Annals of Coloproctology

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Metastasis or chemotherapy

Short-term surgical outcomes following neoadjuvant immunotherapy in mismatch repair-deficient colorectal cancer: initial experience from a tertiary referral center: Ejaz Ahmed Latif, Ayman Abdelhafiz Ahmed, Mahmood Saad Al-Dhaheri, Ammar Aleter, Ali Toffaha, Mohamed Kurer, Tausief Fatima, Amjad Parvaiz, Mohmmad Hosni Abunada; Ann Coloproctol. 2025;41(4):338-345. Published online August 28, 2025; DOI: https://doi.org/10.3393/ac.2025.00381.0054

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Abstract PDF: Purpose
Immunotherapy has demonstrated remarkable efficacy in mismatch repair-deficient (MMR-D) colorectal cancer (CRC). Due to their significant response rates, immune checkpoint inhibitors have emerged as a promising neoadjuvant therapy. However, data regarding short-term surgical outcomes following immunotherapy remain limited. The aim of this study is to evaluate the safety and feasibility of surgical resection after immunotherapy, as well as its short-term clinical outcomes.
Methods
A retrospective review of prospectively collected data was performed at a tertiary referral center from January 2020 to July 2024. Fifteen consecutive patients with MMR-D CRC treated with pembrolizumab were analyzed. The patients’ demographics, tumor characteristics, clinical outcomes, and histopathological responses were assessed.
Results
In total, 15 patients diagnosed with MMR-D locally advanced or metastatic colorectal cancers received neoadjuvant immunotherapy followed by surgery. Of the 15 patients, 11 (73.3%) were male, 12 (80.0%) presented with T3/T4 tumors, and 3 (20.0%) had metastatic disease at diagnosis. The median number of immunotherapy cycles was 5 (range, 3–13). Surgery was performed without any anastomotic leaks or 30-day mortality. The median length of hospital stay was 5 days (range, 3–14 days). All surgical specimens had negative resection margins. Major pathological response was observed in 11 patients (73.3%), including complete response in 8 (53.3%) and near-complete response in 3 (20.0%). The median follow-up was 14 months (range, 1–56 months). One patient developed liver metastasis, which was successfully resected.
Conclusion
Surgical resection of MMR-D CRC following neoadjuvant immunotherapy is safe and associated with low morbidity. Neoadjuvant immunotherapy in MMR-D CRC facilitates high rates of major pathological response.

Colorectal cancer

Comparing the efficacy of combined versus single immune cell adaptive therapy targeting colorectal cancer: Denis Nchang Che, NaHye Lee, Hyo-Jung Lee, Yea-Won Kim, Solongo Battulga, Ha Na Lee, Won-Kook Ham, Hyunah Lee, Mi Young Lee, Dawoon Kim, Haengji Kang, Subin Yun, Jinju Park, Daeyoun David Won, Jong Kyun Lee; Ann Coloproctol. 2024;40(2):121-135. Published online April 22, 2024; DOI: https://doi.org/10.3393/ac.2023.00402.0057

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1 Web of Science

Abstract PDF Supplementary Material: Purpose
Colorectal cancer (CRC) is the most frequent cancer with limited therapeutic achievements. Recently, adoptive cellular immunotherapy has been developed as an antitumor therapy. However, its efficacy has not been tested in CRC. This study investigated the ability of an immune cell cocktail of dendritic cells (DCs), T cells, and natural killer (NK) cells to overcome immunological hurdles and improve the therapeutic efficacy of cell therapy for CRC.
Methods
CRC lysate-pulsed monocyte-derived DCs (Mo-DCs), CRC antigen-specifically expanded T cells (CTL), and in vitro-expanded NK cells were cultured from patient peripheral blood mononuclear cells (PBMC). The ability of the combined immune cells to kill autologous tumor cells was investigated by co-culturing the combined immune cells with patient-derived tumor cells.
Results
The Mo-DCs produced expressed T cell co-stimulating molecules like CD80, CD86, human leukocyte antigen (HLA)-DR and HLA-ABC, at high levels and were capable of activating naive T cells. The expanded T cells were predominantly CD8 T cells with high levels of CD8 effector memory cells and low levels of regulatory T cells. The NK cells expressed high levels of activating receptors and were capable of killing other cancer cell lines (K562 and HT29). The immune cell cocktail demonstrated a higher ability to kill autologous tumor cells than single types. An in vivo preclinical study confirmed the safety of the combined immune cell adaptive therapy showing no therapy-related death or general toxicity symptoms.
Conclusion
The results suggested that combined immune cell adaptive therapy could overcome the limited efficacy of cell immunotherapy.

Case Report

Malignant disease,Rare disease & stoma,Complication

Colonic Perforation After Treatment With Nivolumab in Esophageal Cancer: A Case Report: Hye Jung Cho, Woo Ram Kim, Joo-Hang Kim, Duk Hwan Kim, Dae Jung Kim, Haeyoun Kang; Ann Coloproctol. 2021;37(Suppl 1):S39-S43. Published online June 24, 2021; DOI: https://doi.org/10.3393/ac.2020.00213.0030

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7 Web of Science
9 Citations

Abstract PDF

With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.

Citations

Citations to this article as recorded by

Intestinal perforation in recurrent cervical cancer following bevacizumab and pembrolizumab therapy: A case report
Yuanchun Fan, Shihao Liu, Jiangjing Zhao, Yawei Fu, Jiahui Yang, Chunyang Wang, Hui Zhang
Medicine.2025; 104(15): e40473. CrossRef
Iatrogenic effect of immune checkpoint inhibitors and targeted therapies on the lower gastrointestinal tract
Dua Abuquteish, Ahmad Yousef Alazzam, Aws Khalid Abushanab, Omar Amjad Almajdoubah, Sara Aljfout, Mahmoud Taysir Mousa, Mus’ab Theeb Mustafa, Bashar Khater, Maher Sughayer
Frontline Gastroenterology.2025; : flgastro-2025-103094. CrossRef
Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review
Renee M. Maina, Caroline Rader, Jeevan Kypa, Constantine Asahngwa, Hilary M. Jasmin, Nia N. Zalamea, John S. Nelson, Jonathan L. Altomar, Mary Brinson Owens, Clarisse S. Muenyi, Denis A. Foretia
Annals of Medicine & Surgery.2024; 86(5): 2828. CrossRef
Update on immunotherapy‐mediated colitis: Clinical features, mechanisms, and management
Dandan Wang, Yiwei Zhao, Yiyun Zeng, Lanlin Hu, Chuan Xu
Malignancy Spectrum.2024; 1(4): 225. CrossRef
Gastrointestinal perforation associated with novel antineoplastic agents: A real-world study based on the FDA Adverse Event Reporting System
Zicheng Yu, Haibin Zhu, Hongjun Chen, Lifei Zhu, Xiaolan Liao
Journal of Pharmacy & Pharmaceutical Sciences.2023;[Epub] CrossRef
Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review
Zainab I. Alruwaii, Elizabeth A. Montgomery
Advances in Anatomic Pathology.2023; 30(3): 230. CrossRef
An updated review of gastrointestinal toxicity induced by PD-1 inhibitors: from mechanisms to management
Yiyu Cheng, Fangmei Ling, Junrong Li, Yidong Chen, Mingyang Xu, Shuang Li, Liangru Zhu
Frontiers in Immunology.2023;[Epub] CrossRef
Nivolumab

Reactions Weekly.2022; 1892(1): 181. CrossRef
Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review
Zainab I. Alruwaii, Elizabeth A. Montgomery
Advances in Anatomic Pathology.2022; 29(4): 183. CrossRef

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