Journal of Clinical Medicine

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10 pages, 879 KiB

Open AccessArticle

Robotic Total Mesorectal Excision for Low Rectal Cancer: A Narrative Review and Description of the Technique

by Giampaolo Formisano, Luca Ferraro, Adelona Salaj, Simona Giuratrabocchetta, Gaetano Piccolo, Giulia Di Raimondo and Paolo Pietro Bianchi

J. Clin. Med. 2023, 12(14), 4859; https://doi.org/10.3390/jcm12144859 - 24 Jul 2023

Viewed by 1393

Abstract

Robotic surgery may offer significant advantages for treating extraperitoneal rectal cancer. Although laparoscopy has been shown to be safe and effective, laparoscopic total mesorectal excision (TME) remains technically challenging and is still performed in selected centers. Robotic anterior resection (RAR) may overcome the [...] Read more.

Robotic surgery may offer significant advantages for treating extraperitoneal rectal cancer. Although laparoscopy has been shown to be safe and effective, laparoscopic total mesorectal excision (TME) remains technically challenging and is still performed in selected centers. Robotic anterior resection (RAR) may overcome the drawback of conventional laparoscopy, providing high-quality surgery with favorable oncological outcomes. Moreover, recent data show how RAR offers clinical and oncological benefits when affording difficult TMEs, such as low and advanced rectal tumors, in terms of complication rate, specimen quality, recurrence rate, and survival. This series aims to review the most recent and relevant literature, reporting mid- and long-term oncological outcomes and focusing on minimally invasive RAR for low rectal cancer. Full article

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

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13 pages, 1554 KiB

Open AccessArticle

Would Surgeons Like to Be Submitted to Anal Fistulotomy? An International Web-Based Survey

by Carlo Ratto, Angelo Alessandro Marra, Angelo Parello, Veronica De Simone, Paola Campennì and Francesco Litta

J. Clin. Med. 2023, 12(3), 825; https://doi.org/10.3390/jcm12030825 - 20 Jan 2023

Viewed by 1353

Abstract

Traditional fistulotomy is the most performed surgical procedure in anal fistula surgery. We conducted an international online survey to explore colorectal surgeons’ opinions and preferences on fistulotomy. Considering the healing and continence impairment rates reported in the literature, surgeons were invited to answer [...] Read more.

Traditional fistulotomy is the most performed surgical procedure in anal fistula surgery. We conducted an international online survey to explore colorectal surgeons’ opinions and preferences on fistulotomy. Considering the healing and continence impairment rates reported in the literature, surgeons were invited to answer as a hypothetic patient susceptible to being submitted to fistulotomy for low and high anal fistula. A total of 767 surgeons completed the survey from 72 countries. The majority of respondents were consultants, having treated more than 20 anal fistulas in the last year. Most of them declared that anal fistula would be able to negatively affect quality of life and would be worried/anxious about it. Taking into account all aspects, 87.5% and 37.8% of respondents would agree to be treated with a fistulotomy in case of a low and high fistula, respectively, with an acceptance rate that varied worldwide. At multivariate analysis, factors correlated to the acceptance of anal fistulotomy were male gender (p = 0.003), practice of less than 20 fistula operations during last year (p = 0.020), and low fistula (p < 0.001). Surgeons recognized the extreme complexity of this approach. This study highlighted the necessity of an accurate patients’ selection and the adoption of alternative strategy to reduce the risk of anal continence impairment. Full article

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

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11 pages, 776 KiB

Open AccessArticle

Surgery as an Emotional Strain: An Observational Study in Patients Undergoing Elective Colorectal Surgery

by Ann-Kathrin Lederer, Ines Manteufel, Agnes Knott, Lampros Kousoulas, Paul Georg Werthmann, Maximilian Andreas Storz, Roman Huber and Alexander Müller

J. Clin. Med. 2022, 11(10), 2712; https://doi.org/10.3390/jcm11102712 - 11 May 2022

Cited by 1 | Viewed by 1352

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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10 pages, 1227 KiB

Open AccessArticle

Could Stoma Be Avoided after Laparoscopic Low Anterior Resection for Rectal Cancer? Experience with Transanal Tube in 195 Cases

by Antonio Sciuto, Roberto Peltrini, Federica Andreoli, Andrea Gianmario Di Santo Albini, Maria Michela Di Nuzzo, Nello Pirozzi, Marcello Filotico, Federica Lauria, Giuseppe Boccia, Michele D’Ambra, Ruggero Lionetti, Carlo De Werra, Felice Pirozzi and Francesco Corcione

J. Clin. Med. 2022, 11(9), 2632; https://doi.org/10.3390/jcm11092632 - 07 May 2022

Cited by 2 | Viewed by 2091

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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8 pages, 245 KiB

Open AccessArticle

Risk Stratification of Endoscopic Submucosal Dissection in Colon Tumors

by Katarzyna Winter, Marcin Włodarczyk, Jakub Włodarczyk, Igor Dąbrowski, Ewa Małecka-Wojciesko, Adam Dziki and Michał Spychalski

J. Clin. Med. 2022, 11(6), 1560; https://doi.org/10.3390/jcm11061560 - 12 Mar 2022

Cited by 1 | Viewed by 1825

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

Jump to: Research

7 pages, 668 KiB

Open AccessReview

Surgical Management of Hemorrhoidal Disease in Inflammatory Bowel Disease: A Systematic Review with Proportional Meta-Analysis

by Ugo Grossi, Gaetano Gallo, Gian Luca Di Tanna, Umberto Bracale, Mattia Ballo, Elisa Galasso, Andrea Kazemi Nava, Martino Zucchella, Francesco Cinetto, Marcello Rattazzi, Carla Felice and Giacomo Zanus

J. Clin. Med. 2022, 11(3), 709; https://doi.org/10.3390/jcm11030709 - 28 Jan 2022

Cited by 2 | Viewed by 3427

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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