Special Issue "Colorectal Surgery: Current Challenges and Future Perspectives"

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: 25 January 2023 | Viewed by 2705

Special Issue Editor

Prof. Dr. Umberto Bracale
E-Mail Website
Guest Editor
Department of Gastroenterology, Endocrinology and Surgical Endoscopy, Federico II University Hospital, Naples, Italy
Interests: laparoscopy; robotic-assisted surgery; colorectal cancer; gastric cancer; gastrointestinal benign disease; AI and surgery, abdominal wall surgery
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Special Issue Information

Dear Colleagues,

I am pleased to announce an upcoming Special Issue of JCM entitled “Colorectal Surgery: Current Challenges and Future Perspectives”.

There has been significant growth in the application of minimally invasive surgery (MIS) for the management of colorectal benign and malignant diseases. Along with Enhanced Recovery Program after Surgery (ERAS) programs, MIS has gained popularity, improving clinical outcomes. For this reason, different approaches, such as laparoscopic, robotic, and transanal, have been developed in colorectal surgery to ensure the best results. Furthermore, MIS is no longer conceivable without using new technologies including advanced optic systems (3D, 4K), new energy devices, and intraoperative fluorescence-guided imaging. Likewise, preoperative assessment of 3D-CT/MRI reconstructions is spreading more and more among surgeons’ clinical practice.

In this setting, the fundamental principles of surgical oncology should always be guaranteed in cases of malignant disease, although more conservative therapeutic management for rectal cancer is evolving. Therefore, organ-preserving strategies for rectal cancer such as “Watch and Wait” or local excision following neoadjuvant therapy are also welcome among our topics.

For this Special Issue, we encourage the submission of original research or review articles on a range of topics covering the technical aspects of MIS, novel technologies, preoperative optimization, and postoperative outcomes.

We look forward to receiving your submissions.

Prof. Dr. Umberto Bracale
Guest Editor

Manuscript Submission Information

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Keywords

  • laparoscopy
  • robotic-assisted surgery
  • transanal excision
  • indocyanine green
  • ERAS
  • 3D imaging
  • colorectal cancer
  • diverticular disease
  • postoperative outcomes

Published Papers (4 papers)

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Research

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Article
Surgery as an Emotional Strain: An Observational Study in Patients Undergoing Elective Colorectal Surgery
J. Clin. Med. 2022, 11(10), 2712; https://doi.org/10.3390/jcm11102712 - 11 May 2022
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Abstract
Recent research suggests an impact of psychological distress on postoperative outcomes in orthopedic and neurosurgery. It is widely unknown whether patients’ mood might affect the postoperative outcome and complication rate in colorectal surgery. Over a period of 22 months, a monocentric, observational study [...] Read more.
Recent research suggests an impact of psychological distress on postoperative outcomes in orthopedic and neurosurgery. It is widely unknown whether patients’ mood might affect the postoperative outcome and complication rate in colorectal surgery. Over a period of 22 months, a monocentric, observational study among patients undergoing elective colorectal surgery without the creation of an ostomy was conducted. Patients were asked to fill in a standardized multi-dimensional mood questionnaire (MDMQ) preoperatively as well as on the third, sixth, and ninth postoperative days to assess mood, wakefulness, and arousal. The results of 80 patients (51% male, mean age 59 years) were analyzed. Almost half of the patients (58%) developed postoperative complications according to the Clavien–Dindo classification (Grade I 14%, Grade II 30%, Grade III 9%, Grade IV 3%). Patients’ mood increased continually from the preoperative day to the ninth postoperative day. Patients’ wakefulness decreased initially (pre- to third postoperative day) and increased again in the further course. Patients’ arousal decreased pre- to postoperatively. Neither preoperative mood, nor arousal or wakefulness of patients showed a clear association with the development of postoperative complications. In conclusion, preoperative psychological distress measured by MDMQ did not affect the postoperative complication rate of patients undergoing elective colorectal surgery. Full article
(This article belongs to the Special Issue Colorectal Surgery: Current Challenges and Future Perspectives)
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Article
Could Stoma Be Avoided after Laparoscopic Low Anterior Resection for Rectal Cancer? Experience with Transanal Tube in 195 Cases
J. Clin. Med. 2022, 11(9), 2632; https://doi.org/10.3390/jcm11092632 - 07 May 2022
Viewed by 378
Abstract
Anastomotic leakage is the most-feared complication of rectal surgery. Transanal devices have been suggested for anastomotic protection as an alternative to defunctioning stoma, although evidence is conflicting, and no single device is widely used in clinical practice. The aim of this paper is [...] Read more.
Anastomotic leakage is the most-feared complication of rectal surgery. Transanal devices have been suggested for anastomotic protection as an alternative to defunctioning stoma, although evidence is conflicting, and no single device is widely used in clinical practice. The aim of this paper is to investigate the safety and efficacy of a transanal tube for the prevention of leakage following laparoscopic rectal cancer resection. A transanal tube was used in the cases of total mesorectal excision with low colorectal or coloanal anastomosis, undamaged doughnuts, and negative intraoperative air-leak test. The transanal tube was kept in place until the seventh postoperative day. A total of 195 consecutive patients were retrieved from a prospective surgical database and included in the study. Of these, 71.8% received preoperative chemoradiotherapy. The perioperative mortality rate was 1.0%. Anastomotic leakage occurred in 19 patients, accounting for an incidence rate of 9.7%. Among these, 13 patients underwent re-laparoscopy and ileostomy, while 6 patients were managed conservatively. Overall, the stoma rate was 6.7%. The use of a transanal tube may be a suitable strategy for anastomotic protection following restorative rectal cancer resection. This approach could avoid the burden of a stoma in selected patients with low anastomoses. Full article
(This article belongs to the Special Issue Colorectal Surgery: Current Challenges and Future Perspectives)
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Article
Risk Stratification of Endoscopic Submucosal Dissection in Colon Tumors
J. Clin. Med. 2022, 11(6), 1560; https://doi.org/10.3390/jcm11061560 - 12 Mar 2022
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Abstract
Background: Endoscopic submucosal dissection (ESD) is a technique proven effective in the treatment of early neoplastic lesions in the gastrointestinal tract. However, in the case of colon lesions, many doubts remain. The purpose of our study is to stratify the success rates of [...] Read more.
Background: Endoscopic submucosal dissection (ESD) is a technique proven effective in the treatment of early neoplastic lesions in the gastrointestinal tract. However, in the case of colon lesions, many doubts remain. The purpose of our study is to stratify the success rates of the ESD procedure in the colon. Materials and Methods: A retrospective analysis of 601 patients who underwent ESD procedure for colorectal neoplasm from 2016 to 2019 in Center of Bowel Treatment, Brzeziny, Poland. Excluding 335 rectal neoplasms, we selected 266 patients with lesions located in the colon. Results: Lesions located in the left colon were characterized by the statistically higher en bloc resection and success rate, compared with the right colon—87.76% vs. 73.95% (p = 0.004) and 83.67% vs. 69.75% (p = 0.007), respectively. The success rate was significantly lower in lesions with submucosal cancer, compared to low- and high-grade dysplasia (p < 0.001). Polyps located in the right colon were characterized by a slightly higher complication rate compared to the left colon, without statistical significance—13.45% vs. 9.52% (p = 0.315). Conclusions: Our results show that colonic ESD has a high success rate, especially in the left colon, with a low risk of complications, slightly higher than in the right colon. Full article
(This article belongs to the Special Issue Colorectal Surgery: Current Challenges and Future Perspectives)

Review

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Review
Surgical Management of Hemorrhoidal Disease in Inflammatory Bowel Disease: A Systematic Review with Proportional Meta-Analysis
J. Clin. Med. 2022, 11(3), 709; https://doi.org/10.3390/jcm11030709 - 28 Jan 2022
Cited by 1 | Viewed by 993
Abstract
Surgical treatment of hemorrhoidal disease (HD) in inflammatory bowel disease (IBD) has been considered to be potentially harmful, but the evidence for this is poor. Therefore, a systematic review of the literature was undertaken to reappraise the safety and effectiveness of surgical treatments [...] Read more.
Surgical treatment of hemorrhoidal disease (HD) in inflammatory bowel disease (IBD) has been considered to be potentially harmful, but the evidence for this is poor. Therefore, a systematic review of the literature was undertaken to reappraise the safety and effectiveness of surgical treatments in this special circumstance. A MEDLINE, Web of Science, Scopus, and Cochrane Library search was performed to retrieve studies reporting the outcomes of surgical treatment of HD in patients with Crohn’s disease (CD) and ulcerative colitis (UC). From a total of 2072 citations, 10 retrospective studies including 222 (range, 2–70) patients were identified. Of these, 119 (54%) had CD and 103 (46%) UC. Mean age was between 41 and 49 years (range 14–77). Most studies lacked information on the interval between surgery and the onset of complications. Operative treatments included open or closed hemorrhoidectomy (n = 156 patients (70%)), rubber band ligation (n = 39 (18%)), excision or incision of thrombosed hemorrhoid (n = 14 (6%)), and doppler-guided hemorrhoidal artery ligation (DG-HAL, n = 13 (6%)). In total, 23 patients developed a complication (pooled prevalence, 9%; (95%CI, 3–16%)), with a more than two-fold higher rate in patients with CD compared to UC (11% (5–16%) vs. 5% (0–13%), respectively). Despite the low quality evidence, surgical management of HD in IBD and particularly in CD patients who have failed nonoperative therapy should still be performed with caution and limited to inactive disease. Further studies should determine whether advantages in terms of safety and effectiveness with the use of non-excisional techniques (e.g., DG-HAL) can be obtained in this patient population. Full article
(This article belongs to the Special Issue Colorectal Surgery: Current Challenges and Future Perspectives)
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