Colorectal Disease最新文献

Purpose: This study aimed to delineate the existing knowledge regarding the impact of colorectal cancer surgery on the sexuality of LGB patients, highlighting the need for culturally competent care tailored to their unique needs.

Methods: A comprehensive search was conducted from October 2024 onwards across PubMed, Embase, CINAHL, Google Scholar, Web of Science, Scopus, PsychINFO, Cochrane Library, and Joanna Briggs Institute using the MeSH terms 'sexual and gender minorities', 'colorectal surgery', 'colorectal neoplasms' and 'sexuality'. Inclusion criteria required LGB patients over 18 years, at least 50% of the sample diagnosed with colorectal cancer and treated operatively. All studies were critically appraised.

Results: Six studies from the UK and the US were included. Sample size ranged from 1 to 480. Participants identifying as LGB ranged from 26.4 to 100%. Key findings revealed LGB patients experience similar physical consequences to heterosexual patients (erectile and ejaculatory dysfunction, dyspareunia, vaginal dryness), but implications might differ, e.g., regarding anal intercourse. A lower mental quality of life was reported, including body image issues related to stomas. Relationship challenges and intimacy issues were highlighted. The cultural competence of healthcare providers has a significant influence on patient experiences, highlighting a gap in inclusive care. Critical appraisal revealed both methodological strengths and weaknesses.

Conclusion: This review highlighted the sexual health challenges of LGB patients after colorectal cancer surgery, with issues like sexual function and mental wellbeing often being underreported. Cultural competence training for healthcare providers and integrating patients' partners into cancer care are crucial for a holistic approach.

Background: Anorectal incontinence is a major health issue due to its economic burden and impact on quality of life. Its true prevalence remains under-estimated and a matter of debate. Our aim was to evaluate the prevalence of anal incontinence among the collaborators of a tertiary hospital.

Methods: An anonymous survey was distributed to all collaborators of a tertiary hospital using a standardized electronic questionnaire, incorporating Jorge-Wexner and LARS scores and items covering different definitions of anorectal incontinence, along with demographic characteristics and specific medical history.

Results: Among 14,270 collaborators, 2535 filled the questionnaire. This sample was comparable to the total hospital staff concerning age, gender and occupation. Anorectal incontinence (defined by a Jorge-Wexner score ≥ 3) was present in 20.9% of participants. However, only 2.3% fulfilled the strict Rome IV criteria for faecal incontinence. The presence of anorectal incontinence was higher in women (16.2% vs. 4.7%, p = 0.001), but the Rome IV criteria were comparable. In women, vaginal delivery was not associated with anal incontinence in univariate and multivariate analyses or with Rome IV criteria after adjustment. Diabetes was markedly associated with the presence of Rome IV criteria (OR: 3.3, 95% CI: 1.09-10.08, p = 0.035). History of proctological procedure was also substantially associated with anorectal incontinence and Rome IV criteria (OR: 4, 95% CI: 1.86-8.6, p < 0.001).

Conclusion: Prevalence of anal incontinence was higher than expected in an active population, and in this medically sensitized working cohort, traditional obstetric factors appeared less strongly associated with anorectal incontinence than anticipated, suggesting a more complex risk profile.

Aim: Right hemicolectomy is the standard procedure for appendiceal adenocarcinoma to ensure adequate lymph node sampling. However, due to biological diversity, appendiceal adenocarcinoma has a wide survival range. Therefore, this study investigated risk factors associated with lymph node metastases and conditional overall survival, or the probability of surviving an additional 2 years after treatment, which may provide a more dynamic estimate of survival.

Method: A retrospective cohort study was conducted using the National Cancer Database to identify adults undergoing segmental colectomy for stage I-III appendiceal adenocarcinoma from 2004 to 2018. Cox regression models estimated patient and treatment effects on risk of lymph node metastases and survival outcomes.

Results: Of 3185 patients, 24% had nodal metastases. Probability of lymph node involvement increased with higher tumour grade, non-mucinous and signet cell histology, and advanced T stages. Overall, 5-year survival was 79%. After 2 years, 2716 patients (85%) survived, with 86% of that cohort surviving to 5 years. Age > 70, public or no insurance, higher grade, increasing pathological T stage and nodal metastases were associated with worse 2-year conditional overall survival (all p < 0.05).

Conclusion: In this national cohort, one-fourth of appendiceal adenocarcinoma patients had nodal metastases, which were associated with worse prognosis, validating the importance of segmental colectomy in staging and management. Although patients who survived at least 2 years had improved long-term outcomes, those with higher T stage, tumour grade or nodal involvement remained at elevated risk of mortality and may need prolonged close surveillance.

Background: Muscle retraction (MR) is a major cause of technical difficulty and perforation during colorectal endoscopic sub-mucosal dissection (ESD). However, no established method exists for predicting MR preoperatively. This study investigated whether computed tomography-colonography (CTC) can detect MR before ESD.

Methods: We retrospectively analysed 69 patients who underwent colorectal ESD without muscular invasion (Validation 1). The serosal-side appearance of the tumour on CTC was classified into four types-bulge, matchstick, round depression and sharp depression-and compared with endoscopically observed MR (eMR). To validate the findings, 55 surgically resected colorectal cancers without muscular invasion were analysed for pathological MR (pMR) and correlated with the same CTC classification (Validation 2). Logistic regression analyses were performed to identify predictors of MR.

Results: In Validation 1, all eMR-positive lesions (5/5) showed the sharp depression type on CTC, whereas 3 of 64 eMR-negative lesions did (Fisher's exact test, p < 0.0001). In Validation 2, multivariate logistic regression showed that both the sharp depression type (OR 138, p < 0.0001) and severe sub-mucosal fibrosis (OR 4453, p = 0.0079) were independent predictors of pMR. Intero-bserver agreement was almost perfect (κ = 0.93-0.95).

Conclusions: The serosal-surface appearance of colorectal tumours on CTC, especially the sharp depression type, strongly predicts MR. CTC may serve as a simple, non-invasive preoperative tool for identifying MR and selecting optimal treatment strategies, including surgery, before colorectal ESD.

Aim: The gut microbiome plays a crucial role in health and disease, and its involvement in postoperative complications like anastomotic leakage (AL) is of growing interest. Despite substantial preclinical evidence linking microbiome alterations to surgical outcomes, human studies are scarce, particularly those exploring the perioperative dynamics of the gut microbiome beyond a single time point. This descriptive, hypothesis-generating pilot study aims to elucidate the perioperative changes in the faecal microbiome of patients undergoing rectal cancer surgery.

Method: Seventeen patients from Amsterdam University Medical Centers participated in the IMARI-study and the IntAct-trial between April 2020 and April 2022. All patients in these studies underwent rectal resection for malignancy with a primary anastomosis, with or without a diverting ileostomy. Samples collected included preoperative stool, intraoperative anastomotic colonic tissue and swab and postoperative stool. Bacterial DNA was extracted and analysed using 16S rRNA gene sequencing.

Results: An increase in Enterococcus and Streptococcus was observed postoperatively compared to preoperative and intraoperative samples. Postoperative samples showed a significant decrease in alpha diversity compared to preoperative and intraoperative samples. Beta diversity analysis revealed distinct clustering of postoperative stool and ileostomy samples. Preoperative oral antibiotics significantly altered the intraoperative microbiome composition and reduced postoperative alpha diversity.

Conclusion: This pilot study reveals significant perioperative shifts in the gut microbiome of rectal cancer patients. These findings underscore the importance of considering microbiome dynamics perioperatively when designing and interpreting studies that correlate the microbiome with clinical outcomes. However, the conclusions should be viewed as preliminary and require confirmation in larger studies, including causal relation, to postoperative outcomes.