The American College of Surgeons (ACS) hosted their Clinical Congress 2024 in San Francisco from October 19–22. This prestigious event provided a unique platform for education, networking, and exposure to cutting-edge surgical innovations that are shaping the field. Distinguished experts delivered a series of Named Lectures, covering a diverse range of topics within their respective specialties. In addition, attendees had access to over 100 Panel Sessions, addressing both clinical and non-clinical issues relevant to modern surgical practice.

Highlighted below are concise summaries of studies presented at ACS Clinical Congress 2024 that focus on advancing the field of colon and rectal surgeries.

Recurrent Rectal Prolapse: Re-Recurrence Rate and Risk Factors

  • Rectal prolapse surgery often results in a high rate of recurrence, typically around 20 to 30%. In cases where recurrence occurs, patients may require additional surgery known as recurrent rectal prolapse (RRP) surgery. Unfortunately, there are currently no established guidelines to assist surgeons in making decisions regarding RRP surgery.
  • The objective of this study was to assess the re-recurrence rate of rectal prolapse and to identify potential risk factors for re-recurrence. The findings revealed that the perineal approach during RRP surgery was a significant risk factor for re-recurrence. As a result, the researchers recommend that surgeons consider utilizing an abdominal approach when treating RRP in order to minimize the likelihood of rectal prolapse re-recurrence.
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Differences in Objective Performance Indicators during Robotic Proctectomy: Early vs Advanced Cancer Patients

  • Surgery for patients with advanced rectosigmoid cancer is often considered more intricate, yet a lack of objective intraoperative data impedes a comprehensive understanding of the varying techniques required for such procedures. Objective performance indicators (OPIs), utilizing machine-learning-enabled metrics, offer valuable data on surgeon movements and robotic arm kinematics. In our research, we have pinpointed disparities in OPIs during robotic proctectomy (RP) between patients with early and advanced rectosigmoid cancer.
  • This groundbreaking study is the first to highlight specific OPIs that diverge during RP in patients with different stages of rectosigmoid cancer. While the findings showcase the feasibility of this approach, further research involving larger patient cohorts is imperative to validate the results.
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Temporal Trends and Factors Associated with Declining Surgery in Patients with Resectable Colon Cancer

  • Colorectal cancer stands as the third leading cause of cancer-related deaths in the United States, with oncologic resection serving as the cornerstone of potential cure. Despite the critical role of surgery in achieving a potential cure, a subset of patients opt to decline this potentially life-saving intervention. Our objective was to analyze the patterns of surgery refusal and pinpoint the factors influencing this decision.
  • Recent data indicates a concerning uptick in the rates of patients declining surgery for colon cancer over the past decade. Of particular concern is the revelation of racial and socioeconomic disparities within this trend. With limited alternative curative options available, it is paramount to delve into the motivations behind this choice to forego surgery. This understanding can address the disparities through targeted interventions and fostering meaningful risk-benefit conversations with patients.
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The Impact of Operative Start Time on The Outcomes of Minimally Invasive Colectomy

  • The advent of minimally invasive surgery has revolutionized the practice of colorectal surgery. Despite its many benefits, there are occasions when a conversion to open surgery is necessary to ensure the safe completion of the procedure. While it may seem logical that a later start time could have a negative impact on outcomes, there is a lack of research addressing this issue. This study aims to explore the relationship between surgical start time and surgical outcomes.
  • The research indicates a significant association between surgical start times and outcomes for abdominal colorectal procedures. While factors related to the surgeon and the operating room environment may contribute to this correlation, further investigation is needed to pinpoint any potentially modifiable factors that could explain the findings.
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Risk Factors for Withdrawal of Care after Colorectal Surgery

  • Risk factors for mortality following colorectal surgery have been identified and utilized to inform surgical decision-making and patient counseling. While postoperative mortality highlights the most serious complications and instances of failure to rescue, analyzing trends in the withdrawal of care offers a more nuanced and patient-centered understanding of these complex postoperative scenarios. This study aims to pinpoint the risk factors associated with postoperative withdrawal of care following colorectal surgery.
  • Factors such as advanced age, decreased functional status, urgency of the operation, and major postoperative complications like respiratory failure, renal failure, and sepsis have been found to be significantly linked to the decision to withdraw care after colorectal surgery.
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Intracorporeal Anastomosis: A Nine-Year Review of Minimally Invasive Colorectal Surgery Outcomes

  • Restoring intestinal continuity and creating anastomoses present significant challenges in the field of colorectal surgery. Presently, there exist two minimally invasive techniques for performing ileocolonic and colorectal anastomosis: intracorporeal and extracorporeal methods.
  • Intracorporeal colonic anastomosis stands as a viable and secure option. The positive outcomes observed in terms of reduced surgical site infections, shorter hospital stays, and improved recovery of intestinal function serve to underscore the advantages of this approach.
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Robotic versus Laparoscopic Surgery for Colon Cancer: Short-term Outcomes of a Randomized Trial

  • To date, current literature has not yielded definitive evidence supporting the superiority of robotic surgery. Therefore, the decision to implement robotic surgery for the treatment of colonic cancer should be contingent upon the confirmation of superior perioperative outcomes.
  • Robotic surgery offers the benefit of minimal severe complications and improved post-operative recovery following colonic resections. The advantages of the robotic platform have been particularly evident in right colonic resections.
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Anesthesia Adjuncts on Patients Undergoing Colectomy: An Analysis of NSQIP- Reported Outcomes

  • The incorporation of regional and spinal anesthesia techniques has been associated with decreased pain and enhanced outcomes across various fields of general surgery. This study seeks to assess the efficacy of these techniques in patients undergoing colectomy procedures.
  • The utilization of adjunctive anesthesia, specifically regional and spinal anesthesia, in patients undergoing colectomies has been correlated with a reduction in hospital stay duration, improved functional status upon discharge, and decreased morbidity rates.
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Safety of Laparoscopic and Robotic Surgery for Elderly Patients with Colorectal Cancer; A Multicenter Retrospective Study

  • The practice of minimally invasive surgery for colorectal cancer has been rapidly expanding worldwide. Despite this growth, there remains a lack of comprehensive research on the safety of this procedure for elderly patients.
  • In the case of elderly colorectal cancer patients aged 80 and above, it is imperative for surgeons to focus on reducing operation time and minimizing blood loss. Additionally, special care and attention must be given to super-elderly patients, as they are at a heightened risk for postoperative complications.
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As we wrap up ACS Clinical Congress 2024, we encourage you to click here to access the comprehensive list of research that was presented. We are eagerly anticipating Clinical Congress 2025 in Chicago!

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