title: 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.
authors.affiliation: Jeroen LA van Vugt, Djamila Boerma, Department of Surgery, St Antonius Hospital, 3430 EM Nieuwegein, The Netherlands.
authors.forename: Jeroen L A
authors.initials: JL
authors.lastname: van Vugt
authors.affiliation: Jeroen LA van Vugt, Djamila Boerma, Department of Surgery, St Antonius Hospital, 3430 EM Nieuwegein, The Netherlands.
authors.forename: Kostan W
authors.initials: KW
authors.lastname: Reisinger
authors.affiliation: Jeroen LA van Vugt, Djamila Boerma, Department of Surgery, St Antonius Hospital, 3430 EM Nieuwegein, The Netherlands.
authors.forename: Joep P M
authors.initials: JP
authors.lastname: Derikx
authors.affiliation: Jeroen LA van Vugt, Djamila Boerma, Department of Surgery, St Antonius Hospital, 3430 EM Nieuwegein, The Netherlands.
authors.forename: Djamila
authors.initials: D
authors.lastname: Boerma
authors.affiliation: Jeroen LA van Vugt, Djamila Boerma, Department of Surgery, St Antonius Hospital, 3430 EM Nieuwegein, The Netherlands.
authors.forename: Jan H M B
authors.initials: JH
authors.lastname: Stoot
mesh_terms: D003082:Colectomy / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D006304:Health Status; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Anastomotic leakage; Audits; Colorectal surgery; Enhanced recovery after surgery; Frailty; Laparoscopic surgery; Nutritional status; Sarcopenia