P. Terry Phang

There is growing interest in non-operative management (NOM) for rectal cancer patients who achieve a complete response to neoadjuvant therapy. The patients’ perspectives of these approaches are limited. Here, we describe a qualitative study where we conducted semi-structured interviews with fourteen rectal cancer patients, including seven men and seven women, who were successfully treated by NOM at our center between 2020 and 2022. The responses were analyzed using the constant comparative method. Four major thematic categories emerged: impact of rectal cancer diagnosis, treatment values, decision-making factors, and the impact of NOM surveillance. Avoidance of a stoma was a major theme in both determining patient treatment values as well as ultimately driving their decision-making. Trust in the treating physician was also found to be a major theme in decision-making. While the psychological burden of surveillance did emerge as a major theme, patients who did not have recurrence were still quite satisfied with their decision to pursue NOM. Limitations of this study include selection bias, the single-center design, and the lack of patients who ultimately experienced recurrence following NOM. As NOM of rectal cancer becomes more commonplace, understanding the patients’ perspectives will ensure appropriate counseling and shared decision-making.

Karen Mulder was not included as an author in the original publication

The 24th annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Richmond, British Columbia, on 28–29 October 2022. The WCGCCC is an interactive multidisciplinary conference attended by healthcare professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals such as dieticians, nurses and a genetic counsellor participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer.

Discrepancy between patient expectations and outcomes can negatively affect patient satisfaction and quality of life. We aimed to assess patient expectations of bowel, urinary, and sexual function after rectal cancer treatments, and whether a preoperative education video changed expectations. A total of 45 patients were assessed between January 2018 and January 2021 in a tertiary care hospital in Vancouver, Canada. Patients included were rectal cancer patients who had neoadjuvant chemoradiation and were listed for low anterior resection but had not yet had surgery. Following surgical consultation but before surgery, a questionnaire assessing expectations of lifestyle after treatments was administered. Patients then watched an educational video and repeated the questionnaire to assess for changes in expectations. Patient scores indicated expectation that control of bowel movements, urination, and sexual function would sometimes be problematic, but had a range from occasionally problematic to good function. Significant change after the video was seen in the expectation of needing medications for bowel control, and 44%-69% of individual patient answers changed from prevideo to post-video, depending on the question. The education video was scored as helpful or very helpful by 82% of patients. Patients have varying expectations of problematic control of bowel, urinary, and sexual function following rectal cancer treatments. A pretreatment education video resulted in a trend toward changed expectations for functional outcomes in most patients. Further educational modalities for patients may provide more uniform expectations of function and increase patient satisfaction after rectal cancer treatments.

Surgical site infections (SSI) pose significant morbidity after colorectal surgery. We sought to document current practices in colorectal surgery SSI prevention in British Columbia (BC). Reporting the current provincial landscape on SSI prevention helps to understand the foundation upon which improvements can take place. We surveyed all BC surgeons performing elective colon and rectal resections, and 97 surveys were completed (60% response rate). Eighty-six per cent of respondent hospitals tracked SSI rates. The reported superficial SSI was less than 5% and the anastomotic leak/organ space rate was less than 10%. All respondents gave preoperative prophylactic antibiotics, with 24% continuing antibiotics postoperatively; 62% are using oral antibiotics (OAB) and mechanical bowel preparation (MBP) and 29% use MBP without OAB. Areas for improvement include OAB with MBP and discontinuing prophylactic antibiotics postoperatively, as recommended by the World Health Organization.

Aim: Perianal sepsis in Crohn's disease (CD) fistulas is managed with antibiotics and surgical drainage; a noncutting seton is used for an identified transsphincteric fistula tract. The optimal management following seton placement for initial control of perianal sepsis remains to be determined. Our main aim was to assess the success rates of curative surgery, seton removal or long‐term indwelling seton in patients with and without CD.Method: This was a retrospective cohort of consecutive patients with a perianal fistula treated with a noncutting seton between 2010 and 2019, including 83 CD patients and 94 patients without CD. Initial control of symptomatic perianal infection with a seton and subsequent healing and reintervention rates were compared between the three postseton management strategies.Results: A total of 177 patients, 61% male and 83.1% with complex fistulas, were followed for a median of 23 months (interquartile range 11–40 months). Immunomodulatory treatment was used in 90.4% of CD patients after seton placement. Good initial control of perianal infection was achieved with a seton in CD and non‐CD patients, at 92.9% and 96.7%, respectively (p = 0.11). Overall fistula healing or control for CD and non‐CD patients was, respectively, 64% and 86% (p = 0.1) after curative surgery, 49% and 71% after seton removal (p = 0.21) and 58% and 50% with long‐term seton placement (p = 0.72). Overall reintervention for recurrence was 83% in CD versus 53.1% in non‐CD patients during the follow‐up period (p = 0.002).Conclusion: Definitive surgery was possible in only a minority of CD patients. Long‐term seton management was an effective option in patients with CD with acceptable improvement and recurrence rates.

Aim The aim of this study is to report changes in health‐related quality of life attributable to lateral internal sphincterotomy for treatment of anal fissure. There is very little evidence on whether the overall health‐related quality of life of patients is detrimentally affected by the condition, or which aspects of self‐perceived health status improve after lateral internal sphincterotomy. This study will articulate which aspects of health tend to improve and guide postoperative expectations appropriately. Knowledge gained from this study may also identify gaps in an individual patient's episode of care. Method Patients were prospectively identified when they consented to surgical treatment of their anal fissure and were contacted by phone to participate. Participants completed a number of patient‐reported outcomes preoperatively and 6 months postoperatively. Faecal incontinence‐related quality of life, pain and depression were measured at both time points. The severity of faecal incontinence was measured at both times. Results Participants reported high levels of pain preoperatively. Postoperatively, improvement in pain exceeded the threshold of clinical relevance (P < 0.01). Thirty‐five per cent of participants reported significant effects of faecal incontinence preoperatively, while 26% did so postoperatively. Participants with multiple comorbidities were more likely to report faecal incontinence postoperatively than preoperatively. Conclusion This study reports that lateral internal sphincterotomy improved pain symptoms without adverse effects on continence. Not all domains of health‐related quality of life were similarly positively affected by anal fissure repair.

Aim Surgical site infections are disproportionately common after colorectal surgery and may be largely preventable. The objective of this retrospective cohort study was to determine the effect of oral antibiotics with mechanical bowel preparation on surgical site infections. Method A retrospective study of a consecutive series of elective colonic and rectal resections following an Enhanced Recovery After Surgery pathway, which also included mechanical bowel preparation from September 2014 to September 2017. The addition of oral antibiotics, neomycin and metronidazole, with mechanical bowel preparation was assessed. Development of surgical site infections within 30 days was the main outcome of measure. The secondary outcome was assessment of possible surgical site infection predictors. Results 732 patients were included: 313 (43%) pre‐intervention and 419 (57%) post‐intervention. Surgical site infection rates pre vs. post intervention were: overall 20.8% vs. 10.5%, p<0.001; superficial 10.9% vs. 4.3%, p<0.001 and organ space 9.9% vs. 6.2%, p=0.03. Subgroup analysis of colonic resections revealed a significant reduction in overall (17.1% vs. 6.8%), superficial (10.7% vs. 4.3%) and organ space infections (6.4% vs. 2.6%). Rectal resections had significant reduction in overall (26.2% vs. 15.3%) and superficial infection rates (11.1% vs. 4.4%), but not organ space infections (15.1% vs. 10.9%). Multivariate regression analysis revealed open vs. minimally invasive surgery (MIS) (p<0.001) and omission of oral antibiotics (p=0.004) as independent predictors of surgical site infections. Conclusion A s ignificant reduction in superficial and organ space infections was found after colonic resections with use of oral antibiotics; however, a significant reduction was found in only superficial infections following rectal resections with oral antibiotics.