Oncological Colorectal Surgery Research Articles

3D-reconstruction printed models and virtual reality improve teaching in oncological colorectal surgery.

This study aimed to evaluate the use of 3D image processing and reconstruction (3D-IPR) combined with virtual reality (VR) technology and printed models (PM) as teaching tools in oncological colorectal surgery. We designed two courses, one for general surgery trainees and another for young colorectal surgeons, structured around stations of pre-test, anatomical lessons, real-case presentations, 3D-IPR models, VR experiences, and life-size abdominal PM with surgical approach explanations and a final post-test. Fourteen course participants were evaluated. Pre-test scores averaged 5.15, with a median of 5.5, while post-test scores increased to an average of 7.75, with a median score of 8. Course satisfaction surveys indicated high ratings for expectations, duration, relevance, presenter knowledge, teaching materials, communication, and overall course segments, with an average rating exceeding 4.8 out of 5. Results highlight the potential of 3D-IPR, VR, and PM as tools for improving teaching for surgery residents and colorectal surgeons. These technologies offer immersive, risk-free experiences for learners, potentially enhancing skill acquisition and anatomical understanding. This study demonstrates the effectiveness of 3D-IPR, VR, and PM courses in improving understanding of colorectal surgery. As these technologies continue to advance, they offer enhanced immersion and accessibility, transforming surgical education and medical training.

Improving recovery after bowel cancer surgery: mixed methods feasibility study of a co-produced information intervention (Recover Together).

Recovery after surgery for colorectal cancer is a complex process, involving numerous physiological, emotional, social and economic challenges. Good information is a key factor for enabling patients to recover well, but there is a paucity of evidence to guide how this should be done. A new information intervention (Recover Together) comprising a booklet, an online video and an inpatient goal board has been developed. This study explores its feasibility, as well as the feasibility of key study methods, during its first use in the United Kingdom National Health Service (NHS). This is a mixed methods, multi-centre, feasibility study of a complex intervention. A total of 105 participants undergoing oncological colorectal surgery will be recruited across three to four study sites in the UK. Participants will receive each component of the Recover Together intervention at defined timepoints before and during hospital admission. A series of patient-centred outcome instruments will be administered in hospital and during follow-up at 30 days and 6 months. Outcomes of feasibility will comprise the time taken to establish the intervention at participating sites, assessments of intervention fidelity and acceptability, as well as return rates of key clinical outcome instruments. The mixed methods design will comprise interviews and focus groups with patients and health professionals, non-participant observation in ward areas and clinics, user-specific video analytics and daily photographs of the goal boards. The findings of this study will provide a feasibility assessment of the Recover Together intervention when used for the first time in NHS practice. If shown to be feasible, this will guide the development of a future definitive study to explore the clinical and cost effectiveness of the Recover Together intervention to improve recovery after surgery. ISRCTN62430915.

Impact of Clostridium difficile Infection Versus Colonization on Postoperative Outcomes After Oncological Colorectal Surgery: An Observational Single-Center Study With Propensity Score Analysis.

There is limited research available concerning the risk anastomotic leakage in the context of Clostridium difficile infection (CDI). Herein, we aim to elucidate the correlation between CDI, encompassing both preoperative asymptomatic C. difficile carriers (CDC) and postoperative hospital acquired C. difficile infections (HA-CDI), and the occurrence of anastomotic leakage in patients undergoing oncological colorectal surgery. This is an observational, single-center study. Data were sourced from surgical logs between 2018 and 2023, via the hospital's electronic system. Patients were split into three subgroups: CDC, HA-CDI, and control group (CG). Groups were compared in terms of patient characteristics, morbidity, and mortality via Fisher's exact test and Kruskal-Wallis test. One-to-one propensity score matching was performed to reduce selection bias. A total of 522 patients were analyzed, split into three subgroups: CDC, n = 35; HA-CDI, n = 27; CG, n = 460. One-to-one propensity score matching reduced the CG to 62 patients. Patients in the HA-CDI group had higher rates of overall morbidity (p < 0.0001), higher rates of anastomotic leaks (p = 0.002), more surgical site infections (SSI) (p = 0.001), and a longer length of stay (26 vs. 11.2 vs. 9.3 days, p < 0.001), while patients in the CDC group had comparable rates of complications with the CG. HA-CDI is associated with a higher risk of anastomotic leak after oncological colorectal surgery, while asymptomatic CDC do not have higher morbidity and may be operated electively, under standard CD treatment.

Multimodal prehabilitation in elective oncological colorectal surgery enhances postoperative functional recovery: A secondary analysis of the PREHAB randomized clinical trial

IntroductionColorectal cancer (CRC) ranks as the second leading cause of cancer-related deaths. The PREHAB trial revealed that prehabilitation in colorectal surgery leads to a reduction of severe complications and enhanced functional capacity. Nevertheless, risk selection for prehabilitation and the potential benefits for patients without postoperative complications remains unclear. This study aims to assess postoperative functional capacity, also in patients without postoperative complications. Materials & methodsThis study was a secondary analysis of the PREHAB trial. Functional capacity tests, including cardiopulmonary exercise testing (CPET), steep ramp test (SRT), 6-min walking test (6MWT), stair climb test (SCT), 30” sit-to-stand test (STS), timed-up-and-go test (TUG), and muscle strength assessments, were conducted at baseline (T0) and 4 weeks postoperatively (T3). The primary outcome was the relative change in functional capacity from baseline to postoperative (ΔT0-T3) per group (i.e., prehabilitation vs control). Secondary, identical analysis were performed for patients without postoperative complications in each group. ResultsIntention-to-treat analysis included 251 patients. For postoperative functional capacity, prehabilitation patients showed improvements in VO2peak (p = 0.024), VO2AT (p = 0.017), SRT (p = 0.001), 6MWT (p = 0.049), SCT (p = 0.012), and STS (p = 0.001) compared to the control group. Regarding muscle strength, prehabilitation patients showed improvements in estimated 1RM lateral pull down (p = 0.016), 1RM chest press (p = 0.001), 1RM leg press (p = 0.001) and HGS (p = 0.005) compared to controls. Additionally, prehabilitation patients more often reached baseline levels at T3 in VO2AT (p = 0.037), SRT (p = 0.008), 6MWT (p = 0.013), STS (p = 0.012), estimated 1RM lateral pull down (p = 0.002), 1RM chest press (p = 0.001) and 1RM leg press (p = 0.001) compared to controls. Moreover, even patients without postoperative complications in the prehabilitation group showed better postoperative functional capacity and more often reached baseline levels at T3, compared to controls. ConclusionMultimodal prehabilitation in CRC surgery is associated with improved postoperative functional capacity, even in patients without postoperative complications.

The value of C-reactive protein, leucocytes and vital signs in detecting major complications after oncological colorectal surgery

PurposeTo assess the association of postoperative C-reactive protein (CRP), leucocytes and vital signs in the first three postoperative days (PODs) with major complications after oncological colorectal resections in a tertiary referral centre for colorectal cancer in The Netherlands.MethodsA retrospective cohort study, including 594 consecutive patients who underwent an oncological colorectal resection at Maastricht University Medical Centre between January 2016 and December 2020. Descriptive analyses of patient characteristics were performed. Logistic regression models were used to assess associations of leucocytes, CRP and Modified Early Warning Score (MEWS) at PODs 1–3 with major complications. Receiver operating characteristic curve analyses were used to establish cut-off values for CRP.ResultsA total of 364 (61.3%) patients have recovered without any postoperative complications, 134 (22.6%) patients have encountered minor complications and 96 (16.2%) developed major complications. CRP levels reached their peak on POD 2, with a mean value of 155 mg/L. This peak was significantly higher in patients with more advanced stages of disease and patients undergoing open procedures, regardless of complications. A cut-off value of 170 mg/L was established for CRP on POD 2 and 152 mg/L on POD 3. Leucocytes and MEWS also demonstrated a peak on POD 2 for patients with major complications.ConclusionsStatistically significant associations were found for CRP, Δ CRP, Δ leucocytes and MEWS with major complications on POD 2. Patients with CRP levels ≥ 170 mg/L on POD 2 should be carefully evaluated, as this may indicate an increased risk of developing major complications.

Multimodal prehabilitation in elective oncological colorectal surgery enhances preoperative physical fitness: a single center prospective real-world data analysis.

Surgery can lead to curation in colorectal cancer (CRC) but is associated with significant morbidity. Prehabilitation plays an important role in increasing preoperative physical fitness to reduce morbidity risk; however, data from real-world practice is scarce. This study aimed to evaluate the change in preoperative physical fitness and to evaluate which patients benefit most from prehabilitation. In this single-arm prospective cohort study, consecutive patients undergoing elective colorectal oncological surgery were offered a 3- to 4-week multimodal prehabilitation program (supervised physical exercise training, dietary consultation, protein and vitamin supplementation, smoking cessation, and psychological support). The primary outcome was the change in preoperative aerobic fitness (steep ramp test (SRT)). Secondary outcomes were the change in functional walking capacity (6-minute walk test (6MWT)), and muscle strength (one-repetition maximum (1RM) for various muscle groups). To evaluate who benefit most from prehabilitation, participants were divided in quartiles (Q1, Q2, Q3, and Q4) based on baseline performance. In total, 101 patients participated (51.4% male, aged 69.7 ± 12.7 years). The preoperative change in SRT was +28.3 W, +0.36 W/kg, +16.7% (P<0.001). Patients in all quartiles improved at the group level; however, the relative improvement decreased from Q1-Q2, Q2-Q3, and Q3-Q4 (P=0.049). Change in 6MWT was +37.5 m, +7.7% (P<0.001) and 1RM improved with 5.6-33.2 kg, 16.1-32.5% for the various muscle groups (P<0.001). Prehabilitation in elective oncological colorectal surgery is associated with enhanced preoperative physical fitness regardless of baseline performance. Improvements were relatively larger in less fit patients.

Developing and validation of a smartphone app for post-discharge early follow-up after colorectal cancer surgeries.

Colorectal surgeries are complex procedures associated with high rates of complications and hospital readmission. This study aimed to develop an electronic post-discharge follow-up plan to remotely monitor patients' symptoms in the postoperative period of colorectal surgeries and evaluate the outcomes of emergency department visits and the rate of severe complications within 15 days after hospital discharge. We developed a digital tool capable of remotely assessing symptoms that could indicate complications related to colorectal surgical procedures and directing early management. This project was divided into two stages. The first was platform development with an algorithm for identifying symptoms and directing conduct, and the second was clinical validation of the program and evaluation of patient's experience. Patients who underwent elective oncological colorectal surgery were invited to participate in this study. We used commercial software (CleverCare) that was adjusted according to the clinical algorithm developed in this study, predicting complications and directing conduct with minimal human intervention using a Chatbot with Natural Language Processing (NPL) and artificial intelligence. We planned three Interim Analyses to evaluate the outcomes of complications, referrals to the Emergency Department (ED), ED visits, adherence, and patient satisfaction. After each analysis, specialists validated the changes before implementation. A total of 92 eligible participants agreed to participate in the study. The ability to detect complications increased with each adjustment phase, and after the third and last phase, the digital solution identified 3(4.8%) real complications, with a sensitivity of 75%, specificity of 83%, accuracy of 82%, positive predictive value of 27%, and negative predictive value of 97%. Complete adherence to the monitoring program was 83.7% with an NPS score of 94 in the last evaluation phase. The digital platform is safe with high adherence rates and good patient acceptance.

ERAS Protocol Applied to Oncological Colorectal Mini-invasive Surgery Reduces the Surgical Stress Response and Improves Long-term Cancer-specific Survival.

Enhanced recovery after surgery (ERAS) protocols are known to reduce postoperative complications and improve short-term outcomes by minimizing the surgical stress response (SSR). Retrospective reviews of large cohorts suggest that they may also have an impact on long-term oncological outcomes. In 2016, Mari et al published a randomized trial on ERAS protocol and the impact on the SSR; they found that IL-6 was less expressed in patients who undergo laparoscopic colorectal surgery within an ERAS protocol compared with controls. The aim of the present study is to report the long-term oncological outcomes of patients enrolled 5 years after the conclusion of the study. Patients enrolled had received the indication for major colorectal surgery, aged between 18 and 80 years, with American Society of Anesthesiologists (ASA) grades I to III, autonomous for mobilization and walking, eligible for laparoscopic technique. In total, 140 patients were enrolled and randomized into 2 groups of 70 patients each. Among these patients, 52 in the ERAS group (EG) and 53 in the Standard group (SG) had colorectal cancer. For them, a 5-year oncological follow-up according to the NCCN16 guidelines was planned. IL-6, C-reactive protein, prolactine, white blood cell count, albumin, and prealbumin were compared between oncological patients in the EG and in the SG. EG showed lower IL-6 on postoperative day 1 (21.2±9.1 vs. 40.3 ±11.3; P<0.05) and on day 5 (14.9±6.2 vs. 38.7±8.9; P<0.05), lower C-reactive protein on day 1 (48.3±15.7 vs. 89.4±20.3; P<0.05) and on day 5 (38.3±11.4 vs. 74.3±19.7; P<0.05), and lower pre-albumine on day 5 (18.9±7.2 vs. 12.3±6.9; P<0.05) compared with SG. Median oncological follow-up was 57 months [46.5 to 60]. There was no statistically significant difference in overall survival (log rank=0.195) and disease-free survival (Log rank=0.089) between groups. Cancer-specific survival was significantly better (log rank=0.038) in the EG compared with patients in the SG. ERAS protocol applied to colorectal laparoscopic surgery for cancer is able to minimize the SSR. As a possible result, cancer-specific survival seems to be improved in patients within enhanced protocols. However, even though there may be an association between an excess of SSR and worse oncological outcomes, the favorable effect of ERAS protocols toward better overall and disease-free survival is yet to be demonstrated.

Improving the Outcomes in Oncological Colorectal Surgery

Aim: To evaluate the improvement in the outcomes in oncological colorectal surgery. Study Design: Prospective study, Place &amp; duration of study: Department of General Surgery, LUMHS Jamshoro from 1st January 2020 to 31st December 2022. Methodology: One hundred and fifty cases of colorectal cancer undergoing surgery were enrolled. They were multidisciplinary requiring compliance of surgeons at the operating room with their surgical teams. These interventions were based on sequential implementation of the evidence-based surgical site infection bundle (SSIB) and enhanced recovery after surgery (ERAS) protocols for all the patients undergoing colorectal surgery. Primary outcomes evaluated were duration of hospital stay as well as rate of complication in accordance with wound healing. Inverse proportional-weighting method was used for controlling possible variance within groups. The secondary outcome measures post improvement strategies were mortality within day 30, readmission within same period (30 days) or unplanned return to the operating table as well as numerous related complications. Results: The mean age of the cases in group A (pre-ERAS or pre-SSIB) was 61.2±10.9 years while in group B (pre-ERAS or post-SSIB) was 61.8±9.9 years and the mean age of Group C (post-ERAS or post-SSIB) was 63.7±10.1 years. There were more females within three groups such as 60%, 56% and 54% respectively than males. Hospital stay was highest within group A. The 30 days outcomes showed that the outcomes in group A showed highest number of death, wound infection and blood transfusion however the difference was insignificant for all other variable except wound infection. Conclusion: The subsequent addition of quality improvement within groups added positive outcomes in patients of oncological colorectal surgery with reduction in mortality, hospital stay as well as wound infection. Key words: Outcome, Colorectal carcinoma, Mortality, Hospital stay, Wound infection

Prehabilitation in elective oncological colorectal surgery enhances preoperative physical fitness: a single center prospective real-world data analysis

Prehabilitation in elective oncological colorectal surgery enhances preoperative physical fitness: a single center prospective real-world data analysis

Augmented Reality Technology Applied to Surgical Planning in Oncological Colorectal Surgery

This paper describes the application of augmented reality technology from three-dimensional colon models as a method of preoperative planning in oncological colorectal surgery. We have developed holograms of augmented reality from threedimensional anatomical models of the colon, obtained from computed tomography images (Siemens Somatom Perspective 64) with abdominal image cuts 3 mm thick. The recovery of the images was in DICOM format. The processing to achieve the threedimensional reconstruction was performed with the program OsiriX, which made a complete segmentation of the colon surface and modified the image density. 3D models were obtained of the isolated colon and in relationship with the bony structures. The smartphone Colon 3D AR application was designed (increased hyper experience- visualizer with SLAM technology) to apply augmented reality technology. An individualized hologram of augmented reality (scale 1:1) was created from each three-dimensional model. A projection with the smartphone on the patient's abdomen was made by modifying the position in the height of the reconstruction, using the pelvic bones as an anatomic reference point to calibrate the hologram's orientation. Three-dimensional reconstruction of the tumor in the preoperative plan of oncological colorectal surgery, combined with hyperreality technology, allows developing augmented reality models to improve colon anatomy knowledge and plan the surgical technique. The application is easy to use and may have advantages in preoperative colon surgery planning.

Usefulness of the skeletal muscle index in postoperative ileus of colorectal cancer patients: a retrospective cohort study

BackgroundPostoperative complications of colorectal cancer mainly include infections (surgical site infection, remote infection, etc.), post-operative ileus (POI), and anastomosis leakage. POI reportedly prolongs the hospital stay and increases medical costs. Therefore, predicting POI is very important. There have been some reports on the relationships between sarcopenia and postoperative complications in colorectal cancer patients, but none have been limited to POI. We therefore conducted a retrospective clinical study with a logistic regression analysis to confirm the risk factors for ileus after colorectal cancer surgery.MethodsWe retrospectively analyzed 213 patients who underwent elective oncological colorectal surgery for colorectal cancer from November 2017 to July 2021. The skeletal muscle mass (SMM, kg) was estimated using a whole-body bioelectrical impedance analysis (BIA), and the skeletal muscle index (SMI) was calculated as the SMM/height2. We divided all patients into 2 groups based on a low SMI (male < 8.958 kg/m2, female < 8.443 kg/m2) or normal SMI. Preoperative and intraoperative factors as well as, postoperative outcomes were then compared between the two groups.ResultsThe median (range) age of the 213 included patients was 72.0 (33–91) years old. Complications were noted in 96 patients (45.1%), including 21 (9.9%) with POI. There were 68 (31.9%) low SMI patients. POI occurred significantly more frequently in low SMI patients (19.1%) than in normal SMI patients (5.5%) (p = 0.005). In the multivariate analysis, bleeding (p = 0.039) and a low SMI (p = 0.031) were significantly associated with POI. In addition, a propensity score matching analysis was performed to further reduce the selection bias. As a result, a low SMI was the only independent POI predictor among the 78 matched cases.ConclusionA preoperative low SMI in colorectal cancer patients was considered a risk factor for POI.

Robotic oncologic colorectal surgery with a new robotic platform (CMR Versius): hope or hype? A preliminary experience from a full-robotic case-series

BackgroundThe present case-series describes the first full-robotic colorectal resections performed with the new CMR Versius platform (Cambridge Medical Robotics Surgical, 1 Evolution Business Park, Cambridge, United Kingdom) by an experienced robotic surgeon.MethodsIn a period between July 2020 and December 2020, patients aged 18 years or older, who were diagnosed with colorectal cancer and were fit for minimally invasive surgery, underwent robotic colorectal resection with CMR Versius robotic platform at “Casa di Cura Cobellis” in Vallo della Lucania,Salerno, Italy. Three right colectomies, 2 sigmoid colectomies and 1 anterior rectal resection were performed. All the procedures were planned as fully robotic. Surgical data were retrospectively reviewed from a prospectively collected database.ResultsFour patients were male and 2 patients were female with a median (range) age of 66 (47–72) years. One covering ileostomy was created. Full robotic splenic flexure mobilization was performed. No additional laparoscopic gestures or procedures were performed in this series except for clipping and stapling which were performed by the assistant surgeon due to the absence of robotic dedicated instruments. Two ileocolic anastomoses, planned as robotic-sewn, were performed extracorporeally. One Clavien–Dindo II complication occurred due to a postoperative blood transfusion. Median total operative time was 160 (145–294) min for right colectomies, 246 (191–300) min for sigmoid colectomies and 250 min for the anterior rectal resection.ConclusionsThe present series confirms the feasibility of full-robotic colorectal resections while highlighting the strengths and the limitations of the CMR Versius platform in colorectal surgery. New devices will need more clinical development to be comparable to the current standard.

Efficacy of High-Resolution Preoperative 3D Reconstructions for Lesion Localization in Oncological Colorectal Surgery-First Pilot Study.

When planning an operation, surgeons usually rely on traditional 2D imaging. Moreover, colon neoplastic lesions are not always easy to locate macroscopically, even during surgery. A 3D virtual model may allow surgeons to localize lesions with more precision and to better visualize the anatomy. In this study, we primary analyzed and discussed the clinical impact of using such 3D models in colorectal surgery. This is a monocentric prospective observational pilot study that includes 14 consecutive patients who presented colorectal lesions with indication for surgical therapy. A staging computed tomography (CT)/magnetic resonance imaging (MRI) scan and a colonoscopy were performed on each patient. The information gained from them was provided to obtain a 3D rendering. The 2D images were shown to the surgeon performing the operation, while the 3D reconstructions were shown to a second surgeon. Both of them had to locate the lesion and describe which procedure they would have performed; we then compared their answers with one another and with the intraoperative and histopathological findings. The lesion localizations based on the 3D models were accurate in 100% of cases, in contrast to conventional 2D CT scans, which could not detect the lesion in two patients (in these cases, lesion localization was based on colonoscopy). The 3D model reconstruction allowed an excellent concordance correlation between the estimated and the actual location of the lesion, allowing the surgeon to correctly plan the procedure with excellent results. Larger clinical studies are certainly required.

Do or doughnut: A systematic review and pooled analysis on the utility of pathological evaluation of the anastomotic doughnut in oncological colorectal operations.

End-to-end anastomosis staplers are frequently used in colorectal surgery, generating two anastomotic doughnuts. Whether pathological evaluation of the doughnut changes clinical practice remains unclear. We aim to identify any effects of pathological evaluation of anastomotic doughnuts after oncological colorectal surgery. We performed a systematic literature search utilizing PubMed, Clinicaltrials.gov, Cochrane, Embase and Web of Science databases and selected studies on evaluation of the anastomotic doughnut after oncological colorectal surgery with stapled end-to-end anastomosis. Outcome measures included: involved distal margin on the oncological sample, histological involvement of the doughnut, clinical change in management from a positive doughnut and study recommendations. Of the 5761 studies identified, eight studies encompassing 1754 patients were evaluated. Most operations were for primary colon (37.5%) or rectal adenocarcinoma (37.5%). Incidence of distal margin involvement of the oncological sample was reported in three papers, with six positive cases (1.1%). Of the 1754 doughnut pairs evaluated, five were positive for neoplasia (0.29%), three for adenomas (0.18%) and one for metaplastic polyp (0.06%), none of which changed postoperative treatment. Four studies recommended abandoning routine histopathological evaluation of anastomotic doughnuts, while the remaining four recommended evaluation only under certain criteria, including gross distal margin <2cm (one study), gross distal margin <3cm (one study), tumours undetected on gross examination (one study), 'histologically aggressive cancers' or grossly involved distal margin (one study). Routine evaluation of anastomotic doughnuts should be reconsidered, as <1% are positive for neoplasia. Exceptions may include specific scenarios where histopathology is likely to be clinically useful.

Oncologic colorectal surgery in the time of the COVID-19 pandemic

Oncologic colorectal surgery in the time of the COVID-19 pandemic

Oncologic colorectal surgery in a general surgery unit of a small region of Italy—a successful “referral Centre Hub & Spoke Learning Program” very important to reduce mobility in the Covid-19 era

Oncologic colorectal surgery in a general surgery unit of a small region of Italy—a successful “referral Centre Hub & Spoke Learning Program” very important to reduce mobility in the Covid-19 era

In real-life, preoperative immunonutrition did not reduce postoperative morbidity in elective oncological colo-rectal surgery with an enhanced recovery protocol

In real-life, preoperative immunonutrition did not reduce postoperative morbidity in elective oncological colo-rectal surgery with an enhanced recovery protocol

Oncological colorectal surgery during the COVID-19pandemic\u2014a national survey

PurposeThe aim of this study was to clarify the surgical supply situation of oncological colorectal patients in Germany during limitations of the OR caseload due to the COVID-19 pandemic.MethodsBetween 11th and 19th April 2020, all members of a consortium of German colorectal cancer centers were invited to participate in a web-based survey on the current status of surgical care situation of colorectal cancer patients in Germany.ResultsA total of 112 colorectal surgeons of 101 German hospitals participated in the survey. Eighty-seven percent of the participating hospitals had to reduce their total surgical caseload and 34% their surgical volume for oncological colorectal patients during COVID-19 pandemic. Restrictions of the surgical caseload were independent of the size of the hospital and the number of cases of COVID-19 in the federal state of the hospital. Sixteen percent of colorectal surgeons consider surgical limitations to be not justified and 78% to be justified only if the care of oncological patients is ensured. Ninety-five percent of the colorectal surgeons interviewed stated that all oncological colorectal patients with an indication for surgery should be operated in time, despite the current reservations for COVID-19 patients. For the majority of the respondents (63% and 51%, respectively), an extended waiting time for surgery of up to 2 weeks was acceptable for non-metastatic and metastatic patients, respectively.ConclusionIn Germany, there is a temporarily relevant reduction of surgical volume in oncological colorectal patients. Most colorectal surgeons stated that oncological colorectal surgery should not be compromised despite the measures taken during the COVID-19 pandemic.

Exercise-induced myocardial dysfunction detected by cardiopulmonary exercise testing is associated with increased risk of mortality in major oncological colorectal surgery

BackgroundCardiopulmonary exercise testing (CPET) identifies high-risk patients before major surgery. In addition to using oxygen uptake and ventilatory efficiency to assess functional capacity, CPET can be used to identify underlying myocardial dysfunction through the assessment of the oxygen uptake to heart rate response (oxygen pulse response). We examined the relationship of oxygen pulse response, in combination with other CPET variables and known cardiac risk factors, with mortality after colorectal cancer surgery. MethodsThis work focused on a retrospective cohort study of patients who had CPET and underwent colorectal cancer surgery. The primary outcome was a composite of in-hospital and 30-day mortality. Ventilatory inefficiency (Ve/Vco2>34) and exercise-induced myocardial dysfunction (abnormal oxygen pulse response) were investigated for an association with mortality using bivariable analysis and multivariable Cox regression. ResultsA total of 1214 patients who underwent colorectal cancer surgery were included, and the primary outcome occurred in 26 patients (2.1%). Multivariable Cox regression showed abnormal oxygen pulse response was independently associated with the primary outcome (odds ratio [OR]=2.75; 95% confidence interval [CI], 1.17–6.47). Bivariable analysis showed that Ve/Vco2 >34 was associated with the primary outcome (OR=3.43; 95% CI, 1.47–8.01). Combining Ve/Vco2 >34 and abnormal oxygen pulse response conferred an increased risk for the primary outcome (OR=4.47; 95% CI, 1.62–12.34), compared with Ve/Vco2 >34 and normal oxygen pulse response. ConclusionVentilatory inefficiency and an abnormal oxygen pulse response were independently associated with short- (30-day) and long-term (2-yr) mortality. Oxygen pulse response may provide additional information when considering perioperative risk stratification.