A novel predictive model effectively identifies patients likely to achieve a pathological complete response after total neoadjuvant therapy for locally advanced rectal cancer, aiding in selection for watch-and-wait strategies. In a study of 308 patients, the model predicted pCR with an area under the receiver operator curve (AUROC) of 0.71. External validation in 83 patients […]
Category: Intestine and Lower Gastrointestinal Tract
Negligible benefit of terminal ileal intubation in asymptomatic colonoscopy
Routine terminal ileal intubation in asymptomatic patients undergoing colon cancer screening shows minimal diagnostic value. Overall diagnostic yield for any ileal finding is just 1.74%. Yield for clinically significant pathology is only 0.28%, with Crohn’s disease detection at 0.1%. Surgeons should reconsider routine TII during screening and surveillance colonoscopies due to negligible benefit. Review by […]
Colonic obstruction management redefined: SEMS trumps surgery.
Using self-expanding metal stents (SEMS) as bridge-to-surgery improved outcomes for obstructive left colon cancer. One-year stoma rates were lower with SEMS (44.4%) compared to emergency surgery (73.4%). Fewer readmissions (4.2% vs 15.9%) and faster chemotherapy initiation (76.1% vs 55.8%) were noted with SEMS. Consider SEMS for selected patients to reduce stoma rates and enhance quality […]
Robotic and Laparoscopic APR for Anal Cancer Show Lower Mortality
Minimally invasive surgery for anal cancer improves patient outcomes compared to open approaches. Robotic APR showed lower 30-day mortality rates (1.2% vs 2.2% for open) and reduced 90-day mortality (3.2% vs 4.9% for open). Laparoscopic APR also had lower mortality and similar survival rates to robotic APR, with a five-year survival of 54%. Choosing robotic […]
Preoperative Anxiety and Depression Surge Risk in Colorectal Surgery
Patients with high anxiety and depression scores face greater postoperative complications after colorectal surgery. 25% of patients experienced clinically relevant complications, with inflammatory bowel disease and active smoking identified as risk factors. High hospital anxiety and depression scores increased the odds of complications (OR 1.07). Surgeons should routinely screen for these psychological issues to improve […]
Comparing LAR and APR for Low Rectal Cancer Outcomes
Surgeons face critical choices between low anterior resection (LAR) and abdominoperineal resection (APR) for low rectal cancer, as outcomes vary and affect patient quality of life. No significant long-term difference in overall quality of life: LAR (68.3) vs. APR (71.2). Major low anterior resection syndrome impacted 44.9% of LAR patients; 31.3% of APR patients reported […]
New Prognostic Tool for Stage III Rectal Cancer Survival
This study identifies how combining perineural invasion and lymph node ratio can improve survival predictions in stage III rectal cancer. Perineural invasion-positive patients have significantly lower 3-year (74.7% vs 86.7%) and 5-year survival (61.7% vs 76.0%) compared to negative patients. The integrated nomogram shows high accuracy (AUC 0.764-0.839) for cancer-specific survival, enhancing patient stratification. Use […]
Optimizing Emergency Care for Colorectal Cancer Patients
Emergency management of colorectal cancer is crucial due to high rates of complications and mortality. Up to one-third of CRC patients present with obstruction, perforation, or bleeding, leading to worse survival outcomes. Right colectomy with primary anastomosis is safe for selected patients, while diversion is advised for unstable cases. Surgical strategies must balance swift intervention […]
Colorectal cancer liver metastases: new strategies for unresectable cases
Surgeons need to adapt to evolving treatments for unresectable colorectal liver metastases (uCRLM) that significantly impact outcomes. Advances in systemic therapy combined with liver-directed strategies have broadened curative options, using techniques like ablation and transarterial therapies. Patient selection now focuses on tumor biology and therapy response, moving away from strict anatomy-based criteria. Early referral to […]
New robotic force feedback enhances safety in rectal surgery
Robotic rectal cancer surgery with da Vinci’s new force feedback technology shows promise for reducing tissue stress during procedures. Mean force during static retraction dropped significantly with higher feedback sensitivity (off: 3.07 n, low: 2.58 n, medium: 2.03 n; pā=ā0.039). Median maximum force in dynamic retraction also decreased with increased sensitivity (off: 36.19 n, low: […]