients with MSI-H/dMMR tumors.
• To propose the concept of selective surgery, including lymph node management, based on these findings.

Main Methods:

• Systematic review of clinical trials focusing on immunotherapy in colorectal cancer.
• Analysis of treatment outcomes, particularly organ preservation rates in MSI-H/dMMR patient cohorts.
• Conceptualization of selective surgical strategies based on immunotherapy response.

Main Results:

• Significant progress has been achieved in immunotherapy, especially immune checkpoint blockade, for mCRC and LACRC.
• Breakthroughs in organ preservation are evident in patients with high microsatellite instability or DNA mismatch repair deficiency (MSI-H/dMMR) undergoing immunotherapy.
• These advancements support the development of novel treatment paradigms.

Conclusions:

• Immunotherapy offers new possibilities for organ preservation in specific colorectal cancer subtypes.
• The concept of selective surgery, involving tailored lymph node management, warrants further investigation.
• Future research should focus on validating these selective surgical approaches to optimize CRC treatment.