Colorectal Disease最新文献

Aim

To systematically evaluate the safety and feasibility of intraluminal bypass devices (IBDs) as alternatives to defunctioning stoma for colorectal/coloanal anastomoses after anterior resection.

Method

The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Endpoints were feasibility (placement, fixation, maintenance, removal) and safety (device-related events, postoperative morbidity and anastomotic leakage).

Results

In total, 10 studies evaluating five types of IBDs were included in this systematic review. Each IBD had a head portion with a proximal fixation component and a tail portion consisting of a transanal endoluminal tubular sheath or tube for faecal diversion but with a distinct design. Device-related events included migration, sheath internalization, partial colonic wall erosions and enterocutaneous fistula. Overall postoperative complications were reported in 0–74% and anastomotic leakage in 0–32% across studies. Stoma avoidance ranged from 66.7% to 100%.

Conclusion

IBDs are technically feasible and appear acceptably safe, with potential to reduce reliance on defunctioning stoma; however, evidence remains early and heterogeneous. Further studies are needed, and optimization of fixation and anti-migration strategies should be prioritized.

Background

With the widespread adoption of robotic surgical platforms, a hybrid approach for rectal cancer combining abdominal robotic surgery with transanal or transperineal total mesorectal excision (TME) technique has been introduced. However, in this two-team approach, the docked robotic arms extend over the patient and frequently obstruct the transanal surgeon's line of sight, making it difficult to view the operative monitor and causing excessive cervical rotation and neck strain. To address this ergonomic issue, we implemented a three-dimensional head-mounted display (3D-HMD) using 3D View Vision system (FA. System Engineering Co., Ehime, Japan), which provides stereoscopic, high-definition visualization regardless of head position.

Materials and Methods

The system offers 3840 × 1080-pixel resolution, minimal latency, light weight, and seamless switching between robotic and transperineal views, and images from both 2D and 3D endoscopes can be converted to stereoscopic 3D. The transperineal surgeon wore the 3D-HMD during transperineal TME and lateral pelvic lymph node dissection in coordination with the abdominal robotic team. Using this set-up, five abdominoperineal resections and one total pelvic exenteration were performed, all with bilateral lateral pelvic lymph node dissection.

Results

The median operating time was 530 min, with a median 3D-HMD usage of 315 min. The surgeon subjectively reported no cervical discomfort, visual disturbance, or device-related fatigue, and the visual field remained stable throughout the prolonged procedures.

Conclusion

The integration of a 3D-HMD into a hybrid two-team approach was feasible and subjectively well tolerated, providing high-resolution stereoscopic visualization without reported cervical discomfort.

Background

Colorectal mucinous adenocarcinoma (MAC) is challenging due to its unique pathophysiology and increasing incidence in younger populations. Treatment guidelines for early-onset MAC remain unclear, with clinical decisions often based on extrapolated data from classical adenocarcinoma. We aimed to assess the association between the extent of surgical resection and systemic therapy in patients with early-onset colonic MAC and survival.

Methods

Retrospective cohort analysis of patients aged 20–50 with stage II–III colonic MAC using the SEER database (2000–2020). We evaluated overall survival (OS) and cancer-specific survival (CSS) based on surgical resection (segmental vs. extended) and systemic therapy, using Kaplan–Meier and Cox regression analyses.

Results

The cohort included 2553 patients (58.5% male; mean age 42.7 years). Segmental resection was performed in 27.6%. Extended resection was more commonly performed in right-sided and stage III disease. Systemic therapy was administered to 62.1%, predominantly for stage III disease with unfavourable tumour features. Systemic therapy was associated with improved restricted mean 5-year CSS (51.7 vs. 47.8 months, p = 0.041) and OS (51.1 vs. 45.9 months, p = 0.008) in stage III, but not stage II, disease. Extended resection was associated with a modest survival benefit for CSS (56.5 vs. 54.3 months, p = 0.027) and OS (56.0 vs. 53.3 months, p = 0.007) in stage II, but not stage III, disease.

Conclusion

Systemic therapy was associated with a significant survival benefit in patients with stage III early-onset MAC, supporting its role as a cornerstone of treatment despite the histology's presumed chemoresistance.

Background

The incidence of surgical site infections (SSIs) has been reported to be significantly higher in colorectal surgeries compared to other surgical procedures. Wound protectors have been developed to help reduce the incidence of SSIs by creating a barrier between the incisional wound and the contaminated surgical field, but their efficacy remains uncertain.

Objective

To assess whether the use of wound protectors reduces the incidence of SSIs in patients undergoing open colorectal surgery.

Data Sources

A comprehensive literature review was conducted using PubMed, Embase, Web of Science and Cochrane databases from inception to January 2025.

Study Selection

Randomised controlled trials (RCTs) assessing the efficacy of wound protectors for reducing the incidence of SSIs in patients undergoing open colorectal surgery.

Interventions

The intervention consisted of wound protectors (e.g., Alexis O-ring wound retractors, plastic ring drape).

Main Outcomes Measures

The main outcome was SSI. We pooled risk ratios (RRs) with a 95% confidence interval (CI) using a random effects model. Statistical analysis was performed using R software (version 4.4.2).

Results

We included 6 RCTs comprising 666 patients, of whom 327 (49 %) were randomised to the wound protectors’ group. The mean follow-up duration was 30 days post-operatively. The incidence of SSIs was significantly lower in the intervention group (RR 0.44; 95% CI 0.22–0.88; p = 0.021). Subgroup analysis of four RCTs evaluating Alexis-O ring wound retractors showed a significantly lower incidence of SSIs in the experimental group (RR 0.21; 95% CI 0.09–0.48; p < 0.001).

Conclusion

Wound protectors were associated with a significantly lower incidence of SSIs in patients undergoing open colorectal surgery.

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.

Background

The European Society of Coloproctology (ESCP) conducted a global survey capturing wound closure practices across a spectrum of surgical contexts, including clean-contaminated and contaminated operations. The results revealed considerable variations in fascial closure techniques, suture types, and infection prevention measures, even within comparable operative scenarios. This variability highlights the urgent need for high-quality, real-world data to inform the development of evidence-based, globally relevant best practices in abdominal surgery.

Method

The WOLVERINE study is an international, prospective, multicenter cohort study designed to evaluate current wound closure techniques and surgical site infection (SSI) prevention strategies in adult patients undergoing general or colorectal abdominal surgery. The primary objective of this study is to investigate the relationship between wound closure materials and techniques and the development of early and late wound complications. Further objectives include quantifying the burden of wound complications on patient-reported outcomes, health-related quality of life, healthcare utilisation, and postoperative recovery timelines.

Participating centres include any hospital or surgical unit performing elective, expedited, or emergency abdominal, general, and colorectal operations via open, laparoscopic, or robotic approaches. This study adheres to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for reporting cohort studies.

Discussion

The WOLVERINE cohort study will provide the first truly global, prospective portrait of abdominal wall closure practice and its short- and long-term sequelae across the full spectrum of elective, expedited, and emergency general and colorectal surgery. This project bridges this fundamental knowledge gap.

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.

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.