Purpose Young-onset rectal cancer (YORC) is increasingly common and often presents with aggressive histological features; however, its effect on recurrence remains uncertain. This study aimed to estimate the causal effect of age at diagnosis on recurrence in patients with rectal cancer using advanced causal inference methods. Methods This multicenter retrospective cohort study was conducted at 2 university hospitals in Thailand. Patients diagnosed with rectal adenocarcinoma between 2013 and 2022 who underwent curative-intent treatment were included. The primary exposure was age at diagnosis, categorized as YORC (<50 years) or late-onset rectal cancer (LORC; ≥50 years). Confounders were prespecified using a directed acyclic graph and addressed using a confounder composite score. Age was also modeled as a continuous variable using natural splines. The primary outcome was cancer recurrence. Results Among 585 patients, 116 (19.8%) had YORC and 469 (80.2%) had LORC. Patients with YORC had fewer comorbidities but more unfavorable histological features than those with LORC. Overall, recurrence occurred in 40.2% of patients and most commonly involved distant metastasis. The estimated average causal effect of age on recurrence was −6.5% (95% confidence interval, −16.6% to 3.5%; P=0.202), indicating that younger age was not associated with an increased risk of recurrence, although a protective effect was not confirmed. Natural spline modeling indicated a nonlinear increase in recurrence hazard with advancing age. Conclusion Younger age at diagnosis was not associated with worse recurrence outcomes despite adverse pathological features, and a potential protective association could not be excluded.
Purpose Yellow enhancement (YE) is an image processing technology available in advanced endoscopic and laparoscopic systems. By increasing the contrast of yellow tissue tones, YE is intended to improve tissue differentiation and the identification of dissection planes. However, because YE is a relatively new technology, supporting evidence remains limited. This study qualitatively explored general surgery residents’ perceptions of the usefulness of YE compared with conventional white light imaging and aimed to establish a foundation for developing a qualitatively anchored scoring system for evaluating YE. Methods A piloted online survey was electronically distributed to general surgery residents. After providing basic demographic information, respondents viewed videos with and without YE and then assessed their perceptions of the videos, provided general feedback, and reported their overall opinions of YE. Open-ended responses were coded inductively, followed by reflexive thematic analysis. Results A total of 34 responses were obtained. The analysis identified 7 recurring themes related to the utility of YE, including superior visualization for structure identification and enhanced contrast for tissue differentiation. Three recurring themes were noted regarding the limitations of YE, including visual distortion and fatigue, as well as issues related to transition, training, and understanding of YE. Conclusion Based on video demonstrations, surgical residents generally perceived YE as beneficial in laparoscopic surgery. However, variability in perceptions highlights the subjective and context-dependent nature of YE. Ultimately, YE should be conceptualized as a specialized adjunct to, rather than a replacement for, conventional white light imaging in laparoscopic surgery.
Purpose Early mobilization is a key component of Enhanced Recovery After Surgery (ERAS) pathways following colorectal cancer surgery; however, objective postoperative mobility quantification remains limited. We evaluated whether early postoperative step counts measured using a wearable device could be associated with the achievement of ERAS-based discharge eligibility. Methods In this prospective pilot study, adults undergoing elective colorectal cancer resection at a single tertiary academic referral hospital wore a consumer wearable device (Galaxy Watch 5) from the day of surgery. Cumulative step counts on postoperative days (PODs) 1 and 2 were recorded. Discharge readiness was assessed daily by predefined ERAS criteria. The patients were dichotomized according to the median cumulative step count (3,781 steps). The primary endpoint was the achievement of ERAS-based discharge eligibility by POD 3, and the secondary endpoints included time to discharge readiness and postoperative length of stay. Results Between August 2023 and December 2024, 38 patients were evaluated. Discharge readiness by POD 3 was more frequent in the active group (68.4% vs. 26.3%; odds ratio, 6.07; 95% confidence interval, 1.49–24.76; P=0.009), which achieved discharge readiness earlier (median, POD 3 vs. POD 4; P=0.003) and had a shorter postoperative stay (median, 5 days vs. 6 days; P=0.041) than did the inactive group. Early diet tolerance differed between the groups (P=0.013). Conclusion Higher early postoperative step counts were associated with earlier ERAS-based discharge readiness and shorter hospitalization. Wearable-derived mobility might provide an objective marker of recovery and target for postoperative mobilization strategies.
