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Perioperative and Surgical Management of Gastrointestinal Cancers
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Perioperative and Surgical Management of Gastrointestinal Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 March 2025) | Viewed by 6156

Special Issue Editor

Dr. Malcolm West

E-Mail Website
Guest Editor
1. NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
2. Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
Interests: colorectal cancer; complex pelvic cancer; perioperative medicine; prehabilitation; tumour outcomes; shared decision making; body composition; mitochondrial bioenergetics

Special Issue Information

Dear Colleagues,

Surgery remains a cornerstone of modern cancer care. Significant recent technological innovations, such as minimally invasive gastrointestinal surgery, novel surgical techniques, perioperative risk stratification, neoadjuvant cancer treatments, diagnostic and interventional radiology, prehabilitation and enhanced recovery care bundles have become standards of care. Combined, these novel approaches have made surgery safer, with a significantly lower stress response and improved perioperative and long-term outcomes. Despite these innovations, major gastrointestinal cancer surgery still carries substantial risks. Postoperative complications prolong length of hospital stay, increase costs, increase readmissions, and impair a ‘back to baseline’ recovery. This Special Issue entitled ‘Perioperative and surgical management of gastrointestinal cancers’ aims to bring together international experts in gastrointestinal surgery and perioperative medicine in the fields of gastrointestinal cancer surgery, including but not limited to, upper gastrointestinal, colorectal, complex abdominal and pelvic cancer surgery, together with rarer surgical groups like anal, appendiceal and peritoneal malignancies.

This Special Issue will invite international experts to contribute comprehensive narrative and systematic reviews, as well as encourage the submission of original research and clinical trial data from a variety of international health-care models, with the aspiration of highlighting current clinical unmet needs and setting the future research agenda. Topics that are currently envisaged are minimally invasive surgery, management of polyp cancers, surgical treatment of locally advanced cancers, novel oncological techniques in gastrointestinal cancer treatment, the roles of perioperative medicine in the treatment of gastrointestinal cancers, the role of prehabilitation as part of the cancer journey and updates from rarer surgical tumour types like pseudomyxoma peritonei, small bowel cancers, peritoneal carcinomatosis and anal cancer surgery.   

Dr. Malcolm West
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gastrointestinal surgery
  • colorectal cancer
  • upper gastrointestinal cancer
  • anal cancer
  • peritoneal carcinomatosis
  • perioperative medicine
  • prehabilitation
  • minimally invasive surgery
  • advanced cancer surgery
  • exenterative surgery

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Published Papers (5 papers)

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Research

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11 pages, 810 KiB  
Article
Intravenous Iron for Perioperative Anaemia in Colorectal Cancer Surgery: A Nested Cohort Analysis
by Dominic Fritche, Frances Wensley, Yanika L. Johnson, Callum Robins, Mai Wakatsuki, Imogen C. Fecher-Jones, Lisa Sheppard, Malcolm A. West, Alice Aarvold, Mark R. Edwards, Michael P. W. Grocott, James Plumb and Denny Z. H. Levett
Cancers 2025, 17(11), 1877; https://doi.org/10.3390/cancers17111877 - 3 Jun 2025
Viewed by 490
Abstract
Background/Objectives: Iron deficiency anaemia (IDA) is a common complication in patients with colorectal cancer presenting for surgery. Perioperative IDA is associated with increased post-operative mortality and morbidity. The impact on clinical outcomes for the active management of anaemia before surgery, with treatments such [...] Read more.
Background/Objectives: Iron deficiency anaemia (IDA) is a common complication in patients with colorectal cancer presenting for surgery. Perioperative IDA is associated with increased post-operative mortality and morbidity. The impact on clinical outcomes for the active management of anaemia before surgery, with treatments such as intravenous (IV) iron, is uncertain. Methods: We performed a single-centre nested cohort study, analysing prospectively collected data from patients with colorectal cancer who were treated with IV iron prior to elective major abdominal surgery. Cox proportional hazard models were used to quantify the effect of anaemia treatment on length of stay. Other outcomes, including transfusion rates, were estimated using logistic regression analyses. Models were adjusted for age, sex, comorbidities and surgical details. Results: The length of stay was longer for patients with untreated anaemia compared to patients without anaemia (adjusted hazard ratio, HR 0.66 [95% confidence interval, CI 0.45, 0.95]). For patients with anaemia, the length of stay was shorter in those treated when compared to those not treated (adjusted HR 0.59 [95% CI 0.45, 0.78]). Patients with untreated anaemia had higher transfusion rates than patients with treated anaemia (adjusted odds ratio, OR 0.35 [95% CI 0.18, 0.66]) and non-anaemic patients (adjusted odds ratio, OR 0.20 [95% CI 0.07, 0.55]). Conclusions: This study suggests that treating iron deficiency anaemia with IV iron pre-operatively reduces length of stay and transfusion rates in colorectal cancer patients. Full article
(This article belongs to the Special Issue Perioperative and Surgical Management of Gastrointestinal Cancers)
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15 pages, 1542 KiB  
Article
The Impact of Prehabilitation on Patient Outcomes in Oesophagogastric Cancer Surgery: Combined Data from Four Prospective Clinical Trials Performed Across the UK and Ireland
by Sowrav Barman, Beth Russell, Robert C. Walker, William Knight, Cara Baker, Mark Kelly, James Gossage, Janine Zylstra, Greg Whyte, James Pate, Jesper Lagergren, Mieke Van Hemelrijck, Mike Browning, Sophie Allen, Shaun R. Preston, Javed Sultan, Pritam Singh, Timothy Rockall, William B. Robb, Roisin Tully, Lisa Loughney, Jarlath Bolger, Jan Sorensen, Chris G. Collins, Paul A. Carroll, Claire M. Timon, Mayilone Arumugasamy, Thomas Murphy, Noel McCaffrey, Mike Grocott, Sandy Jack, Denny Z. H. Levett, Tim J. Underwood, Malcolm A. West and Andrew R. Daviesadd Show full author list remove Hide full author list
Cancers 2025, 17(11), 1836; https://doi.org/10.3390/cancers17111836 - 30 May 2025
Viewed by 655
Abstract
Background: Prehabilitation is increasingly being used in patients undergoing multimodality treatment for oesophagogastric cancer (OGC). Most studies to date have been small, single-centre trials. This collaborative study sought to assess the overall impact of prehabilitation on patient outcomes following OGC surgery. Methods: Data [...] Read more.
Background: Prehabilitation is increasingly being used in patients undergoing multimodality treatment for oesophagogastric cancer (OGC). Most studies to date have been small, single-centre trials. This collaborative study sought to assess the overall impact of prehabilitation on patient outcomes following OGC surgery. Methods: Data came from four prospective prehabilitation trials conducted in the UK or Ireland in patients undergoing multimodality treatment for OGC. The studies included three randomised and one non-randomised clinical trial, each comparing a prehabilitation intervention group to controls. The prehabilitation interventions included aerobic training delivered by exercise physiologists alongside dietetic input throughout the treatment pathway. The primary outcome was survival (all-cause and disease-specific mortality). Secondary outcomes were differences in complications, cardio-respiratory fitness (changes in VO2 peak and anaerobic threshold (AT)), chemotherapy completion rates, hospital length of stay, changes in body mass index, tumour regression and complication rates of anastomotic leak and pneumonia. Cox and logistic regression analysis provided hazard ratios (HR) and odds ratios (OR), respectively, with 95% confidence intervals (CI), adjusted for confounders. Results: Among 165 patients included, 88 patients were in the prehabilitation group and 77 patients were in the control group. All-cause and disease-specific mortality were not improved by prehabilitation (HR 0.67 95% CI 0.21–2.12 and HR 0.82 95% CI 0.42–1.57, respectively). The prehabilitation group experienced fewer major complications (20% vs. 36%, p = 0.034; adjusted OR of 0.54; 95%CI 0.26–1.13). There was a mitigated decline in VO2 peak following neo-adjuvant therapy (delta prehabilitation −1.07 mL/kg/min vs. control −2.74 mL/kg/min; p = 0.035) and chemotherapy completion rates were significantly higher following prehabilitation (90% vs. 73%; p = 0.016). Hospital length of stay (10 vs. 12 days, p = 0.402) and neoadjuvant chemotherapy response (Mandard 1–3 41% vs. 35%; p = 0.494) favoured prehabilitation, albeit not statistically significantly. Conclusion: Despite some limitations in terms of heterogeneity of study methodology, this study suggests a number of meaningful clinical benefits from prehabilitation before surgery for OGC patients. Current initiatives to agree on national standards for delivering prehabilitation and the results of ongoing trials will help to further refine this important intervention and expand the evidence base to support the widespread adoption and implementation of prehabilitation programs. Full article
(This article belongs to the Special Issue Perioperative and Surgical Management of Gastrointestinal Cancers)
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19 pages, 6070 KiB  
Article
A Prospective Observational Cohort Study Comparing High-Complexity Against Conventional Pelvic Exenteration Surgery
by Charles T. West, Abhinav Tiwari, Yousif Salem, Michal Woyton, Natasha Alford, Shatabdi Roy, Samantha Russell, Ines S. Ribeiro, Julian Smith, Hideaki Yano, Keith Cooper, Malcolm A. West and Alex H. Mirnezami
Cancers 2025, 17(1), 111; https://doi.org/10.3390/cancers17010111 - 1 Jan 2025
Cited by 2 | Viewed by 1686
Abstract
Background: Conventional pelvic exenteration (PE) comprises the removal of all or most central pelvic organs and is established in clinical practise. Previously, tumours involving bone or lateral sidewall structures were deemed inoperable due to associated morbidity, mortality, and poor oncological outcomes. Recently however [...] Read more.
Background: Conventional pelvic exenteration (PE) comprises the removal of all or most central pelvic organs and is established in clinical practise. Previously, tumours involving bone or lateral sidewall structures were deemed inoperable due to associated morbidity, mortality, and poor oncological outcomes. Recently however high-complexity PE is increasingly described and is defined as encompassing conventional PE with the additional resection of bone or pelvic sidewall structures. This observational cohort study aimed to assess surgical outcomes, health-related quality of life (HrQoL), decision regret, and costs of high-complexity PE for more advanced tumours not treatable with conventional PE. Methods: High-complexity PE data were retrieved from a prospectively maintained quaternary database. The primary outcome was overall survival. Secondary outcomes were perioperative mortality, disease control, major morbidity, HrQoL, and health resource use. For cost–utility analysis, a no-PE group was extrapolated from the literature. Results: In total, 319 cases were included, with 64 conventional and 255 high-complexity PE, and the overall survival was equivalent, with medians of 10.5 and 9.8 years (p = 0.52), respectively. Local control (p = 0.30); 90-day mortality (0.0% vs. 1.2%, p = 1.00); R0-resection rate (87% vs. 83%, p = 0.08); 12-month HrQoL (p = 0.51); and decision regret (p = 0.90) were comparable. High-complexity PE significantly increased overall major morbidity (16% vs. 31%, p = 0.02); and perioperative costs (GBP 37,271 vs. GBP 45,733, p < 0.001). When modelled against no surgery, both groups appeared cost-effective with incremental cost-effectiveness ratios of GBP 2446 and GBP 5061. Conclusions: High-complexity PE is safe and feasible, offering comparable survival outcomes and HrQoL to conventional PE, but with greater morbidity and resource use. Despite this, it appears cost-effective when compared to no surgery and palliation. Full article
(This article belongs to the Special Issue Perioperative and Surgical Management of Gastrointestinal Cancers)
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Review

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21 pages, 918 KiB  
Review
A Scoping Review of the Implications and Applications of Body Composition Assessment in Locally Advanced and Locally Recurrent Rectal Cancer
by Dinh Van Chi Mai, Ioanna Drami, Edward T. Pring, Laura E. Gould, Jason Rai, Alison Wallace, Nicola Hodges, Elaine M. Burns, John T. Jenkins and on behalf of the BiCyCLE Research Group
Cancers 2025, 17(5), 846; https://doi.org/10.3390/cancers17050846 - 28 Feb 2025
Viewed by 978
Abstract
Background: A strong body of evidence exists demonstrating deleterious relationships between abnormal body composition (BC) and outcomes in non-complex colorectal cancer. Complex rectal cancer (RC) includes locally advanced and locally recurrent tumours. This scoping review aims to summarise the current evidence examining [...] Read more.
Background: A strong body of evidence exists demonstrating deleterious relationships between abnormal body composition (BC) and outcomes in non-complex colorectal cancer. Complex rectal cancer (RC) includes locally advanced and locally recurrent tumours. This scoping review aims to summarise the current evidence examining BC in complex RC. Methods: A literature search was performed on Ovid MEDLINE, EMBASE, and Cochrane databases. Original studies examining BC in adult patients with complex RC were included. Two authors undertook screening and full-text reviews. Results: Thirty-five studies were included. Muscle quantity was the most commonly studied BC metric, with sarcopenia appearing to predict mortality, recurrence, neoadjuvant therapy outcomes, and postoperative complications. In particular, 10 studies examined relationships between BC and neoadjuvant therapy response, with six showing a significant association with sarcopenia. Only one study examined interventions for improving BC in patients with complex RC, and only one study specifically examined patients undergoing pelvic exenteration. Marked variation was also observed in terms of how BC was quantified, both in terms of anatomical location and how cut-off values were defined. Conclusions: Sarcopenia appears to predict mortality and recurrence in complex RC. An opportunity exists for a meta-analysis examining poorer BC and neoadjuvant therapy outcomes. There is a paucity of studies examining interventions for poor BC. Further research examining BC specifically in patients undergoing pelvic exenteration surgery is also lacking. Pitfalls identified include variances in how BC is measured on computed tomography and whether external cut-off values for muscle and adipose tissue are appropriate for a particular study population. Full article
(This article belongs to the Special Issue Perioperative and Surgical Management of Gastrointestinal Cancers)
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Other

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22 pages, 3314 KiB  
Systematic Review
Interventions Provided by Physiotherapists to Prevent Complications After Major Gastrointestinal Cancer Surgery: A Systematic Review and Meta-Analysis
by Sarah White, Sarine Mani, Romany Martin, Julie Reeve, Jamie L. Waterland, Kimberley J. Haines and Ianthe Boden
Cancers 2025, 17(4), 676; https://doi.org/10.3390/cancers17040676 - 17 Feb 2025
Viewed by 1225
Abstract
Background/Objectives: Major surgery for gastrointestinal cancer carries a 50% risk of postoperative complications. Physiotherapists commonly provide interventions to patients undergoing gastrointestinal surgery for cancer with the intent of preventing complications and improving recovery. However, the evidence is unclear if physiotherapy is effective compared [...] Read more.
Background/Objectives: Major surgery for gastrointestinal cancer carries a 50% risk of postoperative complications. Physiotherapists commonly provide interventions to patients undergoing gastrointestinal surgery for cancer with the intent of preventing complications and improving recovery. However, the evidence is unclear if physiotherapy is effective compared to providing no physiotherapy, nor if timing of service delivery during the perioperative pathway influences outcomes. The objective of this review is to evaluate and synthesise the evidence examining the effects of perioperative physiotherapy interventions delivered with prophylactic intent on postoperative outcomes compared to no treatment or early mobilisation alone. Methods: A protocol was prospectively registered with PROSPERO and a systematic review performed of four databases. Randomised controlled trials examining prophylactic physiotherapy interventions in adults undergoing gastrointestinal surgery for cancer were eligible for inclusion. Results: Nine publications from eight randomised controlled trials were included with a total sample of 1418 participants. Due to inconsistent reporting of other perioperative complications, meta-analysis of the effect of physiotherapy was only possible specific to postoperative pulmonary complications (PPCs). This found an estimated 59% reduction in risk with exposure to physiotherapy interventions (RR 0.41, 95%CI 0.23 to 0.73, p < 0.001). Sub-group analysis demonstrated that timing of delivery may be important, with physiotherapy delivered only in the preoperative phase or combined with a postoperative service significantly reducing PPC risk (RR 0.32, 95%CI 0.17 to 0.60, p < 0.001) and hospital length of stay (MD–1.4 days, 95%CI −2.24 to −0.58, p = 0.01), whilst the effect of postoperative physiotherapy alone was less certain. Conclusions: Preoperative-alone and perioperative physiotherapy is likely to minimise the risk of PPCs in patients undergoing gastrointestinal surgery for cancer. This challenges current traditional paradigms of providing physiotherapy only in the postoperative phase of surgery. A review with broader scope and component network analysis is required to confirm this. Full article
(This article belongs to the Special Issue Perioperative and Surgical Management of Gastrointestinal Cancers)
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