Colorectal Surgery Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped colorectal surgery practice.

Laparoscopic vs Open Colorectal Cancer Surgery

Equivalent oncologic outcomes

Open → COST/COLOR/CLASSIC (2004-2005) → laparoscopic equivalent → robotic

Organ preservation movement

Surgery always → Habr-Gama → complete clinical response → OPRA → organ preservation

From mandatory surgery to antibiotics optional

Operate after 2 episodes → DIRECT/DIABOLO → antibiotics optional → only for complicated

Fast-track recovery

Traditional 7-10 days → Kehlet fast-track → ERAS protocols → implementation → sustained

Intensification before surgery

Adjuvant chemoRT → neoadjuvant → RAPIDO/PRODIGE 23 TNT → pCR → intensification