Vanessa W. Hui

Background and Objective: Colorectal cancer (CRC) remains a critical public health concern, particularly in the United States, where it accounted for 7.6% of all newly diagnosed cancers in 2024. While the overall incidence of the disease has declined over the last two decades, particularly among patients over the age of 50 years, a concerning rise in early-onset CRC among patients requires a reassessment of screening strategies, the optimization of existing treatment strategies, and the adoption of new approaches to improve patient outcomes. While minimally invasive techniques have demonstrated clear benefits over open surgery (OS), there is limited consensus over long-term oncologic outcomes, cost-effectiveness, and applicability in locally advanced or recurrent CRC. The objective of this review is to provide a comprehensive review of current treatment modalities in the treatment of CRC and their long-term oncologic outcomes. Methods: For this narrative review, an updated review of the English literature was performed between 1993 and 2023 using the PubMed database. The authors reviewed and highlighted landmark papers at their time and the impact they had on the evolution of the management of CRC. Key Content and Findings: Despite significant advances in our understanding of tumor biology, chemotherapy, and screening recommendations, surgery remains a mainstay of treatment for CRC. Continued advancements in surgical technology, equipment, and training have revolutionized our surgical approaches to CRC. Procedures that once required a midline laparotomy can now often be performed in a minimally invasive fashion, which is associated with reduced postoperative pain, shortened length of stay, and overall improved patient satisfaction. Conclusions: With the advent of robotic surgery (RS) and increasingly sophisticated endoscopic procedures, the surgical treatment landscape in colorectal surgery continues to evolve. Over time, the use of laparoscopic surgery (LS) and RS has become the preferred option, given similar oncologic outcomes and improved pain, hospital length of stay, and decreased complication rates. The advancement in robotic technology, medical devices, and pharmaceuticals will continue to push the boundary on the minimally invasive approach that can provide safe oncologic outcomes in the management of CRC.

Background/Objectives: Colorectal surgeons continue to care for an aging cancer population with increasing comorbidities and frailty. Frailty, characterized by a systemic physiologic decline associated with aging, is an increasingly popular focus in surgical outcomes research. This retrospective study investigates how frailty impacts outcomes in the octogenarian and nonagenarian populations undergoing surgical treatment for colon cancer. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) colectomy-targeted variables dataset from 2015 to 2021 were utilized for this analysis, including patients 80 years of age and older. Frailty was assessed using the five-factor modified frailty index (mFI-5). The study examined post-operative outcomes across frailty groups in this population. Results: From 2015–2021, there were 10,671 patients aged 80 years and older who underwent colectomy for colon cancer, of whom 1259 (11.8%) were 90 years or older and 2844 (26.7%) were severely frail. Frailty significantly impacted post-operative colectomy outcomes in this population. On univariate analysis, frail patients had higher rates of pneumonia (p = 0.015), unplanned intubation (p = 0.012), stroke (p < 0.001), myocardial infarction (p = 0.011), readmission (p < 0.001), long length of stay (p < 0.001), and mortality (p < 0.001) compared to non-frail patients. On multivariate analysis, severe frailty (mFI-5 of 2 or more) was associated with an increased odds of unplanned intubation (aOR 2.41, 95% CI 1.27–4.59), long length of stay (aOR 1.73, 95% CI 1.44–2.09), readmission (aOR 1.84, 95% CI 1.42–2.39), and mortality (aOR 1.95, 95% CI 1.20–3.15) compared to non-frail patients. Conclusions: Frailty plays a critical role in influencing the outcomes of octogenarians and nonagenarians undergoing colectomy for colon cancer within the NSQIP dataset. Future work should investigate whether addressing frailty prior to surgery in this population can improve patients’ post-operative courses.

Background/Objectives: Colorectal surgeons continue to care for an aging cancer population with increasing co-morbidities and frailty. Frailty, characterized by a systemic physiologic decline associated with aging, is an increasingly popular focus in surgical outcomes research. This retrospective study aimed to investigate the impact of frailty on outcomes in the octogenarian and nonagenarian populations undergoing surgical treatment for colon cancer. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) colectomy-targeted variables dataset from 2015 to 2021 were utilized for this analysis. Inclusion criteria included patients 80 years of age and older. Frailty was assessed using the 5-factor modified frailty index (mFI-5). The study examined post-operative outcomes across frailty groups in this population. Results: From 2015-2021, 10,815 patients >=80 years old with colon cancer underwent colectomy, 11.9% (n=1,285) were 90 years or older. Frailty significantly impacted post-operative colectomy outcomes in this population. On univariate analysis, frail patients had higher rates of pneumonia (p=0.002), unplanned intubation (p48 hours (p=0.027), stroke (p5 days (p<0.001), readmission (p<0.001), and mortality (p=0.007) compared to non-frail patients. Conclusions: Frailty plays a critical role in influencing the outcomes of octogenarians and nonagenarians undergoing colectomy for colon cancer within the NSQIP dataset. Future work should investigate whether addressing frailty prior to surgery in this population can improve patient’s post-operative course.

Purpose: Firearm injuries are a major public health crisis; however, providers are not routinely educated on how to discuss this topic with their patients. To address this gap, a firearm safety curriculum was developed for medical students during their surgery clerkship. Perceptions, knowledge, and preparedness for counseling patients was evaluated before and after dissemination. Methods: All second-year medical students enrolled in the surgery core clerkship from March 2023 to March 2024 were included. The curriculum consists of a 30-min didactic presentation discussing gun violence with techniques to identify and counsel at-risk patients followed by a 30-min, interactive case-based discussion where students simulate counseling strategies. Pre- and post-session surveys included a 5-point Likert scale to evaluate efficacy of the curriculum. Paired student’s t test was conducted to compare pre- and post-survey responses. Results: Of the 249 students, 54.6% % were female, 50.9% were White, and mean age was 25 ± 2 years. While 91.9% of students responded that they had never owned a gun, 37.8% had lived in a home where a gun was present, and 48.2% had fired a gun before. Only 24.7% of students had previously taken a gun-safety course, and 15.4% received training on counseling patients on firearm safety. One hundred thirty three students completed both pre- and post-session surveys for analysis. After the course, students had higher agreement on the importance of physician’s roles and responsibilities in patient education on firearm safety, and students felt more prepared to counsel patients. Knowledge of patient risk factors for firearm injury increased significantly from students being able to identify 1.4 ± 1.1 risk factors correctly on pre-test to identifying 2.6 ± 1.6 risk factors correctly on post-test ( t (64) = − 5.6, p < 0.01). Conclusion: The firearm safety curriculum is a simple and effective tool that augments students’ knowledge and understanding of gun violence, as well as prepares them to counsel patients on firearm safety. This curriculum can be widely implemented as an important intervention to equip future physicians with the necessary tools to help address the firearm crisis in the United States.

Purpose of Review: Mpox, formerly known as monkeypox, is a zoonotic illness caused by a virus that is part of the Orthopoxvirus family. Originally identified in humans in the Democratic Republic of Congo in 1970, the disease has been endemic in central African nations. In 2022, an outbreak of Monkeypox warranted a declaration by the World Health Organization (WHO) that the virus was a Public Health Emergency of International Concern. Prior literature documented the dermatological manifestations of the disease, but fewer papers have described and navigated the complexities of mpox gastrointestinal manifestations. We aim to update the current literature on the gastrointestinal (GI) manifestations of mpox, through a review of the literature via PubMed search for English language papers reporting GI manifestations of the virus. Recent Findings: Individual reports of symptomatic manifestations of mpox have been reported. Upper and lower GI symptoms have been described and, in multiple cases, required multidisciplinary team care to successfully treat the patients. Summary: GI manifestations of mpox disease are reported in a variety of severities and, in some instances, may require multidisciplinary management.

Indocyanine Green (ICG) has significantly advanced minimally invasive surgery. It is widely recognized for its ability to visualize blood vessel patency in real-time across various surgical specialties. While its primary use in colorectal surgery is to evaluate anastomoses for leaks, numerous other applications have been documented in the literature. In this review, we aim to explore both established and emerging applications of ICG fluorescence in colorectal surgery, with the goal of improving patient outcomes. This includes preoperative tumor marking and the detection of metastatic disease. Some applications, such as lymphatic mapping, require further research to determine their impact on clinical practices. Conversely, others, like the intraoperative localizations of ureters, necessitate additional procedures and are not yet widely accepted by the surgical community. However, the development of alternative compounds could offer better solutions. Future research should focus on areas like quantitative ICG and protocol standardization in prospective multicenter studies.

Indocyanine Green (ICG) has significantly advanced minimally invasive surgery. It is widely recognized for its ability to visualize blood vessel patency in real-time across various surgical specialties. While its primary use in colorectal surgery is to evaluate anastomoses for leaks, nu-merous other applications have been documented in the literature. In this review, we aim to explore both established and emerging applications of ICG fluorescence in colorectal surgery, with the goal of improving patient outcomes. This includes preoperative tumor marking and the detection of metastatic disease. Some applications, such as lymphatic mapping, require further research to determine their impact on clinical practices. Conversely, oth-ers, like the intraoperative localizations of ureters, necessitate additional procedures and are not yet widely accepted by the surgical community. However, the development of alternative com-pounds could offer better solutions. Future research should focus on areas like quantitative ICG and protocol standardization in prospective multicenter studies.

Ostomy formation is a vital component in the treatment of advanced gastrointestinal diseases, including colorectal cancer and inflammatory bowel disease. It usually involves externalizing a part of the colon or small bowel to the skin surface. Thus, the creation of an ostomy can often have a major negative impact on quality of life. This study aimed to evaluate whether the use of an ostomy belt could improve quality of life measures in stoma patients through a prospective interventional open-label study of 17–80-year-old English- and Spanish-speaking patients with stomas who were using an ostomy belt for 8 weeks. Changes in quality of life were assessed using the Stoma Quality of Life Scale questionnaire at baseline, at 4 weeks, and at 8 weeks post ostomy belt use. A total of 45 patients enrolled (20 female, mean age 48) in the study. The ostomy belt significantly improved quality of life scores from baseline to 4 weeks regarding overall life satisfaction (F(2, 76) = 14.77, p < 0.001) and in the domains of work/social function (F(2, 72) = 30.32, p < 0.001), sexuality/body image (F(2, 68) = 3.34, p = 0.04), and stoma function (F(2, 72) = 8.72, p < 0.001). These improvements were sustained at the 8-week follow-up. No significant differences were observed in the domains of financial impact and skin irritation. This study represents the first prospective interventional study that provides evidence for the simple low-cost intervention of ostomy support belt use in improving quality of life in patients with a stoma.

Background and objective Colonoscopy is a common procedure performed by colorectal surgeons for screening, diagnosis, and surveillance of various colorectal diseases. Existing literature has conflicting data on quality outcomes of colonoscopies performed in the afternoon and the morning schedules and only includes colonoscopies performed by gastroenterologists. We sought to analyze procedural outcomes between morning and afternoon colonoscopies performed by colorectal surgeons. Data sources and main outcome measures A retrospective chart review of colonoscopies performed by colorectal surgeons at a tertiary care center from October 2018 through July 2020 was performed. Complete colonoscopies with documented times were included. Patients with colonic resection and incomplete colonoscopy were excluded. Main outcome measures adenoma and polyp detection rates and colonoscopy time variables were compared between morning and afternoon colonoscopies. Results A total of 781 patients were analyzed. Colonoscopies were evenly distributed during shifts (49% morning and 51% afternoon). The overall polyp and adenoma detection rates were 46% and 29%, respectively. There were no significant differences in adenoma and polyp detection rates and colonoscopy duration between morning and afternoon colonoscopies. Multivariate analysis demonstrated that history of prior polypectomy was an independent predictor of adenoma detection rate (OR: 2.17, 95% CI 1.33–3.54, p = 0.002) and was associated with significantly increased colonoscopy times in afternoon shift. Conclusion There were no differences in quality outcomes of adenoma and polyp detection rates between morning and afternoon colonoscopies performed by colorectal surgeons. In addition to known predictors, cecal intubation time and history of polypectomy were also independent predictors of adenoma detection rate. Patients with prior polypectomy had increased colonoscopy times in afternoon shift. Since colorectal surgeons perform higher proportion of diagnostic and surveillance colonoscopies, these patients may be better suited for colonoscopies in morning shift.