Colorectal Disease最新文献

Aim: To describe patient characteristics, management and in-hospital outcomes of ischaemic colitis, and to compare the rates of surgery and in-hospital death between patients who did and did not receive antibiotics.

Method: We retrospectively identified hospital admissions for ischaemic colitis between April 2016 and March 2023 from the Diagnosis Procedure Combination inpatient database in Japan. We described the overall patient characteristics, management practices and outcomes, which were stratified by antibiotic use. The primary outcome was a composite of receipt of surgery and in-hospital mortality. We examined the association between antibiotic use within the first 2 days of admission and the primary outcome occurring on or after day 3 of hospitalization using multivariable logistic regression analyses.

Results: Among 111,750 eligible cases, 36.2% received antibiotics within the first 2 days of admission. Of them, 0.9% underwent surgery and 1.3% died during hospitalization. The primary outcome occurred in 2.1% of cases in the overall cohort (≤2 days: 0.6%; ≥3 days: 1.5%) and in 1.0% of cases who did not receive (≤2 days: 0.2%; ≥3 days: 0.8%) and 4.2% of cases who received antibiotics (≤2 days: 1.5%; ≥3 days: 2.7%). After covariate adjustment, antibiotic use was associated with higher odds of the primary composite outcome (adjusted odds ratio 1.98, 95% confidence interval: 1.77-2.21).

Conclusion: The surgical rate and in-hospital mortality in ischaemic colitis were lower than previously reported. Antibiotic use was associated with higher odds of surgery and in-hospital mortality; however, this finding should be interpreted cautiously, given potential unmeasured confounding.

Background: The oncological benefits of Laparoscopic Complete Mesocolic Excision (LCME) over conventional surgery are often challenged by single-centre designs, small cohorts or short and incomplete follow-up. This study aimed to examine the difference in recurrence risk 5 years after surgery and 30-day postoperative complications before and after a population-based, multicentre LCME implementation.

Method: LCME was implemented in the Central Denmark Region, Denmark following a training programme in 2017 for all colon cancer surgeons. Colon cancer patients from before (2015-2016, PRE-group) and after the implementation (2018-2019, POST-group) were identified through the Danish Colorectal Cancer Group Database. Recurrence 5 years after surgery was ascertained through national registers using a validated algorithm. The Aalen-Johansen estimator for competing risk was used to calculate cumulative incidence of recurrence.

Results: A total of 1919 patients (PRE, n = 1024; POST, n = 895) underwent curative-intended surgery in the study period. The 5-year cumulative incidence of recurrence was 16.1% (95% CI: 13.8, 18.4) in the PRE group and 12.5% (95% CI: 10.2, 14.9) in the POST group, with a significant absolute risk difference of 3.6% (95% CI: 0.3, 6.9). Furthermore, a significantly lower hazard rate of recurrence was observed in stage II patients after the LCME implementation, with a hazard rate ratio of 0.42 (95% Cl: 0.24, 0.72). Risk of severe postoperative complications was also significantly lower in the POST, compared to the PRE group.

Conclusion: LCME implementation was associated with a significantly lower risk of recurrence and lower rate of severe postoperative complications. This study indicates that multicentre LCME implementation may improve clinical outcomes without compromising patient safety.

Background: Colorectal cancer (CRC) represents a major challenge for public health in Brazil due to its high incidence and mortality. This study examines temporal trends, regional disparities and outcomes of CRC surgeries performed in Brazil between 2014 and 2024.

Methods: We conducted a retrospective observational analysis using data from the Hospital Information System of the Unified Health System (SIH-SUS). We included all patients who underwent CRC surgery financed by the SUS during the period. We analysed patient demographics, surgery rates per 100,000 inhabitants (excluding the population covered by voluntary private health insurance), in-hospital mortality and length of stay in the five geographic regions of Brazil.

Results: In total, we identified 313,531 CRC surgeries. Most patients were between 60 and 69 years old (30.1%), with a similar distribution between genders (50.2% men). Surgery rates varied considerably across regions, from 51.4 per 100,000 inhabitants in the North to 319.9 in the South. In-hospital mortality ranged from 5.2% to 6.7%, with variation among geographic regions. The number of procedures increased by 74% during the period, except for a decline in 2020, possibly related to the COVID-19 pandemic.

Conclusion: Our findings reveal substantial regional heterogeneity in surgical provision and in-hospital outcomes for CRC within the Brazilian public health system, particularly affecting the North region. These descriptive patterns may inform health system monitoring and future policy-oriented research and decision making.

Aim: Anastomotic leak remains a serious complication after left-sided colorectal resection with substantial morbidity, mortality and healthcare costs. This systematic review and meta-analysis evaluated whether intraoperative indocyanine green (ICG) fluorescence angiography reduces anastomotic leak rates in patients undergoing left-sided colorectal resections.

Methods: A systematic search of major databases and trial registries was conducted for RCTs comparing ICG angiography with standard visual assessment in adults undergoing elective left-sided colorectal resection. The primary outcomes were overall and clinically significant (ISGRC Grade B/C) anastomotic leak. Risk ratios (RRs) were pooled using a random-effects model. Risk of bias was assessed with the Cochrane ROB2 tool.

Results: Ten trials involving 3,772 patients were included. ICG fluorescence angiography, compared to control, reduced overall anastomotic leak (RR 0.62, 95% CI 0.53-0.73; I² = 0%; prediction interval 0.50-0.77) and clinically significant leak (RR 0.66, 95% CI 0.51-0.85; I² = 0%). Assuming a 10% baseline leak rate, ICG prevents one leak per 27 patients treated. Subgroup analysis showed benefit even when ICG did not prompt surgical plan modification (RR 0.67, 95% CI 0.50-0.90). Between-study heterogeneity was negligible across all analyses. ICG use did not prolong operating time and has reduced postoperative complications (RR 0.88, 95% CI 0.73-1.05).

Conclusion: Intraoperative ICG fluorescence angiography significantly reduces anastomotic leak rates after left-sided colorectal resection, with consistent benefit across diverse surgical settings. The technology is practical and does not prolong operating time. ICG angiography should be considered a valuable adjunct in left-sided colorectal resections.