The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Embryonic and induced pluripotent stem cell staining and sorting with the live-cell fluorescence imaging probe CDy1

10.1038/nprot.2011.350Nature Protocols671044-105

Role of cytomegalovirus in driving cytotoxic CD28null T cells

Accumulation of CD28null T cells has been traditionally considered a sign of aging, as the percentage of these cells is increased in the elderly. However, the permanent loss of CD28 on T cells is caused by chronic antigenic stimulation. In that sense, CMV infection seems to be an important factor, particularly in the CD4 T-cell compartment, where significant expansions of these cells have been observed in CMV-seropositive individuals only and independently of age. In contrast to this, the CD28null CD8 T-cell subset is more heterogeneous, consisting of different type of cells with diverse origins, phenotype, and functions. Indeed, contrarily to their CD4 counterparts, CD28null CD8 T cells can be found expanded in the absence of CMV. CD28null CD4 T cells are cytotoxic and produce high amounts of pro-inflammatory cytokines. Expansions of these cells has been shown to be associated with many diseases and seems to have a relevant role in CVD (cardiovascular diseases). We, therefore, propose that CMV-related CVD risk may be mediated in part by CD28null CD4 T-cells, capable of damaging the vasculature