Neoadjuvant Chemotherapy Without Radiation for Locally Advanced Rectal Cancer: A Meta-analysis of Surgical Outcomes after Total Mesorectal Excision.

Background: Neoadjuvant chemotherapy alone (with radiation omission) for locally advanced rectal cancer has been evaluated in several randomized controlled trials. While oncologic outcomes have been well described, the impact of this treatment strategy on surgical outcomes is unknown.

Objective: To evaluate how important surgical outcomes were reported in previous trials comparing neoadjuvant chemotherapy to chemoradiation for locally advanced rectal cancer and to perform a meta-analysis of available data.

Impact of a Patient-centered Program for Low Anterior Resection Syndrome: A Multicenter, Single-blinded, Randomized Controlled Trial.

Objective: The objective of this study was to evaluate the impact of a low anterior resection syndrome (LARS) patient-centered program (LARS-PCP)-an informational and guided self-management intervention-on global quality of life (QoL) after surgery in comparison to standard care.

Background: Self-management using conservative measures is the cornerstone of LARS treatment; however, due to the individual and symptom-based nature of LARS, self-management largely consists of unguided troubleshooting with minimal success.

Methods: Adult patients who had undergone a restorative proctectomy with a diverting ostomy and who were scheduled for ostomy closure were randomized in a 1:1 ratio into 1 of 2 arms: LARS-PCP or standard care.

SAGES white paper on antibiotic omission in the management of acute uncomplicated diverticulitis: why, when, who, and most importantly, how.

Background: Historically, the management of acute uncomplicated diverticulitis was centered on antibiotics. However, modern theories regarding the pathogenesis of diverticulitis have challenged the notion that antibiotics are necessary in all cases. Despite major reform in many societal guidelines, the adoption of non-antibiotic therapy for uncomplicated diverticulitis has been limited, especially in North America.

Patients with class III obesity are at elevated risk of postoperative morbidity after surgery for left-sided diverticular disease: a retrospective population-level study.

Background: Although obesity is a well-established risk factor for the development of diverticular disease, studies focusing on the effect of body mass index (BMI) on postoperative outcomes require updating. This population-level retrospective cohort study was designed to evaluate the effect of BMI on postoperative outcomes after operative intervention for left-sided diverticular disease.

Methods: This was a population-based retrospective cohort study using the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) (September 1, 2015 to December 31, 2019).

Robotic-assisted surgery for locally advanced rectal cancer beyond total mesorectal excision planes: the Mayo Clinic experience.

Background: The purpose of this study was to evaluate the surgical and oncological outcomes of robotic-assisted beyond-TME surgery for locally advanced rectal cancer.

Methods: Consecutive adult (≥ 18 years old) patients who underwent a robotic-assisted proctectomy beyond-TME planes for primary or recurrent rectal cancer at three Mayo Clinic (USA) hospitals from 2017-2023 were included. Patient demographics and tumor and disease characteristics were obtained by review of the electronic health record.

The impact of an interactive online informational and peer support application (app) for patients with low anterior resection syndrome (LARS) on quality of life: a multicenter randomized controlled trial.

Introduction: Low Anterior Resection Syndrome (LARS) describes bowel dysfunction post-restorative proctectomy (RP) and is associated with poor quality of life (QoL). The aim of this study was to assess the impact of an interactive online informational and peer support App on participants' QoL (primary outcome), LARS, and emotional distress (secondary outcomes).

Methods: A multicentre, randomized, parallel-group trial was conducted across five Canadian colorectal surgery practices.

Postoperative bowel dysfunction in patients with rectal cancer - Does a minimally invasive surgical approach improve outcomes?

Introduction: The purpose of this study was to evaluate the association of MIS approaches for rectal cancer with long-term postoperative bowel dysfunction.

Materials And Methods: This was an Institutional Review Board-approved observational cohort study including consecutive patients with rectal or rectosigmoid cancer who underwent surgical resection between 2007 and 2017. The primary exposure was surgical approach, defined as open surgery or MIS (laparoscopy or robotic surgery).

Current Management of Diverticulitis.

Over the last few decades, our understanding of the pathophysiology and natural history of sigmoid diverticulitis has greatly improved. This knowledge has challenged many of the traditional principles in the management for diverticulitis, such as routine antibiotic administration in all cases, number-based recommendations for elective surgery, and the necessity for an end colostomy in emergency surgery. This review will cover the breadth of management for sigmoid diverticulitis, covering both uncomplicated and complicated disease as well as elective and emergent disease presentations.

Low Anterior Resection Syndrome following Restorative Proctectomy for Rectal Cancer: Can the Surgeon Have Any Meaningful Impact?

Postoperative bowel dysfunction following restorative proctectomy, commonly referred to as Low Anterior Resection Syndrome (LARS), is a common long term sequela of rectal cancer treatment. While many of the established risk factors for LARS are non-modifiable, others may be well within the surgeon's control. Several pre-, intra-, and postoperative decisions may have a significant impact on postoperative bowel function.

Is the Hartmann's procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 2018.

Background: Historically, Hartmann's procedure (HP) has been the operation of choice for diverticulitis in the emergency setting. However, recent evidence has demonstrated the safety of primary anastomosis (PA) with or without diverting ileostomy. The purpose of this study was to evaluate the trends of, and factors associated with, HP compared to PA in emergency surgery for diverticulitis over 25 years.

An online educational and supportive care application for rectal cancer survivors with low anterior resection syndrome: A mixed methods pilot study.

Aim: Restorative proctectomy is commonly associated with significant bowel dysfunction, known as low anterior resection syndrome (LARS), which has a negative impact on patients' quality of life. We developed an online patient-centred application on LARS (eLARS) for rectal cancer survivors. The primary objective of this study was to assess the feasibility of eLARS for rectal cancer survivors with LARS following restorative proctectomy.

Incidence and Factors Associated With Mental Health Disorders in Patients With Rectal Cancer Post-Restorative Proctectomy.

Background: Most patients with rectal cancer experience bowel symptoms post-restorative proctectomy. The incidence of mental health disorders post-restorative proctectomy and its association with bowel symptoms are unknown.

Objectives: This study aimed 1) to describe the incidence of mental health disorders in patients who underwent restorative proctectomy for rectal cancer and 2) to study the association between incident mental health disorders and bowel dysfunction after surgery.

Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded, randomized controlled trial.

Introduction: The objective of this study was to evaluate the impact of preoperative bowel stimulation on the development of postoperative ileus (POI) after loop ileostomy closure.

Methods: This was a multicenter, randomized controlled trial (NCT025596350) including adult (≥ 18 years old) patients who underwent elective loop ileostomy closure at 7 participating hospitals. Participants were randomly assigned (1:1) using a centralized computer-generated sequence with block randomization to either preoperative bowel stimulation or no stimulation (control group).

Consensus priority research questions in gastrointestinal and endoscopic surgery in the year 2020: results of a SAGES Delphi study.

Introduction: The objectives of this study were to identify consensus priority research questions according to members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and to explore differences in priorities according to specific membership subgroups.

Methods: A modified Delphi study was conducted including active members of SAGES. An initial list of research questions was compiled by members of 26 SAGES Committees and Task Forces, and was further refined by the SAGES Delphi Task Force.

Low Anterior Resection Syndrome: Predisposing Factors and Treatment.

Bowel dysfunction after restorative proctectomy, commonly referred to as Low Anterior Resection Syndrome (LARS), is a common long-term sequela of rectal cancer treatment that has a significant impact on a patient's quality of life. While the pathophysiology of LARS is poorly understood, its underlying cause that it is likely multifactorial, and there are numerous patient, tumor, and treatment-level factors associated with its development. In accordance with these risk factors, several strategies have been proposed to mitigate LARS postoperatively, including modifications in the technical approach to restorative proctectomy and advancements in the multidisciplinary care of rectal cancer.

Assessment of long-term bowel dysfunction after restorative proctectomy for neoplastic disease: A population-based cohort study.

Background: The purpose of this study was to describe postoperative bowel dysfunction after restorative proctectomy, and to identify factors associated with its development.

Methods: Patients who underwent restorative proctectomy for rectal cancer between April 1998 and November 2018 were identified from the Hospital Episode Statistics database and linked to the Clinical Practice Research Datalink for postoperative follow-up. Bowel dysfunction was defined according to relevant symptom-based read codes and medication prescription-product codes.

Long-term Implications of Persistent Diverticulitis: A Retrospective Cohort Study of 915 Patients.

Background: Persistent (or ongoing) diverticulitis is a well-recognized outcome after treatment for acute sigmoid diverticulitis; however, its definition, incidence, and risk factors, as well as its long-term implications, remain poorly described.

Objective: The purpose of this study was to assess the incidence, risk factors, and long-term outcomes of persistent diverticulitis.

Design: This was a retrospective cohort study.

Observational versus antibiotic therapy for acute uncomplicated diverticulitis: A non-inferiority meta-analysis based on a Delphi consensus.

Background: The purpose of this study was to determine if observational therapy is noninferior to antibiotics for acute uncomplicated diverticulitis according to clinically relevant margins.

Methods: MEDLINE, EMBASE, and Cochrane were systematically searched by 2 independent reviewers to identify comparative studies of observational therapy versus antibiotics for acute uncomplicated diverticulitis. Non-inferiority margins (ΔNI) for each outcome were based on Delphi consensus including 50 patients and 55 physicians: persistent diverticulitis (ΔNI = 4.

Financial and occupational impact of low anterior resection syndrome in rectal cancer survivors.

Aim: The aim of this study was to assess bowel-related financial stress and strain and to evaluate its association with global quality of life.

Method: This was a retrospective cohort study with cross-sectional follow-up including consecutive patients who underwent restorative proctectomy for neoplastic disease of the rectum at a single university-affiliated hospital in Montreal, Quebec, Canada. Bowel-related financial impact and occupational impact were compared between patients with major low anterior resection syndrome (LARS) and those with minor/no LARS.

Interactive online informational and peer support application for patients with low anterior resection syndrome: patient survey and protocol for a multicentre randomized controlled trial.

Aim: Low anterior resection syndrome (LARS) refers to a constellation of bowel symptoms that affect the majority of patients following restorative proctectomy. LARS is associated with poorer quality of life (QoL), and can lead to distress, anxiety and isolation. Peer support could be an important resource for people living with LARS, helping them normalize and validate their experience.