Locoregional recurrence (LRR) after segmental colectomy occurs in 4–12
In this study, we aim to assess the impact of tumor height on surgical strategy, oncological outcomes, and long-term function in locally advanced rectal cancer. This retrospective cohort study included patients with cT3–T4 and/or N+ rectal cancer treated between 2017 and 2024. Tumors were classified as low locally advanced rectal cancer (LARC; 0 to < 5 cm) or middle locally advanced rectal cancer (MARC; ≥ 5 to < 10 cm). All patients underwent total mesorectal excision (TME) following multimodal therapy. Outcomes included perioperative variables, overall survival (OS), disease-free survival (DFS), and functional results assessed using Wexner, low anterior resection syndrome (LARS), the 36-Item Short-Form health survey (SF-36), and Five-Item International Index of Erectile Function (IIEF-5) scores. Predictors of permanent stoma were analyzed using multivariable regression. A total of 164 patients were included (MARC n = 84; LARC n = 80). Sphincter-sacrificing procedures were significantly more frequent in LARC (abdominoperineal resection [APR]: 48.8
Transanal endoscopic microsurgery (TEM) and transanal endoscopic operation (TEO) allow for organ-preserving removal of rectal neoplasms. However, changes in indications, anesthesia, and outcomes over time are not clearly defined. This retrospective review (1993–2025) of a prospectively maintained database categorized procedures into TEM (group A, 1993–2008), early TEO (group B, 2008–2016), and late TEO (group C, 2016–2025). Primary endpoint was uneventful 30-day course (no postoperative complications, readmission, reintervention, death) and secondary endpoints were intra-/postoperative complications, peritoneal entry, length of stay (LOS), readmission, mortality, reintervention, margins, and recurrence. Among 1077 transanal endoscopic procedures, 1048 were TEM/TEO with complete 30-day data (median age 69 years; 58
Salvage surgery for local regrowth following watch-and-wait (W W) after total neoadjuvant therapy (TNT) is perceived to be technically more difficult than immediate surgery after treatment. However, surgical difficulty lacks standardised definition and reporting. This methodological review proposes a structured minimum outcome set (MOS) to distinguish intra-operative technical complexity from surgery-related morbidity and evaluates current reporting against this framework. A predefined framework comprised two domains: (1) surgery-related morbidity (Clavien–Dindo major complications, 30- or 90-day mortality, anastomotic leak, reoperation/readmission within 30 days and stoma status) and (2) intra-operative technical complexity (surgical approach, conversion, operative time, blood loss and a predefined pelvic complexity metric). R0/R1 resection status was recorded separately as a contextual oncological measure. A systematic review identified studies reporting salvage surgery for local regrowth after TNT and W W. Reporting of MOS variables was enumerated and risk of bias assessed using a topic-specific ROBINS-I tool. Ten studies met the inclusion criteria, comprising 569 patients managed with TNT and W W; 198 (35
Reversal of Hartmann’s procedure is technically demanding and occasionally performed via open surgery, which is associated with substantial morbidity. Minimally invasive approaches have expanded, yet comparative evidence between robotic and laparoscopic reversal remains limited. We conducted a systematic review and meta-analysis to compare perioperative outcomes of both approaches. Databases were searched through 20 July 2026. Studies reporting outcomes after laparoscopic and/or robotic Hartmann’s reversal were included. Random-effects meta-analyses were performed with preplanned subgroup comparisons (robotic versus laparoscopic). Pooled estimates were reported with 95
The purpose of this study was to review the clinical application of cold resection for colorectal polyps and determine its efficacy and safety for polyps of different sizes. A narrative review was conducted to analyze and compare key indicators, including complete resection rate (CRR), bleeding rate, perforation rate, and recurrence rate, for polyps of different sizes undergoing cold versus hot resection. The CRR of cold snare polypectomy (CSP) for resecting colorectal polyps measuring ≤ 10 mm is comparable to that of hot resection. However, the risk of delayed bleeding and perforation is significantly lower with CSP. With nonpedunculated colorectal polyps measuring 10–19 mm, particularly sessile serrated lesions (SSLs), cold resection (e.g., piecemeal cold snare polypectomy (pCSP)) is a safe and feasible option. For colorectal adenomas, however, the risk of recurrence with cold resection may be slightly higher than with hot resection. For large (≥ 20 mm) sessile serrated lesions (L-SSLs), cold resection offers significant safety advantages; however, the risk of recurrence is higher than with hot resection. Due to the higher risk of recurrence, cold resection is not recommended for removing large (≥ 20 mm) nonpedunculated adenomatous polyps (LNPCPs). Cold resection is particularly suitable for patients taking anticoagulants and those in poor health who cannot tolerate complications. Cold resection has become the standard treatment for small polyps due to its excellent safety profile. It is now also used for some larger polyps, particularly SSLs. However, strict adherence to histology guidance is crucial for larger polyps and adenomatous lesions because of the higher rate of postoperative recurrence.
Perianal Crohn’s disease (pCD) is a distinct and debilitating phenotype of Crohn’s disease and an independent predictor of long-term adverse outcomes. Traditionally, outcome measurement has focused on fistula healing to assess treatment success; however, as we recognise distinct classes of patients and shift towards shared decision making, healthcare professionals are increasingly acknowledging the importance of assessing more nuanced outcomes such as downstaging, quality of life, sex and intimacy and the impact on family, education or work. Current challenges in outcome measurement include substantial heterogeneity in definitions, measurement tools and time points used. This review will cover the current landscape, reporting on historical measurement instruments, such as the fistula drainage assessment (FDA), perianal disease activity index (PDAI) and the collective move towards patient-centred and patient-developed tools, such as the Crohn’s anal fistula quality of life scale (CAF-QoL). It will also assess the value of core outcome measurement sets, which provide a uniform but flexible framework to standardise outcome reporting across studies and support comparison of interventions in clinical practice. Importantly, the incorporation of patient perspectives within their methodology ensures that their recommendations reflect outcomes that truly matter to those with pCD. The contemporary need is for novel clinical and radiological tools to monitor perianal disease activity that are predictive, preventative and provide treatment thresholds, so that patients can live well with their fistulising disease, if it cannot be eradicated. There will no doubt also be a role for digital applications and artificial intelligence in enhancing outcome measurement further for perianal Crohn’s disease.
Selected patients with obstructed defecation syndrome (ODS) and concomitant pelvic organ prolapse (POP) may require laparoscopic resection rectopexy (L-RRP) with laparoscopic sacrocolpopexy (L-SCP). This trial compared the safety and efficacy of biologic versus synthetic mesh (BM or SM) in L-SCP. In this single-center randomized pilot trial, 30 women with severe ODS underwent combined L-RRP and L-SCP using either a BM or SM. The primary endpoint was the severe adverse event rate. Secondary endpoints included functional and anatomical outcomes related to ODS and POP. Follow-up was complete at 12 months for all patients. The 30 patients (15 per group) had similar baseline characteristics, comparable frequency of additional surgical procedures, longer operative time in the SM group, lower pain in the BM group, similar length of hospital stay, comparable adverse event rates, and no mesh-related complications. Severe adverse events were reported by two patients (13
Anorectal manometry (ARM) provides objective physiological information on anal sphincter function, rectal or neorectal sensation, reservoir capacity, and anorectal reflexes after rectal cancer surgery. In rectal cancer surgery, ARM has been used to evaluate functional changes after sphincter-preserving procedures, reconstruction with colonic J-pouch, neoadjuvant radiotherapy, and postoperative bowel dysfunction, including low anterior resection syndrome (LARS). This review summarizes the clinical applications of ARM in rectal cancer surgery, with emphasis on historical and contemporary manometric parameters, their relationship with patient-reported outcomes, and their limitations in postoperative functional assessment. Although several studies have reported associations between manometric findings and bowel dysfunction, the clinical interpretation of ARM remains limited by heterogeneity in measurement protocols, equipment dependency, timing of assessment, and variable correlation with quality-of-life measures. Recent advances, including high-resolution manometry and standardized testing protocols, may improve the reliability and clinical utility of ARM. ARM may provide adjunctive physiological information in selected patients and research settings, but current evidence does not support its use as a stand-alone diagnostic test for LARS or as a routine treatment-decision tool.
The elderly population represents an increasing proportion of patients undergoing surgery for colorectal cancer. Their risks and outcomes may differ from the general population. This study aimed to identify risk factors associated with anastomotic leak (AL) and the outcomes related to this complication in elderly patients, using a large retrospective cohort from a high-volume colorectal surgery unit. A retrospective cohort study was conducted including patients aged ≥ 75 years who underwent colorectal cancer surgery between January 2015 and March 2019 at a tertiary centre. Univariable and multivariable logistic regression analyses were used to identify predictors of AL. Kaplan–Meier and Cox regression analyses assessed long-term survival. A total of 416 patients (mean age 81.3 ± 4.7 years, 56
Surgical management of hemorrhoidal disease (HD) in patients with IBD remains controversial because of concerns about impaired outcomes. This study aimed to evaluate the safety and IBD-related outcomes of surgical treatments for HD in patients with IBD and to explore factors potentially associated with postoperative complications and IBD flare. HEAD-IBD is a retrospective cohort study promoted by the Italian Group for the study of IBD (IG-IBD). Adults with established ulcerative colitis (UC) or Crohn’s disease (CD) who underwent surgery for HD between 2004 and 2024 and had at least 12 months of follow-up were included. Surgical techniques, 1-, 6-, and 12-month complications, IBD flares (6 months), new onset perianal disease, and continence outcomes were analyzed. A total of 38 patients were included (21 UC, 17 CD), 55
Defecatory disorders and pelvic floor dysfunctions are prevalent and significantly impact quality of life. Due to their multifactorial etiology, a multidisciplinary approach and pelvic floor rehabilitation (PFR) are recommended; however, their implementation varies widely. This study aimed to evaluate current practices in multidisciplinary management and rehabilitation strategies for defecatory disorders in Italy. A 25-item, web-based survey was distributed to members of the Italian Society of Colorectal Surgery between May and July 2024. The questionnaire explored the professional background of the responders, the availability and composition of the multidisciplinary team (MDT), and the use of PFR and related clinical practices. A total of 183 colorectal surgeons from 20 Italian regions completed the survey. Only 49
Minimally invasive surgery (MIS) improves short-term outcomes in Crohn’s disease (CD), but its impact on long-term surgical recurrence is uncertain. The objective of this study was to assess risk factors for surgical recurrence after intestinal resection for CD, with emphasis on surgical approach. A retrospective single-centre study of patients undergoing elective intestinal resection for CD between 1995 and 2020 was conducted. Demographics, disease features, surgical details and complications were analysed. Recurrence was assessed using Kaplan–Meier and Cox regression. A total of 641 patients were included, with a mean follow-up of 12.4 years. Mean age at surgery was 38.3 years; mean disease duration was 11.5 years. Laparoscopy was performed in 270 patients, and open surgery in 371. Cumulative recurrence was 25
Incisional hernia is a common long-term complication following colorectal surgery. In laparoscopic low anterior resection (LAR) for rectal cancer, specimen extraction is most commonly performed via a periumbilical midline incision, although the Pfannenstiel incision has emerged as an alternative approach with the potential to reduce hernia rates. However, its adoption has been limited by technical demands, and comparative evidence in a homogeneous rectal cancer cohort remains scarce. This study compared incisional hernia risk, postoperative recovery, and oncologic outcomes according to extraction site in laparoscopic LAR. This retrospective cohort study included patients who underwent laparoscopic LAR for rectal cancer between 2014 and 2021. Specimen extraction was performed via either a Pfannenstiel incision or a periumbilical midline incision. The primary outcome was incisional hernia at the extraction site, assessed by computed tomography. Secondary outcomes included postoperative recovery, perioperative complications, and long-term oncologic outcomes. Risk factors for incisional hernia were evaluated using Cox proportional hazards regression. Among 242 patients, 115 underwent Pfannenstiel extraction and 127 periumbilical extraction. Incisional hernia occurred in one patient (0.9
Rectovaginal fistula (RVF) is a rare but severe complication of stapled prolapsectomy (SP), resulting from inadvertent inclusion of the posterior vaginal wall within the stapler line. RVFs secondary to SP represent a distinct iatrogenic subtype, characterized by a short, low-lying fistulous tract and localized ischemic tissue damage. We evaluated the feasibility and outcomes of a transvaginal repair strategy consisting of inverse T-shaped colpotomy, transvaginal fistulectomy, closure of the rectal defect from the vaginal side, and layered reconstruction without fecal diversion in patients with early RVF after SP. This monocentric, retrospective observational study included adult female patients treated for RVF secondary to SP between January 2023 and April 2025. All patients underwent transvaginal fistulectomy with internal orifice closure without protective stoma. Demographic data, fistula characteristics, operative details, postoperative outcomes, and healing at 6 and 12 months were analyzed. Four consecutive patients were included. Median age was 60 years (range 54–74), and median BMI was 23.5 kg/m2 (range 20–25). Median time from SP to RVF repair was 18 days (range 15–30). Median operative time was 91 min (range 45–110). No intraoperative or postoperative complications occurred (Clavien–Dindo grade 0). At both 6- and 12-month follow-up, all patients demonstrated complete clinical healing, with no persistence, recurrence, or late complications. Transvaginal fistulectomy with internal orifice closure without fecal diversion could be a safe and effective surgical option for RVF secondary to SP. Given the limitations of this small retrospective single-cohort series, these findings should be considered preliminary. Number CET 371-2025, date of registration 12/11/2025, retrospectively registered.
Total proctocolectomy with ileal pouch–anal anastomosis serves as the standard surgical treatment for medically refractory ulcerative colitis, yet long-term pouch failure remains a significant clinical challenge. This study aimed to identify independent predictors of pouch failure and to develop a practical clinical nomogram for individualized risk assessment. A retrospective cohort study was conducted utilizing a prospectively maintained database at a European tertiary referral center, analyzing procedures performed between December 2005 and June 2025. The study included 851 adult patients with a confirmed histologic diagnosis of ulcerative colitis who underwent restorative surgery. The primary outcome was pouch failure, defined as permanent pouch excision or indefinite fecal diversion. Independent predictors were identified using penalized logistic regression modeling to build a predictive risk tool. Over a median follow-up of 37.0 months for the entire cohort, pouch failure occurred in 4.7
Fecal incontinence (FI) is a debilitating condition that may be associated with structural abnormalities of the anal sphincter complex. Nonablative anal laser therapy has been proposed as a minimally invasive treatment option; however, its anatomical correlates remain insufficiently defined. The objectives of this study were to evaluate endoanal ultrasound (EAUS)-detected changes in internal anal sphincter (IAS) morphology after nonablative 1470-nm diode laser therapy and to explore their association with clinical outcomes. In this prospective single-arm pilot study, 30 patients with mild-to-moderate FI and IAS defects or atrophy underwent up to six sessions of nonablative 1470-nm diode laser therapy. EAUS was performed before and after treatment to assess IAS thickness, IAS length, and defect length. Clinical response was assessed using the Wexner score, and anorectal manometry and Fecal Incontinence Quality of Life (FIQL) scores were evaluated. A total of 24 patients completed treatment and post-treatment reassessment. EAUS demonstrated small but statistically significant increases in IAS thickness and length, with a concomitant reduction in IAS defect length (p < 0.05). Symptomatic improvement was observed in 17/24 completing patients (70.8
Burnout and low quality of life are common among surgeons in the USA. While self-care habits, such as physical activity, have been associated with improved well-being, they have not been evaluated among colorectal surgeons. To provide a cross-sectional analysis of exercise habits among colorectal surgeons in the USA and to evaluate the association between exercise and burnout symptoms, as well as to identify commonly reported burnout symptoms among this population. Cross-sectional analysis collected via a national survey. American Society of Colon and Rectal Surgeons members. Not applicable. Not applicable. Frequency of burnout symptoms and analysis of physical activity among colorectal surgeons. A total of 208 responses were analyzed. The respondents had a median of 16.2 [range 0–50] years in practice. Exercise frequency varied, with 13.9
Closed‑incision negative-pressure wound therapy (ciNPT), or incisional negative-pressure wound therapy (NPWT), has been used prophylactically to reduce perineal wound morbidity after oncologic abdominoperineal resection (APR) and extralevator abdominoperineal excision (ELAPE). However, published evidence is heterogeneous and includes prophylactic incisional use as well as therapeutic/intracavitary applications. We conducted a systematic review and meta‑analysis of NPWT strategies for perineal wound outcomes following oncologic APR/ELAPE. A systematic search was executed across PubMed, Scopus, Web of Science, and the Cochrane Library from inception to July 2025, including studies that evaluated the role of NPWT in postoperative perineal wounds after oncologic APR/ELAPE. We included both prophylactic closed-incision NPWT (ciNPT) after primary closure and therapeutic NPWT for open/infected perineal wounds; quantitative pooling was limited to comparable comparative studies. The outcomes of interest were the perineal wound complications and infection, surgical revision, and hospital stay. Data were synthesized through a DerSimonian–Laird random effect meta-analysis model, with risk ratios (RR) or mean differences with their 95
