Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12445
Revised: March 18, 2014
Accepted: June 14, 2014
Published online: September 21, 2014
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.
Core tip: Laparoscopic surgery is a fundamental improvement in oncological colorectal surgery, associated with better short-term outcomes. However, anastomotic leakage still presents a major challenge in the postoperative course. Future research should therefore aim at the prevention, timely recognition and treatment of this complication. Correction of nutritional compromise, frailty and muscle loss, optimization of fluid and microcirculatory status, implementation of clinical and laboratory diagnostic markers, and the use of clinical audits may all contribute to a reduction of anastomotic leakage.