Clinics in Colon and Rectal Surgery最新文献

Acute diverticulitis is a common sequela of colonic diverticulosis that often poses a significant dilemma for surgeons and patients considering surgical management of the disease. Importantly, the decision to recommend surgery for patients with diverticular disease hinges on identifying those who will benefit most in terms of preventing future disease-related complications. This review focuses on identifying patient risk factors that are predictive of onset of diverticulitis, recurrence of disease, and progression to complicated disease, such as abscess, fistula, or stricture, and aims to assist clinicians with counseling patients who are considering surgery versus medical management. Specifically, a variety of modifiable and nonmodifiable risk factors have been identified across several studies that have strong associations with the development of diverticulitis, recurrence of uncomplicated disease, and progression to complicated disease. A handful of clinical scores have been described to guide surgeons and patients on their individual risk; however, none have been adopted into wider clinical practice. A novel polygenic risk score does show promise in potentially fulfilling this role. Nevertheless, there is significant room for innovation and development of new methods to risk-stratify patients presenting with the spectrum of diverticular disease.

Diverticular disease is the leading cause of elective colon surgery. With a rising incidence in younger populations, it continues to pose a significant burden on the health care system. Traditional etiopathogenesis implicated an infectious mechanism, while recent challenges to this theory have demonstrated the microbiome playing a significant role, along with genetic predispositions and associations with obesity and diet. Therefore, the role of antibiotics in uncomplicated disease merits reconsideration. In this review, we aim to outline the current knowledge regarding antibiotics for diverticulitis treatment, broadly define the microbiome components, functions, and modifiability, and discuss newly proposed pathogenetic mechanisms for diverticular disease that incorporate information regarding the microbiome. Analytic techniques for microbiota characterization and function continue to advance at a rapid pace. As emerging technology advances, we will continue to elucidate the role of the microbiome in diverticular disease development.

[This corrects the article DOI: 10.1055/s-0040-1714247.].

Many colorectal cancers arise from either adenomatous polyps or sessile serrated lesions. However, due to the implementation of screening guidelines at the age of 45 years and the ability to perform therapeutic endoscopic polyp resections, the incidence and mortality of colorectal cancer has been decreasing in the United States. Polyps can be distinguished not only by pathology, but characterized by their complexity depending on the size, location, and morphology. Historically, polyps that were endoscopically more challenging to resect were referred for surgical resection. However, due to rapid advancement in endoscopic techniques and availability of tools, many of these complex polyps can be safely and effectively resected endoscopically. In this section, we review the different methods and potential challenges associated with endoscopic resection techniques including endoscopic mucosal resection, endoscopic submucosal dissection, or endoscopic full-thickness resection of a complex polyp.

Hereditary colorectal cancer (CRC) syndromes account for up to 5% of CRC. Patients have an increased risk of CRC and extracolonic cancers, both of which develop at an early age. The main polyposis syndromes include familial adenomatous polyposis, MYH-associated polyposis, Peutz-Jeghers syndrome, juvenile polyposis syndrome, and PTEN hamartoma syndrome. The non-polyposis syndromes include Lynch syndrome and familial colorectal cancer type X. Each of the syndromes have distinct but sometimes overlapping phenotypes. Clinical evaluation and ultimately the underlying germline genetic pathogenic variants define the syndromes. Each syndrome has polyp, CRC, and extracolonic risks and management is based on early and timely surveillance with therapeutic and often extended prophylactic surgery. Surgical intervention strategies are individualized, considering not only the earlier onset of malignancies and heightened risks for metachronous cancers but also the patient's needs and quality of life. This article reviews the different diagnostic approaches to hereditary CRC and highlights subsequent disease-specific management and surgical decision-making strategies.

Early-onset colorectal cancer (EO-CRC), characterized by diagnosis before the age of 50 years, has emerged as a significant healthcare challenge with increasing global incidence. While traditional risk factors such as family history and inherited syndromes contribute to EO-CRC, a substantial proportion of cases remain sporadic, necessitating further investigation into additional etiological factors. Molecular studies reveal heterogeneity in EO-CRC, with distinct mutational profiles compared to late-onset CRC. Clinical management presents unique considerations, including challenges in early detection and treatment strategies tailored to younger patients. Addressing EO-CRC requires a multidisciplinary approach integrating epidemiological, molecular, and clinical insights to improve prevention, diagnosis, and therapeutic outcomes. Emerging research avenues explore novel biomarkers and therapeutic targets, offering promise for advancing understanding and management of this disease in contemporary oncology practice.

Guidelines recommend individualized decision making for screening colonoscopy for colorectal cancer (CRC) in patients after the age of 75 years due to low additional benefits. That should be taken with a grain of salt, as these recommendations are based on expert opinion and simulation models which do not consider (1) the differences in pathogenesis and cancer biology of CRC in elderly; (2) the risks of colonoscopy in this patient population; (3) and the impact of new surgical and nonsurgical therapies for CRC. In this review, our goal is to bring a surgeon's perspective to understand the role of screening colonoscopy in patients older than 75 years.

As the incidence of colorectal cancer (CRC) in the younger population increases and women start their childbearing journey at later ages, CRC in pregnancy will become an increasingly relevant and decreasingly rare occurrence. Unfortunately, there is a dearth of data on this subject given its historical rarity. CRC is often diagnosed at a late stage in pregnancy because of the conflation of symptoms of pregnancy with symptoms of CRC. A major branch point for the diagnosis and treatment of CRC in pregnancy is whether it is diagnosed early or late in pregnancy. The workup for cancer is similar for pregnant and nonpregnant populations and includes endoscopy and staging computed tomography. Treatment is dependent on the stage of cancer and term of pregnancy. This review summarizes the current evidence for diagnosis, workup, and treatment of CRC during pregnancy and explores issues of fertility after a diagnosis of CRC.

We have made steady gains in improving overall survival in patients with metastatic, unresectable, colon cancer in the last 5 to 10 years. The backbone of systemic treatment for most patients remains combination chemotherapy, but the field is becoming increasingly biomarker driven, with exciting new targeted therapies on the horizon. This review is organized in sections corresponding to currently relevant biomarkers in colon cancer and will summarize first-, second-, and third-line standard of care for metastatic, unresectable, colon cancer. The last section is intended to introduce the reader to promising agents and novel therapeutic strategies currently under investigation.