Complex and Reoperative Colorectal Surgery: Setting Expectations and Learning from Experience

Abstract

Surgeons who perform colorectal operations are bound to face their share of complex and reoperative cases. For many, these challenging operations are what attracted us to the field. To maximize success and minimize complications in these circumstances, the surgeon must ensure adequate preoperative planning with good imaging and enlistment of help from other specialists, set expectations for the patient and operating room staff, and be aware of his or her own abilities. This issue of Clinics in Colon and Rectal Surgery is meant to serve as a resource so that surgeons and patients may benefit from the lessons learned by our expert contributors over years of experience. From a health systems and policy standpoint, it is important to recognize that these complex and reoperative cases confer a higher risk for morbidity and mortality when reporting quality outcomes, and to consider ways to optimize outcomes by concentrating the experience. Preoperative PreparationPreparation for the operation is often as important as the operation itself and consists of setting expectations for all parties involved-the surgeon and the surgical team, the patient, the operating room staff, and the nursing staff on the surgical ward. Failure to do this may result in significant delays, complications, poor delivery of care, and patient dissatisfaction. Imaging and Preoperative AssessmentOperative planning for complex and reoperative cases consists of obtaining high-quality imaging to reduce the risk of unplanned surgical findings. Other aspects of the workup include an assessment of the patient's risk for undergoing a general anesthetic and a major operation. Older patients are likely to undergo a full cardiopulmonary assessment to assess their readiness for a major operation based on the risk factor of age, and patients who are chronologically young yet frail due to their underlying illness should also undergo evaluation. Simple tools to measure a patient's frailty include gait speed, timed-up-and-go, and administration of screening questionnaires such as the Frail scale. 1-3 Assembling the Operating TeamMany complex and reoperative cases require a multidisciplinary approach, involving collaboration with other specialists including urologists, gynecologists, radiation oncologists, and plastic surgeons. The colorectal surgeon should function as the lead surgeon in these cases and coordinate the other players in the operative plan.Another consideration for a surgeon embarking on a difficult case is to ensure that an experienced colleague is available to help should the need arise. This is especially important for junior surgeons, but even very experienced senior surgeons will face particularly challenging cases where Keywords ► complex surgery ► reoperative surgery ► complications AbstractA range of topics are covered in this issue dedicated to complex and reoperative colorectal surgery, from radiation-induced surgical problems, to enterocutaneous fistulas and locally advanced or recurrent rectal cancer. Common themes include the importanc...

Factors affecting operative morbidity and long‐term outcomes in patients undergoing surgery for presacral tumours: a multicentric cohort study from the Turkish Collaborative Group for Quality Improvement in Colorectal and Pelvic Surgery

“…Surgical treatment of presacral tumours should be performed at tertiary care referral centres by multidisciplinary teams experienced in complex abdominopelvic surgery for reasons of a wide variety of difficulties related to disease, a hostile intrapelvic environment and complicated surgical technique [10]. The type of surgery is planned based on the location of the presacral tumour.…”

Management and Morbidity of Major Pelvic Hemorrhage in Complex Abdominopelvic Surgery

“…Any radical abdominopelvic operation which is not standardized is complex. Hence, radical oncologic operations for the primary advanced or recurrent carcinoma of pelvic organs, revisional operations for failed restorative operations for maintaining intestinal continuity are considered as CAPS [1].…”

“…Complex abdominopelvic surgery (CAPS) includes a wide variety of difficulties related to primary disease and hostile intrapelvic environment [1]. Any radical abdominopelvic operation which is not standardized is complex.…”