Anatomy is the foundation of surgery. However, traditional anatomical concepts based on autopsy are no longer sufficient to guide the development of modern surgery. With the advancement of histology and embryology and application of high-resolution laparoscopic technology, surgical anatomy has gradually developed. Meanwhile, some important concepts and terms used to guide surgery have emerged, including: mesentery, fascia, and space. The confusing, controversial, and even inaccurate definitions and anatomical terms related to colorectal surgery seriously affect academic communication and the training of young surgeons. Therefore, the Chinese Society of Colorectal Surgeons, the Chinese Society of Colorectal Surgery, National Health Commission Capacity Building and Continuing Education Center, and China Sexology Association of Colorectal Functional Surgery organized colorectal surgeons to make consensus on the definition and terminology of mesentery, fascia, and space related to colon and rectum, to promote surgeons' understanding of modern anatomy related to colorectal surgery and promote academic communication.
Humans ; Rectum/surgery* ; Consensus ; Mesentery/anatomy & histology* ; Fascia/anatomy & histology* ; Colorectal Neoplasms

Humans ; Intestinal Polyps ; Colonic Polyps/surgery* ; Intestinal Polyposis ; Colorectal Neoplasms

Early colorectal cancers refer to invasive cancers that have infiltrated into the submucosa without invading muscularis propria, and approximately 10% of these patients have lymph node metastases that cannot be detected by conventional imaging. According to the guidelines of Chinese Society of Clinical Oncology (CSCO) Colorectal Cancer, early colorectal cancer cases with risk factors for lymph node metastasis (poor tumor differentiation, lymphovascular invasion, deep submucosal invasion and high-grade tumor budding) should receive salvage radical surgical resection; however, the specificity of this risk-stratification is inadequate, making most patients undergo unnecessary surgery. Firstly, this review focuses on the definition, oncological impact importance and controversy of the above "risk factors". Then, we introduce the progress of the risk stratification system for lymph node metastasis in early colorectal cancer, including the identification of new pathological risk factors, the construction of new risk quantitative models based on pathological risk factors, artificial intelligence and machine learning technology and the discovery of novel molecular markers associated with lymph node metastasis based on gene test or liquid biopsy. Aim to enhance clinicians' understanding of the risk assessment of lymph node metastasis in early colorectal cancer; we suggest to take the patient's personal situation, tumor location, anti-cancer intention and other factors into account to make individualized treatment strategies.
Humans ; Lymphatic Metastasis/pathology* ; Artificial Intelligence ; Colorectal Neoplasms/surgery* ; Risk Factors ; Risk Assessment ; Neoplasm Invasiveness ; Lymph Nodes/pathology*

The theory of membrane anatomy has been widely used in the field of colorectal surgery. The key point to perform high quality total mesorectal excision (TME) and complete mesocolic excision (CME) is to identify the correct anatomical plane. Intraoperative identification of the various fasciae and fascial spaces is the key to accessing the correct surgical plane and surgical success. The landmark vessels refer to the small vessels that originate from the original peritoneum on the surface of the abdominal viscera during embryonic development and are produced by the fusion of the fascial space. From the point of view of embryonic development, the abdominopelvic fascial structure is a continuous unit, and the landmark vessels on its surface do not change morphologically with the fusion of fasciae and have a specific pattern. Drawing on previous literature and clinical surgical observations, we believe that tiny vessels could be used to identify various fused fasciae and anatomical planes. This is a specific example of membrane anatomical surgery.
Humans ; Mesentery/surgery* ; Colonic Neoplasms/surgery* ; Colorectal Surgery ; Digestive System Surgical Procedures ; Peritoneum/surgery* ; Rectal Neoplasms/surgery* ; Laparoscopy

Obstructive colorectal cancer is a common malignant bowel obstruction. Colostomy or colostomy following tumor resection may be the first choice for emergency surgery. The intestinal and systemic conditions of patients undergoing emergency surgery are often poor, and patients need to undergo multiple operations, which increase the surgical risk and economic burden and reduce the quality of life of patients. Poor intraoperative visualization may also affect the radical operation of emergency surgery. Transanal decompression tube (TDT) can rapidly decompress and drain the obstructed bowel, effectively relieve obstruction symptoms, and improve the success rate of primary radical resection. The TDT squeeze the tumor lightly, causing no spread of tumor cells, and is cheap, but the cavity of transanal decompression tube is small and easily blocked, and requires tedious flushing or regular replacement. Self-expanding metallic stents (SEMS) can relieve intestinal obstruction effectively, provide sufficient preparation time for preoperative examination and improvement of nutritional status. By improving patient's tolerance to radical surgery, SEMS might be used as an important treatment strategy choice for obstructive colorectal cancer. However, SEMS may squeeze the tumor, leading to the spread of tumor cells, increase the recurrence rate and metastasis rate, and reduce the survival rate. Moreover, intestinal wall edema still existed during the operation following SEMS, and the rate of ostomy after anastomosis was as high as 34%. We hypothesized that prolonging the interval between stent insertion and surgery to 2 months, with neoadjuvant chemotherapy administered during this interval (SEMS-neoadjuvant chemotherapy strategy), would help improve outcomes. The SEMS-neoadjuvant chemotherapy strategy is a safe, effective, and well tolerated treatment approach with a high laparoscopic resection rate, low stoma formation rate and improvement in the overall survival for patients with left-sided colon cancer obstruction. The patient physical status is improved, the primary tumor is downstaged, and intestinal wall edema is relieved during the relatively longer interval between SEMS placement and surgery. The SEMS-neoadjuvant chemotherapy strategy may be a preferred therapeutic strategy for obstructive left colon cancer.
Humans ; Quality of Life ; Self Expandable Metallic Stents/adverse effects* ; Colonic Neoplasms/surgery* ; Stents/adverse effects* ; Intestinal Obstruction/surgery* ; Treatment Outcome ; Colorectal Neoplasms/complications* ; Retrospective Studies

Peritoneal metastasis is one of the common metastasis of gastrointestinal malignancy. Intraperitoneal chemotherapy (including hyperthermic intraperitoneal chemotherapy and intraoperative intraperitoneal chemotherapy) not only can effectively increase the peritoneal drug concentration, but also can reduce side effects of systemic chemotherapy. It can significantly prolong the long term survival of patients with peritoneal metastasis and improve the quality of life. In order to standardize the popularization and application of intraperitoneal chemotherapy, relevant professional committees have formulated expert consensus on intraperitoneal chemotherapy. However, there is no systematic guidance on the prevention and treatment of related complications of intraperitoneal chemotherapy. Under the guidance of the Complications Management Committee of the Colorectal Cancer Professional Committee of the Chinese Medical Association and the Colorectal Cancer Professional Committee of the Chinese Anti-cancer Association, we organized domestic experts in relevant fields to formulate this consensus according to the procedural specifications and relevant literature reports. This consensus aims to summarize the causes of common complications of intraperitoneal chemotherapy such as pneumonia, intraperitoneal hemorrhage, fever, peritonitis, ileus, intestinal dysfunction, anastomotic bleeding, anastomotic leakage, leakage or infection of perfusion tube, nausea and vomiting, myelosuppression, hepatic or nephritic dysfunction. After repeatedly soliciting the opinions of domestic authoritative experts and their discussion and modification, a consensus was formed to provide effective reference for the prevention and treatment of complications.
Humans ; Peritoneal Neoplasms/secondary* ; Hyperthermia, Induced ; Consensus ; Quality of Life ; Combined Modality Therapy ; Gastrointestinal Neoplasms/therapy* ; Perfusion ; Colorectal Neoplasms/surgery* ; China

Minimally invasive colorectal surgery has been an entity for just over 30 years. Compared with traditional open surgery, minimally invasive surgery has the advantages of less trauma, more delicate operation and faster postoperative recovery. At present, minimally invasive surgery for colorectal tumor shows a diversified trend in terms of surgical approach, surgical platform or surgical methods. Besides, standardized comprehensive treatment and immunotherapy have had far-reaching impacts on the development of minimally invasive surgery. The diagnosis and treatment of perioperative complications is still another important topic in the research of minimally invasive surgery in the future. In addition to the short-term outcomes, the most important thing that patients truly require and emphasize is the permanence of the curative effect, that is, long-term survival and good defecation, urination and sexual function. Thus, permanence is the ultimate goal of minimally invasive surgery. To achieve this, we should strive to correct improper treatment methods, rationally select applicable groups of emerging surgical approaches and surgical platforms, pay more attention to comprehensive tumor diagnosis and treatment, and prudently carry out new technology research on the basis of the basic concept of patient safety.
Colorectal Neoplasms/surgery* ; Goals ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Postoperative Period

Colectomy ; Colorectal Neoplasms/surgery* ; Humans ; Laparoscopy ; Treatment Outcome

Colonoscopy with endoscopic resection of detected colonic adenomas interrupts the adenoma-carcinoma sequence and reduces the incidence of colorectal cancer and cancer-related mortality. In the past decade, there have been significant developments in instruments and techniques for endoscopic polypectomy. Guidelines have been formulated by various professional bodies in Europe, Japan and the United States, but some of the recommendations differ between the various bodies. An expert professional workgroup under the auspices of the Academy of Medicine, Singapore, was set up to provide guidance on the endoscopic management of colonic polyps in Singapore. A total of 23 recommendations addressed the following issues: accurate description and diagnostic evaluation of detected polyps; techniques to reduce the risk of post-polypectomy bleeding and delayed perforation; the role of specific endoscopic resection techniques; the histopathological criteria for defining endoscopic cure; and the role of surveillance colonoscopy following curative resection.
Adenoma/surgery* ; Colonic Neoplasms/surgery* ; Colonic Polyps/surgery* ; Colonoscopy/methods* ; Colorectal Neoplasms/pathology* ; Humans ; Singapore ; United States

In recent years, natural orifice specimen extraction surgery (NOSES) has been widely used in surgery of colorectal cancer. The rapid development of NOSES is mainly attributed to its own great advantages and values, including the reduction of surgical trauma, the acceleration of postoperative recovery and the reduction of adverse psychological reactions for patients. These advantages of NOSES are also important embodiment and perfect interpretation of the organ functional protection. Organ functional preservation is a hot topic in surgery today, and it is also an inevitable requirement for minimally invasive surgery. Essentially, NOSES and organ functional preservation are proposed in the same background, and the goals are highly compatible. NOSES is an important practitioner of organ functional preservation, and organ functional preservation is also the vane of the development of the theoretical system of NOSES. These two items complement each other and together constitute the important element in the development of modern minimally invasive surgery. In order to comprehensively discuss the relationship between NOSES and organ functional protection, we elaborate the important role and value of functional protection in NOSES from five key procedures of colorectal surgery, namely surgical approach, extent of resection, lymph node dissection, digestive tract reconstruction and specimen extraction.
Colorectal Neoplasms/surgery* ; Digestive System Surgical Procedures ; Humans ; Laparoscopy/methods* ; Natural Orifice Endoscopic Surgery/methods* ; Specimen Handling ; Treatment Outcome