EAES Lecture: Advanced imaging and AI in colorectal surgery

Tuesday, 1 December 2026, 6:10 pm

Luigi Boni argues that advanced imaging —particularly fluorescence-guided techniques — can make key features such as bowel perfusion and anatomy visible in real time. This gives colorectal surgeons information that’s beyond what they can see with conventional white-light vision. The next step is to combine these imaging capabilities with AI, allowing computer vision to interpret complex intraoperative data and potentially support decisions such as identifying perfusion, dissection planes, and surgical phases. For colorectal surgery, the idea is not to replace the surgeon’s judgment, but to add objective, real-time info while acknowledging that robust clinical validation is still needed before these technologies become standard practice.

Prevention & Repair of parastomal hernia

Tuesday, 1 December 2026, 5:40 pm

Salvador Morales-Conde frames parastomal hernia management around prevention at the index operation, emphasising meticulous stoma construction and prophylactic mesh in appropriately selected patients. For established parastomal hernias, he advocates a tailored repair strategy based on defect characteristics and patient factors, with techniques designed to reinforce the abdominal wall and minimize recurrence. His main message is to treat prevention and repair as part of a continuum of abdominal wall reconstruction, rather than as isolated stoma-related procedures.

How to avoid and treat skin-related complications

Tuesday, 1 December 2026, 5:10 pm

When a stoma is needed, protecting the skin around a stoma starts before the operation. Jacqueline Metzger, a Swiss expert in stoma care, explains how important it is to position stomas carefully, choose the right equipment and teach patients how to take care of their stomas to prevent skin problems. When problems do occur, it’s important to look into them as soon as possible and to make sure that each patient gets their own stoma care. This can help us to find out what is causing the problem and make sure that the skin around the stoma heals properly. This is an important part of making sure that patients with colorectal problems have good long-term results.

How to avoid a stoma?

Tuesday, 1 December 2026, 4:50 pm

Jérémie Lefevre contends that routine prophylactic diverting stomas after low anterior resection unnecessarily subject most patients to stoma-related complications, since only a fraction will suffer an anastomotic leak. He therefore recommends a strategy of deferred diversion using a temporary endoluminal bypass sheath for the first 10 postoperative days to protect the anastomosis while avoiding stoma formation in patients who heal uneventfully. This approach aims to retain the safety of diversion for true high-risk cases while markedly reducing the overall rate of stomas and their associated morbidity, costs, and second operations.

Lessons learned from the Norwegian stoma trial

Tuesday, 1 December 2026, 4:30 pm

Lars Grønvold’s advocates for large-scale, prospective, multicentre data as they can clarify whether the benefits of anastomotic protection outweigh stoma-related morbidity and functional impairment, thereby enabling evidence-based surgical decision-making and patient counselling.

The reason: existing evidence is conflicted and often biased, with stomas potentially reducing leakage severity but introducing significant morbidity and LARS risk. The key message is to translate the trial’s findings into more consistent, evidence-based perioperative practice.

Prevention after APR

Tuesday, 1 December 2026, 2:00 pm

Samar Alhomoud highlights the importance of anticipating perineal complications rather than managing them after they develop. She focuses on strategies that address the pelvic-floor defect and reduce the risk of perineal wound problems and hernia following APR. As surgical techniques evolve, prevention and tailored reconstruction are becoming an increasingly important part of the APR pathway.

Strategies for obstructed cancers in the emergency

Tuesday, 1 December 2026, 12:30 pm

Fabian Grass frames emergency management of obstructing colorectal cancers around rapid stabilization, careful assessment of resectability and patient fitness, and choosing an individualized strategy rather than a one-size-fits-all operation. He emphasizes balancing immediate relief of obstruction against oncologic principles, with options such as decompression, stenting, diversion, or resection with or without a damage control (2-stage) strategy selected according to the clinical and tumor context. For colorectal surgeons, the key message is to use the emergency as an opportunity for structured decision-making that preserves both short-term safety and subsequent oncologic treatment options.

Colorectal cancer & genetics – what should we know, what’s new?

Tuesday, 1 December 2026, 12:00 pm

Gabriela Möslein highlights why genetic assessment is becoming increasingly relevant in colorectal cancer care — not only for identifying hereditary syndromes such as Lynch syndrome and polyposis, but also for guiding surveillance and management of patients and their families. For colorectal surgeons, the key message is practical: recognising when genetics matters can influence treatment, follow-up and prevention across generations.

Early onset colorectal cancer: current views and prospects for the future

Tuesday, 1 December 2026, 11:30 am

Early-onset colorectal cancer is more than an age-defined phenomenon: Caterina Foppa highlights distinct clinicopathological and molecular characteristics that warrant greater attention from colorectal surgeons. Younger patients may present with more advanced disease and, in rectal cancer, show less favorable responses to neoadjuvant therapy, challenging the assumption that younger age necessarily translates into better oncological outcomes. The future, therefore, lies in age-specific strategies spanning earlier recognition and prevention through personalized treatment—while further research is needed to clarify the biological drivers of this increasingly important disease.

Watch & Wait: are we ready for all rectal cancers?

Tuesday, 1 December 2026, 10:00 am

Perez argues that a “watch-and-wait” strategy for rectal cancer can spare selected patients the morbidity of radical surgery when they achieve a sustained complete clinical response after neoadjuvant therapy. But not all rectal cancers should be managed with watch-and-wait. Instead, he emphasizes that the approach requires rigorous patient selection, standardized response assessment, and intensive surveillance because residual or recurrent disease can occur. For colorectal surgeons, the key question is therefore not whether watch-and-wait should replace surgery, but whether multidisciplinary teams are equipped to identify appropriate candidates and safely manage surveillance and salvage surgery.

Abdomino-perineal resection: How I do it

Tuesday, 1 December 2026, 9:30 am

Geerard Beets presents abdominoperineal resection as an oncologically focused procedure in which meticulous pelvic dissection and appropriate specimen geometry are central to achieving clear circumferential margins. His approach reflects the evidence that low rectal cancers undergoing APR have particular risks of CRM involvement and local recurrence, with tumour location and stage influencing these risks. The technique aims to achieve an adequate cylindrical specimen while respecting surrounding pelvic structures and addressing the substantial risk of perineal wound morbidity associated with APR.

Strategies for lateral pelvic lymph nodes

Tuesday, 1 December 2026, 9:00 am

Choi argues for a selective, risk-adapted approach to lateral pelvic lymph nodes, using high-quality MRI to identify clinically suspicious nodes rather than treating all low rectal cancers with routine LPN dissection. For colorectal surgeons, the practical message is to integrate pre- and post-treatment MRI, response to neoadjuvant therapy, and the morbidity of LPN dissection when deciding which patients need an extended pelvic operation.

The Anatomy of Successful Mesocolic Excision: Embryological Planes and Vascular Variations

Monday, 30 November 2026, 6:15 pm

Mehmet Ayhan Kuzu argues that successful complete mesocolic excision starts with embryology: meticulous dissection along the natural visceral–parietal fascial planes preserves an intact mesocolon and exposes the correct vascular anatomy. He emphasizes that vascular variation is the critical operative variable, requiring deliberate identification of arterial and venous anatomy—including the vessels around the pancreas—before central ligation. The practical message is clear: follow the planes, anticipate the variants, know the vessels, and dissect precisely. And: turn CME from a technically demanding procedure into a reproducible anatomical operation.

Low anterior resection syndrome and trajectories

Monday, 30 November 2026, 4:45 pm

Low anterior resection syndrome (LARS) is not a static complication but a dynamic, individual trajectory that can evolve over years after rectal cancer surgery. Therese Juul will show why longitudinal assessment with the LARS score is essential to identify patients with persistent and clinically significant dysfunction. For healthcare professionals working with LAR-patients, the message is clear: screen systematically for LARS during follow-up and intervene when major LARS persists.

Near complete response: what to do now?

Monday, 30 November 2026, 3:20 pm

Geerard Beets contests the notion that a near-complete response should invariably result in TME, as further tumour regression remains a possibility. A meticulous re-evaluation employing DRE, endoscopy and MRI can identify patients who are eligible for ongoing observation and organ preservation, with close surveillance. Prior to determining whether to operate or await events, he advances a compelling argument for establishing a clear and reproducible definition of a near-complete response.

Can we convert CRC-MSS tumors to be responsive to immunotherapy?

Monday, 30 November 2026, 3:00 pm

Michael Bergmann argues that MSS colorectal cancers may be made responsive to immunotherapy by reprogramming their immunologically “cold” tumour microenvironment. Combining immunotherapy with treatments such as chemoradiation or oncolytic viruses may enhance tumour immunogenicity and T-cell infiltration. The goal is to turn an immune-resistant tumour into one that the immune system can recognise and attack.

Brachytherapy: what are the benefits?

Monday, 30 November 2026, 2:40 pm

Cristina Picardi argues that, for selected rectal-cancer patients, Papillon contact X-ray brachytherapy enables highly targeted intratumoral dose escalation – a key factor in achieving a complete clinical response and, consequently, successful organ preservation. Her Swiss experience, together with her involvement in the randomized OPERA trial, highlights the potential of this approach to increase organ-preservation rates and avoid radical surgery. For colorectal surgeons, Papillon therefore represents an important component of a multidisciplinary organ-preservation strategy.

Which TNT strategy to choose for which cancer

Monday, 30 November 2026, 2:15 pm

Rodrigo Pérez emphasizes that the future of total neoadjuvant therapy lies in tailoring treatment to tumor biology and individual risk, rather than applying a one-size-fits-all approach. The optimal sequence and intensity—from induction versus consolidation chemotherapy to the role of radiotherapy—should be selected according to disease characteristics, systemic risk, and the goal of organ preservation. The message: TNT is not a single strategy, but a toolbox to be matched to the right patient and tumor.

Neoadjuvant therapy for colon cancer. Is it worthwhile?

Monday, 30 November 2026, 12:15 pm

Neoadjuvant therapy for colon cancer: Is it a no-brainer? Shrink the tumour, improve the chance of an R0 resection, treat micrometastatic disease earlier, and make surgery easier. So why did we spend decades operating first? What are the risks of unnecessary toxicity, or delaying curative surgery? Does FOxTROT tip the balance in favour of treating selected patients before surgery? Michael Montemurro will explore the data and discuss which patients might benefit most.

Strategies for flexure cancers: extended or limited resection?

Monday, 30 November 2026, 11:45 am

Patricia Tejedor argues that surgery for flexure cancers should be tailored to tumor location and vascular anatomy rather than defaulting to an extended resection. Limited resection can provide sound oncologic clearance while preserving more colon and potentially reducing surgical morbidity, whereas extended colectomy may be justified when achieving adequate margins or lymphadenectomy requires it. Her message is therefore a balanced, anatomy- and tumor-specific approach rather than a one-size-fits-all operation.

Implementing CME and CVL nationwide. What is the new standard?

Monday, 30 November 2026, 11:15 am

Jurriaan Tuynman posits that CME and CVL should become the new nationwide standard, as they have the capacity to enhance oncological outcomes and ensure greater surgical consistency. The necessity of standardised techniques, appropriate training, and systematic quality monitoring for successful implementation is emphasised. The goal is to move from individual expertise to a reproducible, evidence-based standard of care across the country.

What’s new in endoscopic surgery?

Monday, 30 November 2026, 10:15 am

Elena De Cristofaro highlights how advanced endoscopic submucosal dissection (ESD) is expanding the boundaries of minimally invasive treatment for increasingly challenging lesions. Beyond technical innovations, she will explore the evolving role of ESD as a diagnostic and therapeutic strategy in selected lesions where accurate pre-treatment staging remains challenging. In these situations, diagnostic ESD may provide definitive histological staging while potentially avoiding unnecessary or functionally impactful surgery. She will also demonstrate successful approaches to technically challenging lesions. Her presentation will illustrate how advances in endoscopy are changing not only the tools we use, but also the treatment pathways we can offer to selected patients.

Resection after neoadjuvant therapy?

Monday, 30 November 2026, 9:45 am

Simon Bach’s work centres on response-adapted treatment after neoadjuvant therapy. The TREC/STAR-TREC strategy deliberately uses radiotherapy or chemoradiotherapy to induce tumour regression, then selects watch-and-wait, transanal excision or TME according to clinical response. Its success depends on precise response assessment and rigorous surveillance, with timely salvage surgery for local regrowth.

Strategies for early rectal cancer

Monday, 30 November 2026, 9:15 am

Roel Hompes argues that early rectal cancer should increasingly be approached with organ preservation in mind, rather than automatically proceeding to radical total mesorectal excision (TME). He advocates a local-excision-first, risk-adapted strategy, using the pathology from the local excision to identify patients who genuinely need completion surgery or additional treatment. The goal is to spare carefully selected patients the substantial functional and quality-of-life consequences of radical surgery while maintaining strong oncological outcomes.