Perineural invasion (PNI) is a well-recognized adverse prognostic factor in colorectal cancer (CRC), associated with aggressive tumor biology, higher metastatic potential, and poor survival outcomes. However, PNI is typically identified only after surgical resection on histopathology.
Perineural invasion (PNI) is a well-recognized adverse prognostic factor in colorectal cancer (CRC), associated with aggressive tumor biology, higher metastatic potential, and poor survival outcomes. However, PNI is typically identified only after surgical resection on histopathology. The ability to predict PNI preoperatively could significantly influence risk stratification, surgical planning, and decisions regarding neoadjuvant or adjuvant therapy.
Problem Statement
Currently, there is no reliable preoperative tool to predict perineural invasion in colorectal cancer. This limits the ability to identify high-risk patients early and incorporate this critical prognostic factor into multidisciplinary decision-making before definitive treatment.
Summary
This large SEER-based case-control study involving over 223,000 CRC patients identified key predictors of PNI, including male sex, tumor location (left colon and rectum), poor differentiation, nodal involvement (N1/N2), and elevated carcinoembryonic antigen levels. PNI was present in 13.1% of cases and was strongly associated with worse 5-year overall and cancer-specific survival, as well as increased liver and lung metastases. The derived Cleveland Clinic Florida PNI prediction score demonstrated excellent negative predictive value (93%), making it particularly useful to rule out PNI preoperatively. This model has potential clinical utility in guiding personalized treatment strategies and improving multidisciplinary planning in colorectal cancer.
Introduction: Chronic postoperative inguinal pain (CPIP) remains one of the most important long-term complications after laparoscopic groin hernia repair, despite lower rates than with open surgery. Whether different mesh types and fixation methods influence the...
Introduction: Venous involvement is common in locally advanced pancreatic cancer and often necessitates superior mesenteric-portal vein resection with reconstruction during pancreaticoduodenectomy. However, reconstruction may not always be feasible because of extensive venous disease or unfavorable...
Introduction: Pancreatoduodenectomy remains one of the most complex abdominal operations. Robotic pancreatoduodenectomy (RPD) has been proposed to improve postoperative recovery, but robust randomized evidence has been limited. The PORTAL trial compared robotic and open pancreatoduodenectomy...
Introduction: Surgery is an inherently high-stress profession, where complications, patient deaths, and difficult decisions can lead to burnout, moral injury, and mental health disorders. Inspired by the US Marine Corps' Combat and Operational Stress Control...
Introduction: As surgical techniques and perioperative therapies have advanced, vascular resection during pancreatic cancer surgery has become increasingly common in selected patients with locally advanced disease. This study evaluated the long-term outcomes of venous and...
Introduction: Optimal drain management after pancreatoduodenectomy (PD) remains critical for preventing postoperative pancreatic fistula (POPF) while supporting enhanced recovery. This study proposes a dynamic, risk-adapted algorithm based on intraoperative risk and postoperative biochemical markers. Why...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.