СОВРЕМЕННЫЙ ВЗГЛЯД НА ОПТИМАЛЬНЫЕ СПОСОБЫ ПОДГОТОВКИ ТОЛСТОЙ КИШКИ ПЕРЕД ПЛАНОВЫМИ КОЛОРЕКТАЛЬНЫМИ ОПЕРАЦИЯМИ

Purpose: to assess current data on the effect of different approaches to preoperative bowel preparation before elective colorectal surgery on short-term treatment outcomes.Material and Methods. Online system PubMed of U.S. National Library of Medicine was used to find articles with key words “mechanical bowel preparation”, “surgical site infection”, “oral antibiotics”. A total of 226 articles were reviewed. 31 articles were selected for final review. Furthermore, ClinicalTrials.gov site was used to find actual and recruiting trials.Results. Mechanical bowel preparation (MBP) used to be a standard procedure for a long time. Nowadays, routine use of MBP seems to be debatable. Alternative approaches, e.g. absolutely no preparation or the use of MBP in combination with oral antibiotics, are considered. Data on performing different kinds of bowel preparation is reviewed in this article.Conclusion. Optimal approach of preoperative bowel preparation is still questionable. Combination of mechanical bowel preparation and oral antibiotics seems to be a preferable method. However, there is not enough evidence to exclude anothertechniques. It’s required to conduct additional randomized controlled trials.Цель исследования – обобщение имеющихся данных по влиянию применения разных подходов предоперационной подготовки кишки на непосредственные результаты при плановых операциях на толстой кишке.Материал и методы. С помощью электронной системы американской национальной медицинской библиотеки PubMed проводился поиск статей по ключевым словам: mechanical bowel preparation, surgical site infection, oral antibiotics. В ходе анализа изучено 226 статей, 31 из которых отобрана для окончательного обзора. Также для поиска текущих исследований использовалась электронная база ClinicalTrials.gov.Результаты. Применение механической подготовки кишки при операциях на толстой кишке считалось стандартом в течение многих лет. В настоящее время целесообразность механической подготовки кишки подвергается сомнению, в связи с чем рассматривается возможность полного отказа от механической подготовки кишки либо, напротив, дополнение механической подготовки кишки пероральными антибиотиками. В обзоре представлены данные литературы по влиянию применения разных подходов предоперационной подготовки кишки на непосредственные результаты.Заключение. Оптимальный способ предоперационной подготовки кишки остается предметом дискуссии в хирургическом сообществе. В настоящее время наиболее предпочтительным способом следует считать комбинацию MBP и пероральных антибиотиков. Однако данная область изучена недостаточно и требует проведения дополнительных рандомизированных исследований

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

BJS commission on surgery and perioperative care post-COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era

BJS commission on surgery and perioperative care post-COVID-19

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)