PURPOSE:Article processing charges (APCs) are central to author-paid open access (OA) publishing. Disparities appear in oncology, pathology, and global surgery, but not colorectal surgery, spanning coloproctology, general surgery, gastroenterology, and oncology journals. We examined APC levels, citation-impact linkage, and authorship geography. METHODS:This study was a cross-sectional bibliometric analysis of 32 journals (MEDLINE/PubMed search). APCs (publisher-direct 2026) and 2024 citation metrics (Journal Impact Factor [JIF], SCImago Journal Rank [SJR], SCImago H-index) were extracted. First- and last-author countries for all 2024-2025 articles (n=31,164) were mapped to World Bank income groups. Multivariable ordinary least squares regression modeled log10(APC) on publisher group, region, OA model, and log10(JIF 2024). RESULTS:Median APC was US $3,980 (interquartile range, $3,580-$4,390), varying by region: $1,467 in Asia, $3,840 in the United Kingdom, $4,140 in Western Europe, and $4,175 in the United States. APC correlated with the SCImago H-index (ρ=0.51, P=0.003) but not with JIF (P=0.25) or SJR (P=0.13). Of 30,320 articles, first authors were from high-income countries in 62.5%, upper-middle-income countries in 34.7%, and lower-middle- or low-income countries in 2.8%; China (30.9%), the United States (23.1%), and Japan (8.0%) were the leading countries. First authors were more often from non-high-income countries than last authors (median difference, +0.68 percentage points; P<0.001). In multivariable regression (R2=0.90), society-direct publishing was associated with lower APCs (β=-0.44, P<0.001), whereas US-based publishing (β=+0.18, P=0.019), UK-based publishing (β=+0.16, P=0.037), and a hybrid OA model (β=+0.15, P=0.014) were associated with higher APCs. JIF was not independently associated with APC (P=0.93). CONCLUSION:Colorectal surgery APCs are high and decoupled from citation impact after adjustment, with underrepresentation of lower-resource-setting authors, especially at senior-author level. Society-owned and Asia-based journals offer lower-cost alternatives but remain a minority.
PURPOSE:The Hugo robotic-assisted surgery (RAS) system is a novel modular robotic platform that has recently been introduced in colorectal surgery. Although robotic approaches have improved surgical ergonomics and precision, evidence specific to the Hugo RAS system remains limited. This systematic review synthesizes the current literature on colorectal procedures performed with the Hugo RAS system and evaluates feasibility, safety, and early oncologic outcomes. METHODS:A systematic literature search of PubMed, Scopus, Embase, and Ovid was conducted through September 2025 in accordance with the PRISMA 2020 guidelines. Eligible studies included case series, cohort studies, and comparative analyses that reported perioperative or oncologic outcomes of colorectal procedures performed using the Hugo RAS system. RESULTS:Thirteen studies were included and encompassed right and left hemicolectomies, rectal resections, and total colectomies. The median docking time was 7.5 minutes (range, 5-18 minutes), the median operative time was 225 minutes (range, 163-632 minutes), the conversion rate was 3.6%, and the mean hospital stay was 5.6 days. The overall complication rate was 11%, and most complications were Clavien-Dindo grade I-II. Perioperative and oncologic outcomes, including lymph node yield, total mesorectal excision quality, and circumferential resection margin status, were comparable to those reported for laparoscopy. Reported advantages included modular arm flexibility, an ergonomic open-console design, and stable visualization, whereas reported limitations included setup time and arm bulkiness. CONCLUSION:The available evidence supports the feasibility and safety of the Hugo RAS system in colorectal surgery, with outcomes broadly comparable to those of laparoscopy; however, the evidence remains limited by study heterogeneity, the absence of randomized trials, and reliance mainly on small retrospective series. The platform offers potentially useful ergonomic and technical features, but multicenter prospective studies with larger cohorts, long-term follow-up, and cost-effectiveness analyses are needed to define its role in oncologic colorectal surgery. Trial registration: The protocol was registered in PROSPERO (No. CRD420251028698).
PURPOSE:The choice between linear side-to-side and circular end-to-end staplers for colorectal anastomosis after laparoscopic sigmoidectomy remains a topic of debate. This study compared intraoperative efficiency, postoperative recovery, complications, and quality of life (QoL) between the 2 techniques. METHODS:This retrospective cohort study included 83 patients who underwent elective laparoscopic sigmoidectomy for sigmoid cancer at a single center between January 2023 and August 2024. Patients were grouped according to the stapling technique used for anastomosis (linear stapler, n=23; circular stapler, n=60). Intraoperative characteristics, including operative time and stapler use; postoperative outcomes, including length of hospital stay and complications; and longitudinal QoL, assessed using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Colorectal Cancer (QLQ-CR29) questionnaire at 1, 3, 6, 9, and 12 months, were analyzed. RESULTS:Baseline characteristics were comparable between groups. Operative time did not differ significantly between the linear and circular stapler groups (90.73±14.02 minutes vs. 94.63±13.65 minutes, P=0.25). The linear stapler group required more staplers overall (3.04±0.82 vs. 1.53±0.72, P<0.001) but had a shorter hospital stay (10.09±1.83 days vs. 11.70±3.62 days, P=0.04). Oncologic outcomes and complication rates were low and comparable (anastomotic leakage: 4.3% vs. 0%, P=0.277). At 12 months, QoL scores did not differ significantly between groups, although descriptive trends suggested faster recovery of bowel function and abdominal pain in the linear stapler group during the first 6 months. CONCLUSION:In this single-center retrospective series, both linear side-to-side and circular end-to-end stapling techniques appeared safe, feasible, and clinically acceptable. Circular stapling required fewer stapling devices intraoperatively, whereas linear stapling was associated with modestly shorter hospitalization and descriptively faster early functional recovery. These findings are hypothesis-generating and warrant prospective validation in larger, balanced cohorts to guide patient- and technique-specific surgical decision-making.
PURPOSE:Anastomotic leakage (AL) is a serious complication of rectal cancer surgery, and a properly positioned pelvic drain may aid early detection and conservative management; however, intraperitoneal drains frequently migrate. We evaluated whether extraperitoneal tunneling (EPT) of the pelvic drain reduces drain displacement compared with conventional intraperitoneal placement. METHODS:This single-center before-and-after comparative study enrolled adults with rectal cancer located within 15 cm of the anal verge who underwent elective radical resection between August 2021 and July 2024. Patients operated between August 2021 and December 2022 received conventional intraperitoneal drains (non-EPT group) and those operated between January 2023 and July 2024 received EPT drains (EPT group). The primary outcome was drain displacement (>3 cm from the anastomotic staple line) on postoperative day 2 plain radiograph. Secondary outcomes were AL, EPT-related complications, and the need for additional intervention. Multivariate logistic regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were performed. RESULTS:Of 228 patients, 111 received EPT and 117 received conventional drains. Drain displacement occurred in 5 of 111 EPT patients (4.5%) versus 55 of 117 non-EPT patients (47.0%; P<0.001). After multivariate adjustment, EPT was an independent protective factor (adjusted odds ratio [OR], 0.05; 95% confidence interval [CI], 0.02-0.13; P<0.001). The protective association was robust across PSM (matched OR, 0.07; 95% CI, 0.02-0.18) and IPTW (OR, 0.05-0.06; both P<0.001). AL occurred in 6 patients (2.6%) without a significant between-group difference (EPT, 1.8% vs. non-EPT, 3.4%; Fisher exact, P=0.681). Operative time, overall complications, and EPT-related complications did not differ between groups. CONCLUSION:In this single-center before-and-after series, EPT was associated with a substantially lower rate of postoperative day 2 drain displacement after rectal cancer surgery.
PURPOSE:Artificial intelligence (AI) can improve colonoscopy quality by increasing adenoma detection rates. At Sengkang General Hospital (SKH), Singapore, AI-assisted colonoscopy was introduced in July 2021. An initial survey suggested that attitudes toward AI were shaped more by hands-on experience than by general knowledge of AI. This follow-up survey assessed how these attitudes evolved over time and compared responses from SKH with those from endoscopists at institutions without routine AI use. METHODS:An online survey was conducted 3 years after implementation of routine AI-assisted colonoscopy at SKH to evaluate endoscopists' knowledge, perceptions, and behaviors regarding AI. Endoscopists from 7 tertiary institutions in Singapore were invited to participate. The 44-item questionnaire covered 4 thematic domains. Responses were compared with those from SKH's initial survey and across institutions. RESULTS:A total of 57 endoscopists, including 46 consultants and 11 residents, completed the survey. Most respondents were familiar with AI, but only approximately half understood its underlying mechanisms. Most endoscopists supported early AI training, although agreement was significantly lower at SKH than at other hospitals (62.0% vs. 88.9%, P=0.02). Overall, 91.2% agreed that AI should be used as an adjunct to colonoscopy, and 80.7% agreed that AI can improve the quality of a performed colonoscopy. Enjoyment of AI-assisted colonoscopy was higher at SKH than at other hospitals (85.7% vs. 58.3%, P=0.04). CONCLUSION:Endoscopists generally perceived AI as improving colonoscopy quality. Greater colonoscopy experience and more extensive exposure to AI-assisted colonoscopy appeared to be associated with more positive attitudes toward AI and greater acceptance of its potential benefits.
PURPOSE:Patients with chronic functional constipation suffer from debilitating symptoms which are unresponsive to conventional treatment options. Spinal magnetic stimulation (SMS) and its extracorporeal stimulation of peripheral nerves offer a potential noninvasive therapeutic option. METHODS:A pilot blinded randomized sham-controlled study was performed. Patients randomized to the treatment SMS-arm underwent daily 60-minute SMS sessions at T9 and L3 spinal processes for 2 weeks. Symptom relief was measured at regular intervals up to 14 weeks after treatment with the use of constipation and quality-of-life questionnaires (Patient Assessment of Constipation Symptoms [PAC-SYM], EuroQOL 5-dimension instrument [EQ-5D], and Hospital Anxiety and Depression Scale [HADS]). RESULTS:From December 2015 to July 2023, 14 patients completed the study (6 in the SMS arm and 8 in the sham arm). Mean age was 55 years (range, 41-70 years), and 12 (85.7%) were male. Median average bowel movements per week and spontaneous bowel movements per week at baseline for the SMS arm was 1.5 and 0.3, respectively, while the sham arm was 4 and 1, respectively. At 14 weeks from start of treatment, SMS arm patients showed a trend in improvement of symptoms in 11 out of 16 questions of PAC-SYM. Average bowel movements per week and EQ-5D health state scores increased from 1.5 to 3 and 50 to 60, respectively. However, these changes did not reach statistical significance. No statistical difference in the symptoms was noted in PAC-SYM (13 questions at weeks 1, 2, 4, 6, 8, 10, 12, and 14), EQ-5D (5 questions at weeks 0, 2, 14), and HADS (14 questions at weeks 0, 2, and 14) questionnaires within both arms. CONCLUSION:The pilot study showed the use of SMS is safe and feasible. While it improved constipation symptoms, the results did not achieve statistical significance possibly related to insufficient participants.
Purpose This study defined “optimal recovery” as a multidimensional composite endpoint for colorectal cancer surgery and investigated whether its predictors were specific to tumor location. Methods In this retrospective cohort of 396 patients undergoing curative-intent resection, optimal recovery required achievement of 5 criteria: no major complications, timely gastrointestinal recovery, ambulation by postoperative day (POD) 2, oral intake by POD 4, and discharge by POD 7. Multivariable logistic regression was used to identify predictors in the overall cohort and site-specific subgroups. The endpoint was then evaluated against 30-day patient-reported outcomes using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30). Results The optimal recovery rate was 44.4%. Four independent predictors emerged: age <60 years (odds ratio [OR], 2.35; P<0.001), prognostic nutritional index (PNI) ≥46 (OR, 2.70; P<0.001), operation time ≤180 minutes (OR, 2.94; P<0.001), and blood loss ≤30 mL (OR, 2.17; P=0.005). Subgroup analysis revealed marked divergence between cancer sites: blood loss was the dominant predictor in colon cancer (OR, 6.67; P<0.001), whereas PNI predominated in rectal cancer (OR, 2.56; P=0.005). Patients achieving optimal recovery reported significantly better global health status (72.4 vs. 63.8; P<0.001) and physical functioning (83.5 vs. 74.2; P<0.001) at 30 days. Conclusion Optimal recovery provides a stringent quality benchmark, with findings highlighting site-specific determinants of recovery. Recovery after colon surgery was associated primarily with technical factors, particularly lower blood loss, whereas recovery after rectal surgery was strongly linked to nutritional status. These results support precision prehabilitation strategies tailored to site-specific pathophysiology. Trial registration Registered in the Chinese Clinical Trial Registry (No. ChiCTR2300075424) on September 9, 2023.
PURPOSE:Surgery for cT4b rectal cancer remains technically demanding, and outcomes may vary substantially across institutions. This study evaluated perioperative and oncologic outcomes of cT4b rectal cancer surgery performed at a university center compared with those at regional hospitals within a collaborative network. METHODS:A total of 103 patients who underwent curative-intent surgery for cT4b rectal cancer between 2016 and 2024 were retrospectively reviewed. After 1:1 propensity score matching based on baseline characteristics and treatment factors, 54 patients were included in the analysis. Perioperative outcomes, pathological findings, and long-term oncologic outcomes were compared between the university hospital and affiliated regional institutions. Overall survival, relapse-free survival, and local control rate were additionally evaluated in patients with pathological stage II-III disease. RESULTS:Postoperative hospital stay was significantly shorter at the university center (18 days vs. 25 days, P=0.022). Local control was higher in the university hospital group (3-year local control rate: 95.2% vs. 71.5%, P=0.025). Among patients with pathological stage II-III disease, 3-year relapse-free survival was comparable between groups (51.8% vs. 49.0%, P=0.434), whereas local control demonstrated a favorable trend in the university hospital group (91.7% vs. 65.4%, P=0.063). CONCLUSION:Perioperative safety in cT4b rectal cancer surgery was comparable across institutions; however, higher local control at the university center suggests that technically complex cases may benefit from selective centralization in specialized centers. These findings support a hybrid model in which regional collaboration ensures safety while advanced procedures are concentrated in specialized centers.
PURPOSE:Colon cancer represents a major global health challenge, with a steadily increasing incidence. Therefore, the identification of novel and easily accessible biomarkers in colon cancer is essential. Although the neutrophil to lymphocyte ratio (NLR) has emerged as a potential prognostic indicator in various malignancies, its applicability in colon cancer within Latin America remains unexplored. This study evaluated the association between preoperative NLR and overall survival (OS) and disease-free survival (DFS). METHODS:We conducted a retrospective cohort study at the gastroenterology department of Mexico's National Cancer Institute between 2008 and 2022. All patients with nonmetastatic colon cancer who underwent upfront surgery were screened for inclusion. The optimal NLR cutoff value was determined using X-tile software and receiver operating characteristic curve analysis. Prognostic factors were assessed using Cox proportional hazards regression models. RESULTS:A total of 522 patients were included in the analysis and categorized into high NLR (>3.0, n=230) and low NLR (≤3.0, n=292). High NLR was associated with worse 3- and 5-year OS compared with low NLR (89.9% vs. 97.5% and 84.8% vs. 94.8%, respectively) in both univariate (P<0.001) and multivariate analyses (hazard ratio [HR], 3.020; 95% confidence interval [CI], 1.638-5.570; P<0.001). High NLR was also associated with worse 3- and 5-year DFS compared with low NLR (74.2% vs. 86.5% and 72.4% vs. 82.9%, respectively) in univariate (P=0.002) and multivariate analyses (HR, 1.627; 95% CI, 1.106-2.392; P=0.013). CONCLUSION:This exploratory study highlights the prognostic relevance of NLR in nonmetastatic colon cancer and supports its utility for predicting OS and DFS in a Latin American population. As a readily available biomarker, NLR may be particularly useful in low-income settings. Further prospective studies are required to validate its clinical applicability.
Purpose Given the increasing staffing shortages that often necessitate noncolorectal surgeons performing emergency colorectal procedures, this study aims to evaluate the effect of surgeon subspecialty on short-term postoperative outcomes in patients undergoing emergency Hartmann procedure and whether strengthening residency training in Hartmann procedure could improve surgical outcomes. Methods This retrospective study included 141 patients who underwent emergency Hartmann procedure at a single tertiary center between January 2010 and December 2021. Patients were categorized into colorectal and noncolorectal groups. The clinical characteristics, operative details, and outcomes were compared. Complications were classified using the Clavien-Dindo classification. Logistic regression analysis was used to identify complications and mortality. Results The noncolorectal group showed higher age (75 years vs. 69 years, P=0.038), hypertension prevalence (58.4% vs. 40.4%, P=0.039), and physiological instability (C-reactive protein >6.0 mg/dL: 55.1% vs. 36.5%, P=0.034; lactate: 1.90 mmol/L vs. 0.80 mmol/L, P<0.001). Complications were lower in the colorectal group (68.5% vs. 36.5%, P<0.001), with fewer major complications (Clavien-Dindo grade ≥III, 51.7% vs. 15.4%). The colorectal group had a lower mortality rate (25.8% vs. 3.8%, P=0.001). In the multivariate analysis, surgery performed by noncolorectal surgeons remained a significant independent risk factor for complications (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.27–6.89; P=0.012) and mortality (OR, 15.53; 95% CI, 2.11–114.18; P=0.006) even after adjusting for age, diagnosis, American Society of Anesthesiologists physical status, C-reactive protein levels, and time to surgery. Conclusion Emergency Hartmann procedure for acute conditions yielded better short-term outcomes when performed by colorectal surgeons. These findings suggest that surgeon subspecialty is a critical determinant of survival, independent of patient severity or surgical timing. Improving surgical residency training in Hartmann procedure may enhance outcomes when noncolorectal surgeons must perform it due to staffing constraints.
Purpose Early detection is the most critical factor in effectively managing complications following routine colorectal surgery. This study aimed to identify the most effective and useful factors related to body composition and inflammation in the selection of high-risk groups for postoperative complications. Methods A retrospective review of 109 patients who underwent elective surgery between January 2021 and May 2023 was conducted. Patients were categorized according to the Clavien-Dindo classification into those discharged without complications (grade 0), those with minor complications (grades 1 and 2), and those with major complications (grade 3+). The characteristics of patients without complications and those with minor or major complications were compared. Results Twenty patients developed only minor complications. Bowel obstruction at diagnosis and elevated C-reactive protein (CRP) levels at 2 days postoperatively were statistically significant factors. Eleven patients experienced major complications, and a low lymphocyte count at 2 days postoperatively was a significant predictor of complications. Receiver operating characteristic analysis revealed that CRP levels >125.6 mg/L on postoperative day 2 and lymphocyte count <905 cells/µL were associated with a higher likelihood of minor and major complications. Conclusion These findings suggest that monitoring inflammatory markers on postoperative day 2 may help identify patients at risk of complications, enabling early intervention. Further prospective studies are warranted to validate these predictive markers and improve surgical outcomes.
