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Colorectal Surgery: Innovative Techniques and Enhanced Patient Outcomes
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Colorectal Surgery: Innovative Techniques and Enhanced Patient Outcomes

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

Deadline for manuscript submissions: 20 August 2026 | Viewed by 5456

Special Issue Editors

Dr. Filippo Carannante

E-Mail Website
Guest Editor
Colorectal Surgery Unit, Campus Bio-Medico University Hospital, Via Álvaro del Portillo, 200, 00128 Rome, Italy
Interests: colorectal surgery; minimally invasive techniques; artificial intelligence; perioperative patient management; translational research in coloproctology
Dr. Leandro Siragusa

E-Mail Website
Guest Editor
Division of Colon and Rectal Surgery, Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
Interests: colorectal surgery; minimally invasive techniques; artificial intelligence; perioperative patient management; translational research in coloproctology

Special Issue Information

Dear Colleagues,

Colorectal surgery has experienced rapid advancements in recent years, with newer technologies and techniques increasingly becoming part of surgical practice. However, there are still many areas in coloproctology that remain underexplored, and the drive to clarify these uncertainties continues to grow, alongside the integration of innovations into clinical practice. The aim of this Special Issue is to provide a platform for critically evaluating how recent technological developments have influenced colorectal surgery outcomes, perioperative patient management, postoperative recovery, and the overall patient experience during surgery. Manuscripts are invited that critically assess the role of minimally invasive approaches, the application of artificial intelligence and big data in decision-making, perioperative patient optimization, the use of translational research in coloproctology, or the comparison of outcomes between various innovative approaches to colorectal diseases. Priority will be given to high-quality original studies and well-designed and conducted systematic reviews or meta-analyses that offer a concise and comprehensive overview of the current state of the art on a specific topic.

Dr. Filippo Carannante
Dr. Leandro Siragusa
Guest Editors

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 short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

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. Journal of Clinical Medicine 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 2600 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

  • colorectal surgery
  • minimally invasive techniques
  • artificial intelligence
  • perioperative patient management
  • translational research in coloproctology

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Published Papers (4 papers)

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Research

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10 pages, 883 KB  
Article
Increased Risk of Central Mesocolic Lymph Node Metastases in BRAF-Mutated Stage I-III Colon Cancer
by Justas Kuliavas, Kristina Marcinkeviciute, Ieva Vaicekauskaite, Rasa Sabaliauskaite, Augustinas Bausys, Audrius Dulskas, Ugnius Mickys, Rokas Stulpinas and Kestutis Strupas
J. Clin. Med. 2026, 15(7), 2766; https://doi.org/10.3390/jcm15072766 - 6 Apr 2026
Viewed by 391
Abstract
Background: The optimal extent of lymphadenectomy in colon cancer (CC) remains controversial. While Complete Mesocolic Excision (CME)/D3 dissection may improve oncological outcomes, the survival benefit appears limited to patients with central lymph node metastases (LNMs). Molecular profiling could help identify patients who [...] Read more.
Background: The optimal extent of lymphadenectomy in colon cancer (CC) remains controversial. While Complete Mesocolic Excision (CME)/D3 dissection may improve oncological outcomes, the survival benefit appears limited to patients with central lymph node metastases (LNMs). Molecular profiling could help identify patients who may benefit from extended lymphadenectomy. Methods: This prospective cohort sub-study of the international T-REX trial included 97 patients with stage I–III CC who underwent curative resection at the National Cancer Centre, Vilnius, Lithuania (2015–2018). Lymph node mapping was performed by anatomical zones, and BRAF and KRAS mutation status in primary tumors was determined by quantitative PCR. Associations between genetic mutations, LNM distribution, and survival outcomes were analyzed. Results: A total of 2710 lymph nodes were retrieved from 97 patients, of which 100 (3.7%) were metastatic, and identified in 33 (34.0%) patients. Central LNMs were observed in 5 (5.2%) patients overall but were significantly more frequent among those with BRAF-mutated tumors (30.8%) compared to KRAS-mutated (2.4%) or wild-type (0%) cases (p < 0.001). BRAF mutations were associated with increased odds of intermediate (OR 8.1, 95% CI 1.4–45.6) and central (OR 36.8, 95% CI 3.7–366.7) LNMs. Mutation status did not impact overall or disease-free survival. Conclusions: BRAF mutations in primary CC are linked to higher rates of intermediate and central LNMs. Patients with BRAF-mutated tumors may benefit from extended lymphadenectomy. Future randomized trials should evaluate biomarker-driven surgical strategies in CC. Full article
(This article belongs to the Special Issue Colorectal Surgery: Innovative Techniques and Enhanced Patient Outcomes)
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6 pages, 174 KB  
Article
Adenoma Detection Rates: Does Endoscopic Volume or Provider Specialty Matter More?
by Jacob Applegarth, Alexander Menning, Michael Tolkacz, Diane Studzinski and Matthew Ziegler
J. Clin. Med. 2025, 14(20), 7201; https://doi.org/10.3390/jcm14207201 - 13 Oct 2025
Viewed by 707
Abstract
Background: Adenoma detection rate (ADR) is a well-established quality indicator for colonoscopy. Previous studies have demonstrated a superior ADR for gastroenterologists versus non-gastroenterologists. However, the number of annual colonoscopies performed by non-gastroenterologists in these studies has been variable and often far fewer [...] Read more.
Background: Adenoma detection rate (ADR) is a well-established quality indicator for colonoscopy. Previous studies have demonstrated a superior ADR for gastroenterologists versus non-gastroenterologists. However, the number of annual colonoscopies performed by non-gastroenterologists in these studies has been variable and often far fewer than the number performed by gastroenterologists. Our study aims to compare ADR in gastroenterologists and specifically colorectal surgeons of comparable colonoscopy volumes at a single institution. Methods: A retrospective chart review of all screening colonoscopies for average-risk patients was performed at a single tertiary care facility, including colonoscopies performed by both gastroenterologists and colorectal surgeons. Univariate analysis was performed using GraphPad Prism v9.3.0. Results: No significant difference in overall adenoma detection rates (ADR) was appreciated between gastroenterologists and colorectal surgeons at our institution (36.3% (SD 12.3%) vs. 30.8% (SD 6.7%), respectively, p = 0.224). Colorectal surgeons were more likely to have a longer withdrawal time (15.20 min vs. 11.17 min). Gastroenterologists were more likely to collect any specimen during colonoscopy (40.4% vs. 53.6%). However, there was no statistically significant difference in ADR when comparing the top five highest volume colorectal surgeons and the top five highest volume gastroenterologists, and both high-volume groups met recognized benchmarks for male, female, and overall ADR (30%, 20%, 25%). Conclusions: Colorectal surgeons removed a similar number of tubulovillous adenomas compared to gastroenterologists. Gastroenterologists tend to remove more polyps overall, including more hyperplastic polyps and sessile serrated adenomas. Despite this, no significant difference in ADR was identified between high-volume colorectal surgeons and gastroenterologists. Full article
(This article belongs to the Special Issue Colorectal Surgery: Innovative Techniques and Enhanced Patient Outcomes)
8 pages, 987 KB  
Article
Improved Survival with Improved NAPRC Compliance: A Single-Institution Experience
by Harry Wasvary, Jacob A. Applegarth, Scarlett Hao, Tyler A. Kowalczyk, Gayaneh Nazarian and Claire Bova
J. Clin. Med. 2025, 14(19), 6872; https://doi.org/10.3390/jcm14196872 - 28 Sep 2025
Viewed by 671
Abstract
Background: The National Accreditation Program for Rectal Cancer (NAPRC) was developed in 2017. This study investigates three-year survival after diagnosis of rectal cancer as a function of compliance with NAPRC standards. Methods: A prospective database recorded compliance with 15 NAPRC standards for patients [...] Read more.
Background: The National Accreditation Program for Rectal Cancer (NAPRC) was developed in 2017. This study investigates three-year survival after diagnosis of rectal cancer as a function of compliance with NAPRC standards. Methods: A prospective database recorded compliance with 15 NAPRC standards for patients diagnosed August 2019 through August 2021. This database was retrospectively reviewed for compliance and three-year survival after diagnosis. Results: Three groups were identified (low, moderate, and high compliance) without significant difference in age (p = 0.662), sex (p = 0.919), race (p = 0.88), or disease stage (p = 0.166) between groups. Compared to the least compliant group, both moderate- and high-compliance groups had statistically significant lower hazard ratios (HR 0.22 and HR 0.12, respectively). Conclusions: Increased compliance led to a significant survival benefit. Rectal cancer patients who received care adherent to at least eight components of the NAPRC standards had a significant survival benefit three years after diagnosis compared to patients with less compliance. Full article
(This article belongs to the Special Issue Colorectal Surgery: Innovative Techniques and Enhanced Patient Outcomes)
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17 pages, 2202 KB  
Systematic Review
C-Reactive Protein in Peritoneal Fluid for Predicting Anastomotic Leakage After Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis
by Tharith Vun, Zhanghao Wu, Chetra Chea, Weidong Liu, Ran Tao and Youming Deng
J. Clin. Med. 2025, 14(6), 2099; https://doi.org/10.3390/jcm14062099 - 19 Mar 2025
Cited by 1 | Viewed by 3003
Abstract
Background: Anastomotic leakage (AL) is a serious and potentially fatal complication that can occur after colorectal cancer (CRC) surgery, and it significantly affects patient recovery and increases morbidity. While serum C-reactive protein (CRP) is a recognized systemic inflammatory marker, the level of [...] Read more.
Background: Anastomotic leakage (AL) is a serious and potentially fatal complication that can occur after colorectal cancer (CRC) surgery, and it significantly affects patient recovery and increases morbidity. While serum C-reactive protein (CRP) is a recognized systemic inflammatory marker, the level of CRP in peritoneal fluid may serve as a more specific and localized biomarker for early AL detection. This meta-analysis explores the diagnostic potential of peritoneal fluid CRP, aiming to enhance postoperative care for CRC patients. Methods: A comprehensive literature search was conducted following the PRISMA guidelines. Eligible studies were included based on strict inclusion and exclusion criteria. Diagnostic accuracy was pooled using a random-effects model. The risk of bias was assessed using the QUADAS-2 tool. Results: The pooled sensitivity and specificity were 0.74 and 0.83, respectively, with an area under the curve (AUC) of 0.84, indicating good diagnostic accuracy. The overall diagnostic performance was consistent for sensitivity with no significant heterogeneity, but high heterogeneity was observed for specificity, suggesting variability between studies. Subgroup analysis revealed improved diagnostic performance between postoperative days 5–7 and higher CRP cut-off values (70–150 mg/L). The analysis confirmed the stability of the results through a sensitivity analysis and found no significant publication bias. Conclusions: Peritoneal fluid CRP is a reliable biomarker for detecting AL after CRC surgery, especially in the later postoperative period. However, heterogeneity in study methodologies and patient populations limits the generalizability of the findings. Future research should focus on standardizing protocols and exploring additional biomarkers to improve diagnostic accuracy. Full article
(This article belongs to the Special Issue Colorectal Surgery: Innovative Techniques and Enhanced Patient Outcomes)
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