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Objective: This study aims to conduct a meta-analysis to evaluate the short-term and long-term therapeutic effects of robot-assisted laparoscopic treatment in patients with mid and low rectal cancer. Methods: A comprehensive search strategy was employed to retrieve relevant literature from PubMed, NCBI, Medline, and Springer databases, spanning the database inception until August 2023. The focus of this systematic review was on controlled studies that compared the treatment outcomes of robot-assisted (Rob) and conventional laparoscopy (Lap) in the context of mid and low rectal cancer. Data extraction and literature review were meticulously conducted by two independent researchers (HMW and RKG). The synthesized data underwent rigorous analysis utilizing RevMan 5.4 software, adhering to established methodological standards in systematic reviews. The primary outcomes encompass perioperative outcomes and oncological outcomes. Secondary outcomes include long-term outcomes. Result: A total of 11 studies involving 2239 patients with mid and low rectal cancer were included (3 RCTs and 8 NRCTs); the Rob group consisted of 1111 cases, while the Lap group included 1128 cases. The Rob group exhibited less intraoperative bleeding (MD = −40.01, 95% CI: −57.61 to −22.42, P < 0.00001), a lower conversion rate to open surgery (OR = 0.27, 95% CI: 0.09 to 0.82, P = 0.02), a higher number of harvested lymph nodes (MD = 1.97, 95% CI: 0.77 to 3.18, P = 0.001), and a lower CRM positive rate (OR = 0.46, 95% CI: 0.23 to 0.95, P = 0.04). Additionally, the Rob group had lower postoperative morbidity rate (OR = 0.66, 95% CI: 0.53 to 0.82, P < 0.0001) and a lower occurrence rate of complications with Clavien–Dindo grade ≥ 3 (OR = 0.60, 95% CI: 0.39 to 0.90, P = 0.02). Further subgroup analysis revealed a lower anastomotic leakage rate (OR = 0.66, 95% CI: 0.45 to 0.97, P = 0.04). No significant differences were observed between the two groups in the analysis of operation time (P = 0.42), occurrence rates of protective stoma (P = 0.81), PRM (P = 0.92), and DRM (P = 0.23), time to flatus (P = 0.18), time to liquid diet (P = 0.65), total hospital stay (P = 0.35), 3-year overall survival rate (P = 0.67), and 3-year disease-free survival rate (P = 0.42). Conclusion: Robot-assisted laparoscopic treatment for mid and low rectal cancer yields favorable outcomes, demonstrating both efficacy and safety. In comparison to conventional laparoscopy, patients experience reduced intraoperative bleeding and a lower incidence of complications. Notably, the method achieves comparable short-term and long-term treatment results to those of conventional laparoscopic surgery, thus justifying its consideration for widespread clinical application. [ABSTRACT FROM AUTHOR]

Objective: To assess the viability, limitations, technical challenges, and outcomes of malignant rectal tumors laparoscopic mesorectal resection with the assessment of postoperative continence. Patients and Methods: The study involved 20 people who had malignant rectal tumors. All patients underwent laparoscopic mesorectal resection. Data were recorded and investigated during Preoperative, operative, and postoperative periods. Results: Low anterior, anterior, and intersphincteric resections were performed in 30%, 7%, and 35% of patients, respectively. The mean operative period lasted was on average of 3.10 ± 0.72 h. Only one case (5%) showed postoperative complications. The peristalsis became audible after one to two days, on an average of 1.65 ± 0.49 days. The hospital staying mean duration was 4.25 ± 0.72. Only for 7 patients with intersphincteric resection, the mean Wexner score was 3.0 ± 1.91 after the closure of ileostomy. Patients who underwent low anterior resection had significantly longer postoperative hospital stays (p = 0.020). There was a substantial relationship between the number of both the resected lymph nodes (LN) and the involved ones (p < 0.001). Conclusion: Laparoscopic mesorectal excision for rectal tumors is superior nowadays on traditional open approach, has no increased operative time and has privileges of decreasing postoperative pain, decreasing complications, decreasing the hospital stay, early recovery and fast first bowel motion and helps for better visualization and resection of all related lymph nodes. Intersphincteric mesorectal excision of rectal tumors is preferred for all patients below 60 years old with distal rectal tumors regardless of the tumor lower edge's extended length from the anal verge as long as the external sphincters are preserved. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Patient body composition (BC) has been shown to help predict clinical outcomes in rectal cancer patients. Artificial intelligence algorithms have allowed for easier acquisition of BC measurements, creating a comprehensive BC profile in patients using data from an entire three‐dimensional (3D) region of the body. This study has utilized AI technology to measure BC from the entire lumbosacral (L1‐S5) region and assessed the associations between BC and clinical outcomes in rectal cancer patients who have undergone neoadjuvant therapy followed by surgery.A retrospective, cross sectional analysis was performed on locally advanced rectal cancer (LARC) patients treated with neoadjuvant long‐course chemoradiotherapy followed by curative resection with total mesorectal excision at a tertiary referral centre, Western Health, Melbourne, Australia. A pre‐trained and validated in‐house AI segmentation model was used to automatically segment and measure intramuscular adipose tissue (IMAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and skeletal muscle (SM) from CT slices across the entire L1–S5 level of each patient. Multivariate analysis between patient BC and clinical outcomes was performed.Two hundred and fourteen patients were included in the study. One hundred and fifty‐one (70.6%) patients were male and 63 (29.4%) patients were female. The average age at diagnosis was 62.4 (±12.7) years. SM density, but not volume, was associated with better overall survival (OS) (HR 0.24, P = 0.029), recurrence‐free survival (RFS) (HR 0.45, P = 0.048) and decreased length of stay (LoS) (HR 1.58, P = 0.036). Both IMAT volume (HR 0.13, P = 0.008) and density (HR 0.26, P = 0.006) were associated with better OS.This study measured 3D BC from the entire lumbosacral region of rectal cancer patients. SM density was the most significant BC parameter, and was associated with improved OS, RFS and LoS. This adds to growing evidence that SM is a key component of BC in cancer patients and should be optimized prior to treatment. IMAT was also a prognostic factor, giving rise to avenues of future research into the role of adiposity on nutrition and tumour immunology. [ABSTRACT FROM AUTHOR]

Purpose: The optimal treatment of ypT1 rectal cancer after neoadjuvant chemoradiotherapy (nCRT) remains controversial. This study aimed to determine whether local excision is non-inferior to radical surgery and whether adjuvant chemotherapy (ACT) would improve survival in patients with ypT1 rectal cancer after nCRT. Methods: We enrolled 1212 and 91 patients with ypT1 rectal cancer underwent nCRT followed by radical surgery from the SEER database (2004–2018) and the Zhejiang Cancer Hospital (ZJCH) (2010–2022), respectively. Another 62 patients underwent LE were also identified from SEER registries. Propensity score matching was performed to balance baseline characteristics between patients in different treatment groups. Results: Regional nodal metastasis was histopathologically detected in 257 patients (20.7%) within the SEER cohort, showing a significant association with poor cancer-specific survival (CSS) and overall survival (OS). Consistent findings were also observed in the ZJCH cohort. After 1:1 propensity score matching (60 pairs), no significant differences were observed between the extended resection and local excision groups in CSS (hazard ratio [HR] 0.88, P = 0.785) and OS (HR 0.81, P = 0.450). Patients with regional nodal metastases were more likely to receive ACT, while no apparent survival benefit was observed with additional ACT after PSM adjusting (187 pairs). Notwithstanding, for individuals younger than 50 years, ACT might provide a survival benefit in CSS (HR 0.25, P = 0.033) and OS (HR 0.30, P = 0.022). Conclusion: Although patients with ypT1 rectal cancer have a non-negligible risk for nodal metastasis, oncologic outcomes of local excision following nCRT seem to be comparable to radical surgery. ACT could not effectively improve prognosis in patients with ypT1 tumors, except for those younger than 50 years of age. [ABSTRACT FROM AUTHOR]

Background: Colorectal surgery is associated with a high complication rate. Imaging has an essential role in the postoperative assessment of the colon and rectum, being able to delineate early and late complications. Multidetector CT is the first-line imaging modality for assessing complications in the early and late postoperative period. Familiarity with the surgical techniques, the incidence and appearance of common postoperative complications is essential for accurate characterization of the imaging features and prompt diagnosis. Herein, we describe the main surgical procedures related to the sigmoid colon and rectum and the imaging characteristics of the most common postoperative complications with emphasis on CT, together with brief clinical notes. Short conclusion: Complications following colorectal surgery represent a major concern. Imaging plays a vital role in the assessment of the postsurgical sigmoid colon and rectum, with CT being the modality of choice in most of the cases. Knowledge of the imaging appearance of common complications, in conjunction with the surgical and clinical history, is essential for facilitating a prompt diagnosis and guide early management. [ABSTRACT FROM AUTHOR]

Background: Local recurrence is a major problem after surgery for rectal cancer. Precision of the circumferential resection margin (CRM) has been shown to be an independent predictor of local recurrence. The purpose of this study is to evaluate the usefulness of robotic surgery for defining the CRM. Methods: A retrospective cohort study of patients with rectal cancer who underwent radical surgery at Tokushima University Hospital from January 2012 to April 2023 was included in this study to evaluate risk factors for CRM involvement. Short-term outcomes, including CRM rates, as well as long-term outcomes, were compared between patients who had undergone robot-assisted versus laparoscopic surgery following propensity score analysis. Results: A total of 223 patients were analyzed in this study. Multivariate analysis demonstrated that lymph node metastasis was the most significant predictive factor for CRM involvement (p = 0.030), and that robot-assisted surgery tended to lead to less CRM involvement (p = 0.085). The CRM involvement rate for robotic and laparoscopic surgery before propensity score matching was 4.7% and 11.7%, respectively. Following propensity score matching, the CRM involvement rate for robotic surgery was 4.5% versus 11.4% for laparoscopic surgery. Disease-free survival (DFS) and overall survival (OS) rates for patients who had undergone robot-assisted and laparoscopic surgery were not significantly different before or after matching (DFS before matching: p = 0.876, DFS after matching: p = 0.805, OS before matching: p = 0.511, OS after matching: p = 0.458). Conclusion: Robot-assisted surgery may be useful in defining the CRM for rectal cancer. [ABSTRACT FROM AUTHOR]

Summary Background Objective Study design Methods Results Conclusion Uterine torsion (UT) is an infrequent serious obstetric disorder in pregnant mares.To record the outcome of standing flank laparotomy (SFL) for correction of UT in Straight Egyptian Arabian mares.Retrospective analysis of medical records.Hospital records of all pregnant mares that underwent SFL for correction of UT between 2018 and 2022 were analysed. The signalment, history, clinical signs, results of diagnostic techniques, direction and degree of UT, treatment and outcome, rebreeding and recurrence were retrieved and analysed.Out of 97 mares treated with SFL for correction of UT, 87 (89.7%) animals were Straight Egyptian Arabian mares. The median age of the Straight Egyptian Arabian mares presented with UT was 12 ± 2.3 years (Range: 5–18 and IQR: 7–15 years). The median gestational age at the time of occurrence of UT was 270 ± 2.4 days (Range: 210–315 and IQR: 255–260 days). The majority of UT (75.9%) was recorded ≤270 days. The direction of torsion was clockwise in 36 (41.4%) mares and anticlockwise in 51 (58.6%) mares. The degree of UT ranged between <180° and ≥360°. After surgery, 82/87 (94.3%) mares successfully delivered a live foal. However, four mares (4.6%) aborted after 2–15 days of surgery and one mare (1.1%) died after surgery due to rectal tears and intestinal prolapse. Following SFL, 86/87 (98.9%) mares survived. Of the surviving 86 mares, 82 (95.3%) gave birth to viable mature foals. In contrast to the direction of torsion and gender of the foal, the stage of gestation at which UT occurred significantly affected foal survival (p = 0.018).Pregnant Straight Egyptian Arabian mares are at risk of developing UT during the third trimester of pregnancy. Standing flank laparotomy is an effective operation for treating UT in mares, with good foal and mare survival rates. [ABSTRACT FROM AUTHOR]

Objective: Compare the efficacy and safety of robotic versus laparoscopic approach for rectal cancer treatment, addressing the ongoing debate within the medical community regarding the optimal surgical approach. Background: Traditionally, surgery has been the cornerstone of rectal cancer treatment, aimed at tumor removal and intestinal function preservation. Recent advancements have introduced laparoscopic and robotic surgeries as minimally invasive alternatives to conventional methods. However, it faces limitations in instrument mobility and dexterity. Robotic approach, on the other hand, enhances these aspects by providing surgeons with advanced precision, a three-dimensional high-definition view, and superior tissue manipulation capabilities, making it an increasingly preferred option for rectal cancer treatment. Methods: This systematic review and meta-analysis following PRISMA-2020 guidelines was carried out. This study analyzed phase 2 and 3 randomized controlled trials assessing the efficacy and safety of robotic versus laparoscopic approach in treating rectal cancer. Only studies meeting specific criteria were included, with congress abstracts, narrative reviews, case reports, and letters to the editor excluded. Results: We identified 350 studies, 8 met the inclusion criteria, encompassing 2525 patients from diverse geographical locations. The main outcomes analyzed were regional recurrence, anastomotic leak, postoperative complications, and mortality. The findings indicated no significant differences between robotic and laparoscopic surgeries in terms of Grade III Clavien-Dindo complications, mortality, and anastomotic leakage. The diverse geographical origin of the studies suggests the applicability of the results across different health care settings, although system-specific considerations are essential. Conclusion: Robotic approach does not show significant advantages over laparoscopic approach in terms of major complications and mortality rates in rectal cancer treatment, indicating that both surgical approaches are viable options with their specific benefits and limitations. [ABSTRACT FROM AUTHOR]

Backgrounds Methods Results Conclusion This study aims to evaluate the clinical efficacy and functional outcomes of DA Vinci (Xi)‐assisted surgery compared to conventional laparoscopic surgery for middle and low rectal cancer, focusing on oncologic cure and functional preservation.Between December 2020 and June 2021, 102 patients with middle and low rectal cancer (tumour lower margin ≤10 cm) were enrolled at the affiliated Hospital of Xuzhou Medical University. Participants were divided into two groups: robot‐assisted (n = 51) and laparoscopy‐assisted (n = 51). Each group underwent a radical resection using their assigned method. Clinical and functional outcomes were analysed post‐surgery.Preoperative data did not differ significantly between groups (P > 0.05). All surgeries were successfully completed without conversion to open surgery. The robotic group experienced significantly less intraoperative blood loss (55.2 ± 29.8 mL vs. 109.5 ± 58.5 mL) and faster recovery in gastrointestinal function (35.1 ± 9.4 h vs. 40.7 ± 1.9 h), diet recovery (2.1 ± 0.8 days vs. 2.9 ± 0.4 days), and catheter removal (2.9 ± 2.7 days vs. 5.3 ± 2.1 days). The robotic group also dissected more lymph nodes (23 ± 6 vs. 15 ± 4). However, they had longer operative times (239.8 ± 29.6 min vs. 141.1 ± 18.5 min) and higher hospital costs. Satisfaction levels regarding defecation, voiding, and sexual functions were notably higher in the robotic group.No significant differences in surgical safety or immediate postoperative outcomes were observed between robotic and laparoscopic approaches. However, robotic surgery demonstrated superior lymph node dissection, anal function preservation, and gastrointestinal recovery, enhancing overall functional outcomes. [ABSTRACT FROM AUTHOR]

Background: The incidence of rectal cancer is increasing in the elderly population, yet the safety of surgical interventions in this group, particularly robotic surgery, is still debated. This study aims to investigate the safety and short-term postoperative outcomes of robotic surgery in geriatric patients (aged ≥ 70 years) with rectal cancer. Patients: Patients diagnosed with rectal cancer and undergoing robotic surgery between March 2021 and September 2023 were divided into two groups based on age: the elderly group (aged ≥ 70 years) and the younger group (aged < 70 years), totaling 108 patients. Results: The study included 80 younger patients in group 1 and 28 elderly patients in group 2. The groups had similar gender distribution and tumor characteristics. The elderly group had higher ASA scores and lower albumin levels and underwent the Miles procedure more frequently. The stoma rate was higher in the elderly group. Operation duration, tumor diameter, lymph node dissection numbers, pathological stage, and other histopathological features were similar in the two groups. Postoperative outcomes like hospital stay, complication rates, anastomotic leakage, reoperation rates, unplanned readmissions, and mortality were comparable between the groups. Conclusions: Robotic surgery for rectal cancer in elderly patients is technically feasible and safe. Age should not be a determining factor in patient selection for robotic surgery or be considered a risk factor for postoperative complications. [ABSTRACT FROM AUTHOR]

Aim: Anastomotic leakage following rectal cancer surgery remains a challenging complication, with a nonhealing rate of approximately 50% at 1 year. Pelvic sepsis may require tertiary treatment that encompasses additional admissions, extensive surgery and other types of interventions. The aim of this study is to analyse the financial burden of pelvic sepsis in a tertiary hospital. Method: From 2010 until 2020, all patients referred to a tertiary centre for pelvic sepsis after low anterior resection for rectal cancer were prospectively registered and retrospectively reviewed. The cost analysis adhered to Dutch National Healthcare Institute guidelines and covered hospital‐imposed medical costs from salvage surgery to the last registered intervention, adjusted for inflation and priced in euros. Results: This analysis included 126 patients, with an average total cost per patient of €31 131. Salvage surgery accounted for €21 326, with an additional €9805 for reinterventions and readmissions. Salvage surgery comprised nonrestorative surgery in 48% and restorative salvage surgery in the remaining cases. Length of hospital stay averaged 9.6 days on the general ward and 0.8 days in the intensive care unit. Common reinterventions included endoscopic vacuum sponge changes (n = 153), stoma closures (n = 59) and radiological abscess drainages (n = 51). Total costs did not differ significantly between nonrestorative surgery and restorative surgery (mean = €31 950 vs. €30 362, respectively; p = 0.893). Conclusion: Treating pelvic sepsis after rectal cancer resection in a tertiary hospital carries a substantial economic burden, averaging €31 131 per patient, and this work helps to quantify the potential economic impact of innovative care to reduce anastomotic leakage. [ABSTRACT FROM AUTHOR]

Aim: Patients requiring a beyond total mesorectal excision (bTME) procedure for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) will probably benefit from enhanced recovery after surgery (ERAS) protocols. However, implementation of ERAS protocols in such groups of patients is considered challenging. The aims of this study were to evaluate ERAS‐related outcomes of patients with LARC or LRRC undergoing bTME and to investigate the possibility of designing a tailored ERAS protocol. Method: This study was divided into four phases. Phase one consisted of a literature study to compare functional recovery and postoperative outcomes in patients undergoing bTME. In phase two, outcomes on ERAS care elements in bTME were retrospectively evaluated. In phase three, differences in ERAS‐related outcomes and compliance of the colorectal ERAS protocol in patients who had undergone bTME were studied. In phase four, multidisciplinary team meetings were held to develop an ERAS protocol for bTME patients. Results: Seven studies reported on ERAS‐related outcomes in patients undergoing bTME. Median length of hospital stay was 9–19 days, median stay in the intensive care unit was 2–4 days and 30‐day postoperative major complication rates were 22.6%–61.3%. Seventy‐five bTME patients were included for retrospective analysis. In these patients, length of stay was 9.0 days and major postoperative complications were observed in 40.0%. The overall ERAS compliance was 44.4%. Compared with the colorectal ERAS protocol, the largest differences in management were observed in the use of epidural anaesthesia, the postoperative use of urethral catheters, oral intake and mobilization. Conclusion: Patients undergoing bTME for LARC or LRRC are substantially different from patients treated with the colorectal ERAS protocol, regarding ERAS‐related outcomes. A tailored, multimodal ERAS protocol with specific modifications was developed by an expert multidisciplinary team for patients undergoing bTME for LARC or LRRC. [ABSTRACT FROM AUTHOR]

Background Neoadjuvant therapy leads to a clinical complete response in a considerable proportion of patients with locally advanced rectal cancer, allowing for possible nonoperative management. The presence of mucin on magnetic resonance imaging (MRI) after neoadjuvant therapy leads to uncertainty about residual disease and appropriateness of a watch-and-wait strategy in patients with no evidence of disease on proctoscopy (endoscopic clinical complete response). Methods MRI reports for locally advanced rectal cancer patients seen between July 2016 and January 2020 at Memorial Sloan Kettering Cancer Center were queried for presence of mucin in the tumor bed on MRI following neoadjuvant therapy. Clinicodemographic, pathologic, and outcome data were compiled and analyzed. Results Of 71 patients with mucin on posttreatment MRI, 20 had a clinical complete response, and 51 had abnormalities on endoscopy and/or physical exam. One patient with a clinical complete response opted out of watch-and-wait; thus, 19 (27%) patients entered watch-and-wait, and 52 (73%) patients were planned for surgery (non–watch-and-wait). Of the 19 watch-and-wait patients, 15 (79%) have had no local regrowth with median follow-up of 50 months (range = 29-76 months), while 4 (21%) experienced regrowth between 9 and 29 months after neoadjuvant therapy. Of the 52 patients who were planned to have surgery (non–watch-and-wait), 49 underwent resection while 3 developed metastatic disease that precluded curative-intent surgery. Of the 49 patients who underwent surgery, 5 (10%) had a pathologic complete response (including the patient with an endoscopic clinical complete response). Conclusions The presence of mucin after neoadjuvant therapy for locally advanced rectal cancer does not preclude watch-and-wait management in otherwise appropriate candidates who achieve an endoscopic clinical complete response. [ABSTRACT FROM AUTHOR]

Colorectal surgery is one of the specialties that have significantly benefited from the adoption of robotic technology. Over 20 years since the first robotic rectal resection, the Intuitive Surgical Da Vinci system remains the predominant platform. The introduction of new robotic systems into the market has enabled the first documented total mesorectal excision (TME) using alternative platforms. This scoping review aimed to assess the role and adoption of these emerging robotic systems in performing TME for rectal cancer surgery. Methods: A comprehensive search of the Medline, Embase, and Cochrane databases was conducted up to August 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Results: Thirty-six studies were included in the review. The majority of rectal surgical procedures were performed using eight different robotic platforms. Intraoperative, short-term, and functional outcomes were generally favorable. However, pathological results were frequently incomplete. Several studies identified the lack of advanced robotic instruments as a significant limitation. Conclusions: The quality of the resected specimen is critical in rectal cancer surgery. Although TME performed with new robotic platforms appears to be feasible and safe, the current body of literature is limited, particularly in the assessment of pathological and long-term survival outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Robotic surgery (RS) is gaining prominence in colorectal procedures owing to advantages like three-dimensional vision and enhanced dexterity, particularly in rectal surgery. Although recent reviews report similar outcomes between laparoscopic surgery (LS) and RS, this study investigates the evolving trends in outcomes over time, paralleling the increasing experience in RS. Methods: A systematic review, meta-analysis and meta-regression were conducted of randomised controlled trials exploring postoperative outcomes in patients undergoing RS or LS for colorectal pathology. The primary outcome measure was postoperative complications. Risk of bias was evaluated using the Cochrane Collaboration's assessment tool. Randomised controlled trials were identified from the PubMed®, Embase® and CINAHL® (Cumulative Index to Nursing and Allied Health Literature) databases via the Cochrane Central Register of Controlled Trials. Results: Of 491 articles screened, 13 fulfilled the inclusion criteria. Meta-analysis of postoperative complications revealed no significant difference between RS and LS (relative risk [RR]: 0.96, 95% confidence interval [CI]: 0.79 to 1.18, p=0.72). Meta-regression analysis of postoperative complications demonstrated a significant trend favouring RS over time (yearly change in Ln(RR): −0.0620, 95% CI: −0.1057 to −0.0183, p=0.005). Secondary outcome measures included operative time, length of stay, blood loss, conversion to open surgery, positive circumferential resection margins and lymph nodes retrieved. The only significant findings were shorter operative time favouring LS (mean difference: 41.48 minutes, 95% CI: 22.15 to 60.81 minutes, p<0.001) and fewer conversions favouring RS (RR: 0.57, 95% CI: 0.37 to 0.85, p=0.007). Conclusions: As experience in RS grows, evidence suggests an increasing safety profile for patients. Meta-regression revealed a significant temporal trend with complication rates favouring RS over LS. Heterogeneous reporting of complications hindered subgroup analysis of minor and major complications. LS remains quicker. Rising adoption of RS coupled with emerging evidence is expected to further elucidate its clinical efficacy. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the effectiveness and safety of 2D laparoscopy vs 3D laparoscopy for the treatment of colorectal cancer. Methods: A literature search was conducted through PubMed, Web of Science, and Embase from their inception to January 2024. Studies investigating different outcomes of colorectal surgery were included. Results are presented as odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). The protocol for this review has been registered on PROSPERO (CRD42024504902). Results: A total of 10 publications were retrieved in this article. The 3D group is associated with a significant improvement in intraoperative blood loss (MD = -8.04, 95% CI = -14.18 to -1.89, P = 0.01, I² = 55%), operative time (MD = -17.33, 95% CI = -29.15 to -5.51, P = 0.004, I² = 90%), and postoperative hospital stay (MD = -0.23, 95% CI = -0.43 to -0.04, P = 0.02, I² = 48%) compared to that of patients treated in the 2D group, particularly for rectal cancer patients above three results (MD = -10.36, 95% CI = -15.00 to -5.73, P < 0.001, I² = 0%), (MD = -18.85, 95% CI = -34.88 to -2.82, P = 0.02, I² = 57%), and (MD = -0.93, 95% CI = -1.53 to -0.34, P = 0.002, I² = 0%), respectively. There was no significant statistical difference in the time of pass flatus (MD = -0.14, 95% CI = -0.49 to 0.21, P = 0.44, I² = 79%) and the number of dissected lymph nodes (MD = 0.36, 95% CI = -0.49 to 1.21, P = 0.41, I² = 45%), but the 3D group had an earlier postoperative pass flatus for rectal cancer patients (MD = -0.46, 95% CI = -0.66 to -0.27, P<0.001, I² = 0%) and the more number of dissected lymph nodes for colon cancer patients (MD = 1.54, 95% CI = 0.05 to 3.03, P = 0.04, I² = 69%) than the 2D group. There was no significant difference in postoperative overall complication (OR = 0.94, 95% CI = 0.67 to 1.31, P = 0.71, I² = 0%) and anastomotic leakage (OR = 0.93, 95% CI = 0.48 to 1.80, P = 0.83, I² = 0%) in the two groups, regardless of rectal cancer and colon surgery patients. Conclusion: This meta-analysis demonstrates that 3D laparoscopy could reduce the amount of blood loss, accelerate postoperative pass flatus, and shorten the operation time and postoperative hospital stay over 2D for radical rectal cancer surgery, without obvious advantage for radical colon cancer surgery. Moreover, 3D laparoscopy increases the number of dissected lymph nodes for radical colon cancer surgery but may not be observed in rectal cancer surgery. [ABSTRACT FROM AUTHOR]

Background: It has been reported that the oral and gut microbiomes are associated with the prognosis in patients who undergo surgery, chemotherapy, and radiation for colorectal cancer. This study is the first to identify a correlation between the number of healthy teeth, which is an oral health indicator, and the efficacy of preoperative chemotherapy for rectal cancer. Methods: This retrospective single-center study included 30 patients who underwent radical surgery after preoperative chemoradiotherapy (CRT) between December 2013 and June 2021. The relationship between number of teeth before CRT and the efficacy of CRT, CRT-related adverse events, postoperative complications, and long-term postoperative outcomes was examined. Results: The number of healthy teeth was significantly greater in patients with downstaging of their disease than in those without downstaging (P = .027) and in patients with a complete response according to the Response Evaluation Criteria in Solid Tumors than in those who did not have a complete response (P = .014). Patients were divided into two groups according to whether they had ≥15 teeth or ≤14 teeth. There was no significant between-group difference in CRT-related adverse events. The incidence of all postoperative complications and grade II postoperative complications tended to be higher in patients with ≥15 teeth (P = .071 and P = .092, respectively), as did the 5-year overall survival rate (P = .083) and the 5-year disease-free rate (P = .007). Discussion: The number of healthy teeth predicted the response to preoperative CRT, postoperative complications, and the outcome of subsequent surgery in patients with rectal cancer. [ABSTRACT FROM AUTHOR]

Rectal prolapse (RP) is a rare condition presenting as a partial or complete protrusion of the rectum or as mucosa through the anal canal, and it usually occurs in the elderly or females with multiple risk factors. An initial presentation of incarcerated RP is even rarer. We present a case of a previously healthy 39-year-old man who presented with an incarcerated RP that necessitated urgent perineal proctosigmoidectomy (Altemeier procedure), with diverting sigmoid colostomy, followed by a reversal of the colostomy three months later. This case highlights the importance of surgical management (the modified Altemeier procedure) for a patient with an incarcerated RP. There are no specific guidelines for management of RP; all the recommendations and latest approaches are patients-based approaches according to their presentations, risk factors, age, and gender. [ABSTRACT FROM AUTHOR]

Background/Aim: In rectal cancer surgery, anastomotic leakage (AL) is the most important complication and has a reported frequency of 11-15%. The causes of AL leakage are complex, and AL prevention should be performed in multiple directions. Thus, this study examined the usefulness of the comprehensive and multifaceted AL preventive measures. Patients and Methods: In total, 164 rectal surgery patients who had low rectal staple anastomosis below the peritoneal reflection were enrolled. The patients were divided into two groups: (i) the multifaceted AL prevention group (MP group, n=34) and (ii) the insufficient AL prevention group (IP group, n=130). Multifaceted AL prevention was defined as intestinal blood flow evaluated via indocyanine green (ICG)-fluorescence imaging (FI), the use of a single-staple technique (SST) without intersecting stapling lines or "dog ears", the use of transanal suture reinforcement according to the air leakage test, and the use of a transanal tube for anatomical decompression and a diverting stoma for diverting the fecal stream. The AL rates were retrospectively compared between the two groups. The data are expressed as the median and interquartile range. Results: The rate of AL was significantly lower in the MP group (0%) than in the IP group (11.54%) (p=0.0423). Conclusion: Multifaceted AL prevention, including ICG-FI and SST, achieved a zero incidence of AL. Multifaceted prevention significantly lessened AL more than inadequate prevention did. Therefore, if the weight of each preventive measure cannot be clearly identified, to avoid AL, it is important to take all preventive measures from multiple aspects. [ABSTRACT FROM AUTHOR]

Pivotal articles that had been published between 2022 and 2023 on surgical and perioperative adjuvant treatments for locally advanced colorectal cancer (CRC) were reviewed. This review focuses on new evidence in the following areas: optimization of surgical procedures for colon cancer, including the optimal length of bowel resection and use of the no‐touch isolation technique; minimally invasive surgery for rectal cancer, such as laparoscopic transanal total mesorectal excision and robotic surgery; neoadjuvant treatments for rectal cancer, including total neoadjuvant therapy; neoadjuvant chemotherapy for colon cancer; and postoperative adjuvant chemotherapy for Stage II and III colon cancer. Although the current understanding may not enable perfect decision‐making for patients and medical professionals, ongoing advancements are expected to result in more effective personalized treatment plans, ultimately improving the prognosis and quality of life of patients. [ABSTRACT FROM AUTHOR]

Background: In Japan, the Endoscopic Surgical Skill Qualification System (ESSQS) is used to evaluate surgical skills essential for laparoscopic surgery, but whether surgeons with this certification as operators improve the short‐term outcomes and prognosis after rectal cancer surgery is unclear. This cohort study was designed to compare the short‐term and long‐term outcomes of laparoscopic surgery for advanced rectal cancer performed by an ESSQS‐certified surgeon versus a surgeon without ESSQS certification. Methods: The outcomes of cStage II and III rectal cancer surgery cases performed at 56 Japanese hospitals between 2014 and 2016 were retrospectively reviewed. To examine the impact of ESSQS‐certified surgeons as surgeons, the outcomes of cases with only ESSQS‐certified surgeons as operators were compared with those without involvement of ESSQS‐certified surgeons. Results: A total of 3197 cases were enrolled, with 1015 in which surgery was performed by ESSQS‐certified surgeons, and 544 in which there was no involvement of ESSQS‐certified surgeons. After propensity score matching, the ESSQS group had significantly shorter operative time (p < 0.001), a lower conversion rate to open surgery (p < 0.001), and more dissected lymph nodes (p = 0.002). Conclusion: Laparoscopic rectal surgery performed by ESSQS‐certified surgeons was significantly associated with improved short‐term outcomes. This demonstrates the utility of the ESSQS certification system. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether the use of a laxative with reduced patient burden in oral antibiotics and mechanical bowel preparation (OAMBP) could prevent surgical site infection (SSI) in left‐sided colon and rectal cancers. Methods: This multicenter, non‐blinded, randomized, non‐inferiority trial included patients who underwent elective colorectal surgery for colorectal cancer in a university and community hospital in Japan from April 1, 2021 to March 31, 2023. We compared conventional OAMBP (polyethylene glycol, metronidazole, and kanamycin) (cOAMBP group) with modified OAMBP (sodium picosulfate hydrate, metronidazole, and kanamycin) (mOAMBP group). The primary outcome was overall incidence of SSI. Secondary outcomes were postoperative complications, degree of patient burden, and intraoperative bowel dilatation. Results: Among 119 patients, 112 were randomly assigned to the two groups, with 56 patients in each group. SSI occurred in three (5.4%) and five patients (8.3%) in the mOAMBP and cOAMBP groups, respectively (90% confidence interval [CI]: −12.8–5.3), with a 15% margin of non‐inferiority. Anastomotic leakage occurred in no patient in the mOAMBP group and three patients (5.4%) in the cOAMBP group (p = 0.24). The cOAMBP group reported significantly more pain than the mOAMBP group (50 [90.9%] vs. 7 [12.5%] participants). The mOAMBP group showed significantly lesser bowel dilatation than the cOAMBP group (1 [1.8%] vs. 21 [37.5%] participants). Conclusion: mOAMBP is safe and less burdensome, can reduce intraoperative bowel dilatation, and is non‐inferior compared with cOAMBP in preventing SSI. Therefore, mOAMBP may be more suitable for sigmoid colon and rectal cancer. Trial Registration: UMIN000043162 (http://www.umin.ac.jp/ctr/). Registered on January 28, 2021. [ABSTRACT FROM AUTHOR]

Transanal total mesorectal excision (TaTME) has emerged as a surgical method for treating rectal malignancies in the middle and lower third of the rectum over the past 15 years. This approach was adopted because of the challenges encountered in secure total mesorectal excision (TME). Patient selection criteria and the rationale for TaTME have evolved, leading to improved oncological outcomes and patient quality of life. The procedure includes inserting a unique platform through the anus, forming a purse‐string closure, and endoscopically sealing the lower rectum. The mesorectum is then removed laparoscopically following a ‘down‐to‐up’ approach, finalised with a transabdominal laparoscopic phase and anastomosis. Pelvic anatomy complexity poses challenges, including potential injuries to the urinary tract, surgical site leakage, sinus damage, sagittal vein harm, nerve injury, carbon dioxide embolism, bowel function disturbance, sphincter mechanism issues, and rectal abscess formation. Proficient anatomy knowledge, precise surgical techniques, and advanced technologies contribute to their prevention. In conclusion, TaTME offers a promising approach to rectal surgery with satisfactory oncological outcomes. However, vigilance is required to eliminate potential complications. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative urinary dysfunction poses a significant challenge for rectal cancer patients. While pelvic floor muscle training (PFMT) has shown promise in other contexts, its efficacy following rectal cancer surgery remains uncertain. Results: A clinical trial involving 79 rectal cancer patients found that initiating Kegel exercises post-surgery led to significant improvements in urinary symptoms compared to standard care. Adherence to exercises correlated with symptom reduction, with no reported adverse events. We have defined the main outcome of our study as the improvement in urinary function scores post-surgery. Effectiveness is considered as any statistically significant improvement in these scores. Conclusion: Early initiation of Kegel exercises shows promise in alleviating postoperative urinary dysfunction in rectal cancer patients. Further research is needed to optimize postoperative care protocols and enhance patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the effectiveness of a novel method for anastomosis reinforcement to minimize the occurrence of anastomotic complications after surgical resection of rectal and sigmoid cancer. Methods: We recruited 378 patients who underwent laparoscopic rectal anterior resection of rectal cancer and sigmoid cancer in SYSUCC. The occurrence rates of intraoperative bleeding, operation time, and postoperative anastomotic complications were compared between the treatment group receiving anastomotic reinforcement and the control group without anastomotic reinforcement. Results: The incidence of anastomotic leakage in the treatment group was significantly lower than that in the control group (1.59% vs. 11.64%, p < 0.001). Following the application of inverse probability of treatment weighting (IPTW) to adjust for factors influencing the occurrence of anastomotic leakage, the incidence of anastomotic leakage remained significantly lower in the treatment group compared to the control group (2.54% vs. 12.08%, p < 0.001). Conclusion: The circumferential continuous anastomosis reinforcing suture method, recommended for laparoscopic surgery for rectal and sigmoid cancer, has the potential to effectively minimize the occurrence of anastomotic complications. [ABSTRACT FROM AUTHOR]

Background: The hiatal ligament, as the anatomical landmark for the completion of total mesorectal excision (TME) for ultra‐low rectal cancer, represents a continuation of the longitudinal muscle of the rectum. It receives vascular supply from the median sacral artery and contains lymphatic vessels. In cases where ultra‐low rectal cancer is located in the posterior rectal wall, the hiatal ligament may theoretically serve as an anatomical region susceptible to direct tumor cell spread or distant metastasis. Objective: To evaluate the effect of circumferential tumor location (CTL) on postoperative survival of low rectal cancer and to determine the effect of total hiatal ligament excision (THLE) on the prognosis of patients with posterior rectal cancer. Methods: Patients with ultra‐low rectal cancer who underwent laparoscopic surgery between March 2014 and October 2021 were enrolled in this study. Propensity score matching (PSM) analysis was used to compare the clinicopathological characteristics and prognosis of patients in the posterior group and the non‐posterior group. Prognostic factors were identified using COX regression. PSM analysis was also used in the posterior tumor subgroup to compare the clinicopathological characteristics and prognosis of patients in the hiatal ligament traditional transection (HLTT) and THLE groups. Results: After PSM, OS, and DFS were comparable between the posterior and non‐posterior groups. Similarly, no difference was noted in the local recurrence rate between the two groups (p = 0.23). The prognosis of ultra‐low rectal cancer was not affected by CTL. However, the local recurrence rate was significantly lower in the THLE group compared with the HLTT group (p = 0.023). Multivariate analysis of the posterior group identified CRM, TNM stage III, and HLTT as independent risk factors for local recurrence‐free survival. Conclusions: CTL is not a prognostic risk factor for low rectal cancer. In posterior wall tumors, THLE significantly reduces the local recurrence rate for low rectal cancer. [ABSTRACT FROM AUTHOR]

Aim: The type of surgical procedure used in rectal cancer treatment may affect cancer recurrence. The aim of this study was to determine whether the type of procedure influences oncological outcomes in rectal cancer surgery. Method: We gathered data from the Swedish Colorectal Cancer Registry regarding patients with TNM Stage I–III rectal cancer who underwent R0/R1 surgery from 2013 to 2017. The outcomes after Hartmann's procedure (HP), anterior resection (AR) and abdominoperineal resection (APR) were compared, and a multivariable Cox regression analysis was performed. The primary outcome of the study was the local recurrence rate. The secondary outcomes were distant metastasis, disease‐free survival and overall survival at 5 years as well as risk factors for local recurrence. Results: A total of 4741 patients were included in the study: 614 underwent HP, 3075 underwent AR and 1052 underwent APR. Multivariable Cox regression revealed no difference in local recurrence, distant metastasis or disease‐free survival. Overall survival was higher following AR (OR 0.62, CI 0.54–0.72). Risk factors for local recurrence were intraoperative bowel perforation (OR 2.41, CI 1.33–4.40), a pT4 tumour (OR 1.93, CI 1.11–3.4) and a positive circumferential resection margin (OR 5.62, CI 3.28–9.61). Conclusions: This nationwide study showed that the type of procedure did not affect the local recurrence rate or distant metastasis. In patients who are unfit for restorative surgery, HP is a viable alternative with oncological outcomes similar to those of APR. [ABSTRACT FROM AUTHOR]

The article in the journal "Colorectal Disease" discusses the use of robotic posterior pelvic exenteration for locally advanced rectal cancer. The authors present a case study of a 44-year-old woman with a middle-third adenocarcinoma and describe the surgical approach using a robotic platform. The postoperative outcome was favorable, with the patient recovering well after surgery. The study was approved by the institutional ethics review board, and informed consent was obtained from the patient. [Extracted from the article]

Introduction: The American Society of Anesthesiologists (ASA) classification is used to assess the fitness of a patient for surgery. Whether laparoscopic surgery is appropriate for colorectal cancer patients with poor ASA performance status (PS) remains unclear. Methods: Among 4585 patients who underwent colorectal surgery between 2016 and 2023, this study retrospectively reviewed all 458 patients with ASA‐PS ≥3. Patients were divided into two groups: patients treated by open surgery (O group, n = 80); and patients treated by laparoscopic surgery (L group, n = 378). We investigated the impact of surgical approach on postoperative complications in patients with colorectal cancer and ASA‐PS ≥3. Results: Operation time was longer (170 min vs. 233 min, p <.001), blood loss was less (156 mL vs. 23 mL, p <.001), postoperative complications were less frequent (40.0% vs. 25.1%, p =.008), and hospital stay was shorter (23 days vs. 14 days, p <.001) in L group. Univariate analysis revealed rectal cancer, open surgery, longer operation time, and blood loss as factors significantly associated with postoperative complications. Multivariate analysis revealed open surgery (odds ratio [OR] 2.100, 95% confidence interval [CI] 1.164–3.788; p =.013) and longer operation time (OR 1.747, 95% CI 1.098–2.778; p =.018) as independent predictors of postoperative complications. Conclusion: Laparoscopic surgery provides favorable outcomes for colorectal cancer patients with poor ASA‐PS. [ABSTRACT FROM AUTHOR]

This article provides practice guidelines for qualified surgeons on the use of laparoscopic surgery for various conditions related to colorectal cancer. The guidelines recommend laparoscopic surgery for colon cancer due to its comparable long-term results and superior short-term outcomes compared to open surgery. However, the use of laparoscopic surgery for transverse colon and rectal cancer is still controversial. The guidelines also discuss the applicability of laparoscopic surgery based on disease stage, comorbidities, and age. Overall, laparoscopic surgery is considered safe and effective, but individual patient factors should be carefully considered. The article also mentions the use of laparoscopic surgery for acute appendicitis, diverticula of the large intestine, ulcerative colitis, Crohn's disease, elderly patients, obese patients, and Stage IV colorectal cancer, providing insights into the short-term and long-term outcomes of laparoscopic surgery for these conditions. The article concludes that further research is needed, particularly in the area of robotic surgery for colorectal cancer. [Extracted from the article]

Background: Intraoperative administration of dexmedetomidine has shown promise in improving postoperative gastrointestinal function. In the context of colorectal surgery, the results remain inconsistent. This review aims to provide a synthesis of studies assessing the effect of dexmedetomidine on postoperative gastrointestinal function in colorectal surgery patients. Methods: CENTRAL, Emcare, Embase, and MEDLINE were searched up to September 2023. Randomized controlled trials involving adult patients (≥ 18 years) undergoing elective colorectal surgery, comparing dexmedetomidine administration to a control group, and reporting on postoperative gastrointestinal function were included. Non-comparative and emergent procedures were excluded. Primary outcome was time to first flatus or bowel movement, and secondary outcomes included length of stay and time to solid oral intake. Risk of bias was assessed using the Cochrane risk of bias tool for randomized studies. Results: After screening 1194 citations, eight studies were included. Studies comprised of 570 patients in the dexmedetomidine group (mean age: 65.8 years, 43% female, mean BMI: 22.7 kg/m2) and 556 patients in control group (mean age 70.6 years, 40% female, mean BMI 22.5 kg/m2). Dexmedetomidine administration resulted in a shorter time to flatus (MD -4.55 h, 95% CI: 20.14−8.95, p < 0.005, very low certainty of evidence), a shorter time to first bowel movement (MD -11.9 h, 95% CI: 18.74−5.05, p < 0.005, very low certainty of evidence), a shorter time to solid oral intake (MD -4.34 h, 95% CI: 17.43−11.24, p < 0.005, moderate certainty of evidence), and a shorter length of stay (MD -.06 days, 95% CI: 1.99−0.12, p < 0.05, very low certainty of evidence). Conclusion: In adult patients undergoing elective colorectal surgery, intraoperative use of dexmedetomidine results in clinically meaningful improvements in postoperative gastrointestinal function and consequently, shorter length of stay. Therefore, dexmedetomidine may serve as a valuable adjunct in enhancing postoperative recovery of patients following elective colorectal surgery, thereby reducing healthcare utilization, and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Transcolonic endoscopic appendectomy (TEA) is rapidly evolving and has been reported as a minimally invasive alternative to appendectomy. We aimed to characterize the feasibility and safety of a novel unassisted single-channel TEA. Method: We retrospectively investigated 23 patients with appendicitis or appendiceal lesions who underwent TEA from February 2016 to December 2022. We collected clinicopathological characteristics, procedure‑related parameters, and follow‑up data and analyzed the impact of previous abdominal surgery and traction technique. Results: The mean age was 56.0 years. Of the 23 patients with appendiceal lesions, fourteen patients underwent TEA and nine underwent traction-assisted TEA (T-TEA). Eight patients (34.8%) had previous abdominal surgery. The En bloc resection rate was 95.7%. The mean procedure duration was 91.1 ± 45.5 min, and the mean wound closure time was 29.4 ± 18.6 min. The wounds after endoscopic appendectomy were closed with clips (21.7%) or a combination of clip closure and endoloop reinforcement (78.3%), and the median number of clips was 7 (range, 3–15). Three patients (13.0%) experienced major adverse events, including two delayed perforations (laparoscopic surgery) and one infection (salvage endoscopic suture). During a median follow-up of 23 months, no residual or recurrent lesions were observed, and no recurrence of abdominal pain occurred. There were no significant differences between TEA and T-TEA groups and between patients with and without abdominal surgery groups in each factor. Conclusion: Unassisted single-channel TEA for patients with appendiceal lesions has favorable short- and long-term outcomes. TEA can safely and effectively treat appendiceal disease in appropriately selected cases. [ABSTRACT FROM AUTHOR]

Purpose: This study explored the difficulty factors in robot-assisted low and ultra-low anterior resection, focusing on simple measurements of the pelvic anatomy. Methods: This was a retrospective analysis of the clinical data of 61 patients who underwent robot-assisted low and ultra-low anterior resection for rectal cancer between October 2018 and April 2023. The relationship between the operative time in the pelvic phase and clinicopathological data, especially pelvic anatomical parameters measured on X-ray and computed tomography (CT), was evaluated. The operative time in the pelvic phase was defined as the time between mobilization from the sacral promontory and rectal resection. Results: Robot-assisted low and ultra-low anterior resections were performed in 32 and 29 patients, respectively. The median operative time in the pelvic phase was 126 (range, 31–332) min. A multiple linear regression analysis showed that a short distance from the anal verge to the lower edge of the cancer, a narrow area comprising the iliopectineal line, short anteroposterior and transverse pelvic diameters, and a small angle of the pelvic mesorectum were associated with a prolonged operative time in the pelvic phase. Conclusion: Simple pelvic anatomical measurements using abdominal radiography and CT may predict the pelvic manipulation time in robot-assisted surgery for rectal cancer. [ABSTRACT FROM AUTHOR]

Background Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists. Methods A post-hoc analysis was conducted using a prospectively collected data set of patients from the 2017 European Society of Coloproctology snapshot audit who underwent elective left-sided resection (left hemicolectomy, sigmoid colectomy, or rectal resection) with a manual circular stapled anastomosis. Rates of anastomotic leak and unplanned intensive care unit stay in association with manual circular stapling were assessed. Patient-, disease-, geographical-, and surgeon-related factors as well as stapler brand were explored using multivariable regression models to identify predictors of adverse outcomes. Results Across 3305 procedures, 8.0% of patients had an anastomotic leak and 2.1% had an unplanned intensive care unit stay. Independent predictors of anastomotic leak were male sex, minimal-access surgery converted to open surgery, and anastomosis height C11 (lower third rectum) (all P < 0.050). Independent predictors of unplanned intensive care unit stay were minimal-access surgery converted to open surgery and American Society of Anesthesiologists grade IV (all P < 0.050). Stapler device brand was not a predictor of anastomotic leak or unplanned intensive care unit stay in multivariable regression analysis. There were no differences in rates of anastomotic leak and unplanned intensive care unit stay according to stapler head diameter, geographical region, or surgeon experience. Conclusion In patients undergoing left-sided bowel anastomosis, choice of manual circular stapler, in terms of manufacturer or head diameter, is not associated with rates of anastomotic leak and unplanned intensive care unit stay. [ABSTRACT FROM AUTHOR]

Abstract Background Postoperative neurogenic bladder (PONB) frequently occurs as a complication after rectal cancer surgery. This study aimed to analyze risk factors for developing PONB after rectal cancer surgery, particularly the association between pelvic anatomy and visceral fat mass. Methods We included 138 patients who underwent rectal resection for lower rectal cancer in our department between 2017 and 2021. PONB was defined as the need for urethral catheter reinsertion or oral medication administration for urinary retention after catheter removal with severe NB that required treatment for ≥ 60 days. We obtained visceral fat area (VFA) at the umbilical level based on a CT scan and measured five pelvic dimensions. Results Of the 138 patients, 19 developed PONB, with 16 being severe cases. PONB more frequently occurs in patients with a height of

Background: Postoperative neurogenic bladder (PONB) frequently occurs as a complication after rectal cancer surgery. This study aimed to analyze risk factors for developing PONB after rectal cancer surgery, particularly the association between pelvic anatomy and visceral fat mass. Methods: We included 138 patients who underwent rectal resection for lower rectal cancer in our department between 2017 and 2021. PONB was defined as the need for urethral catheter reinsertion or oral medication administration for urinary retention after catheter removal with severe NB that required treatment for ≥ 60 days. We obtained visceral fat area (VFA) at the umbilical level based on a CT scan and measured five pelvic dimensions. Results: Of the 138 patients, 19 developed PONB, with 16 being severe cases. PONB more frequently occurs in patients with a height of < 158 cm, age ≥ 70 years, surgery lasting ≥ 8 h, intraoperative bleeding volume ≥ 150 mL, lateral lymph node dissection, and narrower pelvis. It was more prevalent in cases with low VFA. Conversely, gender, body mass index (BMI), and medical history showed no significant correlations. Multivariate analysis revealed older age, prolonged surgery, and low VFA as independent risk factors for PONB. Independent risk factors for severe PONB included low VFA, older age, prolonged surgery, and deep pelvis. Conclusion: Lower VFA, older age, and prolonged surgery are independent risk factors for developing PONB. Additionally, a deep pelvis is an independent risk factor for severe PONB. Delicate surgical techniques should consider the risk of nerve injury in cases with low VFA and deep pelvis. [ABSTRACT FROM AUTHOR]

Purpose: Robotic-assisted rectal surgery (RARS) and Laparoscopic-assisted rectal surgery are the two techniques that are increasingly used for rectal cancer, and both have their advantages and disadvantages. This meta-analysis will analyze the outcomes of both techniques to determine their relative performance and suitability. Methods: An extensive search was carried out on PubMed, Cochrane, Scopus, Embase, and Google Scholar, followed by a meta-analysis of all randomized controlled trials (RCTs) to assess both approaches for rectal cancer. Results: This meta-analysis is comprised of fifteen RCTs. The conversion to open surgery (RR = 0.53, 95% CI: 0.38–0.74, P = 0.0002) was significantly lower in the RARS group. The outcomes like anastomotic leak, postoperative ileus, postoperative urinary retention (POUR), surgical site infection (SSI), and intra-abdominal abscess showed no significant difference between the two groups. The reoperation rate (RR = 0.56, 95% CI: 0.34–0.95, P = 0.03) was lower in the robotic group. High heterogeneity was obtained when pooling data on operative time, length of hospital stay, and blood loss. Oncological outcomes, including local recurrence, the number of harvested lymph nodes (LN) and distal resection margin showed no significant distinction among both groups, while the positive circumferential resection margin (CRM) (RR = 0.67, 95% CI: 0.49–0.91, P = 0.01) was lower in the RARS group. RARS demonstrated a significantly higher rate of total mesorectal excision (TME) (RR = 1.07, 95% CI: 1.01–1.14, P = 0.03). Conclusion: RARS is safe and feasible for rectal cancer patients and may be superior or equivalent to Laparoscopic-assisted rectal surgery, but high-standard, large-scale trials are required to determine the best approach. [ABSTRACT FROM AUTHOR]

Introduction: Limited data exists on oncological outcomes following rectal cancer surgery in men who have previously been diagnosed with prostate cancer (PC). This study aimed to assess overall mortality and rectal cancer recurrence in men previously diagnosed with PC who underwent bowel resection. Methods: Data from the Swedish Colorectal Cancer Registry identified men who had rectal cancer surgery between 2000 and 2016, and the National Prostate Cancer Registry was used to identify those with a prior PC diagnosis. Cox regression analysis with propensity score matching was employed for data analysis. The primary outcome was overall mortality. Secondary outcome was recurrence for rectal cancer. Results: Out of 13,299 men undergoing bowel resection for rectal cancer between 2000 and 2016, 1130 had a history of PC. Overall mortality did not significantly differ between men with and without a prior PC diagnosis. Cox regression analyses with propensity score matching revealed that men with previously diagnosed low- or intermediate-risk (HR, 0.79; 95% CI, 0.70–0.90) and high-risk PC (HR, 0.85; 95% CI, 0.74–0.98) had lower overall mortality after rectal cancer surgery compared with men without a PC. There was no significant difference in rectal cancer recurrence between men with a previous low or intermediate-risk PC (HR, 0.92; 95% CI, 0.74–1.14) or high-risk PC (HR, 0.73; 95% CI, 0.52–1.01) compared with those without PC history. Conclusion: Men undergoing rectal cancer surgery with a previous diagnosis of prostate cancer do not experience an increased risk of rectal cancer recurrence or overall mortality compared with men without a previous history of prostate cancer. [ABSTRACT FROM AUTHOR]

Rectal cancer surgery is complex and more technically challenging than colonic surgery. Over the last 30 years internationally, there has been a growing impetus for centralizing care to improve outcomes for rectal cancer. Centralizing care may potentially reduce variations of care, increase standardization and compliance with clinical practice guidelines. However, there are barriers to implementation at a professional, political, governance and resource allocation level. Centralization may increase inequalities to accessing healthcare, particularly impacting socioeconomically disadvantaged and rural populations with difficulties to commuting longer distances to "centres of excellence". Furthermore, it is unclear if centralization actually improves outcomes. Recent studies demonstrate that individual surgeon volume rather than hospital volume may be more important in achieving optimal outcomes. In this review, we examine the literature to assess the value of centralization for rectal cancer surgery. [ABSTRACT FROM AUTHOR]

Aim: Ensuring an adequate distal resection margin (DRM) is a key factor in achieving the gold standard in surgical treatment for rectal surgery. The aim of this article is to describe our surgical technique and the usefulness of intraoperative ultrasonography (IOUS) for evaluating the DRM during robotic rectal surgery (RRS). Method: Prospective data on five consecutive patients with rectal cancer who underwent RRS between January 2023 and December 2023 were collected. IOUS was utilized to evaluate the DRM in all patients. Results: The mean time for the IOUS examination ranged from 5 to 10 min. There were no intraoperative complications or conversions to open surgery. The median length of hospital stay was 6.4 days (±1.67 days). During hospitalization, one patient experienced a Grade II complication according to the Clavien–Dindo classification, specifically postoperative ileus. Furthermore, one patient experienced a delayed anastomotic fistula, which was conservatively treated without readmission. At definitive pathology, the median distance of the tumour from the DRM was 29 mm (±1.41 mm) and all patients had an R0 resection. Conclusion: IOUS is a reproducible and helpful modality for identifying the distal margin of the cutting line during robotic resection of rectal cancers. It does not affect the operating time compared with other methods and could be an alternative method for assessment of the DRM during RRS. [ABSTRACT FROM AUTHOR]

Aim: Diverting stomas are routinely used in restorative surgery following total mesorectal exicision (TME) for rectal cancer to mitigate the clinical risks of anastomotic leakage (AL). However, routine diverting stomas are associated with their own complication profile and may not be required in all patients. A tailored approach based on personalized risk of AL and selective use of diverting stoma may be more appropriate. The aim of the TAilored SToma policY (TASTY) project was to design and pilot a standardized, tailored approach to diverting stoma in low rectal cancer. Method: A mixed‐methods approach was employed. Phase I externally validated the anastomotic failure observed risk score (AFORS). We compared the observed rate of AL in our cohort to the theoretical, predicted risk of the AFORS score. To identify the subset of patients who would benefit from early closure of the diverting stoma using C‐reactive protein (CRP) we calculated the Youden index. Phase II designed the TASTY approach based on the results of Phase I. This was evaluated within a second prospective cohort study in patients undergoing TME for rectal cancer between April 2018 and April 2020. Results: A total of 80 patients undergoing TME surgery for rectal cancer between 2016 and 2018 participated in the external validation of the AFORS score. The overall observed AL rate in this cohort of patients was 17.5% (n = 14). There was a positive correlation between the predicted and observed rates of AL using the AFORS score. Using ROC curves, we calculated a CRP cutoff value of 115 mg/L on postoperative day 2 for AL with a sensitivity of 86% and a negative predictive value of 96%. The TASTY approach was designed to allocate patients with a low risk AFORS score to primary anastomosis with no diverting stoma and high risk AFORS score patients to a diverting stoma, with early closure at 8–14 days, if CRP values and postoperative CT were satisfactory. The TASTY approach was piloted in 122 patients, 48 (39%) were identified as low risk (AFORS score 0–1) and 74 (61%) were considered as high risk (AFORS score 2–6). The AL rate was 10% in the low‐risk cohort of patient compared to 23% in the high‐risk cohort of patients, p = 0.078 The grade of Clavien‐Dindo morbidity was equivalent. The incidence of major LARS was lowest in the no stoma cohort at 3 months (p = 0.014). Conclusion: This study demonstrates the feasibility and safety of employing a selective approach to diverting stoma in patients with a low anastomosis following TME surgery for rectal cancer. [ABSTRACT FROM AUTHOR]

Background: Anastomotic leakage (AL) is one of the most feared complications in colorectal surgery, with an incidence of 12–39% and associated risk of mortality of 2–24%. The causes of AL and the ways to prevent it are currently under investigation. This study aims to verify if a quadruple assessment of colorectal anastomosis could reduce AL incidence. Methods: A retrospective analysis of prospectively collected data on rectal cancer surgery performed from January 2015 to December 2017 and from January 2021 to December 2023 at a tertiary referral cancer centre was performed. Demographics, clinicopathological features, short-term outcomes, recurrences, and survival were investigated. Results: A total of 293 patients were enrolled. AL incidence was lower in the quadruple assessment group than in the control group, reaching a statistically significant result (7.7% vs. 16%; p = 0.001). This result was also confirmed after a propensity score match analysis (PSM), in which the AL rate was lower in the quadruple assessment group (5.4% vs. 12.3%; p = 0.01). Conclusions: This study shows how the systematic implementation of a quadruple assessment when performing a colorectal anastomosis could increase awareness on anastomotic success and reduce the incidence of AL. [ABSTRACT FROM AUTHOR]

Rectal cancer shows specific characteristics in terms of pattern of recurrence, which occurs commonly at both local and distant sites. The standard of care for locally advanced rectal cancer (LARC) including neoadjuvant chemoradiotherapy, followed by surgery based on the total mesorectal excision principles leads to a reduction in the rates of local recurrences to 6–7% at 5 years. However, the outcomes among those with high-risk lesions remain unsatisfactory. On the contrary, neoadjuvant chemoradiotherapy results in long-term morbidities among those with low-risk lesions. Furthermore, the overall survival benefit of neoadjuvant therapy is still a subject to be debated, except for patients with complete or near-complete response to neoadjuvant therapy. Total neoadjuvant therapy (TNT) is a new paradigm of management of high-risk rectal cancer that includes early administration of the most effective systemic therapy either before or after neoadjuvant radiotherapy with or without chemotherapy prior to surgery with or without adjuvant chemotherapy. TNT potentially improves disease-free survival, even though whether it can prolong survival has been debatable. Recently, neoadjuvant chemotherapy only has been proved to be non-inferior to neoadjuvant chemoradiotherapy in patients with low-risk lesions. This review intends to review the current evidences of neoadjuvant therapy and propose a more customized paradigm of management of LARC. [ABSTRACT FROM AUTHOR]

This document contains summaries of several videos on colorectal surgery techniques. The videos cover a range of topics including rectal cancer surgery, pelvic exenteration, diagnostic tests, and surgical procedures for various conditions. The summaries provide information on the safety, feasibility, and efficacy of these techniques, as well as the importance of understanding anatomical variations. These videos offer valuable insights for researchers and library patrons interested in colorectal surgery. [Extracted from the article]

Background: Robotic three-dimensional magnified visual effects and field of view stabilization have enabled precise surgical operations. Intracorporeal anastomosis in right-sided colorectal cancer surgery is expected to shorten operation times, avoid paralytic ileus, and shorten wound lengths; however, there are few reports of intracorporeal anvil fixation for intestinal anastomosis in left-sided colorectal cancer surgery. Herein, we introduce a simple, novel procedure for using robotic purse-string suture (RPSS) in intracorporeal anastomosis with the double-stapling technique in rectal and sigmoid cancer surgery and report short-term outcomes. Methods: From September 2022 to April 2024, 105 consecutive patients underwent robotic surgery with double-stapling technique anastomosis for rectal or sigmoid colon cancer at our institution. Their data were retrospectively analyzed. Intracorporeal anastomosis with the double-stapling technique using RPSS was performed in 26 patients (the RPSS group), while the double-stapling technique anastomosis with extracorporeal anvil fixation was performed in 79 patients (the EC group). A 1:1 propensity score-matched analysis was performed (matching criteria: sex, age, body mass index (BMI), tumor location and tumor size) using a caliper 0.3. In the RPSS group, after tumor-specific or total mesorectal excision, specimens were extracted from the umbilical wound with simultaneous anvil placement in the body cavity. The oral colonic stump was robotically excised and robotically circumferentially stitched with 3–0 Prolene in all layers. After anvil insertion into the stump, the bowel wall of the colon was completely sewn onto the central rod of the anvil. Reconstructions were anastomosed using the double-stapling technique. Results: The matched cohort contained 23 patients in each group. The RPSS group had significantly less bleeding than the EC group (p = 0.038). Super-low anterior resection (SLAR) in the RPSS group had shorter total operative times than those in the EC group (p = 0.045). The RPSS group experienced no perioperative complications greater than Clavien–Dindo grade III or any anastomosis-related complications. Conclusions: The RPSS technique can be performed safely without any anastomosis-related complications and reduces the total operative times in SLAR and blood loss through total robotic surgery. This may be a useful modality for robotic colorectal surgery. [ABSTRACT FROM AUTHOR]

This review article explores advanced surgical approaches and anatomical insights for tailoring rectal cancer surgery, particularly focusing on low‐lying rectal cancer. With the evolution of imaging technologies, precise preoperative planning has become possible, enhancing the visualization of anatomy surrounding the rectum and enabling more accurate assessments of circumferential resection margin (CRM) involvement. The article emphasizes the dynamic nature of rectal cancer treatment, advocating for individualized surgical planning based on comprehensive preoperative imaging and intraoperative assessment. This approach aims to optimize patient care by integrating recent advancements and anatomical insights into clinical practice for the management of low‐lying rectal cancer. Particularly, the article discusses the importance of customizing the excision of Denonvilliers' fascia (DVF) based on tumor characteristics for optimal oncologic and functional outcomes, especially for anteriorly located tumors. It highlights the need for precise dissection techniques to ensure a negative CRM while preserving critical anatomical structures. Additionally, the review addresses the surgical management of tumors at the anorectal ring and introduces the Gate Approach for deep anterolateral pelvic dissection. Special attention is given to tumors impacting the membranous and prostate urethra, emphasizing tailored surgical approaches to balance complete tumor resection with the preservation of urogenital functions. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the outcomes of robotic-assisted rectal resection with conventional laparoscopic and open approaches, focusing on complication rates, conversion rates, length of hospital stay, and oncologic outcomes. Methods: A retrospective single-center cohort study included 106 patients with non-metastatic rectal cancer (UICC stages I-III) who underwent rectal resection from January 2013 to December 2023. Patients were assigned to open surgery (n = 23), conventional laparoscopic surgery (n = 55), or robotic-assisted surgery (n = 28). Results: Robotic surgery demonstrated significantly lower conversion rates compared to minimal-invasive surgeries (p = 0.047) and shorter hospital stays (11.5 ± 8 days) compared to open (17.91 ± 12 days) and laparoscopic (17.2 ± 14 days) surgeries (p = 0.001). The quality of the specimen was significantly better (Score 1) in robotic (85.71%) and open (89.09%) cases compared to laparoscopic approaches (47.83%) (p < 0.001). Laparoscopic surgery was identified as a risk factor for worse specimen quality (p < 0.001). Older patients (> 63 years) had a higher risk for conversion in univariate analysis (p = 0.049). Morbidity was comparable between the groups (p = 0.131), and the anastomotic leakage rate did not differ significantly (laparoscopic: 18.18%, open: 13.04%, robotic: 17.86%). Kaplan–Meier survival curves showed no significant differences in overall survival probabilities among the groups. Conclusion: Robotic-assisted rectal resection provides significant advantages in terms of lower conversion rates, better specimen quality, and shorter hospital stays while maintaining comparable complication rates and oncologic outcomes to conventional laparoscopic and open approaches. These findings support robotic surgery as a standard treatment option for rectal cancer. [ABSTRACT FROM AUTHOR]

Background: The da Vinci™ Surgical System, recognized as the leading surgical robotic platform globally, now faces competition from a growing number of new robotic surgical systems. With the expiration of key patents, innovative entrants have emerged, each offering unique features to address limitations and challenges in minimally invasive surgery. The hinotori™ Surgical Robot System (hinotori), developed in Japan and approved for clinical use in November 2022, represents one such entrant. This study demonstrates initial insights into the application of the hinotori in robot-assisted surgeries for patients with rectal neoplasms. Methods: The present study, conducted at a single institution, retrospectively reviewed 28 patients with rectal neoplasms treated with the hinotori from November 2022 to March 2024. The surgical technique involved placing five ports, including one for an assistant, and performing either total or tumor-specific mesorectal excision using the double bipolar method (DBM). The DBM uses two bipolar instruments depending on the situation, typically Maryland bipolar forceps on the right and Fenestrated bipolar forceps on the left, to allow precise dissection, hemostasis, and lymph node dissection. Results: The study group comprised 28 patients, half of whom were male. The median age was 62 years and the body mass index stood at 22.1 kg/m2. Distribution of clinical stages included eight at stage I, five at stage II, twelve at stage III, and three at stage IV. The majority, 26 patients (92.9%), underwent anterior resection using a double stapling technique. There were no intraoperative complications or conversions to other surgical approaches. The median operative time and cockpit time were 257 and 148 min, respectively. Blood loss was 15 mL. Postoperative complications were infrequent, with only one patient experiencing transient ileus. A median of 18 lymph nodes was retrieved, and no positive surgical margins were identified. Conclusions: The introduction of the hinotori for rectal neoplasms appears to be safe and feasible, particularly when performed by experienced robotic surgeons. The double bipolar method enabled precise dissection and hemostasis, contributing to minimal blood loss and effective lymph node dissection. [ABSTRACT FROM AUTHOR]

Background: Anastomotic stricture (AS) is a common complication following rectal cancer surgery with anastomosis, but its diagnosis and management pose significant challenges due to the lack of standardized diagnostic criteria. We present a case highlighting the complexities encountered in diagnosing and managing occult AS post-rectal cancer surgery. Case presentation: A 51-year-old male patient presented with symptoms suggestive of AS following robot-assisted laparoscopic low anterior resection for rectal adenocarcinoma. Despite conventional evaluations, including colonoscopy, digital rectal examination, and radiography, AS was not identified. Following prolonged and ineffective treatment for suspected conditions such as low anterior resection syndrome (LARS), the patient underwent anal dilatation, resulting in significant symptom improvement. Conclusions: This case underscores the challenges associated with diagnosing and managing occult AS following rectal cancer surgery. The absence of standardized diagnostic criteria and reliance on conventional modalities may lead to underdiagnosis and inadequate treatment. A comprehensive diagnostic approach considering intestinal diameter, elasticity, and symptoms related to difficult defecation may enhance diagnostic accuracy. Further research is needed to refine the diagnostic and therapeutic strategies for occult AS. [ABSTRACT FROM AUTHOR]