Colorectal Surgery

Broad-spectrum penicillins and cephalosporin-based regimens best reduce SSI in elective colorectal surgery

This network meta-analysis included 105 randomized trials with 18,273 adults undergoing elective colorectal procedures given prophylaxis within 24 hours preoperatively. Broad-spectrum penicillins, third-generation cephalosporins, metronidazole plus second-generation cephalosporins, and tetracyclines markedly reduced 30-day SSI versus placebo or no antibiotics. Broad-spectrum penicillins and fluoroquinolone–penicillin combinations also significantly decreased 30-day all-cause mortality compared with placebo. Evidence certainty for leading regimens was high to moderate, supporting these classes as preferred prophylaxis anchors within stewardship and resistance constraints. 1

SCREESCO: colonoscopy and FIT increase early-stage CRC detection without early incidence reduction

The SCREESCO trial randomized 278,280 60-year-olds to once-only colonoscopy, two rounds of low-cutoff FIT, or usual care without organized screening. After 4.8 years, CRC incidence did not differ significantly between colonoscopy and control, or between FIT and control groups. Both colonoscopy and FIT arms showed higher rates of stage I–II CRC than controls, indicating a stage shift toward earlier detection. Gastrointestinal and cardiovascular events were modestly increased in the first year in screened groups, then converged toward control rates. 2

Prehabilitation improves functional recovery and lowers severe complications after colorectal cancer surgery

This meta-analysis pooled 11 randomized trials including 976 adults scheduled for elective colorectal cancer resection with or without structured prehabilitation. Prehabilitation increased postoperative 6-minute walk distance by about 33 meters, exceeding the minimal clinically important difference for functional capacity. It significantly reduced severe postoperative complications, with a risk ratio of 0.65, without clear changes in overall complications or hospital stay. Benefits were greatest with multimodal programs of at least three weeks and when assessed more than four weeks after surgery. 3

LASSO: long-term outcomes similar after laparoscopic and open adhesiolysis for adhesive small bowel obstruction

The LASSO randomized trial followed 100 patients with adhesive small bowel obstruction assigned to laparoscopic or open adhesiolysis for up to five years. Recurrent SBO rates were low and similar between groups at one and five years, with no statistically significant differences. Incisional hernia incidence and long-term SF-36 and GIQLI scores were also comparable between approaches. Thus, laparoscopic adhesiolysis does not confer long-term advantages over open surgery for recurrence, hernia, or quality of life. 4