Trevor M. Yeung

Aim Patients with locally advanced rectal cancer may avoid surgery if they develop a clinical complete response (cCR) to total neoadjuvant therapy (TNT). During surveillance, detection of local regrowth can be challenging. The ability of MRI to predict local regrowth is uncertain, especially when it differs from endoscopic findings. This study evaluates the ability of MRI and endoscopy to predict local regrowth in patients under surveillance for cCR after TNT. Method All rectal cancer patients in our institution from 2006 to 2020 who achieved cCR following TNT, and entered watch and wait (WW), with findings suspicious for local regrowth during surveillance and subsequently underwent surgery were assessed. The main outcomes were the ability of MRI to correctly identify the local regrowths and its correlation with endoscopy and pathology. Results 1426 patients were diagnosed with locally advanced rectal cancer. 388 patients achieved cCR after TNT and underwent surveillance. 112 patients developed clinical and/or radiological findings suspicious of local regrowth. Of 99 patients who proceeded to surgery, 12 (12%) had a pathological complete response (pCR). For patients with an abnormal MRI only and normal endoscopy, pCR rate was 4/9 (44%). For patients with an abnormal endoscopy, pCR rates in those with a normal MRI and those with an abnormal MRI were 6/34 (18%) and 2/56 (4%), respectively (χ²-test, p = 0.001). Normal endoscopy was significantly associated with higher odds of pCR (OR 8.2, p = 0.012) whereas normal MRI showed a non-significant association (OR 2.11, p = 0.33). Conclusion In rectal cancer patients achieving cCR after TNT, local regrowth without detectable endoscopic findings is rare. When isolated abnormal MRI findings occur, repeat radiologic surveillance prior to deciding on surgery may minimize unnecessary surgical interventions.

Robotic colorectal surgery is increasingly adopted worldwide, with mentored programs for established surgeons becoming more common. However, there is a paucity of dedicated robotic training programs for colorectal fellows. This study aims to assess the feasibility and efficacy of a structured, apprentice-based robotic colorectal training program delivered to multiple fellows concurrently. The fellowship program incorporates simulation training, dry/wet laboratory work, dedicated robotic console time in the operating room (OR) and individualised mentorship. Overall robotic proficiency was assessed using the Global Evaluative Assessment of Robotic Skills (GEARS) and procedure-specific proficiency was assessed using a modified European Academy of Robotic Colorectal Surgery (EARCS) Global Assessment Score (GAS) throughout the fellowship. A total of 59 cases (29 right hemicolectomies, 30 anterior resections) were evaluated between August 2023 and July 2024. Significant improvements were observed in GEARS scores ( p = 0.0065) and modified GAS for both right hemicolectomies ( p = 0.0052) and anterior resections ( p = 0.0005), demonstrating a high level of competence and independence. Mean operative times were 213 min (right hemicolectomy) and 328 min (anterior resection). Median length of stay in the hospital was 2 days (right hemicolectomy) and 4 days (anterior resection). Median lymph node yield was 29 (right hemicolectomy) and 26 (anterior resection). There was 0% involved margins for both procedures. Robotic colorectal surgical oncology training delivered to multiple fellows concurrently in an apprenticeship model with dedicated console time is achievable and successful, leading to high levels of robotic competency and independence, whilst maintaining a high standard of clinical care and oncological outcome.

Robotic colorectal surgery represents a major technological advancement in the treatment of patients with colorectal disease. Several recent randomized controlled trials comparing robotic colorectal surgery with laparoscopic surgery have demonstrated improved short-term patient outcomes in the robotic group. Whilst the primary focus of research in robotic surgery has been on patient outcomes, the robotic platform also provides unparalleled benefits for the surgeon, including improved ergonomics and surgeon comfort, with the potential to reduce occupational injuries and prolong career longevity. It is becoming clear that robotic surgical systems improve patient outcomes and may provide significant benefits to the surgical workforce.

With advances in modern medicine, there is a constant need for accurate and up-to-date readily available information online to ensure patients are well-equipped for informed decision making. This study sets out to analyze websites that provide patient-centered information on robotic colorectal surgery. Three search engines (Google, Yahoo and Firefox) were used with search terms ‘robotic colorectal surgery’ and the first 20 results on each platform assessed. After screening sites using predetermined criteria, further analysis was performed with the DISCERN questionnaire and Cohen Kappa analysis. Out of the 60 websites identified from the initial search, only 14 websites contained patient information on robotic colorectal surgery. Of these, only three (21%) sites had been updated in the past year and one site was last updated 10 years ago. Ten (71%) websites were affiliated with hospitals and the majority (12, 86%) were based in the United States of America (USA). Approximately half of the websites explored alternative surgical techniques, only three (21%) discussed the risks, a similar number had details on post-operative experience, and none mentioned cost implications, ongoing research or the waiting list involved. Overall, no website had a perfect score of 5 to be classified as good or excellent. There was at least a fair level of agreement (reliability score of > 0.2) in 12 DISCERN criteria (80%), 4 of which were statistically significant. Despite the huge volume of generic information on colorectal surgery, there is still a paucity of comprehensive patient-centered information on robotics as a modality of treatment.