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Background: Management for locally advanced rectal cancer (LARC) conventionally comprises long‐course chemoradiotherapy (LCCRT), total mesorectal excision (TME), and adjuvant chemotherapy. However, the RAPIDO study published in 2021 showed that total neoadjuvant therapy (TNT) led to better oncological outcomes without increased toxicity. We review the surgical and short‐term oncological outcomes of patients with high‐risk LARC who underwent TNT or LCCRT before TME. Methods: Patients with high‐risk LARC who underwent TNT or LCCRT before TME between 2021 and 2022 were reviewed. Results: Thirty‐five patients (66%) had TNT as per RAPIDO whilst 18 underwent LCCRT. Median follow‐up was 16 months (range 5–25). Of the patients who had TNT, median age was 65 years old (range 44–79), 34 (97%) had clinical Stage 3 LARC and median height FAV was 5 cm (range 0.5–14). Nine (26%) required a dose delay/reduction due to treatment toxicity. Seven (50%) showed resolution of previously enlarged lateral nodes. Three (9%) had pathological complete response. Postoperative major morbidity was 23%, of which 4 patients required a reoperation. Six (17%) patients had disease‐related treatment failure, with two having disease progression during TNT, two developed local recurrence, and two developed distal metastasis following surgery. Median duration to surgery following completion of chemotherapy was significantly shorter with TNT (36 days versus 74 days) (P < 0.001). There were no other significant differences in outcomes. Conclusion: TNT is clinically safe in high‐risk LARC patients with no significant difference to surgical and short‐term oncological outcomes compared to LCCRT, although a higher incidence of early surgical morbidity was observed. [ABSTRACT FROM AUTHOR]

Background: Primary closure of the defect following radical excision of pilonidal sinus disease often has high complication rates. Objectives: This study aims to compare the outcomes of the Karydakis and Bascom off-midline flap closure techniques with the more recently described Dufourmentel rhomboid flap technique. Design: Retrospective cohort study. Setting: Patients who underwent elective pilonidal sinus excision with flap reconstruction at a tertiary referral center from January 2019 to January 2023. Patients and Methods: De-identified data of patients who underwent elective pilonidal sinus excision with flap reconstruction at a tertiary referral center from January 2019 to January 2023 were analyzed. Patients who underwent pilonidal sinus surgery without flap reconstruction were not included in the analysis. Institutional ethical committee review was waived for this study. Main Outcome Measures: Wound healing time, postoperative complications, disease recurrence, operative duration, and length of hospital stay. Sample Size: Forty-four patients. Results: Over a 4-year duration, 44 patients had elective pilonidal sinus surgery, of whom 44 (36 men, eight women) underwent flap reconstruction of the defect. Mean age and body mass index was 25.6 years and 26.6 kg/m2, respectively. The overall mean complete wound healing time was 10.8 weeks, with the Dufourmentel group having the quickest healing time compared to the Karydakis and Bascom groups (6.1 weeks versus 10.8 weeks versus 13.9 weeks, respectively; P = 0.206) At a mean follow-up duration of 8 months, 18 (40.1%) patients developed postoperative wound complications. Overall wound complication rate was lowest in the Dufourmentel group (9.1% versus 52.9% versus 56.3%, respectively; P = 0.030). This was largely contributed by the reduced wound dehiscence rate (9.1% versus 35.3% versus 56.3%, respectively; P = 0.043). The rates of wound infection, sinus recurrence, and reoperation were low and statistically comparable across all three groups. Conclusion: Our findings suggest the superiority of the Dufourmentel flap reconstruction technique compared to the Karydakis and Bascom closure techniques following elective pilonidal sinus excision. Limitations: Retrospective study with a small sample size and short follow-up duration. Conflict of Interest: The authors have no conflict of interest to declare. [ABSTRACT FROM AUTHOR]

Background: In recent years, new technology has emerged with the potential to considerably influence the future landscape of gastrointestinal endoscopy. One example of this is real-time artificial intelligence-assisted colonoscopy (AIC). Reported improvements in polyp detection rate (PDR) and adenoma detection rate (ADR) over standard colonoscopy (SC) have led to its rapid adoption in several tertiary endoscopy centers worldwide. However, many clinicians have mixed attitudes concerning the use of AIC. Similar to other skill-based procedures, the quality of endoscopy is directly proportional to the technical expertise and proficiency of the endoscopist. Objective: To evaluate the use of real-time AIC versus SC at a tertiary, high-volume referral center. Design: Retrospective cohort study. Settings: Single tertiary referral center. Patient and Methods: Data was retrospectively analyzed from patients who underwent elective colonoscopy at Singapore General Hospital from August 1, 2022 to October 31, 2022. Main Outcome Measures: The primary study outcome was PDR and ADR. Subgroup analysis assessed the differences in polyp detection according to the experience level of the endoscopist. Sample Size: Eight hundred and fifty-nine patients. Results: Over the 3-month study period, 859 patients underwent complete colonoscopies performed by nine accredited endoscopists; 430 patients underwent SC and 429 underwent AIC. Both groups were statistically similar in age, gender, and indication for colonoscopy. The median ADR was 34.2% (range, 24.6%-57.3%) for the entire cohort. Overall detection rates were higher for AIC than SC for diminutive polyps (=5 mm) (45.7% vs 38.6%, P = 0.045), sessile polyps (48.5% vs 37.4%, P = 0.009), and polyps with adenomatous (42.4% vs. 36.3%, P = 0.043) or serrated histology (1.2% vs. 0%, P = 0.025). Using SC, PDR among junior versus senior endoscopists was comparable at 47.9% vs 45.6% (P = 0.672) and ADR at 36.1% vs 36.8% (P = 0.912). With real-time AI enhancement, PDR and ADR for junior endoscopists considerably increased over their senior counterparts, with PDR at 69.5% vs 44.9% (P = 0.0001) and ADR at 50.0% vs 37.7% (P = 0.016). Among senior endoscopists, AIC did not result in any statistical improvement of PDR (P = 0.999) and ADR (P = 0.854) compared to SC. Conclusions: AIC significantly increases PDR and ADR compared to SC, particularly for detecting diminutive and sessile polyps. This benefit was only observed among less experienced endoscopists. Limitations: This study is limited by its retrospective nature, short study duration, and availability of the AI system, leading to practical constraints. Conflict of Interest: The authors have no conflict of interest to declare. [ABSTRACT FROM AUTHOR]