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Management of Severe Colitis and Toxic Megacolon Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-12-29 Marjorie R. Liggett, Hasan B. Alam
Severe colitis is a well-defined condition encompassing several etiologies but is most often caused by severe ulcerative colitis or Clostridioides difficile infection. Severe colitis can evolve into toxic colitis, or toxic megacolon when associated with bowel dilation and systemic manifestations, resulting in a life-threatening scenario where multidisciplinary management is often required. Medical
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Large Bowel Obstruction: Etiologies, Diagnosis, and Management Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-12-29 Kevin A. Chen, Muneera R. Kapadia
Large bowel obstructions (LBOs) often require urgent surgical intervention. Diagnosis relies on astute history and physical examination, as well as imaging with computed tomography (CT) scan for stable patients. Because of the high mortality associated with colonic perforation in patients with LBOs, decisive surgical decision-making is needed for optimal outcomes. This review seeks to provide an overview
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Colonic Volvulus Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-12-28 Samantha L. Savitch, Calista M. Harbaugh
Colonic volvulus represents 10 to 15% of all large bowel obstructions in the United States. It most commonly occurs in the sigmoid colon or cecum. Morbidity and mortality from colonic volvulus are high. It is therefore essential to have a high level of suspicion based on presentation and expedient diagnosis and management to prevent progression to ischemia or perforation. Broad goals of management
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Management of Acute Hemorrhoidal Crisis: Evaluation, Treatment, and Special Considerations Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-12-28 Ayman Khan, Arielle E. Kanters
Hemorrhoidal disease is one of most common pathologies seen by colorectal and general surgeons. Although hemorrhoids themselves are a normal anatomic occurrence, development of symptomatic disease, usually due to bleeding, prolapse, or thrombosis, can cause significant patient distress. Acute presentation related to significant thrombosis or bleeding is referred to as acute hemorrhoidal crisis. Management
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Evaluation and Management of Traumatic Rectal Injury Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-12-21 Nina M. Clark, Rebecca G. Maine
Traumatic injury to the rectum is rare but associated with high morbidity and mortality. In recent years, diagnostic and treatment recommendations for these complex injuries have changed. While rare, it is critical for general surgeons to understand the basic principles of injury assessment, damage control, and definitive management of traumatic rectal injuries. This article reviews the literature
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Blunt and Penetrating Injury to the Bowel: A Review Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-12-20 Graham Skelhorne-Gross, James Kenny
Traumatic injuries to the small and large bowel are common and can be highly morbid. Identifying these injuries, especially in stable patients who suffer blunt trauma, can be challenging. It is critical that traumatic bowel injuries are diagnosed in a timely fashion as delays in diagnosis and treatment are associated with worse outcomes. The literature outlining the management of traumatic bowel injuries
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Mesenteric Ischemia Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-12-15 Christopher O. Audu, David W. Schechtman, Frank M. Davis
Mesenteric ischemia occurs when perfusion of the visceral organs fails to meet normal metabolic requirements and subsequently results in abdominal symptoms such as diffuse postprandial pain, peritonitis, food fear, and weight loss. While generally divided into acute and chronic manifestations, mesenteric ischemia is commonly misdiagnosed at initial presentation due to the significant overlap with symptoms
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Diverticulitis: A Review of Current and Emerging Practice-Changing Evidence Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-12-13 Sonia Wu, Maher Al Khaldi, Carole S. Richard, François Dagbert
Acute diverticulitis represents a common colorectal emergency seen in the Western world. Over time, management of this condition has evolved. This review aims to highlight recent evidence and update current recommendations. Notable evidence has emerged in certain aspects of diverticulitis. This includes disease pathogenesis, as emerging data suggest a potentially greater role for the microbiome and
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Stoma Complications Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-12-13 Aaron J. Dawes, John V. Gahagan
Stoma-related complications are among the most common sources of perioperative morbidity in colorectal surgery. Complications can occur intraoperatively, in the immediate postoperative period, or even months to years after stoma creation. Although some will require urgent surgical intervention, most are treated nonoperatively with a combination of education, appliance adjustment, and behavioral intervention
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Anorectal Abscess Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-12-08 Anna Kata, Jonathan S. Abelson
Anorectal abscesses are a common colorectal emergency. The hallmark of treatment is obtaining source control while avoiding injury to the underlying sphincter complex. Understanding the anatomy of an anorectal abscess is critical to planning the appropriate drainage strategy and decreasing the risk of complex fistula formation. Use of antibiotics should be reserved for those with extensive cellulitis
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Surveillance after Total Neoadjuvant Therapy: What to do for Near-Complete Responders Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-09-13
A proportion of patients who undergo total neoadjuvant therapy for rectal cancer will achieve what is classified as a near-complete response. Significant debate exists as to the optimal management strategy for these patients with large heterogeneity in management. This article will examine the therapeutic and surveillance options for these patients as well as the relevant outcomes data.
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Robotic Transanal Minimally Invasive Surgery for Rectal Polyps Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-21 Garrett Friedman, Miguel Rodriguez
Transanal minimally invasive surgery (TAMIS) can be utilized to manage a wide variety of rectal lesions but can be technically demanding with traditional laparoscopic equipment. Robotic platforms such as the da Vinci Single Port system can reduce the technical barriers of TAMIS and allow more complicated lesions to be addressed. Robotic TAMIS with the SP system follows similar indications for local
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Radiotherapy for Rectal Cancer: How Much is Enough? Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-21 William C. Chapman, Steven R. Hunt, Lauren E. Henke
Though resection has been the mainstay of treatment for nonmetastatic rectal cancer over the past century, radiation has become an increasingly integral component of care for locally advanced disease. Today, two predominant radiotherapy approaches—hyperfractionated chemoradiotherapy and “short-course” radiation—are widely utilized to reduce local recurrence and, in some cases, cure disease. Both have
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Role of Lateral Pelvic Node Dissection in Rectal Cancer Surgery Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-11 Ilker Ozgur, Emre Gorgun
The role of lateral pelvic lymph node dissection in the treatment of patients with locally advanced rectal cancer is a matter of controversy. Surgical practices in Korea and Japan have accepted this approach and are widely utilized; however, it is not routinely incorporated in the practice of countries in the Western hemisphere. This review will examine the role of lateral pelvic lymph node dissection
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Chemoradiation, Consolidation Chemotherapy, and Watch and Wait for Early Rectal Cancer Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-11 Carlos Cerdan-Santacruz, Guilherme Pagin São Julião, Bruna Borba Vailati, Rodrigo Oliva Perez
As watch and wait has become an attractive management alternative among patients with rectal cancer who achieve a clinical complete response to neoadjuvant chemoradiation, the focus of organ preservation has now shifted toward the use of this approach in patients with early rectal cancer. These patients would otherwise be treated without the use of neoadjuvant therapy for oncological reasons. The sole
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Treatment of Microsatellite-Unstable Rectal Cancer in Sporadic and Hereditary Settings Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-11 Cristan E. Anderson, David Liska
Microsatellite instability is rare in rectal cancer and associated with younger age of onset and Lynch syndrome. All rectal cancers should be tested for microsatellite instability prior to treatment decisions. Patients with microsatellite instability are relatively resistant to chemotherapy. However, recent small studies have shown dramatic response with neoadjuvant immunotherapy. Patients with Lynch
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Surgical Decision-Making in Familial Adenomatous Polyposis Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-10 Allie E. Steinberger, Maggie L. Westfal, Paul E. Wise
Familial adenomatous polyposis (FAP) is an autosomal dominant disorder affecting patients with germline mutations of the adenomatous polyposis coli (APC) tumor suppressor gene. The surgical treatment of colorectal disease in FAP, which has the goal of colorectal cancer prevention, varies based on both patient and disease factors but can include the following: total colectomy with ileorectal anastomosis
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Stage IV Rectal Cancer and Timing of Surgical Approach Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-10 Roheena Z. Panni, Michael D'Angelica
Liver metastases are seen in at least 60% of patients with colorectal cancer at some point during the course of their disease. The management of both primary and liver disease is uniquely challenging in rectal cancer due to competing treatments and complex sequence of treatments depending on the clinical presentation of disease. Recently, several novel concepts are shaping new treatment paradigms,
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A System for Teaching Advanced Colonoscopic Skills and Endoscopic Submucosal Dissection Based on Nonclinical Models Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-10 Neil Mitra, Richard L. Whelan
Endoscopic submucosal dissection (ESD) requires skills that the vast majority of endoscopists do not possess. ESD be broken down into component skills and at least three of the necessary skill sets can be taught separately. In the United States most trainees initially participate in half- or full-day courses that utilize ex vivo and in vivo animal models and the great majority learn these advanced
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Management of Rectal Cancer in Lynch Syndrome: Balancing Risk Reduction and Quality of Life Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-10 Bradley A. Krasnick, Matthew F. Kalady
Patients with Lynch syndrome are predisposed to developing colorectal cancer and a variety of extracolonic malignancies, at a young age. The management of rectal cancer in the setting of Lynch syndrome is a complex clinical scenario that requires the expertise of a multidisciplinary management team. In this review, we delve into the approach for rectal cancer in these patients, and specifically focus
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The Natural History of Hereditary Colorectal Cancer Syndromes: From Phenotype to Genotype? Where Do We Stand and What Does the Future Hold? Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-09 James Church
Applying the concept of a “natural history” to hereditary colorectal cancer is an interesting exercise because the way the syndromes are approached has changed so drastically. However, the exercise is instructive as it forces us to think in depth about where we are, where we have been, and, most helpfully, about where we may be going. In this article the diagnosis, along with endoscopic and surgical
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Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-07 Sumeyye Yilmaz, Emre Gorgun
Up to 15% of colorectal polyps are amenable for conventional polypectomy. Advanced endoscopic resection techniques are introduced for the treatment of those polyps. They provide higher en bloc resection rates compared with conventional techniques, while helping patients to avoid the complications of surgery. Note that 20 mm is considered as the largest size of a polyp that can be resected by polypectomy
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The Importance of Parental Leave and Lactation Support for Surgeons Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-08-02 Arielle E. Kanters, Sarah P. Shubeck
Despite the growing population of surgeons who will spend the bulk of their potential childbearing years in medical school, training, or early in practice, the stigma associated with pregnancy remains. The challenges of childbearing for surgeons also extend to the pregnancy experience from a health perspective including increased rates of infertility, miscarriage, and preterm labor. Given the unique
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Colorectal Cancer Risk between Mendelian and Non-Mendelian Inheritance Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-31 Elizabeth A. Hibler, Brittany Szymaniak, Mohammad Ali Abbass
Hereditary colorectal cancer has been an area of focus for research and public health practitioners due to our ability to quantify risk and then act based on such results by enrolling patients in surveillance programs. The wide access to genetic testing and whole-genome sequencing has resulted in identifying many low/moderate penetrance genes. Above all, our understanding of the family component of
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Current Trends in Vaccine Development for Hereditary Colorectal Cancer Syndromes Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-31 Charles M. Bowen, Krishna M. Sinha, Eduardo Vilar
The coming of age for cancer treatment has experienced exponential growth in the last decade with the addition of immunotherapy as the fourth pillar to the fundamentals of cancer treatment—chemotherapy, surgery, and radiation—taking oncology to an astounding new frontier. In this time, rapid developments in computational biology coupled with immunology have led to the exploration of priming the host
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Hereditary Colorectal Cancer Syndromes Registry: What, How, and Why? Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-31 Mohammad Ali Abbass, Vitaliy Poylin, Scott Strong
Caring for patients with colorectal cancer inherited cancer syndromes is complex, and it requires a well-thought integration process between a multidisciplinary team, an accessible database, and a registry coordinator. This requires an aligned vision between the administrative business team and the clinical team. Although we can manage most of the cancers that those patients develop according to oncologic
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Management of Desmoid Disease in Familial Adenomatous Polyposis Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-25 Joshua Sommovilla, Dale Shepard, David Liska
Desmoid disease, though technically a benign condition, is nevertheless a leading cause of morbidity and mortality in patients with familial adenomatous polyposis (FAP). Desmoid disease impacts approximately 30% of FAP patients, with several known risk factors. It runs the gamut in terms of severity—ranging from small, slow-growing asymptomatic lesions to large, focally destructive, life-threatening
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Precision Medicine in the Era of Genetic Testing: Microsatellite Instability Evolved Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-25 Dina Ioffe, Michelle McSweeny, Michael J. Hall
The recognized importance of microsatellite instability (MSI) in cancer has evolved considerably in the past 30 years. From its beginnings as a molecular predictor for Lynch syndrome, MSI first transitioned to a universal screening test in all colorectal and endometrial cancers, substantially increasing the identification of patients with Lynch syndrome among cancer patients. More recently, MSI has
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Combined Endoscopy–Laparoscopy Surgery: When and How to Utilize This Tool Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-21 Jordan Wlodarczyk, Abhinav Gupta, Sang W. Lee
Combined endoscopic and laparoscopic surgery (CELS) has been used to resect colon polyps since the 1990s. These colon-sparing techniques, however, have not yet been widely adopted. With the evolution of technology in both diagnosing and treating colon cancer, colorectal surgeons should strive for a diverse and complete armamentarium through which they can best serve their patients. In this article
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Assessment and Techniques for Endoscopic Closure Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-19 Ragavan Siddharthan, Peter Marcello
Endoscopic closure is an essential technique to perform safe advanced endoscopy. Without appropriate closure of a defect, patients can experience spillage of fecal contents into the peritoneal cavity resulting in abdominal sepsis. The essential components to performing endoscopic closure are assessing the defect appropriately and choosing the correct closure technique. Assessing the defect involves
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Shared Decision-Making, Sphincter Preservation, and Rectal Cancer Treatment: Identifying and Executing What Matters Most to Patients Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-19 Srinivas Joga Ivatury, Pasithorn A. Suwanabol, Ana C. De Roo
Rectal cancer treatment often encompasses multiple steps and options, with benefits and risks that vary based on the individual. Additionally, patients facing rectal cancer often have preferences regarding overall quality of life, which includes bowel function, sphincter preservation, and ostomies. This article reviews these data in the context of shared decision-making approaches in an effort to better
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The Evolution of Genetic Testing from Focused Testing to Panel Testing and from Patient Focused to Population Testing: Are We There Yet? Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-19 Lauren Gima, Ilana Solomon, Heather Hampel
The field of cancer genetics has evolved significantly over the past 30 years. Genetic testing has become less expensive and more comprehensive which has changed practice patterns. It is no longer necessary to restrict testing to those with the highest likelihood of testing positive. In addition, we have learned that the criteria developed to determine who has the highest likelihood of testing positive
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Chemoprevention in Inherited Colorectal Cancer Syndromes Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-19 Ophir Gilad, Charles Muller, Sonia S. Kupfer
Cancer prevention in hereditary gastrointestinal predisposition syndromes relies primarily on intensive screening (e.g., colonoscopy) or prophylactic surgery (e.g., colectomy). The use of chemopreventive agents as an adjunct to these measures has long been studied both in the general population and in hereditary cancer patients, in whom the risk of malignancy, and therefore the potential risk reduction
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The Role of Intraoperative Radiotherapy Treatment of Locally Advanced Rectal Cancer Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-19 Sudha R. Amarnath
Intraoperative radiation therapy (IORT) has been used in the treatment of locally advanced and recurrent rectal cancers for the last several decades. Given the heterogeneity of patients treated and different indications for use and dosing at different institutions, it has been difficult to discern if IORT adds any appreciable benefit to standard of care therapies. Herein, the rationale for IORT in
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Dual Channel Endoscopic Mucosal Resection Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-17 Julia T. Saraidaridis, Racquel S. Gaetani, Peter W. Marcello
Endoscopic mucosal resection (EMR) is the recommended technique for colon polypectomy for nonpedunculated lesions that are >20 mm in size not requiring excision. Dual-channel EMR (DC-EMR) uses an endoscope with two working channels to facilitate easier submucosal injection, snare resection, and clip closure of polypectomy defects. There is also promising early literature indicating that this endoscopic
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Endoscopic Assessment of Colorectal Polyps Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-17 Jaron Pettis, Jennifer Paruch
Colorectal cancer is the third most common cancer among men and the second among women. In the United States alone, there are 150,000 cases diagnosed each year. Colonoscopy remains the best method for identifying, evaluating, and intervening on patients with precancerous lesions. Multiple guidelines and techniques are available to assist the endoscopist with accurate diagnosis of these lesions. These
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Endoscopic Colorectal Stenting: Lessons Learned from a Two-Decade Journey Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-17 Muharrem Oner, Maher A. Abbas
Endoscopic colorectal stenting has gained momentum over the last two decades as a viable alternative to surgical intervention in a subgroup of patients with colorectal disease. Stenting can be used as a temporizing bridge to surgical intervention or as a definitive treatment measure. Patient selection and the technical expertise of the endoscopist are of paramount importance to optimize the clinical
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Creating the Future of (Endoluminal) GI Interventions Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-17 Jeffrey W. Milsom, Bradley P. Pua, Art Sedrakyan, Lea Lowenfeld, Heather L. Yeo
Major innovation into how we pursue diagnosis and therapies for gastrointestinal (GI) diseases is urgently needed to seek better, less invasive, and less costly innovations in diagnostic and therapeutic interventions in the GI tract. Learning from prior paradigm shifts in cardiac and vascular we present here several initial steps we have undertaken to follow the endoluminal path, using advanced imaging
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Barriers to Implementation of Advanced Endoscopic Procedures Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-07-17 Abhinav Gupta, Jordan Wlodarczyk, Kyle G. Cologne
Advanced endoscopy has been shown to be useful in the diagnosis and treatment of both benign and low-grade malignant colorectal lesions. In fact, advanced endoscopic procedures are being adopted as standard approaches to these lesions in many places around the world; however, their implementation in the United States has not been as widespread. We ascribe the difficulty in implementation to two reasons:
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An Argument for State-Driven Quality Collaboratives. Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-05-22 Arielle Kanters
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Screening and Management of Lynch Syndrome: The Chinese Experience Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-05-03 Jiehai Yu, Pei-Rong Ding, Wu Jiang
Lynch syndrome (LS), caused by germline mutations in the mismatch repair genes, is the most common hereditary colorectal cancer. While LS is also associated with various cancers, early detection of the proband is meaningful for tumor prevention, treatment, and familial management. It has been a dramatic shift on the screening approaches for LS. As the rapid development of the molecular biological methods
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Cancer Risk of Peutz–Jeghers Syndrome and Treatment Experience: A Chinese Medical Center Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-05-03 Zuxin Xu, Guoli Gu
Peutz–Jeghers syndrome (PJS), also known as hereditary mucocutaneous pigmented gastrointestinal polyposis, is a clinically rare autosomal dominant genetic disease, which falls into the category of hereditary colorectal cancer. There are ∼7,000 new cases of PJS in China every year, and 170,000 PJS patients may survive for a long time in society. PJS polyps are characterized by an early age of onset
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Update on Surgical Management of FAP Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-04-17 Tianqi Zhang, Ye Xu
Familial adenomatous polyposis (FAP) is an autosomal dominant disease caused by pathogenic germline adenomatous polyposis coli mutation, and characterized with multiple adenomas in the colon and the rectum. Various genetic variants have been confirmed to be associated with corresponding FAP phenotypes, which play important roles in the diagnosis and surgical treatment of FAP. Generally, proctocolectomy
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Update on Familial Adenomatous Polyposis-Associated Desmoid Tumors Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-04-17 Wanjun Yang, Pei-Rong Ding
Desmoid tumors (DT) represent the second high risk of tumor in familial adenomatous polyposis (FAP) patients. Although FAP-associated DTs (FAP-DT) are caused by germline mutations in the adenomatous polyposis coli (APC) gene, extracolonic manifestations, sex, family history, genotype, and the ileal pouch anal anastomosis procedure are all linked to the development of DTs in FAP patients. Multidisciplinary
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Impact of Molecular Status on Cytoreductive Surgery for Peritoneal Metastases from Colorectal Cancer Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-04-16 Yun Zhong, Keli Yang, Xiusen Qin, Rui Luo, Hui Wang
Colorectal cancer peritoneal metastases (CRC-PM) are present in 5 to 15% of instances of CRC, and the overall survival (OS) of patients with CRC-PM is much lower than that of patients with other isolated metastatic locations. In recent years, the introduction of cytoreductive surgery (CRS) in conjunction with hyperthermic intraperitoneal chemotherapy has resulted in a significant improvement in CRC-PM
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Stage IV Colorectal Cancer at Initial Presentation versus Progression during and after Treatment, Differences in Management: Management Differences for Initial Presentation versus Progression of Disease after Initial Treatment Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-04-16 Brian V. Monahan, Takshaka Patel, Juan Lucas Poggio
Stage IV colorectal cancer is a prevalent disease and understanding the appropriate treatment options is important. Medical oncologic treatment remains the mainstay of treatment in cases where curative resection is not possible. Surgical intervention is indicated if the primary tumor and associated metastases are amenable to curative resection or if obstructive, bleeding, or perforative complications
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Organ Preservation in MSS Rectal Cancer Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-04-16 Yuye Gao, Aiwen Wu
Rectal cancer is a heterogeneous disease with complex genetic and molecular subtypes. Emerging progress of neoadjuvant therapy has led to increased pathological and clinical complete response (cCR) rates for microsatellite stable (MSS) rectal cancer, which responds poorly to immune checkpoint inhibitor alone. As a result, organ preservation of MSS rectal cancer as an alternative to radical surgery
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Application of Molecular Profiling in Colorectal Cancer Surgery. Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-04-17 Pei-Rong Ding
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The Progress of Colorectal Polyposis Syndrome in Chinese Population Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-04-09 Zhijun Yuan, Mengyuan Yang, Ying Yuan
The pathogenesis, clinical phenotype, treatment strategy, and family management of hereditary tumor syndromes are different from those of sporadic tumors. Nearly a quarter of patients with colorectal cancer show significant familial aggregation and genetic predisposition, and 5 to 10% are associated with definite genetic factors. According to the clinical phenotype, it can be divided into nonpolyposis
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Nonoperative Management of dMMR/MSI-H Colorectal Cancer following Neoadjuvant Immunotherapy: A Narrative Review Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-04-09 Binyi Xiao, Jiehai Yu, Pei-Rong Ding
Immunotherapy with PD-1 blockade has achieved a great success in colorectal cancers (CRCs) with high microsatellite instability (MSI-H) and deficient mismatch repair (dMMR), and has become the first-line therapy in metastatic setting. Studies of neoadjuvant immunotherapy also report exciting results, showing high rates of clinical complete response (cCR) and pathological complete response. The high
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Impact of Molecular Status on Metastasectomy of Colorectal Cancer Liver Metastases Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-04-09 Yan-Yan Wang, Ze-Chang Xin, Kun Wang
Although surgical resection could provide better survival for patients with colorectal cancer liver metastases (CRLM), the recurrence rate after resection of CRLM remains high. The progress of genome sequencing technologies has greatly improved the molecular understanding of colorectal cancer. In the era of genomics and targeted therapy, genetic mutation analysis is of great significance to guide systemic
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Management of Dysplasia in Inflammatory Bowel Disease Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-04-09 Merrill Rubens, Radhika Smith
Given the chronic nature of mucosal inflammation present in patients with inflammatory bowel disease (IBD), there is a high risk of dysplastic lesions progressing to cancer, in addition to a high risk of synchronous and/or metachronous cancers developing in those diagnosed with dysplasia. Due to this, consensus guidelines recommend regular surveillance. When visible dysplasia is encountered, options
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Cancer in Anal Fistulas Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-03-29 Sean Perez, Samuel Eisenstein
Fistula-associated anal cancer in Crohn's disease (CD) can be challenging to diagnose and treat. Patients with longstanding fistulas in the setting of CD who present with a sudden change in their symptoms should undergo biopsy under anesthesia with extensive sampling, followed by staging imaging. Pelvic magnetic resonance imaging (MRI) can be helpful in identifying the extent of the disease locally
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The History of Women Leaders in Colon and Rectal Surgery Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-03-29 Ann C. Lowry
Women started to enter the specialty of colon and rectal surgery in the early 1970s. However, it was rare for a woman to hold a leadership position in the specialty before 2000. Since then, considerable progress has been made, although the percentage of women leaders does not yet approach the percentage of women in the field. This article focuses on the history of women in leadership positions in the
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Novel and Innovative Surgical Strategies for Recurrent Rectal Cancer: Uncommon Resections, Local Interventions for Pelvic Reoccurrence, and Intraoperative Radiation Therapy Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-03-24 Shawn Philip Webb, Imran Ahmad
The frequency of recurrent rectal cancer has dropped significantly with improved surgical approaches and adjunctive therapies. These recurrences have proven challenging to obtain R0 resection with salvage operations. Meticulous planning, clear understanding of anatomy with imaging, and multispecialty support have become essential in local control and long-term survival with pelvic recurrence of rectal
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Negotiation and Career Advancement: How Can We Continue to Advance Women in Academic Surgery, What Are the Barriers They Are Facing, and What Can We Do to Overcome Them? Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-03-24
Despite increasing female representation in U.S. medical schools, women remain underrepresented in academic surgery departments across the country. Even as the gap narrows in academic surgery, female surgeons' professional advancement does not parallel that of their male counterparts. This article explores how to continue to advance women in academic surgery, first by considering the barriers women
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Career Transitions: What Are Other Options to Clinical Practice That May Align with New or Evolving Priorities/Goals? Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-03-24
Career transitions are an essential part of the evolution of one's professional life. Transitions can take place at any time and for a variety of reasons. In this article, I review career transitions in the context of my own experiences and offer some advice and guidelines for making a career transition. The article also reviews what opportunities exist for career development and how that can lead
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Impact of Gender Inequity on Women Surgeons in the Professional Setting Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-03-24 Alexandra Onyiego, Jennifer S. Davids
The concept of equity ensures that each individual is given the environment, treatment, and resources needed to reach an equal outcome to those around them. Equity is central to initiatives for advancing diversity and inclusion among physicians. This article will identify key barriers to equity that women surgeons face within the professional setting. More specifically, inadequate female representation
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Cancer in the Anal Transition Zone and Ileoanal Pouch following Surgery for Ulcerative Colitis Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-03-24 Jennifer L. Miller-Ocuin, Jean H. Ashburn
Restorative proctocolectomy with ileal pouch-anal anastomosis remains the gold standard treatment for patients with ulcerative colitis who desire restoration of intestinal continuity. Despite a significant cancer risk reduction after surgical removal of the colon and rectum, dysplasia and cancers of the ileal pouch or anal transition zone still occur and are a risk even if an anal canal mucosectomy
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Toward Allyship and Mentorship: Recognition, Relatability, and Respect Clin. Colon Rectal Surg. (IF 1.4) Pub Date : 2023-03-24
Allyship and mentorship are two critical aspects needed not only to promote the growth of success of people around us, but also to advocate for those that are not as fortunate and are often excluded or marginalized. Understanding the distinctions and commonalities between the two, as well as the required interdependence, will go a long way toward ensuring that an impact toward positive change is made