Clinics in Colon and Rectal Surgery最新文献_第4页

Role of Post-discharge Venous Thromboembolism Prophylaxis after Colorectal Surgery. 结直肠手术后静脉血栓栓塞预防的作用。

IF 1.6 4区医学

Clinics in Colon and Rectal Surgery Pub Date : 2025-04-17 eCollection Date: 2026-01-01 DOI: 10.1055/s-0045-1807287

Pavel Lenkov, Elissa Dabaghi, Stefan Holubar

{"title":"Role of Post-discharge Venous Thromboembolism Prophylaxis after Colorectal Surgery.","authors":"Pavel Lenkov, Elissa Dabaghi, Stefan Holubar","doi":"10.1055/s-0045-1807287","DOIUrl":"10.1055/s-0045-1807287","url":null,"abstract":"Despite significant advances in colorectal surgery (CRS), postoperative venous thromboembolism (VTE) remains a critical issue that contributes to substantial morbidity and mortality. The incidence of VTE, including deep vein thrombosis, pulmonary embolism, and portomesenteric vein thrombosis, in the colorectal surgical population varies from 2 to 15%, with elevated risks in patients with colorectal cancer and inflammatory bowel disease. This review article examines the effects of VTE on postoperative outcomes and explores the efficacy of extended chemoprophylaxis (ePPx) for mitigating these risks. We will review the rates of morbidity and mortality associated with VTE, as well as the role of postdischarge ePPx in VTE prevention, while exploring how other specialties utilize ePPx strategies to decrease their postdischarge VTE rates, some of which may be translatable to CRS patients. Our analysis highlights the role of various prophylactic measures, including low-molecular-weight heparin (LMWH), aspirin, and direct oral anticoagulants (DOACs), comparing their effectiveness and cost implications as well as the use of thromboelastography to help guide ePPx management. Overall, findings suggest that VTE ePPx with LMWH significantly reduces the incidence of postoperative VTE and related complications, although patient compliance remains a challenge. While aspirin is a cost-effective alternative, its efficacy in patients with CRS requires further investigation. Emerging data on DOACs indicate their potential as viable options for ePPx, although their safety profile requires careful consideration. Tailored ePPx strategies, particularly with LMWH, appear to be crucial for reducing VTE in CRS patients. Further research is needed to refine the prophylactic approaches and establish standardized guidelines that incorporate new insights into VTE prevention and management in CRS.","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"39 1","pages":"37-50"},"PeriodicalIF":1.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgery-induced and Associated Long-term Strictures. 手术引起的和相关的长期狭窄。

IF 1.6 4区医学

Clinics in Colon and Rectal Surgery Pub Date : 2025-04-17 eCollection Date: 2026-01-01 DOI: 10.1055/s-0045-1807728

Matthew J Freeman, Corinne E Praska, Cristina B Sanger

{"title":"Surgery-induced and Associated Long-term Strictures.","authors":"Matthew J Freeman, Corinne E Praska, Cristina B Sanger","doi":"10.1055/s-0045-1807728","DOIUrl":"10.1055/s-0045-1807728","url":null,"abstract":"Strictures, commonly referred to as stenoses, are a rare but significant complication for patients who have undergone colorectal surgery. Strictures are difficult to diagnose due to variable clinical presentations, diverse etiologies, and lack of formalized diagnostic criteria. The clinical impact of strictures can be quite variable, ranging from a benign course not requiring intervention to emergent complications (e.g., bowel obstruction, perforation). Importantly, strictures can also have a large impact on patient quality of life and long-term bowel function. Once a stricture is diagnosed or clinically suspected, it is critical to determine its etiology to help guide clinical management and prevent recurrence. Strictures can be categorized as partial or complete, intrinsic or extrinsic, benign or malignant. We propose the ARCTIC mnemonic (Anastomosis, Radiation/Chemotherapy, Technical, Inflammation, and Compression) as a useful tool for remembering common stricture causes in the postoperative environment. This review seeks to provide an overview of the etiologies, diagnosis, and management of strictures in the postoperative setting.","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"39 1","pages":"83-88"},"PeriodicalIF":1.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Low Anterior Resection Syndrome Evaluation and Management. 前低位切除综合征的评估和处理。

IF 1.6 4区医学

Clinics in Colon and Rectal Surgery Pub Date : 2025-04-16 eCollection Date: 2026-01-01 DOI: 10.1055/s-0045-1807741

Samantha M Linhares, Anne K Mongiu

{"title":"Low Anterior Resection Syndrome Evaluation and Management.","authors":"Samantha M Linhares, Anne K Mongiu","doi":"10.1055/s-0045-1807741","DOIUrl":"10.1055/s-0045-1807741","url":null,"abstract":"Low anterior resection syndrome (LARS) is a constellation of symptoms consisting of stool or flatus incontinence, urgency, and/or clustering of bowel movements. Up to 80% of patients experience these symptoms after sphincter-sparing surgery for rectal cancer with concomitant decrease in quality of life. Multiple measurement tools have been developed and different treatment options have been explored. The purpose of this review was to evaluate LARS assessment tools, treatment options, and the supporting evidence for these strategies. We performed a literature review related to the evaluation and treatment of LARS, and ongoing clinical trials up to 2024 were reviewed. We found the definition of LARS was recently revised, with current validated diagnostic tools lagging behind this update. First-line treatment includes optimizing bowel habits, dietary changes, and medications. Second-line treatment includes pelvic floor rehabilitation or transanal irrigation. Third-line treatment includes sacral nerve stimulation or posterior tibial nerve stimulation before the discussion of antegrade enemas or permanent stoma creation. In summary, LARS remains a challenging symptomatic disorder to capture and treat effectively. There are opportunities for better standardization of preoperative education, evaluation, and escalation of treatment strategies. Further investigation into psychosocial and patient support adjuncts need to be developed. Continued research will help to refine and develop a clear treatment algorithm.","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"39 1","pages":"70-82"},"PeriodicalIF":1.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

General Principles of Risk Mitigation before Colorectal Surgery. 结直肠手术前降低风险的一般原则。

IF 1.6 4区医学

Clinics in Colon and Rectal Surgery Pub Date : 2025-04-16 eCollection Date: 2026-01-01 DOI: 10.1055/s-0045-1807736

Sarah Atoui, A Sender Liberman

{"title":"General Principles of Risk Mitigation before Colorectal Surgery.","authors":"Sarah Atoui, A Sender Liberman","doi":"10.1055/s-0045-1807736","DOIUrl":"10.1055/s-0045-1807736","url":null,"abstract":"Preoperative risk mitigation is vital for improving surgical outcomes and patient safety, particularly in colorectal cancer (CRC) surgeries. While traditional approaches have primarily focused on postoperative care, the preoperative period is a unique opportunity for intervention to enhance patients' physiological readiness for surgery and minimize complications. This narrative review examines the general principles of preoperative risk mitigation, identifies common complications in colorectal surgery, and explores the impact of patient comorbidities on surgical outcomes. Additionally, the review discusses the strategic management of modifiable risk factors. The integration and impact of prehabilitation protocols in colorectal surgery are also evaluated. Evidence indicates that addressing modifiable preoperative risk factors can significantly improve surgical outcomes. Obesity management, nutritional optimization, and enhancing functional capacity through prehabilitation have been shown to reduce postoperative complications. Multimodal prehabilitation benefits high-risk and frail patients, improving their postoperative recovery and reducing complication rates. The preoperative period is crucial for implementing risk mitigation strategies to enhance surgical outcomes in CRC patients. Interventions targeting modifiable risk factors and integrating prehabilitation protocols can complement traditional postoperative care, improving recovery and reducing complications. Despite promising findings, further research is necessary to fully understand the long-term benefits and optimize preoperative interventions to mitigate postoperative morbidities effectively.","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"39 1","pages":"15-23"},"PeriodicalIF":1.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sexual Dysfunction after Colorectal Surgery. 结直肠手术后性功能障碍。

IF 1.6 4区医学

Clinics in Colon and Rectal Surgery Pub Date : 2025-04-16 eCollection Date: 2026-01-01 DOI: 10.1055/s-0045-1807737

Sophia Zigouras, James P Taylor

引用次数: 0

Things that go Bump in the Night: Rare, Severe, and Long-term Complications after Colorectal Surgery. 夜间发生的事情：结直肠手术后罕见、严重和长期的并发症。

IF 1.6 4区医学

Clinics in Colon and Rectal Surgery Pub Date : 2025-04-09 eCollection Date: 2026-01-01 DOI: 10.1055/s-0045-1807278

Ira L Leeds

引用次数: 0

Preoperative Risk Stratification for Major Events. 术前重大事件的风险分层。

IF 1.6 4区医学

Clinics in Colon and Rectal Surgery Pub Date : 2025-04-07 eCollection Date: 2026-01-01 DOI: 10.1055/s-0045-1807280

Trevor Wood, Jonathan M Stem

{"title":"Preoperative Risk Stratification for Major Events.","authors":"Trevor Wood, Jonathan M Stem","doi":"10.1055/s-0045-1807280","DOIUrl":"10.1055/s-0045-1807280","url":null,"abstract":"The preoperative assessment of surgical patients, including colorectal patients, has undergone significant changes over the last 20 years. The rationale for such changes is based on evidence-based guidelines that showed a minimal clinical impact from broad base testing in healthy patients. Additionally, nonselective testing has been shown to be a large economic burden to the American health care system. As such, a tailored approach based on risk stratification is recommended rather than a \"standard, one-size-fits-all\" approach. This article will review current risk stratification and preoperative evaluation strategies for patients undergoing elective colorectal surgery. Emphasis will be given to areas in which preoperative optimization strategies may be employed to minimize operative risks. We will review the role and need of preoperative testing in specific patient populations and highlight situations where preoperative evaluation impacts operative timing and planning. Specifically, emphasis will be placed on strategies for mitigation of major adverse cardiac events. The aim is to provide a framework that allows for safe and responsible preoperative assessment.","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"39 1","pages":"9-14"},"PeriodicalIF":1.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ira L. Leeds, MD, MBA, ScM, FACS, FASCRS. Ira L. Leeds， MD， MBA, ScM， FACS， FASCRS。

IF 1.1 4区医学

Clinics in Colon and Rectal Surgery Pub Date : 2025-04-03 eCollection Date: 2026-01-01 DOI: 10.1055/s-0045-1807276

Scott R Steele

引用次数: 0

Optimizing Colorectal Surgery Outcomes: The Role of the Advanced Practice Provider (APP) in Developing a Center for Pelvic Floor Disorders and Maximizing Scope of Practice for APPs. 优化结直肠手术结果：高级实践提供者（APP）在建立盆底疾病中心和最大化APP实践范围中的作用。

IF 1.6 4区医学

Clinics in Colon and Rectal Surgery Pub Date : 2025-03-12 eCollection Date: 2025-11-01 DOI: 10.1055/s-0045-1804515

Holly Bonnette, Lieba R Savitt

{"title":"Optimizing Colorectal Surgery Outcomes: The Role of the Advanced Practice Provider (APP) in Developing a Center for Pelvic Floor Disorders and Maximizing Scope of Practice for APPs.","authors":"Holly Bonnette, Lieba R Savitt","doi":"10.1055/s-0045-1804515","DOIUrl":"10.1055/s-0045-1804515","url":null,"abstract":"Many patients with pelvic floor disorders who are referred to colorectal surgery do not actually need surgery. The Massachusetts General Hospital (MGH) Center for Pelvic Floor Disorders (PFDC) was established in 2008 out of a recognition of the need for a specialized comprehensive treatment for patients living with a pelvic floor disorder. To describe the model that we have created utilizing advanced practice providers (APPs) within the PFDC at the MGH as an example of a model of care for patients who historically may have been managed by colorectal surgeons. The utilization of APPs in surgery has increased, which in turn has had positive effects on patient care and can help reduce the demands put on surgeons to see patients who ultimately do not end up having surgery. There is also a potential for both direct and indirect revenue production through the utilization of APPs at the top of their scope of practice as well as increased access to care for these patients. Training APPs to work at the top of their scope within a surgical practice increases patient's access to care, allows surgeons to focus on those who ultimately require surgery, and can lead to better patient outcomes at a reduced healthcare cost. In order for this symbiotic relationship between APPs and surgeons to be successful, it is essential that there is mutual collaboration and trust between providers. It requires commitment from surgeons to appropriately train their APPs.","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"411-416"},"PeriodicalIF":1.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How to Best Measure and Characterize Symptoms of Patients with Pelvic Floor Disorders. 如何最好地测量和表征盆底疾病患者的症状。

IF 1.6 4区医学

Clinics in Colon and Rectal Surgery Pub Date : 2025-03-05 eCollection Date: 2025-11-01 DOI: 10.1055/s-0045-1804513

Goda Savulionyte, Liliana Bordeianou

{"title":"How to Best Measure and Characterize Symptoms of Patients with Pelvic Floor Disorders.","authors":"Goda Savulionyte, Liliana Bordeianou","doi":"10.1055/s-0045-1804513","DOIUrl":"10.1055/s-0045-1804513","url":null,"abstract":"Pelvic floor disorders (PFDs) are common and can be associated with various symptoms, including fecal incontinence, constipation, urinary incontinence, lower urinary tract symptoms, sexual dysfunction, and pelvic pain. Characterizing symptoms can be challenging due to limitations in patient reporting, provider ability to collect data, and the instruments used to collect the data. Symptoms are assessed using patient-reported outcome measures (PROMs), instruments that can be generic or disease-specific. Here, we describe the frequently used and recommended instruments for assessing symptoms of PFDs. We review the Pelvic Floor Disorders Consortium (PFCD) consensus document called IMPACT (Initial Measurement of Patient-reported Pelvic Floor Complaints Tool), a collection of recommended instruments in their unaltered form as well as within a consolidated short form. A multidisciplinary approach to patient care and interpretation of data is important to best characterize symptoms of PFDs. Future steps should include further collaborating across specialties and with patients to develop more condition-specific and patient-centered PROMs.","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"369-374"},"PeriodicalIF":1.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0