Nir Horesh

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Verified

Nir verified their affiliation via an institutional email.

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• Doctor of Medicine
• Surgeon at Cleveland Clinic

Introduction: Chatbots have been increasingly used as a source of patient education. This study aimed to compare the answers of ChatGPT-4 and Google Gemini to common questions on benign anal conditions in terms of appropriateness, comprehensiveness, and language level. Methods: Each chatbot was asked a set of 30 questions on hemorrhoidal disease,...

Background Inflammatory bowel disease (IBD) affects more than 10 million people worldwide. Men and women are equally affected by Crohn's disease (CD). It has been shown that patients with CD are at an increased risk of a colorectal cancer (CRC) diagnosis and CRC‐related mortality. During the last two decades, biological therapies have revolutionize...

Aim Lymphovascular invasion (LVI) is a well‐known risk factor in colorectal cancer that is associated with a worse prognosis. The present study aimed to assess the characteristics of patients with LVI‐positive colon cancer according to the status of nodal metastases and to study the association between LVI‐nodal status and survival. Method This re...

Pelvic exenteration (PE) entails an en bloc resection of locally advanced primary or recurrent rectal cancer. This study aimed to assess the short-term and survival outcomes of minimally invasive (MI)- and open PE. A retrospective cohort analysis of patients with stage III rectal adenocarcinoma treated with PE from the National Cancer Database (201...

Background Lymphovascular invasion (LVI) is an important prognosticator in rectal cancer (RC). We aimed to determine predictors for LVI in RC and incorporate them into a predictive risk score (PRS). Methods Case‐control analysis of predictors of LVI in RC using data from a national database (2010–2019). Main outcome was LVI in RC and its predictor...

Background and Objectives Infectious complications after pancreatic resections are common, but perioperative factors linked to postoperative bacterial growth are not well‐studied. Methods This retrospective study analyzed bacterial cultures from patients undergoing pancreatic resection (November 2008 to October 2022), assessing predictors for posi...

This cohort study analyzes the characteristics of colorectal cancer in pediatric patients using Surveillance, Epidemiology, and End Results (SEER) registry data.

Rectal prolapse often affects women but may also affect men. This systematic review aimed to provide outcomes of surgery for complete rectal prolapse reported in studies with a predominantly male population. This PRISMA-compliant systematic literature review searched PubMed and Scopus between January 2000 and February 2024; Google Scholar was queri...

Importance: Medical ethics is inherently complex, shaped by a broad spectrum of opinions, experiences, and cultural perspectives. The integration of large language models (LLMs) in healthcare is new and requires an understanding of their consistent adherence to ethical standards. Objective: To compare the agreement rates in answering questions b...

Background Esophageal cancer remains a significant global health challenge. Several treatment modalities were explored in randomized controlled trials (RCTs) in recent decades. This study evaluates the robustness of RCTs focusing on esophageal cancer treatment using the fragility index (FI) and reverse fragility index (RFI). Methods A systematic r...

Aim Anastomotic stricture occurs in up to 30% of colorectal resections; however, evidence on risk factors and preventive measures remains scarce. This study aimed to identify technical factors responsible for increasing the risk for colorectal and coloanal anastomotic strictures. Method This was a retrospective cohort study of patients with anasto...

Background A significant number of patients experience complications of the Kock pouch (KP) warranting revision or excision. This systematic review aimed to assess the pooled prevalence and risk factors for complications and failure of the KP. Methods This Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant system...

BACKGROUND Management of anorectal cancers requires a multidisciplinary team approach. Recently, large language models have been suggested as potential tools for various applications in healthcare. OBJECTIVE Assess suggested management recommendations provided by a generative artificial intelligence chatbot with those of a colorectal cancer multid...

Background We aimed to evaluate outcomes of organ preservation by local excision (LE) compared to proctectomy following neoadjuvant therapy for rectal cancer. Methods This retrospective observational study using the National Cancer Database (NCDB) included patients with locally advanced non-metastatic rectal cancer (ypT0–1 tumors) treated with neo...

Background This study aimed to investigate factors associated with prolonged operative time in laparoscopic right hemicolectomy for colon cancer. Methods This was a retrospective review of patients with colon cancer who underwent laparoscopic right hemicolectomy between 2011 and 2021. Linear and binary logistic regression analyses were performed t...

Background The type of facility where patients with colon cancer are treated may play a significant role in their outcomes. We aimed to investigate the influence of facility types included in the National Cancer Database (NCDB) on surgical outcomes of colon cancer. Methods Retrospective cohort analysis of all patients with stage I–III colon cancer...

Background We aimed to identify predictors of and heterogeneity in survival among different age groups of patients with early‐onset colorectal cancer (EOCRC). Methods This retrospective cohort study used National Cancer Database data from 2004 to 2019. Differences in survival among CRC patients <50 years, subcategorized into age groups (<20, 20–29...

Sphincter preservation in rectal surgery is a primary goal whenever feasible with low anterior resection a very useful surgical option. The appropriate staging of the tumor, evaluation, and optimization of patient comorbidities, fitness status, and expertise of the surgeon are crucial to a favorable outcome. There is a learning curve for skills nee...

Abdominoperineal resection (APR) is a radical rectal surgery that offers definitive treatment in carefully selected distal rectal cancers with significant morbidity. The coning of the resection line in the resection specimen at the level of the pelvic floor in the standard abdominoperineal resection is forestalled by the modification to the cylindr...

Background This umbrella review aimed to summarize the findings and conclusions of published systematic reviews on the prophylactic role of mesh against parastomal hernias in colorectal surgery. Methods PRISMA-compliant umbrella overview of systematic reviews on the role of mesh in prevention of parastomal hernias was conducted. PubMed and Scopus...

Introduction: We assessed the association between increased body mass index (BMI) and rectal cancer outcomes. Methods: We included patients who underwent surgery for stage I-III rectal adenocarcinoma who were divided according to BMI at diagnosis: ideal BMI (18.5-24.9 kg/m2) and increased BMI (≥25 kg/m2). Groups were compared using univariate as...

Introduction Neoadjuvant therapy has become standard of care for locally advanced rectal cancer patients. It is correlated with improved clinical and pathological outcomes, including significant tumor downstaging and organ preservation in certain patients. Magnetic resonance imaging (MRI), which has become the standard for pre-operative staging, is...

Objective: The aim of our study was to assess the learning curve of robotic assisted low anterior resection with diverting loop ileostomy (LARDLI) for low and mid rectal cancer performed by novice in robotic-assisted surgery colorectal surgeon in a public hospital with limited access to the robotic platform. Methods: A retrospective analysis of all...

Aim There is no universally accepted treatment consensus for haemorrhoids, and thus, management has been individualized all over the world. This study was conducted to assess a global view of how surgeons manage haemorrhoids. Methods The research panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) developed a volunt...

PNS is caused by an infection in the sacrococcygeal area triggered by hair particle accumulation in skin tunnels, resulting in infection. Surgical options range from simple excision to complex flap constructions. Primary wound healing failure and recurrence rates contribute to the burden of PNS. RD2 Ver.02, a novel autologous whole-blood clot produ...

Background This study aimed to assess concordance between clinical and pathologic assessment of colon cancer. Patients and Methods A retrospective cohort analysis of patients with stage I–III colon cancer in the National Cancer Database (2010–2019) was conducted. Concordance between clinical and pathologic assessment of colon cancer was calculated...

Background We aimed to assess the efficacy and safety of low-pressure pneumoperitoneum (LPP) in minimally invasive colorectal surgery. Methods A PRISMA-compliant systematic review/meta-analysis was conducted, searching PubMed, Scopus, Google Scholar, and clinicaltrials.gov for randomized-controlled trials assessing outcomes of LPP vs standard-pres...

Background Available platforms for local excision (LE) of early rectal cancer are rigid or flexible [trans‑anal minimally invasive surgery (TAMIS)]. We systematically searched the literature to compare outcomes between platforms. Methods PRISMA-compliant search of PubMed and Scopus databases until September 2022 was undertaken in this random-effec...

Background: Local surgical excision of T1 rectal adenocarcinoma is a well-established approach. Yet, there are still open questions regarding the recurrence rates and its risk factors. Methods: A retrospective multicenter study including all patients who underwent local excision of early rectal cancer with an open or MIS approach and had a T1 lesio...

Aim Sacral neuromodulation (SNM) has become a standard surgical treatment for faecal incontinence (FI). Prior studies have reported various adverse events of SNM, including suboptimal therapeutic response, infection, pain, haematoma, and potential need for redo SNM. The aim of this study was to identify the risk factors associated with long‐term co...

Minimally invasive surgery is safe and effective in colorectal cancer. Conversion to open surgery may be associated with adverse effects on treatment outcomes. This study aimed to assess risk factors of conversion from minimally invasive to open colectomy for colon cancer and impact of conversion on short-term and survival outcomes. This case–contr...

Background Ileus is a common complication of major abdominal surgery, including colorectal resection. The present study aimed to assess the predictors of ileus after laparoscopic right colectomy for colon cancer. Methods This study was a retrospective case-control analysis of a prospective IRB-approved database of patients who underwent laparoscop...

Background and Objectives Pathological nodal staging is relevant to postoperative decision‐making and a prognostic marker of cancer survival. This study aimed to assess the effect of different total neoadjuvant therapy (TNT) regimens on lymph node status following total mesorectal excision (TME) for locally advanced rectal cancer (LARC). Methods A...

Background Rectal neuroendocrine tumors (rNET) are rare and challenging to manage. While most patients with small rNET can be definitively treated with local excision, the role of chemotherapy in general and neoadjuvant therapy particularly in managing advanced rNET has not been well established. Therefore, this study aimed to determine which patie...

Aim Splenic flexure mobilization (SFM) is commonly performed during left‐sided colon and rectal resections. The aim of the present systematic review was to assess the outcomes of SFM in left‐sided colon and rectal resections and the risk factors for complications and anastomotic leak (AL). Method This study was a PRISMA‐compliant systematic review...

Background Incisional hernias (IH) are a significant postoperative complication with profound implications for patient morbidity and healthcare costs. The relationship between IH and perioperative factors in pancreatic surgery, with particular attention to preoperative biliary stents and pancreatic fistulas requires further exploration. Methods Th...

The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. S...

Background It is unclear whether conversion from minimally invasive surgery to laparotomy in patients with colon cancer contributes to worse outcomes compared with those operated by laparotomy. In this study, we aimed to assess the implications of transitioning from minimally invasive surgery to laparotomy in patients with colon cancer compared wit...

Immunotherapy for the systemic treatment of cancer offers new treatment possibilities for advanced malignancies. Despite promising initial results, evidence on efficacy of immunotherapy for colon cancer is lacking. Thus, we aimed to assess short-term and long-term outcomes of immunotherapy in patients with advanced colon cancer. A US National Cance...

There is controversy in the best management of colorectal cancer liver metastasis (CLM). This study aimed to compare short-term and survival outcomes of simultaneous resection of CLM and primary colon cancer compared to resection of only colon cancer. This retrospective matched cohort study included patients from the National Cancer Database (2015–...

Background Microsatellite instability (MSI) is an important prognosticator for colorectal cancer (CRC). The present study aimed to assess the impact of MSI status on the characteristics and outcomes of early-onset compared to late-onset rectal cancer. Methods This retrospective cohort study used data from the US National Cancer Database (2004–2019...

Background This study assessed trends in treatment and outcomes of anal melanomas over a 17‐year period. Methods NCDB was searched for patients with anal melanoma (2004–2020). Receiver‐operating characteristic curve analysis was used to determine cutoff year marking increased overall survival (OS) of anal melanoma. Characteristics, treatments, and...

Management of colon cancer has changed over the last few decades. We assessed the trends in management and outcomes using the US National Cancer Database (NCDB). A retrospective analysis of all patients with colonic adenocarcinoma between 2005 and 2019 was conducted. The cohort was divided into three equal time periods: Period 1 (2005–2009), Period...

BACKGROUND Patients with mucinous rectal carcinoma tend to present in advanced stage with a poor prognosis. OBJECTIVE This study aimed to assess the effect of neoadjuvant radiation therapy on outcomes of patients with stage II-III mucinous rectal carcinomas using data from the National Cancer Database. DESIGN Retrospective analysis of prospective...

Aim Staplers used in ileocolic anastomosis construction differ in length and height. We assessed the impact of stapler type in creating ileocolic anastomoses on postoperative outcomes. Methods This retrospective cohort study of an Institutional Review Board approved database included patients who underwent laparoscopic right colectomy for cancer b...

BACKGROUND Surgical treatment of complex perianal fistula is technically challenging, associated with risk of failure, and may require multiple procedures. In recent years, several biologic agents have been developed for the purpose of permanently eradicating anal fistulous disease with variable success. RD2-Ver.02 treatment is an autologous whole...

Introduction: Obstructed Defecation Syndrome (ODS) is a complex surgical condition which involves structural and functional problems which significantly affects quality of life. There is limited information about the Da-Vinci Robotic System use in the treatment of this condition. This study examines the outcomes of robotic-assisted rectopexy. The p...

Background Rectal cancer patients with microsatellite instability (MSI-H) are candidates for immunotherapy. However, there is little evidence on its effect on overall survival (OS). Methods Retrospective analysis of stage II–IV rectal adenocarcinoma patients in the National Cancer Database (NCDB) between 2010 and 2019. Propensity score matching wa...

People with diabetes feature a life-risking susceptibility to respiratory viral infection, including influenza and SARS-CoV-2 (ref. ¹), whose mechanism remains unknown. In acquired and genetic mouse models of diabetes, induced with an acute pulmonary viral infection, we demonstrate that hyperglycaemia leads to impaired costimulatory molecule expres...

Over the last decades, novel therapeutic options have emerged for the surgical treatment of pilonidal sinus disease (PSD). The aim of this study was to evaluate the outcomes of trephine/pit excision surgery with or without laser therapy in patients with PSD. A retrospective cohort study was conducted at a large tertiary medical center, including al...

Background: First described by Parks and Nicholls in 1978, the ileal pouch-anal anastomosis (IPAA) has revolutionized the treatment of mucosal ulcerative colitis (MUC) and familial adenomatous polyposis (FAP). IPAA is fraught with complications, one of which is pouch-vaginal fistulas (PVF), a rare but challenging complication noted in 3.9-15% of fe...

Background: First described by Parks and Nicholls in 1978, the ileal pouch-anal anastomosis (IPAA) has revolutionized the treatment of mucosal ulcerative colitis (MUC) and familial adenomatous polyposis (FAP). IPAA is fraught with complications, one of which is pouch-vaginal fistulas (PVF), a rare but challenging complication noted in 3.9-15% of f...

Objective Data available at admission to delivery of nulliparous has rarely been investigated for prediction of obstetric anal sphincter injury (OASI). The aim of the present study was to study risk factors for OASI in nulliparous based on information available at admission. Methods A retrospective study of all nulliparous women undergoing labor,...

This systematic review explored different medications and methods for prevention and treatment of pouchitis after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). PubMed, Scopus, and Web of Science were searched for randomized clinical trials that assessed prevention or treatment of pouchitis. The systematic review was reported...

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons’ practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants’ demographics and, 27 questions about their clinical practice. B...

The increased risk of colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) has been well documented in the literature. The present study aimed to assess the characteristics and outcomes of rectal cancer in patients with IBD. This study was a retrospective review of a prospectively maintained IRB-approved database at Cleveland C...

Objective We aimed to compare outcomes of early and standard closure of diverting loop ileostomy (DLI) after proctectomy and determine risk factors for anastomotic leak (AL) and complications. Summary Background Data Formation of DLI has been a routine practice after proctectomy to decrease the incidence and potential adverse sequela of AL. Metho...

we used the NCDB to assessed age-related differences in characteristics and treatments of colorectal cancer and to evaluate the influence of age on outcomes.

This study aimed to compare intra- and extracorporeal division of the vascular pedicle in laparoscopic right colectomy regarding pathological outcomes, short-term morbidity, and local recurrence and distant metastases. Retrospective analysis of an IRB-approved database of all patients who underwent laparoscopic right colectomy for cancer between 01...

Background: Current recommendations suggest that a minimum of 12 lymph nodes (LNs) should be harvested during curative rectal cancer resection. We aimed to assess predictors and survival outcomes of harvesting < 12 lymph nodes in rectal cancer surgery. Methods: A retrospective case-control analysis of factors associated with harvesting < 12 LNs...

Background Computerized tomography (CT) is an integral part of the follow-up and decision-making process in complicated acute appendicitis (AA) treated non-operatively. However, repeated CT scans are costly and cause radiation exposure. Ultrasound-tomographic image fusion is a novel tool that integrates CT images to an Ultrasound (US) machine, thus...

Background and aims The expression of tissue and serum matrix metalloproteinase-7 (MMP-7) was shown to be elevated both in colon cancer and dysplastic lesions. We aimed to evaluate, for the first time, its role as a diagnostic marker in Lynch syndrome (LS) carriers, a hereditary syndrome with predisposition to colon cancer. Methods This was a case...

Background Management of spontaneous intra-abdominal abscess in patients with Crohn’s disease (IAA) with radiologically guided percutaneous drainage (PD) was debated. Method This is a secondary analysis from a multi-centre, retrospective cohort study of all the patients with CD who underwent PD followed by surgery at 19 international tertiary cent...

The present study aimed to assess the characteristics and outcomes of appendiceal malignant mesenchymal tumors. This was a retrospective case-series study of patients with appendiceal malignant mesenchymal tumors in the national cancer database (2005-2019). The main outcomes were overall survival (OS) and short-term mortality. 53 patients (40 GISTs...

Background: CA125 is a widely used serum marker for epithelial ovarian cancer which levels may also rise in benign conditions involving peritoneal irritation. We aimed to determine if serum CA125 levels can predict disease severity in patients presenting with acute diverticulitis. Methods: We conducted a single-center prospective observational stu...

Background: Despite the pivotal role of magnetic resonance imaging (MRI) in rectal cancer staging and evaluation, the reliability of restaging MRI after neoadjuvant therapy is still debatable. This study aimed to assess the accuracy of restaging MRI by comparing post-neoadjuvant MRI findings with those of the final pathology. Methods: This study...

e15580 Background: Studies show that attempts to treat liver metastases during or before primary colonic cancer resection may improve survival. We aimed to compare overall survival of patients with colon cancer and liver metastases who underwent primary tumor resection with/without resection of liver metastases. Methods: This retrospective cohort s...

Background: Although squamous cell carcinoma is the most common malignancy of the anal canal, it rarely affects the rectum. The present study aimed to assess the differences in characteristics, treatments, clinical and pathologic outcomes, and survival between anal and rectal squamous cell carcinoma. Methods: The United States National Cancer Da...

e15631 Background: Rectal neuroendocrine tumors (rNET) are rare and challenging to manage. While most patients with small rNET can be definitively treated with local excision, the role of chemotherapy in general and neoadjuvant therapy specifically in managing advanced rNET has not been well established. Therefore, this study aimed to determine whi...

Objective: Assess long-term outcomes of patients with perforated diverticulitis treated with resection or laparoscopic lavage (LL). Summary background data: Surgical treatment of perforated diverticulitis changed in the last few decades. LL and increasing evidence that primary anastomosis (PRA) is feasible in certain patients have broadened surg...

Background: Neoadjuvant chemotherapy (NAC) is currently indicated for patients with advanced colon cancer. However, there are little data regarding the impact of NAC on short-term outcomes and overall survival (OS). This study aimed to determine the role of NAC in patients with advanced colon cancer. Methods: A retrospective analysis of all patient...

Background: Immunotherapy has been increasingly used in cancer therapy. In rectal cancer, patients with high microsatellite instability (H-MSI) are candidates for immunotherapy, but there is little evidence on its effect on overall survival. Methods: A retrospective analysis of all patients with stage II-IV rectal adenocarcinoma in the US National...

Purpose: To assess whether full bowel preparation affects 30-day surgical outcomes in laparoscopic right colectomy for colon cancer. Methods: A retrospective chart review of all elective laparoscopic right colectomies performed for colonic adenocarcinoma between Jan 2011 and Dec 2021. The cohort was divided into two groups-no bowel preparation (...

Background: Anal adenocarcinomas are a rare condition which account for less than 10% of anal cancers. The present study aimed to assess the impact of neoadjuvant therapy on the clinical and pathologic outcomes and overall survival (OS) of patients with stage II-III anal adenocarcinomas after abdominoperineal resection (APR). Methods: A retrospe...