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Colon and Rectal Surgery: Current Clinical Practice and Future Trends
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Colon and Rectal Surgery: Current Clinical Practice and Future Trends

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 April 2025) | Viewed by 4414

Special Issue Editor

Dr. Konstantinos Romanidis

E-Mail Website
Guest Editor
Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece
Interests: surgical oncology; colorectal cancer surgery; colorectal surgery; laparoscopic surgery; artificial intelligence in surgery; minimally invasive surgery; cellular metabolism in colorectal cancer; metastasis; gastrointestinal surgery; abdominal surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

At present, there are various trends, new challenges, and future directions regarding colorectal surgery. Colorectal cancer represents a leading cause of cancer-related deaths worldwide. Surgical treatment of colorectal cancer patients is mainly driven by the stage at presentation, highlighting the need for prompt diagnosis, evaluation, and management. Colon and rectal surgery is commonly associated with severe postoperative complications that may have a substantial impact on patient morbidity and mortality. Integrating enhanced recovery protocols in colon and rectal surgery has been revealed to reduce complication and mortality rates and improve postoperative survival and quality of life. In recent decades, surgical treatment has made significant progress. Nevertheless, the presence of metastasis, including lymph node involvement, affects patient survival and remains another challenging issue for both surgical treatment and accurate preoperative evaluation. With the intent of treating colorectal cancer patients and predicting their prognosis despite the progress in surgical approaches, intensive research on altered cancer metabolism will eventually lead to combined management strategies in the future. Novel techniques, including artificial intelligence models, have been used in order to achieve better outcomes during and after colorectal surgery. Such technological advances are steadily gaining ground in the field of surgery. This Special Issue aims to highlight current clinical practice and reveal future perspectives in colon and rectal surgery.

Dr. Konstantinos Romanidis
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 short 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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

  • colorectal surgery
  • colorectal cancer
  • complications
  • metastasis
  • artificial intelligence
  • cancer metabolism

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Published Papers (4 papers)

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Research

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10 pages, 435 KiB  
Article
Local Recurrence of Premalignant and Early Malignant Rectal Polyps Treated by TEM—A Single-Center Experience
by Muhammad Khalifa, Rachel Gingold-Belfer and Nidal Issa
J. Clin. Med. 2025, 14(1), 80; https://doi.org/10.3390/jcm14010080 - 27 Dec 2024
Viewed by 552
Abstract
Background: Transanal endoscopic microsurgery (TEM) is a minimally invasive approach for excising rectal polyps, particularly those with high-grade dysplasia (HGD) or early-stage rectal cancer (T1). This study aimed to evaluate the recurrence risk and its associated factors in patients treated with TEM for [...] Read more.
Background: Transanal endoscopic microsurgery (TEM) is a minimally invasive approach for excising rectal polyps, particularly those with high-grade dysplasia (HGD) or early-stage rectal cancer (T1). This study aimed to evaluate the recurrence risk and its associated factors in patients treated with TEM for HGD and T1 rectal tumors. Methods: A retrospective review was conducted on 79 patients who underwent TEM for rectal lesions at Rabin Medical Center-Hasharon Hospital from 2005 to 2019. Data collected included demographics, tumor characteristics, and follow-up outcomes, with specific focus on tumor size, resection margins, mucin production, and distance from anal verge (AV). Separate and unified analyses were performed to assess the recurrence risk factors for both HGD and T1 patients. Results: Sixty-three patients were included in the final analysis. In the unified analysis, larger tumor size was significantly associated with increased recurrence risk (OR = 2.27, p = 0.028), and mucin production was a strong predictor of recurrence in the T1 group and combined analysis (p = 0.0012 and p = 0.014, respectively). Distance from AV demonstrated a borderline association with recurrence (p = 0.053). Conclusions: Larger tumor size and mucin production are significant predictors of recurrence in TEM-treated rectal polyps. Personalized follow-up and postoperative management are essential for patients with these risk factors to reduce the recurrence risk. Full article
(This article belongs to the Special Issue Colon and Rectal Surgery: Current Clinical Practice and Future Trends)
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10 pages, 596 KiB  
Article
The Outcome of Local Excision of Rectal Adenomas with High-Grade Dysplasia by Transanal Endoscopic Microsurgery: A Single-Center Experience
by Muhammad Khalifa, Rachel Gingold-Belfer and Nidal Issa
J. Clin. Med. 2024, 13(5), 1419; https://doi.org/10.3390/jcm13051419 - 29 Feb 2024
Viewed by 2857
Abstract
Background: Local excision by transanal endoscopic microsurgery (TEM) is considered an acceptable treatment for rectal adenomas with high-grade dysplasia (HGD). This study aims to assess the likelihood of harboring an invasive carcinoma in preoperatively diagnosed HGD polyps and evaluate the risk factors [...] Read more.
Background: Local excision by transanal endoscopic microsurgery (TEM) is considered an acceptable treatment for rectal adenomas with high-grade dysplasia (HGD). This study aims to assess the likelihood of harboring an invasive carcinoma in preoperatively diagnosed HGD polyps and evaluate the risk factors for tumor recurrence in patients with final HGD pathology. Methods: Data from patients who underwent TEM procedures for adenomatous lesions with HGD from 2005 to 2018 at the Rabin Medical Center, Hasharon Hospital, were analyzed. Collected data included patient demographics, preoperative workup, tumor characteristics and postoperative results. Follow-up data including recurrence assessment and further treatments were reviewed. The analysis included two subsets: preoperative pathology of HGD (sub-group 1) and postoperative final pathology of HGD (sub-group 2) patients. Results: Forty-five patients were included in the study. Thirty-six patients had a preoperative diagnosis of HGD, with thirteen (36%) showing postoperative invasive carcinoma. Thirty-two patients had a final pathology of HGD, and three (9.4%) experienced tumor recurrence. Large tumor size (>5 cm) was significantly associated with recurrence (p = 0.03). Conclusions: HGD rectal polyps are associated with a significant risk of invasive cancer. Tumor size was a significant factor in predicting tumor recurrence in patients with postoperative HGD pathology. The TEM procedure is an effective first-line treatment for such lesions. Full article
(This article belongs to the Special Issue Colon and Rectal Surgery: Current Clinical Practice and Future Trends)
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Review

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14 pages, 15936 KiB  
Review
Can Thrombosed Abdominal Aortic Dissecting Aneurysm Cause Mesenteric Artery Thrombosis and Ischemic Colitis?—A Case Report and a Review of Literature
by Laurențiu Augustus Barbu, Nicolae-Dragoș Mărgăritescu, Liliana Cercelaru, Daniel-Cosmin Caragea, Ionică-Daniel Vîlcea, Valeriu Șurlin, Stelian-Ștefaniță Mogoantă, Gabriel Florin Răzvan Mogoș, Liviu Vasile and Tiberiu Ștefăniță Țenea Cojan
J. Clin. Med. 2025, 14(9), 3092; https://doi.org/10.3390/jcm14093092 (registering DOI) - 29 Apr 2025
Abstract
Background/Objectives: Ischemic colitis, typically caused by thrombosis or reduced blood flow in the inferior mesenteric artery, is the most common ischemic lesion at the colorectal level. This case contributes to existing knowledge by highlighting the rare co-occurrence of a thrombosed aortic aneurysm and [...] Read more.
Background/Objectives: Ischemic colitis, typically caused by thrombosis or reduced blood flow in the inferior mesenteric artery, is the most common ischemic lesion at the colorectal level. This case contributes to existing knowledge by highlighting the rare co-occurrence of a thrombosed aortic aneurysm and ischemic colitis, pointing to a direct vascular etiology rather than a multifactorial or idiopathic cause. Methods: A thorough electronic search was conducted on PubMed to identify risk factors and etiological determinants of ischemic colitis. Results: We present the case of a 70-year-old male with diffuse abdominal pain and multiple cardiac comorbidities. A CT scan revealed aeroenteritis, aerocolia, fusiform aneurysmal dilation of the abdominal aorta (18 cm long, 7.3 cm in diameter, from below the renal arteries to the bifurcation), parietal thrombosis, a circulating lumen of 2.7 cm, and inferior mesenteric artery thrombosis. Intraoperatively, necrosis was found in the upper rectum, sigmoid colon, descending colon, and the middle third of the left transverse colon, with clear demarcation between healthy and necrotic tissue. A subtotal proctocolectomy with transverse colostomy was performed. Conclusions: This case highlights ischemic colitis as a vascular disorder, urging broader differential diagnosis when common causes are unclear. Timely imaging, a multidisciplinary approach, and attention to vascular risks are key to identifying rare causes like aneurysmal thrombosis. While thrombosed abdominal aortic aneurysms can cause mesenteric ischemia, their link to ischemic and ulcerative colitis is unique, emphasizing the importance of accurate risk assessment in treatment planning. Full article
(This article belongs to the Special Issue Colon and Rectal Surgery: Current Clinical Practice and Future Trends)

Other

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25 pages, 1777 KiB  
Systematic Review
Clinical Significance of Blood Cell-Derived Inflammation Markers in Assessing Potential Early and Late Postoperative Complications in Patients with Colorectal Cancer: A Systematic Review
by Irina Shevchenko, Dragos Serban, Laurentiu Simion, Ion Motofei, Bogdan Mihai Cristea, Dan Dumitrescu, Corneliu Tudor, Ana Maria Dascalu, Crenguta Serboiu, Laura Carina Tribus, Andrei Marin, Adrian Marius Silaghi and Daniel Ovidiu Costea
J. Clin. Med. 2025, 14(7), 2529; https://doi.org/10.3390/jcm14072529 - 7 Apr 2025
Viewed by 414
Abstract
Background/Objectives: Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. Despite advancements in surgical techniques and oncological treatments, postoperative complications remain a significant challenge, affecting both immediate recovery and long-term survival. Systemic inflammation has been identified as a critical factor [...] Read more.
Background/Objectives: Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. Despite advancements in surgical techniques and oncological treatments, postoperative complications remain a significant challenge, affecting both immediate recovery and long-term survival. Systemic inflammation has been identified as a critical factor influencing cancer progression and postoperative outcomes. This systematic review evaluates the clinical significance of blood cell-derived inflammatory markers in predicting early and late postoperative complications in CRC patients. Methods: We included studies involving adult patients (≥18 years) with histologically confirmed colorectal cancer, for whom elective radical surgery was performed, as well as at least one of the considered blood-based inflammatory biomarkers (NLR, PLR, SII, or LMR) documented in relation to outcomes. Results: After removing duplicates, 19 studies published between 2016 and 2025 were included in the qualitative analysis. A total of 7023 patients who underwent elective curative surgery for colorectal cancer were analyzed, with mean age varying widely between 47.3 and 74.6 years. Preoperative NLR values were significantly correlated with severe complications, IAI, AL, and overall complications in 13 out of 19 studies (68.4%), with a cutoff value between 2.21 and 4, while early postoperative NLR values were predictive for AL. Late postoperative complications, such as recurrence and overall survival, were also associated with elevated preoperative NLR and PLR values. However, variability in study designs, patient populations, and cutoff values for these indices contributed to inconsistent findings. Conclusions: Blood cell-derived inflammatory markers offer a valuable, non-invasive tool for assessing postoperative risks in patients with CRC. New design nomograms or risk scores that include, beside blood cell-derived inflammation markers, other relevant data, could ensure an optimal predictive value that could be easily used in clinical practice for personalized risk management in patients with colorectal cancer. Full article
(This article belongs to the Special Issue Colon and Rectal Surgery: Current Clinical Practice and Future Trends)
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