{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:25:09Z","timestamp":1780928709532,"version":"3.54.1"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82373090"],"award-info":[{"award-number":["82373090"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While global registries report a rising incidence of early-onset colorectal cancer (EOCRC), the impact of widespread screening and endoscopic therapeutics on the case-mix of major surgical centers remains undercharacterized. We aimed to quantify the 16-year evolution of surgical demographics, pathological profiles, and quality metrics to delineate how modern practice reshapes surgical volume and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of 30,427 consecutive patients undergoing colorectal cancer (CRC) resection at Fudan University Shanghai Cancer Center from 2008 to 2023. The cohort was stratified into three eras: Era 1 (Open-predominant, 2008\u20132012), Era 2 (Transitional, 2013\u20132017), and Era 3 (Minimally Invasive-predominant, 2018\u20132023). Trends in demographics, tumor morphology, stage distribution, lymph node yield, and 5-year overall survival (OS) were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Contrary to global incidence trends, the proportion of surgically managed EOCRC (&lt;\u200950\u00a0years) declined from 24.8% in 2008 to 14.6% in 2023, while patients aged\u2009\u2265\u200965\u00a0years increased from 27.4 to 39.4% (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). A pattern consistent with a hypothesized \u201cendoscopic filtering effect\u201d was observed: the proportion of surgical Stage 0\u2013I cases contracted from 20.3 to 12.4%, while adenoma with high-grade intraepithelial neoplasia (HGIN) rose dramatically from 1.5 to 12.3%. Mean tumor diameter exhibited a \u201cJ-shaped\u201d trajectory: decreasing from 4.20\u00a0cm in 2012 to a nadir of 3.80\u00a0cm in 2014, before rebounding to 4.20\u00a0cm by 2023. Surgically, laparoscopy adoption surged from 0.2 to 64.5%. This transition was accompanied by a steady increase in mean lymph node yield, rising from 15.4 in Era 1 to 16.9 in Era 3 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). In 2023, the mean lymph node yield in the laparoscopic group (16.3\u2009\u00b1\u20096.8) was numerically superior to the open surgery group (15.6\u2009\u00b1\u20097.7;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.067). Regarding prognosis, 5-year OS peaked during the transitional period (Era 2: 75.9%). Although OS declined in Era 3 (69.5%) concurrent with the shift toward an older and more complex case-mix, outcomes remained robust and comparable to the historical baseline (Era 1: 73.0%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The landscape of surgical CRC has shifted toward an older population with more complex, locally advanced disease, a pattern consistent with upstream endoscopic diversion of early-stage cases. Despite this increased demographic burden, the maturation of minimally invasive techniques has maintained high-quality oncological clearance, as evidenced by improving lymph node yield and declining circumferential resection margin (CRM) positivity rates. After adjusting for age, sex, stage, tumor location, and surgical approach, survival outcomes in the most recent era were comparable to the historical baseline (HR\u2009=\u20091.049, 95% CI 0.976\u20131.128,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.194).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12818-1","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:43:52Z","timestamp":1776707032000},"page":"5101-5110","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Shifting paradigms in 30,427 surgical colorectal cancer cases (2008\u20132023): the impact of endoscopic screening on caseload complexity and the value of minimally invasive quality"],"prefix":"10.1007","volume":"40","author":[{"given":"Zhenting","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junzhe","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiqi","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dakui","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinxiang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingguo","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"issue":"3","key":"12818_CR1","first-page":"229","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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Zhenting Lu, Junzhe Tang, Shiqi Hu, Dakui Luo, Xinyi Wang, Xinxiang Li and Qingguo Li have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"The study protocol was reviewed and approved by the Ethical Committee and Institutional Review Board of Fudan University Shanghai Cancer Center. All participants gave their written informed consent. The reference number was 050432\u20134-2108* (Date: September 21st, 2025).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}}]}}