Colorectal Disease最新文献

英文中文

Facilitating endorobotic submucosal dissection (ERSD) in transanal single-port surgery: A comparative analysis of two ports—A video vignette 在经肛门单孔手术中促进内生机器人粘膜下剥离（ERSD）：两个孔的比较分析-视频片段。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2026-02-09 DOI: 10.1111/codi.70400

Ece Erenler, Metincan Erkaya, Mustafa Oruc, Salih Nafiz Karahan, Emre Gorgun

引用次数: 0

Letter to the Editor: Topical versus oral metronidazole for post-haemorrhoidectomy pain: A systematic review and meta-analysis of randomized controlled trials 致编辑的信：局部与口服甲硝唑治疗痔切除术后疼痛：随机对照试验的系统回顾和荟萃分析。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2026-02-09 DOI: 10.1111/codi.70403

Yuting Shi, Saiya Shi, Yixin Lan

引用次数: 0

The perioperative microbiome of patients undergoing rectal cancer surgery: A pilot study 直肠癌手术患者围手术期微生物组：一项初步研究。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2026-02-09 DOI: 10.1111/codi.70397

Kiedo Wienholts, Claire P. M. van Helsdingen, Henry M. Wood, Kevin Talboom, Johannes H. W. de Wilt, Daniel Bottomley, Caroline Young, Philip Quirke, Joep P. M. Derikx, Pieter J. Tanis, Roel Hompes

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.

目的：肠道微生物群在健康和疾病中起着至关重要的作用，其在吻合口漏（AL）等术后并发症中的作用越来越受到关注。尽管有大量的临床前证据表明微生物组的改变与手术结果有关，但人体研究很少，特别是那些探索超过单一时间点的肠道微生物组围手术期动态的研究。这项描述性的、产生假设的初步研究旨在阐明直肠癌手术患者围手术期粪便微生物组的变化。方法：来自阿姆斯特丹大学医学中心的17名患者在2020年4月至2022年4月期间参加了imari研究和inactt试验。在这些研究中，所有的患者都接受了直肠切除术和原发吻合，有或没有转移回肠造口。收集的样本包括术前大便、术中吻合口结肠组织及拭子、术后大便。提取细菌DNA，采用16S rRNA基因测序进行分析。结果：与术前和术中样本相比，术后观察到肠球菌和链球菌的增加。与术前和术中样本相比，术后样本显示α多样性显著降低。Beta多样性分析显示，术后大便和回肠造口样本具有明显的聚类性。术前口服抗生素显著改变术中微生物组组成，降低术后α多样性。结论：这项初步研究揭示了直肠癌患者围手术期肠道微生物群的显著变化。这些发现强调了在设计和解释微生物组与临床结果相关的研究时，围手术期考虑微生物组动力学的重要性。然而，这些结论应被视为初步的，需要在更大规模的研究中得到证实，包括与术后结果的因果关系。

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引用次数: 0

What has happened to the open surgery for rectal cancer in Japan? 日本直肠癌的开腹手术发生了什么变化？

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2026-02-09 DOI: 10.1111/codi.70402

Pawel Mroczkowski, Michal Mik

引用次数: 0

Patient characteristics, antibiotic use, and in-hospital outcomes in patients with ischaemic colitis: A nationwide retrospective cohort study 缺血性结肠炎患者的患者特征、抗生素使用和住院结果：一项全国性回顾性队列研究

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2026-02-08 DOI: 10.1111/codi.70385

Yasuhiro Kano, Yuya Kimura, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga

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.

目的：描述缺血性结肠炎的患者特征、治疗和住院结果，并比较接受和未接受抗生素治疗的患者的手术率和住院死亡率。方法：我们回顾性地从日本诊断程序组合住院患者数据库中确定2016年4月至2023年3月期间的缺血性结肠炎住院患者。我们描述了患者的总体特征、管理实践和结果，并根据抗生素的使用进行了分层。主要结局是接受手术和住院死亡率的综合结果。我们使用多变量logistic回归分析检查了入院前2天内抗生素使用与住院第3天或之后发生的主要结局之间的关系。结果：在111,750例符合条件的病例中，36.2%的患者在入院前2天内使用了抗生素。其中0.9%接受手术治疗，1.3%在住院期间死亡。在整个队列中，2.1%的病例（≤2天：0.6%；≥3天：1.5%）、1.0%的未接受抗生素治疗的病例（≤2天：0.2%；≥3天：0.8%）和4.2%接受抗生素治疗的病例（≤2天：1.5%；≥3天：2.7%）出现了主要结局。协变量调整后，抗生素的使用与主要综合结局的较高几率相关（调整后的优势比为1.98,95%可信区间为1.77-2.21）。结论：缺血性结肠炎的手术率和住院死亡率低于文献报道。抗生素的使用与更高的手术几率和住院死亡率相关；然而，考虑到潜在的未测量的混杂因素，这一发现应谨慎解释。

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引用次数: 0

Five-year recurrence and postoperative complications after laparoscopic complete Mesocolic excision: A population-based, multicentred study 腹腔镜完整肠系膜切除术后5年复发和术后并发症：一项基于人群的多中心研究。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2026-02-08 DOI: 10.1111/codi.70380

Tora Haug, Jan Brink Valentin, Mai-Britt Worm Ørntoft, Lene Hjerrild Iversen, Søren Paaske Johnsen, Robin Kennedy, Danilo Miskovic, Anders Husted Madsen

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.

背景：腹腔镜完整肠系膜切除术（LCME）相对于传统手术的肿瘤学益处经常受到单中心设计、小队列或短且不完整随访的挑战。本研究旨在研究以人群为基础的多中心LCME实施前后术后5年复发风险和术后30天并发症的差异。方法：LCME在2017年对所有结肠癌外科医生进行培训后在丹麦中部地区实施。通过丹麦结直肠癌组数据库确定实施前（2015-2016，pre -2016组）和实施后（2018-2019，post组）的结肠癌患者。术后5年复发率通过国家登记系统确定。竞争风险的aallen - johansen估计用于计算累积复发率。结果：在研究期间，共有1919例患者（PRE, n = 1024； POST, n = 895）接受了治愈性手术。PRE组5年累积复发率为16.1% (95% CI: 13.8, 18.4)， POST组5年累积复发率为12.5% (95% CI: 10.2, 14.9)，绝对风险差异为3.6% （95% CI: 0.3, 6.9）。此外，LCME实施后II期患者的危险复发率显著降低，危险率比为0.42 （95% Cl: 0.24, 0.72）。与PRE组相比，POST组发生严重术后并发症的风险也显著降低。结论：LCME的实施显著降低了复发风险和术后严重并发症的发生率。本研究表明，多中心LCME的实施可以在不影响患者安全的情况下改善临床结果。

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引用次数: 0

Risk factors for conditional survival and lymph node metastases in appendiceal adenocarcinoma 阑尾腺癌有条件生存和淋巴结转移的危险因素。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2026-02-08 DOI: 10.1111/codi.70388

Lauren Weaver, Shelbi Olson, Shreya Gupta, Sarah L. Mott, Lindsay Welton, Alexander Troester, Niccolo Allievi, Wolfgang B. Gaertner, Imran Hassan, Paolo Goffredo

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.

目的：右半结肠切除术是阑尾腺癌的标准手术，以确保足够的淋巴结采样。然而，由于生物多样性，阑尾腺癌具有广泛的生存范围。因此，本研究调查了与淋巴结转移和有条件总生存相关的危险因素，或治疗后额外存活2年的概率，这可能提供更动态的生存估计。方法：使用国家癌症数据库进行回顾性队列研究，以确定2004年至2018年因I-III期阑尾腺癌接受节段性结肠切除术的成年人。Cox回归模型估计了患者和治疗对淋巴结转移风险和生存结果的影响。结果：3185例患者中有24%发生淋巴结转移。淋巴结受累的可能性随着肿瘤分级、非黏液和印细胞组织学以及晚期T分期的增加而增加。总体而言，5年生存率为79%。2年后，2716例患者（85%）存活，其中86%存活至5年。年龄0 ~ 70岁、公共保险或无保险、分级较高、病理T分期和淋巴结转移增加与较差的2年有条件总生存率相关（均p）。结论：在这个国家队列中，四分之一的阑尾腺癌患者有淋巴结转移，这与较差的预后相关，验证了节段性结肠切除术在分期和治疗中的重要性。尽管存活至少2年的患者的长期预后得到改善，但那些T期、肿瘤分级或淋巴结受累者的死亡风险仍然较高，可能需要长期密切监测。

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引用次数: 0

Anorectal incontinence among a working-age population: A cross-sectional survey of prevalence and epidemiology 工作年龄人群中肛门直肠失禁：患病率和流行病学的横断面调查。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2026-02-05 DOI: 10.1111/codi.70392

Alexandre Balaphas, Emilie Liot, Vaihere Delaune, Jeremy Meyer, Véronique Gogniat, Christian Toso, Guillaume Meurette, Hubert Vuagnat, Frédéric Ris

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.

背景：肛肠失禁是一个主要的健康问题，因为它的经济负担和影响生活质量。它的真实流行程度仍然被低估，这是一个有争议的问题。我们的目的是评估肛门失禁的患病率在三级医院的合作者。方法：对某三级医院的所有合作者进行匿名调查，采用标准化电子问卷，包括Jorge-Wexner和LARS评分以及涵盖肛门直肠失禁不同定义的项目，以及人口统计学特征和特定病史。结果：14270名合作者中，2535人填写了问卷。该样本在年龄、性别和职业方面与医院工作人员总数相当。20.9%的参与者出现肛门直肠失禁（定义为Jorge-Wexner评分≥3）。然而，只有2.3%的人达到了严格的罗马IV型尿失禁标准。女性出现肛门直肠失禁的比例更高（16.2% vs. 4.7%, p = 0.001），但Rome IV标准具有可比性。在女性中，在单因素和多因素分析中，阴道分娩与肛门失禁无关，也与调整后的Rome IV标准无关。糖尿病与Rome IV标准的存在显著相关（OR: 3.3, 95% CI: 1.09-10.08, p = 0.035）。直肠手术史也与肛门直肠失禁和Rome IV标准有显著相关性（OR: 4, 95% CI: 1.86-8.6, p）。结论：在活跃人群中，肛门失禁的患病率高于预期，而在这个医学敏感的工作队列中，传统产科因素与肛门直肠失禁的相关性似乎没有预期的那么强，这表明风险状况更为复杂。

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引用次数: 0

Assurance of rectal side arterial and venous perfusion with indocyanine green fluorescence angiography during anterior resection—A Video Vignette 用吲哚菁绿荧光血管造影检查直肠侧动脉和静脉在前切除术中的灌注-视频片段。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2026-02-04 DOI: 10.1111/codi.70394

Ronan A. Cahill

引用次数: 0

Methodological considerations regarding long-term performance and interpretation of faecal immunochemical testing 关于粪便免疫化学检测的长期性能和解释的方法学考虑。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2026-02-03 DOI: 10.1111/codi.70386

Ting Chen

引用次数: 0

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