Changes in Recommendations for Surgeries of the Colon and Rectum

Surgical management of colon and rectum diseases changes quite quickly. Noting that many changes have been suggested in just the last year, 2 surgeons from the Mayo Clinic in Rochester, Minnesota, assembled a review of the most significant. This paper appears in the January 2015 issue of Current Opinions in Gastroenterology.

This review examines recent publications discussing cancers (colon, rectal, and anal), inflammatory bowel disease, incontinence, diverticulitis, hemorrhoids, fistulas, and quality improvement initiatives.

Among the most significant of findings are the following:

• In patients with rectal cancer, some experts advised a nonsurgical wait-and-see approach since surgery is associated with significant morbidity (the authors reviewed neoadjuvant chemotherapy and radiation). A longer interval between nonsurgical treatment and surgery may be beneficial; studies are underway to examine this possibility.
• Also in rectal cancer, accurate restaging following neoadjuvant chemoradiotherapy can be challenging; neither MRI nor endorectal ultrasounds are highly accurate.
• With regard to diverticulitis, the authors indicate that inpatient and outpatient treatments tend to have similar outcomes, but the cost is 3 times higher when patients are hospitalized. Findings are mixed concerning colonoscopy following an attack, but often, pre-malignant and malignant polyps are removed. In some patients with complicated diverticulitis, nonoperative management can lead to successful outcomes.
• Several studies have examined percutaneous nerve and sacral nerve stimulation for refractory fecal incontinence with promising results.
• The authors advise that several studies strongly support longer postoperative VTE prophylaxis in cancer and irritable bowel disease patients.
• Surgeons should be aware that a diagnosis of diabetes increases risk of all-cause mortality by 17% and cancer-specific death by 12%.

This review concisely captures a large amount of information. The authors remind readers that new technologies and novel questions will continue to improve patient outcomes.