Colorectal Disease最新文献

T4 colon adenocarcinoma, defined by tumour penetration of the visceral peritoneum or invasion of adjacent structures, carries a 15%–30% risk of peritoneal metastases (PM) despite curative resection and adjuvant systemic chemotherapy. Hyperthermic intraperitoneal chemotherapy (HIPEC) offers a biologically rational strategy to eradicate occult intraperitoneal tumour cells by exposing the peritoneal cavity to heated cytotoxic agents with enhanced penetration and synergistic thermal cytotoxicity. Although widely used with cytoreductive surgery for established PM, its prophylactic or adjuvant role in non-metastatic T4 disease remains uncertain. Randomized evidence is conflicting and divergent outcomes may be explained by a mechanistic triad encompassing: (1) timing of intraperitoneal drug exposure relative to early tumour implantation and adhesion formation; (2) pharmacological, thermal, and dosing characteristics of the HIPEC regimen, including its most often single administration; and (3) underlying biological heterogeneity within T4 tumours. Thus, HIPEC for T4 colon cancer remains promising in selected patients, and it may be established as routine if ongoing studies rigorously define timing, agent selection and biomarker-driven patient stratification.

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: Colonoscopy effectiveness in detecting colorectal carcinoma depends on adequate bowel preparation (ABP). This network meta-analysis assesses the efficacy and safety of various bowel preparation regimens in patients with constipation.

Methods: PubMed, Cochrane Central and ScienceDirect were searched till April 2025. A frequentist network meta-analysis was performed using the 'meta' and 'netmeta' packages on R version 4.3.3. The ranking was done using P-scores.

Results: Fifteen randomised controlled trials were included. Compared with 4 L polyethylene glycol (PEG), 3 L PEG + 3d-linaclotide (Lin) (risk ratio [RR] = 1.29; 95% confidence intervals [CI]: [1.12, 1.47]), 4 L PEG + 1d-Lin (RR = 1.25; 95% CI: [1.04, 1.51]), sodium phosphate (NaP) + bisacodyl (RR = 1.52; 95% CI: [1.09, 2.10]), probiotic 14d + NaP (RR = 3.59; 95% CI: [1.83, 7.04]) may show improvements in the rate of ABP. The probiotic 14d + NaP regimen was ranked best regarding ABP (P-score = 0.99) and bloating (P-score = 0.84). The 3 L PEG + 3d-Lin showed a reduction (RR = 0.18; 95% CI: [0.04, 0.88]) in abdominal pain and was ranked best regarding abdominal pain (P-score = 0.89) and vomiting (P-score = 0.80). The 4 L PEG + 1d-Lin was ranked best (P-score = 0.77) in terms of nausea.

Conclusion: The 14d-probiotics + NaP and 3 L PEG + 3d-Lin may be among the more effective and tolerable bowel preparation regimens. While adverse events were similar, the observed reduction in abdominal pain with 3 L PEG + 3d-Lin may suggest improved patient comfort and adherence.

Aim: Completeness of cytoreduction (CC) remains the strongest prognostic determinant after cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases (CPM) yet accurate pre-operative prediction remains difficult. This study aimed to develop and validate a radiomic-clinical machine-learning model to predict cytoreduction completeness.

Methods: 83 patients who underwent CRS ± HIPEC for CPM (2008-2025) were retrospectively analysed. Pre-operative contrast-enhanced CT scans were manually segmented in ITK-SNAP, and radiomic features were extracted using PyRadiomics. Clinical variables were modelled alone and in combination with radiomics features using a nested five-fold cross-validated machine-learning pipeline incorporating least absolute shrinkage and selection operator (LASSO) logistic regression, random forest (RF) and gradient-boosted classifiers (GBC) algorithms. The primary endpoint was incomplete cytoreduction (iCC). Model discrimination (AUROC, AUPRC), Brier score and calibration were assessed.

Results: iCC occurred in 17 of 83 patients (20.5%). Independent predictors of iCC were high radiological PCI (≥15), upper-abdominal disease, absence of pre-operative chemotherapy and normal CEA (≤5 ng/mL). The radiomic-clinical model achieved the best performance (AUROC 0.90, AUPRC 0.69, Brier 0.077, sensitivity 0.83, specificity 0.92), outperforming clinical-only (AUROC 0.82-0.86) and radiomic-only (AUROC 0.69-0.75) models. Key radiomic predictors of iCC-low sphericity, high maximum 2D diameter and high zone entropy-reflected morphological irregularity and heterogeneity of CPM. Integrated models demonstrated superior calibration indicating stable and reliable probability estimates.

Conclusion: A CT-based radiomic-clinical model accurately predicts CC pre-operatively. This exploratory proof-of-concept model supports multicentre external validation to enhance decision-making for CRS ± HIPEC in CPM.

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.