Colorectal Disease最新文献

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Outcomes of rechargeable sacral neuromodulation for faecal incontinence: A single-centre observational study 可充电骶神经调节治疗大便失禁的结果：一项单中心观察性研究。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-12-21 DOI: 10.1111/codi.70344

Michael Okocha, Carlotta La Raja, Stella Nikolaou, Hannah Cuthbert, Ahmad Nasasra, Carolynne J. Vaizey, Gregory P. Thomas

Introduction

Faecal incontinence (FI) remains a debilitating condition with considerable psychosocial burden. Rechargeable sacral neuromodulation (rSNM) systems offer extended battery longevity and MRI compatibility, potentially reducing surgical burden. However, real-world data on their efficacy, safety and acceptability remain limited.

Method

This single-centre observational cohort study evaluated 37 patients who received rSNM (InterStim™ Micro) for FI between August 2020 and August 2022. Patients completed validated questionnaires (St Mark's FI Score, Rockwood FIQOL, SF-36) and a structured telephone interview assessing functional outcomes, adverse events and device satisfaction. Clinical records were reviewed for surgical and 3- to 5-year follow-up data.

Results

Median age was 63 years; 61% had a history of obstetric injury. Twenty-eight patients received rSNM as a replacement for non-rechargeable systems. Device satisfaction was low: 62% expressed regret and 96% reported challenges with charging. Connectivity issues affected 86% of patients. Six patients underwent device explantation and two required lead revision. Rockwood FIQOL and SF-36 scores indicated persistent impairment in lifestyle, emotional well-being and social functioning. Improvements in continence scores were modest and below expectations.

Conclusion

Despite theoretical advantages, rSNM provided limited clinical benefit in this cohort. High rates of dissatisfaction, management difficulties and surgical revisions raise concerns about its broader applicability. While the smaller device may suit select patients, non-rechargeable systems with extended battery life may represent a more acceptable first-line option. Further studies are needed to better define the role of rSNM in FI management.

前言：大便失禁（FI）仍然是一个衰弱的条件与相当大的社会心理负担。可充电的骶骨神经调节（rSNM）系统提供了更长的电池寿命和MRI兼容性，潜在地减轻了手术负担。然而，关于其有效性、安全性和可接受性的真实数据仍然有限。方法：这项单中心观察队列研究评估了2020年8月至2022年8月期间接受rSNM （InterStim™Micro）治疗FI的37例患者。患者完成了有效的问卷调查（St Mark's FI评分、Rockwood FIQOL、SF-36）和结构化的电话访谈，评估功能结果、不良事件和设备满意度。临床记录回顾手术和3- 5年随访资料。结果：中位年龄63岁；61%有产科损伤史。28名患者接受了rSNM替代非充电系统。设备满意度很低：62%的人表示后悔，96%的人表示充电有困难。86%的患者出现了网络连接问题。6例患者接受了器械外植，2例需要导联翻修。Rockwood FIQOL和SF-36评分表明生活方式、情绪健康和社会功能持续受损。自理能力得分的改善幅度不大，低于预期。结论：尽管理论上有优势，rSNM在该队列中提供的临床益处有限。高的不满意率，管理困难和手术修改引起了对其更广泛适用性的关注。虽然较小的设备可能适合特定的患者，但具有延长电池寿命的非充电系统可能是更可接受的一线选择。需要进一步的研究来更好地定义rSNM在FI管理中的作用。

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引用次数: 0

The hidden cost of innovation: Are we neglecting surgical training in the robotic era? 创新的隐性成本：在机器人时代，我们是否忽视了外科培训？

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-12-19 DOI: 10.1111/codi.70348

Charlotte El-Sayed, Zoe Garoufalia, Joshua Richard Burke

引用次数: 0

Colorectal surgeons' perspectives and emotional responses to anastomotic leakage following rectal cancer resection 结直肠外科医生对直肠癌术后吻合口瘘的看法及情绪反应。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-12-17 DOI: 10.1111/codi.70338

Ruth Walsh, Caitlin Fanning, Paolo Meneghesso, Emmet J. Andrews, Ben Creavin, Micahel Devine, Michael Flanagan, Niamh M. Foley, Patrick Jordan, Niall Kennedy, M. Faraz Khan, Jurgen Mulsow, Lauren V. O'Connell, Edward Tobias Pring, Éanna J. Ryan, Des P. Toomey, Ronan A. Cahill

Aim

Anastomotic leak (AL) following rectal cancer resection is a devastating complication. This study describes Irish colorectal surgeons' approaches towards AL prevention, diagnosis and management and their emotional response to its occurrence.

Methods

A qualitative study was conducted using semi-structured interviews with senior colorectal trainees, fellows and consultants in Irish rectal cancer centres. Descriptive statistics summarised clinical approaches and thematic analysis (using NVivo software) explored emotional responses.

Results

Fifteen colorectal surgeons (13 male) from six Irish rectal cancer centres participated. Anastomotic height, tension and perfusion were rated the most important risk factors for AL. All surgeons routinely bowel-prepped patients though regimes varied significantly. Only 33.3% of surgeons routinely place intraoperative drains. 100% conduct routine air leak tests whereas 40.0% routinely use ICG perfusion testing. For AL management, only 6.7% use a fixed protocol approach with the majority individualising their decisions on clinical status, defunctioning stoma presence and defect size. Thematic analysis regarding emotional impact identified (1) profound psychological impact (especially among consultants) including guilt and self-blame following AL modulated by professional experience; (2) impact on professional confidence including doubt in surgical judgement and changed decision-making following a case of AL and (3) reliance on peers and mentors for emotional support and recognition of the multifactorial nature of AL as a coping mechanism.

Conclusion

There is notable variability in surgeons' approach to AL following rectal cancer resection with a general instinctive emotional response of ‘disappointment’ both for the patient and in themselves when AL occurs.

目的：直肠癌术后吻合口瘘是一种严重的并发症。本研究描述了爱尔兰结直肠外科医生对AL的预防、诊断和管理的方法以及他们对其发生的情绪反应。方法：采用半结构化访谈对爱尔兰直肠癌中心的高级结直肠实习生、研究员和顾问进行定性研究。描述性统计总结了临床方法，专题分析（使用NVivo软件）探讨了情绪反应。结果：来自6个爱尔兰直肠癌中心的15名结直肠外科医生（13名男性）参与了研究。吻合口高度、张力和灌注被认为是AL最重要的危险因素。所有外科医生都对患者进行常规肠准备，但方案差异很大。只有33.3%的外科医生例行放置术中引流管。100%进行常规空气泄漏测试，40.0%常规使用ICG灌注测试。对于AL的治疗，只有6.7%的患者采用固定的治疗方案，大多数患者根据临床状况、造口功能缺失和缺损大小进行个性化治疗。情绪影响的专题分析发现：(1)人工智能对心理的深刻影响（尤其是在咨询师中），包括由专业经验调节的内疚和自责；(2)对职业信心的影响，包括对手术判断的怀疑和决策的改变；(3)对同伴和导师的情感支持的依赖，以及对AL作为应对机制的多因素性质的认识。结论：在直肠癌切除术后，外科医生对AL的处理方式存在显著的差异，当AL发生时，对患者和他们自己的一般本能情绪反应都是“失望”。

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引用次数: 0

Laparoscopic colorectal bypass for colorectal anastomosis stricture—A video vignette 腹腔镜结直肠搭桥术治疗结直肠吻合口狭窄

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-12-17 DOI: 10.1111/codi.70351

Mariana Marques, Pedro Martins, Luís Lencastre, Flávio Videira, Joaquim Abreu de Sousa

引用次数: 0

Long-term pain impact after rectal cancer surgery: Trajectories and predictors of patient request for contact from a cohort study 直肠癌手术后的长期疼痛影响：一项队列研究中患者要求接触的轨迹和预测因素。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-12-17 DOI: 10.1111/codi.70342

Louise Kuhlmann, Therese Juul, Katrine Jøssing Emmertsen, Peter Christensen, Nina Abild Frederiksen, Marianne Krogsgaard, Michael Bødker Lauritzen, Asbjørn Mohr Drewes

Aim

Rectal cancer (RC) accounts for one third of colorectal cancers worldwide, with survival rates improving due to advances in screening and treatment. However, chronic pain affects approximately 30% of RC survivors, impacting quality of life, physical function and mental health. This study aimed to evaluate chronic pain prevalence, identify risk factors and explore predictors of requesting contact concerning pain management following RC surgery.

Method

A prospective cohort study was conducted on RC patients undergoing surgery at three Danish hospitals. Patients completed the Rectal Cancer Pain Score at 3, 12, 24 and 36 months after surgery and indicated if they wished to be contacted to discuss treatment options. Pain trajectories were depicted in a Sankey diagram. A mixed-effects model examined factors influencing changes in pain scores over time.

Results

Among 729 patients, 32% reported pain at 3 months, decreasing to 25% at 36 months. Some patients improved, while others developed increasing symptoms. Seventeen per cent of patients requested contact due to pain. Only 13% of these were referred for further pain treatment, while 58% were referred for the management of other late sequelae to the RC treatment. Female gender (p = 0.001), younger age (p ≤ 0.001), obesity (p ≤ 0.003) and radiotherapy (p ≤ 0.001) were associated with higher pain scores.

Conclusion

Chronic pain in RC survivors is dynamic and influenced by identifiable risk factors over time. The findings underscore the need for proactive, tailored pain management strategies.

目的：直肠癌（RC）占全球结直肠癌的三分之一，由于筛查和治疗的进步，生存率提高。然而，慢性疼痛影响了大约30%的RC幸存者，影响了生活质量、身体功能和心理健康。本研究旨在评估慢性疼痛的患病率，确定危险因素，并探讨预测因素，要求联系有关疼痛管理RC手术。方法：对在丹麦三家医院接受手术的RC患者进行前瞻性队列研究。患者在手术后3、12、24和36个月完成直肠癌疼痛评分，并表明是否希望联系他们讨论治疗方案。疼痛轨迹用桑基图描述。一个混合效应模型检查了影响疼痛评分随时间变化的因素。结果：729例患者中，32%在3个月时报告疼痛，36个月时下降到25%。一些患者病情有所好转，而另一些患者症状加重。17%的患者因疼痛要求接触。其中只有13%的患者接受了进一步的疼痛治疗，而58%的患者接受了RC治疗的其他晚期后遗症的治疗。女性（p = 0.001）、年轻（p≤0.001）、肥胖（p≤0.003）和放疗（p≤0.001）与较高的疼痛评分相关。结论：RC幸存者的慢性疼痛是动态的，并受可识别的危险因素的影响。研究结果强调了积极主动、量身定制的疼痛管理策略的必要性。

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引用次数: 0

Laser speckle contrast imaging for real-time assessment of colonic perfusion to prevent anastomotic leakage after anterior rectal resection: A single-centre prospective pilot study 激光散斑造影实时评估直肠前切除术后结肠灌注预防吻合口漏：一项单中心前瞻性先导研究。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-12-17 DOI: 10.1111/codi.70340

Jiazi Yu, Wei Cui, Meiling Du, Tao Zhou, Mian Yang, Yupeng Zheng, Hongyi Yi, Jinling Lu, Pengcheng Li, Suzhan Zhang

Aim

Anastomotic leakage (AL) is a devastating complication following anterior rectal resection. This study aimed to evaluate whether a strategy utilizing real-time Laser Speckle Contrast Imaging (LSCI) for intraoperative perfusion assessment could reduce the incidence of AL.

Methods

We conducted a single-centre study comparing a prospective cohort undergoing LSCI-guided surgery (LSCI group) with a historical cohort (retrospective group). Propensity score matching (PSM) was used to balance baseline characteristics. The LSCI system was used to objectively assess bowel perfusion and guide the selection of the proximal transection site. The primary outcome was the rate of anastomotic leakage.

Results

After PSM, 105 patients in the LSCI group were matched with 176 patients in the control group, with all baseline characteristics being comparable. The incidence of AL was significantly lower in the LSCI group compared to the control group (1.9% vs. 8.5%, p < 0.05). Furthermore, the rate of severe postoperative infective complications requiring major intervention (percutaneous drainage or reoperation) was also significantly reduced in the LSCI group (1.9% vs. 9.6%; p = 0.02). In the LSCI group, real-time perfusion assessment led to an intraoperative change of the planned anastomotic site in 6 patients (5.7%), predominantly in low-to-middle rectal cancer cases.

Conclusion

The use of an LSCI-guided strategy for real-time intraoperative perfusion assessment may reduce the rates of both AL and severe postoperative infective complications undergoing ARR surgery. This objective, quantitative technology is a valuable tool for optimizing surgical decision-making and improving patient outcomes.

目的：吻合口瘘是直肠前切除术后的严重并发症。本研究旨在评估利用实时激光散斑对比成像（LSCI）进行术中灌注评估的策略是否可以降低al的发生率。方法：我们进行了一项单中心研究，比较了接受LSCI引导手术的前瞻性队列（LSCI组）和历史队列（回顾性组）。倾向评分匹配（PSM）用于平衡基线特征。LSCI系统用于客观评估肠灌注并指导近端横断部位的选择。主要观察结果为吻合口瘘发生率。结果：PSM后，LSCI组105例患者与对照组176例患者匹配，所有基线特征具有可比性。与对照组相比，LSCI组AL的发生率显著降低（1.9% vs. 8.5%）。结论：使用LSCI指导策略进行实时术中灌注评估可以降低ARR手术中AL和术后严重感染并发症的发生率。这一目标，定量技术是优化手术决策和改善患者预后的宝贵工具。

{"title":"Laser speckle contrast imaging for real-time assessment of colonic perfusion to prevent anastomotic leakage after anterior rectal resection: A single-centre prospective pilot study","authors":"Jiazi Yu, Wei Cui, Meiling Du, Tao Zhou, Mian Yang, Yupeng Zheng, Hongyi Yi, Jinling Lu, Pengcheng Li, Suzhan Zhang","doi":"10.1111/codi.70340","DOIUrl":"10.1111/codi.70340","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Anastomotic leakage (AL) is a devastating complication following anterior rectal resection. This study aimed to evaluate whether a strategy utilizing real-time Laser Speckle Contrast Imaging (LSCI) for intraoperative perfusion assessment could reduce the incidence of AL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-centre study comparing a prospective cohort undergoing LSCI-guided surgery (LSCI group) with a historical cohort (retrospective group). Propensity score matching (PSM) was used to balance baseline characteristics. The LSCI system was used to objectively assess bowel perfusion and guide the selection of the proximal transection site. The primary outcome was the rate of anastomotic leakage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After PSM, 105 patients in the LSCI group were matched with 176 patients in the control group, with all baseline characteristics being comparable. The incidence of AL was significantly lower in the LSCI group compared to the control group (1.9% vs. 8.5%, <i>p</i> < 0.05). Furthermore, the rate of severe postoperative infective complications requiring major intervention (percutaneous drainage or reoperation) was also significantly reduced in the LSCI group (1.9% vs. 9.6%; <i>p</i> = 0.02). In the LSCI group, real-time perfusion assessment led to an intraoperative change of the planned anastomotic site in 6 patients (5.7%), predominantly in low-to-middle rectal cancer cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The use of an LSCI-guided strategy for real-time intraoperative perfusion assessment may reduce the rates of both AL and severe postoperative infective complications undergoing ARR surgery. This objective, quantitative technology is a valuable tool for optimizing surgical decision-making and improving patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A simultaneous luminal view using a digital rectoscope (LumenEye) for tumour localisation during robotic anterior resection—A video vignette 在机器人前切除术期间，使用数字直肠镜（LumenEye）进行肿瘤定位的同时腔内视图-视频片段。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-12-17 DOI: 10.1111/codi.70347

Shawn P. Fredrick, Janice Miller, Peter G. Vaughan-Shaw, Danielle R. Collins, Nicholas T. Ventham

引用次数: 0

Correction to ‘E-Posters’ 更正“电子海报”

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-12-14 DOI: 10.1111/codi.70349

E-Posters. Colorectal Dis 2025; 27: e70174. https://doi.org/10.1111/codi.70174.

In section P0725, Efferent loop stimulation prior to ileostomy closure: A practical and cost-effective approach in general surgery, the author list was shown as follows:

L. A. Gómez; K. Ponceliz Khristenko; M. de la Antonia Montoro; C. G. Gomez; M. G. J. Antonio; R. A. Moret; I. P. Miguelañez; I. R. Perez

The correct author list should read as follows:

L. Asensio-Gomez; K. Ponceliz Khristenko; M. de la Antonia Montoro; C. Gonzalez Gomez; J. A. Gazo Martinez; R. Abad Moret; I. Pascual Miguelañez; I. Rubio-Perez

We apologize for this error.

E-Posters。结肠直肠癌2025；27: e70174。https://doi.org/10.1111/codi.70174.In章节P0725，回肠造口闭合前的传出回路刺激：一种实用且具有成本效益的普通外科方法，作者名单如下：答:戈麦斯;K. Ponceliz Khristenko；德拉·安东尼娅·蒙托罗先生；c·g·戈麦斯；M. G. J.安东尼奥；r.a.莫雷特；i.p. Miguelañez；正确的作者名单应该如下所示：Asensio-Gomez;K. Ponceliz Khristenko；德拉·安东尼娅·蒙托罗先生；冈萨雷斯·戈麦斯；加索·马丁内斯；R.阿巴德·莫雷；1 . Pascual Miguelañez；我们为这个错误道歉。

引用次数: 0

Laparoscopic splenic flexure resection with en-bloc gastric wedge resection for locally advanced colon cancer with liver metastases: A video vignette 腹腔镜下脾脏屈曲切除联合整体胃楔切除术治疗局部晚期结肠癌伴肝转移：视频片段。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-12-12 DOI: 10.1111/codi.70339

Giuseppe Vita, Pietro Santocchi, Stefano Amore Bonapasta

引用次数: 0

Management of anastomotic leak after elective anterior resection for rectal cancer: A systematic review and pooled analysis 直肠癌择期前切除术后吻合口漏的处理：一项系统回顾和汇总分析。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2025-12-10 DOI: 10.1111/codi.70335

Ruth Walsh, Edward Murphy, Éanna J. Ryan, Ronan A. Cahill

Background

Anastomotic leak (AL) following rectal cancer resection significantly increases the clinical care, risks morbidity and mortality and impairs oncological outcomes. AL management is not standardised. This systematic review and pooled analysis evaluated the comparative efficacy of the various reported strategies.

Method

After protocol generation with AMSTAR2, a systematic search was conducted in EMBASE, PubMed and SCOPUS. Primary and secondary outcome measures were pooled using the DerSimonian–Laird method with 95% confidence intervals, I² statistics for heterogeneity and Egger and Begg's testing for bias, defining success as resolution of pelvic sepsis and/or healing of AL.

Results

Sixteen studies published between 2010 and 2024 comprising 7236 patients, 850 with AL, met eligibility criteria albeit with significant heterogeneity (I² > 50%), reporting variability and moderate bias. Overall, success rates with conservative management (CM) was 44.4%, drainage procedures (DP) 73.7% (78.7% for passive drainage and 73.5% for active drainage), anastomosis conserving surgery (ACS) 69.7% and anastomotic takedown (SAT) 77.0%. Short-term mortality was CM: 0%, DP: 0.97%, ACS: 2.92% and SAT: 1.49%. Mean length of stay was CM: 28.7 days, DP: 59.9 days, ACS: 19.8 days and SAT: 14.7 days. Further intervention occurred in CM: 55.6%, DP: 29.1%, ACS: 53.3% and SAT: 41.1%. Long-term stoma rates were CM: 33.3%, DP: 22.5%, ACS: 27.6% and SAT: 46.0%.

Conclusion

Drainage techniques demonstrate high success with low mortality and further intervention rate albeit with lengthened hospital stay. Surgical approaches also achieve success although mortality and long-term stoma rates are higher. Future studies need a core outcome set.

背景：直肠癌切除术后吻合口漏（AL）显著增加了临床护理，增加了发病率和死亡率的风险，并损害了肿瘤预后。人工智能管理不规范。本系统综述和汇总分析评估了各种报道策略的比较疗效。方法：用AMSTAR2生成协议后，在EMBASE、PubMed、SCOPUS中进行系统检索。主要和次要结局指标采用DerSimonian-Laird方法，95%置信区间，I2统计异质性，Egger和Begg偏倚检验，将成功定义为盆腔败血症的解决和/或AL的愈合。结果：2010年至2024年间发表的16项研究，包括7236例患者，850例AL，符合资格标准，尽管存在显著异质性（I2 bb0 50%），报告变异性和中度偏倚。总体而言，保守治疗（CM）的成功率为44.4%，引流手术（DP）的成功率为73.7%（被动引流78.7%，主动引流73.5%），吻合口保留手术（ACS）的成功率为69.7%，吻合口取下（SAT）的成功率为77.0%。短期死亡率CM: 0%， DP: 0.97%, ACS: 2.92%, SAT: 1.49%。平均住院时间CM: 28.7天，DP: 59.9天，ACS: 19.8天，SAT: 14.7天。CM: 55.6%, DP: 29.1%, ACS: 53.3%, SAT: 41.1%。长期造口率CM: 33.3%, DP: 22.5%, ACS: 27.6%, SAT: 46.0%。结论：引流术成功率高，死亡率低，进一步干预率低，但延长了住院时间。手术方法虽然死亡率和长期造口率较高，但也能取得成功。未来的研究需要一个核心结果集。

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