Yosef Nasseri

BACKGROUND: Surgical site infection remains a common complication after colectomy. Mechanical bowel preparation and oral antibiotics are used to reduce infectious morbidity, but whether their benefit varies across body mass index is unclear. OBJECTIVE: To evaluate the association between preoperative bowel preparation regimen and 30-day postoperative outcomes after elective colectomy for non-metastatic colon cancer, and to assess whether these associations vary across body mass index. DESIGN: Retrospective cohort study. SETTINGS: American College of Surgeons National Surgical Quality Improvement Program targeted colectomy database, 2015–2023. PATIENTS: Adults undergoing elective colectomy for non-metastatic colon cancer (N = 97,395). MAIN OUTCOME MEASURES: Thirty-day surgical site infection, anastomotic leak, and overall postoperative complication. RESULTS: In unadjusted analyses, surgical site infection occurred in 8.7% of patients with no bowel preparation and 5.0% with combined mechanical plus oral antibiotic bowel preparation. In adjusted modified Poisson models, all bowel preparation regimens were associated with lower risk of 30-day postoperative complications versus no preparation (all p < 0.001), with the lowest adjusted relative risk for combined preparation (any surgical site infection: 0.60; anastomotic leak 0.66; any complication: 0.70). In stratified analyses, combined preparation and oral antibiotics alone were superior to no preparation for both left- and right-sided resections, but mechanical preparation alone was not superior to no preparation for right-sided resections. Evidence of effect modification by body mass index was limited (interaction p = 0.09 for surgical site infection, p = 0.26 for overall complications), including when stratified by resection site. LIMITATIONS: Observational design with potential residual confounding; registry data lacked preparation adherence/quality and granular institutional prevention practices; estimates were less precise at extreme body mass index values. CONCLUSIONS: Bowel preparation regimens containing oral antibiotics were associated with lower 30-day surgical site infection and complication risk across the body mass index continuum. These findings suggest that the effectiveness of oral antibiotic-containing bowel preparation is preserved across BMI levels. See Video Abstract .

Recently, stool- and blood-based cancer screening kits have been approved in clinical practice as convenient and noninvasive methods for colon cancer screening. One such test in long-standing practice has included the fecal immunochemical test (FIT), wherein home-based testing has rendered it a convenient initial assay to complement screening colonoscopy, despite limitations in diagnostic performance. In a recent original study published in the journal by Nguyen and colleagues, the feasibility and performance of combining FIT with circulating tumor cell (CTC) enumeration for predicting colorectal neoplasia and the risk of developing colorectal cancer were described. In this commentary, we highlight the potential of this combination as a novel colorectal cancer screening technique. The introduction of CTC as a potential colorectal cancer screening assay is timely, given the emergence of liquid biopsies that hold promise in their ability to detect a multitude of cancer-specific signals, from the detection of minimal residual disease to the detection of molecular alterations for precision therapies in oncology. We place the importance of their results in the context of the evolving landscape of stool- and blood-based colorectal cancer screening tests involving multitarget fecal DNA and cell-free DNA assays. See related article by Nguyen et al., Cancer Epidemiol Biomarkers Prev 2026;35:79–87.

Background Fasciocutaneous flap advancement is a newer alternative surgical approach in pilonidal sinus disease (PSD). This comparative study aimed to assess whether the use of an ovine forestomach matrix (OFM) graft implanted beneath a fasciocutaneous flap closure could minimize dehiscence complications in PSD. Methods PSD patients who received OFM and a fasciocutaneous flap were prospectively enrolled. Findings were compared to retrospective data from control patients who did not receive an OFM graft. Study outcomes were time to heal, incidence of dehiscence, and scar cosmesis. A within-study cost-utility analysis estimated costs and quality-adjusted life-years (QALYs). Results A total of 46 patients who received a flap advancement and OFM graft were compared to 48 retrospective control patients who were treated with flap advancement alone. No difference in median healing time was found in the OFM group (8.0 (IQR: 4.2, 15.8) weeks) compared to the control group (8.0 (IQR: 6.0, 15.2) weeks) (p=0.79). The incidence of dehiscence was significantly less in the OFM group (18%) versus the control group (46%) (p=0.005). The probability of dehiscence in the control group was 3.2 times greater compared to the OFM group. In a cost-utility analysis, the OFM group dominated the control group, with higher QALYs (0.24 vs. 0.23) and lower costs ($4,157 vs. $4,219). Conclusions The use of OFM graft with a fasciocutaneous flap resulted in a significantly lower incidence of dehiscence and potentially higher quality-of-life and cost savings, while maintaining a midline incision with favorable cosmesis.

Background: Minimally invasive surgery (MIS) has significantly better short-term outcomes than open surgery. However, it is unclear whether MIS converted (MISC) to open for rectal cancer carries any benefits compared to open as no prior study has compared these two surgical approaches for rectal cancer. This study compares short-term postoperative outcomes between MISC and upfront open surgery. Methods: This is a retrospective cohort study on elective surgeries for rectal cancer from 2016 and 2022 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into the MISC group and the Open group and balanced using propensity-score matching. 30-day complication, unplanned readmission, and mortality rates and length of stays were compared with Student’s t-test and regression models. Results: The Open group included 2551 (86.3%) patients, and the MISC group included 406 (13.7%) patients (80.5% laparoscopy, 19.5% robotic). Propensity-score matching yielded 400 patients in each group. On univariate analysis, the groups had comparable overall complications, unplanned readmission, and 30-day mortality rates, but the MISC group had a lower median length of stay (6 days vs. 7 days, p = 0.015). On regression analysis, the MISC was not associated with an increased risk for overall complications (OR = 1.04, 95%CI 0.843–1.280; p = 0.716), unplanned readmission (OR = 1.230, 95%CI 0.939–1.620; p = 0.132), and 30-day mortality (OR = 1.750 95%CI 0.648–4750; p = 0.269). However, MISC was significantly associated with a shorter length of stay (OR = − 0.869, 95%CI (−)1.609 − (−)0.129; p = 0.021). Conclusion: Patients undergoing planned open proctectomy and those undergoing MISC to open proctectomy exhibit similar 30-day postoperative outcomes. As completed MIS offers advantages over open surgeries, MIS should be attempted as the default surgical approach for rectal cancer patients, even if conversion to open surgery is needed.

We aim to investigate the correlation between perioperative blood transfusion and postoperative ileus in patients who have undergone minimally invasive elective colectomy for cancer. This is a retrospective study using the 2016–2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients with colon cancer who underwent elective laparoscopic or robotic colectomy were selected. Perioperative transfusion was defined as receiving one or more units of whole/packed RBCs within 72 h of onset of operation. Using multivariable logistic regression with backward elimination, comorbidities, and intraoperative and postoperative variables were analyzed to identify risk factors for postoperative ileus. 48,728 patients were included with a mean age of 64.7 years, 52.3% were males, and a mean BMI of 28.8 kg/m². Overall, men had a higher rate of ileus than women (13 and 7.6%, respectively, P = 0.0001). There was no difference in rates of ileus following robotic and laparoscopic surgery (10.4 and 10.4%, respectively, P = 0.8). Of the 2960 patients who had a blood transfusion, 516 (17.4%) had an ileus, whereas of the 45,768 patients who did not have a blood transfusion, 4569 (10.0%) had an ileus (P = 0.0001). On multivariable logistic regression analysis, patients with blood transfusions were 1.37 times more likely to develop an ileus (95% CI 1.2–1.5, P = 0.0001). Perioperative blood transfusion is an independent risk factor for ileus following minimally invasive colectomy for cancer.

Aim: An estimated 5%–25% of women with endometriosis have colorectal involvement. Colorectal resection is the most suitable surgical management for cases with large bowel infiltration. However, this method is also associated with the highest rate of postoperative complications. Data focusing on surgeon speciality and surgical outcomes are currently limited. The aim of this work was to evaluate the surgical characteristics and short‐term postoperative outcomes following colorectal resection for endometriosis according to surgeon speciality.Method: Using the National Surgical Quality Improvement Program (NSQIP) database, we included women who underwent colorectal resection for endometriosis between 2012 and 2020. Surgeries by general/colorectal surgeons were compared with those by gynaecological surgeons. The primary outcome was major complications according to the Clavien–Dindo classification.Results: Among 745 colorectal resections, 82.3% were performed by general/colorectal surgeons and 17.7% by gynaecologists. Racial and ethnic characteristics differed between groups, but other baseline characteristics were comparable. General/colorectal surgeons performed fewer minimally invasive surgeries (29.9% vs. 58.3%, p < 0.001). General/colorectal surgery cases had lower rates of any postoperative complications and minor complications (14.8% vs. 29.5%, p < 0.001; 10.1% vs. 23.5%, p < 0.001), while major complication rates were similar. Multivariable regression showed no association between major complications and surgical speciality. In a propensity score‐matched analysis, no significant differences were found between the two cohorts.Conclusion: Most colorectal resections are performed by general/colorectal surgeons while a minimally invasive approach is more common among gynaecologists. There were no significant differences in outcomes between the two groups after adjusting for confounding variables. This suggests considering a multidisciplinary or dual surgery team approach to deep infiltrative endometriosis requiring bowel resection.

Although the addition of an ileostomy to low anterior resection (LAR) may often be considered preventative of anastomotic leakage (AL), evidence that clearly demonstrates such benefit is lacking. This study aimed to identify the impact of adding an ileostomy upon AL and organ-space surgical site infection (SSI) rates in patients with lower, middle, or upper rectal cancer. This case–control study included rectal cancer patients who had undergone elective LAR in the American College of Surgeons-National Surgical Quality Improvement Program dataset between 2016 and 2022. Patients with lower, middle, and upper tumors were identified and analyzed according to whether an ileostomy was added or not. Patients’ pre-, intra-, and short-term post-operative data were compared using univariable and multivariable methods. A total of 4048 patients (61.6% males) with a mean age of 60 years, whereof 1166 with lower, 1836 with middle, and 1046 with upper tumors were identified. An ileostomy was added in 2804 (69.3%) patients. Patients with upper tumors had an ileostomy added less frequently (78.5%vs 74.5% vs 49.9%, p < 0.001). The overall AL and organ-space SSI rates were 4.3% and 6.7%. There were no statistically significant differences in AL and organ-space SSI rates (requiring or not requiring re-intervention or re-operation) between patients with and without ileostomy regardless of tumor location. Multivariable logistic regression controlling for confounding variables showed no association between adding an ileostomy and AL and organ-space SSI rates (requiring or not requiring re-intervention or re-operation) regardless of tumor location. This case–control study did not find any evidence in support of a preventative impact upon AL and organ-space SSI rates of adding an ileostomy to LAR in patients with lower, middle, or upper rectal cancer.