The Future of Rectal Cancer Surgery: A Narrative Review of an International Symposium.

Surgery remains the mainstay of curative treatment for primary rectal cancer. For mid and low rectal tumors, optimal oncologic surgery requires total mesorectal excision (TME) to ensure the tumor and locoregional lymph nodes are removed. Adequacy of surgery is directly linked to survival outcomes and, in particular, local recurrence.

Methylene blue fluorescence of the ureter during colorectal surgery.

Background: Iatrogenic ureteric injury is a serious complication of colorectal surgery. Incidence is estimated to be between 0.3 and 1.

Incidence and Risk Factors for Anastomotic Failure in 1594 Patients Treated by Transanal Total Mesorectal Excision: Results From the International TaTME Registry.

Objective: To determine the incidence of anastomotic-related morbidity following Transanal Total Mesorectal Excision (TaTME) and identify independent risk factors for failure.

Background: Anastomotic leak and its sequelae are dreaded complications following gastrointestinal surgery. TaTME is a recent technique for rectal resection, which includes novel anastomotic techniques.

Intraoperative identification and analysis of lymph nodes at laparoscopic colorectal cancer surgery using fluorescence imaging combined with rapid OSNA pathological assessment.

Background: Standard surgical practice for colorectal cancer involves resection of the primary lesion and all draining lymph nodes. Accurate intraoperative assessment of nodal status could allow stratified resectional extent. One-step nucleic acid (OSNA) can provide a rapid method of interrogating nodal tissue, whilst near-infrared (NIR) laparoscopy together with indocyanine green (ICG) can identify relevant nodal tissue intraoperatively.

What To Do With Lateral Nodal Disease in Low Locally Advanced Rectal Cancer? A Call for Further Reflection and Research.

Background: There remains a lack of international consensus on the appropriate management of lateral nodal disease. Although the East manages this more aggressively with lateral lymph node dissections, the West aims to eradicate small-volume disease with neoadjuvant chemoradiotherapy and lateral nodal disease is not considered for routine surgical treatment. However, recent studies have shown that, despite neoadjuvant treatment, a significant number of patients with lateral nodal disease develop local recurrence in the lateral compartment after total mesorectal excision.

Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases.

Objective: This study aims to report short-term clinical and oncological outcomes from the international transanal Total Mesorectal Excision (taTME) registry for benign and malignant rectal pathology.

Background: TaTME is the latest minimally invasive transanal technique pioneered to facilitate difficult pelvic dissections. Outcomes have been published from small cohorts, but larger series can further assess the safety and efficacy of taTME in the wider surgical population.

Natural history of uncomplicated sigmoid diverticulitis.

While diverticular disease is extremely common, the natural history (NH) of its most frequent presentation (i.e., sigmoid diverticulitis) is poorly investigated.

Transanal total mesorectal excision: A valid option for rectal cancer?

Low anterior resection can be a challenging operation, especially in obese male patients and in particular after radiotherapy. Transanal total mesorectal excision (TaTME) might offer technical advantages over laparoscopic or open approaches particularly for tumors in the distal third of the rectum. The aim of this article is to review the current experience with TaTME.

Enhanced Reality and Intraoperative Imaging in Colorectal Surgery.

Colorectal surgery is one of the most common procedures performed around the world with more than 600,000 operations each year in the United States, and more than a million worldwide. In the past two decades, there has been a clear trend toward minimal access and surgeons have embraced this evolution. Widespread adoption of advanced minimally invasive procedures is often limited by procedural complexity and the need for specific technical skills.

Management of Tumors of the Ischiorectal Fossa: The Role of Percutaneous Biopsy.

Background: Noninflammatory masses in the ischiorectal fossa are rare.

Objective: This study aimed to review our experience with ischiorectal fossa tumors and to address the question of whether percutaneous biopsy should be undertaken.

Design: This is a retrospective study.

Assessment of the Quality of Patient-Orientated Information on Surgery for Crohn's Disease on the Internet.

Background: The Internet is a vast resource for patients to search for health information on the treatment of Crohn's disease.

Objective: This study examines the quality of Web sites that provide information to adults regarding Crohn's disease, including treatment options and surgery.

Design: Two search engines (Google and Yahoo) and the search terms "surgery for Crohn's disease" were used.

Cohesin Rad21 mediates loss of heterozygosity and is upregulated via Wnt promoting transcriptional dysregulation in gastrointestinal tumors.

Loss of heterozygosity (LOH) of the adenomatous polyposis coli (APC) gene triggers a series of molecular events leading to intestinal adenomagenesis. Haploinsufficiency of the cohesin Rad21 influences multiple initiating events in colorectal cancer (CRC). We identify Rad21 as a gatekeeper of LOH and a β-catenin target gene and provide evidence that Wnt pathway activation drives RAD21 expression in human CRC.

Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery.

Background: Anastomotic leakage is a devastating complication of colorectal surgery. However, there is no technology indicative of in situ perfusion of a laparoscopic colorectal anastomosis.

Methods: We detail the use of near-infrared (NIR) laparoscopy (PinPoint System, NOVADAQ, Canada) in association with fluorophore [indocyanine green (ICG), 2.

Interstitial cells of Cajal modulate the tone of the human internal anal sphincter in vitro.

Background: Interstitial cells of Cajal, expressing the proto-oncogene c-kit, have been shown to regulate the spontaneous activity of the gastrointestinal tract. They have been described in the human internal anal sphincter; however, their function is still unclear.

Objective: We examined the effects of the c-kit tyrosine kinase inhibitor imatinib mesylate on sphincter strips to investigate the function of the interstitial cells.

Direct and immune mediated antibody targeting of ERBB receptors in a colorectal cancer cell-line panel.

A significant proportion of colorectal cancer (CRC) patients are resistant to anti-ERBB1 [avian erythroblastic leukemia viral (v-erb-b) oncogene homolog, receptor for EGF] monoclonal antibodies (Mabs). We evaluated both immune and nonimmune effects of cetuximab (anti-ERBB1 Mab), trastuzumab (anti-ERBB2 Mab), pertuzumab (anti-ERBB2 Mab), and lapatinib (dual ERBB1 and ERBB2 tyrosine kinase inhibitor) in a large well-characterized panel of 64 CRC cell lines to find response predictive tumor characteristics. There was a significant correlation between the direct effects of cetuximab and lapatinib.

Comparative outcomes of rectal cancer surgery between elderly and non-elderly patients: a systematic review.

Elderly people represent almost all patients diagnosed with and treated for rectal cancer, and this trend is likely to become more apparent in the future. Surgical management and treatment decisions for this disease are becoming increasingly complex, but only a few reports deal specifically with older patients. In this systematic review, we provide an overview of published studies of outcomes after curative surgery for rectal cancer in elderly people (>70 years).

Short-term effects of neoadjuvant chemoradiotherapy on internal anal sphincter function: a human in vitro study.

Background: Neoadjuvant chemoradiotherapy is recommended in the treatment of locally advanced rectal cancer. Studies have suggested that chemoradiotherapy adversely affects anorectal function. However, the functional implication and the underlying neuromyogenic changes involved in radiation-induced damage are poorly understood.

Assessment of the quality of patient-orientated Internet information on surgery for diverticular disease.

Background: The Internet is a vast resource available for patients to obtain health information.

Objective: This study examines the quality of Web sites that provide information on diverticular disease, treatment options, and surgery.

Design: Two search engines (Google and Yahoo) and the search terms "surgery and diverticular disease" and "surgery and diverticulitis" were used.

Near-infrared (NIR) laparoscopy for intraoperative lymphatic road-mapping and sentinel node identification during definitive surgical resection of early-stage colorectal neoplasia.

Background: Appropriate lymphatic assessment is a cornerstone of definitive surgical resection for colorectal cancer. Near-infrared (NIR) laparoscopy may allow real-time intraoperative identification of territorial lymphatic drainage and sentinel nodes in patients with early-stage disease prior to radical basin resection.

Methods: With IRB approval and individual consent, consecutive patients with radiologically localized neoplasia underwent peritumoral submucosal injection of indocyanine green (ICG, a fluorophore capable of injection site tattooing and efferent lymphatic migration) prior to standard laparoscopic oncological resection.

[Surgery for colitis ulcerosa and Crohn's disease in the era of modern medical therapy].

Acute severe ulcerative colitis is a serious condition, which is initially treated with high-dose corticosteroids. Failure to obtain remission should be detected within few days after treatment start, and a decision should be made whether to proceed with either cyclosporine or biological treatment, or to move on to emergency total colectomy with ileostomy. Most patients will later be candidates for a restorative proctocolectomy.

Natural orifice transluminal endoscopic surgery and localized resection for colorectal neoplasia.

Modern methods of surgical intervention have the potential to provide effective, definitive management of early stage colorectal neoplasia by truly minimally invasive means. Margin-free clearance of early colonic neoplasia from within the intestinal lumen can already now be effected by endoscopic submucosal dissection in the colon and transluminal endoscopic microsurgery (TEM) in the rectum. Natural orifice transluminal endoscopic surgery (NOTES) offers the potential for providing transmural, full thickness excision as TEM does but at sites in the colon proximal to the rectum.

The pattern and outcome of acute severe colitis.

Background: The prognosis of acute severe ulcerative colitis (ASC) influences therapeutic decisions, but data on prevalence or long-term outcome are few.

Methods: A systematic review of all patients with UC diagnosed in Oxford was performed to assess the prevalence of ASC defined by Truelove and Witts' (TW) criteria and determine whether outcome is related to disease activity on admission, likelihood of recurrence and long-term prognosis.

Results: 750 patients (median follow up 12.

Colorectal cancer stem cells.

Purpose: The cancer stem cell hypothesis predicts that only a subpopulation of cells within a tumor is responsible for driving growth. If this hypothesis were true, it would have a significant impact on our current treatment of cancer because conventional chemotherapy and radiotherapy target rapidly proliferating cells making up the bulk of the tumor, not specifically cancer stem cells. The aims of this review are to highlight the current evidence supporting the existence of cancer stem cells in colorectal cancer, to consider the relative merits of current cancer stem cell markers, and to discuss the implications of this on our current treatment of cancer.