{"title":"Surgery for uncomplicated pilonidal disease: simpler is better","authors":"Clara Tellez MD , Miguel Pera MD, PhD","doi":"10.1016/j.scrs.2022.100912","DOIUrl":"10.1016/j.scrs.2022.100912","url":null,"abstract":"<div><p><span><span>Chronic pilonidal disease<span> continues to be a therapeutic challenge. Discrepancies in technique, recurrence rates, complications, time to return to work/school, and patient's aesthetic satisfaction between the various treatment options have led to controversy over the best approach. It is undeniable that the best technique should strike a balance between recurrence and surgical morbidity. Despite the plethora of various complex surgical options, it seems that one of the oldest and simplest methods such as </span></span>incision and </span>curettage can balance the various desirable outcomes without excessive morbidity. In this manuscript, we review the literature and the evidence supporting this surgical procedure. We conclude that incision and curettage should be considered as the initial option for most patients with chronic uncomplicated pilonidal disease, and that more complex surgical options should be reserved for severe and recurrent cases.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 4","pages":"Article 100912"},"PeriodicalIF":0.3,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41557472","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}
Maureen Elvira P. Villanueva MD , Hermogenes J. Monroy MD , Marc Paul J. Lopez MD , Jeryl Anne Silvia R. Reyes MD , Romulo R. Cabantac III MD , Maynard Hernal MD , Mary Anne Carol A. Cueto MD
{"title":"Management of pilonidal disease in colorectal surgery training programs in the Philippines","authors":"Maureen Elvira P. Villanueva MD , Hermogenes J. Monroy MD , Marc Paul J. Lopez MD , Jeryl Anne Silvia R. Reyes MD , Romulo R. Cabantac III MD , Maynard Hernal MD , Mary Anne Carol A. Cueto MD","doi":"10.1016/j.scrs.2022.100917","DOIUrl":"10.1016/j.scrs.2022.100917","url":null,"abstract":"<div><p>In this study, we review the clinical course of patients treated for pilonidal disease<span> in the various colorectal surgery training institutions in the Philippines. As part of this review, we aimed to determine the surgical training practice pattern for this rarely encountered disorder in the Philippines.</span></p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 4","pages":"Article 100917"},"PeriodicalIF":0.3,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42635997","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}
D. Doll MD, PhD , Lt Marius Dettmer , F. Schumacher FSJ , M. Maak MD, PhD , D. Wilhelm MD, PhD
{"title":"Seven ideas for potential prevention of pilonidal disease and future research","authors":"D. Doll MD, PhD , Lt Marius Dettmer , F. Schumacher FSJ , M. Maak MD, PhD , D. Wilhelm MD, PhD","doi":"10.1016/j.scrs.2022.100919","DOIUrl":"10.1016/j.scrs.2022.100919","url":null,"abstract":"<div><p><span>Our understanding of the pathophysiology of </span>pilonidal disease continues to evolve. In this manuscript we would like to review the current thinking about plausible causes of pilonidal disease. Based on our current understanding of this benign disorder, we offer seven potential strategies to minimize the development of symptomatic disease and recurrence. Finally, we share some ideas about future research.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 4","pages":"Article 100919"},"PeriodicalIF":0.3,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45370906","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}
{"title":"Robotic and advanced endoscopic approaches to transanal surgery","authors":"Garrett Friedman MD , Katherine Specht DO","doi":"10.1016/j.scrs.2022.100898","DOIUrl":"10.1016/j.scrs.2022.100898","url":null,"abstract":"<div><p><span>Transanal approaches are an important modality for the diagnosis and treatment of rectal neoplasia while allowing for organ preservation. Choosing the appropriate surgical approach based on </span>anatomy, pathology, platform capabilities and surgical skill is paramount to success. In this article we review preoperative considerations, the present options for transanal approach and the relative advantages and disadvantages they each offer. We will focus on advanced transanal options including robotic-assisted approaches and endoscopic submucosal resection.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 3","pages":"Article 100898"},"PeriodicalIF":0.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43264254","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}
{"title":"The history of transanal surgery","authors":"Sean M. Stokes MD, MS , Jessica N. Cohan MD, MAS","doi":"10.1016/j.scrs.2022.100895","DOIUrl":"10.1016/j.scrs.2022.100895","url":null,"abstract":"<div><p>Transanal excision is an important approach in the management of diseases of the rectum. Most notably, advances in transanal excision technique have evolved with efforts to safely excise rectal tumors. There have been many important advancements over the past several thousand years to reach this frontier. In this article, we review the interesting history behind transanal surgery. We begin with the ancient Egyptians and Greeks who performed transanal surgery with high mortality, and end with contemporary approaches, which minimize patient morbidity. Transanal surgery is now an accepted approach in selected patients as a result of overcoming three obstacles: 1) the ability to perform these operations safely; 2) the importance of performing an oncologically sound resection; and 3) technical advances in surgical exposure. What has resulted is a rapidly evolving new era in transanal surgery.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 3","pages":"Article 100895"},"PeriodicalIF":0.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47989996","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}
Liam A Devane , John P Burke , Justin J Kelly , Daniel J Galante , Matthew R Albert
{"title":"Transanal minimally invasive surgery (TAMIS) for rectal cancer","authors":"Liam A Devane , John P Burke , Justin J Kelly , Daniel J Galante , Matthew R Albert","doi":"10.1016/j.scrs.2022.100897","DOIUrl":"10.1016/j.scrs.2022.100897","url":null,"abstract":"<div><p>Transanal minimally invasive surgery<span><span><span> (TAMIS) is a technique that allows high quality local excision of benign </span>rectal neoplasms and early-stage </span>rectal cancers. These lesions can be located more proximal that those treated with conventional transanal excision. Operative costs are minimized and access to the technique is expanded with utilization of conventional laparoscopic instruments. Good oncologic outcomes can be achieved for local excision of early rectal cancers, but its role in the surgical treatment of more advanced tumors is still being evaluated. As with all surgical techniques, appropriate training must be ensured and continued assessment of oncologic outcomes maintained.</span></p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 3","pages":"Article 100897"},"PeriodicalIF":0.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46056153","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}
Doreen Chang MD, Aurian P. García González MD, PhD, John Migaly MD
{"title":"Management of neuroendocrine tumors of the rectum","authors":"Doreen Chang MD, Aurian P. García González MD, PhD, John Migaly MD","doi":"10.1016/j.scrs.2022.100901","DOIUrl":"https://doi.org/10.1016/j.scrs.2022.100901","url":null,"abstract":"<div><p><span><span>Rectal neuroendocrine tumors (NETs) have increased in prevalence due to increased detection via endoscopic screening for </span>colorectal neoplasia<span>, advances and availability of imaging tools along with the indolent nature of the tumor. Imaging techniques<span> to identify rectal NETs include computed tomography<span>, magnetic resonance imaging, and endoscopic rectal ultrasound. Rectal NETs are typically categorized by tumor size to determine if they should undergo endoscopic resection<span>, local excision or transanal excision, or a </span></span></span></span></span>radical resection<span>, as per National Comprehensive Cancer Network guidelines. However, while examining the literature, multiple studies have examined outcomes for patients who did not adhere to these guidelines and had similar recurrence rates and survival as those patients who did. Therefore, we propose less aggressive treatment for rectal NETs in the absence of adverse features.</span></p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 3","pages":"Article 100901"},"PeriodicalIF":0.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138257597","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}
{"title":"Neoadjuvant and adjuvant therapy for local excision of rectal cancer","authors":"Yael Feferman MD, Julio Garcia-Aguilar MD, PhD","doi":"10.1016/j.scrs.2022.100900","DOIUrl":"10.1016/j.scrs.2022.100900","url":null,"abstract":"<div><p><span><span>Local excision (LE) for early-stage </span>rectal cancer<span> is an attractive option compared to total mesorectal excision<span> (TME), as it avoids many of the significant comorbidities and adverse functional outcomes associated with TME. However, LE for tumors with high-risk histopathologic features can lead to unacceptably high rates of local and distant recurrence. Neoadjuvant or adjuvant chemoradiotherapy can mitigate those risks in certain clinical settings and may expand the number of patients who can be safely treated with an organ-preserving approach. In this chapter, we will explore the available date supporting the use of neoadjuvant and adjuvant </span></span></span>chemoradiation<span> (CRT) for the treatment of high-risk early-stage rectal cancer and will discuss future studies that aim to answer some of the ongoing clinical questions related to this practice.</span></p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 3","pages":"Article 100900"},"PeriodicalIF":0.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44488317","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}
{"title":"Transanal approaches to rectal neoplasia","authors":"Meagan Read MD, Seth Felder MD","doi":"10.1016/j.scrs.2022.100899","DOIUrl":"10.1016/j.scrs.2022.100899","url":null,"abstract":"<div><p><span><span>Local excision is a well-tolerated, low risk, curative oncologic operative approach for highly selected early-stage </span>rectal cancers<span>. As with any cancer treatment, cure is balanced with morbidity and </span></span>quality of life<span>. In this respect, the best management for a patient with an early rectal cancer highlights the clinical dilemma balancing concerns for over- versus under-treatment. That is to say, radical resection<span> may be oncologically equivalent to local excision for true early stage cancer, yet, results in much greater morbidity, including the possibility of a permanent colostomy<span>. Alternatively, local excision of a presumed early rectal cancer may be oncologically inferior to mesorectal excision, potentially compromising the cancer outcome dramatically. Navigating between these two surgical extremes requires incorporation of multiple critical clinico-pathologic variables, including accurate clinical staging, precise tumor localization, careful histologic assessment to recognize higher risk features, and patient fitness and preference.</span></span></span></p><p>While pelvic failure following local excision is generally more common than after radical resection, the gap between disease-free and overall survival is not quite as wide, particularly among lower-risk pT1Nx cancers in patients following LE. The lack of histologic lymph node staging and reliance on imperfect imaging to risk estimate micrometastatic mesorectal nodal disease, the higher morbidity associated with completion mesorectal excision pursued for a histologically higher-risk early rectal cancer, and the greater risk of an extended resection at salvage operation for locoregional recurrence collectively emphasize the degree of caution when considering a more limited excisional operative approach.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 3","pages":"Article 100899"},"PeriodicalIF":0.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44079420","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}
{"title":"Conventional transanal excision","authors":"Hallie Baer MD , Jennifer Paruch MD, MS","doi":"10.1016/j.scrs.2022.100896","DOIUrl":"10.1016/j.scrs.2022.100896","url":null,"abstract":"<div><p>Conventional transanal excision allows a direct endoluminal approach through a natural orifice, avoiding the life altering presence of a stoma and associated morbidity and mortality of transabdominal surgery. Benign polyps and early-stage rectal cancer within the low to mid rectum can be definitively treated with transanal excision, with few complications, typically in an outpatient fashion. Other minimally invasive approaches outlined in this issue may demonstrate less specimen fragmentation, higher rate of negative margins, and decreased recurrence, but are often impractical for excising lesions in the low rectum.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 3","pages":"Article 100896"},"PeriodicalIF":0.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42854649","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}
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