Colorectal Disease最新文献

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Towards safer colorectal surgery worldwide: Outcomes and benchmarks from the ESCP CORREA 2022 audit 迈向全球更安全的结直肠手术：ESCP CORREA 2022审计的结果和基准

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-11-24 DOI: 10.1111/codi.70281

2022 European Society of Coloproctology (ESCP) CORREA Collaborating Group

Introduction

Benchmarking colorectal surgery outcomes informs quality improvement. The ESCP CORREA 2022 snapshot audit aimed to assess contemporary colorectal resection practices and short-term outcomes across European countries and beyond.

Methods

An international prospective multicentre audit was conducted in which adults undergoing elective or emergency colorectal resection during a 6-week period (January–April 2022) at participating hospitals were included. Data on patient demographics, indications, surgical approach (open, laparoscopic or robotic) and 30-day postoperative outcomes (complications, reoperation and mortality) were collected for analysis. The outcomes were analysed and compared with those of previous audits to identify trends in colorectal surgery.

Results

The study enrolled 3521 patients (56.8% men) from 216 hospitals across 53 countries. In 72.2% of the cases, the indication for resection was malignancy, followed by diverticular disease in 9.0%, Crohn's disease in 3.7% and ulcerative colitis in 2.3% of the cases. Of the surgeries, 74.4% were elective. Minimally invasive surgery was performed in 55.2% of the cases (48.7% laparoscopic and 6.5% robotic). Primary anastomosis was performed in 90.3% of the patients. The 30-day anastomotic leak rate was 7.96%; in malignant and benign diseases, the leak rates were 7.3% and 10.2%, respectively. The leak rates for right, left, anterior rectal resection, pouch and subtotal colectomy were 6.9%, 7.7%, 9.7%, 16.0% and 11.8%, respectively. In the multivariable analysis, the risk factors for leakage included male sex (9.3% vs. 6.3%, OR = 0.69, 95% CI 0.51–0.95, p = 0.023) and emergency surgery (11.4% vs. 7.1%, OR = 1.58, 95% CI 1.10–2.27, p = 0.013). Thirty-day mortality was 2.38%.

Conclusions

This large international audit provides the status of the management of colorectal surgery. This shows that minimally invasive techniques are widely adopted, and 30-day mortality is low; however, anastomotic leak rates remain persistently high. These findings highlight the ongoing need for targeted research and quality-improvement initiatives to reduce anastomotic failure and improve outcomes of colorectal surgery.

前言：对结直肠手术结果进行基准测试，有助于提高手术质量。ESCP CORREA 2022快照审计旨在评估欧洲及其他国家的当代结直肠癌切除实践和短期结果。方法：进行了一项国际前瞻性多中心审计，纳入了参与医院6周（2022年1月至4月）期间接受选择性或紧急结肠直肠切除术的成年人。收集患者人口统计学、适应症、手术方式（开放、腹腔镜或机器人）和术后30天结果（并发症、再手术和死亡率）的数据进行分析。对结果进行分析，并与以前的审计结果进行比较，以确定结直肠手术的趋势。结果：该研究纳入了来自53个国家216家医院的3521名患者（56.8%为男性）。72.2%的病例切除指征为恶性肿瘤，其次为憩室病（9.0%）、克罗恩病（3.7%）和溃疡性结肠炎（2.3%）。其中74.4%为选择性手术。55.2%的病例采用微创手术（48.7%为腹腔镜手术，6.5%为机器人手术）。90.3%的患者行一期吻合。30 d吻合口漏率为7.96%；在恶性和良性疾病中，泄漏率分别为7.3%和10.2%。右、左、直肠前切、袋和结肠次全切的漏率分别为6.9%、7.7%、9.7%、16.0%和11.8%。在多变量分析中，泄漏的危险因素包括男性（9.3% vs. 6.3%, OR = 0.69, 95% CI 0.51-0.95, p = 0.023）和急诊手术（11.4% vs. 7.1%, OR = 1.58, 95% CI 1.10-2.27, p = 0.013）。30天死亡率为2.38%。结论：这项大型国际审计提供了结直肠手术管理的现状。这表明微创技术被广泛采用，30天死亡率很低；然而，吻合口漏率仍然居高不下。这些发现强调了有针对性的研究和质量改进举措的持续需求，以减少吻合口衰竭和改善结直肠手术的结果。

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引用次数: 0

Laparoscopic total pelvic exenteration: A standardized approach – A video vignette 腹腔镜全盆腔切除：一种标准化的方法-视频短片。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-11-23 DOI: 10.1111/codi.70319

Karthikeyan Parthasarathy, Syed Althaf, Srinivas Chunduri, Pavan Sugoor

引用次数: 0

Does ethnicity impact the long-term outcome after restorative proctocolectomy with ileal pouch anal anastomosis? 种族是否影响回肠袋肛管吻合术后的长期预后？

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-11-23 DOI: 10.1111/codi.70316

Olga Lavryk, Arielle Kanters, Hermann Kessler, Stefan D. Holubar, David Liska, Scott R. Steele, Tracy L. Hull

Background

Racial/ethnic disparities were reported to impact the phenotype of inflammatory bowel disease and its treatment. The impact of race/ethnicity on ileal pouch anal anastomosis (IPAA's) outcomes is unknown. Our aim was to investigate whether it impacts IPAA's outcomes.

Methods

A prospectively maintained IPAA database(1983–2022) was searched to identify patients with IPAA who had race/ethnicity data available regardless of diagnosis. The cohort was divided into 2 groups: Whites and Non-Whites. We analysed patients' demographics, postoperative complications, Kaplan–Meier pouch survival, function (stool number, seepage), quality of life (QoL) scores, social, dietary and sexual restrictions.

Results

A total of 4954 patients were included, with 4674 whites and 280 non-whites. Non-Whites consisted of Black (123, 44%), Asians (23, 8.2%) and Hispanics (134, 48%). The groups were comparable in terms of age, gender and pathological diagnosis (p = 0.16). The rate of long-term anastomotic leaks, pelvic sepsis and strictures was not significantly different between groups. There was a higher rate of pouchitis in White (29%) vs. Non-White (18%) (p < 0.001); fistula [White (8%) vs. Non-White (4.5%) (p = 0.04)] and postoperative obstruction [White (13%) vs. Non-White (9%) (p = 0.04)]. The Kaplan–Meier pouch retention was similar (97% at 5 years, 96% at 10 years and 95% at 15 years) in White and Non-White patients. The average QoL scores were comparable between Non-White (7.7 ± 2.5) and White (7.9 ± 2.4) (p = 0.34). Non-Whites had more social restrictions (25%) vs. Whites (15%) (p = 0.04).

Conclusion

In a large IPAA cohort, more White patients had pouchitis compared to Non-White patients. Social restrictions were more prevalent in Non-White patients compared to those in White patients over the long term. More research is needed to understand how race/ethnicity impacts the IPAA outcomes.

背景：据报道，种族/民族差异会影响炎症性肠病的表型及其治疗。种族/民族对回肠袋肛门吻合术（IPAA）结果的影响尚不清楚。我们的目的是调查它是否会影响IPAA的结果。方法：检索前瞻性维护的IPAA数据库（1983-2022），以确定具有种族/民族数据的IPAA患者，无论诊断如何。研究对象被分为两组：白人和非白人。我们分析了患者的人口统计学、术后并发症、Kaplan-Meier袋存活、功能（粪便数量、渗漏）、生活质量（QoL）评分、社交、饮食和性限制。结果：共纳入4954例患者，其中白人4674例，非白人280例。非白人包括黑人（123,44%）、亚洲人（23,8.2%）和西班牙人（134,48%）。两组在年龄、性别和病理诊断方面具有可比性（p = 0.16）。两组间吻合口长期瘘、盆腔脓毒症及狭窄发生率无显著差异。白人的荷包炎发生率（29%）高于非白人（18%）(p)。结论：在一个大型IPAA队列中，白人患者比非白人患者有更多的荷包炎。长期来看，与白人患者相比，非白人患者的社交限制更为普遍。需要更多的研究来了解种族/民族如何影响IPAA结果。

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引用次数: 0

Efficacy and safety of oral 5-FU-based adjuvant chemotherapy for geriatric patients with colorectal cancer: Integrated analysis of seven clinical trials conducted at the Japanese Foundation for Multidisciplinary Treatment of Cancer 口服5- fu辅助化疗对老年结直肠癌患者的疗效和安全性：日本癌症多学科治疗基金会进行的七项临床试验的综合分析

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-11-23 DOI: 10.1111/codi.70317

Nobuaki Hoshino, Mitsuro Kanda, Koji Oba, Toru Aoyama, Michitaka Honda, Kosuke Kashiwabara, Hiromichi Maeda, Shuhei Mayanagi, Masaru Muto, Kenji Tanaka, Hisakazu Yamagishi, Junichi Sakamoto, Kazutaka Obama, Takaki Yoshikawa

Background

Adjuvant chemotherapy after radical resection is recommended for patients with high-risk Stages II and III colorectal cancer (CRC). However, the efficacy and safety of adjuvant chemotherapy in geriatric patients require elucidation.

Methods

We analysed data from seven clinical trials conducted by the Japanese Foundation for the Multidisciplinary Treatment of Cancer. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. Survival analysis was performed using a Cox proportional hazards model.

Results

This study included 7756 non-geriatric (<70 years) and 1706 geriatric patients (≥70 years). Adjuvant chemotherapy significantly improved the 5-year overall survival in non-geriatric patients (81.6% vs. 73.6%, p < 0.001) but did not significantly improve the survival rate in geriatric patients (78.9% vs. 76.1%, p = 0.129). However, adjuvant chemotherapy was effective for N+ geriatric patients (hazard ratio, 0.48; 95% confidence interval, 0.35–0.66; p < 0.001). Adverse events associated with adjuvant chemotherapy were significantly more frequent in geriatric than in non-geriatric patients.

Conclusion

Adjuvant chemotherapy in geriatric patients with node-positive CRC was as effective as in non-geriatric patients, although no benefit was shown in geriatric patients with node-negative CRC. More adverse events were observed in geriatric patients than in non-geriatric patients.

背景：对于高危II期和III期结直肠癌（CRC）患者，建议在根治后进行辅助化疗。然而，辅助化疗在老年患者中的有效性和安全性有待阐明。方法：我们分析了由日本癌症多学科治疗基金会进行的七项临床试验的数据。使用Kaplan-Meier法估计生存曲线，并使用log-rank检验进行比较。采用Cox比例风险模型进行生存分析。结果：本研究纳入了7756名非老年患者(结论：辅助化疗在结阳性的老年CRC患者中与非老年患者一样有效，尽管对结阴性的老年CRC患者没有显示出益处。老年患者比非老年患者观察到更多的不良事件。

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引用次数: 0

Logistical requirements for high-resolution anoscopy: Pre-procedure preparation and materials – A video vignette 高分辨率肛门镜检查的后勤要求：术前准备和材料。视频简介。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-11-21 DOI: 10.1111/codi.70318

Cigdem Arslan

引用次数: 0

Correction to ‘E-Posters’ 更正“电子海报”

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-11-20 DOI: 10.1111/codi.70315

(2025), E-Posters. Colorectal Dis, 27: e70174. https://doi.org/10.1111/codi.70174.

In section P0872, Validation and reliability of the Turkish AF-QoL scale for cryptoglandular anal fistula, the funding acknowledgement was inadvertently omitted.

The abstract should include the following statement:

Acknowledgements: Participation in the 20th ESCP Scientific Conference (Tripartite Colorectal Meeting, Paris, 10–12 September 2025) was supported by the Scientific and Technological Research Council of Türkiye (TÜBİTAK).

We apologize for this error.

(2025), E-Posters。结直肠疾病杂志，27(4):771 - 774。https://doi.org/10.1111/codi.70174.In章节P0872，隐腺肛瘘的土耳其AF-QoL量表的验证和可靠性，无意中省略了资金确认。致谢：参加第20届ESCP科学会议（三方结直肠会议，巴黎，2025年9月10日至12日）得到了 rkiye科学技术研究理事会（TÜBİTAK）的支持。我们为这个错误道歉。

引用次数: 0

Physical fitness and body composition assessments in advanced cancer patients undergoing exenterative surgery – A pilot cohort study 接受肠外手术的晚期癌症患者的身体健康和身体成分评估-一项试点队列研究。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-11-18 DOI: 10.1111/codi.70298

Marina Looby, Lewis Matthews, Charles T. West, Kashuf Khan, Gillian Ansell, Kathryn Donovan, Laura Wood, Patrick Tapley, Rhys Lewis, Kate Stoddard, Michael P. W. Grocott, Sandy Jack, Hideaki Yano, Denny Levett, Alex Mirnezami, Malcolm A. West

Aim

Locally advanced pelvic malignancies, such as colorectal and anal cancers, can only be cured through multimodal cancer treatment including multi-visceral exenterative resections, which carry a high mortality and morbidity risk. Despite strong predictive abilities in other cancer cohorts, the combined prognostic value of body composition and cardiopulmonary exercise testing (CPET) for major in-hospital morbidity in patients undergoing exenterative surgery for advanced pelvic cancers has not been evaluated.

Method

A locally advanced colorectal and anal cancer cohort was derived from a prospectively maintained quaternary database. CPET was undertaken preoperatively, according to national guidelines. Skeletal muscle index (SMI) and radiation attenuation (SM-RA) were obtained from analysing L3 slices from preoperative computed tomography scans using SliceOmatic 5.0 and classified using predefined thresholds. Major morbidity was defined as Clavien-Dindo classification 3a or greater.

Results

From 247 patients (58% male, median age 60 years), 62.4% and 35.5% had locally advanced or recurrent disease respectively. Physical fitness variables were significantly reduced in low SMI or low SM-RA patients. In multivariate linear regression, SMI was strongly predictive of oxygen uptake at the anaerobic threshold (B = 0.013, p = 0.001) and at peak (B = 0.015, p = 0.002). 17.3% of all patients experienced a major postoperative complication. In multivariate analysis, reduced peak power output (<1.5 W kg⁻¹) was significantly associated with an increased risk of postoperative major morbidity (OR = 2.6, p = 0.012).

Conclusion

CPET may be predictive of in-hospital major morbidity in this cohort. The association of CPET with body composition necessitates further evaluation and external validation in a larger patient cohort, specifically interrogating their combined role in morbidity prediction and as a target for prehabilitation interventions.

目的：局部晚期盆腔恶性肿瘤，如结直肠癌和肛门癌，只能通过包括多脏器切除在内的多模式癌症治疗来治愈，其死亡率和发病率较高。尽管在其他癌症队列中有很强的预测能力，但身体成分和心肺运动试验（CPET）对晚期盆腔癌行肠手术患者主要住院发病率的联合预后价值尚未得到评估。方法：从前瞻性维护的第四纪数据库中提取局部晚期结直肠癌和肛门癌队列。术前根据国家指南进行CPET检查。骨骼肌指数（SMI）和辐射衰减（SM-RA）通过分析术前计算机断层扫描的L3切片，使用SliceOmatic 5.0获得，并使用预定义阈值进行分类。主要发病定义为Clavien-Dindo分级3a及以上。结果：247例患者中，男性占58%，中位年龄60岁，分别有62.4%和35.5%为局部晚期或复发性疾病。低SMI或低SM-RA患者的身体健康变量显著降低。在多元线性回归中，SMI对无氧阈值（B = 0.013, p = 0.001）和峰值（B = 0.015, p = 0.002）的摄氧量有很强的预测作用。17.3%的患者出现了严重的术后并发症。在多变量分析中，峰值输出功率（-1）的降低与术后主要发病风险的增加显著相关（OR = 2.6, p = 0.012）。结论：CPET可预测该队列患者的院内重大发病率。CPET与身体成分的关联需要在更大的患者队列中进一步评估和外部验证，特别是质疑它们在发病率预测中的综合作用以及作为康复干预的目标。

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引用次数: 0

A standardized ten-step robotic approach to completion proctectomy and ileoanal pouch anastomosis – A video vignette 一个标准化的十步机器人方法来完成直肠切除术和回肠袋吻合-一个视频短片。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-11-18 DOI: 10.1111/codi.70311

Orsalia Mangana, Maximos Frountzas, Filomena Liccardo, Valerio Celentano

引用次数: 0

National observational study about the surgical treatment of anal fistula with laser (the FISTULASER study) 国家关于肛瘘激光手术治疗的观察研究（瘘管激光研究）。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-11-17 DOI: 10.1111/codi.70302

Fernando de la Portilla de Juan, María L. Reyes Díaz, Ana Huidobro Piriz, Soledad Oliart Delgado, Rosa Pelaez Barrigón, Lourdes Gomez Bujedo, Teresa Calderon Duque, Begoña Ochoa, FISTULASER Study Group Collaborators

Background

Ablation of anal fistula tract using a radial laser-emitting probe is a sphincter-preserving technique.

Objective

The objective of investigating the safety and efficacy of laser treatment for complex anal fistula.

Design

This was a prospective and observational analysis of the long-term outcomes of 172 patients who underwent laser ablation of the fistula tract.

Settings

This was a multicentre, single-arm study, involving 20 Spanish centres.

Patients

Patients with cryptoglandular anal fistulas with an external orifice, high intersphincteric fistula or low intersphincteric fistula with faecal incontinence, transsphincteric fistula and suprasphincteric fistula.

Interventions

A probe housing a 12-watt laser emitting at a wavelength of 1470 nm and an energy level of 100 joule/cm was used.

Main Outcome Measures

Complete treatment success was defined as the closure of the external opening and the absence of fistula drainage, with closure of the fistula tract confirmed by clinical evaluation. Partial success was defined as the external opening remaining open but without drainage. Surgical complications, including continence disorders, were also assessed. Patients were evaluated at 1, 3, 6, and 12 months after surgery.

Results

A total of 172 patients underwent laser ablation of the fistula tract with a median age of 51 (43–61) years. The majority of them were men (62,8%). A total of 133 patients (77.32%) were followed up for a minimum of 12 months. The number of patients with complete healing was 59 (44.3%) and partial healing was observed in seven (5.26%). Healing (clinical and radiological) was not achieved in 67 patients (50.37%). Nine reported adverse events. None of the patients experienced permanent anal incontinence.

Limitations

It is the loss to follow-up of up to 20% of patients, as many patients do not tolerate waiting within a strict visit schedule.

背景：采用径向激光探针消融肛瘘道是一种保留括约肌的技术。目的：探讨激光治疗复杂肛瘘的安全性和有效性。设计：这是一项前瞻性和观察性分析，对172例接受激光消融瘘管道的患者的长期结果进行了分析。环境：这是一项多中心、单臂研究，涉及20个西班牙中心。患者：隐腺肛瘘伴外孔、高括约肌间瘘或低括约肌间瘘伴大便失禁、经括约肌瘘、门上瘘的患者。干预措施：探头装有12瓦激光，发射波长为1470 nm，能量水平为100焦耳/厘米。主要观察指标：治疗完全成功定义为外开口闭合，无瘘道引流，经临床评价确认瘘道闭合。部分成功被定义为外部开口保持开放但没有引流。手术并发症，包括失禁障碍，也被评估。分别于术后1、3、6、12个月对患者进行评估。结果：共有172例患者接受了激光消融瘘道，中位年龄为51（43-61）岁。其中大多数是男性（62.8%）。133例患者（77.32%）随访至少12个月。完全愈合59例（44.3%），部分愈合7例（5.26%）。67例（50.37%）患者（临床和放射学）未愈合。9例报告了不良事件。没有患者出现永久性肛门失禁。局限性：高达20%的患者失去了随访，因为许多患者无法忍受严格的就诊时间表内的等待。结论：激光消融瘘管束是一种保留括约肌的手术，具有可接受的长期成功率。

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引用次数: 0

Should online, free proctology videos be used for self-directed post-graduate learning? A proposed evaluation using a colorectal video assessment framework 在线免费的肛肠学视频是否应该用于研究生的自主学习？建议使用结直肠视频评估框架进行评估。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-11-16 DOI: 10.1111/codi.70313

Shoeib Mirdha, Evripidis Tokidis, Louise Le Blevec, Tim Wilson

Introduction

Exposure to proctology during post-graduate colorectal training is often variable. Videos of proctological procedures can benefit surgical trainees' self-directed learning. The aim of this study is to evaluate the quality of freely available online video material on proctological procedures using a modified colorectal video assessment framework.

Methods

PubMed and the YouTube™ platform were searched for the following terms related to proctological procedures for haemorrhoids, anal fissure and fistula. These were assessed (cross-sectional study) for quality using a modified video-assessment checklist that was validated by three colorectal surgeons who regularly perform proctology cases. The resulting 9-item evaluation tool was designed to capture the extent to which videos provide concise and structured information typically required for peer review.

Results

A total of 98 surgical videos were assessed, comprising 65 from peer-reviewed. Journals and 35 from YouTube™ only. The median total score for peer-reviewed videos was 16.0 (interquartile range [IQR] 13.0–17.0) compared to 10 (IQR 8.0–12.0) for the non-peer-reviewed videos. This difference was statistically significant (Mann–Whitney U = 2024.0, p < 0.001). In particular, journal videos were significantly better at providing more contextual information about the case including presenting symptoms and outcomes.

Conclusion

As might be expected, the quality of YouTube™ videos from the perspective of proctology training was inferior to those released online by peer-reviewed journals. This provides further evidence for the validity of using modified checklists to assess the quality of training materials. Given the findings of this study, trainees should be encouraged to prioritise journal-related over other freely available material for self-directed learning.

简介：在研究生结肠直肠培训期间，直肠病学的暴露往往是可变的。直肠外科手术视频有利于外科受训者的自主学习。本研究的目的是使用改进的结肠直肠视频评估框架来评估免费提供的直肠外科手术在线视频材料的质量。方法：检索PubMed和YouTube™平台，检索以下与痔疮、肛裂和瘘管直肠外科手术相关的术语。使用改进的视频评估检查表对其质量进行评估（横断面研究），该检查表由三名定期进行直肠外科手术的结直肠外科医生验证。由此产生的9项评价工具旨在捕捉视频提供同行审查通常所需的简明和结构化信息的程度。结果：共评估了98个手术视频，其中65个来自同行评审。期刊和35只从YouTube™。同行评议视频的中位数总分为16.0（四分位间距[IQR] 13.0-17.0），而非同行评议视频的中位数总分为10 （IQR 8.0-12.0）。这一差异具有统计学意义（Mann-Whitney U = 2024.0, p）。结论：正如预期的那样，从直肠科培训的角度来看，YouTube™视频的质量不如同行评议期刊在线发布的视频。这进一步证明了使用修改后的核对表来评估培训材料质量的有效性。鉴于这项研究的结果，应鼓励受训者优先考虑与期刊有关的材料，而不是其他免费提供的材料，以便自主学习。

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引用次数: 0

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