Colorectal Surgery: Clinical Advances and Challenges

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (20 June 2024) | Viewed by 5621

Special Issue Editors


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Guest Editor
General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forli, Italy
Interests: colo-rectal surgery; CRS plus HIPEC; peritoneal surface malignancy; ICG fluorescence; HPB surgery
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Guest Editor
General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forli, Italy
Interests: colo-rectal surgery; CRS plus HIPEC; gastric surgery; peritoneal surface malignancy

Special Issue Information

Dear Colleagues,

Colorectal surgery is well established as the main treatment for colon cancer; however, some topics related to surgical strategy and its integration with other methods are still hotly debated.

The scope of this Special Issue is to gather and present innovative data regarding the following topics:

  • recommendations for the use of complete mesocolic excision (CME);
  • integrated therapeutic strategies (cytoreductive surgery plus HIPEC, EPIC, PIPAC…) that are used to improve the outcomes of OS and DFS in advanced diseases;
  • the latest operative tools used to optimize surgical resection and reduce the risk of iatrogenic injury, including but not limited to the use of targeted tumour tracking and intraoperative fluorescent imaging with indocyanine green.

We welcome original articles on pre-clinical and clinical research, as well as systematic reviews, cohort studies, and case reports adhering to the aforementioned theme of surgical management of colorectal cancer.

Dr. Fabrizio D'Acapito
Dr. Massimo Framarini
Guest Editors

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Keywords

  • colorectal surgery
  • complete mesocolic excision
  • indocyanine green (ICG) fluorescence
  • hyperthermic intraperitoneal chemotherapy
  • injury prevention
  • outcomes

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Published Papers (4 papers)

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Research

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11 pages, 541 KiB  
Article
Clinical Outcomes after Intracorporeal versus Extracorporeal Anastomosis in Patients Undergoing Laparoscopic Right Hemicolectomy for Colon Cancer
by Yu-Yao Chang, Bill Cheng and Gwo-Tarng Sheu
Medicina 2024, 60(7), 1073; https://doi.org/10.3390/medicina60071073 - 29 Jun 2024
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Abstract
Background and Objectives: Laparoscopic right hemicolectomy (LRHC) is commonly performed for patients with colon cancer, selecting between intracorporeal anastomosis (ICA) or extracorporeal anastomosis (ECA). However, the impact of ICA versus ECA on patient outcomes remains debatable. The varying levels of experience among [...] Read more.
Background and Objectives: Laparoscopic right hemicolectomy (LRHC) is commonly performed for patients with colon cancer, selecting between intracorporeal anastomosis (ICA) or extracorporeal anastomosis (ECA). However, the impact of ICA versus ECA on patient outcomes remains debatable. The varying levels of experience among surgeons may influence the outcomes. Therefore, this study sought to compare the short- and long-term outcomes of LRHC using ICA versus ECA. Materials and Methods: This retrospective study extracted patient data from the medical records database of Changhua Christian Hospital, Taiwan, from 2017 to 2020. Patients with colon cancer who underwent LRHC with either ICA or ECA were included. Primary outcomes were post-surgical outcomes and secondary outcomes were recurrence rate, overall survival (OS), and cancer-specific survival (CSS). Between-group differences were compared using chi-square, t-tests, and Fisher’s exact tests and Mann–Whitney U tests. Associations between study variables, OS, and CSS were determined using Cox analyses. Results: Data of 240 patients (61 of ICA and 179 of ECA) with a mean age of 65.0 years and median follow-up of 49.3 months were collected. No recognized difference was found in patient characteristics between these two groups. The ICA group had a significantly shorter operation duration (median (IQR): 120 (110–155) vs. 150 (130–180) min) and less blood loss (median (IQR): 30 (10–30) vs. 30 (30–50) mL) than the ECA group (p < 0.001). No significant differences were found in 30-day readmission (ICA vs. ECA: 1.6% vs. 2.2%, p > 0.999) or recurrence (18.0% vs. 13.4%, p = 0.377) between the two groups. Multivariable analyses revealed no significant differences in OS (adjusted hazard ratio (aHR): 0.65; 95% confidence interval (CI): 0.25–1.44) or CSS (adjusted sub-hazard ratio (aSHR): 0.41, 95% CI: 0.10–1.66) between groups. Conclusions: Both ICA and ECA in LRHC for colon cancer had similar outcomes without statistically significant differences in post-surgical complications, 30-day readmission rates, recurrence rate, and long-term survival outcomes. However, ICA may offer two advantages in terms of a shorter operative duration and reduced blood loss. Full article
(This article belongs to the Special Issue Colorectal Surgery: Clinical Advances and Challenges)
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10 pages, 1521 KiB  
Article
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Management of Colorectal Cancer with Peritoneal Metastasis: A Single-Center Cohort Study
by Fabrizio D’Acapito, Massimo Framarini, Daniela Di Pietrantonio, Francesca Tauceri, Valentina Zucchini, Eleonora Pozzi, Leonardo Solaini and Giorgio Ercolani
Medicina 2024, 60(7), 1058; https://doi.org/10.3390/medicina60071058 - 27 Jun 2024
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Abstract
Multimodal treatment in peritoneal metastases (PM) from colorectal neoplasms may improve overall survival (OS). In this study, we reported our experience in using cytoreductive surgery (CRS) combined with intraperitoneal chemohyperthermia (HIPEC) for the treatment of peritoneal metastases (PM) from colorectal neoplasms. The first [...] Read more.
Multimodal treatment in peritoneal metastases (PM) from colorectal neoplasms may improve overall survival (OS). In this study, we reported our experience in using cytoreductive surgery (CRS) combined with intraperitoneal chemohyperthermia (HIPEC) for the treatment of peritoneal metastases (PM) from colorectal neoplasms. The first aim was to evaluate the overall survival of these patients. Furthermore, using the results of the Prodige 7 Trial and incorporating them with the entropy balance statistical tool, we generated a pseudopopulation on which to test the use of CRS alone. We performed a retrospective analysis based on a prospective database of all 55 patients treated with CRS + HIPEC between March 2004 and January 2023. The median OS was 47 months, with 1-, 3- and 5-year survival rates of 90.8%, 58.7% and 42.7%, respectively. There was no significant difference in the data in the pseudogroup generated with entropy balance. This finding confirms the critical role of complete cytoreduction in achieving the best OS for patients with PM. PCI > 6 seems to be the most important prognostic factor influencing OS. At present, CRS + HIPEC seems to be the therapeutic strategy that guarantees the best results in terms of OS for patients with relatively low PCI and in whom a CCS ≤ 1 can be achieved. Full article
(This article belongs to the Special Issue Colorectal Surgery: Clinical Advances and Challenges)
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9 pages, 1342 KiB  
Article
Long-Term Outcome of Surgery for Perianal Crohn’s Fistula
by Marie Schaad, Alain Schoepfer, Jean-Benoît Rossel, Mamadou Pathé Barry, Gerhard Rogler and Dieter Hahnloser
Medicina 2024, 60(7), 1035; https://doi.org/10.3390/medicina60071035 - 24 Jun 2024
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Abstract
Background and Objectives: Patients with perianal Crohn’s (CD) fistula often need repetitive surgeries and none of the established techniques was shown to be superior or preferable. Furthermore, the long-term outcome of fistula Seton drainage is not well described. The aims of this [...] Read more.
Background and Objectives: Patients with perianal Crohn’s (CD) fistula often need repetitive surgeries and none of the established techniques was shown to be superior or preferable. Furthermore, the long-term outcome of fistula Seton drainage is not well described. The aims of this study were to analyze the long-term healing and recurrence rate of CD perianal fistulas in a large patient cohort. Materials and Methods: Database analysis of the Swiss IBD (Inflammatory Bowel Disease) cohort study. Results: 365 perianal fistula patients with 576 surgical interventions and a median follow-up of 7.5 years (0–12.6) were analyzed. 39.7% of patients required more than one procedure. The first surgical interventions were fistulectomies ± mucosal sliding flap (59.2%), Seton drainage (29.6%), fistula plugs or fibrin glue installations (2.5%) and combined procedures (8.8%). Fistulectomy patients required no more surgery in 69%, one additional surgery in 25% and more than one additional surgery in 6%, with closure rates at 7.5 years follow-up of 77.1%, 74.1% and 66.7%, respectively. In patients with Seton drainage as index surgery, 52% required no more surgery, and over 75% achieved fistula closure after 10 years. Conclusions: First-line fistulectomies, when feasible, achieved the highest healing rates, but one-third of patients required additional surgeries, and one-fourth of patients will remain with a fistula at 10 years. Initial Seton drainage and concurrent medical therapy can achieve fistula closure in 75%. However, in 50% of patients, more surgeries are needed, and fistula closure is achieved in only two-thirds of patients. Full article
(This article belongs to the Special Issue Colorectal Surgery: Clinical Advances and Challenges)
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Review

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16 pages, 1025 KiB  
Review
Obesity and Colorectal Cancer: A Narrative Review
by Bárbara Cristina Jardim Miranda, Francisco Tustumi, Eric Toshiyuki Nakamura, Victor Haruo Shimanoe, Daniel Kikawa and Jaques Waisberg
Medicina 2024, 60(8), 1218; https://doi.org/10.3390/medicina60081218 - 27 Jul 2024
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Abstract
Background and Objectives: Cancer is a multicausal disease, and environmental, cultural, socioeconomic, lifestyle, and genetic factors can influence the risk of developing cancer. Colorectal cancer (CRC) stands as the third most common cancer globally. Some countries have observed a rise in the [...] Read more.
Background and Objectives: Cancer is a multicausal disease, and environmental, cultural, socioeconomic, lifestyle, and genetic factors can influence the risk of developing cancer. Colorectal cancer (CRC) stands as the third most common cancer globally. Some countries have observed a rise in the incidence of CRC, especially among young people. This increase is associated with lifestyle changes over the last few decades, including changes in diet patterns, a sedentary lifestyle, and obesity. Currently, obesity and overweight account for approximately 39% of the world’s population and increase the risk of overall mortality of certain cancer types. This study aims to conduct a literature review examining the association between obesity and CRC. Materials and Methods: This narrative review explored the pathophysiological mechanisms, treatment strategies, and challenges related to obesity and CRC. Results: Several studies have established a clear causal relationship between obesity and CRC, showing that individuals with morbid obesity are at a higher risk of developing colorectal cancer. The adipose tissue, particularly the visceral, secretes proinflammatory cytokines, such as TNF-alpha, interleukin-6, and C-reactive protein. Chronic inflammation is closely linked to cancer initiation and progression, with a complex interplay of molecular mechanisms underlying this association. Obesity can complicate the treatment of CRC due to several factors, reducing the therapeutic effectiveness and increasing the risk for adverse events during treatment. Dietary modification, calorie restriction, and other types of weight-control strategies can reduce the risk of CRC development and improve treatment outcomes. Conclusions: Obesity is intricately linked to CRC development and progression, making it a crucial target for intervention, whether through diet therapy, physical exercises, medical therapy, or bariatric surgery. Full article
(This article belongs to the Special Issue Colorectal Surgery: Clinical Advances and Challenges)
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