Omar Mollema

Background/Objectives: The preoperative improvement of patients’ functional capacity (prehabilitation) has gained attention in the surgical field, especially for colorectal cancer (CRC) patients. Despite the recognized benefits of prehabilitation programs, patients’ motivation to participate in and adhere to them remains a significant challenge. Several studies reported difficulties in recruiting participants and low adherence rates. This systematic review explored patients’ motivation for participation and adherence to prehabilitation programs for colorectal cancer surgery. Methods: A systematic search was conducted in the PubMed (MEDLINE), Embase, Cochrane, CINAHL, and Web of Science databases. Eligible studies included clinical trials published from inception until December 2024, written in English or Dutch, describing barriers and/or motivators affecting patient participation and adherence in prehabilitation programs. Results: A total of 89 studies, including 34 randomized controlled trials, were included. In total, 13,383 patients were included, with 7162 in the prehabilitation cohort. Participation rates ranged from 0 to 99.4%, and adherence rates ranged from 15% to 100%. Factors limiting participation included logistical issues and a busy schedule. Professional guidance, peer support, and regaining a sense of control improved adherence. Medical reasons, conflicting obligations, and intensive exercise limited adherence. Conclusions: This systematic review analyzed the current literature on participation and adherence in prehabilitation programs for colorectal cancer surgery patients. Overcoming logistical barriers and patient concerns through flexible, patient-centered approaches may improve participation and adherence. Future research should focus on large-scale randomized controlled trials, diverse healthcare settings, and strategies to enhance engagement with prehabilitation programs.

BACKGROUND: Although attempts have been made in the past to establish consensus regarding the definitions and grading of the severity of colorectal anastomotic leakage, widespread adoption has remained limited. OBJECTIVE: A systematic review of the literature was conducted to examine the various elements used to report and define anastomotic leakage in colorectal cancer resections. DATA SOURCES: A systematic review was conducted using the PubMed, Embase, and Cochrane Library Database. STUDY SELECTION: All published randomized controlled trials, systematic reviews, and meta-analyses containing data related to adult patients undergoing colorectal cancer surgery and reporting anastomotic leakage as a primary or secondary outcome, with a definition of anastomotic leakage were included. MAIN OUTCOME MEASURES: Definitions of anastomotic leakage, clinical symptoms, radiological modalities and findings, findings at reoperation, and grading terminology or classifications for anastomotic leakage. RESULTS: Of the 471 articles reporting anastomotic leakage as a primary or secondary outcome, a definition was reported in 95 studies (45 randomized controlled trials, 13 systematic reviews, and 37 meta-analyses) involving a total of 346,140 patients. Of these 95 articles, 68% reported clinical signs and symptoms of anastomotic leakage, 26% biochemical criteria, 63% radiological modalities, 62% radiological findings, and 13% findings at reintervention. Only 45% (n = 43) of included studies reported grading of anastomotic leakage severity or leak classification, and 41% (n = 39) included a time frame for reporting. LIMITATIONS: There was a high level of heterogeneity between the included studies. CONCLUSIONS: This evidence synthesis confirmed incomplete and inconsistent reporting of anastomotic leakage across the published colorectal cancer literature. There is a great need to develop and implement a consensus framework for defining, grading, and reporting anastomotic leakage. REGISTRATION: Prospectively registered at PROSPERO (ID 454660).

Background: Nissen Fundoplication (NF) is a frequently performed procedure in children. Robotic-assisted Nissen Fundoplication (RNF), with the utilization of the Senhance^® Surgical System (SSS^®) (Asensus Surgical^® Inc., Durham, NC, USA) featuring 3 mm instruments, aims to improve precision and safety in pediatric surgery. This matched cohort study assesses the safety and feasibility of RNF in children using the SSS^®, comparing it with Laparoscopic Nissen Fundoplication (LNF). Methods and Results: Twenty children underwent RNF with the SSS^® between 2020 to 2023 and were 1:1 matched with twenty LNF cases retrospectively selected from 2014 to 2023. Both groups were similar regarding male/female ratio, age, and weight. Two of the twenty RNF cases (10%) experienced intraoperative complications, whereas three in the LNF group of whom two required reinterventions. The observed percentage of postoperative complications was 5% in the RNF group compared to 15% in the LNF group (p = 0.625). The operative times in the RNF group significantly dropped towards the second study period (p = 0.024). Conclusions: Utilizing SSS^® for NF procedures in children is safe and feasible. Observational results may tentatively suggest that growing experiences and continued development will lead to better outcomes based on more accurate and safe surgery for children.