Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Arbitration in SEP/FRAND disputes: overview and core issues

This article takes a look at arbitration in intellectual property matters with regards to the licensing of standard-essential patents (SEPs) on fair, reasonable, and non-discriminatory (FRAND) terms. Due to the digital transformation, the importance of FRAND licensing of SEPs is likely to increase and with it the need for appropriate conflict resolution. This is where arbitration can come into play due to its flexibility and efficiency. The resolution of SEP/FRAND disputes through Alternative dispute resolution (ADR) is also supported by administrative and judicial bodies and institutions such as the International Court of Arbitration of the International Chamber of Commerce (ICC) or the World Intellectual Property Organization (WIPO) have already gained experience in this field. The article lays down particularities regarding the scope of arbitration in such disputes before briefly touching upon the question of arbitrability. Due to the lack of a law applicable to a pre-existing contract in prototypical SEP/FRAND constellations, the choice of law is also of importance. A special emphasis is put on the issue of confidentiality in view of a public interest in having access to key results of SEP/FRAND arbitration proceedings. As set forth in the article, the FRAND ADR Guidelines authored by the Munich IPDR Forum propose a solution in the form of disclosure of the FRAND determination methodology to a neutral instance, subject to party approval. Lastly, the article looks at how state courts might assess licenses reached in alternative dispute resolution and examines whether EU competition law is a public policy hurdle in subsequent enforcement proceedings

Framing algorithms: competition law and (other) regulatory tools

As other fields of law, competition law is put to the test by new technologies in general and algorithmic market activity in particular. This article takes a holistic approach by looking at areas of law, namely financial regulation and data protection, which have already put in place rules and procedures to deal with issues arising from algorithms. Before making the bridge and assessing whether the application of regulatory tools from these areas might be fruitful for competition law as well, the article discusses some recent competition cases involving algorithmic market activity. It concludes with policy recommendations

Framing Algorithms—Competition Law and (Other) Regulatory Tools

As other fields of law, competition law is put to the test by new technologies in general and algorithmic market activity in particular. This paper takes a holistic approach by looking at areas of law, namely financial regulation and data protection, which have already put in place rules and procedures to deal with issues arising from algorithms. Before making the bridge and assessing whether the application of any such tool might be fruitful for competition law, the paper discusses important competition cases regarding algorithms, including the Google Shopping, Lufthansa and Facebook case. It concludes with some policy recommendations

Ein Rechtsrahmen für algorithmische Marktaktivität – Kartellrecht und weitere Instrumente

Obschon sich der Bezug von Kartellrecht und Algorithmen bzw. so genannter «Künstlicher Intelligenz» (KI) nicht unmittelbar aufdrängen mag, ist dennoch in jüngster Zeit eine intensive Diskussion über diesen Schnittbereich entbrannt. Selbst wenn die heute verwendeten Algorithmen vielfach noch nicht allzu «intelligent» sind, geht die Tendenz klar hin zu komplexeren Systemen, die einen disruptiven Effekt auf fast alle Aspekte unseres Lebens zu entfalten vermögen. Bereits heute können Algorithmen, die in verschiedensten Branchen zum Einsatz kommen, weitreichenden Einfluss auf Art und Bedingungen von wettbewerblichem Marktverhalten haben. Allein schon diese Überlegung zieht das Kartellrecht in die Verantwortung, die Auswirkungen von algorithmischem Marktgeschehen zu untersuchen und bei Wettbewerbsverzerrung einzugreifen. Ein Hauptaugenmerk liegt dabei derzeit auf der Interaktion von Algorithmen und dem hierdurch gegebenen kollusiven Potential; ein weiteres Thema ist die algorithmische Preisbindung zweiter Hand. Es erscheint fraglich, ob das Kartellrecht in seiner jetzigen Form bereits die nötigen Regeln und Techniken vorhält, um solchen Problemen vollumfänglich begegnen zu können. Das machte einen Blick in andere, mit algorithmischen Phänomenen bereits länger befasste Rechtsgebiete sinnvoll, um für das Kartellrecht von deren Erfahrungen zu lernen. Vor diesem Hintergrund verfolgt der hiesige Beitrag einen dreigliedrigen Ansatz: Im ersten Teil werden wichtige Beispiele dafür gegeben, wie andere Rechtsgebiete mit algorithmischer Marktaktivität umgehen. Der zweite Teil skizziert drei prototypische kartellrechtliche Problemstellungen im Zusammenhang mit Algorithmen. Im dritten und letzten Teil schliesslich wird die Frage aufgeworfen, ob die aktuelle kartellrechtliche Toolbox genügt, um solchen Problematiken zu begegnen, ob und welche Konzepte von anderen Rechtsgebieten übernommen werden sollten und wo neue Regelungsinstrumente nötig erscheinen

Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

Background: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy.Methods: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of >= 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site.Results: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of >= 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P = 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH).Conclusion: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes