In light of the recent publication of two multicentric controlled trials, this systematic review and meta-analysis aims to update the evidence of the efficacy of Indocyanine Green fluorescence angiography in preventing the risk of anastomotic leak after colorectal surgery. MEDLINE, EMBASE, and CENTRAL databases were searched for randomized controlled trials using relevant keywords from 2015 until September 2025. The outcomes were the overall rate of anastomotic leaks, the rate of reoperations, and the rate of intraoperative surgical strategy changes. Ten randomized controlled trials were selected, including 4.885 patients, 2.432 (49.7%) who received intraoperative ICG assessment and 2.453 (50.3%) who underwent standard white light assessment. The studies displayed a moderate risk of bias and were included in the meta-analysis. The ICG group showed a reduced rate of anastomotic leak (OR = 0.64; p < 0.0001; high evidence) compared with the standard dressing group and a higher rate of changes in surgical strategy (OR = 7.50; p = 0.02; moderate evidence), while no difference was found in the rate of reoperations (OR = 0.94; p = 0.64; moderate evidence). A subgroup analysis showed reduced anastomotic leak rates in left colon (p = 0.003) and rectal resection (p = 0.0002) and no differences after right colon surgery (p = 0.94). This systematic review and meta-analysis supports the use of ICG to reduce the anastomotic leak rate in colorectal surgery, in particular in left-sided and rectal resections.

Hospital closures pose persistent concerns about health care access, yet the extent to which closures are associated with cancer surgical care and patient outcomes remains unknown. To examine the association between undergoing colon or lung cancer surgery in hospitals that subsequently closed and postoperative and travel outcomes among Medicare beneficiaries. This retrospective cohort study used Medicare administrative data from 2008 to 2019. A national sample of hospital closures was identified using the Provider of Service files from the Centers for Medicare & Medicaid Services. Closed cancer surgical hospitals were those performing at least 1 colon or lung cancer surgery in the period from 2008 to 2019 and that also stopped inpatient care in 2008 to 2019. Participants were Medicare fee-for-service beneficiaries who underwent colon or lung cancer surgery from 2008 to 2019. Analyses were conducted separately by cancer type. Data were analyzed from December 2023 through February 2025. Undergoing cancer surgery at hospitals that subsequently closed. The primary outcomes were postoperative outcomes, including 90-day mortality, 90-day complications, and length of stay. Secondary outcomes were travel measures, including distance to surgical hospital and distance to the nearest alternative surgical hospital. Logistic regression was used to analyze 90-day postoperative mortality and complications, and linear regression was used to analyze length of stay. Travel measures were analyzed descriptively. The total sample was 558 708 participants, with 360 564 beneficiaries (64.5%) who underwent colon cancer surgery (median [IQR] age, 77 [71-83] years; 195 862 [54.3%] female) and 198 144 beneficiaries (35.5%) who underwent lung cancer surgery (median [IQR] age, 73 [69-78] years; 102 418 [51.7%] female) from 2008 to 2019. Of those, 6018 beneficiaries (1.7%) who underwent colon cancer surgery and 1938 beneficiaries (1.0%) who underwent lung cancer surgery underwent those surgical procedures at hospitals that subsequently closed. Beneficiaries treated at hospitals that subsequently closed were more often dually eligible (colon: 1047 [17.4%] closing vs 37228 [10.5%] nonclosing; lung: 234 [12.1%] closing vs 14426 [7.4%] nonclosing) and Black, Hispanic, or other race (ie, American Indian or Alaska Native, Asian, other, and unknown) (colon: 1450 [24.1%] closing vs 53640 [15.1%] nonclosing; lung: 388 [20.0%] closing vs 22048 [11.2%] nonclosing), with urgent admission (colon: 2559 [42.5%] closing vs 123830 [34.9%] nonclosing; lung: 228 [11.8%] closing vs 13394 [6.8%] nonclosing) than those treated at hospitals that did not close. Most beneficiaries bypassed their nearest hospital, but the majority treated at their nearest hospital that subsequently closed (colon, 1967 beneficiaries [79.0%]; lung, 465 beneficiaries [90.6%]) had an alternative surgical hospital within a 15-minute driving distance. Undergoing surgery at hospitals that subsequently closed was significantly associated with higher likelihood of 90-day mortality for colon cancer (adjusted odds ratio [aOR] 1.11; 95% CI, 1.01-1.22) and 90-day complications for both cancer types (colon aOR, 1.10; 95% CI, 1.01-1.21; lung aOR, 1.43, 95% CI, 1.17-1.76). The odds ratio for 90-day mortality after lung cancer surgery was not statistically significant, 1.26 (95% CI, 0.96-1.64). Lengths of stay were similar for both cancers. In this cohort study, undergoing colon and lung cancer surgery at hospitals that subsequently closed was associated with worse postoperative outcomes, but most beneficiaries treated at their nearest hospital had a nearby alternative hospital, suggesting that hospital closures may improve postoperative outcomes for cancer surgery, with minimal increase in travel burden, by directing patients to nearby, better-performing hospitals.

BackgroundColorectal cancer is a common and deadly form of cancer. Sigmoid colon cancer is the most prevalent type of colon cancer. Robotic-assisted surgical systems, like the Senhance Digital Laparoscopy System, have attracted considerable attention in recent years. The purpose of this study was to confirm the non-inferiority of Senhance-assisted surgery regarding its short-term safety compared with conventional laparoscopic surgery for sigmoid colon cancer.MethodsThis retrospective single-center study analyzed data from patients undergoing a sigmoidectomy between March 2020 and 2025. Propensity score matching was employed to create comparable groups. Patient characteristics, short-term surgical outcomes, and pathological data were assessed. Postoperative complications were graded using the Clavien-Dindo system.ResultsPrior to propensity score matching, there were differences in cancer stage between groups. After matching, two groups comprising 45 patients each were comparable across various factors. The operative time was significantly longer in the Senhance-assisted group compared with the conventional laparoscopic surgery group (236min vs 204min, P = .001), underscoring the importance of optimizing surgical techniques. Postoperative Numerical Rating Scale pain scores were significantly lower in the Senhance-assisted group on day 1 (3 [1-5] vs 4 [2-6], P = .03) and day 3 (2 [0-4] vs 3 [2-5], P = .02). However, no there were no significant differences in blood loss, complications, or pathological characteristics between the groups.ConclusionsThis study demonstrated that Senhance-assisted sigmoidectomy was non-inferior to conventional laparoscopic surgery in terms of short-term safety outcomes.

The new modified four-factor functional frailty index (mFF-4) in colorectal surgery: A retrospective cohort study.

Preoperative test requests for elective surgeries of different complexity: Appropriateness and interhospital variability.

Wait Times in Colon Cancer Care Delivery: An Analysis of Disparate Factors and Delay.

Mushroom coffee—blends of coffee with “functional” mushroom powders—has surged in popularity, yet its hemostatic effects are poorly appreciated in perioperative care. We report a postoperative hemorrhage likely potentiated by a commercial mushroom coffee. A 62-year-old man with HIV, hepatitis C, and insulin-treated diabetes underwent colostomy reversal. On postoperative day 9, he developed brisk bleeding at the colonic anastomosis requiring angiography and embolization. Recurrent hemorrhage prompted a detailed supplement history, revealing daily use of mushroom coffee for two months preoperatively. The product’s labeled ingredients include an organic mushroom blend of cordyceps, lion’s mane (Hericium), reishi (Ganoderma), shiitake, turkey tail, and king trumpet, combined with arabica coffee, MCT oil, and coconut milk. Several constituents—reishi, cordyceps, lion’s mane, and chaga (Inonotus obliquus, used in some mushroom blends)—have published antiplatelet or antithrombotic activity in vitro and/or in vivo. After counseling, the patient discontinued mushroom coffee; no further bleeding occurred, and he recovered without additional intervention. This case highlights a clinically important but underrecognized risk: mushroom-based beverages can exert antiplatelet effects comparable to herbal supplements traditionally flagged in preoperative screening. We recommend that preoperative medication reconciliation explicitly query mushroom coffees and “adaptogenic” blends and that such products be held similarly to other agents with antiplatelet properties. Greater awareness among surgeons, anesthesiologists, and internists is needed as functional foods proliferate. Controlled studies are warranted to quantify bleeding risk from multi-mushroom products and to inform evidence-based perioperative guidance

Introduction: colitis is an increasingly common condition in patients, where the mucosa of the colon becomes acutely or chronically inflamed. Histological evaluation is crucial to understanding the structural integrity of the colon, as it provides direct evidence of tissue damage, inflammation, and healing after therapeutic intervention. Objective: to report the experience of the different colitis diagnosed through medical practice in the Colon and Rectal Surgery service. Methods: multicenter study with a retrospective, longitudinal, observational and descriptive design. Reporting disease activity in colon and rectal anatomy, medical treatment lines with or without colon and rectal surgery, morbidity and mortality. Results: with a total of 297 patients: 154 women representing 51.17% and 143 men representing 48.14%. The age range was 18 to 89 years, with an average age of 43 years. Patients who had a follow-up of more than one year, since their diagnosis confirmed histopathologically, with clinical, laboratory and colonoscopy congruence. Treatment and management are determinant of the diagnosis according to each case. Discussion: the diagnoses of colitis and its variety make the veracity complex but demandingly convincing for a coherent and effective treatment: ranging from ulcerative colitis, ischemic colitis, collagenous colitis, lymphocytic colitis, eosinophilic colitis, neutropenic colitis, amoebic colitis and more. Conclusions: there is a lack of knowledge about colitis tacitly both for functional digestive disorders and for anatomical disorders or only stigmatized by the medical vulgar. The current fashion called "consensus" by "experts" (a true empiricism); discarding scientific methodology, the pillar of the essence of a science, trembling its veracity, forcefulness and effectiveness.

Shared Decision-Making in Colon and Rectal Surgery

Colon and Rectal Surgery Regional Society Meetings

BackgroundBowel obstruction in the setting of peritoneal metastases is a complex clinical situation. Evidence for operative intervention in this setting remains unclear. This study aimed to compare outcomes between patients with bowel obstruction and peritoneal metastases who underwent operative intervention vs those who underwent conservative management.MethodsThis was a retrospective single center study of all patients that were consulted on by the Division of Colon and Rectal Surgery in the 6-year period between January 1st 2019 and December 31st 2024 for the management of bowel obstruction in the setting of peritoneal metastases. The study compared patients who underwent operative intervention vs those who underwent conservative management. The primary outcome measures were ability to tolerate solid food at discharge, median obstruction free survival, and median overall survival.ResultsA total of 100 patients were diagnosed with bowel obstruction in the setting of peritoneal carcinomatosis. 47 patients underwent operative intervention and 53 underwent non-operative management. Those who underwent operative intervention were more likely to tolerate solid food at discharge (78.72% vs 47.17%, P < 0.01) and had a longer median obstruction free survival (593 days vs 147 days, P = 0.01). No difference was identified in overall survival (133 days vs 99 days, P = 0.49).ConclusionsBowel obstruction in the setting of peritoneal metastases is a complex situation that requires a personalized and pragmatic approach for each patient. Selecting those who may benefit from operative intervention can be challenging, however, there are subsets of patients for whom surgical management may be offered with acceptable outcomes.

Colonic surgery for Crohn's disease (CD) frequently involves sparing uninvolved segments of the colon. Few studies have assessed recurrence rates after segmental colectomy (SC). The aim of this study was to determine the rate of and identify the risk factors for postoperative CD recurrence. This was a multicenter retrospective study from 3 tertiary inflammatory bowel disease (IBD) referral centers of CD patients who underwent SC between 2000 and 2019. We defined endoscopic recurrence as the presence of ulcers in the remaining colon upon postoperative colonoscopy. A total of 108 patients were included. Sixty-nine (63.9%) patients had evidence of postoperative CD endoscopic recurrence. Age at surgery <40 years and disease duration ≤156 months predicted an increased likelihood for postoperative recurrence (odds ratio [OR], 2.43; P = .031 and OR, 3.29; P = .005, respectively), whereas abdominal perineal resection (OR, 0.21; P = .005), indication for SC of malignancy (OR, 0.14; P = .016), and postoperative use of tumor necrosis factor α (TNFα) inhibitor for prophylactic purposes (OR, 0.38; P = .040) negatively predicted disease recurrence. Disease duration ≤156 months (OR, 2.86; P = .039) and postoperative TNFα inhibitor prophylaxis remained significant (OR, 0.26; P = .013) upon multivariable modeling. Although high rates of recurrence persist within the postoperative phase of SC for CD, the postoperative use of TNFα inhibitor for prophylactic purposes for a subset of patients may promote a more durable endoscopic remission.

Background Hepatotoxicity is a significant concern for patients with colorectal cancer (CRC), potentially leading to severe complications, including death. This study aims to quantify the overall and long-term risks of chronic liver disease and cirrhosis (CLDC) death among CRC patients following surgery. Methods Data of the patients with colon cancer or rectal cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (1992–2021). Cumulative mortality functions, standardized mortality ratios (SMRs), and absolute excess risk (AER) were calculated to evaluate the risk of CLDC mortality. Results CRC survivors had higher CLDC mortality than the general population (colon SMR 1.76; rectal SMR 1.42). Significantly, the highest AER was recorded among individuals diagnosed with colon cancer within the age bracket of 60 to 69 years. This elevated risk persists even with targeted therapies and immunotherapy, highlighting the need for personalized follow-up. Moreover, it is important to note that long-term survivors of colon and rectal cancer continue to face an elevated risk of CLDC-related mortality. Conclusion The study highlights the importance of personalized medicine, comprehensive follow-up, and proactive management of liver health in CRC survivors to mitigate long-term adverse effects of cancer treatments. Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-28763-3.

Abstract Introduction Inflatable penile prosthesis (IPP) is the gold standard treatment for erectile dysfunction (ED) refractory to medical therapy and is associated with high patient satisfaction rates. Traditionally, the reservoir is placed in the space of Retzius; however, this approach can be technically challenging and may lead to serious complications, particularly in patients with a history of major pelvic surgery. Subscarpal reservoir placement (SRP) is an alternative in select patients with prior pelvic surgery. Objective To examine the efficacy and safety of the SRP of IPP reservoir placement. Methods Retrospective analysis of patients who underwent SRP by a single surgeon between May 2016 and September 2024. Patients were evaluated based on age, etiology of ED, history of radiation therapy (RT), body mass index (BMI), diabetes, hypertension, peripheral vascular disease, smoking status, immunosuppression status, prior abdominal surgery, history of Peyronie’s disease (PD), history of priapism, prosthesis type, surgical approach, postoperative complications, and reservoir-related complications. Patients were also asked whether the reservoir was palpable and to report their subjective level of bother, if any. Results A total of 35 patients were identified with SRP during the study period, with a mean age of 67.6 years (SD 7.6) and a mean BMI of 28.9 kg/m2 (SD 3.8). Of these, 71.4% (25/35) had previously undergone radical cystectomy (RC), while the remaining 28.6% (10/35) had undergone radical prostatectomy, associated with additional risk factors, including a history of oncologic colonic surgeries (6/35), pelvic fracture (1/35), or BMI &amp;gt;35 kg/m2 (3/35). All demographic variables are summarized in Table 1. A penoscrotal approach was used in 97.1% (34/35) of cases. A subcoronal approach was used in one patient due to the need for concomitant PD correction. The mean follow-up duration was 31.1 months (SD 29.5). Notably, there were no reservoir-related complications such as erosion or herniation. One patient developed an infection requiring IPP removal. Two patients experienced urethral erosion, necessitating device removal. Four patients presented with mechanical malfunction and subsequently underwent revision surgery. The response rate to the satisfaction survey was 45.6% (16/35). Among the respondents, 75% (12/16) reported palpable reservoirs; however, only 18.8% (3/16) reported being bothered by it. Conclusions SRP is a viable option for carefully selected patients with a history of major pelvic surgery. This approach is safe and associated with a low incidence of reservoir-related complications, such as herniation or erosion. Although many patients are able to palpate the reservoir, only a small proportion report being bothered by it. These findings underscore the importance of thorough preoperative counseling and expectation management in this high-risk population for reservoir-related complications. Disclosure No

Ileal pouch-anal anastomosis (IPAA) is a key procedure to master in colorectal surgery. It is one task of the Colorectal Objective Structured Assessment of Technical Skill (COSATS) of the American Board of Colon and Rectal Surgery. The virtual colorectal surgical trainer-IPAA (VCoST-IPAA) was designed as an innovative platform for training and assessing performance in this procedure. Our aim was to establish the validity of the simulator by demonstrating its ability to distinguish between levels of surgical expertise. In this IRB-approved study, general surgery residents and colorectal surgeons from our institution performed the IPAA procedure on the VCoST simulator. Nineteen task-specific metrics developed by expert consensus were included and automatically recorded by the simulator. Participants were divided into novice (PGY 1-2) and experienced (PGY 3-5 and faculty) groups. The Messick's unitary framework was used to assess the validity. The Mann-Whitney U test was used to compare the performance between the groups. A total of 22 equally distributed participants were included in this study. The Mann-Whitney U test showed significant differences in performance between the two groups on the assessment of J-pouch length (3.67 for experienced vs. 1.50 for novices; p = 0.01) and the gap indicator during trocar retraction (3.89 vs. 1.50; p = 0.04). No significant differences in completion time (670.1 vs. 826.3s; W = 24; p = 0.09) nor the total score computed using 18 metrics (76.33 vs. 70.50; W = 65; p = 0.1) were found. Our VCoST-IPAA simulator showed that J-pouch length and the gap indicator during trocar retraction were important predictors of performance between experienced and novice participants. Participants in our study performed an Altemeier procedure on our validated VCoST-rectal prolapse simulator before the IPAA procedure, which may have had a positive effect on the performance on the VCoST-IPAA simulator.

Abstract Colon and rectal surgeons treat a unique patient population, many of whom identify as racial, ethnic, or sexual minorities. Multiple studies have shown having diverse representation improves not only patient outcomes but also the training and work environment. Surgery and surgical subspecialties have historically not achieved demographic parity due to a multitude of reasons. Current strategies to improve demographic parity include pipeline programs to attract more diverse applicants to residencies and mentorship programs to help early and mid-career surgeons. Improving diversity, equity, and inclusion in colon and rectal surgery training will occur only with training program, institutional and national organization commitment.

Rebuilding the Standardized Letter of Recommendation: A Consensus-Based Redesign of the Standardized Letter for Colon and Rectal Surgery.

Clinical health service research on single-incision laparoscopic colon and rectal surgery: results of 1,170 patients in a 7-year registry analysis.

Beyond traditional risk factors: The identification of preoperative serum ferritin as a novel predictor of anastomotic leakage after colonic surgery.

Abstract The rigorous demands of colon and rectal surgery necessitate comprehensive assessment and continuous professional development. Historically, surgical training relied solely on time-based progression including a non-specific but holistic declaration of competency by program directors, but a global shift toward competency-based medical education (CBME) now prioritizes skill acquisition. For residents, current assessment integrates ACGME milestones, detailed ACGME case logs, and the CARSITE examination, moving beyond traditional subjective evaluations. Although initial board certification retains its written and oral examination structure, maintenance of certification for practicing surgeons has evolved to CertLink, a continuous longitudinal assessment. Furthermore, the advent of ASCRS U and on-demand content has revolutionized access to continuing medical education (CME). This manuscript provides a comprehensive overview of modern assessment strategies for both trainees and board-certified colorectal surgeons, detailing current practices, emerging trends, and future considerations. The commitment to robust assessment ensures high standards of practice and optimal patient outcomes in this dynamic specialty.