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Background Data regarding clinical outcomes of patients undergoing hepatic resection for BRAF-mutated colorectal liver metastases (CRLM) are scarce. Most of the studies report an impaired median overall survival (OS) in BRAF-mutated patients, but controversial Results regarding both recurrence-free survival (RFS) and recurrence patterns. The purpose of this updated meta-analysis was to better precise the impact of BRAF mutations on clinical outcomes following liver surgery for CRLM study, especially on recurrence. Methods A systematic literature review was performed to identify articles reporting clinical outcomes including both OS and RFS, recurrence patterns, and clinicopathological details of patients who underwent complete liver resection for CRLM, stratified according to BRAF mutational status. Results Thirteen retrospective studies, including 5192 patients, met the inclusion criteria. The analysis revealed that both OS (OR = 1.981; 95% CI = [1.613–2.432]) and RFS (OR = 1.49; 95% CI [1.01–2.21]) were impaired following liver surgery for CRLM in BRAF-mutated patients. Risks of both hepatic (OR = 0.42; 95% CI [0.18–0.98]) and extrahepatic recurrences (OR = 0.53; 95% CI [0.33–0.83] were significantly higher in BRAF-mutated patients. These patients tended to have higher rates of right-sided colon primary tumors, primary positive lymph nodes, and multiple CRLM. Conclusions This meta-analysis confirms that BRAF mutations impair both OS and RFS following liver surgery. Therefore, BRAF mutational status should probably be included in further prognostic scores for the assessment of the expected clinical outcomes following surgery for CRLM.

To assess the value of contrast-enhanced (CE) diagnostic CT scans characterized through radiomics as predictors of recurrence for patients with stage II and III colorectal cancer in a two-center context. This study included 193 patients diagnosed with stage II and III colorectal adenocarcinoma from 1 July 2008 to 15 March 2017 in two different French University Hospitals. To compensate for the variability in two-center data, a statistical harmonization method Bootstrapped ComBat (B-ComBat) was used. Models predicting disease-free survival (DFS) were built using 3 different machine learning (ML): (1) multivariate regression (MR) with 10-fold cross-validation after feature selection based on least absolute shrinkage and selection operator (LASSO), (2) random forest (RF), and (3) support vector machine (SVM), both with embedded feature selection. The performance for both balanced and 95% sensitivity models was systematically higher after our proposed B-ComBat harmonization compared to the use of the original untransformed data. The most clinically relevant performance was achieved by the multivariate regression model combining a clinical variable (postoperative chemotherapy) with two radiomics shape descriptors (compactness and least axis length) with a BAcc of 0.78 and an MCC of 0.6 associated with a required sensitivity of 95%. The resulting stratification in terms of DFS was significant (p = 0.00021), especially compared to the use of unharmonized original data (p = 0.17). Radiomics models derived from contrast-enhanced CT could be trained and validated in a two-center cohort with a good predictive performance of recurrence in stage II et III colorectal cancer patients. • Adjuvant therapy decision in colorectal cancer can be a challenge in medical oncology. • Radiomics models, derived from diagnostic CT, trained and validated in a two-center cohort, could predict recurrence in stage II and III colorectal cancer patients. • Identifying patients with a low risk of recurrence, these models could facilitate treatment optimization and avoid unnecessary treatment.

Resume Introduction Les infections de site operatoire sont un enjeu de sante publique. Le but de cette revue etait de faire une revue de la litterature des moyens de preparation cutanee dans le cadre de la prevention des infections de site operatoire en chirurgie abdominale. Methodes Afin d’obtenir le meilleur niveau de preuves, seuls les meta-analyses et les essais cliniques controles randomises etaient retenus d’apres les bases de donnees Cochrane Library et PubMed. Des etudes non randomisees de forte puissance ont ete retenues lorsque l’on manquait de resultats pour les questions posees. Le critere de jugement principal etait le taux d’infection de site operatoire dans les 30 jours. Resultats Les 20 etudes trouvees suggeraient que la depilation du champ operatoire n’est pas recommandee sauf en cas de gene, auquel cas il est recommande une tonte ou une depilation chimique, le rasage devant etre banni. Pour la douche preoperatoire le produit importait peu (produit detergent, antiseptique ou non), et il n’y avait pas de donnees publiees sur le nombre de douches ou le delai par rapport a la chirurgie. Une antisepsie cutanee avec une solution alcoolique du champ operatoire est recommandee, les produits utilises semblant etre equivalents, sans necessite de detersion prealable. L’utilisation de champs adhesifs en chirurgie propre ou contaminee n’est pas recommandee. Conclusion Certaines recommandations dans la preparation cutanee de l’opere abdominal pour diminuer le taux d’infection de site operatoire sont fondees sur un bon niveau de preuves. D’autres recommandations telles que le nombre et le delai de la douche preoperatoire ou les champs adhesifs le sont moins.

Objectifs Evaluer la valeur prognostique des parametres issus de l’analyse d’imagerie diagnostique – radiomiques – pour les patients atteints d’un cancer colorectal de stade II et III. Materiels et methodes Etude retrospective multicentrique portant sur 193 patients diagnostiques avec un adenocarcinome colorectal de stade II et III entre le 1er juillet 2008 et le 15 mars 2017. Pour harmoniser la variabilite des donnees multicentriques, une methode d’harmonisation statistique B-ComBat a ete utilisee. Des modeles predictifs de la recidive ont ete construits en utilisant 3 machine learning (ML) : (1) regression multivariee (MR) avec une validation multiple et Least Absolute Shrinkage and Selection Operator (LASSO), (2) Random Forest (RF) et (3) Support Vector Machine (SVM). Resultats Les performances des modeles etaient systematiquement plus elevees apres l’harmonisation B-ComBat que l’utilisation des donnees originales non transformees. La meilleure performance pour predire la recidive des cancers colorectaux a ete obtenue par le modele RM combinant une variable clinique (chimiotherapie postoperatoire) avec deux parametres issus de l’analyse d’images -radiomiques (compacite et longueur d’axe minimale) avec une balanced accuracy (BAcc) de 0,78, Matthews correlation coefficient (MCC)de 0,6 et une sensibilite de 95 %. La stratification resultante en termes de DFS etait significative (p = 0,00021), en particulier par rapport a l’utilisation de donnees originales non harmonisees (p = 0,17). Conclusions Les modeles radiomiques derives de la tomodensitometrie pre therapeutique ont pu etre realises et valides dans une cohorte multicentrique avec une bonne prediction de la recurrence chez les patients atteints d’un cancer colorectal.

IntroductionColorectal cancer (CRC) is still associated with poor prognosis, especially in patients with advanced disease. Development of new prognostic tools replacing or supplementing those routinely used is definitely needed, with the aim to optimise and personalise treatment strategies. Gut microbiota composition and body composition profile (obesity, sarcopenia and metabolic syndrome) have recently been reported separately as new relevant prognostic factors for postoperative surgical and oncologic outcomes following CRC surgery. However interactions that exist between these factors have been poorly studied. The purpose of this translational prospective cohort study (METABIOTE) is to investigate potential interactions between gut microbiota, body composition profile and postoperative outcomes and recurrence in patients undergoing surgery for non-metastatic sporadic CRC.Methods and analysisThis single-centre project aims to prospectively enrol 300 consecutive patients undergoing surgery for non-metastatic sporadic CRC at the University Hospital of Clermont-Ferrand, France for the identification of specific microbial signatures (from tumour, colonic mucosa and stools samples) associated with particular metabolic profiles that could impact postoperative morbidity and oncologic outcomes, using microbiological, molecular and imaging approaches. The primary outcome is the 5-year overall survival (OS). Other outcomes are 5-year CRC-related OS, 5-year disease-free survival, 30-day postoperative morbidity, 90-day postoperative mortality and length of hospital stay.Ethics and disseminationThis study protocol was reviewed and approved by an independent French regional review board (n°2018-A00352-53, ‘Comité de Protection des Personnes Ile de France VII’ on 4 July 2018, declared to the competent French authority (‘Agence Nationale de Sécurité du Médicament et des produits de santé’, France), and registered on the Clinical Trials web-based platform (NCT 03843905). Oral and written informed consent will be obtained from each included patient. Study results will be reported to the scientific community at conferences and in peer-reviewed scientific journals.Trial registration numberNCT03843905..

Summary Introduction Surgical site infections (SSI) are a public health issue. The purpose of this review is to review the literature on methods of pre-operative skin preparation for the prevention of SSI in abdominal surgery. Methods In order to obtain the best level of evidence, only meta-analyses and randomized controlled clinical trials were selected from the Cochrane Library and PubMed databases. High-powered non-randomized studies were included when results were not available for the questions asked. The primary endpoint was the rate of SSI within 30 days. Results Analysis of the 20 selected studies suggested that hair removal in the operative field is not recommended except when it interferes with surgery; in this case, hair clipping or chemical depilation is recommended and shaving should be banned. For the pre-operative shower, the choice of a detergent product with or without antiseptic does not seem to matter, and there were no published data on the required number of showers or the interval before surgery. Application of an alcohol-based solution to the operative field for cutaneous disinfection is recommended; the products used seem to be equivalent, and there is no need for pre-operative detergent scrubbing. There is no strong evidence to recommend adhesive plastic drapes for clean or contaminated surgery. Conclusion Some recommendations on skin preparation before abdominal surgery to reduce the rate of SSI are based on a high level of evidence. Other recommendations such as the number and duration of pre-operative showers or use of adhesive plastic skin drapes are less well supported.

Laparoscopic liver surgery is seldom performed, mainly because of the risk of hepatic vein bleeding or incomplete resection of the tumour. This risk may be reduced by means of an augmented reality guidance system (ARGS), which have the potential to aid one in finding the position of intrahepatic tumours and hepatic veins and thus in facilitating the oncological resection and in limiting the risk of operative bleeding. We report the case of an 81-year-old man who was diagnosed with a hepatocellular carcinoma after an intraabdominal bleeding. The preoperative CT scan did not show metastases. We describe our preferred approach for laparoscopic left hepatectomy with initial control of the left hepatic vein and preliminary results of our novel ARGS achieved postoperatively. In our ARGS, a 3D virtual anatomical model is created from the abdominal CT scan and manually registered to selected laparoscopic images. For this patient, the virtual model was composed of the segmented left liver, right liver, tumour and median hepatic vein. The patient’s operating time was summed up to 205 min where a blood loss of 300 cc was recorded. The postoperative course was simple. Histopathological analysis revealed the presence of a hepatocellular carcinoma with free margins. Our results of intrahepatic visualization suggest that ARGS can be beneficial in detecting the tumour, transection plane and medial hepatic vein prior to parenchymal transection, where it does not work due to the substantial changes to the liver’s shape. As of today, we have performed eight similar left hepatectomies, with good results. Our ARGS has shown promising results and should now be attempted intraoperatively.