Artificial Intelligence in Colorectal Cancer Surgery: Present and Future Perspectives

Abstract

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.

Artificial Intelligence Applications in Decision Making for Disease Management

“…The results of this study also revealed that AI has important applications in disease screening. AI can have a major role in the screening process, by supporting the screening process and staging, as categorized as the third theme entitled "screening" (43)(44)(45)(46)(47)(48). Screening is an important stage in decision making for disease management and future stages of intervention and treatment.…”

Artificial intelligence in improving the outcome of surgical treatment in colorectal cancer

“…Multiple institutions must collaborate in this context to ensure that data are diverse and representative ( 46 ). Such datasets will be critical for training stronger AI models, and also for demonstrating generalizability through external validation studies ( 47 ).…”

Application of artificial intelligence in diagnosis and treatment of colorectal cancer: A novel Prospect

“…In recent years, with the development of minimally invasive surgery, the application of AI in the field of surgery has also been gradually valued. Compared with more complicated CRC surgery, AI was applied earlier in lung cancer and breast cancer surgery ( 138 ). Notably, people have begun to study the application of AI in colorectal surgery, and gradually realize that AI can provide a new direction for the development of colorectal surgery.…”

“…Much research data on CRC is pouring out. Computer vision (CV) is a subfield of AI that can be used to analyze and evaluate video data ( 138 ). Some researchers in Japan have collected and analyzed 300 videos of laparoscopic colorectal surgery, hoping that these data sets may be employed to optimize the CNN performance in CV ( 118 ).…”