Colorectal Disease最新文献

Aim: Pilonidal sinus disease (PSD) is a common condition particularly affecting the young population. The disease is incompletely understood, and optimal treatment is still debated. However, off-midline closure techniques have become the standard of care in more advanced cases. The literature is, however, lacking disease stratification in evaluation of surgical results. The aim of this study was to evaluate the surgical outcomes in a prospective cohort following Bascom's cleft lift (BCL) in primary extensive disease, nonhealing wounds after previous surgery and recurrence on a large Danish cohort from a high-volume centre.

Method: The study is based on a prospective database established at Randers Regional Hospital in 2016. All patients undergoing BCL surgery from June 2016 until June 2020 were included in this study.

Results: Three hundred and ninety two patients (326 men/66 women) underwent BCL surgery over a 4-year period. Of these, 127 (32.4%) presented with primary extensive PSD, 136 (34.7%) with nonhealing wounds and 129 (33.9%) with recurrent PSD. Overall, 87% healed uneventfully within the first 3 months, and 17% had recurrence at a median follow-up of 60 months (45-73 months). However, the risk of recurrence was higher among patients with nonhealing wounds (20%) and recurrence (17%) compared with primary extensive manifestation (13%).

Conclusion: Treatment of advanced PSD remains challenging with a high rate of wound complications and recurrences, stressing the need for dedicated care. Patients with either failed surgery or recurrence need particular attention.

Aim: Complete mesocolic excision (CME) is an oncologically driven technique for treating right colon cancer. While laparoscopic CME is technically demanding and has been associated with more complications, the robotic approach might reduce morbidity. The aim of this study was to assess the safety of stepwise implementation of robotic CME.

Method: A multicentre retrospective analysis of prospectively collected data on robotic right colectomy was performed at five European tertiary centres. Patients were classified for type of surgery: R-RHC (standard right colectomy), R-impCME (learning cases towards robotic CME defined as R-RHC with one but not all the hallmarks of CME) or R-CME (robotic CME). Primary outcomes were overall and severe 30-day complication rates before and after propensity score matching (PSM) analysis.

Results: Five hundred and fifty-one consecutive patients undergoing robotic surgery for (pre)malignant lesions of the right colon between 2010 and 2020 were included: R-RHC (n = 101), R-impCME (n = 135) and R-CME (n = 315). Baseline characteristics differed for American Society of Anesthesiologists score (p = 0.0012) and preoperative diagnosis of adenocarcinoma (p < 0.001). Procedure time increased by surgical complexity (p < 0.001). Vascular event rates did not differ, with no superior mesenteric vein injuries. Conversion, complication and anastomotic leak rates, time to flatus/soft diet and length of stay (LOS) did not differ. While R-RHC was performed for a lower rate of malignancies (p < 0.001), lymph node yield was significantly higher in R-CME (p < 0.001). After PSM, analyses on 186 patients documented no differences in overall and severe 30-day complication rate, conversion rate, LOS or 30-day mortality.

Conclusion: R-CME can be implemented without increasing the overall or 30-day severe complication rate.

Aim: The aim of this work was to quantify post-colonoscopy colorectal cancer (PCCRC) rates in National Health Service (NHS) Scotland using World Endoscopy Association guidelines, compare incidence between health boards and referral streams and explore comparisons in results with published data from other healthcare systems.

Method: This is a population-based cohort study using NHS Scotland data between 2012 and 2018. All people undergoing colonoscopy between 2012 and 2018 and subsequently diagnosed as having bowel cancer up to 3 years after their investigation were included. The main outcome measures are national trends in the PCCRC rate at 3 years (PCCRC-3yr). with comparison between bowel screening and non-screening referral routes, board of referral and analysis of factors associated with occurrence.

Results: The overall unadjusted PCCRC-3yr was 7.9% (7.4%-8.3%). There was no change in the annual rate over the 7-year study period. The PCCRC rate was lower for the Scottish Bowel Cancer Screening Programme (6.7% vs. 8.3%), but compared unfavourably with rates reported by the NHS England Bowel Cancer Screening Programme from an earlier time period. There was wide variation in rates between health boards of similar population size. Rates were higher in women, with increasing age and in patients with a history of inflammatory bowel disease or diverticular disease.

Conclusion: Despite advances in technology, there has been no improvement in the PCCRC rate in Scotland between 2012 and 2018. Rates in bowel screening colonoscopy are better than in nonscreening colonoscopy but compare unfavourably with NHS England, possibly as a result of less robust endoscopist selection and training. Quality improvement is required in colonoscopy in order to improve patient outcomes nationally, and to allow equitable access to higher-quality colonoscopy in different regions of the country.

Aim: The lungs represent the second most common site of colorectal cancer metastases. Although surgery is commonly considered the best treatment, many other invasive and noninvasive procedures and treatments have been adopted to improve patient survival and there is no clear evidence in the literature of which is the more effective. The aim of this work was to identify which treatment confers the best gain in overall survival for patients with pulmonary metastases from colorectal cancer.

Method: A systematic review and network meta-analysis of survival hazard ratio (HR) including 11 studies was conducted following the PRISMA guidelines and the Cochrane protocol on PubMed, Scopus, Embase, Web of Science and Cochrane Library up to 31 December 2023. Surgery, image-guided thermoablation, stereotactic body radiotherapy, chemotherapy and best standard care, associated or alone, were evaluated. Chemotherapy was adopted as the treatment reference to define survival HRs. Network metaregression was then performed considering patients with pulmonary only or multisite metastases from colorectal cancer.

Results: In patients with pulmonary metastases, the association of surgery, stereotactic body radiotherapy and chemotherapy is the best performing (HR 0.22), while the most effective components alone are image-guided thermoablation (HR 0.53) and surgery (HR 0.57), although this was not significant. After metaregression, multimodal treatments still represent the strategy conferring the best survival gain. However, while surgery (incremental HR 0.26) has the most important role in patients with isolated pulmonary metastatic disease, chemotherapy (incremental HR 0.3) leads for patients with multimetastatic disease.

Conclusion: Multimodal treatment confers the best gain in overall survival in patients with pulmonary metastases from colorectal cancer. Combining multiple therapeutic strategies improves survival, with oligometastatic patients benefiting more from surgery and local therapies while multimetastatic patients mainly benefit from chemotherapy, although ablation and surgery can enhance outcomes when feasible.