Improving the outcomes in oncological colorectal surgery

Abstract

During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication.

Keywords: Anastomotic leakage; Audits; Colorectal surgery; Enhanced recovery after surgery; Frailty; Laparoscopic surgery; Nutritional status; Sarcopenia.

Figure 1

Computed tomography image at the third lumbar vertebral level. The following skeletal muscles are outlined in red: psoas, paraspinal, transverse abdominal, external oblique, internal oblique and rectus abdominis muscles. This female sarcopenia patient had an L3 (third lumbar spine) muscle index of 34.3 cm²/m².