Colon Surgery Research Articles

The Efficacy of Chemical Bowel Preparation Against Incisional Surgical Site Infection in Colorectal Cancer Surgery: A Propensity Score Matching Study.

In colorectal cancer surgery, the risk of surgical site infection (SSI) is relatively high. The development of SSI is related to longer and costlier hospitalization and reduced quality of life; therefore, perioperative prevention of SSI is important. Chemical bowel preparation (CBP) combined with mechanical bowel preparation (MBP) may be more effective in preventing surgical site infection (SSI) compared to MBP alone. Since May 2021, we have been administering oral kanamycin and metronidazole as CBP, in addition to MBP, as a preoperative treatment for colorectal cancer surgery on the day before surgery. In this study, we investigated the clinical value of CBP in addition to MBP in colorectal cancer surgery using propensity score matching (PSM). From January 2017 to December 2021, 136 consecutive patients underwent radical surgery for sigmoid colon and rectal cancer at the Osaka Metropolitan University Hospital. Patients were divided into two groups: CBP and N-CBP. In the N-CBP group, we performed only preoperative MBP, whereas in the CBP group, we performed preoperative CBP in addition to MBP. We retrospectively analyzed this relationship with PSM. Overall, 46 patients underwent preoperative CBP and MBP, 90 patients underwent preoperative MBP only. PSM was performed between the CBP and N-CBP groups based on the following ten factors: age, sex, diabetes mellitus, preoperative therapy, Glasgow Prognostic Score (GPS), operative time, blood loss, stoma, and pathological stage. After PSM, univariate and multivariate analyses of the relationship between SSI and clinicopathological factors were performed. Univariate analysis showed that age and CBP were correlated with the rate of SSI (p=0.039 and p=0.017, respectively), whereas sex was relatively correlated with the rate of SSI (p=0.066). The multivariate analysis of significant factors identified age of 75 or more and non-CBP as an independent risk factor for incisional SSI (HR=9.5; p=0.049 and HR=5.4×e-8; p=0.020). Preoperative CBP in addition to MBP was effective in preventing incisional SSI during colorectal cancer surgery.

Robotic hemi-colectomy for ascending colon cancer in a patient with situs inversus totalis

BackgroundSitus inversus totalis (SIT) is a rare congenital anomaly in which the thoracic and abdominal cavity structures are completely opposite to normal. Performing robot-assisted surgery in these patients is difficult because of these anomalies. A few reports have described robot-assisted surgery for rectal cancer in patients with SIT, but no reports to date have described robot-assisted surgery for colon cancer.Case presentationA 74-year-old female presented with abdominal pain and was diagnosed with ascending colon cancer and SIT. We carefully planned the surgical procedure and performed robot-assisted hemi-colectomy. Although we used unusual port placement, the operation was performed safely. The patient was discharged without any complications.ConclusionsRobot-assisted surgery is safe and efficient for patients with anatomical anomalies.

71223 - Risk factors for severe complications and mortality in elderly undergoing colon surgery – a retrospective cohort study from the ERAS-registry

71223 - Risk factors for severe complications and mortality in elderly undergoing colon surgery – a retrospective cohort study from the ERAS-registry

Optimization of Correction of Intraoperative Blood Loss with Hemocomponents during Colon Surgery in Patients with Colostomies and Colonic Fistulas

Optimization of Correction of Intraoperative Blood Loss with Hemocomponents during Colon Surgery in Patients with Colostomies and Colonic Fistulas

Comparison of robotic and laparoscopic surgery for sigmoid colon and rectal cancer: a single-center retrospective study on surgical outcomes and long-term survival.

Although the safety and short-term outcomes of robotic surgery for sigmoid colon and rectal cancer patients are well-documented, there is limited research on the long-term survival outcomes of robotic colorectal surgery. This is a retrospective study that includes 502 patients who underwent either laparoscopic or robotic anterior resection and abdominoperineal resection for rectal or sigmoid colon cancer between August 2016 and September 2021. All patients were diagnosed with rectal or sigmoid colon adenocarcinoma. Propensity score matching (PSM) was implemented to minimize selection bias. Perioperative outcomes, complication rates, and pathological data were evaluated and compared. The 5-year overall survival rate and disease-free survival rate were calculated and compared. Before matching, patients in the robotic group had earlier pathological T and N stages and were more likely to have received neoadjuvant chemoradiotherapy compared to the laparoscopic group. After matching, most clinicopathological outcomes were similar between the two groups, but the robotic group had longer operative times and a lower conversion rate to open surgery compared with laparoscopic group. After matching for clinical factors, the 5-year DFS rates were 88.19% for the robotic group and 82.46% for the laparoscopic group (P = 0.122), and the OS rates were 90.5% and 79.5% (P = 0.342), showing no significant differences. In the stratified analysis, patients in the robotic surgery group had significantly higher 5-year DFS rates in the following subgroups: age < 65years, TNM stage I-II, received neoadjuvant therapy, and primary tumor located in the rectum. The safety and efficacy of robotic surgery for sigmoid colon and rectal cancer were validated compared to laparoscopic surgery, with both groups of patients exhibiting comparable long-term prognoses.

Opioid free analgesia after return home in ambulatory colonic surgery patients: a single-center observational study

BackgroundBecause of the adverse effects of morphine and its derivatives, non-opioid analgesia procedures are proposed after outpatient surgery. Without opioids, the ability to provide quality analgesia after the patient returns home may be questioned. We examined whether an opioid-free strategy could ensure satisfactory analgesia after ambulatory laparoscopic colectomy.MethodsWe performed a retrospective observational single-center study (of prospective collected database) including all patients eligible for scheduled outpatient colectomy. Postoperative analgesia was provided by paracetamol and nefopam. Postoperative follow-up included pain at mobilization (assessed by a numerical rating scale, NRS), hemodynamic variables, temperature, resumption of transit and biological markers of postoperative inflammation. The primary outcome was the proportion of patients with moderate to severe pain (NRS > 4) the day after surgery.ResultsData from 144 patients were analyzed. The majority were men aged 59 ± 12 years with a mean BMI of 27 [25-30] kg/m2. ASA scores were 1 for 14%, 2 for 59% and 3 for 27% of patients. Forty-seven patients (33%) underwent surgery for cancer, 94 for sigmoiditis (65%) and 3 (2%) for another colonic pathology. Postoperative pain was affected by time since surgery (Q3 = 52.4,p < 0.001) and decreased significantly from day to day. The incidence of moderate to severe pain at mobilization (NRS > 4) on the first day after surgery was (0.19; 95% CI, 0.13–0.27).ConclusionNon-opioid analgesia after ambulatory laparoscopic colectomy seems efficient to ensure adequate analgesia. This therapeutic strategy makes it possible to avoid the adverse effects of opioids.Trial registrationThe study was retrospectively registered and approved by the relevant institutional review board (CERAR) reference IRB 00010254–2018 – 188). All patients gave written informed consent for analysis of their data. The anonymous database was declared to the French Data Protection Authority (CNIL) (reference 221 2976 v0 of April 12, 2019).

The effects of current health policy on social determinants of health, implications in colon and rectal surgery

Despite decades of work on advancing outcomes in colon and rectal surgery, social determinants of health (SDOH) remain an unaddressed component in understanding these outcomes to ensure health equity. Consequently, there is evidence that SDOH have a negative impact on morbidity and mortality of those individuals with colorectal cancer and inflammatory bowel disease in comparison to their counterparts. We sought to elucidate the interplay between SDOH with the access and utilization of Medicaid and how best to improve patient care and outcomes through policy changes. Further education how to address SDOH is needed, as well as a continued push for policy makers to create legislation to improve these rampant inequities in medicine.

CC vs. CC-Plus: A Comparison between Two Cranial-to-Caudal Approaches for Laparoscopic Right Hemicolectomy: A Single-Center Retrospective Study.

Colorectal cancer is a leading cause of cancer-related deaths worldwide, with approximately 1.9 million new cases and over 935,000 deaths in 2020. Right-sided colon cancer, a subset of colorectal cancer, represents a significant health burden. Laparoscopic colon surgery has significantly improved postoperative recovery. The superiority of one approach or landmark over another is still argued about due to the lack of large-scale prospective studies. However, deep understanding both of the anatomical variation and characteristics of each approach is of extreme importance to minimizing adverse effects and maximizing patient benefit after laparoscopic right hemicolectomy. Among these, the cranial-to-caudal approach offers advantages such as reduced intraoperative blood loss, shorter operation time, and decreased risk of vascular injury. The purpose of this study is to compare the efficacy and safety of two cranial-to-caudal approaches for laparoscopic right hemicolectomy (LRH). Specifically, the study aims to evaluate the differences between the conventional cranial-to-caudal approach with medial ligation of the middle colic vein (MCV), and the cranial-to-caudal approach with cranial MCV ligation and surgical trunk sheath opening (CC-plus). The goal is to determine which method offers superior outcomes in terms of intraoperative blood loss, operation time, and overall patient recovery. This single-center retrospective study compared two cranial-to-caudal approaches for LRH. The study included 51 patients who underwent LRH between January 2021 and November 2023 at the Second Affiliated Hospital, Zhejiang University School of Medicine. Patients were divided into two groups: Group A (26 patients) used the cranial-to-caudal approach with medial ligation of the middle colic vein (MCV), and Group B (25 patients) used the cranial-to-caudal approach with cranial MCV ligation and surgical trunk sheath opening (CC-plus). General characteristics, intraoperative parameters, and postoperative outcomes were compared. Statistical analysis was performed using SPSS version 20.0, with significance set at p < 0.05. There were no significant differences between the groups regarding age, gender, tumor location, or clinical staging. All patients achieved R0 resection with no perioperative deaths. The CC-plus group had significantly reduced intraoperative blood loss and shorter operation time compared to the CC group (p < 0.05). No significant differences were found in first postoperative exhausting time, first postoperative defecation time, and postoperative hospital stay between the two groups. Furthermore, no significant differences were evaluated in postoperative complications (surgical site infection (SSI), ileus or bowel obstruction, refractory diarrhea, anastomotic leakage, deep vein thrombosis (DVT), hemorrhage) between the two groups on a median follow up of 12.6 months. Pathological examination showed no significant differences in total lymph nodes dissected and tumor stage. The cranial-to-caudal approach with MCV ligation via the cranial approach (CC-plus) is a safe and effective method for LRH, offering advantages in terms of reduced operation time and intraoperative blood loss. This study's findings suggest that the CC-plus approach may be superior to the conventional cranial-to-caudal approach.

Minimally invasive left colectomy with total intracorporeal anastomosis versus extracorporeal anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation

PurposePerforming intracorporeal anastomoses in minimally invasive colon surgery appears to provide better short-term outcomes for patients with colon cancer. The aim of the study is to compare surgical aspects and short-term outcomes between intracorporeal and extracorporeal techniques in left colectomies with both laparoscopic and robotic approaches and evaluate advantages and disadvantages of intracorporeal anastomosis according to IDEAL framework (Exploration, stage 2b).MethodsThis is a single center, ambispective cohort study comparing total intracorporeal anastomosis (TIA) and standard surgery with extracorporeal anastomosis (EA). Patients with colon cancer treated by left colectomy, sigmoidectomy and high anterior resection by total intracorporeal anastomosis between May 2020 and January 2023 without exclusion criteria were prospectively included in a standardized database. Short-term outcomes in the group undergoing TIA were compared with a historical EA cohort. The main assessment outcomes were intraoperative complications, postoperative morbidity according to the Clavien-Dindo scale and the comparison of pathological. We conducted a preliminary comparative study within the TIA group between approaches, a primary analysis between the two anastomotic techniques, and a propensity score matched analysis including only the laparoscopic approach, between both anastomotic techniques.ResultsTwo hundred and forty-six patients were included: 103 who underwent TIA, 35 of them with laparoscopic approach and 68 with robotic approach, and a comparison group comprising another 103 eligible consecutive patients who underwent laparoscopic EA. There were no statistically significant differences between the two groups in terms of demographic variables. No statistically significant differences were observed in anastomotic dehiscence. Intraoperative complications are fewer in the TIA group, with a higher C-Reactive Protein levels. Relevant anastomotic bleeding and the number of retrieved lymph nodes were higher in EA group. Nevertheless, no differences were observed in terms of overall morbidity.ConclusionMinimally invasive left colectomy with intracorporeal resection and anastomosis is technically feasible and safe suing either a laparoscopic or a robotic approach. Clinical data from this cohort demonstrate outcomes comparable to those achieved through the conventional EA procedure in relation to postoperative morbidity and oncological efficacy, with indications suggesting that the utilization of robotic-assisted techniques may play a contributing role in enhancing overall treatment outcomes.

Wound Irrigation in the Prevention of Surgical Site Infection in Elective Colorectal Surgery: A Retrospective Cohort Study.

Background Surgical site infection in colon surgery is associated with significant cost and increased length of hospital stay. Recently, there has been interest in the use of pulsed lavage to reduce the risk of surgical site infection in contaminated wounds. Although increasingly used and gaining popularity, its effectiveness in elective colorectal surgery has been poorly documented. This study aimed to investigate the incidence of surgical site infection within 30 days of elective colorectal surgery in patients who underwent wound irrigation with pulse lavage versus standard closure. Methodology A retrospective study was conducted at a university hospital over a two-year period between January 2020 and December 2021. All adult patients who underwent elective colorectal surgery were eligible for inclusion. Results A total of 222 patients underwent elective colorectal surgery during the study period. Operative procedures included abdominoperineal resections, left and right hemicolectomies, pelvic exenterations, small bowel or large bowel resections, as well as stoma reversals, formations, and refashioning. In total, 76 patients underwent pulse lavage while 146 did not. The total number of surgical site infections was 39 during the study period. Infection rates in the pulse lavage group were 14.47% compared to 19.18% in the standard closure group. The chi-square analysis concluded the difference in infection rates was not statistically significant (p = 0.213). Conclusions The findings demonstrated a difference in infection rates of almost 5% favouring the pulse lavage group; however, it did not reach a statistical difference. Although infection rates were in keeping with those described in the literature, further studies in the form of randomized controlled trials should be performed to determine the benefits, if any, of pulse lavage in colorectal surgery.

Colon and Rectal Surgery Regional Society Meetings

Colon and Rectal Surgery Regional Society Meetings

Advancements in ectopic reservoir placement for inflatable penile prostheses.

Traditional reservoir placement (RP) into the space of Retzius during three-piece inflatable penile prosthesis implantation has been associated with serious bladder, iliac vessel, and bowel complications, encouraging the development of "ectopic" RP methods. In this study we sought to document an up-to-date, comprehensive analysis of ectopic RP techniques regarding both patient satisfaction and clinical complications. A PubMed, Ovid MEDLINE, and Cochrane Library literature search of English language articles from 1966 to 2023 with keywords "inflatable," "penile prosthesis," "reservoir," and "placement" gave 179 publications, 70 of which were included in a comprehensive chronology and investigation after review. Overall, 12 retrospective studies detailing 9 ectopic RP techniques were compared for discussion. Sufficient data for comparison were found for 9 ectopic RP methods: posterior/anterior to transversalis fascia (PTF/ATF); high submuscular (HSM); HSM "Five-Step" technique (HSM-FST); lateral retroperitoneal (LR); sub-external oblique (SEO); direct vision, transfascial (DVT); low submuscular with transfascial fixation (LSM w/ TFF); and midline submuscular reservoir (MSMR). Although rare, serious complications have occurred with the use of ectopic RP techniques: 2 bladder perforations on implantation with PTF RP, a delayed bowel obstruction with HSM RP, and a colonic injury in a patient with a history of colon surgery with LR RP. Generally, herniation is the most relevant clinical complication in ectopic RP. At the time of this review there was no reported herniation with LR, SEO, LSM w/ TFF, or MSMR, likely due to fixation steps and/or reinforced spaces. Regarding patient satisfaction, HSM, HSM-FST, and LSM w/ TFF had similarly high rates of patient satisfaction while other techniques had no patient satisfaction data available. Importantly, reservoir palpability/visibility relates directly to patient satisfaction. Levels of palpability and/or visibility were reported in patients who underwent PTF/ATF, HSM, HSM-FST, SEO, and LSM w/ TFF, whereas no palpability was reported in patients who underwent LR, DVT, and MSMR. Proper comparison of ectopic methods is not possible without standardized patient surveys, consistent complication reporting, and larger sample sizes, indicating the need for a large, prospective, multisurgeon trial.

Complications and putative risk factors for cecal or colonic surgery in dogs: 79 cases (2002-2015).

To evaluate the complication rate, mortality rate and putative risk factors for cecal or colonic surgery in dogs. A multi-institutional retrospective study including dogs that had undergone surgery that involved the cecum or the colon. Medical records from three referral hospitals were reviewed for patient demographics and clinical data. The association between putative risk factors and survival to discharge or complications was assessed using univariable and multivariable analysis. Seventy-nine dogs met the criteria to be included in this study. Fifty-five dogs had full thickness incision surgeries, while 24 dogs had partial thickness surgeries. The complication and mortality rates for full thickness and partial thickness cecal/colonic surgeries were not statistically different. The dehiscence rate of colonic anastomosis in this study was four of 47 (8.5%). On univariate analysis, performing full thickness procedures out of hours had an association with increased complications and mortality. On multivariable analysis, no factors were associated with survival to discharge or complications. There was no association of board-certified surgeon presence in surgery with complications or mortality. The performance of full thickness cecal/colonic surgery is not associated with a statistically significant increased risk for complications or mortality compared to partial thickness procedures, with a possible increased risk of complications and mortality in full thickness procedures out of hours.

Usefulness of the one-step technique in functional end-to-end anastomosis for colonic surgery: results of a prospective multicentre cohort study from the Japanese KYCC group.

Although functional end-to-end anastomosis (FEEA) using a stapler in the colorectal field has been recognised worldwide, the technique varies by surgeon, and the safety of anastomosis using different techniques is unknown. This multicentre prospective observational cohort study was conducted by the KYCC Study Group in Yokohama, Japan, and included patients who underwent colonic resection at seven centres between April 2020 and March 2022. This study compared the incidence of surgery-related abdominal complications (SAC: anastomotic leakage [AL], anastomotic bleeding, intra-abdominal abscess, enteritis, ileus, surgical site infection, and other abdominal complications) between two different methods of FEEA (one-step [OS] method: simultaneous anastomosis and bowel resection; two-step [TS] method: anastomosis after bowel resection). Complications of Clavien-Dindo classification grade2 or higher were assessed. Among 293 eligible cases, the OS and TS methods were used in 194 (66.2%) and 99 (33.8%) patients, respectively. The baseline characteristics were similar between the groups. The OS method used fewer staplers (three vs. four staplers, p < 0.00001). There were no significant differences in SAC rate between the OS (19.1%) and the TS (16.2%) groups (p = 0.44). The OS group had four cases (2.1%) of AL (two patients; grade3, two patients; grade2) while the TS group had one case (1.0%) of grade2 AL (p = 0.67). Multivariate logistic regression analysis showed that male sex (odds ratio [OR] 3.95; p < 0.00001), an open surgical approach (OR 2.36; p = 0.03), and longer operative duration (OR,2.79; p = 0.002) were independent predictors of complications, whereas the OS method was not an independent predictor (OR 1.17; p = 0.66). The OS and the TS technique for stapled colonic anastomosis in a FEEA had a similar postoperative complication rate. UMIN000039902 (registration date 23 March 2020).

Exploring Socioeconomic Disparities in Surgical Site Infections

Introduction: Social disparities have been shown to impact a wide variety of healthcare outcomes. Surgical site infections (SSIs) are associated with substantial patient morbidity, but studies on the intersection of social disparity and SSI are limited. We sought to evaluate the association between SSI and the Center for Disease Control and Prevention’s social vulnerability index (SVI). Methods: Patients with National Health Safety Network (NHSN) procedure codes for colon, abdominal hysterectomy, hip prosthesis, knee prosthesis and spinal fusion surgeries were retrieved from the electronic medical records of 20 hospitals across 4 geographic markets. SSIs were identified by trained infection preventionists using NHSN definitions. Descriptive statistics were used for baseline demographic and clinical characteristics. Univariate logistic regression was performed to assess the association of demographic, clinical, and procedural factors with the outcome of SSI. Further univariate subgroup analysis was completed by procedure. To account for the nonlinear relationship between the social vulnerability index and SSIs, smoothing splines were used in a Bayesian hierarchical logistic regression model, with random effects to account for the different market practices. Nonlinear effects of procedure duration were also investigated while adjusting for the patient age, procedure type, and health system market. Results: 23,864 surgical procedures among 22,319 unique patients identified between 1 August 2022 and 31 August 2023. 96 patients with infection present at time of surgery were excluded. The study population was mostly white (74%) and female (65%) (Table 1). Less than 13% of the patients had more than one procedure during this time. In a univariate analysis, we found evidence of market and procedure effects, with colon surgery being associated with the highest odds of SSI. Procedure duration was significantly associated with SSI in both univariate and multivariable models, with a drastic increase in the odds of SSI for procedures &gt; 150 mins. In the multivariable model we found that SVIs lower than 0.4 (95% CI 0.28 to 0.55) are associated with an adjusted odds ratio (aOR) &lt; 1. (Figure 1) Conclusions: Our study shows that the relationship of social vulnerability and adverse outcomes is highly complex with nonlinear dynamics at play. After adjusting for procedure type, duration, patient age, gender and health system market the odds of SSIs increase sharply in patients with higher SVI until leveling off at an elevated risk.

Concordance with Preoperative Intravenous Antibiotics Guidelines and Risk of Surgical Site Infection (SSI)

Background: Administration of antimicrobial prophylaxis close to incision time is recommended as an essential practice to prevent surgical site infections (SSI). Despite guideline recommendations, adherence to preoperative intravenous antibiotic guidelines is variable. We aim to assess perioperative factors associated with guideline concordant (GC), guideline second line (GSL) and non-guideline concordant (NGC) antibiotic choice and timing and impact on odds of SSI. Methods: 3173 patients at 9 hospitals with National Health Safety Network (NHSN) procedure codes for colon surgery and abdominal hysterectomy between January 1, 2023, and October 31, 2023, were identified from the electronic medical record. Data on preoperative intravenous antibiotic choice and timing, history of allergy and methicillin resistant staphylococcus aureus (MRSA) history was collated. SSI were identified using NHSN definitions by trained infection preventionists. SSI identified as present at the time of surgery were excluded. Antibiotic choice and timing were compared to institutional guidelines and patients were categorized as having received GC, GSL or NGC antibiotic choice, and GC or NGC antibiotic timing. Descriptive statistics were used to describe clinical data for patient population and subgroups who received GC, GSL and NGC antibiotics. Univariate logistic regression was performed to assess the association of procedural and clinical factors with the likelihood of an SSI. Results: GC was high overall for both antibiotic choice (94%) and timing (94%). (Table 1) NGC and GSL antibiotic choice were more common in colon surgery, urgent/emergent cases, patients with beta lactam allergies and those with a recent history of MRSA. GSL antibiotic choice was more frequent in inpatients. (Table 2). GC antibiotic timing was more common with GC antibiotic choice (98%) than with NGC (37%) or GSL (51$) antibiotic choice. Odds of SSI were lower in patients who were GC for both antibiotic choice and timing (OR 0.4, p &lt; 0 .001) and increased in patients who received GSL antibiotic choice (OR 5.7 compared to GC, p &lt; 0 .001), underwent urgent/emergent surgeries (OR 4.6, p &lt; 0 .001) or had a history of MRSA in the past year (OR 8.4, p &lt; 0 .001). We found a non-significant trend toward lower infections in patients with GC antibiotic timing (OR 0.5, p 0.08). (Table 3) Conclusion: Combined GC for antibiotic choice and timing was high and associated with lower odds of SSI. NGC and GSL antibiotic choice were associated with patient level factors such as history of MRSA and emergent procedures which may also impact risk of SSI.

Incidence of Post Operative Sexual Dysfunction Following Left Sided Colon and Rectal Surgery in a Surgical Patient Cohort in Northern Saskatchewan

Incidence of Post Operative Sexual Dysfunction Following Left Sided Colon and Rectal Surgery in a Surgical Patient Cohort in Northern Saskatchewan

Feasibility and Outcome of Enhanced Recovery Programs in Laparoscopic versus Open Elective Colectomy for Left Side Colonic Carcinoma Surgery

Feasibility and Outcome of Enhanced Recovery Programs in Laparoscopic versus Open Elective Colectomy for Left Side Colonic Carcinoma Surgery

ACBC Study Protocol – Acute Colon Resection Versus Bridge to Colon Surgery with Stent Placement or Stoma Diversion: A Prospective Cohort Study

Abstract Background: Approximately 70% of all colon cancer emergencies result from colonic obstruction. Data from the Swedish Colorectal Cancer Registry indicate that patients undergoing emergency surgical resections for colon cancer face higher overall 30-day morbidity and increased mortality rates—5.8% at 30 days and 11.2% at 90 days—compared to those undergoing elective procedures, which have mortality rates of 1.1% and 2.0%, respectively. Other concerns about acute colon cancer resections are oncological outcomes. Long-term outcomes are significantly worse, with higher rates of recurrence and cancer-related death, regardless of the cancer stage or the use of adjuvant chemotherapy. Objectives: To evaluate the short- and long-term outcomes of primary resection for malignant colonic obstruction compared to only decompression using a self-expandable endoscopic metallic stent or diverting stomas as the first intervention (bridge to surgery) followed by later oncological resection. Design: This is a prospective observational study with data collected through the Swedish Colorectal Cancer Registry with an additional electronic case report form. Settings: Swedish multicenter study at both university and regional hospitals. Patients and Methods: Patients with suspected acute malignant large bowel obstruction due to colonic adenocarcinoma will be identified and followed. Analysis will be performed on an intention-to-treat basis. Descriptive statistics of the study cohort will be presented. Primary endpoints will be subjected to multivariate analyses adjusted for confounders. Main Outcome Measures: 30-day severe morbidity (Clavien–Dindo &gt; 3a), 30- and 90-day mortality rates, and overall survival after three and five years. Sample Size: We aim to include 1000 patients, with an interim analysis after the recruitment of 500 patients. Results: The study is ongoing. Conclusions: Acute colon obstruction is associated with substantial morbidity and mortality. We hypothesize that patients with malignant obstruction benefit from avoidance of emergency cancer resection and that bridge to surgery leads to decreased short-term morbidity and mortality and improved long-term oncological outcomes. Limitations: The main limitation is the risk of selection bias when the study is not a randomized controlled trial, which would be a standard process. A prospective observational study is, nevertheless, considered a pragmatic compromise between feasibility and ability to answer the research question. Conflicts of Interest: None.

Partial Versus Total Mesorectal Excision for the Surgical Treatment of Mid-Rectal Cancer: An Assessment from the Turkish Society of Colon and Rectal Surgery’s Colorectal Cancer Database

Partial Versus Total Mesorectal Excision for the Surgical Treatment of Mid-Rectal Cancer: An Assessment from the Turkish Society of Colon and Rectal Surgery’s Colorectal Cancer Database