Using powered circular staplers in left-sided colorectal anastomoses does not significantly reduce anastomotic leaks compared to manual staplers. Analysis of 9 studies with over 3,100 patients found no significant difference in leak rates (RR 0.56) or morbidity (RR 0.84). However, powered staplers showed a significantly lower rate of post-operative bleeding (RR 0.20, p < 0.001). […]
Category: Intestine and Lower Gastrointestinal Tract
Endoscopic Closure vs. Surgery for Colonic Perforations
Endoscopic closure may be a viable first-line approach for select iatrogenic colonic perforations. No difference in treatment success between endoscopic closure and surgery (RR 1.00, 95% CI 0.94-1.06). Endoscopy was generally used for smaller, immediately recognized injuries, while surgery was preferred for larger, delayed presentations. In ideal candidates (perforations <2 cm with no peritonitis), endoscopy […]
Perioperative CEA Levels Predict Outcomes in Colorectal Cancer
Perioperative carcinoembryonic antigen (CEA) is a key marker for predicting survival and guiding treatment in stage II and III colorectal cancer. Elevated perioperative CEA is linked to worse overall survival (OS) and disease-free survival (DFS). Patients not receiving adjuvant chemotherapy with high CEA experienced significantly poorer outcomes; adjuvant therapy notably improved OS. Surgeons should consider […]
Multimodal Prehabilitation Doesn’t Cut Surgical Complications
Multimodal prehabilitation didn’t show significant benefits for postoperative outcomes in a diverse surgical population. No notable reduction in major complications (adjusted risk ratio 1.02) or length of stay (adjusted incidence rate ratio 1.04). In high-risk GI oncological surgery patients, a non-significant 9% reduction in complications was observed. Surgeons should consider targeted prehabilitation for high-risk patients, […]
Colovac 2 device shows promise for colorectal surgery
Colovac 2 may reduce the need for diverting ostomies after low anterior resection. 100% of Colovac devices were successfully placed and removed without complications. Only 8.3% experienced clinically significant migration, all retrieved successfully with no ostomy conversions. Surgeons can potentially avoid diverting ostomies in 87.5% of patients within 10 days post-surgery. 95.8% achieved fecal diversion […]
New Robotic Procedure Shows Promise for Colorectal Lesions
Endorobotic submucosal dissection (ERSD) using the da Vinci SP system is a safe and effective option for resecting distal colorectal lesions. En-bloc resection rate was 96%, with a median procedure time of 73 minutes. Patients had a median hospital stay of 0 days and minimal long-term complications. This indicates ERSD could expand surgical options for […]
Neoadjuvant Chemotherapy Fails to Outperform Surgery in Colon Cancer
Neoadjuvant chemotherapy does not improve disease-free survival compared to upfront surgery for locally advanced colon cancer, but shows benefits in feasibility and reduced need for adjuvant therapy. Three-year disease-free survival: 87% for upfront surgery vs. 83% for neoadjuvant chemotherapy (p=0.36). Reduced requirement for adjuvant chemotherapy in the neoadjuvant group (59% vs 73%, p=0.02). Surgeons should […]
Long-Term Results of taTME for Rectal Cancer Confirm Efficacy
taTME shows promising long-term outcomes for low rectal cancer patients, crucial for surgical practice. Three-year overall survival was 93.7%, with disease-free survival at 84.6%. Late complications in 32 patients, with 21 classified as severe; one required surgical revision. Surgery can prioritize sphincter preservation without compromising oncologic outcomes. 97% of patients were stoma-free at three years, […]
Prognostic Model Predicts Wound Complications After Internal Hemipelvectomy
Surgeons can now preoperatively assess wound complication risk using a newly validated scoring model for internal hemipelvectomy. Wound complications requiring surgery occurred in 34% of patients overall, with rates of 7.4%, 40%, and 67% in low-, intermediate-, and high-risk groups in the training cohort. Similar results were observed in the validation cohort: 7.1%, 32%, and […]
Cost-Saving Insights from Enhanced Recovery Programs in Colorectal Surgery
High adherence to enhanced recovery program components can significantly cut costs in colorectal surgery. Patients with ≥70% adherence had total costs of $17,576 versus $22,343 for those with <70% adherence (p<0.001). Key cost-saving components included avoiding nasogastric tubes (-$16,036), early mobilization (-$3,476), and discontinuing maintenance intravenous fluids (-$4,460). Targeting specific ERP components could enhance outcomes […]