This study will examine the prevalence of low anterior resection syndrome (LARS) in rectal cancer patients and develop a new system to improve education, tracking and management of LARS symptoms.

The Smart Tissue Autonomous Robot (STAR) is a cutting-edge robotic system for autonomous soft-tissue surgery, utilizing advanced imaging, planning and tracking technologies. It recently completed successful pre-clinical trials, showing promise for consistent and precise surgical outcomes.

The CRRU participates in the ASSURE trial, a pivotal multi-center study evaluating the xBar system by Exero Medical. This investigational device monitors tissue healing after major bowel surgery to enable early detection of anastomotic leaks—dangerous complications where surgically connected bowel sections fail to heal properly.

The xBar system uses a small sensor placed on a standard surgical drain near the anastomosis, detecting electrical changes that may signal the onset of a leak. Early identification allows surgical teams to intervene before severe complications develop, potentially reducing emergency reoperations and prolonged hospitalizations.

This research aligns with the CRRU's mission to advance patient outcomes through innovative surgical technologies and rigorous clinical investigation.

Johns Hopkins is a tertiary referral center for presacral mass resection—rare tumors in the challenging space between the rectum and sacrum. Our team offers the full spectrum of surgical approaches (posterior, anterior, and combined techniques) tailored to individual tumor characteristics.

We have pioneered robotic-assisted resection for select cases, representing one of the largest single-institution robotic experiences reported for this rare condition. Our multidisciplinary approach integrates colorectal, spine, and plastic surgery expertise for complex cases requiring sacrectomy or advanced reconstruction.

With ten years of experience and favorable outcomes, we demonstrate that specialized centers can safely manage these rare lesions using both traditional and minimally invasive techniques.

The CRRU has partnered with the Durr Laboratory in the Department of Biomedical Engineering at Johns Hopkins to explore innovative endoscopic imaging technology. This collaboration applies emerging optical imaging techniques to enhance rectal cancer evaluation, including surveillance for patients managed with the watch-and-wait protocol.

Current endoscopic assessment has inherent limitations that impact clinical decision-making, particularly for patients who may be candidates for organ-preserving strategies following neoadjuvant therapy. Our interdisciplinary team is investigating novel optical sensing approaches to address these challenges and improve tumor surveillance.

This translational research brings together clinical expertise in rectal cancer management with cutting-edge biomedical engineering to advance personalized treatment approaches.

Johns Hopkins has established a preferential short-course radiation (SCRT) approach for locally advanced rectal cancer, contributing valuable real-world data to an important ongoing debate in rectal cancer management.

While total neoadjuvant therapy is standard of care, the optimal radiation regimen remains uncertain. Long-course chemoradiation predominates nationally, yet SCRT offers significant logistical advantages—completing radiation in one week rather than five—with potential benefits for patient quality of life and treatment efficiency.

The CRRU is actively studying outcomes of our SCRT-based protocols to provide evidence guiding personalized treatment decisions for rectal cancer patients. This research reflects our commitment to evaluating treatment approaches that optimize both cancer outcomes and patient experience.

The CRRU is actively studying the watch-and-wait approach for rectal cancer patients who achieve a clinical complete response following neoadjuvant therapy. This organ-preserving strategy offers select patients the possibility of avoiding major surgery while maintaining oncologic safety.

Successful watch-and-wait management requires rigorous long-term surveillance to detect early regrowth. Our team is developing a comprehensive tracking system to systematically monitor these patients, ensuring timely follow-up imaging, endoscopy, and clinical assessments according to protocol.

This research aims to optimize patient selection, standardize surveillance practices, and improve our understanding of outcomes for patients managed non-operatively at Johns Hopkins.

The CRRU is investigating machine learning approaches to predict colorectal cancer recurrence. By leveraging advanced computational methods and clinical data, we aim to develop models that identify patients at higher risk for disease recurrence following treatment.

Accurate prediction of recurrence could enable more personalized surveillance strategies and inform treatment decisions, potentially improving outcomes through earlier detection or risk-adapted therapy. Our research explores how artificial intelligence can enhance traditional prognostic tools and clinical judgment.

This work reflects the CRRU's commitment to integrating data science with colorectal cancer care to advance precision medicine.

**NCT06205836 (Gabre Kidan and Christenson)** – Approximately one-third of patients with colorectal cancer age 80 and older have mismatch repair–deficient disease. Because this population is also at increased risk for surgical and chemotherapy-related complications, we are investigating whether immunotherapy alone can eradicate these tumors without the need for surgery or chemotherapy.

**NCT07281768 (Bafford and Christenson)** – Rectal cancer incidence is rising, particularly among younger patients. While patients who achieve a major or complete response to neoadjuvant treatment have very low recurrence rates, those with less favorable responses remain at high risk for relapse, which is often incurable. Emerging data suggest that immunotherapy may be effective in early-stage colorectal cancer, with pathologic complete responses seen in up to 29% of patients, even in microsatellite-stable disease. In this study, we will assess whether adding immunotherapy to chemotherapy can improve outcomes in patients with standard-risk locally advanced rectal cancer.

**NCT07580339 (Migaly, Meyer, and Christenson)** – The use of radiation and chemotherapy prior to surgery has reduced both local and distant recurrence in patients with rectal cancer. However, treatment effectiveness may be limited in larger tumors due to poor tissue perfusion. Preclinical studies have shown that CD93 inhibition can enhance the effects of both radiation and chemotherapy by reversing adverse vascular changes. In this study, we will combine a CD93 inhibitor (DCSZ11) with radiation and chemotherapy in hopes of improving complete response rates and reducing relapse in patients with high-risk rectal cancer.

As artificial intelligence enters clinical care, understanding patient acceptance is critical. Our interdisciplinary team—spanning Johns Hopkins Surgery, the Carey Business School, and UT Austin—is studying when and why patients trust AI-assisted medical decisions.