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Clinical Aspects and Outcomes in Contemporary Colorectal Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (25 February 2026) | Viewed by 6296

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Dr. Lior Segev

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Head of Colorectal Cancer Surgery Service, Division of Surgery, Sheba Medical Center, Tel Hashomer, Israel Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
Interests: colorectal surgery; colorectal cancer; IBD (inflammatory bowel disease) surgery

Special Issue Information

Dear Colleagues,

Over the last several years, along with the gradual rise in colorectal cancer and Crohn’s disease incidence, the field of colorectal surgery has been rapidly evolving and growing. We, as colorectal surgeons, feel this increase in the volumes of patients with colorectal diseases being referred to us on a daily basis. The aim of the present Topical Collection is to serve as a forum for addressing core issues in colorectal surgery, including, but not limited to, surgical techniques, perioperative management, postoperative recovery, and surgical outcomes. We invite the submission of manuscripts in all areas of colorectal surgery. Priority will be given to high-quality, original studies, but well-designed and conducted systematic reviews (with or without metanalysis) giving a comprehensive overview of the state of the art on a specific topic are also welcome. In summary, this Topical Collection will increase clinicians’ knowledge of poorly explored areas of coloproctology, as well as providing a balanced, sound, and evidence-based overview of advances and potential perspectives in the field of colorectal surgery.

Dr. Lior Segev
Guest Editor

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Keywords

colorectal surgery
colorectal cancer
Crohn’s disease
ulcerative colitis
coloproctology
minimally invasive surgery

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Published Papers (4 papers)

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Research

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14 pages, 562 KB

Open AccessArticle

Female Trans-Sphincteric Anterior Anal Fistula: Still an Unsolved Problem—Results from a Nationwide Cohort Study

by Alba Correa Bonito, Óscar Cano Valderrama, Manuel Muinelo Lorenzo, Begoña Ochoa Villalabeitia, Juan Ocaña Jiménez, Beatriz Martín Pérez, Lidia Cristóbal Poch, Tamara Fernández Miguel, Carlos Cerdán Santacruz and on behalf of Young Group of Spanish Coloproctology Association

J. Clin. Med. 2025, 14(20), 7326; https://doi.org/10.3390/jcm14207326 - 16 Oct 2025

Viewed by 1159

Abstract

Background/Objectives: Female trans-sphincteric anterior anal fistula is one of the most challenging fistulae because of the inherent risk of postoperative incontinence. The objective of this study is to analyze current surgical practices in these patients and their results. Methods: This study is a nationwide cohort retrospective study of all female patients with trans-sphincteric anterior anal fistula that were operated on in 2019. The primary outcomes measured were the analysis of the different techniques used in this type of patient and the results in terms of healing, persistence and recurrence. Results: We analyzed 139 patients that were operated on in 2019 because of an anterior trans-sphincteric fistula. The most usual technique performed was fistulotomy (29.5%), followed by ligation of the inter-sphincteric fistula tract (22.3%). The overall healing rate was 60.4%, taking into account that this rate was higher for fistulotomy (87.8%) than for sphincter-preserving techniques such as ligation of the inter-sphincteric fistula tract, advanced flap and fistulotomy plus sphincterography (51.8%). The main protective factors for healing that have been identified are the absence of current smoking and the realization of a fistulotomy. The overall postoperative incontinence rate is 12.6%, which is higher in patients with higher fistula (25%). It is important to highlight that in low fistula, the rate of incontinence in techniques different from fistulotomy is about 25%. The only risk factor for incontinence that has been identified is obesity. Conclusions: The treatment of this type of fistula is still a big challenge with high diversity in terms of surgical techniques, even though, fistulotomy still remains safe and with good results in terms of healing and incontinence in low fistulas and medium fistulas with strict selection criteria. In these cases, fistulotomy is the indicated procedure. Full article

(This article belongs to the Special Issue Clinical Aspects and Outcomes in Contemporary Colorectal Surgery)

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15 pages, 1037 KB

Open AccessArticle

Decoding the Effect of Frailty vs. Physiologic Age in Octogenarian and Nonagenarian Colectomy Outcomes for Colon Cancer

by Philip Drohat, Alexandra E. Hernandez, Ana M. Reyes, Karishma Kodia, Chelsea Caplan, Talia R. Arcieri, Shayan Khalafi, Matthew S. Meece and Vanessa W. Hui

J. Clin. Med. 2025, 14(17), 5985; https://doi.org/10.3390/jcm14175985 - 24 Aug 2025

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Abstract

Background/Objectives: Colorectal surgeons continue to care for an aging cancer population with increasing comorbidities and frailty. Frailty, characterized by a systemic physiologic decline associated with aging, is an increasingly popular focus in surgical outcomes research. This retrospective study investigates how frailty impacts outcomes in the octogenarian and nonagenarian populations undergoing surgical treatment for colon cancer. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) colectomy-targeted variables dataset from 2015 to 2021 were utilized for this analysis, including patients 80 years of age and older. Frailty was assessed using the five-factor modified frailty index (mFI-5). The study examined post-operative outcomes across frailty groups in this population. Results: From 2015–2021, there were 10,671 patients aged 80 years and older who underwent colectomy for colon cancer, of whom 1259 (11.8%) were 90 years or older and 2844 (26.7%) were severely frail. Frailty significantly impacted post-operative colectomy outcomes in this population. On univariate analysis, frail patients had higher rates of pneumonia (p = 0.015), unplanned intubation (p = 0.012), stroke (p < 0.001), myocardial infarction (p = 0.011), readmission (p < 0.001), long length of stay (p < 0.001), and mortality (p < 0.001) compared to non-frail patients. On multivariate analysis, severe frailty (mFI-5 of 2 or more) was associated with an increased odds of unplanned intubation (aOR 2.41, 95% CI 1.27–4.59), long length of stay (aOR 1.73, 95% CI 1.44–2.09), readmission (aOR 1.84, 95% CI 1.42–2.39), and mortality (aOR 1.95, 95% CI 1.20–3.15) compared to non-frail patients. Conclusions: Frailty plays a critical role in influencing the outcomes of octogenarians and nonagenarians undergoing colectomy for colon cancer within the NSQIP dataset. Future work should investigate whether addressing frailty prior to surgery in this population can improve patients’ post-operative courses. Full article

(This article belongs to the Special Issue Clinical Aspects and Outcomes in Contemporary Colorectal Surgery)

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14 pages, 573 KB

Open AccessArticle

Predictors and Long-Term Outcomes of Pathological Complete Response Following Neoadjuvant Treatment and Radical Surgery for Locally Advanced Rectal Cancer

by Dan Assaf, Yaacov Lawrence, Ofer Margalit, Einat Shacham-Shmueli, Lior Bear, Nadav Elbaz, Alexander Lebedayev, Edward Ram, Yasmin Anderson, Ofir Gruper, Michael Goldenshluger and Lior Segev

J. Clin. Med. 2025, 14(12), 4251; https://doi.org/10.3390/jcm14124251 - 15 Jun 2025

Cited by 3 | Viewed by 2219

Abstract

Background: Pathological complete response (pCR) following neoadjuvant therapy and surgery for locally advanced rectal cancer is associated with improved prognosis. Accurately predicting who will achieve pCR could theoretically eliminate the need for surgery for these patients. We aimed to compare pCR and non-pCR rectal cancer patients following neoadjuvant therapy, searching for clinical predictors for pCR and comparing oncological outcomes between these groups. Methods: This is a single-center retrospective analysis of all patients who underwent a curative-intent rectal resection between 2010 and 2020 for primary non-metastatic rectal cancer following neoadjuvant therapy. The cohort (263 patients) was divided into two groups according to the pathological results from surgery: the pCR group (53 patients) and the non-pCR group (210 patients). Results: The groups were similar in terms of baseline characteristics, clinical presentation, and staging, but tumors of the pCR group were significantly higher in the rectum (mean distance from the anal verge 7.92 cm versus 6.9 cm respectively, p = 0.04), and more of them were located at the posterior rectal wall (37.7% versus 24.3%, p = 0.049). Multivariate analysis found posterior location and tumor height to be significantly associated with pCR (OR 2.23, 95% CI 1.11–4.45, p = 0.023), (OR 1.14, 95% CI 1.03–1.27, p = 0.015). The 5-year overall survival was 95.6% in the pCR group compared with 87.5% in the non-pCR group (p = 0.09), and the 5-year disease-free survival was 92.7% versus 64.5%, respectively (p < 0.001). Conclusions: Tumor location at the posterior wall of the rectum and higher tumor location were found to be associated with pCR. Patients achieving pCR demonstrate improved prognosis compared with non-pCR patients. Full article

(This article belongs to the Special Issue Clinical Aspects and Outcomes in Contemporary Colorectal Surgery)

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Review

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16 pages, 2261 KB

Open AccessReview

The Kock Pouch in Modern Practice Revisited: A Literature Review and Clinically Relevant Summary

by Rozan Marjiyeh Awwad, Pär Myrelid and Hayim Gilshtein

J. Clin. Med. 2025, 14(23), 8541; https://doi.org/10.3390/jcm14238541 - 2 Dec 2025

Viewed by 1078

Abstract

In patients requiring an ileostomy, the selection of the reconstruction method significantly influences long-term functionality and quality of life. Engaging young patients with the reality of a permanent ileostomy for the remainder of their lives is particularly sensitive and naturally encourages the search for alternative options that may be offered in select cases. Although the end ileostomy and ileal pouch–anal anastomosis (IPAA) continue to be the standard procedures, both possess inherent limitations. When neither approach is feasible, or when these reconstructive techniques have been unsuccessful, having an alternative such as the continent ileostomy (CI) (Kock pouch) proves highly valuable. This review aims to summarize the current indications, contraindications, technical challenges, and outcomes of the Kock pouch to provide surgeons, especially persons with less experience with this procedure, with relevant clinically meaningful information for proper counseling and management of patients. Full article

(This article belongs to the Special Issue Clinical Aspects and Outcomes in Contemporary Colorectal Surgery)

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