Aim This study aims to evaluate the feasibility and effectiveness of a modified multi-modal prehabilitation program for Chinese patients with colorectal cancer during their preoperative hospital stay. The impact on perioperative physiological function, postoperative recovery, and overall outcomes was assessed. Design A prospective, randomized controlled trial. Methods A prospective, randomized controlled trial was conducted with 200 patients (100 experimental, 100 control) at a tertiary hospital in Shanghai. The experimental group received a modified multi-modal prehabilitation program, including inspiratory muscle training, aerobic exercise, nutritional supplementation, and psychological support, while the control group received standard perioperative care. Primary outcomes were assessed using the 6-Minute Walk Test (6MWT) on the day before surgery and 30 days postoperatively. Secondary outcomes included postoperative hospital stay duration, time to first flatus, ambulation, oral intake, and incidence of postoperative complications. Results The experimental group showed significantly greater improvements in 6MWT performance compared to the control group both before surgery (400.40 m vs. 383.25 m, P < 0.01) and 30 days postoperatively (375.40 m vs. 336.85 m, P = 0.03). Additionally, the experimental group had a shorter postoperative hospital stay (7.91 days vs. 9.06 days, P < 0.01) and earlier recovery milestones ( P ≤ 0.01) compared to the control group. The incidence of postoperative complications was slightly lower in the experimental group, though not statistically significant. Clinical Trial Registration https://www.chictr.org.cn/ , Identifier ChiCTR2200055764.

Abstract Introduction Involvement of Geriatricians in peri-operative assessment acknowledges the altered physiology of frail patients and helps to evaluate realistic outcomes as part of patient-centred shared decision making. This is with the aim of addressing modifiable risk factors, preventing complications, preparing for a realistic recovery and ensuring that treatment options are aligned to what is important to the patient. There is data suggesting improved survival following geriatric peri-operative assessment but little analysis from the patient’s perspective; their thoughts about the shared decision-making process, regrets about having surgery and the impact it has had on their quality of life. This study aims to identify success of our peri-operative clinic based on patient-centred parameters. Methods We identified 69 patients seen in our joint Anaesthestic and Geriatrician peri-operative assessment clinic before elective colorectal surgery. These patients were over the age of 65, had multiple co-morbidities and had their surgery between 2022–2024. Participants answered a standardised ‘Shared Decision-Making Questionnaire’ (SDM-Q-9) and ‘Decision Regret Scale’ over the phone. Results 45 patients were able to answer our questionnaires. 9 patients had died, 14 did not answer or declined and 1 was incorrectly identified. Ages ranged from 69 to 91, with the majority undergoing laparoscopic hemicolectomies. 100% of respondents felt the team helped them understand information regarding the operation, and 93% felt they made the decision jointly with the doctor. Though 6% felt that the operation did them harm, 100% agreed that it was the right decision and would go for the same choice if they chose again. Conclusion Our study suggests that patients are very satisfied after having undergone surgery and had realistic expectations and goals from combined pre-operative assessment. The shared decision-making analysis is positive and demonstrates the importance of stressing ‘not having surgery’ as an option to patients. The subjective and retrospective nature of the study may limit results.

Minimally invasive colorectal surgery (MIS) offers reduced pain, faster bowel recovery, and shorter hospitalization compared with open surgery. In patients requiring a stoma, the stoma site can be used for specimen extraction, reducing the number of incisions. However, stoma-related complications, particularly parastomal hernia, may be increased. We synthesized evidence comparing stoma-site specimen extraction (SSE) with alternative extraction sites in MIS. A systematic review and meta-analyses were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and gray literature were performed (1990-2025). Eligible studies included adults undergoing elective laparoscopic or robotic colorectal surgery with SSE compared against midline or other extraction sites. Outcomes included stoma-related and nonstoma complications, perioperative parameters, and oncologic safety. Random-effect models were applied. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. The study was prospectively registered with PROSPERO (CRD420251137576). Eighteen studies comprising 5699 patients (SSE: 1363; midline: 539; other incisions: 3797) were included. Overall, stoma-related complication rates were comparable between groups (SSE versus midline: OR: 1.04, 95% confidence interval [CI]: 0.37-2.89; SSE versus others: OR: 1.13, 95% CI: 0.75-1.68). The risk of parastomal hernia did not differ significantly between SSE and comparators (SSE versus midline: OR: 2.67, 95% CI: 0.53-13.54; SSE versus others: OR: 1.36, 95% CI: 0.69-2.67). Non-stoma-related complications (OR: 0.96, 95% CI: 0.66-1.38) and readmission rates were also similar. Perioperative outcomes favored SSE, with shorter operative time (mean difference -22.6 minutes versus others) and earlier return of flatus. SSE is a safe and effective technique in MIS, offering perioperative benefits without increasing overall complication rates. Although parastomal hernia incidence was not significantly higher, vigilance is required, particularly in patients with permanent stomas. With appropriate case selection and meticulous closure, SSE represents a technique of MIS that reduces abdominal wall trauma while maintaining surgical safety.

Incisional hernia (IH) is a common complication of abdominal surgery, and the optimal suture technique for midline fascial closure remains controversial. This study compared continuous barbed sutures with interrupted non-barbed sutures in patients who underwent minimally invasive colorectal cancer surgery. We retrospectively evaluated 299 patients who underwent laparoscopic or robotic radical colorectal resection between 2020 and 2023. Of these, 228 who underwent a small midline umbilical incision were included. Fascial closure was performed using either continuous barbed absorbable sutures (n = 60) or interrupted non-barbed absorbable sutures (n = 162). Propensity score matching (PSM) was performed at a 1:1 ratio, yielding 51 matched pairs for comparison. Primary outcome was IH incidence as confirmed by computed tomography or physical examination. Secondary outcomes focused on infectious complications as well as postoperative morbidity, mortality, and hospital stay. After PSM, the incidence of IH was significantly lower in the continuous barbed group than that in the interrupted non-barbed group (7.8% vs. 33.3%, P = 0.001). In non-obese patients (Body mass index < 25), barbed closure reduced the IH incidence (2.7% vs. 23.5%, P = 0.006). In obese patients, the difference was not statistically significant (21.4% vs. 52.9%, P = 0.07), likely reflecting limited power. Although ileus was more frequent in the interrupted non-barbed group (7.8% vs. 0%, P = 0.02), infectious complications were comparable between groups. Multivariable analysis identified interrupted non-barbed sutures and obesity as independent risk factors for IH. Continuous barbed fascial closure was associated with a significantly lower IH incidence after minimally invasive colorectal cancer surgery without increasing infectious complications. These findings support the effectiveness of a barbed-continuous closure strategy for midline extraction incisions.

This study aimed to delineate the existing knowledge regarding the impact of colorectal cancer surgery on the sexuality of LGB patients, highlighting the need for culturally competent care tailored to their unique needs. A comprehensive search was conducted from October 2024 onwards across PubMed, Embase, CINAHL, Google Scholar, Web of Science, Scopus, PsychINFO, Cochrane Library, and Joanna Briggs Institute using the MeSH terms 'sexual and gender minorities', 'colorectal surgery', 'colorectal neoplasms' and 'sexuality'. Inclusion criteria required LGB patients over 18 years, at least 50% of the sample diagnosed with colorectal cancer and treated operatively. All studies were critically appraised. Six studies from the UK and the US were included. Sample size ranged from 1 to 480. Participants identifying as LGB ranged from 26.4 to 100%. Key findings revealed LGB patients experience similar physical consequences to heterosexual patients (erectile and ejaculatory dysfunction, dyspareunia, vaginal dryness), but implications might differ, e.g., regarding anal intercourse. A lower mental quality of life was reported, including body image issues related to stomas. Relationship challenges and intimacy issues were highlighted. The cultural competence of healthcare providers has a significant influence on patient experiences, highlighting a gap in inclusive care. Critical appraisal revealed both methodological strengths and weaknesses. This review highlighted the sexual health challenges of LGB patients after colorectal cancer surgery, with issues like sexual function and mental wellbeing often being underreported. Cultural competence training for healthcare providers and integrating patients' partners into cancer care are crucial for a holistic approach.

IntroductionIndocyanine green (ICG) near-infrared visualization (NIR) is used in colorectal surgery to evaluate anastomotic limb perfusion and aid sentinel lymph node harvest in oncologic surgeries. Proponents of ICG-NIR claim improved anastomotic and oncologic outcomes, but no large-scale studies are reported. This study aims to evaluate the effect of ICG-NIR on anastomotic and oncologic outcomes after colorectal surgeries on a nationwide scale.MethodsRetrospective cohort analysis of the 2016-2020 ACS-NSQIP colorectal-specific database. Adults who underwent elective minimally invasive colorectal surgeries (low anterior resection (LAR), partial colectomy (PC), or right colectomy (RC)) were stratified into 2 groups based on intraoperative ICG-NIR use. Outcomes measured were operative duration, anastomotic leak, unplanned conversion to open, return to the operating room, perioperative bleeding requiring blood transfusions, survivor-only length of stay (LOS), mortality, and unplanned readmissions. Sub-analysis of lymph node harvest and margin-positive status was performed among patients with colorectal cancer.Results95179 patients were identified (ICG-NIR: 1101 (1.2%); No ICG-NIR: 94078 (98.8%). There were no differences in 30-day outcomes between groups except for longer OR duration among ICG-NIR group. ICG-NIR was not independently associated with reduced adjusted odds of anastomotic leak (aOR 0.790 (95% CI 0.520-1.201), P = 0.270). There were no differences between subgroups in terms of lymph node harvest or resection margin positive status.ConclusionThis is a large nationwide study showing leak rates and oncologic outcomes do not improve with ICG-NIR. The utility of ICG-NIR over preoperative bowel preparation, surgical technique, and gross visualization may be overstated warranting further study.

Understanding patient and surgeon attitudes towards informed consent for sensitive intraoperative exams in colorectal surgery.

What is the impact of nutrition interventions on incidence of anastomotic leak after colorectal surgery? A systematic review of randomized trials.

BackgroundSmoking is an established risk factor for postoperative complications. There is limited data on characteristics of smokers that increase risk beyond pack-years. This study aims to assess the effect of preoperative smoking duration and intensity, periods of cessation, and concurrent smokeless product use on colorectal surgery outcomes.MethodsA retrospective cohort study was conducted to assess operative details, demographic and smoking factors, and postoperative complications in smokers. The cohort included 239 current and former smokers who underwent colorectal surgery from 2012 to 2022. The primary endpoint was major adverse events 30-days postoperatively, defined as incidence of major bleeding, venous-thromboembolism, acute kidney injury, myocardial infarction, acute respiratory distress syndrome, stroke, infection, mortality, or readmission.ResultsThe most common procedure was colon resection. Average age at procedure was 63.9 ± 0.85years, smoking duration was 27.0 ± 1.0years, packs-per-day was 0.94 ± 0.04 packs, and pack-years was 26.0 ± 1.7. It was found that 11% of the patients concurrently used smokeless products (chew, dip, and/or vape). Half of the patients quit smoking prior to surgery. During the follow-up period, 28% had any major adverse event. Independent predictors of increased complications were chronic obstructive pulmonary disease (P = .01), pack-years (P = .02), and concurrent vape use (P = .01). Years of smoking (P = .01) was an independent predictor of complications, whereas packs-per-day (P = .33) was not. Former smokers (P = .03) had fewer complications than current smokers.DiscussionColorectal surgery patients with significant duration of smoking and/or concurrent vape use should be counseled regarding their increased risk of major postoperative complications.

Comparing the Comprehensive Complication Index and Clavien-Dindo classification for evaluating postoperative complication severity in major abdominal surgery.

Compliance with training protocol is essential to achieve physiologic improvements associated with exercise. This study aimed to assess the compliance and response to a 4-week high-intensity interval training (HIIT)-based protocol as part of a multimodal prehabilitation program for patients with colorectal cancer awaiting surgery and to explore potential associated factors. The study analyzed 136 patients allocated to a prehabilitation exercise training program in a multicenter prehabilitation program. Compliance with training was defined based on intensity and time in HIIT during each session. Response to training was considered if patients increased peak oxygen uptake (VO2peak) ≥10 % or >2.5ml/kg/min after training. Data compliance was available for 104 patients. Non-compliant participants (n = 37, 35.6 %) had lower cardiorespiratory fitness (CRF) at baseline (mean difference, -2.74 ml/kg/min; p < 0.01) and tended to be older (p = 0.053). Approximately one of four patients exhibited a clinically meaningful response to exercise. Younger patients and those with lower CRF at baseline had greater odds of responding to training (Epx[B], 0.739; 95 % confidence interval {CI}, 0.58-0.93]) and Exp(B), 476 [95 % CI, 0.266-0.85 respectively). Furthermore, patients who increased VO2peak at least 2.5Mml/kg/min had no severe complications (Comprehensive Complication Index [CCI], ≤20) and experienced better postoperative recovery than the non-responding patients (p = 0.043 and p < 0.001 respectively). Compliance with a HIIT protocol among colorectal cancer patients was found to be affected by baseline CRF and age. Only one of four patients showed a clinically significant improvement in VO2peak after training, which was associated with less severe postoperative complications.

Minority race and ethnicity are underreported in colorectal surgery research: A 14-year systematic review.

Comparison of the Effects of Glycopyrrolate and Atropine on Postoperative Delirium in Older Adult Patients Undergoing Laparoscopic Colorectal Surgery: A Randomized Controlled Trial

BackgroundIncisional hernia remains a common complication following abdominal surgery with significant implications for patient quality of life and healthcare costs. This systematic review and meta-analysis aim to evaluate the relationship between various abdominal incision types and the development of hernias, while identifying key risk factors.MethodsA comprehensive literature search was conducted across multiple databases for studies published between January 2000 and January 2025. Studies reporting incisional hernia rates following abdominal surgery with clearly documented incision types and a minimum follow-up of 6 months were included. Data extraction included study characteristics, patient demographics, incision types, hernia rates, and associated risk factors. Random-effects meta-analysis was performed to calculate pooled hernia rates and odds ratios.ResultsForty studies comprising 183496 patients were included. Midline incisions were associated with the highest hernia rates (12.8-35%, pooled rate 18.7%) compared to transverse incisions (4.8-10.2%, pooled rate 7.4%; OR 0.38, 95% CI 0.26-0.57). In colorectal surgery specifically, midline incisions carried an odds ratio of 11.7 (95% CI 3.3-42.0) for hernia formation compared to transverse approaches. Paramedian, oblique, and Pfannenstiel incisions demonstrated lower hernia rates (2.1-8.6%). Significant patient-related risk factors included obesity (OR 4.74, 95% CI 1.42-15.55), male gender (HR 2.2), COPD (HR 2.35, 95% CI 1.16-4.75), and wound infection (HR 3.66). Most hernias (54-80%) developed within the first year after surgery, though continued development was observed for up to 10 years.ConclusionsTransverse, paramedian, and Pfannenstiel incisions offer significant advantages over midline approaches for reducing incisional hernia risk. Patient-specific factors, particularly obesity and pulmonary comorbidities, substantially influence hernia development. A tailored approach to incision selection based on patient risk profile, coupled with meticulous technique and wound management, is recommended to minimize hernia occurrence.

BackgroundEnhanced recovery after surgery (ERAS) guidelines recommend early postoperative mobilization to reduce complications, but adherence is often suboptimal, highlighting the need for effective tools to monitor and encourage movement. The Mindray enhanced patient monitoring (ePM)/electrophysiology (ep) pod, capable of tracking activity, vital signs, sleep, and pain, offers high-precision postoperative monitoring and is well-suited for research on activity feedback.ObjectiveThe study aims to assess whether wearable device-based (ePM/ep pod) activity feedback could reduce postoperative complications within 30 days of colorectal cancer (CRC) surgery.MethodsWe conducted an open-label, evaluator-blind, randomized controlled trial involving patients aged ≥18 years scheduled for CRC surgery. Patients were randomized to a feedback group or a control group. Both groups were set the same target activity time postoperatively based on ERAS guidelines. The feedback group received real-time visual feedback of movement time daily through the ePM/ep pod device, while the control group did not receive feedback. The primary outcome was the comprehensive complication index (CCI) within postoperative 30 days. Secondary outcomes included daily activity time, pain Numeric Rating Scale scores for rest and movement during the first 3 postoperative days, length of stay, percentage of reaching the scheduled mobilization target, 30-day postoperative mortality rate, and the times of first exhaust and defecation.ResultsTwo hundred thirty-nine patients were recruited between February 2023 and September 2023, with 216 randomized (n=108 for each group). There was no significant difference in CCI within 30 postoperative days between the control group (median CCI 0, range 0‐20.90) and the activity feedback group (median CCI 0, range 0‐12.20). The estimated mean difference was −0.59 (95% CI −3.56 to 2.38; P=.66). Sensitivity analysis excluding patients with low device compliance did not alter these findings. No significant differences between groups were found in daily activity time, length of hospital stay, or pain scores. Post hoc analysis revealed significant negative correlations between 30-day CCI and activity on the second day after operation (r=−0.166) and the third day after operation (POD3) (r=−0.264; P<.05 for both). Linear regression indicated that POD3 activity significantly reduced CCI (β=−.025; 95% CI −0.045 to −0.006; P=.01), with peak CCI reduction at 215 minutes of activity.ConclusionsIn the context of ERAS, this study found no evidence that activity stimulation based on feedback from the wearable device (ePM/ep pod) could reduce 30-day postoperative CCI in patients undergoing CRC surgery. However, the ePM/ep pod could accurately record daily activity duration, which may be negatively correlated with CCI on POD3.

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.

Background/Objectives: Postoperative cognitive dysfunction (POCD) represents a significant and potentially preventable complication in elderly patients undergoing colorectal cancer surgery, with reported incidence ranging from 2.8% to 62.2% depending on perioperative management strategies and assessment methods. This narrative review synthesizes current evidence on the epidemiology, pathophysiology, risk factors, and prevention strategies for POCD in this vulnerable population. Methods: A comprehensive narrative review was conducted to examine the current literature on POCD in elderly colorectal cancer patients. Evidence was synthesized from published studies addressing epidemiology, assessment tools, risk factors, pathophysiological mechanisms, and prevention strategies, with a particular focus on Enhanced Recovery After Surgery (ERAS) protocols and multicomponent interventions. Results: Advanced age, pre-existing cognitive impairment, frailty, and surgical complexity emerge as key risk factors for POCD. ERAS protocols demonstrate substantial protective effects, reducing POCD incidence from 35% under conventional care to as low as 2.8% in optimized pathways. The pathophysiology involves multifactorial mechanisms, including neuroinflammation, blood–brain barrier disruption, neurotransmitter dysregulation, and oxidative stress, with surgical trauma triggering systemic inflammatory cascades that activate microglial responses within the central nervous system. Evidence-based prevention strategies include preoperative cognitive and frailty screening, minimally invasive surgical techniques, multimodal opioid-sparing analgesia, regional anesthesia, depth-of-anesthesia monitoring, and structured postoperative care bundles adapted from the Hospital Elder Life Program. Conclusions: The integration of comprehensive perioperative cognitive care protocols represents a critical priority as surgical volumes in elderly populations continue to expand globally. Emerging directions include biomarker development for early detection and risk stratification, precision medicine approaches targeting individual vulnerability profiles, and novel therapeutic interventions addressing neuroinflammatory pathways. Standardized assessment tools, multidisciplinary collaboration, and implementation of evidence-based preventive interventions offer substantial promise for preserving cognitive function and improving long-term quality of life in elderly colorectal cancer patients.

The global landscape of robotic-assisted surgery is undergoing rapid transformation as new platforms emerge to challenge the long-standing dominance of the da Vinci (DV) system. Although DV remains the most widely adopted robotic platform worldwide, its high acquisition and maintenance costs have limited diffusion, particularly in resource-constrained regions. Next-generation systems-including Hugo RAS, Versius, Senhance, Hinotori, KangDuo, Sentire, and Micro Hand S-aim to expand access through reduced capital expenditure, reusable instrumentation, alternative cost structures, and modular architectures. This narrative review synthesizes available studies comparing the economic performance of these new technologies - including da Vinci Single-Port - with the DV multiport. A systematic search across PubMed, Scopus, and Cochrane Library identified 14 comparative cost studies through October 2025. Radical prostatectomy was the most frequently evaluated procedure, with additional analyses focused on colorectal surgery, hysterectomy, sacrocolpopexy, total mesorectal excision, and pyeloplasty. Overall, emerging platforms demonstrate heterogeneous but promising economic profiles. Hugo RAS and KangDuo showed lower overall procedural expenses in some series, although early inefficiencies may increase initial non-surgical operative time until team proficiency improved. The da Vinci Single Port platform demonstrated possible cost increases relative to the multiport system, largely influenced by institutional discharge pathways and disposable pricing. Economic outcomes varied markedly across institutions, driven by local procurement policies, instrument pricing, operative workflows, and reimbursement models. Current evidence suggests that new robotic platforms can reduce specific cost components without compromising clinical outcomes, yet generalizability remains limited. Standardized, prospective cost evaluations incorporating acquisition models, non-surgical time, learning curves, and long-term outcomes are essential to determine true value across healthcare settings.

Excess weight increases morbidity risk after colorectal cancer surgery. Weight loss might reduce this risk. However, the period between diagnosis and treatment in colorectal cancer is typically less than 1 month, necessitating an intensive weight loss intervention. We tested the feasibility of an intensive preoperative weight loss intervention.

Standardized Letter of Recommendation was introduced to capture more meaningful fellowship applicant evaluations. There are concerns that this letter may introduce subjectivity to assessments traditionally measured by objective metrics, such as board scores and publications. To evaluate the influence of individual application elements on ranking by referee. Collected data included applicant demographics and objective assessments of academic performance, including in-service exam percentiles, Step 1 and Step 2 scores, and publication count. Summary statistics and odds ratios from repeated measures logistic regression models using the method of generalized estimating equations are reported. Standardized letters submitted to a single institution during the 2019 application cycle were analyzed. To determine if objective applicant parameters are associated with being subjectively ranked #1 by the referee. Among 302 standardized LOR forms, 51.3% of the applicants were ranked #1 by the referee. Applicants ranked #1 had higher junior and senior in-training exam percentiles (60.3 vs 50.9, p = 0.0002 and 59.5 vs 48.0, p < 0.0001, respectively), Step 1 scores (235 vs 231, p = 0.0287) and average number of publications (5.9 vs 3.5, p = 0.0011). For each unit rise of in-training percentile and publication number, the odd ratio for being ranked #1 improved by 1.03 (p = 0.002) and 1.08 (p = 0.013), respectively. Ranks lower than #1 did not demonstrate the expected decline in objective performance metrics with decreasing rank except Step 1 percentile (p ≤ 0.001). Technical ability was the strongest predictor of a #1 ranking. Analyses limited to elements included in standardized letters. Standardized letters retain the relationship between objective performance metrics and subjective ratings for applicants ranked #1 by referee. However, this relationship is lost when applicants are ranked lower than first place. Our findings provide valuable insights and inform best practices for employing standardized letters of recommendation in the context of fellowship selection. See Video Abstract.