The effective prevention and treatment of anastomotic leakage after intestinal anastomosis for colorectal diseases is still a major clinical challenge. In order to assist intestinal anastomosis healing and avoid anastomotic leakage caused by high tension, low blood supply or infection, we designed a double-layer nanofiber intestinal anastomosis scaffold, which was composed of electrospun PTMC/PHA nanofibers as the main layer, and electrospun PVA/OHA-Gs nanofibers with antibacterial properties as the antibacterial surface layer. This double-layer scaffold has good toughness, its maximum tensile force value could reach 8 N, elongation could reach 400 %, and it has hydrophilic properties, and its contact angle was about 60°. On the basis of reducing anastomotic tension and isolating intestinal contents, this double-layer nanofiber anastomotic scaffold not only played an antibacterial effect in the short term after surgery to reduce inflammatory response, but also had the characteristics of multiple three-dimensional network structure like extracellular matrix which could promote tissue healing. The PVA/OHA-Gs@PTMC/PHA scaffold was implanted into a rabbit model simulating mechanical intestinal obstruction, and the results showed that the nanofibers of the scaffold could be degraded in vivo while maintaining a certain stability, that is, the overall structure of the PVA/OHA-Gs@PTMC/PHA scaffold would not shrink and deform due to degradation in a certain period of time. Therefore, the treatment with this scaffold showed better healing at the anastomotic site. Compared to the direct anastomosis group and pure PTMC scaffold group, the double-layer scaffold group promoted a faster return to normal anastomotic strength within 7 days. This PVA/OHA-Gs@PTMC/PHA double-layer nanofiber flexible scaffold appears to be a promising therapeutic strategy to prevent anastomotic leakage after intestinal anastomosis.

The aim of this study was to investigate independent risk factors for diversion colitis induced by the surgical interruption of fecal flow in the non-functional colon.

We performed a retrospective study with 163 patients who underwent low anterior resections and created prophylactic ileostomies for rectal cancer between January 2014 and June 2023 at the Department of General Surgery, Air Force Medical University Tangdu Hospital. Colonoscopy results of the non-functional region of the distal colon and clinical variables were collected, including age, sex, body mass index, pathological tumor node metastasis staging, ileostomy method, diversion time, receiving radiotherapy or chemotherapy or not, suffering from preoperative inflammatory bowel disease or postoperative anastomotic leakage or not. Diagnosis of diversion colitis based on the results of the patients' colonoscopy results. Univariate analysis and multivariate analysis of diversion colitis-related risk factors were performed subsequently.

The morbidity of diversion colitis is 53.4% (87/163) in our study. Multivariate analysis showed that risk factors for diversion colitis included single-lumen prophylactic ileostomy (63.2 vs. 30.3%, OR 4.481, 95%CI 1.897-10.584, p<0.001), diversion time ≥90 days (79.3 vs. 40.8%, OR 4.474, 95%CI 1.849-10.826, p<0.001), inflammatory bowel disease (17.2 vs. 3.9%, OR 7.491, 95%CI 1.839-30.507, p=0.005), radiotherapy (58.6 vs. 42.1%, OR 0.515, 95%CI 0.196-1.352, p=0.178).

These findings suggest that single-lumen prophylactic ileostomy, diversion time, and inflammatory bowel disease are independent risk factors for diversion colitis.

Fluorescence imaging is critical for intraoperative intestinal perfusion assessment in colorectal surgery, yet its clinical adoption remains limited by subjective interpretation and lack of quantitative standards. This study introduces an integrated approach combining fluorescence curve analysis, biophysical modeling, and machine learning to improve intraoperative perfusion assessment.

Laparoscopic fluorescence videos from 68 low rectal cancer patients were analyzed, with 1,263 measurement points (15-20 per case) selected along colonic bands. Fluorescence intensity dynamics were extracted via color space transformation, video stabilization and image registration, then modeled using the Random Sample Consensus (RANSAC) algorithm and nonlinear least squares fitting to derive biophysical parameters. Three clinicians independently scored perfusion quality (0-100 scale) using morphological features and biophysical metrics. An XGBoost model was trained on these parameters to automate scoring.

The model achieved superior test performance, with a root mean square error (RMSE) of 2.47, a mean absolute error (MAE) of 1.99, and an R2 of 97.2%, outperforming conventional time-factor analyses. It demonstrated robust generalizability, showing no statistically significant prediction differences across age, diabetes, or smoking subgroups (P > 0.05). Clinically, low perfusion scores in distal anastomotic regions were significantly associated with postoperative complications (P < 0.001), validating the scoring system's clinical relevance and discriminative capacity. The automated software we developed completed analyses within 2 min, enabling rapid intraoperative assessment.

This framework synergistically enhances surgical evaluation through three innovations: (1) Biophysical modeling quantifies perfusion dynamics beyond time-based parameters; (2) Machine learning integrates multimodal data for surgeon-level accuracy; (3) Automated workflow enables practical clinical translation. By addressing limitations of visual assessment through quantitative, rapid, and generalizable analysis, this method advances intraoperative perfusion monitoring and decision-making in colorectal surgery.

Anastomotic leakage (AL) is a serious complication following rectal cancer surgery and is associated with increased recurrence, mortality, extended hospital stays, and delayed chemotherapy. The Onodera prognostic nutritional index (OPNI) and inflammation-related biomarkers, such as the neutrophil-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have been studied in the context of cancer prognosis, but their combined efficacy in predicting AL remains unclear.

To investigate the relationships between AL and these markers and developed a predictive model for AL.

A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023. The patients were divided into two groups on the basis of the occurrence of AL: One group consisted of patients who experienced AL (n = 49), and the other group did not (n = 385). The investigation applied logistic regression to develop a risk prediction model utilizing clinical, pathological, and laboratory data. The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.

In the present study, 11.28% of the participants (49 out of 434 participants) suffered from AL. Multivariate analysis revealed that preoperative levels of the OPNI, NLR, and PLR emerged as independent risk factors for AL, with odds ratios of 0.705 (95%CI: 0.641-0.775, P = 0.012), 1.628 (95%CI: 1.221-2.172, P = 0.024), and 0.994 (95%CI: 0.989-0.999, P = 0.031), respectively. These findings suggest that these biomarkers could effectively predict AL risk. Furthermore, the proposed predictive model has superior discriminative ability, as demonstrated by an area under the curve of 0.910, a sensitivity of 0.898, and a specificity of 0.826, reflecting its high level of accuracy.

The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators, emphasizing their importance in the preoperative evaluation process.

Anastomotic leakage (AL) is a severe surgical complication for mid-low rectal cancers. The efficacy of transanal drainage tube (TDT) has rarely been reported.

To evaluate the efficacy of TDT after AL.

A retrospective analysis was conducted on 68 patients with mid-low rectal cancer who underwent laparoscopic low anterior resection (LAR) and developed ALs. Leakage were identified using imaging studies and digital rectal examinations when local abscesses or systemic infections were present. In each patient, the leakage site was determined using the index finger and a drainage tube was inserted transanally to drain the abscesses and exudates outside the anus. The clinical outcomes of the patients following transanal drainage were analyzed.

A total of 43 patients received TDT treatment, while 25 patients did not receive TDT treatment. Among the patients in the TDT group, 9 required reoperation compared to 12 in the non-TDT group. In the TDT group, 76.74% of the patients were able to restore intestinal continuity, whereas only 40% of the patients in the non-TDT group achieved restored intestinal continuity. In the TDT group, 48.48% of patients developed LAR syndrome (LARS), whereas in the non-TDT group, 90% of patients developed LARS. The median drainage time was 7 days, the median postoperative hospital stay was 21 days, the median fasting time was 6.5 days, and the median hospitalization cost was 109205.93 RMB.

TDT use lowered reoperation rate but did not increase hospitalization expenses. After ≥ 1 year of follow-up, its use improved intestinal patency rate and reduced the incidence of LARS.

Background/Objectives: An anastomotic leak (AL) following colorectal surgery is one of the most feared complications due to its associated morbidity and mortality. Early detection of ALs remains difficult, as the development of clinical signs of deterioration can be a late finding. This is particularly problematic in patients with poor access to care after discharge. C-reactive protein (CRP) is a systemic marker of inflammation that has been proposed as an early AL screening. However, absolute cut-off values have been shown to have limited sensitivity and specificity. We propose the use of CRP trends for early AL detection. Methods: A retrospective chart review of patients undergoing surgery requiring at least one anastomosis at a single tertiary care center was performed. Patients with two or fewer postoperative CRP values were excluded. Postoperative CRP trends were compared between control and AL patients using a mixed model with a Geisser-Greenhouse correction. Results: CRP trends differed significantly between AL and control patients, with a 10% CRP increase after postoperative day two showing 100% sensitivity and 84% specificity for an AL as well as a 100% negative predictive value. Accepted CRP cut-off values on postoperative days three and four had sensitivities of only 71.4% and 80% and specificities of 70.0% and 76.5%, respectively. CRP trends differed in AL versus control patients despite the surgical approach or presence of additional procedures. Conclusions: Daily monitoring of CRP trends (versus absolute cut-offs) may enhance early anastomotic leak detection and aid in discharge decision-making, particularly important in rural settings with limited healthcare access.

BackgroundWe aimed to identify risk factors associated with chronic anastomotic leak (AL) treatment failure.MethodsAdult patients surgically treated for chronic AL after colorectal or coloanal anastomosis for benign and malignant indications were included. The primary outcome was predictors of AL treatment failure, defined as failure to restore bowel continuity and/or having a permanent stoma at completion of treatment. Step-wise multivariable logistic regression analysis of factors that reached statistical significance on univariable analyses was undertaken.Results60 patients [41 (68.3%) males; average age: 56 (SD 6.7) years; and average BMI: 24 (SD 2.1) kg/m2] were included. 61% of patients were referred for treatment; 46 (76.7%) had colorectal and 14 (23.3%) had coloanal anastomosis at index surgery. 38 (63.3%) had successful treatment; 22 (36.7%) required permanent stoma. Patients who failed treatment on univariable analysis were likely older (OR 1.06; P = 0.045), had >2 prior attempted AL treatments (OR 9.53; P = 0.042), and end colostomy at AL surgery (OR 25.4; P = 0.032). Predictors of failed treatment of chronic AL on multivariable analysis were older age and >2 prior treatments.ConclusionMore than 1/3 of patients with chronic AL eventually fail to achieve restored intestinal continuity. Risk factors on multivariable regression are >2 treatments for chronic AL before definitive therapy and older age at treatment. We recommend considering redoing the anastomosis earlier in the treatment of chronic AL.

Postoperative leakage at the colorectal anastomosis is recognized as a significant and serious complication. Its pathogenic factors are complex, the onset process is hidden, and it is often complicated with severe abdominal infection, which leads to sepsis and even multiple organ failure. In order to develop a new type of multifunctional biomaterial which can prevent intestinal bacterial translocation, intestinal fluid spillage and promote the healing of intestinal anastomosis, we prepared a multifunctional temperature-sensitive extracellular matrix hydrogel with the extracellular matrix (ECM) of porcine small intestinal submucosa (SIS) physically modified by boric acid and 4-ARM-PEG-SC as raw materials, in order to avoid abdominal infection and prevent anastomotic leakage. A series of experiments showed that the prepared hydrogel had stable structure, could resist the erosion of digestive juice in physiological range and had good tissue adhesion and mechanical properties, excellent antiexplosion ability and self-healing. Combined with its injectability, it could effectively seal the anastomosis. In vitro experiments showed that the hydrogel had effective antidigestion ability, good antibacterial properties, excellent cell and blood compatibility, as well as antioxidant and anti-inflammatory capabilities. Experiments revealed that the hydrogel could effectively optimize the local microenvironment of the anastomosis, promote the tissue repair of the anastomosis and effectively reduce the incidence of colonic anastomotic leakage in rats by promoting the key factors of cell proliferation, facilitating vascular formation and curtailing the expression of pro-inflammatory factors. The findings of this study pave the way for novel strategies in creating multifunctional materials designed to prevent and manage anastomotic leakage.

Diet impacts cancer in diverse manners. Multiple nutritional effects on tumors are mediated by dietary modulation of commensals, residing in mucosal surfaces and possibly also within the tumor microenvironment. Mechanistically understanding such diet-microbiome-host interactions may enable to develop precision nutritional interventions impacting cancer development, dissemination, and treatment responses. However, data-driven nutritional strategies integrating diet-microbiome interactions are infrequently incorporated into cancer prevention and treatment schemes. Herein, we discuss how dietary composition affects cancer-related processes through alterations exerted by specific nutrients and complex foods on the microbiome. We highlight how dietary timing, including time-restricted feeding, impacts microbial function in modulating cancer and its therapy. We review existing and experimental nutritional approaches aimed at enhancing microbiome-mediated cancer treatment responsiveness while minimizing adverse effects, and address challenges and prospects in integrating diet-microbiome interactions into precision oncology. Collectively, mechanistically understanding diet-microbiome-host interactomes may enable to achieve a personalized and microbiome-informed optimization of nutritional cancer interventions.

Colorectal cancer (CRC) remains a formidable global health challenge, ranking among the most prevalent malignancies and a principal contributor to cancer-associated mortality. While traditional open surgery has historically been the cornerstone of CRC treatment, the advent of minimally invasive techniques, particularly robotic-assisted colorectal surgery (RACS), has garnered significant momentum owing to technological advancements in the field. Robotic platforms, exemplified by the da Vinci Surgical System, offer superior three-dimensional visualization, enhanced dexterity, and heightened precision, yielding improved perioperative outcomes, particularly in anatomically intricate regions such as the pelvis. This review provides a critical appraisal of the current landscape of RACS, emphasizing its superiority over conventional open and laparoscopic approaches. The increased control and precision afforded by robotic surgery have been shown to optimize outcomes in complex procedures such as total mesorectal excision, with evidence indicating reduced intraoperative blood loss, shortened hospital stays, and improved functional recovery. Nonetheless, challenges persist, including absence of haptic feedback, prohibitive costs, and steep learning curve associated with robotic systems. Despite these limitations, RACS has demonstrated considerable promise in sphincter-preserving and function-preserving procedures, ultimately enhancing postoperative quality of life. Beyond the surgical field, this review also investigates the integration of robotic surgery within multidisciplinary treatment strategies for CRC, particularly in the context of locally advanced rectal cancer. The combination of robotic techniques with total neoadjuvant therapy and immunotherapy-especially in tumors characterized by mismatch repair deficiency or high microsatellite instability has shown notable clinical efficacy. Furthermore, emerging personalized therapeutic approaches, including immunotherapies and targeted chemotherapeutic agents, emphasize the transformative potential of RACS in delivering superior oncologic outcomes. Looking towards the future, innovations in robotic platforms, including intraoperative imaging, artificial intelligence, and augmented reality, herald new possibilities for further enhancing the precision and efficacy of colorectal surgeries. The standardization of RACS protocols, alongside ongoing training and robust clinical research, will be critical to fully realizing the benefits of these advancements across diverse clinical settings. By incorporating cutting-edge technologies and personalized treatment methods, robotic-assisted surgery is prepared to become a cornerstone in future of CRC management, with the potential to significantly improve both survival outcomes and patient quality of life.

To analyze and compare the application and efficacy of side-to-side anastomosis and end-to-end anastomosis in natural orifice specimen extraction surgery (NOSES) NOSES operation for left colon cancer.

A retrospective analysis of 69 patients in our hospital from February 2018 to February 2022 who underwent NOSES for left colon tumors. The observation group was performed with side-to-side anastomosis (Overlap). For digestive tract reconstruction, the control group was anastomosed by end-to-end anastomosis; the intraoperative and postoperative conditions and complications were compared between the two groups.

There was no significant difference in operation time and intraoperative blood loss between the two groups (P > 0.05). However, the intraoperative anastomosis time in the observation group was significantly shorter than that in the control group (P < 0.001). Additionally, there was no significant difference in the time of first exhaustion, defecation time, degree of patency of defecation, frequency of defecation, postoperative hospital stays and postoperative pain between the two groups (P > 0.05). Furthermore, the overall incidence of postoperative complications did not show a significant difference (P > 0.05).

In the NOSES surgery of left colon cancer, both side-to-side anastomosis (Overlap) and end-to-end anastomosis yielded comparable intraoperative and postoperative conditions and complications, but the side-to-side anastomosis (Overlap) method was simpler operation-wise and had a shorter intraoperative anastomosis time. As such, this method is the preferred anastomosis method when NOSES for colorectal cancer is carried out in primary hospitals.

ChiCTR1900026104 (2019-09-21).

Anastomotic leakage (AL) is a major complication in colorectal surgery, particularly following rectal cancer surgery, necessitating effective prevention strategies. The increasing frequency of colorectal resections and anastomoses during cytoreductive surgery (CRS) for peritoneal carcinomatosis further complicates this issue owing to the diverse patient populations with varied tumor distributions and surgical complexities. This study aims to assess and compare AL incidence and associated risk factors across conventional colorectal cancer surgery (CRC), gastrointestinal CRS (GI-CRS), and ovarian CRS (OC-CRS), with a secondary focus on evaluating the role of protective ostomies.

A retrospective analysis was performed on 1324 patients undergoing CRC, GI-CRS, and OC-CRS between January 2015 and December 2022. Multivariate analysis was utilized to identify preoperative, intraoperative, and postoperative variables as potential AL risk factors.

The overall AL rate was 3.0% (40/1324), with no significant differences among the three groups. Distinct risk factors were identified for each group: CRC (preoperative chemoradiotherapy), GI-CRS (ECOG score ≥ 2, preoperative albumin < 30 mg/dL), and OC-CRS (BMI < 18 kg/m2, pelvic lymphadenectomy, preoperative albumin < 30 mg/dL, anastomosis distance < 10 cm, postoperative anemia). Protective ostomies did not reduce AL incidence, and a notable discrepancy exists between AL risk factors and those influencing protective ostomy decisions.

AL, while rare, remains a serious postoperative complication in CRC and CRS. Key risk factors include preoperative nutritional status and surgical details such as blood supply and anastomosis level. Each patient group presents unique risks, which must be carefully weighed when considering protective ileostomy.

The utility of procalcitonin for detecting anastomotic leaks after colorectal surgery in older adults has not been well documented. As the immune system undergoes changes with age, procalcitonin levels may differ at baseline, and its diagnostic performance could vary when an anastomotic leak occurs after colorectal surgery in older adult patients with cancer. The aim of this study is to evaluate the diagnostic performance of procalcitonin on postoperative day 3 for detecting anastomotic leaks in older adults with colorectal cancer.

We conducted a diagnostic test study on the basis of a delayed-type cross-sectional design in older adults (≥65 years old) with colorectal cancer. Postoperative day 3 procalcitonin levels were tested. The reference standard was anastomotic leak. We calculated the receiver operating characteristic curve and its area under the curve.

The incidence of anastomotic leak was 7.7%. On postoperative day 3, the receiver operating characteristic demonstrated an area under the curve of 0.68 (95% confidence interval, 0.58-0.78) for the prediction of an anastomotic leak using procalcitonin levels. The cutoff point with the greatest diagnostic performance, according to the Youden index, was 0.61 ng/mL, with a sensitivity of 0.69, specificity of 0.62, a positive likelihood ratio of 1.86, and a negative likelihood ratio of 0.48 for predicting an anastomotic leak. The area under the curve was 0.78 when ileostomies were excluded and 0.81 when evaluating grade C leaks.

Our study reveals that procalcitonin levels on postoperative day 3 are a poor diagnostic marker for identifying anastomotic leaks in older adults with colorectal cancer, with an improvement in performance for the grade C anastomotic leak subgroup.

Background: Anastomotic leakage (AL) is a serious and potentially fatal complication that can occur after colorectal cancer (CRC) surgery, and it significantly affects patient recovery and increases morbidity. While serum C-reactive protein (CRP) is a recognized systemic inflammatory marker, the level of CRP in peritoneal fluid may serve as a more specific and localized biomarker for early AL detection. This meta-analysis explores the diagnostic potential of peritoneal fluid CRP, aiming to enhance postoperative care for CRC patients. Methods: A comprehensive literature search was conducted following the PRISMA guidelines. Eligible studies were included based on strict inclusion and exclusion criteria. Diagnostic accuracy was pooled using a random-effects model. The risk of bias was assessed using the QUADAS-2 tool. Results: The pooled sensitivity and specificity were 0.74 and 0.83, respectively, with an area under the curve (AUC) of 0.84, indicating good diagnostic accuracy. The overall diagnostic performance was consistent for sensitivity with no significant heterogeneity, but high heterogeneity was observed for specificity, suggesting variability between studies. Subgroup analysis revealed improved diagnostic performance between postoperative days 5-7 and higher CRP cut-off values (70-150 mg/L). The analysis confirmed the stability of the results through a sensitivity analysis and found no significant publication bias. Conclusions: Peritoneal fluid CRP is a reliable biomarker for detecting AL after CRC surgery, especially in the later postoperative period. However, heterogeneity in study methodologies and patient populations limits the generalizability of the findings. Future research should focus on standardizing protocols and exploring additional biomarkers to improve diagnostic accuracy.

Anastomotic leak is a well-documented complication of anterior resection, a procedure commonly performed for colorectal carcinoma or inflammatory bowel disease (IBD). Multiple factors contribute to anastomotic leaks, often related to surgical technique or impaired bowel healing. However, blunt trauma or physical injury has not been widely recognised as a risk factor for this complication. This report presents the case of a 72-year-old gentleman who returned to the hospital with a severe anastomotic leak following a physical incident. This case aims to highlight the potential role of trauma as a contributing factor in patients with atypical presentations of anastomotic leak.

Fournier gangrene disease (FGD) is a condition that requires emergent surgery due to its high risk of mortality. The use of biomarkers to predict outcomes after surgery for patients with FGD may be critical, as they assist in tailoring treatment approaches to individual needs. Our aim in our study is to investigate the presence of simple and easily accessible biochemical markers that can be used to predict early mortality.

The medical records of 100 patients diagnosed with FGD at our hospital between January 2015 and December 2023 were retrospectively reviewed. Clinical and laboratory variables were assessed, and predictive factors for mortality were analyzed using multivariate logistic regression.

Demographics and perioperative clinical data of the whole study group, and subgroups according to the mortality status are evaluated. CRP was found to be independent predictor for 30-day mortality in FGD. In ROC curve analysis provided a cutoff value of 121.3 mg/L for CRP which was significantly associated with 30-day mortality for FGD.

Preoperative CRP ≥ 121.3 mg/L value could be predict 30-day mortality in patients diagnosed with FGD.

Background: Anastomotic leakage (AL) is a severe complication of colorectal surgery and is associated with high morbidity, mortality, and prolonged hospital stay. Current predictive models vary in complexity and utility, highlighting the need for clinically accessible and accurate tools. This study aimed to develop and validate the clinical framework-anastomotic leakage prediction score (CF-ALPS) score, a practical and accessible risk prediction model for AL that integrates patient-, tumor-, and surgery-related factors. Methods: A retrospective cohort of 294 patients who underwent colorectal surgery between 2019 and 2024 was analyzed. Patients were categorized into the AL (n = 84) and non-AL groups (n = 210). The factors included age, sex, hypoalbuminemia, and comorbidities. Tumor-related factors included lymph node stage and neoadjuvant therapy, while surgical variables included urgency, duration, and type of procedure. The outcomes evaluated were the incidence of AL, duration of hospital stay, and in-hospital mortality. Independent predictors were identified using multivariate logistic regression analysis. The CF-ALPS score, which was developed from significant predictors, was validated using ROC curve analysis and 10-fold cross-validation. Results: A total of 294 patients who underwent colorectal surgery were included, of whom 84 (28.57%) developed AL. A male predominance was observed in the AL group (73.81% vs. 36.19%; p = 0.001). Nutritional status played a critical role, with significantly lower albumin levels in AL patients (2.8 ± 0.5 g/dL vs. 3.5 ± 0.4 g/dL; p < 0.001). Independent predictors of AL included hypoalbuminemia (<3.0 g/dL, OR: 0.52, p < 0.001), ASA score (OR, 1.85; p = 0.004), advanced lymph node stage (N2/N3, OR: 1.94, p = 0.037), neoadjuvant therapy (OR, 2.89; p = 0.002), and emergent surgery (OR, 1.67; p = 0.042). These variables formed the basis of the CF-ALPS score, which assigns weighted points based on the magnitude of their ORs. The CF-ALPS model achieved a ROC AUC of 0.82 (95% CI: 0.75-0.89) with a sensitivity of 85.0% and specificity of 78.0%. A cutoff score ≥7 demonstrated optimal risk stratification, classifying patients into high- and low-risk groups with a positive predictive value (PPV) of 72.0% and a negative predictive value (NPV) of 88.0%. Cross-validation yielded a moderate AUC of 0.44 (SD = 0.062). Conclusions: The CF-ALPS score offers a simple and effective tool for AL risk prediction in colorectal surgery, emphasizing its practicality and clinical integration. Although its predictive accuracy was moderate, further prospective multicenter validation is warranted.

Background: In the surgical treatment of colorectal cancers, disease-free survival and life expectancy are inversely proportional to the increase in complications. We evaluated the superiority of colonoscopy and air and water tests in detecting anastomotic leaks in sigmoid and rectosigmoid junction colon cancers. Methods: Data of patients who underwent robotic/laparoscopic surgical procedures for sigmoid and rectosigmoid junctional colon cancers at a single center between January 2018 and February 24 were retrospectively evaluated. The anastomoses were evaluated by intraoperative colonoscopy (IOC) and intraoperative air leak test (IALT), and two groups were formed. Intraoperative leaks, intraoperative repair techniques, and postoperative anastomotic leaks were evaluated. Results: In our study, there were 125 patients in the IOC group and 148 patients in the IALT group, totaling 273 patients. Leakage was detected in 7 patients (4.7%) in the IALT group and 14 patients (11.2%) in the IOC group (P = .06). In the IALT group, 5 of 7 patients were repaired primary, and the anastomosis was reconstructed in 2 patients. In the IOC group, 10 of 14 patients were repaired primary, 2 patients underwent reanastomosis, and 2 patients needed colostomy. Of these 15 patients with postoperative leakage, 4 had intraoperative leakage (2 patients in the IALT group and 2 patients in the IOC group), and all of them underwent primary repair. Conclusion: In the anastomotic evaluation of sigmoid colon and rectosigmoid junction tumors, we found that IOC detected more leaks than IALT, but in these leaks, reanastomosis and/or diversion ostomy was superior to primary repair.

Inadequate bowel perfusion is among risk factors for colorectal anastomotic leaks. Perfusion can be assessed with indocyanine green fluorescence angiography (ICG) during colon resections. Possible benefits from its systematic use in high-risk patients with rectal cancer remain inconsistent. This study aimed to evaluate the surgical modifications induced by ICG assessment during rectal cancer surgery and associated anastomotic leaks.

This prospective before and after cohort study was conducted in a single Canadian high-volume colorectal surgery center. Eligible patients were undergoing a low anterior resection for rectal cancer below 15 cm from the anal margin. Stapled and handsewn coloanal anastomoses were included. The experimental group was recruited prospectively, undergoing surgery using fluorescence angiography with ICG. The control group was built retrospectively from consecutive patients who had been operated on without ICG, prior to its implementation.

Each cohort included 113 patients. The use of ICG led to modifications from initial surgical plan in 10.6% of patients, with no occurrence of anastomotic leaks in this specific group. When comparing leak rates, using ICG seemed to be protective, but this could not be statistically proven, overall (13.3% vs. 6.2%, p = 0.07), nor for handsewn coloanal anastomoses (11.8% vs. 5.9%, p = 0.67). A lack of power could explain such non-significant results, especially with low overall anastomotic leak rates recorded.

ICG influenced ultimate proximal resection margin in a clinically relevant proportion of cases. It might be associated with reduced leak rates although not formally proven with this data. This technology is safe and easy to apply in high-volume colorectal centers.

To improve the outcomes in patients with abdominal cancers complicated by diffuse postoperative peritonitis (DPP) using vacuum-assisted laparostomy (VAL) with elective staged peritoneal lavage.

There were 141 patients with DPP: group I (63 patients) - VAL, group II (78 patients) - redo laparotomy on demand (RD). Negative pressure therapy was performed using commercial vacuum systems with vacuum dressing changes after 48 - 72 hours. We assessed mortality, morbidity, abdominal cavity status (Björck classification) and incidence of primary fascial closure of abdominal cavity.

There were 10 (15.9%) and 24 (30.8%) deaths, respectively (p=0.040). Complications Clavien-Dindo grade 3-5 were significantly more common in the 2nd group. According to the Björck classification, grades 2A (39.7%) and 2B (41.3%) became more common after the 2nd peritoneal lavage in the 1st group. After the 3rd and further staged peritoneal lavages, «frozen open abdomen» (grade 3A and 4) prevailed. This classification revealed significant correlations with abdominal index, intra-abdominal hypertension and C-reactive protein. Primary fascial closure of abdominal cavity was performed in 40 (63.5%) patients in the 1st group.

Vacuum-assisted laparostomy is effective for diffuse postoperative peritonitis compared to on-demand relaparotomy. This approach provides lower mortality and morbidity rates, as well as better control over local inflammatory process and intra-abdominal pressure.

Optimal selection of anastomosis technique is crucial in colectomy surgeries to ensure success and minimize postoperative complications. Various methods, both manual and stapler-assisted, are employed for intestinal anastomosis. This study aims to compare two surgical methods of intestinal anastomosis through macroscopic and microscopic examination.

Twenty-five albino Wistar rats were randomly divided into two groups: the first group (n = 10) underwent Side-to-End anastomosis, while the second group (n = 15) underwent End-to-End anastomosis. After a 5-day observation period under uniform laboratory conditions, both groups underwent a second surgery. Anastomoses were assessed for adhesion and leakage, followed by histopathological examination of excised samples using the oxygenal method. Data were analyzed using the Mann-Whitney statistical method with a significance level of p < 0.05.

Following the initial surgery, the second group exhibited a higher mortality rate compared to the first group. Based on our data, the mortality of the rats was unrelated to the type of anastomosis or the surgical procedure. The higher mortality rate in one group was due to other factors. Additionally, the second group demonstrated significantly greater adhesion formation. Histopathological examination revealed no significant difference between the groups, although neovascularization and collagen accumulation appeared more pronounced in the Side-to-End group.

Histopathologically, Side-to-End anastomosis showed superior repair conditions compared to End-to-End anastomosis. However, due to the limited sample size, statistical significance was not achieved. Conversely, Side-to-End anastomosis was associated with increased adhesion formation. These findings suggest the need for further comprehensive studies with larger sample sizes conducted in well-equipped centers to ascertain the preferred distal colon anastomosis technique and to achieve statistically significant results that can be more reliably generalized.

Anastomotic leakage (AL) is a severe complication of colorectal surgery. The risk of AL is affected by both surgery and patient factors. Gut microbiomes can be generated from the residual material from the fecal immunochemical test (FIT). We, therefore, examined if AL after colorectal cancer surgery could be associated with specific baseline microbiomes in the FIT screening sampling tubes collected weeks before surgery.

Samples from patients participating in the Danish colorectal cancer screening program were biobanked from 2016 to 2018, and samples from patients who had surgery for screening-detected cancer were included. They were matched with patients without AL in a 1:2 ratio based on age, sex, location of anastomosis (colonic/rectal), ASA classification, and smoking habits. Bacterial DNA was extracted from the sampling tubes, and the fecal microbiomes were analyzed with targeted 16S ribosomal RNA third-generation sequencing.

18 patients who developed AL after surgery were matched with 36 without AL. The alpha diversity was lower in the AL group (p = 0.035), and the AL group separated from the Controls in the PCoA plot (p < 0.001). This was due to the patients undergoing rectal resections, with significant differences in alpha- and beta diversity (p = 0.025 and p = 0.002, respectively). The prevalence of bacteria with the potential to produce collagenase was higher in patients who developed AL (odds ratio 1.29 (95% CI 1.28-1.30), p < 0.001).

We found differences in the baseline microbiome profile associated with subsequent development of AL after surgery for screening-detected rectal cancer.

Fluid overload and hypovolemia promote postoperative complications in patients undergoing cytoreductive surgery for ovarian cancer. In the present study, postoperative complications and anastomotic leakage were investigated before and after implementation of pulse pressure variation-guided fluid management (PPVGFM) during ovarian cancer surgery.

A total of n = 243 patients with ovarian cancer undergoing cytoreductive surgery at the University Hospital Bonn were retrospectively evaluated. Cohort A (CA; n = 185 patients) was treated before and cohort B (CB; n = 58 patients) after implementation of PPVGFM. Both cohorts were compared regarding postoperative complications.

Ultrasevere complications (G4/G5) were exclusively present in CA (p = 0.0025). No difference between cohorts was observed regarding severe complications (G3-G5) (p = 0.062). Median positive fluid excess was lower in CB (p = 0.001). This was independent of tumor load [peritoneal cancer index] (p = 0.001) and FIGO stage (p = 0.001). Time to first postoperative defecation was shorter in CB (CB: d2 median versus CA: d3 median; p = 0.001). CB had a shorter length of hospital stay (p = 0.003), less requirement of intensive medical care (p = 0.001) and postoperative ventilation (p = 0.001). CB received higher doses of noradrenalin (p = 0.001). In the combined study cohort, there were more severe complications (G3-G5) in the case of a PFE ≥ 3000 ml (p = 0.034) and significantly more anastomotic leakage in the case of a PFE ≥ 4000 ml (p = 0.006).

Intraoperative fluid reduction in ovarian cancer surgery according to a PPVGFM is safe and significantly reduces ultrasevere postoperative complications. PFEs of ≥ 3000 ml and ≥ 4000 ml were identified as cutoffs for significantly more severe complications and anastomotic leakage, respectively.

This study aims to develop a risk prediction model for multidrug-resistant bacterial and fungal infections in patients with gastrointestinal fistulas during the perioperative period.

A retrospective cohort study was conducted at Anhui No. 2 Provincial People's Hospital from January 2022 to July 2024. We analyzed the distribution, resistance patterns, and mechanisms of multidrug resistance. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. A nomogram was constructed based on these risk factors, and its performance was evaluated using calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).

A total of 266 patients were included, with 157 (59.02%) testing positive for multidrug-resistant infections. We isolated 329 pathogenic strains: 84 Gram-positive (25.53%), 215 Gram-negative (65.35%), and 30 fungal strains (9.11%). The most common isolate was Klebsiella pneumoniae (57 strains, 17.33%). Patients were divided into a training cohort (n = 177) and a validation cohort (n = 89). Multivariate analysis identified six key indicators: secondary surgery, length of hospital stay, preoperative white blood cell (WBC) count, preoperative neutrophil count, postoperative WBC count, and postoperative C-reactive protein (CRP) levels. The nomogram demonstrated excellent predictive ability, with an area under the curve (AUC) of 0.905 in the training cohort and 0.793 in the validation cohort. Calibration curves indicated high consistency between predicted probabilities and observed values. DCA confirmed the clinical utility of the nomogram.

Our study shows that multidrug-resistant infections in patients with gastrointestinal fistulas are predominantly caused by Gram-negative bacilli, especially carbapenem-resistant Enterobacteriaceae. Key risk factors include secondary surgery and various blood count parameters. The developed nomogram provides robust predictive accuracy, aiding healthcare providers in implementing targeted infection prevention strategies.

This study investigates the effects of hexagonal microtextured titanium sheets on fibroblast growth and collagen synthesis, crucial factors in anastomotic healing.

Hexagonal titanium sheets were fabricated using a laser microtextured machine. Mouse fibroblastic embryonic stem cells (NIH/3T3) were cultured on these sheets. Cell proliferation was assessed using a CCK8 assay, and expression of TGF-β/Smad pathway-related genes and collagen types I and III was evaluated through qRT-PCR and western blot.

Hexagonal titanium sheets significantly enhanced fibroblast growth and collagen synthesis. The 50-30 group, with the smallest contact angle (48 ± 2.3°), exhibited the highest cell growth rates by CCK8 assay. Gene expression analysis revealed that TGF-β1, Smad2, Smad3, Smad4, and COL1A1 were significantly upregulated in the 50-30 group on day 7. Meanwhile, type I collagen expression was significantly increased in the 50-30 group on day 7 by western blot analysis.

Our findings demonstrate that laser-fabricated hexagonal microtextured titanium sheets enhance hydrophilicity and promote fibroblast growth, activating the TGF-β/Smad pathway to facilitate collagen synthesis. These results have important implications for tissue repair and regeneration.

To compare rates of diverting ileostomy in patients with ovarian cancer, undergoing cytoreduction with bowel resection before and after the acquisition of indocyanine green fluorescence angiographic scans for anastomotic perfusion assessment.

A retrospective cohort study of patients with ovarian cancer undergoing bowel resection during cytoreductive surgery between 2010 and 2021. We evaluated whether using indocyanine green fluorescence angiography impacted rates of diverting ileostomy. Baseline characteristics and rates of diversion were compared between those who had indocyanine green fluorescence assessment and those with bowel resection without anastomotic fluorescence assessment.

Overall, 181 patients were included. Of whom, 84 (46%) underwent anastomotic fluorescence assessment following bowel resection, and 97 (54%) had bowel resection without assessment. Mean age of the cohort was 58.2 years and 132 (73%) had stage III disease. There was no difference between groups in rates of diverting ileostomy (41% vs 41%, p=1.0). In a univariable logistic regression, the odds of having an ileostomy were 2.92 times higher in patients undergoing primary surgery than in patients undergoing interval cytoreductive surgery (95% CI 1.25 to 6.85, p=0.013). The use of fluorescence angiography did not predict performing diverting ileostomy (OR=0.97, 95% CI (0.53 to 1.76), p=0.92).

In this cohort, the simple introduction of indocyanine green fluorescence angiography had no impact on the rates of anastomotic diversion. Developing a systematic, reproducible diversion protocol with selection criteria that include fluorescence angiography is needed to assess the impact of this surgically innovative tool on the rates of anastomotic diversion in patients with advanced ovarian cancer.

Colon adenocarcinoma (COAD) is a malignant tumor type. Fever is the most common postoperative complication of COAD. The present study described the treatment of a patient with early-stage COAD with precancerous colon polyps and the possible cause of postoperative fever. The patient was a 48-year-old woman with intermittent hematochezia, defecation urgency and liquid feces. The patient received surgical treatment, a whole segment from the intestine was removed, which contained a 4-cm-long mass and a 2-cm-long firm mass. Within 3 days after the operation, the patient's incision healed well, but the body temperature increased to a range of 37.8-38.6°C. The suture was removed on the 10th postoperative day. After another three days, it was discovered that the upper end of the patient's surgical incision split to the anterior rectus abdominis sheath. The patient was provided with recombinant human acidic fibroblast growth factor to promote wound healing. The patient was finally diagnosed with rectosigmoid junction adenocarcinoma and precancerous colon polyps according to pathological examination results. The patient was given intravenous bevacizumab combined with irinotecan hydrochloride and oral capecitabine, and all drugs were repeatedly applied every 3 weeks, and a total of four treatment cycles were used. The cause of this postoperative fever was concluded to be anemia coming from chronic hematochezia and combined with deep wound dehiscence with secondary infection. The present study showcased that low-dose and short-course prophylactic adjuvant therapy is feasible for early-stage COAD with precancerous colon polyps.

Since the introduction of powered circular staplers in colorectal surgery, there has been growing interest in their impact on reducing complications, particularly anastomotic leakage. This study compared short-term postoperative outcomes between powered and manual circular staplers.

This retrospective study included colorectal cancer patients at the tertiary referral center from April to October 2023 who underwent anterior or low anterior resection (LAR) using a circular stapler. According to energy source, patients were divided into powered and manual groups, which used two powered and four types of manual staplers, respectively. All open, laparoscopic, and robotic approaches were included. Propensity score matching (PSM) analysis was used to reduce selection bias. Postoperative complications within 30 days, especially for anastomosis-related complications, were compared between the groups.

Among 511 patients, the powered group was 161 (32%). After PSM, 143 pairs of 286 patients were analyzed. The proportions of LAR were 53.8% and 51.0%, and initial diverting stoma rates were 23.1% and 22.4% for the Powered and Manual groups, respectively. Comprehensive complication rates were similar between the Powered group and the Manual group, without statistical significance (13.3% vs. 21.0%, P = 0.063). Anastomotic leakage was not different between the Powered and Manual groups (4.2% vs. 4.9%, P = 0.782). There was no significant difference in other complications, including anastomotic bleeding, ileus, surgical site infection, and intra-abdominal hematoma.

The study implies that powered circular staplers may not significantly reduce postoperative complications, including anastomotic leakages, compared to manual staplers in colorectal surgery of high-volume centers.

Objectives: To assess the impact of topical papaverine administration in complete and incomplete colonic anastomosis, by examining bursting pressure, hydroxyproline concentration, collagen content, inflammation levels, inflammatory cell infiltration, neoangiogenesis, and necrosis grades. Methods: We performed an experimental study on rats, in which they were divided into the following 4 groups of 16 subjects each. Group 1 [complete anastomosis (CA) without papaverine (CA -P) group], Group 2 [CA with papaverine (CA +P) group], Group 3 [incomplete anastomosis (ICA) without papaverine (ICA -P) group], and Group 4 [ICA with papaverine (ICA +P) group]. Results: The lymphocyte infiltration score of the ICA +P3 (day 3) group was significantly higher compared to the ICA -P3 group (p = 0.018). The median Ehrlich-Hunt score (p = 0.012), inflammation score (p = 0.026), and neutrophil infiltration score (p = 0.041) of the CA +P7 (day 7) group were significantly lower than the corresponding data of the CA -P7 group. Additionally, the necrosis score of the ICA +P7 group was significantly lower than that of the ICA -P7 group (p = 0.014). Conclusions: Data from the current study reveal that, although topical papaverine seems to suppress inflammation in anastomosis tissue and reduce necrosis at 7 days, definite conclusions regarding its impact on anastomotic leak cannot be drawn without further studies investigating anastomotic wound healing and anastomotic leak, preferably with both shorter- and longer-term evaluations.

In this study, we investigated the molecular mechanisms underlying the impact of extracellular vesicles (EVs) derived from bone marrow stromal cells (BMSCs) on colorectal cancer (CRC) development. The focus was on the role of MAGI2-AS3, delivered by BMSC-EVs, in regulating USP6NL DNA methylation-mediated MYC protein translation modification to promote CDK2 downregulation. Utilizing bioinformatics analysis, we identified significant enrichment of MAGI2-AS3 related to copper-induced cell death in CRC. In vitro experiments demonstrated the downregulation of MAGI2-AS3 in CRC cells, and BMSC-EVs were found to deliver MAGI2-AS3 to inhibit CRC cell proliferation, migration, and invasion. Further exploration revealed that MAGI2-AS3 suppressed MYC protein translation modification by regulating USP6NL DNA methylation, leading to CDK2 downregulation and prevention of colorectal cancer. Overexpression of MYC reversed the functional effects of BMSC-EVs-MAGI2-AS3. In vivo experiments validated the inhibitory impact of BMSC-EVs-MAGI2-AS3 on CRC tumorigenicity by promoting CDK2 downregulation through USP6NL DNA methylation-mediated MYC protein translation modification. Overall, BMSC-EVs-MAGI2-AS3 may serve as a potential intervention to prevent CRC occurrence by modulating key molecular pathways.

Introduction: Cytoreductive surgery (CRS) coupled with hyperthermic intraperitoneal chemotherapy (HIPEC) is a potentially curative approach to peritoneal disease (PD) and corresponds to the needs of patients with dire survival rates. However, the oncological community remains cautious toward this procedure because of its significant morbidity and mortality rates. This evolving evidence around CRS and HIPEC and its impact suggests a need for more standardized procedures in existing centers. Because of its complexity and potential for high morbidity and mortality, critical observation of our center's complication rates using complication management documentation tools were crucial to further develop our standard operating procedures (SOP) and maximize patient safety. Methods: Our prospectively maintained institutional database was queried to identify all patients who underwent CRS and HIPEC and had a filled-out quality management (QM) and complication management documentation tool at discharge at the surgical department of the Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany, between January 2018 and December 2023. Results: A total of 155 patients had a surgical and/or medical complication recorded. In total, 305 surgeries were surveyed. Some patients had more than one postoperative complication; hence, 344 events in 50 categories were recorded, of which 267 were graded 3a or higher in 92 patients. The most common medical complications were of pulmonary and renal origin. On the surgical side, surgical site infections (SSI) were most common. The incidence of anastomotic leakage (AL) was 5% (n = 8), with no events between 2021 and the present. Patients with longer surgery duration times were at higher risk for developing postoperative complications. Conclusions: Major abdominal surgeries like CRS and HIPEC are associated with significant patient morbidity despite achieving optimal oncological outcomes. Postoperative complications are managed through strict surveillance and transparency, particularly in our large reference centers, to minimize patient risk. Quality management programs in our department have successfully maintained high standards of care without compromising patient safety.

Loop ileostomy is commonly performed by colorectal and general surgeons to protect newly created large bowel anastomoses. The optimal timing for ileostomy closure remains debatable. Defining the timing associated with the best postoperative outcomes can significantly improve the clinical results for patients undergoing ileostomy closure. The LILEO study was a prospective multicenter cohort study conducted in Poland from October 2022 to December 2023. Full data analysis involved 159 patients from 19 surgical centers. Patients were categorized based on the timing of ileostomy reversal: early (<4 months), standard (4-6 months), and delayed (>6 months). Data on demographics, clinical characteristics, and perioperative outcomes were analyzed for each group separately and compared. No significant differences were observed in length of hospital stay (p = 0.22), overall postoperative complications (p = 0.43), or 30-day reoperation rates (p = 0.28) across the three groups. Additional analysis of Clavien-Dindo complication grades was performed and did not show significant differences in complication severity (p = 0.95), indicating that the timing of ileostomy closure does not significantly impact perioperative complications or hospital stay. Decisions on ileostomy reversal timing should be personalized and should consider individual clinical factors, including the type of adjuvant oncological treatment and the preventive measures performed for common postoperative complications.

Indocyanine green (ICG) fluorescence imaging has revolutionized surgical practice across various medical and surgical specialties. This article reviews the clinical applications of ICG in abdominal, urological, thoracic, and gynecological surgery. ICG fluorescence imaging has been widely adopted in general surgery for various applications, including perfusion assessment, intraoperative visualization of the ureter, and tumor localization. It is particularly valuable in evaluating anastomotic leaks and aiding in precise tumor resection during minimally invasive surgeries. Studies have shown mixed results on its effectiveness in reducing anastomotic leak rates, highlighting the need for further research. In thoracic surgery, ICG facilitates the identification and resection of pulmonary bullae, as well as the precise localization of pulmonary nodules during video-assisted surgery. In urology, ICG aids in localizing renal tumors and guiding selective arterial occlusion during partial nephrectomy. Its role in identifying the lymphatic pathway in prostate cancer and sentinel lymph node biopsy in gynecological cancer is also discussed. Despite its benefits, the use of ICG fluorescence faces challenges such as limited tissue penetration, the potential for false results, a lack of standardized protocols, and high equipment costs. Nonetheless, it remains a powerful tool that could improve surgical outcomes.

To evaluate the risk factors for postoperative incision infection in colorectal cancer, this meta-analysis aimed to identify key variables impacting infection incidence following colorectal cancer surgery.

Utilizing a meta-analytical approach, studies published from January 2015 to December 2022 were systematically collected and analyzed through the assessment of factors like body mass index, diabetes, albumin levels, malnutrition, and surgical duration.

The meta-analysis of eleven high-quality studies revealed that elevated BMI, diabetes, low albumin levels, malnutrition, and extended surgical duration were associated with increased infection risk, while laparoscopic procedures showed potential for risk reduction.

This study underscores the significance of preoperative risk assessment and management in mitigating postoperative incision infections in colorectal cancer patients. The findings present actionable insights for clinicians to enhance patient prognoses and overall quality of life.

Anastomotic leak (AL) represents the most relevant and devastating complication in colorectal surgery. Endoscopic vacuum therapy (EVT) using the VACStent is regarded as a significant improvement in the treatment of upper gastrointestinal wall defects. The innovative concept of the VACStent was transferred to the lower GI tract, gaining initial experience by investigating safety and efficacy in 12 patients undergoing colorectal resections.

The pilot study, as part of a German registry, began with 2 patients suffering from AL, who were treated with the VACStent after stoma placement. Subsequently, 6 patients with AL were treated with the VACStent omitting a stoma placement, with a focus on fecal passage and wound healing. Finally, the preemptive anastomotic coverage was investigated in 4 patients with high-risk anastomoses to avoid prophylactic stoma placement.

In total 26 VACStents were placed without problems. The conditioning and drainage function were maintained, and no clogging problems of the sponge cylinder were observed. No relevant clinical VACStent-associated complications were observed; however, in 2 patients, a dislodgement of a VACStent occurred. The 6 patients with AL but without stoma had a median treatment with 3 VACStents per case with a laytime of 17 days, leading to complete wound healing in all cases. The 4 prophylactic VACStent applications were without complications.

The clinical application of the VACStent in the lower GI tract shows that successful treatment of anastomotic colonic leaks and avoidance of creation of an anus praeter is possible.

Clinicaltrials.gov NCT04884334, date of registration 2021-05-04, retrospectively registered.

Focused perioperative nutrition strategies have proven benefits on the outcomes for patients undergoing major abdominal surgery. In this brief article, we will review these strategies and the evidence to support them with a focus on gastrointestinal anastomotic healing. We will elaborate the risks and benefits of enteral feeds, immune- and metabolic-modulating formulas, prebiotics and probiotics, and prehabilitation in preparation for surgery. Additionally, we will discuss the role of fish oils (eicosapentaenoic acid and docosahexaenoic acid) in the surgical patient and new data on specialized proresolving mediators in inflammation resolution. Finally, this article will consider the harmful impact surgical trauma has on the microbiome and the potential for perioperative dietary modulation to attenuate these negative effects.

Anastomotic leakage (AL) is one of the most serious complications after laparoscopic anus-preserving surgery for rectal cancer, which significantly prolongs the patient's hospital stay, leads to dysfunction, and even increases the patient's perioperative morbidity and mortality, and little is known about the effectiveness of anastomotic reinforcement sutures to prevent AL. Thus, this study was conducted to evaluate the efficacy of anastomotic reinforcement sutures as a means to prevent AL during laparoscopic surgery for rectal cancer.

A comprehensive and systematic search was performed in the literature database by combining subject and free terms up to 10 October 2023. The overall literature included was integrated and analyzed using Stata 12.0 software and Review Manager version 5.4 software to assess the effect of anastomotic reinforcement sutures on the incidence of AL.

A total of 2,452 patients from 14 studies were included, and an integrated analysis showed that the use of anastomotic reinforcement sutures significantly reduced the incidence of AL [odds ratio (OR) = 0.26; 95% confidence interval (CI), 0.18-0.37; P < 0.00001; I2 = 0%]. However, the findings confirmed whether or not the anastomosis reinforced with sutures did not affect the incidence of anastomotic stenosis (OR = 0.69; 95% CI, 0.37-1.32; P = 0.27; I2 = 0%). We performed subgroup analyses of the results of the study, the randomized controlled studies (OR = 0.31; 95% CI, 0.15-0.65; P < 0.001) as well as retrospective studies (OR = 0.28; 95% CI, 0.19-0.41; P < 0.001), 3-0 sutures (OR = 0.28; 95% CI, 0.17-0.45; P < 0.001) versus 4-0 sutures (OR = 0.26; 95% CI, 0.13-0.53; P < 0.001), barbed wire sutures (OR = 0.26; 95% CI, 0.14-0.48; P < 0.001) versus non-barbed wire sutures (OR = 0.30; 95% CI, 0.20-0.46; P < 0.001), interrupted (OR = 0.30, 95% CI, 0.20-0.46; P < 0.001) versus continuous sutures (OR = 0.29, 95% CI, 0.16-0.51; P < 0.001) to the anastomosis, full-thickness suture (OR = 0.29; 95% CI, 0.16-0.51; P < 0.001) versus sutured with the seromuscular layer (OR = 0.27; 95% CI, 0.14-0.53; P < 0.001), anastomotic sutured in one (OR = 0.27; 95% CI, 0.14-0.53; P < 0.001) versus non-one circle (OR = 0.30; 95% CI, 0.20-0.44; P < 0.001), and reinforcing sutures to the dog-ear area (OR = 0.26; 95% CI, 0.14-0.50; P < 0.001) versus the non-dog-ear area (OR = 0.30; 95% CI, 0.20-0.45; P < 0.001), which have suggested that there is no significant difference between each other and that all of them reduce the incidence of AL.

This study provides evidence that performing reinforcement suturing of the anastomosis during laparoscopic rectal surgery significantly lowers the incidence of postoperative AL but has no significant effect on anastomotic stenosis. It is important to note that further randomized controlled studies are required to confirm this conclusion.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022368631.

Colorectal anastomotic leakage (CAL) remains a feared complication after colorectal surgery and requires prompt detection and proper treatment. With the upswing of fast-track recovery programs in recent years this challenge has increased, as clinical features may only arise after discharge. Therefore, identification of the best diagnostic tools is of utmost importance, also since early treatment is associated with high success rates. Diagnostic tools range from general screening tools to invasive procedures to assess the severity of the leak. Laboratory tests, in particular the inflammation biomarkers C-reactive protein and procalcitonin, have a significant role in the detection of CAL after colorectal surgery. As these biomarkers are unspecific for CAL, additional imaging should be performed when blood levels are elevated. The golden standard for the detection of AL after colonic resections is a computed tomography (CT-scan). If tolerated, a contrast medium should be administered rectally to enhance diagnostic accuracy. When suspicion of CAL remains high despite negative previous tests, further endoscopy examination should be conducted. However, endoscopic examinations become more suitable for the early diagnostic work-up after rectal resections. This review aims to provide an overview of current diagnostics for the screening and assessment of the severity of CAL after colorectal surgery.

Previous studies have analyzed the risk factors for complications after ileostomy reversal for rectal cancer (RC), but there were significant differences in the reported risk factors for complications after stoma reversal. No studies have analyzed the risk factors for stoma-related complications and overall postoperative complications separately.

To analyze the risk factors for overall complications and stoma-related complications after ileostomy reversal for patients with RC.

This was a retrospective study of 439 patients who underwent ileostomy reversal at a clinical center and were followed up between September 2012 and September 2022. Continuous variables are expressed as the mean ± SD and were analyzed with independent-sample t tests, while frequency variables are expressed as n (%), and the χ2 test or Fisher's exact test was used. Univariate and multivariate logistic regression analyses were used to identify predictors of overall complications and stoma-related complications.

The overall complication rate after ileostomy reversal was 11.4%. Patients with lower preoperative albumin concentration (P < 0.01), greater blood loss (P = 0.017), and longer operative times (P < 0.01) were more likely to experience postoperative complications. The incidence of stoma-related complications was 6.4%. Analysis of the study showed that a higher body mass index (BMI) (P < 0.01), preoperative comorbid hypertension (P = 0.049), time from primary surgery to ileostomy reversal (P < 0.01) and longer operation time (P = 0.010) were more likely to result in stoma-related complications postoperatively. Multivariate logistic regression analysis revealed that a lower preoperative albumin level (P < 0.01, OR = 0.888, 95%CI: 0.828-0.958) was an independent risk factor for overall complications. Moreover, multivariate analysis revealed that BMI (P < 0.01, OR = 1.176, 95%CI: 1.041-1.330) and time from primary surgery to ileostomy reversal (P < 0.01, OR = 1.140, 95%CI: 1.038-1.252) were independent risk factors for stoma-related complications after stoma reversal.

The preoperative albumin level was a predictor of overall complications. Preoperative BMI and the time from primary surgery to ileostomy reversal were predictors of stoma-related complications.

Anastomotic leaks (ALs) are a significant and feared postoperative complication, with incidence of up to 30% despite advances in surgical techniques. With implications such as additional interventions, prolonged hospital stays, and hospital readmission, ALs have important impacts at the level of individual patients and healthcare providers, as well as healthcare systems as a whole. Challenges in developing unified definitions and grading systems for leaks have proved problematic, despite acknowledgement that colorectal AL is a critical issue in intestinal surgery with serious consequences. The aim of this study was to construct a narrative review of literature surrounding definitions and grading systems for ALs, and consequences of this postoperative complication.

A literature review was conducted by examining databases including PubMed, Web of Science, OVID Embase, Google Scholar, and Cochrane library databases. Searches were performed with the following keywords: anastomosis, anastomotic leak, colorectal, surgery, grading system, complications, risk factors, and consequences. Publications that were retrieved underwent further assessment to ensure other relevant publications were identified and included.

A universally accepted definition and grading system for ALs continues to be lacking, leading to variability in reported incidence in the literature. Additional factors add to variability in estimates, including differences in the anastomotic site and institutional/individual differences in operative technique. Various groups have worked to publish guidelines for defining and grading AL, with the International Study Group of Rectal Cancer (ISGRC/ISREC) definition the current most recommended universal definition for colorectal AL. The burden of AL on patients, healthcare providers, and hospitals is well documented in evidence from leak consequences, such as increased morbidity and mortality, higher reoperation rates, and increased readmission rates, among others.

Colorectal AL remains a significant challenge in intestinal surgery, despite medical advancements. Understanding the progress made in defining and grading leaks, as well as the range of negative outcomes that arise from AL, is crucial in improving patient care, reduce surgical mortality, and drive further advancements in earlier detection and treatment of AL.

In this editorial we comment on the article by Zhang et al published in a recent issue of the World Journal of Gastrointestinal Surgery. Gastrectomy with appropriate lymph node dissection is still standard curative treatment in locally advanced gastric cancer. Several studies point out that gastric cancer surgery is a complex procedure that leads to a high risk of morbidity and mortality. Many factors can contribute to the onset of complications with consequent effects on prognosis and increased mortality. The complications can be divided in complications related to anastomosis, to motility and to surgical site infection. The study presented by Zhang B et al represent an interesting analysis on the possibility to prevent postoperative morbidity. The study was performed on 131 patients with distal gastric cancer who underwent gastrectomy with D2 lymph node dissection. Of these patients, 16% developed early postoperative complications. The univariate analysis showed that prealbumin level, hypertension, diabetes, history of abdominal surgery, R0 resection, and blood transfusion were factors influencing early postoperative complications after distal gastrectomy. Moreover, the inclusion of the above significant variables in the logistic regression analysis revealed that hypertension, diabetes, a history of abdominal surgery, and blood transfusion were independent predictors of postoperative complications. In conclusion, preoperative and intraoperative factors can be used to establish an early postoperative nomogram model. The results of the study presented by Zhang et al suggest that the prediction model can be used to guide the detection of postoperative complications and has clinical reference value.