Colorectal Disease最新文献

Aim

This retrospective observational cohort study aimed to investigate the prevalence of suspected lateral lymph node metastases (LLNM), as diagnosed by magnetic resonance imaging (MRI), and its impact on local recurrence (LR) and overall survival (OS). Patients who underwent dissection of suspected lymph nodes were evaluated in subgroup analysis.

Method

Patients diagnosed with rectal cancer in Sweden between 2017 and 2021 were identified through the Swedish colorectal cancer registry and grouped by MRI findings. Main outcome measures were LR at 3 years and OS at 3 and 5 years.

Results

In all, 2779 patients were analysed. Frequency of lateral lymph node (LLN) enlargement on MRI was 9.4%. In univariable analysis, the risk of LR at 3 years was increased in LLN-positive patients, HR 2.79 (CI 1.55–5.03). In multivariable analysis, adjusted for patient, tumour and neoadjuvant treatment factors, this difference remained (HR 1.97 (CI 1.04–3.73)). No difference in 3-year OS was observed. At 5 years, univariable analysis indicated increased mortality in LLN-positive patients (HR 1.64 (CI 1.24–2.17)), but not in multivariable analysis.

Among LLN-positive patients, those who had undergone LLN dissection (LLND) had an LR rate of 12.5% and increased risk at 3 years in univariable analysis (HR 3.73 (CI 1.93–10.76)). However, in multivariable analysis, there was no difference in LR risk or OS.

Conclusion

MRI-detected LLN positivity is associated with a higher risk of LR and correlates with other adverse prognostic factors. The effect of LLND on LR remains unclear. Further research is needed to optimize treatment strategies for patients with suspected LLNM.

Background

Colostomy irrigation is a well-established technique used for bowel management in patients with a permanent, left-sided colostomy. When performed routinely every 24–48 hours, it enables stool-free intervals, often allowing the use of only a stoma cap or simple dressing. Scientific evidence has shown significant improvements in health-related quality of life (HRQoL) for patients using this method.

Aim

This study aimed to evaluate the current application of colostomy irrigation in Germany and Austria and to identify reasons for its limited use, despite known benefits. A specific focus was placed on the perspectives and practices of stoma care nurses.

Methods

A cross-sectional, retrospective survey was conducted among certified stoma care nurses in both countries. Data were collected anonymously and analysed descriptively, including the use of interval-weighted means.

Results

A mean of 39 patients per stoma therapist per year with a permanent colostomy in the descending or sigmoid colon—regions anatomically suitable for irrigation—were reported. However, irrigation had been recommended to only 43.6% of these patients, and just 53% of those adopted it in daily practice. This results in an average of only nine patients per stoma expert using the technique annually. Reported barriers included time constraints, perceived patient reluctance, short inpatient stays and doubts regarding clinical indication.

Conclusion

Stoma irrigation therapy has shown potential to improve autonomy, self-image and everyday function. This study contributes valuable insights into under-explored care practices in the German-speaking context and underlines the need for enhanced training and awareness among healthcare professionals to better integrate irrigation therapy into routine care.

Aim

Perforated diverticulitis of the left colon with peritonitis remains life-threatening. However, the optimal surgical strategy is still under debate. The presented study compares the impact of a routinely applied two-stage damage control strategy (DCS) in perforated purulent or faeculent diverticulitis with currently used non-DCS strategies.

Methods

This international multicentre retrospective cohort study was conducted in nine European hospitals. In five hospitals, the therapeutic algorithm covered the routine application of a two-stage DCS as a surgical standard for treating perforated diverticulitis. Four hospitals performed conventional one-stage surgeries and served as controls. The primary outcome was stoma rate at the end of the initial hospital stay. The key secondary outcomes were morbidity and mortality rates.

Results

Overall, data from 558 patients were included, 365 of whom were from DCS centres with equally distributed sex. Patients treated in DCS centres were significantly younger (67 ± 14 vs. 70 ± 14, p = 0.007) but showed a higher Mannheim peritonitis index (22.3 ± 7.9 vs. 20.4 ± 8.0, p = 0.008). At discharge, patients treated in DCS hospitals had a significantly lower stoma rate (stoma-free: DCS, 45.6% vs. non-DCS, 20.8%; p = 0.001).

Secondary outcome parameters showed no differences between the investigated cohorts, in addition to significantly longer ICU stays (7.28 ± 11.13 vs. 5.15 ± 9.60 days; p < 0.001) and an increased number of surgical interventions during the hospital stay in DCS centres (2.64 ± 1.89 vs. 1.51 ± 1.10; p < 0.001).

Conclusion

Patients treated in DCS hospitals for perforated diverticulitis are significantly more likely to be discharged without a stoma than patients treated in hospitals using the current standard treatment.

Objectives

Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer-related death. Colonoscopy (CO) is the gold standard for screening, but its invasive nature and low adherence limit its use. Second-generation capsule endoscopy (CCE-2) emerges as a non-invasive alternative. This study aimed to evaluate the diagnostic accuracy of CCE-2 in detecting colorectal polyps, using CO as the reference standard.

Methods

A systematic review and meta-analysis of prospective studies in adults undergoing CCE-2 followed by CO was performed. Searches were conducted in PubMed, EMBASE and Cochrane up to May 2025. Diagnostic accuracy metrics were pooled using a Bayesian bivariate model with construction of HSROC curves. To assess clinical impact, a fictitious cohort of 1000 patients was simulated based on polyp prevalence and submitted to decision curve analysis (DCA).

Results

Twelve studies including 4316 patients were analysed. CCE-2 demonstrated sensitivity/specificity of 0.89/0.94 for polyps ≥6 mm and 0.91/0.98 for ≥10 mm. In FIT-positive patients, performance was superior. In the simulated cohort, CCE-2 showed greater net benefit from a 20% pre-test probability threshold of a patient to have a polyp of any size, surpassing the universal CO strategy, avoiding unnecessary colonoscopies to make this diagnostic.

Conclusion

CCE-2 is a non-invasive, safe and accurate alternative for CRC screening, with potential to increase adherence, particularly in patients with contraindications or refusal of CO. However, the lack of therapeutic capability and absence of evidence regarding mortality reduction limit its role as a first-line tool. Randomized clinical trials are needed to consolidate its role in personalized screening.

Aim

Standard management with chemoradiotherapy (CRT) or total neoadjuvant therapy (TNT) followed by total mesorectal excision (TME) reduces local recurrence but often is associated with significant long-term functional impairment. Organ preservation (OP) has become a key therapeutic goal in rectal cancer to reduce surgery-related morbidity without compromising oncological outcomes. Three main OP strategies have been developed: Watch and Wait (W&W) strategy, Local Excision (LE) and Contact X-ray Brachytherapy (CXB), both applicable in patients showing a favourable tumour response after neoadjuvant therapy. The current challenge is defining the optimal timing and modalities for response assessment to accurately identify complete clinical response while balancing oncological control, functional outcomes and patient preferences. This trial evaluates whether a structured tumour response surveillance program combined with shared decision-making (SDM) can safely increase OP rates.

Methods

GRECCAR 20 is a multicentre, randomized, open-label, phase III trial enrolling patients with cT2-T3N0-1 rectal adenocarcinoma ≤ 8 cm from the anal verge and ≤ 4 cm in length, without involvement of the anal canal. Across the French GRECCAR and PRODIGE network, 270 patients will be recruited over 36 months. After neoadjuvant treatment (CRT or induction chemotherapy followed by CRT), participants are randomized to either a structured tumour response surveillance strategy with SDM over 8 to 24 weeks (experimental arm) or standard response assessment without SDM at 8 weeks (control arm). In the experimental arm (Arm A), reassessments at 2-, 4- and 6-month post-treatment will guide management decisions—W&W, LE, CXB or TME—through a collaborative process between patient and clinician. In the control arm (Arm B), treatment decisions at 2 months will be made solely by the clinician, between LE or TME, based on clinical, endoscopic and radiological assessment. The primary outcome is the OP rate at 2 years. Secondary endpoints include disease-free survival, TME-free survival, functional outcomes, quality of life (QoL) and patient-reported outcome measures (PROMs).

Conclusion

GRECCAR 20 is the first randomized trial to assess a structured tumour response surveillance program incorporating SDM in rectal cancer. By prioritizing patient values and QoL, this trial aims to improve OP rates without compromising oncological safety, potentially establishing a new standard of personalized, patient-centred care.