Circulating Tumor DNA Has Potential Value for Predicting Disease Recurrence following resection of CRC Metastases
Bansal VV, Belmont E, Godley IV F, et al. Utility of Circulating Tumor DNA Assessment in Characterizing Recurrence Sites after Optimal Resection for Metastatic Colorectal Cancer. J Am Coll Surg. 2024, in press
Circulating tumor DNA (ctDNA) is a promising biomarker for determining risk of recurrence following complete resection of colorectal cancer (CRC) metastases. Varun Bansal, MBBS, and coauthors reported data from a single institution study to determine if ctDNA assessments could predict rate of recurrence and location of recurrent lesions following resection of CRC metastases.
Locations of resected metastases included peritoneum, distant lymph nodes or liver. Recurrent lesions were diagnosed by imaging or laparoscopy and were classified as peritoneal-only or distant sites (liver, lymph nodes, or body wall).
31 patients were included in the study; ctDNA was detected in 26 patients with recurrence and in five patients with no detectable recurrence. At 3 months of follow up, ctDNA was detected in 25% of patients with peritoneal recurrence and 94.4% of patients with distant recurrence. Levels of ctDNA were lower in patients with peritoneal recurrences. Elevated levels of ctDNA were detected at a median of 9 weeks prior to clinical diagnosis of recurrence.
In the discussion section of the article, the authors noted that the differences in levels and time of appearance of ctDNA in patients with peritoneal versus distant recurrence is probably due to the difference in vascular architecture of the peritoneum compared to other sites. The authors concluded that ctDNA monitoring has potential value for predicting time and location of disease recurrence following resection of CRC metastases.
Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Show Similar Perioperative Risk for Morbidly Obese Patients, Study Finds
Hedberg S, Thorell A, Osterberg J, et al. Comparison of Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(1):e2353141.
Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are effective procedures for achieving weight loss in morbidly obese patients. Available evidence has suggested that postoperative mortality and rates of complications are higher after Roux-en-Y gastric bypass.
This article reported results from a randomized prospective trial that compared perioperative outcomes of patients (n = 1,735) undergoing RYGB or SG for treatment of morbid obesity in several Swedish hospitals. Outcomes of interest were mortality and complications (classified as adverse events and serious adverse events). Serious adverse events were defined as Clavien-Dindo grade >IIIB. Mortality data were collected for 90 days of postoperative follow-up. Preoperative BMI ranged from 35 to 50; all patients included were older than 18 years.
The data analysis showed that SG was associated with shorter operative time compared with RYGB; hospital stay averaged 1 day for both groups. Readmission rates within 30 days were not significantly different. There was no postoperative mortality recorded in either group. Serious adverse event rates were 1.7% for SG and 2.7% for RYGB, but this difference was not statistically significant.
Of note is the fact that bowel obstruction and anastomotic leakage were observed more often in RYGB patients. Long term data on complications such as bowel obstruction and gastroesophageal reflux were not provided.
The authors concluded that perioperative risk was similar for both procedures and that risk of mortality and complications should not be the main factors used when counselling patients on the choice of operation for morbid obesity.
