Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

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Introduction lncRNAs are strands larger than 200 nucleotides that do not encode proteins. They have regulatory functions in cell proliferation, apoptosis and migration. They are stable over a long period and may have diagnostic value in colorectal cancer (CRC). Their availability as effective biomarkers for CRC screening would represent a substantial advance, as tests could be performed with minimal risk and wide acceptance. The aim of this study is to evaluate selected lncRNAs in plasma as potential diagnostic biomarkers in CRC. Methods Prospective cohort study between patients operated on for CRC (cases) and healthy patients (controls). Blood samples were processed in the biobank to obtain plasma by centrifugation. Subsequently, the levels of three CRC-related lncRNAs (HOTAIR, CCAT2 and PVT1) were determined in the laboratory of the Electroanalysis Group of the University of Oviedo (GEUO). Results In the initial results, an overexpression of the three genes (HOTAIR, CCAT2 and PVT1) was observed in CRC patients, with HOTAIR being the one that best differentiates between CRC and healthy patients. In addition, the combined determination of the three lncRNAs could obtain better results than the individual determination of each of them. Conclusions The lncRNAs studied are overexpressed in the CRC patient sample. The sample size needs to be increased to confirm this trend. It is logical to postulate that molecular technologies will lead to the development of better screening modalities and individualised treatments.

Introduction Laparoscopic colorectal surgery (LCRS) offers similar oncologic outcomes to the open approach along with early postoperative recovery but is not without complications, with bleeding being uncommon but with variable impact and technical resource demand. Methods A descriptive and retrospective study of bleeding in patients undergoing elective LCRS in our center between 01/012018 and 31/12/2021. The data analysis was performed using the SPSS statistical software. Results Out of 945 LCRS, 45 patients (4.8%) presented some hemorrhagic event. The main diagnosis was colorectal cancer (35), followed by diverticular disease (6). The procedures most frequently associated with bleeding were sigmoidectomy (13), TATME (7) and right hemicolectomy (7). Five patients presented moderate (4) or severe (1) intraoperative bleeding, controlled during surgery. The most commonly used hemostatic devices were biopolar energy (29.5%) and combined (34.1%). The diagnosis of postoperative bleeding was clinical in 20 cases (45.5%), 17 by CT angiography (38.6%) and 7 by endoscopy (15.9%). In 36.4% the origin of hemorrhage was in the anastomosis, demonstrated by endoscopy or radiological study. Eleven patients (25%) required reintervention: seven by open approach and four by laparoscopy (two conversions). Therapeutic endoscopy was performed in 7 patients (15.9%), in 1 patient interventional radiology-surgery was combined, and in another patient endoscopy-surgery. There was no mortality due to this cause. The mean length of stay after surgery was 19.52 days. Conclusions Hemorrhage in LCRS is a rare but potentially serious complication that requires early diagnosis and staged multidisciplinary approaches, including advanced therapeutic endoscopy and interventional radiology procedures.

Introduction Epigenetic alterations are related to the process of tumorigenesis and resistance to oncological therapies. Although more than 60 types of histone post-translational modifications (HPTMs) have been described, the alterations that manifest simultaneously in tumor tissue have not been systematically studied in colorectal cancer (CRC). This project aims to develop a new screening methodology to delineate epigenetic alterations present in CRC and to obtain a set of biomarkers related to malignancy and tumor response. Methods Using state-of-the-art tandem mass spectrometry (MS-MS) techniques, a direct injection protocol will be performed to simultaneously identify the presence of &gt;200 HPTMs-related peptides in a cohort of primary tumors and paired healthy CRC tissue. Patterning of spectra and statistical analyses will be performed with the automated processing algorithm EpiProfile 2.0. Results A histone extraction protocol optimized for human tumor samples was developed. Likewise, we managed to make MS/MS sample processing more flexible by implementing a multiplatform workflow (Thermo / Sciex), which will increase the screening and data analysis capacity. Through this process we managed to detect &gt;200 peptides related to HPTMs in control samples, and we observed significant differences in certain HPTMs with pharmacological treatments in primary cultures. Conclusions These results will allow the identification of epigenetic biomarkers related to grade, stage and recurrence in the context of CRC.