Seminars in Colon and Rectal Surgery最新文献

Management of rectal cancer in Lynch syndrome and polyposis syndromes 直肠癌Lynch综合征和息肉病综合征的处理

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-09-01 Epub Date: 2026-07-01 DOI: 10.1016/j.scrs.2026.101176

Jeongyoon Moon MD, MS

{"title":"Management of rectal cancer in Lynch syndrome and polyposis syndromes","authors":"Jeongyoon Moon MD, MS","doi":"10.1016/j.scrs.2026.101176","DOIUrl":"10.1016/j.scrs.2026.101176","url":null,"abstract":"<div><div>Rectal cancer arising in hereditary cancer syndromes requires highly individualized, multidisciplinary management that extends well beyond the principles applicable to sporadic disease. In Lynch syndrome (LS), surgical decision-making should incorporate the evolving role of immunotherapy, including organ preservation, taking into account the patient's lifelong risk of metachronous colorectal and extracolonic malignancies. In polyposis syndromes, total proctocolectomy is the cornerstone of surgical management, with reconstructive decisions shaped by radiation history, desmoid tumor risk, fertility considerations, and baseline anorectal function. In both settings, the rarity of hereditary rectal cancer presentations underscores the importance of centralizing care at experienced hereditary cancer programs with dedicated multidisciplinary expertise. Several critical questions define the future research agenda. In LS, as the role of immunotherapy continues to expand, organ preservation may be feasible across a wider range of clinical stages. The optimal extent of surgery for LS-associated rectal cancer (proctectomy versus total proctocolectomy) remains debated, and increasingly granular germline genotyping may allow the extent of resection to be tailored to the individual patient's metachronous colon cancer risk. Equally important are dedicated quality of life and functional outcome data following immunotherapy, including effects on bowel, urinary, and sexual function, outcomes after salvage surgery, and comparative outcomes between nonoperative management and radical resection .[40] In polyposis syndromes, desmoid disease remains one of the least evidence-based areas of surgical management in familial adenomatous polyposis (FAP). Randomized data are lacking to guide medical therapy selection, thresholds for operative intervention, and reconstructive strategies in the setting of established desmoid disease. Addressing these challenges will require large-scale, collaborative, registry-based research efforts with syndrome-specific outcome reporting.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 3","pages":"Article 101176"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hamartomatous polyposis syndromes: diagnosis, surveillance, and operative management for the surgeon 错构瘤性息肉综合征：外科医生的诊断、监测和手术管理

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-09-01 Epub Date: 2026-07-16 DOI: 10.1016/j.scrs.2026.101188

Elissa Dabaghi MD, Michael Cruise MD, PhD, David Liska MD

{"title":"Hamartomatous polyposis syndromes: diagnosis, surveillance, and operative management for the surgeon","authors":"Elissa Dabaghi MD, Michael Cruise MD, PhD, David Liska MD","doi":"10.1016/j.scrs.2026.101188","DOIUrl":"10.1016/j.scrs.2026.101188","url":null,"abstract":"<div><div>Hamartomatous polyposis syndromes (HPS) are rare autosomal dominant conditions characterized by multiple gastrointestinal hamartomatous polyps and an elevated risk of gastrointestinal and extraintestinal malignancies. The three major HPS, including juvenile polyposis syndrome (JPS), Peutz-Jeghers syndrome (PJS), and PTEN hamartoma tumor syndrome (PHTS), each have distinct genotypes, polyp distributions, histopathological features, and cancer risk profiles with direct implications for surveillance and operative management. This review provides a comprehensive, surgically focused overview of JPS, PJS, and PHTS, with an emphasis on genotype-phenotype correlations, endoscopic surveillance, and surgical decision-making. Lifelong endoscopic surveillance and polypectomy remain the primary approach for all three syndromes, with surgery reserved for endoscopically unmanageable polyposis, refractory symptoms, or malignancy. Surgical indications and operative approach vary by syndrome, with total abdominal colectomy with ileorectal anastomosis favored for JPS, intraoperative enteroscopy and “clean sweep” technique playing a critical role in PJS, and individualized segmental or total colectomy guided by polyp distribution and histology in PHTS. Cascade testing of at-risk family members is critical to facilitate timely surveillance and appropriate intervention. Chemoprevention remains investigational across all three HPS, although emerging data on mTOR inhibitors and other targeted agents show promise. These syndromes are best managed at specialized hereditary colorectal cancer centers with multidisciplinary expertise.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 3","pages":"Article 101188"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Serrated polyposis and the less common polyposis syndromes 锯齿状息肉病和不常见的息肉病综合征

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-09-01 Epub Date: 2026-07-24 DOI: 10.1016/j.scrs.2026.101190

Mary Smithson MD, Robert H. Hollis MD, MSPH

引用次数: 0

Chemoprevention and chemo-suppression in hereditary colorectal cancer syndromes 遗传性结直肠癌综合征的化学预防和化学抑制

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-09-01 Epub Date: 2026-07-24 DOI: 10.1016/j.scrs.2026.101191

Sara Keshavjee MD, Mohammad Ali Abbass MD, MPH

引用次数: 0

Genetic risk assessment for hereditary colorectal cancer and polyposis: updates and clinical implications 遗传性结直肠癌和息肉病的遗传风险评估：最新进展和临床意义

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-09-01 Epub Date: 2026-07-08 DOI: 10.1016/j.scrs.2026.101178

Maureen E. Mork, Julie Moskowitz, Jessica M. Long

{"title":"Genetic risk assessment for hereditary colorectal cancer and polyposis: updates and clinical implications","authors":"Maureen E. Mork, Julie Moskowitz, Jessica M. Long","doi":"10.1016/j.scrs.2026.101178","DOIUrl":"10.1016/j.scrs.2026.101178","url":null,"abstract":"<div><div>Identification of hereditary colorectal cancer (CRC) predisposition prompts important healthcare considerations for affected individuals and at-risk relatives. Approximately 5–10% of CRC cases are attributable to known hereditary syndromes, with higher prevalence among early-onset cases. Lynch syndrome remains the most common cause, while adenomatous and hamartomatous polyposis syndromes account for additional sources of hereditary CRC risk. Given overlapping phenotypes across syndromes, multi-gene panel testing (MGPT) is essential to establish accurate molecular diagnoses and guide risk stratification, surveillance, and risk-reduction strategies. This narrative review summarizes hereditary CRC and polyposis syndromes, current and emerging strategies for genetic testing, and evolving models of care delivery. Indications for genetic evaluation are outlined based on personal and family history, tumor molecular features, and polyp burden, along with consideration of universal genetic testing in CRC. Emerging diagnostic approaches, such as RNA analysis, assessment of constitutional <em>MLH1</em> hypermethylation, and evaluation for mosaicism, are introduced as potential options for improved diagnostic yield in patients with unexplained but suggestive clinical presentations. Interpretation of genetic test results is discussed with emphasis on the substantive impact of cascade testing in relatives. Finally, alternative genetic service delivery models, including point-of-care and mainstreaming approaches, are introduced as potential means of enhancing access and scalability of cancer genetics services.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 3","pages":"Article 101178"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Desmoid disease in familial adenomatous polyposis 家族性腺瘤性息肉病的硬纤维瘤病

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-09-01 Epub Date: 2026-06-27 DOI: 10.1016/j.scrs.2026.101174

Nikita Wadhwani MD, Philip S. Bauer MD, Matthew F. Kalady MD

引用次数: 0

Extracolonic manifestations of Lynch syndrome and familial adenomatous polyposis Lynch综合征和家族性腺瘤性息肉病的结肠外表现

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-09-01 Epub Date: 2026-07-02 DOI: 10.1016/j.scrs.2026.101175

Timothy Yen, Ying Liu, Dimitrios N. Varvoglis, Swati G. Patel

引用次数: 0

CHAPTER: Upfront TME in locally advanced rectal cancer 第四章：局部晚期直肠癌的前期TME治疗

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-06-01 Epub Date: 2026-06-17 DOI: 10.1016/j.scrs.2026.101171

Laura Fernandez MD, PhD, José Azevedo MD, Mahmood Al-Dhaheri MD, Nahir Queiro MD, Miguel Cunha MD, Hugo Domingos MD, Richard Heald MD, Amjad Parvaiz MD

引用次数: 0

Contemporary multimodal treatment of rectal cancer 当代直肠癌的多模式治疗

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-06-01 Epub Date: 2026-08-07 DOI: 10.1016/j.scrs.2026.101199

Rodrigo Oliva Perez, Leonardo Ervolino Corbi, Guilherme Pagin São Julião, Bruna Borba Vailati, Fernanda Lopez Mazzucato Maloni, Angelita Habr-Gama

{"title":"Contemporary multimodal treatment of rectal cancer","authors":"Rodrigo Oliva Perez, Leonardo Ervolino Corbi, Guilherme Pagin São Julião, Bruna Borba Vailati, Fernanda Lopez Mazzucato Maloni, Angelita Habr-Gama","doi":"10.1016/j.scrs.2026.101199","DOIUrl":"10.1016/j.scrs.2026.101199","url":null,"abstract":"<div><div>Rectal cancer management has evolved quite significantly over time. From the initial surgery-only approach, the use of neoadjuvant chemoradiotherapy was included to address the local recurrence problem and ultimately led surgeons to avoid TME in patients who developed a complete clinical response. Advancements in MRI evaluation helped better stage patients and tailor their treatments. Progressively, chemotherapy was added to the neoadjuvant treatment in an effort to reduce distant recurrence: Total neoadjuvant therapy, which also led to higher complete response rates. Finally, immunotherapy showed promising results with excellent response in mismatch-repair deficient patients, adding yet another strategy in the multimodal treatment of the disease.</div><div>In the present contribution, we will attempt to provide the reader with available evidence to support contemporary management of rectal cancer using each one of the multimodality treatment alternatives (surgery, chemotherapy and radiation therapy) separately or in combination with a particular focus on optimal sequencing, taking into consideration oncological outcomes but also organ-preservation outcomes.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 2","pages":"Article 101199"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148775940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Contemporary management of rectal cancer: Lateral node dissection during rectal cancer surgery 当代直肠癌的处理：直肠癌手术中的侧结清扫

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-06-01 Epub Date: 2026-07-04 DOI: 10.1016/j.scrs.2026.101177

Tsuyoshi Konishi MD, PhD, Kentaro Ochiai MD, PhD

{"title":"Contemporary management of rectal cancer: Lateral node dissection during rectal cancer surgery","authors":"Tsuyoshi Konishi MD, PhD, Kentaro Ochiai MD, PhD","doi":"10.1016/j.scrs.2026.101177","DOIUrl":"10.1016/j.scrs.2026.101177","url":null,"abstract":"<div><div>Management of lateral pelvic lymph nodes remains one of the most debated aspects of rectal cancer surgery. Historically, Western practice relied on neoadjuvant chemoradiotherapy and total mesorectal excision, whereas Japanese practice incorporated lateral lymph node dissection as a regional nodal procedure for advanced low rectal cancer. Contemporary evidence has narrowed this apparent East-West divide. Enlarged lateral nodes, particularly those measuring at least 7 mm in short-axis diameter on baseline magnetic resonance imaging, are associated with a clinically important risk of lateral local recurrence after chemoradiotherapy and total mesorectal excision alone. Selective lateral node dissection can substantially reduce this risk. However, treatment response is not binary. Nodes that shrink after chemoradiotherapy or total neoadjuvant therapy may still contain viable tumor, and downsizing alone should not automatically preclude surgery. Baseline nodal morphology, post-treatment size, nodal anatomical compartment, primary tumor height, overall tumor biology, patient fitness, and operative risk should all inform multidisciplinary decision making. Total neoadjuvant therapy improves primary tumor response but does not reliably sterilize clinically suspicious lateral nodes. Therefore, baseline short-axis diameter of 7 mm remains a reasonable practical threshold, while lower primary tumors and nodes with malignant morphologic features warrant heightened concern. Technically, lateral node dissection should be performed as a structured, plane-based, nerve-sparing operation. Because case volume is low outside referral centers, cadaveric training, video-based education, proctorship, and multidisciplinary quality assurance are essential for safe dissemination. This review summarizes the evidence supporting selective lateral node dissection in the modern era and proposes a practical framework for patient selection and technical implementation.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 2","pages":"Article 101177"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148775936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0