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How to improve polyp detection: Quality measures and new techniques and tools for improvement
The quality of screening colonoscopy, the cornerstone of colorectal cancer prevention, varies among endoscopists and directly impacts rates of adenoma detection and the incidence of interval cancers. Through continuous quality improvement, it may be possible to improve the performance of otherwise low level adenoma detectors. This section reviews a variety of possible interventions that may impact individual practitioners ′ adenoma detection rates. Despite advances in imaging technology and the introduction of novel devices into the endoscopy suite, self-improvement by incorporating best practice techniques is the most e...
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Daniel L. Feingold, Emmanouil P. Pappou, Steven A. Lee-Kong Source Type: research

Preface
Advanced endoscopic procedures and endo-luminal interventions have continued to experience tremendous growth in both community and academic settings. Many technical advances in endoscopic tools and platforms have transformed the way we treat patients with colon and rectal diseases. As surgeons explore less invasive surgical techniques and gastroenterologists more complex therapeutic endoscopic procedures, the convergence of interests will lead to further innovations and evolution of the way we treat our patients. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Sang W. Lee Source Type: research

Future endoscopic toolbox for endoluminal surgery
Differences between flexible GI endoscopy and laparoscopic surgery are mostly responsible for failure of NOTES and current technical difficulties of endoluminal interventions. A set of new tools will bridge gaps between endoscopy and laparoscopy, and may foster their positive integration towards next generation endoscopic intervention. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Kiyokazu Nakajima Source Type: research

Endoscopic submucosal dissection and endoscopic mucosal resection methods for the removal of large sessile polyps
In expert hands, Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) methods can successfully and definitively treat large sessile polyps, thus, eliminating the need for segmental colectomy. The goal should be to utilize ESD whenever feasible as it yields an en bloc specimen. ESD methods can also be used to definitively treat superficial invasive colorectal cancers which have a very low chance of lymph node involvement. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Erica Pettke, Abhnit Shah, Richard L. Whelan Source Type: research

Advanced endoscopic imaging: Polyps and dysplasia detection
Colonoscopy is the gold standard for colorectal cancer screening and diagnosis. Colonoscopy is a minimally invasive procedure that provides visual inspection of colonic mucosa. The goal of imaging is to detect adenomatous changes which are the primary risk factor for colonic adenocarcinoma. Adenomatous polyps represent structurally visible low grade dysplasia. Their detection is the key to screening for and preventing colorectal cancer. Many technological advances have been designed to improve the detection of colonic dysplasia. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Anna Skay, Jacques Van Dam Source Type: research

Combined Endoscopic and Laparoscopic Surgery (CELS)
Patients who present with benign but difficult colon polyps that are not amenable for endoscopic removals will typically undergo colon resection. Although the laparoscopic approach has improved short-term outcomes, morbidities associated with bowel resection are still significant. A combined approach using both laparoscopy and colonoscopy (combined endoscopic laparoscopic surgery, CELS) is a safe and effective alternative to bowel resection and may result in significantly improved short-term outcomes and cost savings over colon resection. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Sang W. Lee, Kelly A. Garrett, Jeffrey W. Milsom Source Type: research

Epidemiology, risk factors, and prevention
Colorectal cancer (CRC) represents a significant burden of disease worldwide. It is the third most commonly diagnosed malignancy with an estimated prevalence of 1.1 million cases. Numerous factors have been linked to the development of CRC. Non-modifiable factors associated with risk include age, family history, race, and the presence of inflammatory bowel disease. There are many modifiable factors which also affect risk such as dietary habits, level of physical activity, tobacco abuse, and the use of certain medications such as aspirin, non-steroidal anti-inflammatory drugs and hormone replacement therapy. (Source: Semina...
Source: Seminars in Colon and Rectal Surgery - April 25, 2016 Category: Gastroenterology Authors: Radhika Smith, David J. Maron Source Type: research

Introduction
It is an honor to serve as the guest editor for this issue of Seminars in Colon and Rectal Surgery, “Current Treatment of Colon Cancer.” I thank Dr. David Schoetz for the invitation and opportunity to oversee its content. Although colon cancer remains one of the most common cancers and causes of cancer death in the United States and throughout the world, it still is one of the most preventable and curable. Both incidence and mortality rates have improved over the last several decades. Several factors have contributed to these increased outcomes. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 24, 2016 Category: Gastroenterology Authors: Matthew F. Kalady Source Type: research

Molecular genetics of colorectal Cancer
Colorectal cancer is the end result of an accumulation of destabilizing mutations and other genetic events that occur in colonocyte nuclei over many years. While each colorectal cancer is genetically unique, there are at least three distinct mechanisms by which the process occurs. The commonest is chromosomal instability, producing microsatellite stable, aneuploidy cancers. The second is DNA promoter methylation, that underlies CpG island methylation phenotype cancers, either microsatellite stable or unstable, and the third is loss of DNA mismatch repair, causing microsatellite unstable, diploid cancers. (Source: Seminars ...
Source: Seminars in Colon and Rectal Surgery - April 24, 2016 Category: Gastroenterology Authors: James Church Source Type: research

Advances in colonoscopy and screening for colon cancer
Physicians have a plethora of options when choosing a diagnostic test or procedure for colon cancer screening. Clinicians are no longer limited to fecal occult blood tests and standard colonoscopy. Newer choices include advanced stool tests and imaging modalities such as computed tomography colonography. Even the “standard” colonoscope has multiple accessories, ranging from simple plastic caps to multisystem high definition imaging. Each new innovation brings with it data touting its excellence and deciding the best modality can be a daunting task. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 24, 2016 Category: Gastroenterology Authors: Nathan H. Hite, David A. Margolin Source Type: research

Management of malignant polyps
Malignant polyps of the colon may be managed with endoscopic therapy or oncologic resection, with the appropriateness of each dependent on histologic features, polyp location, and patient preference. Lesions at increased risk for having nodal metastases should undergo oncologic resection. High-risk features include lymphovascular invasion, poor differentiation, and greater depth of submucosal invasion. However, while there are some clear indications for endoscopic or oncologic resection, many cases of malignant polyps fall into a gray zone where management is under debate. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 24, 2016 Category: Gastroenterology Authors: Cindy Kin Source Type: research

Staging, prognosis, and survivorship in colon cancer
The American Joint Committee on Cancer released the 7th edition of their staging manual for colon cancer in 2010. The biggest changes were the subcategories added for stage II and III colon cancer, as there is a significant difference in survival based upon the tumor depth of invasion (T stage) within these two stages. The 8th edition is awaiting release in the near future. However, there continues to be a dilemma of which patients with Stage II cancer may benefit from adjuvant chemotherapy. There are guidelines that now include clinical, pathologic and genomic factors that allow us to stratify patients into high and low-r...
Source: Seminars in Colon and Rectal Surgery - April 24, 2016 Category: Gastroenterology Authors: Kevin Kniery, Madhuri Nishtala, Scott R. Steele Source Type: research

Surgical approach to colon cancer
Surgery remains the most definitive treatment for colon cancer. A complete colon exam is critical to localize the primary lesion and exclude other pathology in the colon that may influence the extent of resection. In the comorbid aging population, the surgeon must be able to accurately prognosticate postoperative morbidity and mortality. Enhanced recovery interventions, including minimally invasive approaches to resection offer improved short-term outcomes without oncologic compromise. Colectomy for cancer follows four oncologic principles; adequate lymphadenectomy of ≥12 lymph nodes, high ligation of the primary vessel,...
Source: Seminars in Colon and Rectal Surgery - April 24, 2016 Category: Gastroenterology Authors: Matthew G. Mutch, Katerina O. Wells Source Type: research

Advances in adjuvant therapy of colon Cancer
Surgical resection is the primary curative modality for colon cancer but outcomes are variable and dependent on risk of recurrence. Currently, stage and a variety of clinicopathologic risk factors are used to estimate recurrence risk. Adjuvant chemotherapy is recommended for most patients with stage III disease and high-risk patients with stage II disease to reduce the risk of recurrence and improve outcomes. Fluoropyrimidines with and without oxaliplatin have proven benefit, but there is no effect of other agents including irinotecan, anti-vascular endothelial growth factor, or anti-epidermal growth factor agents in this ...
Source: Seminars in Colon and Rectal Surgery - April 24, 2016 Category: Gastroenterology Authors: Santosh Kumar, Marcus S. Noel, Alok A. Khorana Source Type: research