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Artificial intelligence (AI) and computer vision (CV) are beginning to impact medicine. While evidence on the clinical value of AI-based solutions for the screening and staging of colorectal cancer (CRC) is mounting, CV and AI applications to enhance the surgical treatment of CRC are still in their early stage. This manuscript introduces key AI concepts to a surgical audience, illustrates fundamental steps to develop CV for surgical applications, and provides a comprehensive overview on the state-of-the-art of AI applications for the treatment of CRC. Notably, studies show that AI can be trained to automatically recognize surgical phases and actions with high accuracy even in complex colorectal procedures such as transanal total mesorectal excision (TaTME). In addition, AI models were trained to interpret fluorescent signals and recognize correct dissection planes during total mesorectal excision (TME), suggesting CV as a potentially valuable tool for intraoperative decision-making and guidance. Finally, AI could have a role in surgical training, providing automatic surgical skills assessment in the operating room. While promising, these proofs of concept require further development, validation in multi-institutional data, and clinical studies to confirm AI as a valuable tool to enhance CRC treatment.

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Circular staplers for colorectal anastomoses signi cantly ameliorated post-operative outcomes after rectal resection. The more recent three row technology was conceived to improve anastomotic resistance and, thus, lower the incidence of anastomotic complications. The aim of this study was to evaluate potential advantages of three row circular staplers(Three-CS) on anastomotic leakage(AL), stenosis(AS) and hemorrhage(AH) rates after rectal resection as compared to two row circular staplers(Two-CS). MethodsAll rectal resections for rectal cancer between 2016 and 2021 were retrospectively included. Patients were classi ed according to the circular stapler employed in Two-CS and Three-CS cohorts. AL, AS and AH rates were compared between the two populations. Additionally, the prognostic role of the type of circular stapler on AL onset was evaluated. ResultsThree-hundred and seventy-ve patients underwent a rectal resection with an end-to-end anastomosis during the study period:197 constituted the Two-CS group and 178 the Three-CS cohort. AL rate was 6.7%, signi cantly higher in the Two-CS group(19-9.6%) as compared to the Three-CS cohort(6-3.4%) (p=0.01). No difference was noted in terms of AL severity. Although not statistically signi cant, a lower incidence rate of AL was evidenced even in the subset of patients with low rectal cancers(4.5%vs12.5% in the Two-row cohort;p=0.33). At the multivariate analysis, Two-CSs was a negative prognostic factor for AL onset(OR: 2.63;p=0.03). No difference was noted between the two groups in terms of AS and AH. ConclusionThree-row CSs signi cantly decrease the rate of AL after rectal resection. Further multicenter controlled trials are still needed to con rm the advantages of Three-row CSs on anastomotic complications.

Robotic surgery has progressively gained popularity in the treatment of rectal cancer. However, only a few studies on its oncologic effectiveness are currently present, with contrasting results. The purpose of this study is to report a single surgeon’s experience on robotic rectal resection (RRR) for cancer, focusing on the analysis of oncologic outcomes, both in terms of pathological features and long-term results. One-hundred and twenty-two consecutive patients who underwent RRR for rectal cancer from January 2013 to December 2019 were retrospectively enrolled. Patients’ characteristics and perioperative outcomes were collected. The analyzed oncologic outcomes were pathological features [distal (DM), circumferential margin (CRM) status and quality of mesorectal excision (TME)] and long-term outcomes [overall (OS) and disease-free survival (DFS)]. The mean operative time was 275 (± 60.5) minutes. Conversion rate was 6.6%. Complications occurred in 27 cases (22.1%) and reoperation was needed in 2 patients (1.5%). The median follow-up was 30.5 (5.9–86.1) months. None presented DM positivity. CRM positivity was 2.5% (2 cases) while a complete TME was reached in 94.3% of cases (115 patients). Recurrence rate was 5.7% (2 local, 4 distant and 1 local plus distant tumor relapse). OS and DFS were 90.7% and 83%, respectively. At the multivariate analysis, both CRM positivity and near complete/incomplete TME were recognized as negative prognostic factors for OS and DFS. Under appropriate logistic and operative conditions, robotic surgery for rectal cancer proves to be oncologically effective, with adequate pathological results and long-term outcomes. It also offers acceptable peri-operative outcomes, further confirming the safety and feasibility of the technique.