Editorial to research topic "Surgical Management of Colorectal Pathologies"

Prof. Dr. med. Peter C C. Ambe, M.D., MBA, FEBS^1*Michail Karanikas²Selman Sokmen³

• ¹Faculty of Health, Witten/Herdecke University, Witten-Herdecke, Germany
• ²Medical School, Democritus University of Thrace, Alexandroupolis, Greece
• ³Dokuz Eylül University, Alsancak, İzmir, Türkiye

with the anterograde technique by Ko et al. (1), indicating that retrograde dissection was significantly longer than antegrade dissection (34.85 min vs. 40.92 min, p=0.002). However, there was no statistically significant diBerence amongst both techniques with regards to perioperative complications. While the meaning of a delta of about six minutes between both techniques remains questionable, this study demonstrates the safety of the retrograde technique of laparoscopic appendectomy (1) The surgical management of complicated diverticular disease can be very challenging.Amongst the complications of diverticular disease, colovesical fistula warrants special attention due to the involvement of both the bowel and the urinary system. Antonia Rizzuto et al. reported their experience shifting from an open to a laparoscopic approach, indication the advantages of minimally invasive access in this challenging surgical population (2).In a study with the title "Microsatellite Instability is highly prevalent in older patients with Colorectal Cancer", Jakob et al. questioned the practice of performing screening for microsatellite instability (MSI) in an age -based manner. The authors found MSI-H tumor in 18.2 % of cases > 50 years, and in 20.6 % of patients > 60 years in their collective. The authors argued that both the role of MSI-H as an indicator of a hereditary cancer predisposition (Lynch Syndrome) as well as its relevance in the decision-making with regard to the need and choice of additive chemotherapy should warrant a systematic screening, independent of age and clinical criteria (3) Malignant colonic obstruction remains a serious complication of colorectal cancer and it´s management can not only be challenging but may also be associated with poor overall outcome. Evidence-guided management is literally not available, and the current clinical The results reported in this study may be helpful in counselling patients e.g. with regards to the need of adjuvant chemotherapy and for follow -up after right colectomy for cancer (6).Total mesorectal excision (TME) represents the standard technique for radical resection of rectal cancer and the laparoscopic approach has been established a standard procedure.Laparoscopic TME requires a high level of expertise and thus may pose some degree of challenge. Thus, predicting the diBiculty of surgery may ease decision-making with regard to patient selection. In the paper titled "Interpretable Machine Learning Model to Predict Surgical DiBiculty in Laparoscopic Resection for Rectal Cancer"m Miao Yu et al. demonstrated an XGBoost model for predicting the diBiculty of laparoscopic TME, thus providing a useful tool to help surgeons select appropriate candidates for laparoscopic TME (7).Postoperative pain management represents an important aspect of enhanced recovery after surgery (ERAS). However, striking a balance between pain management and medicationinduced adverse events, including bowel paralysis following colorectal surgery, may be challenging. In the RCT by Lu Cao et al. (8), the eBicacy of postoperative pain control using a combination of ropivacaine and parecoxib was compared with patient controlled intravenous analgesia (PCIA) consisting of 100ug sufentanil and 16mg ondansetron after laparoscopic surgery for CRC. The study endpoint included pain measured via the VAS as well as biochemistry markers including Interleukin 6 (IL-6) and C-reactive protein (CRP). The results of this RCT confirmed a statistically significant reduction in postoperative pain control using PCIA. This trend correlated with a significantly lower expression of IL-6 in the PCIA group. As expected, there was no statistically significant diBerence amongst both groups with regard to postoperative CRP. This RCT addresses two important issues: First, PCIA is associated with eBective postoperative pain control and should be part of standard ERAS programs following colorectal resection and second, IL-6 may represent an objective tool for measuring postoperative pain (8).In the manuscript with the title "EBect of prehabilitation exercises on postoperative frailty in patients undergoing laparoscopic colorectal cancer surgery" Fuyu Yang et al. (9) explored a new intensive prehabilitation program that combines prehabilitation exercises with stand enhanced recovery after surgery on frailty in a randomized controlled trial (9). The study indicated that prehabilitation exercises can improve postoperative frailty and accelerate recovery in elderly patients undergoing laparoscopic oncologic colorectal resections. This is a meaningful finding in light of the changing global demographics with an increasingly aging population.While only 43 % of all submissions was accepted for publication, the editors and reviewers applauded all submitting groups for their contribution to the success of this special issue.More importantly, all manuscript that didn´t qualify for publication received fair-minded comments to help the authors improve their work.