Colorectal Surgery: Latest Advances and Prospects

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

Deadline for manuscript submissions: closed (15 June 2023) | Viewed by 85630

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Guest Editor
1. Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
2. Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
Interests: artificial intelligence; prehabilitation; technologies in coloproctology; rectal cancer management; biomolecular diagnosis; translational research; robotic surgery; transanal surgery; inflammatory bowel diseases; colorectal cancer
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Special Issue Information

Dear Colleagues,

Colorectal surgery has been rapidly evolving over the last few years. Newer technologies and techniques are increasingly being used and have become part of surgical armamentarium. Indeed, much needs to be explored in the field of coloproctology, as the desire to shed light on grey areas is constantly growing, in parallel with the implementation of innovations into clinical practice. The aim of the present Topical Collection is to serve as a forum for critically addressing how the advent of recent technological developments has impacted the outcomes of colorectal surgery, the way patients are managed perioperatively, postoperative recovery, and patient experience throughout an operation. Manuscripts are invited critically assessing the role of minimally invasive approaches, application of artificial intelligence and big data to decision making, peroperative patient optimization, application of transational research in coloproctology, or comparing the outcomes of different innovative approaches to colorectal diseases. Priority is given to high-quality, original studies, but well-designed and conducted systematic reviews (with or without metanalysis) giving a coincise and exaustive vision on the state-of-the-art on a specific topic are welcome. In summary, the Topical Collection aims to increase clinicians’ knowledge of poorly explored areas of coloproctology, as well as to provide a balanced, sound, and evidence-based overview of the advances and potential perspectives in the field.

Dr. Gianluca Pellino
Guest Editor

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Keywords

  • coloproctology
  • innovations
  • technologies
  • translational research
  • outcomes
  • complications
  • patient experience
  • colorectal cancer
  • inflammatory bowel disease

Published Papers (28 papers)

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11 pages, 4319 KiB  
Article
Robotic Lateral Pelvic Lymph Node Dissection in Rectal Cancer: A Feasibility Study from a European Centre
by Tou Pin Chang, Oroog Ali, Kostas Tsimogiannis, Giuseppe S. Sica and Jim S. Khan
J. Clin. Med. 2024, 13(1), 90; https://doi.org/10.3390/jcm13010090 - 23 Dec 2023
Viewed by 2548
Abstract
Introduction: The role of robotic lateral pelvic lymph node dissection (LPLND) for lateral pelvic nodal disease (LPND) in rectal cancer has yet to be investigated in the Western hemisphere. This study aims to investigate the safety and feasibility of robotic LPLND by utilising [...] Read more.
Introduction: The role of robotic lateral pelvic lymph node dissection (LPLND) for lateral pelvic nodal disease (LPND) in rectal cancer has yet to be investigated in the Western hemisphere. This study aims to investigate the safety and feasibility of robotic LPLND by utilising a well-established totally robotic TME protocol. Methods: We conducted a retrospective study on 17 consecutive patients who underwent robotic LPLND for LPND ± TME for rectal cancer between 2015 and 2021. A single docking totally robotic approach from the left hip with full splenic mobilisation was performed using the X/Xi da Vinci platform. All patients underwent a tri-compartmental robotic en bloc excision of LPND with preservation of the obturator nerve and pelvic nerve plexus, leaving a well-skeletonised internal iliac vessel and its branches. Results: The median operative time was 280 min, which was 40 min longer than our standard robotic TME. The median BMI was 26, and there were no conversions. The median inpatient stay was 7 days with no Clavien-Dindo > 3 complications. One patient (6%) developed local recurrence and metastatic disease within 5 months. The proportion of histologically confirmed LPND was 41%, of which 94% were well to moderately differentiated adenocarcinoma. Median pre-operative lateral pelvic node size was significantly higher in positive nodes (14 mm vs. 8 mm (p = 0.01)). All patients had clear resection margins on histology. Discussion: Robotic LPLND is safe and feasible with good peri-operative and short-term outcomes, with the ergonomic advantages of a robotic TME docking protocol readily transferrable in LPLND. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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15 pages, 1903 KiB  
Article
Short-Term Results of Operative Treatment of Primary Ileocecal Crohn’s Disease: Retrospective, Comparative Analysis between Early (Luminal) and Complicated Disease
by Nicolas Avellaneda, Tora Haug, Mai-Britt Worm Ørntoft, Sanne Harsløf, Lars Peter Skovgaard Larsen and Anders Tøttrup
J. Clin. Med. 2023, 12(7), 2644; https://doi.org/10.3390/jcm12072644 - 1 Apr 2023
Cited by 2 | Viewed by 1505
Abstract
Early surgical treatment for patients with ileocecal Crohn’s disease (CD) could be an alternative to biological therapy. The aim of this study is to compare operative outcomes following ileocecal resection for patients with luminal and complicated CD. Patients operated for primary ileocecal CD [...] Read more.
Early surgical treatment for patients with ileocecal Crohn’s disease (CD) could be an alternative to biological therapy. The aim of this study is to compare operative outcomes following ileocecal resection for patients with luminal and complicated CD. Patients operated for primary ileocecal CD during 8 years in one tertiary-referral hospital were allocated into 2 groups: those operated for early (luminal) disease (ECD), and for complications of CD (CCD). A retrospective comparative analysis was performed. A total of 273 patients were included in the analysis, 85 (31%) of which were in the ECD group. No difference was found regarding time from diagnosis to surgery. Surgical procedures were longer in the CCD group, with lower rates of laparoscopic approach (93 vs. 99%, p = 0.035) and higher conversion rates (20 vs. 2%, p < 0.001). ECD had non-significant differences in terms of major postoperative complications (9.4 vs. 14.9%, p = 0.215), shorter hospital stays, and lower rates of anastomotic leakage (3.5 vs. 6.8%, p = 0.285). Conversely, the CCD group had higher reoperation and re-hospitalization rates. Adequate timing for the indication of surgery in primary ileocecal CD, including an early discussion considering both medical and surgical treatment as options, could positively influence operative outcomes. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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14 pages, 1093 KiB  
Article
Influence of COVID-19 Pandemic on Colorectal Cancer Presentation, Management and Outcome during the COVID-19 Pandemic
by B. M. Pirozzi, L. Siragusa, G. Baldini, M. Pellicciaro, M. Grande, C. Efrati, R. Finizio, V. Formica, G. Del Vecchio Blanco and G. S. Sica
J. Clin. Med. 2023, 12(4), 1425; https://doi.org/10.3390/jcm12041425 - 10 Feb 2023
Cited by 3 | Viewed by 1466
Abstract
The aim of the study was to investigate whether the COVID-19 pandemic and related measures had an influence on colorectal cancer (CRC) presentation, management, and outcomes; it was a retrospective monocentric study. CRC patients undergoing surgery during the COVID-19 pandemic (1 March 2020–28 [...] Read more.
The aim of the study was to investigate whether the COVID-19 pandemic and related measures had an influence on colorectal cancer (CRC) presentation, management, and outcomes; it was a retrospective monocentric study. CRC patients undergoing surgery during the COVID-19 pandemic (1 March 2020–28 February 2022) (group B) were compared with patients operated on in the previous two years (1 March 2018–29 February 2020) in the same unit (group A). The primary outcome was to investigate whether there were differences in concern regarding the stage at presentation, as a whole and after dividing groups based on cancer location (right colon cancer, left colon cancer, rectal cancer). Secondary outcomes included differences in the number of patients admitted from emergency departments and emergency surgeries between periods, and differences in the postoperative outcomes. A subanalysis within the pandemic group was conducted on the same outcomes, dividing the aforementioned group based on pandemic trends. Two hundred and eighty (280) were operated on during the study period: 147 in group A and 133 in group B. Stage at presentation was similar between groups; however, the subgroups analysis showed that in the pandemic group, the number of early-stage left colon cancer occurrences almost halves, yet not significantly. Emergency department referral was more common in group B (p-value: 0.003); in group B, they also had longer operations and there was a more frequent use of ostomy. No differences in the number of postoperative complications nor in the postoperative outcomes were found. Patients with CRC were more frequently referred through the emergency department during the COVID-19 pandemic and left-sided cancers appear to be generally diagnosed at a more advanced stage. Postoperative outcomes showed that high specialized colorectal units can deliver standard high-level treatment under high-pressure external conditions. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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7 pages, 502 KiB  
Article
Percutaneous Drainage vs. Surgery as Definitive Treatment for Anastomotic Leak after Intestinal Resection in Patients with Crohn’s Disease
by Angela Belvedere, Gerti Dajti, Cristina Larotonda, Laura Angelicchio, Fernando Rizzello, Paolo Gionchetti, Gilberto Poggioli and Matteo Rottoli
J. Clin. Med. 2023, 12(4), 1392; https://doi.org/10.3390/jcm12041392 - 9 Feb 2023
Viewed by 1248
Abstract
Background: Anastomotic leak (AL) remains one of the most relevant complications after intestinal resection for Crohn’s disease (CD). While surgery has always been considered the standard treatment for perianastomotic collection, percutaneous drainage (PD) has been proposed as a potential alternative. Methods: Retrospective study [...] Read more.
Background: Anastomotic leak (AL) remains one of the most relevant complications after intestinal resection for Crohn’s disease (CD). While surgery has always been considered the standard treatment for perianastomotic collection, percutaneous drainage (PD) has been proposed as a potential alternative. Methods: Retrospective study in consecutive patients treated with either PD or surgery for AL after intestinal resection for CD between 2004 and 2022. AL was defined as a perianastomotic fluid collection confirmed by radiological findings. Patients with generalized peritonitis or clinical instability were excluded. Primary aim: To compare the success rate of PD vs. surgery. Secondary aims: To compare the outcomes at 90 days after the procedures; to identify the variables associated with the indication for PD. Results: A total of 47 patients were included, of which 25 (53%) underwent PD and 22 (47%) surgery. The success rate was 84% in the PD and 95% in the surgery group (p = 0.20). There were no significant differences between the PD and surgery group in postoperative medical and surgical complications, discharge, readmission or reoperation rates at 90 days. PD was more likely to be performed in patients with later diagnosis of AL (OR 1.25, 95% CI 1.03–1.53, p = 0.027), undergoing ileo-colic anastomosis alone (OR 3.72, 95% CI 2.29–12.45, p = 0.034) and treated after 2016 (OR 6.36, 95% CI 1.04–39.03, p = 0.046). Conclusion: The present study suggests that PD is a safe and effective procedure to treat anastomotic leak and perianastomotic collection in CD patients. PD should be indicated in all eligible patients as an effective alternative to surgery. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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8 pages, 598 KiB  
Communication
Laparoscopic Management of Acute Small Bowel Obstruction in Non-Selected Patients: A 10-Year Experience
by Nikoletta A. Petrou, Eugenia M. Bonelli, Naomi Watson, Jonathan Wood, Christos Kontovounisios and Nebil Behar
J. Clin. Med. 2022, 11(21), 6275; https://doi.org/10.3390/jcm11216275 - 25 Oct 2022
Viewed by 1535
Abstract
The laparoscopic approach to the management of small bowel obstruction (SBO) has been associated with reduced length of hospital stay, complications, and mortality. The laparoscopy-first approach has been limited to highly selective cases to date. In this retrospective observational study, we report our [...] Read more.
The laparoscopic approach to the management of small bowel obstruction (SBO) has been associated with reduced length of hospital stay, complications, and mortality. The laparoscopy-first approach has been limited to highly selective cases to date. In this retrospective observational study, we report our 10-year experience and outcomes within a dedicated Emergency Surgery unit that adopted a non-selective approach in the laparoscopic management of SBO. The surgical approach to all patients that underwent surgery for SBO by an experienced Emergency Surgeon, over a period of 10 years, was divided into two groups of open surgery (OS) or laparoscopy-first (LF). Outcomes included length of stay, complications, mortality, readmission rates and reasons for conversion. Data were reviewed to identify patterns of learning. A total of 189 patients were included in the study. A total of 81.5% were managed with an LF approach. Of these, 25.3% required conversion. LF patients had a similar length of stay, lower 30-day readmission rates and wound complications. Reasons for conversion included need for bowel resection, perforation, and malignancy. Our study had a high intention-to-treat LF population and identified major indications for conversion. As our laparoscopic experience increased, conversion rates substantially reduced. We propose that a LF approach is feasible and can benefit from training within dedicated Emergency Surgery teams. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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12 pages, 749 KiB  
Article
Colostomy Reversal following Hartmann’s Procedure: The Importance of Timing in Short- and Long-Term Complications: A Retrospective Multicentric Study
by Marco Clementi, Renato Pietroletti, Filippo Carletti, Federico Sista, Antonella Grasso, Fabiana Fiasca, Sonia Cappelli, Andrea Balla, Vinicio Rizza, Andrea Ciarrocchi and Stefano Guadagni
J. Clin. Med. 2022, 11(15), 4388; https://doi.org/10.3390/jcm11154388 - 28 Jul 2022
Cited by 3 | Viewed by 4233
Abstract
The restoration of bowel continuity following Hartmann’s Procedure (HP) has been reported hitherto with high morbidity and mortality rates. No clear guidelines exist about timing in Hartmann’s Reversal (HR), the literature data being conflicting. We have sought to investigate the effect of the [...] Read more.
The restoration of bowel continuity following Hartmann’s Procedure (HP) has been reported hitherto with high morbidity and mortality rates. No clear guidelines exist about timing in Hartmann’s Reversal (HR), the literature data being conflicting. We have sought to investigate the effect of the interval time between HP and HR in short- and long-term HR outcomes through a retrospective study based on consecutive patients undergoing HR between 2009 and 2017 in two regional hospitals in Italy. Demographic characteristics, comorbidities, intra- and post-operative data, as well as early complications, were recorded. Long-term data were collected on the surgical site occurrences of Incisional Ventral Hernia (IVH). One hundred and five patients were recruited for the study. Late HR, female gender, and long operating time were related to the highest incidence of peri-operative complications. Patients who developed IVH had undergone HR at significantly shorter times and had a higher Body Mass Index (BMI). The timing of HR seems to be an important variable linked to the onset of early and late post-operative complications. The patients submitted to early HR show a significantly lower complication rate but, at the same time, a higher rate of IVH incidence after restorative surgery. These data, in our opinion, reflect the need for planning, where possible, an early restoration of bowel continuity after HP. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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11 pages, 1209 KiB  
Article
Multimodal Management of Fecal Incontinence Focused on Sphincteroplasty: Long-Term Outcomes from a Single Center Case Series
by Carlos Cerdán Santacruz, Débora M. Cerdán Santacruz, Lucía Milla Collado, Antonio Ruiz de León and Javier Cerdán Miguel
J. Clin. Med. 2022, 11(13), 3755; https://doi.org/10.3390/jcm11133755 - 28 Jun 2022
Cited by 6 | Viewed by 2510
Abstract
The management of patients with fecal incontinence and an external anal sphincter (EAS) defect remains controversial. A retrospective series of overlapping anal sphincteroplasties performed between 1985–2013 from a single center, supplemented by selective puborectalis plication and internal anal sphincter repair is presented. Patients [...] Read more.
The management of patients with fecal incontinence and an external anal sphincter (EAS) defect remains controversial. A retrospective series of overlapping anal sphincteroplasties performed between 1985–2013 from a single center, supplemented by selective puborectalis plication and internal anal sphincter repair is presented. Patients were clinically followed along with anorectal manometry, continence scoring (Cleveland Clinic Incontinence Score—CCS) and patient satisfaction scales. Patients with a suboptimal outcome were managed with combinations of biofeedback therapy (BFT), peripheral tibial nerve stimulation (PTNS), sacral nerve stimulation (SNS) or repeat sphincteroplasty. There were 120 anterior sphincter repairs with 90 (75%) levatorplasties and 84 (70%) IAS repairs. Over a median follow-up of 120 months (IQR 60–173.7 months) there were significant improvements in the recorded CCIS values (90.8% with a preoperative CCIS > 15 vs. 2.5% postoperatively; p < 0.001). There were 42 patients who required ancillary treatment with four repeat sphincteroplasties, 35 patients undergoing biofeedback therapy, 10 patients treated with PTNS and three managed with SNS implants with an ultimate good functional outcome in 92.9% of cases. No difference was noted in ultimate functional outcome between those treated with sphincteroplasty alone compared with those who needed ancillary treatments (97.1% vs. 85.7%, respectively). Overall, 93.3% considered the outcome as either good or excellent. Long-term functional outcomes of an overlapping sphincteroplasty are good. If the initial outcome is suboptimal, response to ancillary treatments remains good and patients are not compromised by a first-up uncomplicated sphincter repair. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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12 pages, 1072 KiB  
Article
Has the Removing of the Mesentery during Ileo-Colic Resection an Impact on Post-Operative Complications and Recurrence in Crohn’s Disease? Results from the Resection of the Mesentery Study (Remedy)
by Michela Mineccia, Giovanni Maconi, Marco Daperno, Maria Cigognini, Valeria Cherubini, Francesco Colombo, Serena Perotti, Caterina Baldi, Paolo Massucco, Sandro Ardizzone, Alessandro Ferrero and Gianluca M. Sampietro
J. Clin. Med. 2022, 11(7), 1961; https://doi.org/10.3390/jcm11071961 - 1 Apr 2022
Cited by 8 | Viewed by 1913
Abstract
Some evidence suggests a reduction in clinical and surgical recurrence after mesenteric resection in Crohn’s Disease (CD). The aim of the REsection of the MEsentery StuDY (Remedy) was to assess whether mesenteric removal during surgery for ileocolic CD has an impact in terms [...] Read more.
Some evidence suggests a reduction in clinical and surgical recurrence after mesenteric resection in Crohn’s Disease (CD). The aim of the REsection of the MEsentery StuDY (Remedy) was to assess whether mesenteric removal during surgery for ileocolic CD has an impact in terms of postoperative complications, endoscopic and ultrasonographic recurrences, and long-term surgical recurrence. Among the 326 patients undergoing primary resection between 2009 and 2019 in two referral centers, in 204 (62%) the mesentery was resected (Group A) and in 122 (38%) it was retained (Group B). Median follow-up was 4.7 ± 3 years. Groups were similar in the peri-operative course. Endoscopic and ultrasonographic recurrences were 44.6% and 40.4% in Group A, and 46.7% and 41.2% in Group B, respectively, without statistically significant differences. The five-year time-to-event estimates, compared with the Log-rank test, were 3% and 4% for normal or thickened mesentery (p = 0.6), 2.8% and 4% for resection or sparing of the mesentery (p = 0.6), and 1.7% and 5.4% in patients treated with biological or immunosuppressants versus other adjuvant therapy (p = 0.02). In Cox’s model, perforating behavior was a risk factor, and biological or immunosuppressant adjuvant therapy protective for surgical recurrence. The resection of the mesentery does not seem to reduce endoscopic and ultrasonographic recurrences, and the five-year recurrence rate. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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7 pages, 556 KiB  
Article
Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes
by Francesco Pata, Luigi Maria Bracchitta, Giancarlo D’Ambrosio and Salvatore Bracchitta
J. Clin. Med. 2022, 11(1), 218; https://doi.org/10.3390/jcm11010218 - 31 Dec 2021
Cited by 10 | Viewed by 2142 | Correction
Abstract
Background: Sclerobanding is a novel technique combining rubber band ligation with 3% polidocanol foam sclerotherapy for the treatment of hemorrhoidal disease (HD). The aim of this study is to evaluate the feasibility, safety and short-term outcomes of sclerobanding in the treatment of second- [...] Read more.
Background: Sclerobanding is a novel technique combining rubber band ligation with 3% polidocanol foam sclerotherapy for the treatment of hemorrhoidal disease (HD). The aim of this study is to evaluate the feasibility, safety and short-term outcomes of sclerobanding in the treatment of second- and third-degree HD. Methods: A retrospective analysis of second- and third-degree HD cases from November 2017 to August 2021 was performed. Patients on anticoagulants or with other HD degrees were excluded. Follow-up was conducted at 1 month, 3 months, 6 months, 1 year and then every 12 months. Results: 97 patients with second- (20 pts; 20.6%) and third-degree (77 pts; 79.4%) HD with a mean age of 52 years (20–84; SD ± 15.5) were included. Fifty-six patients were men (57.7%) and forty-one women (42.3%). Median follow-up was 13 months (1–26 months). No intraoperative adverse events or drug-related side effects occurred. Minor complications occurred in four patients (4.1%) in the first 30 postoperative days and all resolved after conservative treatment at the 3-month follow-up visit. No mortality or readmissions were observed. Conclusions: Sclerobanding is a safe technique with a low rate of minor postoperative complications. Further studies on larger samples are necessary to establish the effectiveness and long-term outcomes of the technique. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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8 pages, 363 KiB  
Article
Intracorporeal versus Extracorporeal Anastomosis for Laparoscopic Right Hemicolectomy: Short-Term Outcomes
by Antonio Biondi, Gianluca Di Mauro, Riccardo Morici, Giuseppe Sangiorgio, Marco Vacante and Francesco Basile
J. Clin. Med. 2021, 10(24), 5967; https://doi.org/10.3390/jcm10245967 - 19 Dec 2021
Cited by 10 | Viewed by 2853
Abstract
Laparoscopic right hemicolectomy represents an effective therapeutic approach for right colon cancer (RCC). The primary aim of this study was to evaluate bowel function recovery, length of hospital stay, operative time, and the number of general and anastomosis-related postoperative complications from intracorporeal anastomosis [...] Read more.
Laparoscopic right hemicolectomy represents an effective therapeutic approach for right colon cancer (RCC). The primary aim of this study was to evaluate bowel function recovery, length of hospital stay, operative time, and the number of general and anastomosis-related postoperative complications from intracorporeal anastomosis (ICA) vs. extracorporeal anastomosis (ECA); the secondary outcome was the number of lymph nodes retrieved. This observational study was conducted on 108 patients who underwent right hemicolectomy for RCC; after surgical resection, 64 patients underwent ICA and 44 underwent ECA. The operative time was slightly longer in the ICA group than in the ECA group, even though the difference was not significant (199.31 ± 48.90 min vs. 183.64 ± 35.80 min; p = 0.109). The length of hospital stay (7.53 ± 1.91 days vs. 8.77 ± 3.66 days; p = 0.036) and bowel function recovery (2.21 ± 1.01 days vs. 3.45 ± 1.82 days; p < 0.0001) were significantly lower in the ICA group. There were no significant differences in postoperative complications (12% in ICA group vs. 9% in ECA group), wound infection (6% in ICA group vs. 7% in ECA group), or anastomotic leakage (6% in ICA group vs. 9% in ECA group). We did not observe a significant difference between the two groups in the number of lymph nodes collected (19.46 ± 7.06 in ICA group vs. 22.68 ± 8.79 in ECA group; p = 0.086). ICA following laparoscopic right hemicolectomy, compared to ECA, could lead to a significant improvement in bowel function recovery and a reduction in the length of hospital stay in RCC patients. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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10 pages, 444 KiB  
Article
Oral Antibiotic Prophylaxis Lowers Surgical Site Infection in Elective Colorectal Surgery: Results of a Pragmatic Cohort Study in Catalonia
by Josep M. Badia, Miriam Flores-Yelamos, Ana Vázquez, Nares Arroyo-García, Mireia Puig-Asensio, David Parés, Miguel Pera, Joaquín López-Contreras, Enric Limón, Miquel Pujol and Members of the VINCat Colorectal Surveillance Team
J. Clin. Med. 2021, 10(23), 5636; https://doi.org/10.3390/jcm10235636 - 29 Nov 2021
Viewed by 2353
Abstract
Background: The role of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP) in the prevention of surgical site infection (SSI) after colorectal surgery is still controversial. The aim of this study was to analyze the effect of a bundle including both measures [...] Read more.
Background: The role of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP) in the prevention of surgical site infection (SSI) after colorectal surgery is still controversial. The aim of this study was to analyze the effect of a bundle including both measures in a National Infection Surveillance Network in Catalonia. Methods: Pragmatic cohort study to assess the effect of OAP and MBP in reducing SSI rate in 65 hospitals, comparing baseline phase (BP: 2007–2015) with implementation phase (IP: 2016–2019). To compare the results, a logistic regression model was established. Results: Out of 34,421 colorectal operations, 5180 had SSIs (15.05%). Overall SSI rate decreased from 18.81% to 11.10% in BP and IP, respectively (OR 0.539, CI95 0.507–0.573, p < 0.0001). Information about bundle implementation was complete in 61.7% of cases. In a univariate analysis, OAP and MBP were independent factors in decreasing overall SSI, with OR 0.555, CI95 0.483–0.638, and OR 0.686, CI95 0.589–0.798, respectively; and similarly, organ/space SSI (O/S-SSI) (OR 0.592, CI95 0.494–0.710, and OR 0.771, CI95 0.630–0.944, respectively). However, only OAP retained its protective effect at both levels at multivariate analyses. Conclusions: oral antibiotic prophylaxis decreased the rates of SSI and O/S-SSI in a large series of elective colorectal surgery. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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10 pages, 740 KiB  
Article
Predictors of Lymph Node Metastasis in T1 Colorectal Cancer in Young Patients: Results from a National Cancer Registry
by Daryl Ramai, Jameel Singh, Antonio Facciorusso, Saurabh Chandan, Banreet Dhindsa, Amaninder Dhaliwal, Barbara Galassi, Gianluca Tomasello and Michele Ghidini
J. Clin. Med. 2021, 10(23), 5511; https://doi.org/10.3390/jcm10235511 - 25 Nov 2021
Cited by 3 | Viewed by 1886
Abstract
The objective of this study is to fill the knowledge gap by examining predictors of lymph node metastasis (LNM) in young patients, less than 45 years, using a national cancer registry. Methods: Patients diagnosed with T1 colorectal cancer were identified in the Surveillance, [...] Read more.
The objective of this study is to fill the knowledge gap by examining predictors of lymph node metastasis (LNM) in young patients, less than 45 years, using a national cancer registry. Methods: Patients diagnosed with T1 colorectal cancer were identified in the Surveillance, Epidemiology, and End Results registry. In total, 692 patients with T1 colorectal cancer were identified. Most tumors occurred in white race (77.7%), between 40 and 44 years of age (49.4%), with grade III tumor differentiation (59.8%) and 1 to 1.9 cm size (32.2%), and were left-sided tumors (61.1%). The overall rate of LNM was 22.5% (n = 149). LNM was associated with tumor grade IV (undifferentiated) (odds ratio (OR) 2.94, CI: 1.06–8.12; p = 0.038), and increasing tumor size (1 cm–1.9 cm: OR 2.92, CI: 1.71–4.97, p < 0.001; 2.0 cm–2.9 cm: OR 2.00, CI: 1.05–3.77, p = 0.034; and ≥3.0 cm: OR 2.68, CI: 1.43–5.01, p = 0.002). Five-year cancer-specific survival for patients with LNM was 91% and for patients without LNM this was 98%. Adjusted cox proportion models showed that LNM was associated with a four times higher rate of mortality (hazard ratio (HR) 4.43, CI: 1.27–15.52, p = 0.020). In this population-based analysis of patients with T1 colorectal cancer, tumor size and grade were significant predictors of LNM. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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13 pages, 687 KiB  
Article
Minor Sphincter Sparing Surgery for Successful Closure of Perianal Fistulas in Patients with Crohn’s Disease
by Jennifer Merten, Ann-Kathrin Eichelmann, Rudolf Mennigen, Isabelle Flammang, Andreas Pascher and Emile Rijcken
J. Clin. Med. 2021, 10(20), 4721; https://doi.org/10.3390/jcm10204721 - 14 Oct 2021
Cited by 1 | Viewed by 2009
Abstract
The purpose of this study is to demonstrate that repetitive minor surgical procedures allow for a high rate of permanent closure of perianal fistulas in patients with Crohn’s disease (CD). Patients with perianal fistulizing CD (PFCD) who underwent perianal surgery at the University [...] Read more.
The purpose of this study is to demonstrate that repetitive minor surgical procedures allow for a high rate of permanent closure of perianal fistulas in patients with Crohn’s disease (CD). Patients with perianal fistulizing CD (PFCD) who underwent perianal surgery at the University Hospital of Muenster between 2003 and 2018 were assessed for fistula characteristics and surgical procedures. We included 45 patients (m:f = 28:17) with a mean age of 27 years at first fistula appearance. Of these, 49% suffered from a complex fistula. An average of 4.2 (1–14) procedures were performed, abscess incisions and fistula seton drainages included. Draining setons were left in place for 5 (1–54) months, until fistula closure. Final surgical techniques were fistulotomy (31.1%), seton removal with sustained biological therapy (26.7%), Anal Fistula Plug (AFP) (17.8%), Over-The Scope-Clip proctology (OTSC) (11.1%), and mucosa advancement flap (4.4%). In 8.9% of cases, the seton was kept as permanent therapy. The time from first to last surgery was 18 (0–182) months and the median follow-up time after the last surgery was 90 (15–200) months. The recurrence rate was 15.5% after 45 (17–111) months. Recurrent fistulas healed after another 1.86 (1–2) surgical re-interventions. The final success rate was 80%. Despite biological treatment, PFCD management remains challenging. However, by repeating minor surgical interventions over a prolonged period of time, high permanent healing rates can be achieved. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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14 pages, 1330 KiB  
Article
Effect of Early Peripheral Parenteral Nutrition Support in an Enhanced Recovery Program for Colorectal Cancer Surgery: A Randomized Open Trial
by Luis Sánchez-Guillén, Leticia Soriano-Irigaray, Francisco López-Rodríguez-Arias, Xavier Barber, Ana Murcia, M José Alcaide, Verónica Aranaz-Ostáriz, Álvaro Soler-Silva, Andrés Navarro-Ruiz and Antonio Arroyo
J. Clin. Med. 2021, 10(16), 3647; https://doi.org/10.3390/jcm10163647 - 18 Aug 2021
Cited by 14 | Viewed by 3181
Abstract
Background: Peripheral parenteral nutrition allows repletion of acute nutrient deficiencies and could prevent further nutrition deficits before and after colorectal surgery. A randomized open study was performed to evaluate the effect of perioperative peripheral parenteral nutrition (PPN) support on postoperative morbidity after colorectal [...] Read more.
Background: Peripheral parenteral nutrition allows repletion of acute nutrient deficiencies and could prevent further nutrition deficits before and after colorectal surgery. A randomized open study was performed to evaluate the effect of perioperative peripheral parenteral nutrition (PPN) support on postoperative morbidity after colorectal cancer surgery within an enhanced recovery program. Methods: Patients were randomized into two groups: peripheral parenteral nutrition (PPN) (with Peri-Olimel N4-E) versus conventional fluid therapy (FT). Ninety-day postoperative complications, laboratory parameters, length of hospital stay, and compliance with the ERAS protocol were assessed. Results: A total of 158 patients were analysed. The overall 90-day complication rate was 38.6% (61 patients), and 24 patients had major complications (Clavien–Dindo III–V) (15.2%). In the multivariate analysis, the intervention (PPN vs. FC) showed a protective effect against postoperative complications (p = 0.0031, OR = 0.2 (CI: 0.08–0.87)). Following ordinal regression, PPN and early oral tolerance showed a protective effect, being less likely to develop complications or to move from minor to major complications. In patients with low compliance to ERAS during the first postoperative day, PPN showed a protective effect, preventing 28% of morbidity. Conclusions: Perioperative peripheral parenteral nutrition (PPN) support with Peri-Olimel N4-E in colorectal cancer surgery associated with early oral intake could reduce postoperative complications. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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11 pages, 4246 KiB  
Article
The Role of Demographics, Social Deprivation and Ethnicity on Anal Squamous Cell Carcinoma Incidence in England
by Danielle R. L. Brogden, Christos Kontovounisios, Sundhiya Mandalia, Paris Tekkis and Sarah C. Mills
J. Clin. Med. 2021, 10(16), 3621; https://doi.org/10.3390/jcm10163621 - 17 Aug 2021
Cited by 3 | Viewed by 2227
Abstract
Anal Squamous Cell Carcinoma (ASCC) is an HPV-related malignancy with increasing incidence in high-income economies. Although ethnicity and social deprivation are known to be risk factors in other malignancies, little is known about socioeconomic status and risk of ASCC. This is a cross-sectional [...] Read more.
Anal Squamous Cell Carcinoma (ASCC) is an HPV-related malignancy with increasing incidence in high-income economies. Although ethnicity and social deprivation are known to be risk factors in other malignancies, little is known about socioeconomic status and risk of ASCC. This is a cross-sectional study following the STROBE Statement. Demographic data from the English Clinical Outcomes and Services Dataset (COSD) were extracted for all patients diagnosed with ASCC in England between 2013 and 2018. Outcomes included ethnicity, social deprivation, staging and treatment. This study included 5457 patients. Incidence increased by 23.4% in 5 years, with female incidence increasing more rapidly than male incidence (28.6% vs. 13.5%). Men were more likely to present with early staging (p < 0.001) and have surgery as their only treatment (p < 0.001). The rate of incidence of Stage 1 tumours in men was 106.9%; however, women had the greatest increase in metastatic tumours (76.1%). Black Caribbean and Black African patients were more likely to present at an earlier age with later staging (p < 0.001) and social deprivation was associated with younger age (p < 0.001). ASCC incidence is rapidly increasing in patterns consistent with two separate populations: one male with early staging, the other female and related to social deprivation and ethnicity factors. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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11 pages, 6412 KiB  
Article
Endorectal Ultrasound and Magnetic Resonance Imaging for Rectal Cancer Staging: A Modern Multimodality Approach
by Alfonso Reginelli, Alfredo Clemente, Angelo Sangiovanni, Valerio Nardone, Francesco Selvaggi, Guido Sciaudone, Fortunato Ciardiello, Erika Martinelli, Roberto Grassi and Salvatore Cappabianca
J. Clin. Med. 2021, 10(4), 641; https://doi.org/10.3390/jcm10040641 - 8 Feb 2021
Cited by 19 | Viewed by 3690
Abstract
Preoperative staging represents a crucial point for the management, type of surgery, and candidacy for neoadjuvant therapy in patient with rectal cancer. The most recent clinical guidelines in oncology recommend an accurate preoperative evaluation in order to address early and advanced tumors to [...] Read more.
Preoperative staging represents a crucial point for the management, type of surgery, and candidacy for neoadjuvant therapy in patient with rectal cancer. The most recent clinical guidelines in oncology recommend an accurate preoperative evaluation in order to address early and advanced tumors to different therapeutic options. In particular, potential pitfalls may occur in the assessment of T3 tumors, which represents the most common stage at diagnosis. The depth of tumor invasion is known to be an important prognostic factor in rectal carcinoma; as a consequence, the T3 imaging classification has a substantial importance for treatment strategy and patient survival. However, the differentiation between tumor invasion of perirectal fat and mesorectal desmoplastic reactions remains a main goal for radiologists. Magnetic resonance imaging (MRI) is actually considered as the best imaging modality for rectal cancer staging. Although the endorectal ultrasound (ERUS) is the preferred staging method for early tumors, it could also be useful in identifying perirectal fat invasion. Moreover, the addiction of diffusion weighted imaging (DWI) improves the diagnostic performance of MRI in rectal cancer staging by adding functional information about rectal tumor and adjacent mesorectal tissues. This study investigated the diagnostic performance of conventional MRI alone, in combination with the DWI technique and ERUS in order to assess the best diagnostic imaging combination for rectal cancer staging. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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11 pages, 634 KiB  
Article
Preoperative Immunonutrition vs. Standard Dietary Advice in Normo-Nourished Patients Undergoing Fast-Track Laparoscopic Colorectal Surgery
by Manfredi Tesauro, Andrea M. Guida, Leandro Siragusa, Bruno Sensi, Vittoria Bellato, Nicola Di Daniele, Andrea Divizia, Marzia Franceschilli and Giuseppe S. Sica
J. Clin. Med. 2021, 10(3), 413; https://doi.org/10.3390/jcm10030413 - 22 Jan 2021
Cited by 9 | Viewed by 2605
Abstract
Immunonutrition (IN) appears to reduce infective complications and in-hospital length of stay (LOS) after major gastrointestinal surgery, but its use in normo-nourished patients is still controversial. The primary aim of this comparative observational study was to evaluate if pre-operative IN reduces in-hospital stay [...] Read more.
Immunonutrition (IN) appears to reduce infective complications and in-hospital length of stay (LOS) after major gastrointestinal surgery, but its use in normo-nourished patients is still controversial. The primary aim of this comparative observational study was to evaluate if pre-operative IN reduces in-hospital stay in patients undergoing laparoscopic colorectal resection for cancer under an enhanced recovery after surgery (ERAS) program. The influence of IN on time to first bowel movements, time to full oral diet tolerance, number and type of complications, reasons of prolonged LOS and readmission rate was evaluated as secondary outcome. Patients undergoing ERAS laparoscopic colorectal resection between December 2016 and December 2019 were reviewed. Patients who have received preoperative IN (group A) were compared to those receiving standard dietary advice (group B). Mean in-hospital LOS was significantly shorter in patients receiving preoperative IN than standard dietary advice (4.85 ± 2.25 days vs. 6.06 ± 3.95 days; p < 0.0492). No differences in secondary outcomes were observed. Preoperative IN associated with ERAS protocol in normo-nourished patients undergoing laparoscopic colorectal cancer resection seems to reduce LOS. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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8 pages, 714 KiB  
Article
Outcomes of Intra- versus Extra-Corporeal Ileocolic Anastomosis after Minimally Invasive Right Colectomy for Cancer: An Observational Study
by Francesc Vallribera, Miquel Kraft, Meritxell Pera, Laura Vidal and Eloy Espín-Basany
J. Clin. Med. 2021, 10(2), 307; https://doi.org/10.3390/jcm10020307 - 15 Jan 2021
Cited by 6 | Viewed by 2158
Abstract
Intracorporeal anastomoses (IA) are increasingly being used in colorectal surgery. Some data suggest that these might confer benefits compared with extracorporeal anastomoses (EA). The aim of this study is to compare the short-term complications associated with IA versus EA for minimally invasive right [...] Read more.
Intracorporeal anastomoses (IA) are increasingly being used in colorectal surgery. Some data suggest that these might confer benefits compared with extracorporeal anastomoses (EA). The aim of this study is to compare the short-term complications associated with IA versus EA for minimally invasive right colectomy. This is a single-centre, retrospective study on a prospective database. Patients who underwent minimally invasive right colectomy for cancer between January 2017 and December 2019 were assessed for inclusion. The primary outcome was global 30-day morbidity. Overall, 189 patients were included, of whom 102 had IA. Global morbidity and medical complications were higher in patients with EA (23.5% vs. 40.2%, p = 0.014; 5.9% vs. 14.9%, p = 0.039, respectively). None of the patients with IA had non-infectious surgical wound complications, compared to 4.6% in the EA group (p = 0.029). No differences were found in anastomotic leakage (9.8% vs. 10.3%, p = 0.55). At multivariable analysis, EA was an independent risk factor for both surgical (OR = 3.71 95% CI: 1.06–12.91, p = 0.04) and overall complications (OR = 3.58 95% CI: 1.06–12.12, p = 0.04). IA lowers the risk for global, medical, and surgical complications with minimum risk for wound complications, without increasing the risk of AL. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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8 pages, 3422 KiB  
Article
Impact of COVID-19 Quarantine on Advanced Hemorrhoidal Disease and the Role of Telemedicine in Patient Management
by Paola Campennì, Angelo A. Marra, Lorenzo Ferri, Raffaele Orefice, Angelo Parello, Francesco Litta, Veronica De Simone, Marta Goglia and Carlo Ratto
J. Clin. Med. 2020, 9(11), 3416; https://doi.org/10.3390/jcm9113416 - 25 Oct 2020
Cited by 8 | Viewed by 2890
Abstract
The aims of this population study were to assess the lockdown impact on patients waiting for hemorrhoidal surgery, and the role of telemedicine in patient management. All patients on our waiting list for hemorrhoidal surgery were considered. Eligible patients were contacted by phone. [...] Read more.
The aims of this population study were to assess the lockdown impact on patients waiting for hemorrhoidal surgery, and the role of telemedicine in patient management. All patients on our waiting list for hemorrhoidal surgery were considered. Eligible patients were contacted by phone. Rørvik score was evaluated and compared to the baseline score. Univariate and multivariate analyses were performed. A numeric rating scale was used to estimate patient satisfaction regarding telemedicine. One-hundred and ten patients were found to be eligible. Finally, 103 patients were included in the study of whom 16 (15.3%) were already considered for priority surgery. Patients waiting for a longer time showed significantly worse scores (p < 0.001). After telemedicine evaluation the priority waiting list increased by 43.8% (plus 23 patients). Weight loss of at least 3 kg and physical activity were found to be protective factors (p = 0.02 and p = 0.002 respectively). A high grade of satisfaction (almost 80%) towards telemedicine was registered. COVID-19-related delays are linked to a deterioration of hemorrhoidal symptoms and patients’ well-being. Weight and lifestyle changes were deemed key factors in determining disease severity. Telemedicine was a valuable tool to evaluate and re-evaluate patients waiting for hemorrhoidal surgery and was considered satisfactory by patients. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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Review

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11 pages, 3065 KiB  
Review
Colonic Lipoma Causing Bowel Intussusception: An Up-to-Date Systematic Review
by Francesco Menegon Tasselli, Fabrizio Urraro, Guido Sciaudone, Giulia Bagaglini, Francesca Pagliuca, Alfonso Reginelli, Franca Ferraraccio, Salvatore Cappabianca, Francesco Selvaggi and Gianluca Pellino
J. Clin. Med. 2021, 10(21), 5149; https://doi.org/10.3390/jcm10215149 - 2 Nov 2021
Cited by 22 | Viewed by 3149
Abstract
Background: Colonic lipomas are rare and can sometimes cause intussusception. The aim of this review was to define the presentation and possible management for colocolic intussusception caused by colonic lipomas. Methods: A systematic search for patients with colocolic intussusception caused by colonic lipoma, [...] Read more.
Background: Colonic lipomas are rare and can sometimes cause intussusception. The aim of this review was to define the presentation and possible management for colocolic intussusception caused by colonic lipomas. Methods: A systematic search for patients with colocolic intussusception caused by colonic lipoma, including all available reports up to 2021. Epidemiological, clinical, laboratory, and instrumental data and details about the treatments performed were gathered. Results: Colocolic intussusception caused by lipoma is more frequent in women (57%), occurring between 40 and 70 years of age. Up to 83% of patients report abdominal pain, followed by constipation (18%), rectal bleeding (16%), and diarrhea (12%), with abdominal tenderness (37%), and distension in 16%, whereas 24% have a negative exploration. CT (72%) and colonoscopy (62%) are more commonly able to diagnose the entity. The most common location of intussusception is the transverse colon (28%). The surgical operation varies according to the site. The average dimensions of the lipoma are 59.81 × 47.84 × 38.9 mm3. Conclusions: A correct preoperative diagnosis of colonic lipoma causing intussusception might not be easy. Despite nonspecific clinical and laboratory presentation, cross-sectional imaging can help differential diagnosis. Surgical treatment depends on the localization. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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12 pages, 36726 KiB  
Review
Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer
by Ailín C. Rogers, John T. Jenkins, Shahnawaz Rasheed, George Malietzis, Elaine M. Burns, Christos Kontovounisios and Paris P. Tekkis
J. Clin. Med. 2021, 10(21), 4921; https://doi.org/10.3390/jcm10214921 - 25 Oct 2021
Cited by 9 | Viewed by 5023
Abstract
Treatment strategies for advanced or recurrent rectal cancer have evolved such that the ultimate surgical goal to achieve a cure is complete pathological clearance. To achieve this where the sacrum is involved, en bloc sacrectomy is the current standard of care. Sacral resection [...] Read more.
Treatment strategies for advanced or recurrent rectal cancer have evolved such that the ultimate surgical goal to achieve a cure is complete pathological clearance. To achieve this where the sacrum is involved, en bloc sacrectomy is the current standard of care. Sacral resection is technically challenging and has been described; however, the technique has yet to be streamlined across units. This comprehensive review aims to outline the surgical approach to en bloc sacrectomy for locally advanced or recurrent rectal cancer, with standardisation of the operative steps of the procedure and to discuss options that enhance the technique. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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14 pages, 25680 KiB  
Review
Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives
by Antonino Spinelli, Virginia Laurenti, Francesco Maria Carrano, Enrique Gonzalez-Díaz and Katarzyna Borycka-Kiciak
J. Clin. Med. 2021, 10(15), 3261; https://doi.org/10.3390/jcm10153261 - 23 Jul 2021
Cited by 11 | Viewed by 8457
Abstract
Perineal injury during childbirth is a common event with important morbidity associated in particular with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries—OASIS). Early diagnosis of these damages is mandatory to define a prompt therapeutic strategy and thus avoid [...] Read more.
Perineal injury during childbirth is a common event with important morbidity associated in particular with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries—OASIS). Early diagnosis of these damages is mandatory to define a prompt therapeutic strategy and thus avoid the development of late-onset consequences, such as faecal incontinence. For this purpose, various diagnostic exams can be performed after a thorough clinical examination. The management of OASIS includes several measures and should be individualized according to the timing and features of the clinical presentation. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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18 pages, 5446 KiB  
Review
Therapeutic Targets and Tumor Microenvironment in Colorectal Cancer
by Gaetano Gallo, Giuseppina Vescio, Gilda De Paola and Giuseppe Sammarco
J. Clin. Med. 2021, 10(11), 2295; https://doi.org/10.3390/jcm10112295 - 25 May 2021
Cited by 29 | Viewed by 3531
Abstract
Colorectal cancer (CRC) is a genetically, anatomically, and transcriptionally heterogeneous disease. The prognosis for a CRC patient depends on the stage of the tumor at diagnosis and widely differs accordingly. The tumor microenvironment (TME) in CRC is an important factor affecting targeted cancer [...] Read more.
Colorectal cancer (CRC) is a genetically, anatomically, and transcriptionally heterogeneous disease. The prognosis for a CRC patient depends on the stage of the tumor at diagnosis and widely differs accordingly. The tumor microenvironment (TME) in CRC is an important factor affecting targeted cancer therapy. The TME has a dynamic composition including various cell types, such as cancer-associated fibroblasts, tumor-associated macrophages, regulatory T cells, and myeloid-derived suppressor cells, as well as extracellular factors that surround cancer cells and have functional and structural roles under physiological and pathological conditions. Moreover, the TME can limit the efficacy of therapeutic agents through high interstitial pressure, fibrosis, and the degradation of the therapeutic agents by enzymatic activity. For this reason, the TME is a fertile ground for the discovery of new drugs. The aim of this narrative review is to present current knowledge and future perspectives regarding the TME composition based on strategies for patients with CRC. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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11 pages, 4225 KiB  
Review
The Emerging Role of Robotics in Pelvic Exenteration Surgery for Locally Advanced Rectal Cancer: A Narrative Review
by Tou Pin Chang, Aik Yong Chok, Dominic Tan, Ailin Rogers, Shahnawaz Rasheed, Paris Tekkis and Christos Kontovounisios
J. Clin. Med. 2021, 10(7), 1518; https://doi.org/10.3390/jcm10071518 - 5 Apr 2021
Cited by 14 | Viewed by 3741
Abstract
Pelvic exenteration surgery for locally advanced rectal cancers is a complex and extensive multivisceral operation, which is associated with high perioperative morbidity and mortality rates. Significant technical challenges may arise due to inadequate access, visualisation, and characterisation of tissue planes and critical structures [...] Read more.
Pelvic exenteration surgery for locally advanced rectal cancers is a complex and extensive multivisceral operation, which is associated with high perioperative morbidity and mortality rates. Significant technical challenges may arise due to inadequate access, visualisation, and characterisation of tissue planes and critical structures in the spatially constrained pelvis. Over the last two decades, robotic-assisted technologies have facilitated substantial advancements in the minimally invasive approach to total mesorectal excision (TME) for rectal cancers. Here, we review the emerging experience and evidence of robotic assistance in beyond TME multivisceral pelvic exenteration for locally advanced rectal cancers where heightened operative challenges and cumbersome ergonomics are likely to be encountered. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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9 pages, 239 KiB  
Review
Re-Operative Laparoscopic Colorectal Surgery: A Systematic Review
by Constantine Halkias, Athanasios Zoikas, Zoe Garoufalia, Michalis K. Konstantinidis, Argyrios Ioannidis and Steven Wexner
J. Clin. Med. 2021, 10(7), 1447; https://doi.org/10.3390/jcm10071447 - 1 Apr 2021
Cited by 7 | Viewed by 2976
Abstract
Introduction: Re-operative laparoscopic colorectal surgery is becoming increasingly common. It can be a challenging procedure, but its benefits can outweigh the associated risks. Methods: A systematic review of the literature reporting re-operative laparoscopic surgery was carried out. Retrospective and prospective cohort studies and [...] Read more.
Introduction: Re-operative laparoscopic colorectal surgery is becoming increasingly common. It can be a challenging procedure, but its benefits can outweigh the associated risks. Methods: A systematic review of the literature reporting re-operative laparoscopic surgery was carried out. Retrospective and prospective cohort studies and case series were included, with case reports being excluded. Results: Seventeen articles dated from 2007 to 2020 were included in the systematic review. In total, 1555 patients were identified. Five hundred and seventy-four of them had a laparoscopic procedure and 981 an open re-operation. One hundred and eighty-three women had a laparoscopic operation. The median age ranged from to 44.9 years to 68.7 years. In seven studies, the indication of the index operation was malignancy, one study regarded re-laparoscopy for excision of lateral pelvic lymph nodes, and one study looked at redo surgery of ileal J pouch anal anastomosis. There were 16 mortalities in the laparoscopic arm (2.78%) and 93 (9.4%) in the open surgery arm. One hundred and thirty-seven morbidities were recorded in the open arm and 102 in the laparoscopic arm. Thirty-nine conversions to open occurred. The median length of stay ranged from 5.8 days to 19 days in laparoscopy and 9.7 to 34 days in the open surgery arm. Conclusions: Re-operative laparoscopic colorectal surgery is safe when performed by experienced hands. The management of complications, recurrence of malignancy, and lateral pelvic floor dissection can be safely performed. The complication rate is low, with conversion to open procedures being relatively uncommon. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
17 pages, 1579 KiB  
Review
Mast Cells, microRNAs and Others: The Role of Translational Research on Colorectal Cancer in the Forthcoming Era of Precision Medicine
by Giuseppe Sammarco, Gaetano Gallo, Giuseppina Vescio, Arcangelo Picciariello, Gilda De Paola, Mario Trompetto, Giuseppe Currò and Michele Ammendola
J. Clin. Med. 2020, 9(9), 2852; https://doi.org/10.3390/jcm9092852 - 3 Sep 2020
Cited by 41 | Viewed by 3602
Abstract
Colorectal cancer (CRC) is a heterogeneous disease, molecularly and anatomically, that develops in a multi-step process requiring the accumulation of several genetic or epigenetic mutations that lead to the gradual transformation of normal mucosa into cancer. In fact, tumorigenesis is extremely complex, with [...] Read more.
Colorectal cancer (CRC) is a heterogeneous disease, molecularly and anatomically, that develops in a multi-step process requiring the accumulation of several genetic or epigenetic mutations that lead to the gradual transformation of normal mucosa into cancer. In fact, tumorigenesis is extremely complex, with many immunologic and non-immunologic factors present in the tumor microenvironment that can influence tumorigenesis. In the last few years, a role for mast cells (MCs), microRNAs (miRNAs), Kirsten rat sarcoma (KRAS) and v-raf murine sarcoma viral oncogene homologue B (BRAF) in cancer development and progression has been suggested, and numerous efforts have been made to thoroughly assess their correlation with CRC to improve patient survival and quality of life. The identification of easily measurable, non-invasive and cost-effective biomarkers, the so-called “ideal biomarkers”, for CRC screening and treatment remains a high priority. The aim of this review is to discuss the emerging role of mast cells (MCs), microRNAs (miRNAs), KRAS and BRAF as diagnostic and prognostic biomarkers for CRC, evaluating their influence as potential therapy targets in the forthcoming era of precision medicine. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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Other

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2 pages, 178 KiB  
Correction
Correction: Pata et al. Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes. J. Clin. Med. 2022, 11, 218
by Francesco Pata, Luigi Maria Bracchitta, Giancarlo D’Ambrosio and Salvatore Bracchitta
J. Clin. Med. 2023, 12(15), 5159; https://doi.org/10.3390/jcm12155159 - 7 Aug 2023
Viewed by 679
Abstract
In the original publication [...] Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
16 pages, 3675 KiB  
Systematic Review
Locally Recurrent Rectal Cancer According to a Standardized MRI Classification System: A Systematic Review of the Literature
by Zena Rokan, Constantinos Simillis, Christos Kontovounisios, Brendan Moran, Paris Tekkis and Gina Brown
J. Clin. Med. 2022, 11(12), 3511; https://doi.org/10.3390/jcm11123511 - 18 Jun 2022
Cited by 6 | Viewed by 5633
Abstract
(1) Background: The classification of locally recurrent rectal cancer (LRRC) is not currently standardized. The aim of this review was to evaluate pelvic LRRC according to the Beyond TME (BTME) classification system and to consider commonly associated primary tumour characteristics. (2) Methods: A [...] Read more.
(1) Background: The classification of locally recurrent rectal cancer (LRRC) is not currently standardized. The aim of this review was to evaluate pelvic LRRC according to the Beyond TME (BTME) classification system and to consider commonly associated primary tumour characteristics. (2) Methods: A systematic review of the literature prior to April 2020 was performed through electronic searches of the Science Citation Index Expanded, EMBASE, MEDLINE, and CENTRAL databases. The primary outcome was to assess the location and frequency of previously classified pelvic LRRC and translate this information into the BTME system. Secondary outcomes were assessing primary tumour characteristics. (3) Results: A total of 58 eligible studies classified 4558 sites of LRRC, most commonly found in the central compartment (18%), following anterior resection (44%), in patients with an ‘advanced’ primary tumour (63%) and following neoadjuvant radiotherapy (29%). Most patients also classified had a low rectal primary tumour. The lymph node status of the primary tumour leading to LRRC was comparable, with 52% node positive versus 48% node negative tumours. (4) Conclusions: This review evaluates the largest number of LRRCs to date using a single classification system. It has also highlighted the need for standardized reporting in order to optimise perioperative treatment planning. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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