Colorectal Disease最新文献

英文中文

Look east for perianal fistula surgery

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2024-12-29 DOI: 10.1111/codi.17282

Yasuko Maeda

引用次数: 0

Robotic sigmoid colectomy and anterior resection with the novel procedure, the RoboLap cooperative technique—a video vignette

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2024-12-29 DOI: 10.1111/codi.17275

Takehito Yamamoto, Meiki Fukuda, Yoshiki Oshimo, Yoshihisa Okuchi, Kojiro Taura, Hiroaki Terajima

引用次数: 0

Risk stratification scores for lymph node metastases in T1 colorectal cancer—A systematic review T1 结直肠癌淋巴结转移风险分层评分--系统综述

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2024-12-29 DOI: 10.1111/codi.17265

Rakesh Quinn, Giuleta Jamsari, Ewan MacDermid

Aim

Local resection, by an endoscopic or surgical approach, has the potential to completely treat T1 colorectal cancers (CRCs). However, T1 CRCs have a 10% risk of lymph node metastasis (LNM), requiring colonic resection and lymph node dissection. Several high-risk clinico-histopathological features are associated with LNMs and multiple risk stratification scores have been developed. In this systematic review, we aimed to analyse these scores to identify which is most accurate and clinically useful.

Method

A search of MEDLINE, Cochrane Database of Systematic Review and EMBASE for T1 CRC risk assessment scores was performed following PRISMA guidelines.

Results

Of 323 studies, 22 full texts and three abstracts met the inclusion criteria. Twelve studies developed clinicopathological scores presented as nomograms or algorithms. They used an average of 4.8 (SD ±1.72) parameters, the most utilized being tumour grade, lymphovascular invasion and tumour budding. Two studies incorporated preoperative CT results in their risk score. Artificial intelligence (AI) machine learning models were used for 10 studies, with pathologist-dependent parameters and pathologist-independent whole-slide imaging. The area under the curve (AUC) of the scores ranged from 0.57 to 0.99. Only two scores were externally validated, including a nomogram with an AUC of 0.77 and an AI model with an AUC of 0.83. The generalizability of several scores is limited by using special histopathology tests and AI programming/equipment.

Conclusion

There are several promising risk stratification scores for predicting LNM, particularly with the advent of AI. However, no score adequately stratifies the independent risks of rectal and colonic malignant polyps. Further studies are required to address the heterogeneity and lack of external validation within these nonrandomized trials to provide a more accurate risk stratification of LNMs.

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引用次数: 0

Reported outcomes following cytoreductive surgery for colorectal peritoneal metastases: A systematic review to inform evidence-based practice and international consensus 结直肠腹膜转移的细胞减少手术后的报道结果：一项系统综述，以证据为基础的实践和国际共识。

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2024-12-29 DOI: 10.1111/codi.17280

Pratik Raichurkar, Kilian Brown, Cherry Koh, Annie Dela Cruz, Darshan Sitharthan, Brendan Moran, Nabila Ansari, Nima Ahmadi, Michael Solomon, Daniel Steffens

Aim

Cytoreductive surgery provides a chance for long-term survival and cure in selected patients with colorectal peritoneal metastases. As clinical and academic interest in this field increases, heterogeneity in outcome reporting hinders the valid and meaningful synthesis of data into high-quality meta-analyses. The aim of this systemic review was to investigate variability in outcome reporting following cytoreductive surgery with or without intraperitoneal chemotherapy for colorectal peritoneal metastases.

Method

Five electronic databases [MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINAHL)] were interrogated from 2000 to October 2023 to identify all reported outcomes in the current literature. Extracted outcomes were catalogued and reviewed by a multidisciplinary working group into standardized terms and domains.

Results

A total of 294 studies, from 5112 screened, were included for analysis. We extracted 2903 outcomes verbatim from included studies and catalogued them into 85 standardized outcomes across seven outcome domains. The most frequently reported domains were survival, in 274 (93%) studies, and pathological outcomes, in 232 (79%) studies. Outcomes pertaining to function and life impact were only reported in seven (2%) studies. Reported outcomes were only defined in 35% of cases, and significant variability existed between definitions.

Conclusion

This systematic review highlights the heterogeneity of outcome measurement and reporting following cytoreductive surgery for colorectal peritoneal metastases. Patient-reported outcomes are relatively underrepresented in the current literature. The results of this review will inform an international collaborative effort to create a core outcome set to address these issues.

目的：细胞减少手术为结直肠腹膜转移患者提供了长期生存和治愈的机会。随着临床和学术对该领域兴趣的增加，结果报告的异质性阻碍了有效和有意义的数据合成到高质量的荟萃分析中。本系统综述的目的是调查结肠直肠腹膜转移患者在接受或不接受腹腔化疗的细胞减少手术后结果报告的可变性。方法：检索2000年至2023年10月期间的5个电子数据库[MEDLINE、Embase、Scopus、Cochrane中央对照试验注册库（Central）和护理与相关健康文献累积索引（CINAHL）]，以确定当前文献中报道的所有结局。提取的结果由一个多学科工作组编目和审查到标准化的术语和领域。结果：从筛选的5112项研究中，共有294项研究被纳入分析。我们从纳入的研究中逐字提取了2903个结果，并将其分为7个结果域的85个标准化结果。最常报道的领域是生存（274项（93%）研究）和病理结果（232项（79%）研究）。与功能和生命影响相关的结果仅在7项（2%）研究中报告。报告的结果仅在35%的病例中有定义，并且定义之间存在显著差异。结论：本系统综述强调了结肠直肠腹膜转移的细胞减少手术后结果测量和报告的异质性。在目前的文献中，患者报告的结果相对较少。这次审查的结果将为国际合作努力提供信息，以创建解决这些问题的核心成果集。

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引用次数: 0

Endoscopic submucosal dissection versus endoscopic mucosal resection for laterally spreading rectal tumours 内镜下粘膜夹层与内镜下粘膜切除术治疗直肠肿瘤。

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2024-12-18 DOI: 10.1111/codi.17268

Hadrien Alric, Maximilien Barret, Alix Becar, Enrique Perez Cuadrado Robles, Arthur Belle, Guillaume Perrod, Félix Corre, Stanislas Chaussade, Christophe Cellier, Gabriel Rahmi

Aim

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the two main techniques used for endoscopic resection of superficial rectal tumours. The aim of this study was to compare the outcomes of ESD and EMR in treating superficial rectal tumours.

Method

A retrospective observational study was conducted at two French centres including all patients treated with ESD or EMR for superficial rectal tumours. The primary outcome was the rate of local recurrence at the first follow-up endoscopy after endoscopic resection. Secondary outcomes included the curative resection rate, procedure duration, length of hospital stay, complication rates and the need for additional surgery.

Results

A total of 254 patients were included, 159 treated with ESD and 95 treated with EMR. The local recurrence rate at the first follow-up endoscopy was 8.6% and was significantly lower in the ESD group than in the EMR group (4.3% vs. 16.9%; p = 0.005). The rates of en bloc and histologically complete resections were higher in the ESD group (88.1% vs. 42.7% and 85.5% vs. 38.9%, respectively; p < 0.001), while the curative resection rate was 90.6% in the EMR group and 92.5% in the ESD group (p = 0.59). Mostly due to poor histoprognostical criteria, 6.0% of patients underwent additional surgery (6.3% vs. 5.2% in the ESD vs. EMR group, respectively; p = 0.73).

Conclusion

ESD demonstrated higher rates of en bloc, R0 resection than EMR, translating into significantly lower rates of local recurrence at the first follow-up endoscopy.

目的：内镜下粘膜切除（EMR）和内镜下粘膜剥离（ESD）是内镜下直肠浅表肿瘤切除术的两种主要技术。本研究的目的是比较ESD和EMR治疗直肠浅表肿瘤的结果。方法：回顾性观察研究在两个法国中心进行，包括所有接受ESD或EMR治疗的浅表直肠肿瘤患者。主要结果是内镜切除后第一次随访内镜时的局部复发率。次要结果包括治愈率、手术时间、住院时间、并发症发生率和额外手术的需要。结果：共纳入254例患者，其中ESD治疗159例，EMR治疗95例。第一次内镜随访时局部复发率为8.6%，ESD组明显低于EMR组(4.3% vs. 16.9%；p = 0.005)。整体切除率和组织学完全切除率在ESD组更高（分别为88.1%对42.7%和85.5%对38.9%）；结论：与EMR相比，ESD具有更高的整体R0切除率，这意味着首次随访内镜检查时的局部复发率显著降低。

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引用次数: 0

ChatGPT as a patient education tool in colorectal cancer—An in-depth assessment of efficacy, quality and readability ChatGPT作为结直肠癌患者教育工具的疗效、质量和可读性的深入评估

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2024-12-17 DOI: 10.1111/codi.17267

Adrian H. Y. Siu, Damien P. Gibson, Chris Chiu, Allan Kwok, Matt Irwin, Adam Christie, Cherry E. Koh, Anil Keshava, Mifanwy Reece, Michael Suen, Matthew J. F. X. Rickard

Aim

Artificial intelligence (AI) chatbots such as Chat Generative Pretrained Transformer-4 (ChatGPT-4) have made significant strides in generating human-like responses. Trained on an extensive corpus of medical literature, ChatGPT-4 has the potential to augment patient education materials. These chatbots may be beneficial to populations considering a diagnosis of colorectal cancer (CRC). However, the accuracy and quality of patient education materials are crucial for informed decision-making. Given workforce demands impacting holistic care, AI chatbots can bridge gaps in CRC information, reaching wider demographics and crossing language barriers. However, rigorous evaluation is essential to ensure accuracy, quality and readability. Therefore, this study aims to evaluate the efficacy, quality and readability of answers generated by ChatGPT-4 on CRC, utilizing patient-style question prompts.

Method

To evaluate ChatGPT-4, eight CRC-related questions were derived using peer-reviewed literature and Google Trends. Eight colorectal surgeons evaluated AI responses for accuracy, safety, appropriateness, actionability and effectiveness. Quality was assessed using validated tools: the Patient Education Materials Assessment Tool (PEMAT-AI), modified DISCERN (DISCERN-AI) and Global Quality Score (GQS). A number of readability assessments were measured including Flesch Reading Ease (FRE) and the Gunning Fog Index (GFI).

Results

The responses were generally accurate (median 4.00), safe (4.25), appropriate (4.00), actionable (4.00) and effective (4.00). Quality assessments rated PEMAT-AI as ‘very good’ (71.43), DISCERN-AI as ‘fair’ (12.00) and GQS as ‘high’ (4.00). Readability scores indicated difficulty (FRE 47.00, GFI 12.40), suggesting a higher educational level was required.

Conclusion

This study concludes that ChatGPT-4 is capable of providing safe but nonspecific medical information, suggesting its potential as a patient education aid. However, enhancements in readability through contextual prompting and fine-tuning techniques are required before considering implementation into clinical practice.

目的：人工智能（AI）聊天机器人，如聊天生成预训练变形金刚4 (ChatGPT-4)，在生成类似人类的反应方面取得了重大进展。在广泛的医学文献语料库上训练，ChatGPT-4具有增加患者教育材料的潜力。这些聊天机器人可能对考虑诊断结直肠癌（CRC）的人群有益。然而，患者教育材料的准确性和质量对知情决策至关重要。考虑到影响整体护理的劳动力需求，人工智能聊天机器人可以弥合CRC信息的差距，覆盖更广泛的人口统计数据并跨越语言障碍。然而，严格的评估是必不可少的，以确保准确性，质量和可读性。因此，本研究旨在利用患者式问题提示，评估ChatGPT-4生成的CRC答案的有效性、质量和可读性。方法：利用同行评议文献和谷歌Trends得出8个crc相关问题，对ChatGPT-4进行评估。8位结直肠外科医生对人工智能反应的准确性、安全性、适宜性、可操作性和有效性进行了评估。使用经过验证的工具进行质量评估：患者教育材料评估工具（PEMAT-AI）、改良的DISCERN （DISCERN- ai）和全球质量评分（GQS）。测量了一些可读性评估，包括Flesch Reading Ease （FRE）和Gunning Fog Index （GFI）。结果：反应总体准确（中位数4.00）、安全（中位数4.25）、适宜（中位数4.00）、可操作（中位数4.00）、有效（中位数4.00）。质量评估将PEMAT-AI评为“非常好”（71.43），分辨力- ai为“一般”（12.00），GQS为“高”（4.00）。可读性分数表示难度（FRE 47.00, GFI 12.40），表明需要较高的教育水平。结论：本研究表明，ChatGPT-4能够提供安全但非特异性的医学信息，表明其作为患者教育辅助工具的潜力。然而，在考虑实施到临床实践之前，需要通过上下文提示和微调技术来增强可读性。

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引用次数: 0

Surveillance of low-grade appendiceal mucinous neoplasms for progression to pseudomyxoma peritonei: Results from a structured surveillance programme 低级别阑尾黏液肿瘤进展为腹膜假性黏液瘤的监测：结构化监测方案的结果。

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2024-12-17 DOI: 10.1111/codi.17266

Enda Hannan, Lorena Martin Roman, Lukas O'Brien, Anna Mueller, Oonagh Staunton, Conor Shields, John Aird, Jurgen Mulsow

Aim

Low-grade appendiceal mucinous neoplasm (LAMN) of the appendix is a rare tumour that can progress to pseudomyxoma peritonei (PMP). There is a lack of standardization of surveillance following resection of LAMN as the progression rate to PMP is unclear. The aim of this study was to evaluate the rate of progression following resection of LAMN to PMP in a structured surveillance programme.

Method

Data for all patients referred for LAMN surveillance from 2013 to 2021 were retrospectively collected. The surveillance regime consisted of annual CT and tumour markers for a 5-year period. Patients who progressed to PMP were identified.

Results

Of the patients enrolled in surveillance following appendicectomy and LAMN diagnosis (65.1% female, median age 56 years), 83 had completed at least 1 year of surveillance (median follow-up 24 months). Of these, 6% (n = 5) showed disease progression during follow-up. The median time to progression was 23 months. Survival analysis revealed no statistically significant difference in progression with regards to T staging (p = 0.39), margin positivity (p = 0.11) or appendiceal perforation (p = 0.26). No patients with Tis disease developed PMP. A statistically significant difference in progression was seen in patients with M1b staging (p = 0.021) and in those with mucin beyond the right iliac fossa at diagnosis (p = 0.04).

Conclusion

The observed progression rate justifies the necessity of postappendicectomy surveillance in patients with LAMN, with the risk of progression being highest within the first 3 years of diagnosis. The described surveillance programme allows for early detection of subclinical progression to PMP.

目的：阑尾低级别黏液瘤是一种罕见的肿瘤，可发展为腹膜假性黏液瘤（PMP）。LAMN切除后的监测缺乏标准化，因为进展到PMP的速度尚不清楚。本研究的目的是在一个结构化的监测方案中评估LAMN切除后向PMP的进展率。方法：回顾性收集2013年至2021年所有LAMN监测患者的数据。监测方案包括5年的年度CT检查和肿瘤标志物检查。确定进展为PMP的患者。结果：在阑尾切除术和LAMN诊断后纳入监测的患者中（65.1%为女性，中位年龄56岁），83例完成了至少1年的监测（中位随访24个月）。其中，6% （n = 5）在随访期间出现疾病进展。中位进展时间为23个月。生存分析显示，在T分期（p = 0.39）、切缘阳性（p = 0.11）或阑尾穿孔（p = 0.26）方面，进展无统计学差异。无Tis患者发生PMP。M1b分期患者（p = 0.021）和诊断时粘液蛋白超过右髂窝的患者（p = 0.04）的进展差异有统计学意义。结论：观察到的进展率证明了LAMN患者阑尾切除术后监测的必要性，诊断后3年内进展风险最高。所描述的监测方案允许早期发现亚临床进展到PMP。

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引用次数: 0

Faecal immunochemical tests for patients with symptoms suggestive of colorectal cancer: An updated systematic review and multiple-threshold meta-analysis of diagnostic test accuracy studies 粪便免疫化学测试对提示结直肠癌症状的患者：诊断测试准确性研究的最新系统回顾和多阈值荟萃分析

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2024-12-17 DOI: 10.1111/codi.17255

Sue Harnan, Jean Hamilton, Emma Simpson, Mark Clowes, Aline Navega Biz, Sophie Whyte, Shijie Ren, Katy Cooper, Muti Abulafi, Alex Ball, Sally Benton, Richard Booth, Rachel Carten, Stephanie Edgar, Willie Hamilton, Matthew Kurien, Louise Merriman, Kevin Monahan, Laura Heathcote, Hayley E. Jones, Matt Stevenson

Aim

Extending faecal immunochemical tests for haemoglobin (FIT) to all primary care patients with symptoms suggestive of colorectal cancer (CRC) could identify people who are likely to benefit from colonoscopy and facilitate earlier treatment. The aim of this work was to investigate the diagnostic accuracy of FIT across different analysers at different thresholds, as a single test or in duplicate (dual FIT).

Method

This systematic review and meta-analysis searched 10 sources (December 2022). Diagnostic accuracy studies of HM-JACKarc, OC-Sensor, FOB Gold, QuikRead go, NS-Prime and four Immunodiagnostik (IDK) tests in primary care patients were included. Risk of bias was assessed (QUADAS-2). Statistical syntheses produced summary estimates of sensitivity and specificity at any chosen threshold for CRC, inflammatory bowel disease and advanced adenomas separately. Sensitivity analyses investigated reference standard and population type (high, low or all-risk). Subgroup analyses investigated patient characteristics (e.g. anaemia, age, sex, ethnicity).

Results

Thirty-seven studies were included. At a threshold of 10 μg/g, pooled results for sensitivity and specificity (95% credible intervals) for CRC, respectively, were: HM-JACKarc (n = 16 studies) 89.5% (84.6%–93.4%) and 82.8% (75.2%–89.6%); OC-Sensor (n = 11 studies) 89.8% (85.9%–93.3%) and 77.6% (64.3%–88.6%); FOB Gold (n = 3 studies), 87.0% (67.3%–98.3%) and 88.4% (81.7%–94.2%). There were limited or no data on the other tests, dual FIT and relating to patient characteristics.

Conclusion

Test sensitivity at a threshold of 10 μg/g highlights a requirement for adequate safeguards in test-negative patients with ongoing symptoms. Further research is needed into the impact of patient characteristics and dual FIT.

目的：将粪便血红蛋白（FIT）免疫化学试验推广到所有有结直肠癌（CRC）症状的初级保健患者，可以确定可能从结肠镜检查中获益的人群，并促进早期治疗。这项工作的目的是研究在不同阈值下不同分析仪的FIT诊断准确性，作为单一测试或重复（双重FIT）。方法：本系统综述和荟萃分析检索了10个来源（2022年12月）。包括HM-JACKarc、OC-Sensor、FOB Gold、QuikRead go、NS-Prime和四种免疫诊断（IDK）测试在初级保健患者中的诊断准确性研究。评估偏倚风险（QUADAS-2）。统计综合得出了CRC、炎症性肠病和晚期腺瘤在任何选择阈值下的敏感性和特异性的汇总估计。敏感性分析调查了参考标准和人群类型（高、低或全风险）。亚组分析调查了患者的特征（如贫血、年龄、性别、种族）。结果：纳入37项研究。在10 μg/g阈值下，CRC的敏感性和特异性（95%可信区间）的汇总结果分别为：HM-JACKarc （n = 16项研究）89.5%（84.6%-93.4%）和82.8% (75.2%-89.6%)；OC-Sensor (n = 11研究)89.8%(85.9% - -93.3%)和77.6% (64.3% - -88.6%);FOB黄金(n = 3的研究),87.0%(67.3% - -98.3%)和88.4%(81.7% - -94.2%)。其他测试、双重FIT和与患者特征相关的数据有限或没有。结论：检测灵敏度阈值为10 μg/g时，强调对检测阴性且症状持续的患者需要足够的保障措施。需要进一步研究患者特征和双重FIT的影响。

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引用次数: 0

Editor's Choice December 2024 2024年12月。

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2024-12-16 DOI: 10.1111/codi.17262

Sue Clark

引用次数: 0

Editorial December 2024 社论 2024 年 12 月。

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease

Pub Date : 2024-12-16 DOI: 10.1111/codi.17257

Sue Clark

引用次数: 0

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