Frank Pfeffer

This study aims to develop an anatomic landmark-based ordinal grading system for surgical difficulty in robot-assisted rectal resection and to assess its preoperative predictability, with the potential to support preoperative assessment of surgical difficulty. We divided the procedure into two phases: mesocolon dissection and mesorectal dissection. Surgical difficulty was defined using an anatomy-based ordinal grading system (grades 1-3) for each phase. A cohort of 158 patients undergoing robot-assisted rectal resection was included. Regression analysis was performed for each phase using preoperative variables to select predictors. Pooled tenfold cross-validation was used for model validation. For the mesocolic phase, a four-predictor model (body mass index, sex, lung disease, and age) achieved moderate performance (accuracy 0.648; AUC (≤ 1 vs > 1) 0.787; AUC (≤ 2 vs 3) 0.831). For the mesorectal phase, a three-predictor model (body mass index, sex, and neoadjuvant chemoradiotherapy) achieved good predictive performance (accuracy 0.697; AUC (≤ 1 vs > 1) 0.927; AUC (≤ 2 vs 3) 0.850). The final equations were implemented in a ready-to-use calculator to facilitate clinical application. This study introduces a novel, phase-specific grading system that allows preoperative estimation of anatomical difficulty in robot-assisted rectal resection. The model is consistent with established preoperative risk factors. By utilizing standard preoperative data, this tool may assist surgeons in anticipating operative complexity and tailoring their surgical approach.

Background: Lymphadenectomy in right-sided colon cancer lacks standardized reporting. The aim was to develop a visual analogue scale (VAS) based on mesenteric vessels to describe the extent of lymphadenectomy. Methods: We included patients undergoing surgery for right-sided colon cancer from January 2021 to September 2024. Data were collected via a web-based database. Immediately after surgery, surgeons recorded the VAS score, vascular visualization, and specimen quality. Results: Data from 155 patients were analyzed. Median age was 74 (IQR: 68–80), with 53% female. The median VAS score was 8.2 (IQR: 7.8–8.9). The superior mesenteric vein (SMV) was visualized in 84% of cases, with a median VAS score of 8.4 (IQR: 8.0–9.2) for visualized and 7.0 (IQR: 6.8–7.5) for non-visualized ( p < 0.001). The gastrocolic trunk of Henle (GTH) was visualized in 51%, with a median VAS score of 8.7 (IQR: 8.3–9.7) for visualized and 7.9 (IQR: 7.3–8.0) for non-visualized ( p < 0.001). Specimen quality was Type 0 (best) in 54% (VAS score 8.6, IQR: 8.2–9.5), Type I in 37% (VAS score 7.9, IQR: 7.3–8.0), and Type II in 6% (VAS score 6.9, IQR: 6.5–7.9; p < 0.001). A positive correlation between VAS score and lymph node count was found ( r = 0.43, p < 0.001). Conclusions: The VAS score is a reliable and feasible method to describe lymphadenectomy in right-sided colon cancer. Unlike categorical classifications, the VAS score is based on anatomical landmarks and does not depend on consensus definitions. It reflects the visualization of vascular structures and correlates with specimen quality and lymph node yield. Clinical trial: ClinicalTrials.gov Identifier NCT06329102 (registered on March 24, 2024). Article type: Prospective observational study.

Background: Lymphadenectomy in right-sided colon cancer lacks standardized reporting. The aim was to develop a visual analogue scale (VAS) based on mesenteric vessels to describe the extent of lymphadenectomy. Methods: We included patients undergoing surgery for right-sided colon cancer from January 2021 to September 2024. Data were collected via a web-based database. Immediately after surgery, surgeons recorded the VAS score, vascular visualization, and specimen quality. Results: Data from 155 patients were analyzed. Median age was 74 (IQR: 68–80), with 53% female. The median VAS score was 8.2 (IQR: 7.8–8.9). The superior mesenteric vein (SMV) was visualized in 84% of cases, with a median VAS score of 8.4 (IQR: 8.0–9.2) for visualized and 7.0 (IQR: 6.8–7.5) for non-visualized (p < 0.001). The gastrocolic trunk of Henle (GTH) was visualized in 51%, with a median VAS score of 8.7 (IQR: 8.3–9.7) for visualized and 7.9 (IQR: 7.3–8.0) for non-visualized (p < 0.001). Specimen quality was Type 0 (best) in 54% (VAS score 8.6, IQR: 8.2–9.5), Type I in 37% (VAS score 7.9, IQR: 7.3–8.0), and Type II in 6% (VAS score 6.9, IQR: 6.5–7.9; p < 0.001). A positive correlation between VAS score and lymph node count was found (r = 0.43, p < 0.001). Conclusions: The VAS score is a reliable and feasible method to describe lymphadenectomy in right-sided colon cancer. Unlike categorical classifications, the VAS score is based on anatomical landmarks and does not depend on consensus definitions. It reflects the visualization of vascular structures and correlates with specimen quality and lymph node yield. ClinicalTrials.gov Identifier: NCT06329102 (registered on March 24, 2024)

Hyperthermia was added to standard preoperative chemoradiation for rectal adenocarcinomas in a phase II study. Patients with T3-4 N0-2 M0 rectal cancer or local recurrences were included. Radiation dose was 54 Gy combined with capecitabine 825 mg/m² × 2 daily and once weekly oxaliplatin 55 mg/m². Regional hyperthermia aimed at 41.5–42.5 °C for 60 min combined with oxaliplatin infusion. Radical surgery with total or extended TME technique, was scheduled at 6–8 weeks after radiation. From April 2003 to April 2008, a total of 49 eligible patients were recruited. Median number of hyperthermia sessions were 5.4. A total of 47 out of 49 patients (96%) had the scheduled surgery, which was clinically radical in 44 patients. Complete tumour regression occurred in 29.8% of the patients who also exhibited statistically significantly better RFS and CSS. Rate of local recurrence alone at 10 years was 9.1%, distant metastases alone occurred in 25.6%, including local recurrences 40.4%. RFS for all patients was 54.8% after 5 years and CSS was 73.5%. Patients with T50 temperatures in tumours above median 39.9 °C had better RFS, 66.7% vs. 31.3%, p = 0.047, indicating a role of hyperthermia. Toxicity was acceptable.

Background: Rectal tumor treatment strategies are individually tailored based on tumor stage, and yield different rates of posttreatment morbidity, mortality, and local recurrence. Therefore, the accuracy of pretreatment staging is highly important. Here we investigated the accuracy of staging by magnetic resonance imaging (MRI) and endorectal ultrasound (ERUS) in a clinical setting. Material and methods: A total of 500 patients were examined at the rectal cancer outpatient clinic at Haukeland University Hospital between October 2014 and January 2018. This study included only cases in which the resection specimen had a histopathological staging of adenoma or early rectal cancer (pT1–pT2). Patients with previous pelvic surgery or preoperative radiotherapy were excluded. The 145 analyzed patients were preoperatively examined via biopsy (n = 132), digital rectal examination (n = 77), rigid rectoscopy (n = 127), ERUS (n = 104), real-time elastography (n = 96), and MRI (n = 84). Results: ERUS distinguished between adenomas and early rectal cancer with 88% accuracy (95% CI: 0.68–0.96), while MRI achieved 75% accuracy (95% CI: 0.54–0.88). ERUS tended to overstage T1 tumors as T2–T3 (16/24). MRI overstaged most adenomas to T1–T2 tumors (18/22). Neither ERUS nor MRI distinguished between T1 and T2 tumors. Conclusions: In a clinical setting, ERUS differentiated between benign and malignant tumors with high accuracy. The present findings support previous reports that ERUS and MRI have low accuracy for T-staging of early rectal cancer. We recommend that MRI be routinely combined with ERUS for the clinical examination of rectal tumors, since MRI consistently overstaged adenomas as cancer. In adenomas, MRI had no additional benefit for preoperative staging.