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Colorectal Cancer

Published:March 09, 2022DOI:https://doi.org/10.1016/j.soc.2022.02.001
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      Traci L. Hedrick, MD, MSc, FACS, FACRS, Editor
      CRC screening rates steadily improved in the United States to a peak of nearly 70% at the start of the year 2020.

      CDC. Use of Colorectal Cancer Screening Tests. 2021. Available at: https://www.cdc.gov/cancer/colorectal/statistics/use-screening-tests-BRFSS.htm. Accessed September 1, 2021.

      However, the COVID-19 pandemic brought about a reduction in CRC screening and early diagnosis leading to the proliferation of more advanced disease.
      • Morris E.J.A.
      • Goldacre R.
      • Spata E.
      • et al.
      Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study.
      The impact of COVID-19 has yet to be fully realized but will inevitably have far-reaching effects on the trajectory of CRC for years to come.
      • Malagon T.
      • Yong J.H.E.
      • Tope P.
      • et al.
      Predicted long-term impact of COVID-19 pandemic-related care delays on cancer mortality in Canada.
      This is particularly true for disadvantaged groups, who have borne the greatest burden of the pandemic.
      • Shiels M.S.
      • Haque A.T.
      • Haozous E.A.
      • et al.
      Racial and ethnic disparities in excess deaths during the COVID-19 pandemic, March to December 2020.
      Despite improvements in CRC screening and treatment resulting in improved CRC survival, certain disadvantaged groups also experience higher incidence of CRC with worsened mortality rates.
      • Carethers J.M.
      Racial and ethnic disparities in colorectal cancer incidence and mortality.
      In the current issue, we explore the cause, implications, and possible strategies to address these tragic racial, social, and financial disparities as they pertain to the diagnosis and management of CRC.
      The management paradigm of CRC has evolved significantly over the last century since Miles’ original description of the extralevator abdominoperineal resection with an accompanying 41% mortality rate.
      • Miles W.E.
      A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908).
      Innovative endoscopic and transanal techniques along with advancements in novel therapeutic agents have led to substantial improvements in oncologic and patient-reported outcomes with increasing rates of sphincter preservation. In the current issue, we learn from the world’s experts, who are leading this innovative renaissance.
      As history demonstrates, controversy frequently lies in the shadow of innovation. Two particularly controversial topics in the surgical treatment of CRC focus on the technical aspects of the mesenteric excision: (1) the complete mesocolic excision and extent of lymphadenectomy for colon cancer, and (2) the minimally invasive total mesorectal excision (laparoscopy, robotics, transanal) for rectal cancer. We delve into both of these important topics, hearing from highly skilled surgeons in the technical and practice aspects of each of these evolving techniques.
      In the current issue of Surgical Oncology Clinics of North America, we sought to highlight the most important surgical aspects of CRC management. I am inspired by and thankful to my esteemed colleagues, who contributed their expertise to the current issue, and I hope you will gain valuable information to improve your practice.

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        • Morris E.J.A.
        • Goldacre R.
        • Spata E.
        • et al.
        Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study.
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        Predicted long-term impact of COVID-19 pandemic-related care delays on cancer mortality in Canada.
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        • Shiels M.S.
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        • Haozous E.A.
        • et al.
        Racial and ethnic disparities in excess deaths during the COVID-19 pandemic, March to December 2020.
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        Racial and ethnic disparities in colorectal cancer incidence and mortality.
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