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PODCAST

Colorectal Surgery Review

Allen Kamrava, MD MBA FACS FASCRS

An academic, sponsor-free audio review of core concepts in colon and rectal surgery. Using the power of A.I., created by Dr. Allen Kamrava, Associate Teaching Faculty at Cedars-Sinai Medical Center, this series is designed for residents, fellows, and practicing surgeons to stay current with concise, evidence-based updates. Covering textbook foundations, landmark trials, and evolving ASCRS guidelines, each episode delivers practical surgical education for the commute, workout, or even to wind down at

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All Episodes

00:43:05

GIST, Neuroendocrine Tumors and Lymphoma

Colorectal Surgery Review ·

2026/01/12

Focuses on three complex non-epithelial entities that demand specialized algorithms. For GIST, diagnosis is based on CD117 (KIT) and DOG1, and management hinges on molecular genetics (Exon 11 is favorable; Exon 9 requires higher imatinib dosing). Rectal GIST presents a core dilemma, as local excision carries a strikingly high local recurrence rate (up to 77%); neo-adjuvant imatinib is used to downsize tumors and facilitate sphincter preservation. Adjuvant imatinib must be given for a minimum of 3

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00:36:10

Appendiceal Neoplasms

Colorectal Surgery Review ·

2026/01/08

A detailed analysis of appendiceal neoplasms, highlighting how management is strictly driven by histology and classification. For invasive adenocarcinoma, a formal right hemicolectomy (RHC) is the standard due to the high risk of nodal metastasis (up to 30%). For mucinous neoplasms (LAMN/HAMN), the management pivots away from RHC to aggressive surveillance, driven by the critical distinction between high-risk cellular mucin versus low-risk acellular mucin found outside the appendix. For

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00:46:33

Rectal Cancer - Local Recurrence

Colorectal Surgery Review ·

2026/01/05

This episode tackles the highly complex and morbid radical management of Locally Recurrent Rectal Cancer (LRC), a disease defined as extra-TME pathology, operating in dense, irradiated, fibrotic tissue. Achieving an R0 resection is the single biggest determinant of cure (40-50% 5-year OS). Planning requires mandatory Multidisciplinary Team (MDT) input and combined PTCT/MRI, recognizing the limitations of MRI in delineating small pelvic sidewall structures. The modern radical approach often

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00:30:59

Management of Colorectal Metastases

Colorectal Surgery Review ·

2026/01/01

A deep dive into the aggressive, curative-intent management of stage IV colorectal cancer with distant metastasis, fueled by an average 40% 5-year overall survival rate for resectable liver metastases. The discussion centers on critical decision points, including sequencing for resectable synchronous metastases (neo-adjuvant chemo is preferred for high-volume disease to assess tumor biology). For liver lesions, modern resectability hinges on achieving R0 clearance and preserving an adequate Future

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00:28:53

Adjuvant Therapy for Colorectal Cancer

Colorectal Surgery Review ·

2025/12/29

A high-yield review of the post-operative management of resected stage II and III colorectal cancer. Key topics include the non-negotiable need for adjuvant chemotherapy (chemo) in stage III patients, leveraging landmark trials like MOSAIC. The episode details the paradigm shift in duration: 3 months of CAPOX is now the standard for low-risk stage III disease following the IDEA collaboration, reducing debilitating oxaliplatin toxicity. For stage II, management relies heavily on risk stratification

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00:42:23

Rectal Cancer - Proctectomy

Colorectal Surgery Review ·

2025/12/08

This episode reviews the technical and academic principles governing Proctectomy for Rectal Cancer, highlighting that the foundation of modern care is Total Mesorectal Excision (TME). We emphasize the consequences of surgical failure, noting that a Circumferential Resection Margin (CRM) of less than 1 mm carries a local recurrence rate greater than 50%.The episode details the meticulous anatomy required for nerve sparing, focusing on maintaining the Holy Plane during posterior dissection. Violation

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00:26:04

Rectal Cancer - Non-operative Management

Colorectal Surgery Review ·

2025/12/04

This episode details the revolutionary Watch and Wait (WW) strategy, the most significant paradigm shift in modern rectal cancer care. We distinguish PCR (Pathological Complete Response, post-surgical) from CCR (Clinical Complete Response, the goal for organ preservation), and discuss how Total Neoadjuvant Therapy (TNT) maximizes the CCR rate. The primary motivation for WW is avoiding the guaranteed morbidity of proctectomy, particularly the debilitating effects of Low Anterior Resection Syndrome

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00:43:43

Rectal Cancer - Local Excision

Colorectal Surgery Review ·

2025/12/01

This deep dive focuses on the high-stakes risk-benefit analysis of Local Excision (LE) for rectal cancer, balancing the functional benefits of organ preservation against the critical risk of missing occult lymph node metastases. We trace the technical path from conventional surgery to the modern standard of TAMIS (Transanal Minimally Invasive Surgery), emphasizing that oncologic LE requires an en block, full thickness resection.The core discussion centers on the histological predictors that mandate

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00:40:36

Rectal Cancer - Neoadjuvant Therapy in 2025

Colorectal Surgery Review ·

2025/11/27

This episode explores the evolution of rectal cancer management to Total Neoadjuvant Therapy (TNT), driven by the failure of traditional trimodal approaches to address the high (30–40%) risk of distant recurrence. We review the foundational role of Total Mesorectal Excision (TME) and high-resolution MRI staging, which identifies a threatened Circumferential Resection Margin (<1 mm) as a mandate for aggressive treatment.The episode highlights that pre-operative treatment is superior because only

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00:44:38

Colorectal Cancer - Operative Principles

Colorectal Surgery Review ·

2025/11/24

This academic review details the foundational principles and technical specifics of colectomy for colon cancer, emphasizing the oncologic triad of achieving negative circumferential margins, removing the entire mesentery, and accurate staging. We confirm the mandatory margin requirement is a minimum of 5 cm proximally and distally. We address localization challenges, detailing the critical technique for endoscopic tattooing using a saline bleb (0.5–1.0 ml) to contain the India ink and ensure

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00:49:48

Preop Planning and Staging of Colorectal Cancer

Colorectal Surgery Review ·

2025/11/20

This episode provides a comprehensive review of pre-operative evaluation and staging for colorectal cancer, emphasizing the shift toward highly reproducible imaging and personalized risk stratification. We detail screening methods and clarify when pre-operative biopsy is mandatory (absolutely required for rectal tumors to obtain immediate MMR testing). We establish the modern definition of the rectum using fixed MRI bony landmarks (sacral promontory to symphysis pubis), superseding the variable 12

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00:30:10

Malignant Polyps - What to do?

Colorectal Surgery Review ·

2025/11/17

This deep dive tackles the challenging management of the malignant polyp (early T1 colorectal cancer), focusing on the pivotal decision point: endoscopic cure versus formal surgical resection. We review key precursor lesions (adenomas, sessile serrated lesions or SSLs) and the critical anatomical distinction of invasion beyond the muscularis mucosa.A major focus is on predicting invasion depth using enhanced endoscopic criteria, including Paris morphology (depressed lesions, e.g., 0-III, are high

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00:46:02

Colorectal Cancer - Sporadic vs. Inherited

Colorectal Surgery Review ·

2025/11/14

This episode of Colorectal Surgery Review provides a focused, deep dive into the absolute current state-of-the-art management of Colorectal Cancer (CRC). Targeted specifically toward practicing clinicians and academic colorectal surgeons, the discussion dissects the fundamental molecular biology, changing epidemiology, screening variance, and the critical nuances in surgical and medical treatment guidelines for both sporadic and inherited forms of the disease.Key Topics Covered in this Deep

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00:32:44

Presacral Tumors

Colorectal Surgery Review ·

2025/10/22

The Deep Dive: Presacral Tumors – The Deep Dive on Anatomy, Nerve Preservation, & Oncologic StrategyThis episode tackles the incredibly rare but complex topic of presacral tumors. Though they are rarely encountered, maybe appearing in only one in 40,000 hospital admissions, they present high stakes due to their location near critical nerves and vessels, requiring a solid, almost academic understanding for effective management.What We Cover:Anatomic Foundation & Function: We break down the

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00:33:33

Anal Cancer

Colorectal Surgery Review ·

2025/10/20

This episode of Colorectal Surgery Review provides a comprehensive deep dive into the evolving management of anal cancer, focusing on key clinical updates and the minutiae essential for effective practice.Key Discussion Points:The Paradigm Shift: The episode explores the foundational change in treatment from radical surgery to definitive chemoradiation (CRT) as the standard of care for most anal canal Squamous Cell Carcinoma of the Anus (SCA). This shift is based on the Nigro Paradigm, which

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00:32:51

Anal Dysplasia

Colorectal Surgery Review ·

2025/10/17

This episode offers a rigorous academic deep dive into Anal Intraepithelial Neoplasia (AIN), a critical premalignant condition driven overwhelmingly by the Human Papilloma Virus (HPV). Essential for practicing and board-certified colon and rectal surgeons, this review tackles the nuances, fundamental changes in nomenclature, and evidence-based management of this disease.Nomenclature Standardization (The LAST Project): We clarify the mandatory shift from the outdated three-tiered system (AIN 1, 2, 3)

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00:35:35

Sexually Transmitted Diseases

Colorectal Surgery Review ·

2025/10/15

This crucial episode delivers a deep dive into an essential, rapidly evolving, and clinically critical domain for practicing surgeons and clinicians. We tackle the surge in sexually transmitted infections (STIs)—including Chlamydia, Gonorrhea, Syphilis, and HPV—and focus on their rising prevalence within the anorectum.STIs in this region are often "diagnostic masquerades," mimicking common surgical issues like fissures, bad hemorrhoids, or even inflammatory bowel disease (IBD). Learn how

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00:38:38

Pruritis Ani

Colorectal Surgery Review ·

2025/10/06

Pruritus ani—chronic itching around the anus—is one of the most common yet frustrating conditions in colorectal practice. Often dismissed as a minor problem, it can severely impact quality of life and frequently overlaps with dermatologic disease. In this episode, we bring dermatology and colorectal care together to explore the full spectrum of causes, evaluation strategies, and treatment options for pruritus ani.We begin by defining pruritus ani and breaking down its prevalence, common risk

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00:46:47

Pilonidal Disease & Hidradenitis Supporativa

Colorectal Surgery Review ·

2025/10/03

Pilonidal disease and hidradenitis suppurativa are two chronic, often misunderstood conditions that significantly impact quality of life. Though different in origin, they share common themes of recurrent infection, inflammation, and the need for thoughtful long-term management. In this episode, we take a deep dive into both conditions, outlining their anatomy, causes, diagnostic challenges, and modern treatment strategies.We begin with pilonidal disease—a condition commonly affecting young adults,

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00:33:14

Rectovaginal Fistulas

Colorectal Surgery Review ·

2025/10/01

Rectovaginal fistulas are among the most difficult and emotionally impactful conditions in colorectal surgery. In this episode, we explore the causes, diagnosis, and management of rectovaginal fistulas with a focus on both the surgical and human aspects of care.We begin by breaking down the anatomy and mechanisms that lead to fistula formation, including obstetric injury, surgical complications, inflammatory bowel disease, and radiation. Listeners will gain an understanding of how these pathways

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