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Perioperative Assessment and Optimization in Major Colorectal Surgery
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1760867 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - February 7, 2023 Category: Surgery Authors: Hedrick, Traci L. Tags: Preface Source Type: research

Smoking Cessation for Preoperative Optimization
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1760870Cigarette smoking is associated with pulmonary and cardiovascular disease and confers increased postoperative morbidity and mortality. Smoking cessation in the weeks before surgery can mitigate these risks, and surgeons should screen patients for smoking before a scheduled operation so that appropriate smoking cessation education and resources can be given. Interventions that combine nicotine replacement therapy, pharmacotherapy, and counseling are effective to achieve durable smoking cessation. When trying to stop smoking in the preoperative period, surgical patients exper...
Source: Clinics in Colon and Rectal Surgery - February 3, 2023 Category: Surgery Authors: Vu, Joceline V. Lussiez, Alisha Tags: Review Article Source Type: research

Frailty Assessment and Prehabilitation as Part of a PeRioperative Evaluation and Planning (PREP) Program for Patients Undergoing Colorectal Surgery
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1761151Frailty assessment and prehabilitation can be incrementally implemented in a multidisciplinary, multiphase pathway to improve patient care. To start, modifications can be made to a surgeon's practice with existing resources while adapting standard pathways for frail patients. Frailty screening can identify patients in need of additional assessment and optimization. Personalized utilization of frailty data for optimization through prehabilitation can improve postoperative outcomes and identify patients who would benefit from adapted care. Additional utilization of the multid...
Source: Clinics in Colon and Rectal Surgery - February 3, 2023 Category: Surgery Authors: Sharon, Cimarron E. Strohl, Catherine Saur, Nicole M. Tags: Review Article Source Type: research

Preparing the Bowel (Microbiome) for Surgery: Surgical Bioresilience
Clin Colon Rectal Surg DOI: 10.1055/s-0042-1760675The preparation of the bowel for radical surgery is a corner stone of elective colorectal practice. The evidence for this intervention is of variable quality and it is often contradictory, yet there is now a global move toward the adoption of oral antibiotic therapy for the reduction of perioperative infective complications, such as surgical site infections. The gut microbiome is a critical mediator of the systemic inflammatory response to surgical injury, wound healing, and perioperative gut function. The loss of critical microbial symbiotic functions caused by bowel prepa...
Source: Clinics in Colon and Rectal Surgery - February 3, 2023 Category: Surgery Authors: Paine, Heidi Jones, Faye Kinross, James Tags: Review Article Source Type: research

Perioperative Assessment and Optimization in Major Colorectal Surgery: Medication Management
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1761156The colorectal surgeon is often faced with medications that can be challenging to manage in the perioperative period. In the era of novel agents for anticoagulation and immunotherapies for inflammatory bowel disease and malignancy, understanding how to advise patients about these medications has become increasingly complex. Here, we aim to provide clarity regarding the use of these agents and their perioperative management, with a particular focus on when to stop and restart them perioperatively. This review will begin with the management of both nonbiologic and biologic th...
Source: Clinics in Colon and Rectal Surgery - February 3, 2023 Category: Surgery Authors: Kane, William J. Berry, Puja Shah Tags: Review Article Source Type: research

Combined Resection Approaches: Decision Making for Synchronous Resection, Timing of Staged Intervention to Optimize Outcome
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1761475Advancement in systemic and regional radiation therapy, surgical technique, and anesthesia has provided a path for increased long-term survival and potential cure for more patients with stage IV rectal cancer in recent years. When patients have resectable disease, the sequence for surgical resection is classified in three strategies: classic, simultaneous, or combined, and reversed. The classic approach consists of rectal cancer resection followed by metastatic disease at a subsequent operation. Simultaneous resection addresses both rectal and metastatic disease in a single...
Source: Clinics in Colon and Rectal Surgery - February 3, 2023 Category: Surgery Authors: Asai, Megumi Dobesh, Kaitlyn D. Tags: Review Article Source Type: research

Craig Reickert, MD, MBA, FACS, FASCRS
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1761445 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - February 3, 2023 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to Guest Editor Source Type: research

Preoperative Assessment and Optimization of Cardiopulmonary Disease in Noncardiac Surgery
This article details an approach to preoperative interview and examination, indications for preoperative testing, and strategies for optimization in patients with underlying cardiopulmonary disease. It also includes guidelines on optimal timing of elective surgery in certain clinical scenarios that can escalate perioperative risk. Through the use of thorough preoperative assessment, targeted preoperative testing, and multidisciplinary optimization of preexisting disease, perioperative risk can be decreased significantly and perioperative outcomes improved. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floo...
Source: Clinics in Colon and Rectal Surgery - January 28, 2023 Category: Surgery Authors: Savery, Kelsey E. Kleiman, Amanda M. Walters, Susan M. Tags: Review Article Source Type: research

Informed Consent and Shared Decision Making in the Perioperative Environment
This article details aspects of and issues surrounding informed consent and SDM. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - January 28, 2023 Category: Surgery Authors: Krebs, Elizabeth D. Hoang, Sook C. Tags: Review Article Source Type: research

Social Determinants of Health and Impact in Perioperative Space
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1761155The Centers for Disease Control and Prevention (CDC) defines the social determinants of health (SDOH) as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a range of health, functioning, and quality-of-life outcomes and risks,” which includes economic stability, access to quality health care, and physical environment. There is increasing evidence that SDOH have an impact in shaping a patient's access and recovery from surgery. This review evaluates the role surgeons play in reducing these disparities. [...] ...
Source: Clinics in Colon and Rectal Surgery - January 28, 2023 Category: Surgery Authors: Devin, Courtney L. Shaffer, Virginia O. Tags: Review Article Source Type: research

Role of Bacteria in the Development of Colorectal Cancer
Clin Colon Rectal Surg DOI: 10.1055/s-0042-1760679Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. Once limited to older populations, the incidence of CRC in patients under the age of 50 years is increasing and the etiology for this is uncertain. One hypothesis lies on the impact of the intestinal microbiome. The intestinal microbiome, composed primarily of bacteria but also viruses, fungi, and archaea, has been shown to regulate CRC development and progression both in vitro and in vivo. In this review, the role and intersection of the bacterial microbiome in various stages ...
Source: Clinics in Colon and Rectal Surgery - January 25, 2023 Category: Surgery Authors: Thomas, Ryan M. Tags: Review Article Source Type: research

A Brief History of Microbial Study and Techniques for Exploring the Gastrointestinal Microbiome
Clin Colon Rectal Surg DOI: 10.1055/s-0042-1760678Over the past 20 years, the study of microbial communities has benefited from simultaneous advancements across several fields resulting in a high-resolution view of human consortia. Although the first bacterium was described in the mid-1600s, the interest in community membership and function has not been a focus or feasible until recent decades. With strategies such as shotgun sequencing, microbes can be taxonomically profiled without culturing and their unique variants defined and compared across phenotypes. Approaches such as metatranscriptomics, metaproteomics, and metab...
Source: Clinics in Colon and Rectal Surgery - January 25, 2023 Category: Surgery Authors: Sidebottom, Ashley M. Tags: Review Article Source Type: research

Hyperglycemia in the Perioperative Period
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1761153Perioperative hyperglycemia is a risk factor in surgical patients. Complications, including infection and mortality, are associated with hyperglycemia in both diabetic and nondiabetic patients. Stress hyperglycemia results in a state of insulin resistance. Insulin administration has been shown to reduce the complications associated with hyperglycemia. Glycemic targets provide goals for individualized treatment of hyperglycemia in surgical patients in the preoperative, intraoperative, and postoperative periods. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th F...
Source: Clinics in Colon and Rectal Surgery - January 25, 2023 Category: Surgery Authors: Shuford, Rebecca Miller-Ocuin, Jennifer L. Tags: Review Article Source Type: research

Preoperative Identification and Management of Anemia in the Colorectal Surgery Patient
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1760868Preoperative anemia is a common finding in patients undergoing colorectal surgery, particularly those with cancer. While often multifactorial, iron deficiency anemia remains the most common cause of anemia in this patient population. Although seemingly innocuous, preoperative anemia is associated with an increased risk of perioperative complications and need for allogenic blood transfusions, both of which may worsen cancer-specific survival. Preoperative correction of anemia and iron deficiency is thus necessary to diminish these risks. Current literature supports preoperat...
Source: Clinics in Colon and Rectal Surgery - January 25, 2023 Category: Surgery Authors: Lynch, Kevin T. Hassinger, Taryn E. Tags: Review Article Source Type: research

The Role of the Microbiome in the Etiology of Inflammatory Bowel Diseases
Clin Colon Rectal Surg DOI: 10.1055/s-0042-1760680Inflammatory bowel diseases (IBDs) result from dysregulated immune responses to environmental and microbial triggers in genetically susceptible hosts. Many clinical observations and animal studies support the role of the microbiome in the pathogenesis of IBD. Restoration of the fecal stream leads to postoperative Crohn's recurrence, while diversion can treat active inflammation. Antibiotics can be effective in prevention of postoperative Crohn's recurrence and in pouch inflammation. Several gene mutations associated with Crohn's risk lead to functional changes in microbial ...
Source: Clinics in Colon and Rectal Surgery - January 25, 2023 Category: Surgery Authors: Halper-Stromberg, Ariel Dalal, Sushila R. Tags: Review Article Source Type: research