Preface

Vlad V. Simianu, MD, MPH

Caring for colon cancer is a fundamental pillar of colorectal surgery. The prevalence of colon cancer is rising in the population and this mainstay of our practice is becoming increasingly complex—with evolving technology, understanding of cancer biology, and improving cancer care delivery. This edition of Clinics in Colon and Rectal Surgery (CCRS) is intended to update on contemporary colon cancer care. We aim to provide a primer on some of the technical aspects of colon cancer operations, decision-making in particular clinical scenarios, nuances in individualizing perioperative care, and some of the evolving “big issues” that impact colon cancer care delivery.

The edition begins with an excellent summary of the details that go in operative planning for oncologic colectomy. I am grateful to Drs. Bauer, Wlodarczyk, and Widmar for providing a thorough description of the concept and data behind complete mesocolic excision, and when to extend lymphadenectomy. This is followed by a discussion by Drs. Westfal and Curran of the journey to the wide adoption of minimally invasive surgery for colon cancer operations, and the future directions in which the field is expected to continue to evolve.

The next sections dive into important decisions on patient selection. Drs. Hendren and Sommovilla review emerging data in patients with Lynch's syndrome—including how to selectively avoid extended resection based on pathogenic variants, patient-specific factors, and prevention strategies. Drs. Charboneau and Kaplan discuss endoscopic techniques and when to exercise caution with malignant polyps. Drs. Onyiego and Maykel review both operative and nonoperative options in managing and palliating malignant bowel obstructions. Across these articles, you will note summaries of current guidelines and also the multiple considerations for what might be the “right outcome” in these specific patients.

The next two articles dive into important perioperative care related to colon cancer biology. Drs. Heit and Cohen provide a summary of current uses and limitations of contemporary circulating tumor DNA (ctDNA) assays, as well as a sneak peek of upcoming trials that will help guide clinical decision-making. Then, Drs. Pang, Baldi, and Herzig deliver a practical look at the data behind neoadjuvant chemotherapy and immunotherapy, and a guide on how to individualize postoperative therapy.

This edition finishes with three important aspects of colon cancer care. Drs. Sokas and Ivantury introduce the use of patient-reported outcome measures (PROMs) in routine practice. This piece, I believe, offers important information that can enhance shared decision-making beyond traditional outcomes, and highlights special populations on which to focus these practices. Next, Drs. Shaefer and Harbaugh offer a thought-provoking piece on the good and bad of centralizing colon cancer care. Finally, Drs. Morris and Kin use the perspectives of appropriateness and standards of care to elaborate on how to continue to elevate high-quality colon cancer care.

I am grateful for the time and expertise of the many authors who contributed to this edition. They are leaders in the field of colon cancer, and I believe you will find new and practical information in each article. Continuing to be engaged and meticulous in colon cancer care—from patient selection to technical aspects of our operations to building successful health systems—is critical to elevating the care we deliver to our patients.

Publikationsverlauf

Artikel online veröffentlicht:
13. Januar 2025