Wolfgang Gaertner

An important milestone in rectal cancer care: the @FDA has granted accelerated approval of dostarlimab for adults with previously untreated stage II or III dMMR/MSI-H locally advanced rectal cancer. In 2022, the initial @NEJM report found a clinical complete response in all 12 patients who completed six months of dostarlimab. The result was striking, but came from a small cohort. The 2025 NEJM report expanded the evidence: all 49 patients with rectal cancer who completed treatment had a clinical complete response and chose nonoperative management. Two-year recurrence-free survival was 96% in this cohort. The approval was based primarily on AZUR-1, a multicenter phase 2 trial of 154 patients, with supporting data from the NEJM study. For eligible patients, this approach may help avoid chemoradiation and surgery, underscoring the importance of routine MMR/MSI testing at diagnosis. Close surveillance by an experienced multidisciplinary team remains critical, and longer follow-up is needed to confirm durability. #RectalCancer #Immunotherapy #ColorectalCancer #PrecisionOncology @AndreaCercek @MSKCancerCenter @ASCO @ASCRS_1 @GaertnerWB @SWexner

The 2026 @ASCRS_1 Clinical Practice Guidelines for the Surgical Management of Ulcerative Colitis are out. Here’s what changed from the 2021 guidelines. Two new recommendations: Consider perioperative physical and psychological rehabilitation for patients undergoing UC surgery, and discuss restorative and nonrestorative options before elective surgery. Both are strong recommendations based on low-quality evidence. Dysplasia guidance is more detailed, emphasizing multidisciplinary review and management tailored to the findings. Visible, completely resectable low-grade dysplasia may be managed endoscopically with close surveillance. Dysplasia that cannot be completely excised endoscopically, remains invisible, or is multifocal or metachronous should typically prompt consideration for total proctocolectomy, with or without IPAA. Multiple risk factors, including multifocality, lesions >10 mm or with nonpolypoid morphology, PSC, recurrent dysplasia, uncontrolled inflammation, limited visualization, family history, smoking, or prior piecemeal excision, strengthen the case for surgery. Any dysplasia in a patient with PSC typically warrants strong consideration for proctocolectomy. For biopsies indefinite for dysplasia amid active inflammation, treat toward mucosal healing before reassessment. Other updated recommendations address early surgical consultation, emergency colectomy, and staged surgery after corticosteroid or advanced medical therapy exposure. Three 2021 recommendations were not carried forward into the 2026 surgical guidelines: the standalone statement on surveillance, ileorectal anastomosis for selected patients with relative rectal sparing, and appendectomy to reduce proctocolectomy for medically refractory disease. The surveillance item’s omission does not mean surveillance is no longer recommended. #UlcerativeColitis #IBD #ColorectalSurgery #ASCRS #UC @AmyLightnerMD @GaertnerWB @SWexner @escp_tweets @DCRjournal