Seminars in Colon and Rectal Surgery最新文献_第2页

Baseline assessment of rectal cancer – how baseline features affect contemporary management of rectal cancer 直肠癌的基线评估——基线特征如何影响当代直肠癌的治疗

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-06-01 Epub Date: 2026-06-25 DOI: 10.1016/j.scrs.2026.101173

Monique Maas MD PhD

{"title":"Baseline assessment of rectal cancer – how baseline features affect contemporary management of rectal cancer","authors":"Monique Maas MD PhD","doi":"10.1016/j.scrs.2026.101173","DOIUrl":"10.1016/j.scrs.2026.101173","url":null,"abstract":"<div><div>Treatment strategies for primary rectal cancer have evolved from a uniform surgical approach with total mesorectal excision (TME) toward increasingly personalized, risk-adapted strategies aimed at long-term local and distant control but also organ preservation. This shift has fundamentally changed the role of baseline MRI, from purely anatomical staging toward imaging-driven treatment selection. At primary staging, the key clinical question is no longer only resectability, but whether escalation, de-escalation, or organ-preserving strategies are appropriate. Therefore, radiologists plays a pivotal role in identifying prognostic and predictive imaging features that guide treatment decisions. These include tumor subtype, height and location using the sigmoid take-off, depth of extramural invasion, involvement of the mesorectal fascia, and invasion beyond the mesorectal compartment. In addition, pathways of tumor spread such as extramural venous invasion (EMVI), tumor deposits, and nodal disease (including lateral node involvment) are critical factors in staging and treatment. As EMVI and tumor deposits have emerged as stronger predictors of outcome than mesorectal nodal status, recent guidelines have reduced the emphasis on detailed cN subclassification while stressing the importance of reporting high-risk features that directly influence neoadjuvant treatment selection. Accurate identification and communication of these findings are essential for multidisciplinary decision-making. Given the central role of MRI in contemporary rectal cancer management, radiologists must move beyond structured anatomical reporting toward decision-oriented interpretation and take on an active role in multidisciplinary teams. Future advances in integrated diagnostics will further strengthen the radiologist’s role in personalized rectal cancer treatment.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 2","pages":"Article 101173"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148776564","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

A plea for local excision as the initial treatment strategy 请求局部切除作为初始治疗策略

IF 0.8

Seminars in Colon and Rectal Surgery Pub Date : 2026-06-01 Epub Date: 2026-07-09 DOI: 10.1016/j.scrs.2026.101179

R. Hompes MD, PhD, J.B. Tuynman

{"title":"A plea for local excision as the initial treatment strategy","authors":"R. Hompes MD, PhD, J.B. Tuynman","doi":"10.1016/j.scrs.2026.101179","DOIUrl":"10.1016/j.scrs.2026.101179","url":null,"abstract":"<div><div>The widespread implementation of colorectal cancer screening has led to a substantial increase in the diagnosis of early-stage rectal cancer, necessitating treatment strategies that maximize organ preservation without compromising oncological outcomes. Although total mesorectal excision (TME) remains the standard of care, its considerable morbidity and long-term functional consequences contrast with the relatively low risk of lymph node metastasis in appropriately selected early rectal cancers. This review advocates a local excision first strategy as the preferred initial approach for early rectal cancer. Beyond its therapeutic role, local excision provides definitive histopathological staging, enabling individualized risk stratification and selective escalation to completion TME, adjuvant chemoradiotherapy, or close surveillance when indicated. Contemporary evidence demonstrates that this stepwise, risk-adapted approach achieves high rates of organ preservation while maintaining excellent oncological outcomes. Advances in local excision techniques, imaging, and pathological risk assessment have further strengthened this paradigm. Local excision should therefore be regarded not as an alternative to radical surgery, but as the cornerstone of modern management for early rectal cancer, reserving radical treatment for the minority of patients who truly require it.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 2","pages":"Article 101179"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148776565","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

The Evolving Role of Organ Preservation in Locally Advanced Rectal Cancer 器官保存在局部晚期直肠癌中的作用

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Seminars in Colon and Rectal Surgery Pub Date : 2026-06-01 Epub Date: 2026-06-09 DOI: 10.1016/j.scrs.2026.101170

Megan Delisle, Kilian G.M. Brown, Kelly Sanders, J. Joshua Smith

{"title":"The Evolving Role of Organ Preservation in Locally Advanced Rectal Cancer","authors":"Megan Delisle, Kilian G.M. Brown, Kelly Sanders, J. Joshua Smith","doi":"10.1016/j.scrs.2026.101170","DOIUrl":"10.1016/j.scrs.2026.101170","url":null,"abstract":"<div><div>Organ preservation is a standard-of-care option for select patients with locally advanced rectal cancer, allowing avoidance of a proctectomy without compromising oncologic outcomes. As compared with (chemo)radiation alone, total neoadjuvant therapy, which delivers both (chemo)radiation and chemotherapy before surgery, increases clinical complete (cCR) and near clinical complete (nCR) response rates and may expand eligibility for organ preservation. Eligibility is determined through a standardized response assessment, which incorporates digital rectal examination, endoscopy, and rectal protocol magnetic resonance imaging, which are performed and interpreted by experienced clinicians. Patients with a cCR/nCR may defer immediate surgery with the view to potential organ preservation, provided they adhere to intensive ‘watch and wait’ surveillance every 3–6 months for 5 years to enable early detection of local regrowth and timely salvage. In carefully selected patients managed within experienced programs, organ preservation achieves oncologic outcomes comparable to immediate surgery and may improve functional and quality-of-life outcomes. Ongoing research focuses on personalizing neoadjuvant therapy to balance response and toxicity and on developing more accurate and feasible approaches for detecting residual disease and regrowth.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 2","pages":"Article 101170"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148775937","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

Local excision as a component of organ preservation in rectal cancer 直肠癌局部切除作为器官保存的一个组成部分

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Seminars in Colon and Rectal Surgery Pub Date : 2026-06-01 Epub Date: 2026-06-16 DOI: 10.1016/j.scrs.2026.101172

Barbara Noiret MD, Quentin Denost MD, PhD

{"title":"Local excision as a component of organ preservation in rectal cancer","authors":"Barbara Noiret MD, Quentin Denost MD, PhD","doi":"10.1016/j.scrs.2026.101172","DOIUrl":"10.1016/j.scrs.2026.101172","url":null,"abstract":"<div><h3>Background</h3><div>The management of rectal cancer has evolved with the widespread adoption of total neoadjuvant therapy, leading to higher rates of tumor regression and complete response. While total mesorectal excision (TME) remains the oncologic standard, it is associated with substantial short- and long-term functional morbidity. These developments have prompted increasing interest in organ-preservation (OP) strategies, in which local excision (LE) plays an increasingly important role.</div></div><div><h3>Methods</h3><div>This narrative review summarizes current evidence on OP strategies centered on LE, including the impact of neoadjuvant treatment, available surgical techniques, indications across clinical scenarios, and functional and oncologic outcomes.</div></div><div><h3>Results</h3><div>In carefully selected patients, LE provides acceptable oncologic outcomes in early rectal cancer and in good responders after neoadjuvant therapy. Within response-adapted strategies, LE facilitates pathological assessment of tumor response and allows rectal preservation in a substantial proportion of patients, with lower morbidity and improved functional outcomes compared with TME. LE may also be used selectively for local regrowth within watch-and-wait protocols, acknowledging the higher morbidity associated with completion surgery when required.</div></div><div><h3>Conclusions</h3><div>LE is an integral component of contemporary, response-driven rectal cancer management. When appropriately selected and discussed within a multidisciplinary framework, it supports OP while maintaining oncologic safety and limiting long-term functional impairment.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 2","pages":"Article 101172"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148775938","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

Radiation‑sparing strategies in rectal cancer: Avoiding LARS without compromising oncologic outcomes 直肠癌的放射保护策略：避免LARS而不影响肿瘤预后

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Seminars in Colon and Rectal Surgery Pub Date : 2026-06-01 Epub Date: 2026-07-11 DOI: 10.1016/j.scrs.2026.101180

Zarrukh Baig MD MPH, Carl Brown MD MSc

引用次数: 0

Postoperative venous thromboembolism after colon and rectal surgery 结肠和直肠手术后静脉血栓栓塞

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Seminars in Colon and Rectal Surgery Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI: 10.1016/j.scrs.2025.101163

Hannah K. Holland MD , Timothy J. Ridolfi MD, MS

引用次数: 0

Nonhealing perineal wounds: Current strategies and emerging therapies 会阴不愈合伤口：当前的策略和新出现的治疗方法

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Seminars in Colon and Rectal Surgery Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI: 10.1016/j.scrs.2025.101161

Laura M. Nicolais MD , Gerald Gantt MD

引用次数: 0

Perineal Hernias: Diagnosis and surgical management 会阴疝：诊断和外科治疗

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Seminars in Colon and Rectal Surgery Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI: 10.1016/j.scrs.2025.101162

Ahad Azimuddin , Saieesh A. Rao , Mohammad Ali Abbass

{"title":"Perineal Hernias: Diagnosis and surgical management","authors":"Ahad Azimuddin , Saieesh A. Rao , Mohammad Ali Abbass","doi":"10.1016/j.scrs.2025.101162","DOIUrl":"10.1016/j.scrs.2025.101162","url":null,"abstract":"<div><div>Perineal hernias are an uncommon but clinically significant condition faced by the colorectal surgeon, commonly as a complication following abdominoperineal resection or pelvic exenteration. Clinical presentation varies based on hernia size and contents, often involving gastrointestinal or urinary symptoms. Diagnosis primarily relies on clinical examination and cross-sectional imaging, with computed tomography as the preferred modality in acute settings. Although rare, perineal hernias can result in serious complications, including enterocutaneous fistulas, bowel obstruction, and herniation of pelvic organs. Management requires an individualized surgical approach based on defect size, hernia contents, and patient factors. Abdominal approaches, particularly open approaches, tend to offer lower recurrence rates compared to perineal repairs but are associated with longer recovery times. Mesh reinforcement is generally preferred for large defects, while flap reconstruction remains crucial for radiated or complex surgical fields. Despite advances in technique, recurrence remains a challenge, particularly following primary suture repairs. Reconstructions with synthetic mesh via abdominal or perineal approaches, with or without flaps, may provide the best outcomes.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 1","pages":"Article 101162"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147408063","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

Postoperative adrenal insufficiency and perioperative steroid management 术后肾上腺功能不全及围手术期类固醇治疗

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Seminars in Colon and Rectal Surgery Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI: 10.1016/j.scrs.2025.101159

Lucille Y. Yao, Lisa M. Cannon

引用次数: 0

Postoperative ileus 术后肠梗阻

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Seminars in Colon and Rectal Surgery Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI: 10.1016/j.scrs.2025.101160

Carine Dornbush MD , Jennifer Hrabe MD FACS FACRS

引用次数: 0