ctDNA as a predictor of outcome after curative resection for locally advanced rectal cancer: systematic review and meta-analysis.

Aim: To assess the efficacy of ctDNA measurement at different time intervals in predicting response and prognosis in patients diagnosed with locally advanced rectal cancer (LARC) who underwent neoadjuvant treatment prior to curative resection.

Method: English language randomized controlled trials and observational studies, published from 1946 to January 2024, comparing outcomes between ctDNA-positive and ctDNA-negative patients with LARC undergoing neoadjuvant treatment prior to curative surgical resection were included in the search. The search included Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews (CDSR).

Postoperative Ileus after Minimally Invasive Colorectal Surgery: A Summary of Current Strategies for Prevention and Management.

Background: Postoperative ileus (POI) is one of the most common postoperative complications after colorectal surgery and prolongs hospital stays. Minimally invasive surgery (MIS) has reduced POI, but it remains common. This review explores the current methods for preventing and managing POI after MIS.

Lateral pelvic lymph node dissection in the management of locally advanced low rectal cancer: Summary of the current evidence.

Lateral pelvic lymph nodes (LPLN) are a major site for local recurrence following curative resection for low locally advanced rectal cancer. Ongoing advances in imaging techniques have improved predicting LPLN metastasis (LPLNM) during pre-operative staging. However, there is ongoing debate on optimal management of this subgroup of patients with variation between guidance of different societies.

Does adding lateral pelvic lymph node dissection to neoadjuvant chemotherapy improve outcomes in low rectal cancer?

Purpose: Lateral pelvic lymph node metastasis occurs in 15 to 20% of patients with locally advanced low rectal cancer which increases risk of local recurrence and reduced survival following neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME). Adding lateral pelvic lymph node dissection (LPLND) could improve outcomes in those patients. This review aims to determine if the addition of LPLND to the conventional management of advanced rectal cancer would yield improved outcomes.

Treatment of Uncomplicated Acute Diverticulitis Without Antibiotics: A Systematic Review and Meta-analysis.

Background: Despite low-quality and conflicting evidence, the Association of Coloproctology of Great Britain and Ireland recommends the routine use of antibiotics in the treatment of uncomplicated acute diverticulitis. Recent studies have shown that treatment without antibiotics did not prolong recovery. Some new guidelines currently recommend selective use of antibiotics.

Impact of elevated glycosylated hemoglobin on hospital outcome and 1 year survival of primary isolated coronary artery bypass grafting patients.

Objective: It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting.

Methods: From December 2013 to November 2015, 80 consecutive patients underwent primary isolated CABG surgery at national heart institute, their data were prospectively collected and they were classified according to their HbA1c level into two groups, Group (A): Forty patients with fair glycemic control (HbA1c below or equal to 7%), Group (B): Forty patients with poor glycemic control (HbA1c above 7%). Hospital morbidity, mortality and one year survival were examined in both groups.

'Watch and wait' in rectal cancer: summary of the current evidence.

Background: The management of rectal cancer has evolved considerably over the last few decades with increasing use of neoadjuvant chemoradiotherapy (nCRT). Complete clinical response (cCR) and even complete pathological response (pCR) have been noted in a proportion of patients who had surgery after nCRT. This raises the concern that we may have been 'over-treating' some of these patients and lead to an increasing interest in 'watch and wait' (W&W) approach for patients who had cCR to avoid the morbidity associated with rectal surgery.

The role of oral antibiotics prophylaxis in prevention of surgical site infection in colorectal surgery.

Background: Surgical site infection (SSI) continues to be a challenge in colorectal surgery. Over the years, various modalities have been used in an attempt to reduce SSI risk in elective colorectal surgery, which include mechanical bowel preparation before surgery, oral antibiotics and intravenous antibiotic prophylaxis at induction of surgery. Even though IV antibiotics have become standard practice, there has been a debate on the exact role of oral antibiotics.

Low vs. standard dose computed tomography in suspected acute appendicitis: Is it time for a change?

Background: Clinical diagnosis is accurate in only 80% of patients with suspected appendicitis with negative appendectomy rates of up to 21%. In the UK the use of standard-dose CT (SDCT) is conservative due to concerns over radiation exposure and resource implications. The use of low dose computer tomography (LDCT) instead of standard dose computer tomography (SDCT) may partially address these concerns.

The effects of enteral immunonutrition in upper gastrointestinal surgery: A systematic review and meta-analysis.

Aim: The beneficial of immunonutrition on overall morbidity and mortality remains uncertain. We undertook a systematic review to evaluate the effects of immune-enhancing enteral nutrition (IEN) in upper gastrointestinal (GI) surgery.

Methods: Main electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (ClinicalTrial.

Exact analytical solution of the peristaltic nanofluids flow in an asymmetric channel with flexible walls and slip condition: application to the cancer treatment.

In the cancer treatment, magnetic nanoparticles are injected into the blood vessel nearest to the cancer's tissues. The dynamic of these nanoparticles occurs under the action of the peristaltic waves generated on the flexible walls of the blood vessel. Studying such nanofluid flow under this action is therefore useful in treating tissues of the cancer.

Robotic colonic surgery: is it advisable to commence a new learning curve?

Background: Robotic surgery has potential advantages in rectal and pelvic surgery, in which the dissection is performed within a confined operative field. However, the position of robotic colonic surgery remains largely undefined with limited insight of whether it offers any potential advantages over open or laparoscopic colon surgery.

Objectives: The aim of this systematic review was to compare the short-term outcomes of the published robotic colonic surgery with those of laparoscopic colonic surgery.

Does robotic rectal cancer surgery offer improved early postoperative outcomes?

Background: Laparoscopic rectal surgery continues to be challenging, especially in low rectal cancers, because the technique has several limitations. Robotic rectal surgery could potentially address these limitations. However, it still remains unclear whether robotic surgery should be accepted as the new standard treatment in rectal cancer surgery.

Is routine blood cross-matching necessary in elective laparoscopic colorectal surgery?

Background: Routine pre-operative cross-matching of two units of packed red cells (PRC) is current practice in most hospitals for patients undergoing elective laparoscopic colorectal surgery (LCS).

Aims: To determine the usage of PRC in patients undergoing elective LCS & its cost implications.

Methods: Retrospective analysis of 116 consecutive laparoscopic colorectal resections under the care of 2 consultant surgeons.

Endometriosis in the canal of Nuck hydrocele: An unusual presentation.

The authors describe an unusual rare presentation of endometriosis in a hydrocoele of the canal of Nuck. A 43-year-old lady presented with a swelling in her right groin associated with mild discomfort. Examination revealed a cystic swelling in the groin for which she underwent an exploration and excision of the swelling.

APRIL is a novel clinical chemo-resistance biomarker in colorectal adenocarcinoma identified by gene expression profiling.

Background: 5-Fluorouracil(5FU) and oral analogues, such as capecitabine, remain one of the most useful agents for the treatment of colorectal adenocarcinoma. Low toxicity and convenience of administration facilitate use, however clinical resistance is a major limitation. Investigation has failed to fully explain the molecular mechanisms of resistance and no clinically useful predictive biomarkers for 5FU resistance have been identified.

Laparoscopic colorectal surgery: summary of the current evidence.

Introduction: Laparoscopic colectomy has not been accepted as quickly as laparoscopic cholecystectomy. This is because of its steep learning curve, concerns with oncological outcomes, lack of randomised controlled trials (RCTs) and initial reports on port-site recurrence after curative resection. The aim of this review is to summarise current evidence on laparoscopic colorectal surgery.

Non-compliance with national guidelines in the management of acute pancreatitis in the United kingdom.

Background: Deficiencies and lack of standardisation of the management of acute pancreatitis in the UK have been reported. National UK guidelines for the management of acute pancreatitis were published in 1998. However, implementation of national guidelines in other areas has been patchy, suggesting that evaluation of the uptake of the pancreatitis guidelines would be appropriate.