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Anorectal and Colorectal Surgery: Current Challenges and Future Prospects

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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 (31 May 2023) | Viewed by 3597

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Special Issue Editor

Dr. Hiroki Hashida

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Guest Editor

Kobe City Medical Center General Hospital, Kobe, Japan
Interests: gastroenterology; colon cancer; IBD; general surgery; GI sugery; laparoscopic surgery; robotic surgery; chemotherapy; molecular biology

Special Issue Information

Dear Colleagues,

Minimally invasive surgery for advanced colorectal cancer is a sophisticated procedure that achieves functional preservation and oncologic curability. However, there is insufficient evidence for the effectiveness of laparoscopic and robotic surgery in achieving these goals.

We would like to present the outcomes of laparoscopic, robot-assisted colorectal surgery and taTME from the perspective of both radical cure and functional preservation, as well as discuss emerging challenges and the new techniques and strategies used to overcome them.

In addition, multidisciplinary treatment has improved the outcomes of rectal cancer. Highly invasive lesions (direct invasion of the anterolateral region, lateral lymph node metastasis, major vascular invasion, and local recurrence) can determine the prognosis. This Special Issue aims to report on these surgeries, including the techniques used and results achieved, with the hope of promoting further advances in this field.

Dr. Hiroki Hashida
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.

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 cancer
colorectal surgery
laparoscopic surgery
robot-assisted surgery
taTME
colorectal diseases
anorectal diseases

Published Papers (3 papers)

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Research

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10 pages, 1049 KiB

Open AccessArticle

Management of Anastomotic Leakage after Colorectal Resection: Survey among the German CHIR-Net Centers

by Flavius Șandra-Petrescu, Nuh N. Rahbari, Emrullah Birgin, Konstantinos Kouladouros, Peter Kienle, Christoph Reissfelder, Emmanouil Tzatzarakis and Florian Herrle

J. Clin. Med. 2023, 12(15), 4933; https://doi.org/10.3390/jcm12154933 - 27 Jul 2023

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Abstract

(1) Background: A widely accepted algorithm for the management of colorectal anastomotic leakage (CAL) is difficult to establish. The present study aimed to evaluate the current clinical practice on the management of CAL among the German CHIR-Net centers. (2) Methods: An online survey of 38 questions was prepared using the International Study Group of Rectal Cancer (ISREC) grading score of CAL combined with both patient- and surgery-related factors. All CHIR-Net centers received a link to the online questionary in February 2020. (3) Results: Most of the answering centers (55%) were academic hospitals (41%). Only half of them use the ISREC definition and grading for the management of CAL. A preference towards grade B management (no surgical intervention) of CAL was observed in both young and fit as well as elderly and/or frail patients with deviating ostomy and non-ischemic anastomosis. Elderly and/or frail patients without fecal diversion are generally treated as grade C leakage (surgical intervention). A grade C management of CAL is preferred in case of ischemic bowel, irrespective of the presence of an ostomy. Within grade C management, the intestinal continuity is preserved in a subgroup of patients with non-ischemic bowel, with or without ostomy, or young and fit patients with ischemic bowel under ostomy protection. (4) Conclusions: There is no generally accepted therapy algorithm for CAL management within CHIR-Net Centers in Germany. Further effort should be made to increase the application of the ISREC definition and grading of CAL in clinical practice. Full article

(This article belongs to the Special Issue Anorectal and Colorectal Surgery: Current Challenges and Future Prospects)

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11 pages, 708 KiB

Open AccessArticle

The Impact of KRAS Status on the Required Surgical Margin Width for Colorectal Liver Metastasis Resection

by Kentaro Iwaki, Satoshi Kaihara, Tatsuya Koyama, Kai Nakao, Shotaro Matsuda, Kan Toriguchi, Koji Kitamura, Nobu Oshima, Masato Kondo, Hiroki Hashida, Hiroyuki Kobayashi and Kenji Uryuhara

J. Clin. Med. 2023, 12(6), 2313; https://doi.org/10.3390/jcm12062313 - 16 Mar 2023

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Abstract

Local recurrence after colorectal liver metastasis (CRLM) resection severely affects survival; however, the required surgical margin width remains controversial. This study investigated the impact of KRAS status on surgical margin width and local recurrence rate (LRR) post-CRLM resection. Overall, 146 resected CRLMs with KRAS status (wild-type KRAS (wtKRAS): 98, KRAS mutant (mKRAS): 48) were included. The LRR for each group, R1 (margin positive) and R0 (margin negative), was analyzed by KRAS status. R0 was further stratified into Ra (margin ≥ 5 mm) and Rb (margin < 5 mm). Patients with local recurrence had significantly worse 5-year overall survival than those without local recurrence (p = 0.0036). The mKRAS LRR was significantly higher than wtKRAS LRR (p = 0.0145). R1 resection resulted in significantly higher LRRs than R0 resection for both wtKRAS and mKRAS (p = 0.0068 and p = 0.0204, respectively), and while no significant difference was observed in the Ra and Rb LRR with wtKRAS, the Rb LRR with mKRAS (33.3%) was significantly higher than Ra LRR (5.9%) (p = 0.0289). Thus, R0 resection is sufficient for CRLM with wtKRAS; however, CRLM with mKRAS requires resection with a margin of at least 5 mm to prevent local recurrence. Full article

(This article belongs to the Special Issue Anorectal and Colorectal Surgery: Current Challenges and Future Prospects)

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Other

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16 pages, 1880 KiB

Open AccessSystematic Review

Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-Analysis

by Maurizio Zizzo, Andrea Morini, Magda Zanelli, David Tumiati, Francesca Sanguedolce, Andrea Palicelli, Federica Mereu, Stefano Ascani and Massimiliano Fabozzi

J. Clin. Med. 2023, 12(11), 3607; https://doi.org/10.3390/jcm12113607 - 23 May 2023

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Abstract

Background and Objectives: Anterior rectal resection (ARR) represents one of the most frequently performed methods in colorectal surgery, mainly carried out for rectal cancer (RC) treatment. Defunctioning ileostomy (DI) has long been chosen as a method to “protect” colorectal or coloanal anastomosis after ARR. However, DI does not rule out risks of more or less serious complications. A proximal intra-abdominal closed-loop ileostomy, the so-called virtual/ghost ileostomy (VI/GI), could limit the number of DIs and the associated morbidity. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Meta-analysis was performed by use of RevMan [Computer program] Version 5.4. Results: The five included comparative studies (VI/GI or DI) covering an approximately 20-year study period (2008–2021). All included studies were observational ones and originated from European countries. Meta-analysis indicated VI/GI as significantly associated with lower short-term morbidity rates related to VI/GI or DI after primary surgery (RR: 0.21, 95% CI: 0.07–0.64, p = 0.006), fewer dehydration (RR: 0.17, 95% CI: 0.04–0.75, p = 0.02) and ileus episodes after primary surgery (RR: 0.20, 95% CI: 0.05–0.77, p = 0.02), fewer readmissions after primary surgery (RR: 0.17, 95% CI: 0.07–0.43, p = 0.0002) and readmissions after primary surgery plus stoma closure surgery (RR: 0.14, 95% CI: 0.06–0.30, p < 0.00001) than the DI group. On the contrary, no differences were identified in terms of AL after primary surgery, short-term morbidity after primary surgery, major complications (CD ≥ III) after primary surgery and length of hospital stay after primary surgery. Conclusions: Given the significant biases among meta-analyzed studies (small overall sample size and the small number of events analyzed, in particular), our results require careful interpretation. Further randomized, possibly multi-center trials may be of paramount importance in confirming our results. Full article

(This article belongs to the Special Issue Anorectal and Colorectal Surgery: Current Challenges and Future Prospects)

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