Reza L, Bapir L, Iqbal N, Sackitey C, Hughes S, Babbar M, et al. PAVFCOS: the development of a core outcome set for pouch anal and vaginal fistula. Colorectal Dis. 2025;27(8):e70184. https://doi.org/10.1111/codi.70184
In the Appendix section, listing all the ‘Collaborators’, Tricia Levasseur's name has now been added, as it was omitted from the original article.
We apologize for this error.
Perianal fistula (PAF) is a common condition encountered in surgical and gastroenterological practice. Distinguishing between cryptoglandular disease (CGD) and inflammatory bowel disease (IBD)-related perianal disease is critical to ensure appropriate management. Faecal calprotectin (FC) has emerged as a promising non-invasive biomarker for IBD; however, its role in acute perianal disease is not well established. This systematic review aimed to evaluate the diagnostic accuracy of FC in distinguishing IBD-related perianal disease from CGD.
A systematic literature search was conducted in PubMed, Embase and Cochrane databases following PRISMA guidelines. Studies were included if they assessed FC levels in patients with PAF and provided diagnostic accuracy metrics. Data extraction focused on study design, population characteristics, FC cut-off values, sensitivity, specificity and area under the curve (AUC) metrics.
Three studies met the inclusion criteria, all reporting significantly higher FC levels in IBD-related PAF compared to CGD-related fistulas. The proposed FC cut-off values varied, ranging from 110 μg/g to 344 μg/g, with corresponding sensitivities between 52% and 81%, as well as specificities between 77% and 93%. The AUC values indicated moderate to high diagnostic accuracy.
FC shows potential as a diagnostic tool for differentiating IBD-related perianal disease from CGD. A cut-off of 110–150 μg/g appears most suitable for early screening, whereas a higher threshold may be appropriate for confirmatory diagnosis. Further prospective studies with standardized protocols are necessary to refine these thresholds and validate FC as a clinical decision-making tool.
Lymph node yield (LNY) is a recognised prognostic factor in patients with colon cancer. Recent studies suggest LNY may reflect anti-tumour immune responses rather than surgical quality. Given the recognised difference in anti-tumour immunity according to mismatch repair (MMR) status, this study investigated whether LNY and its association with prognosis differed between colon cancers with deficient MMR (dMMR) and proficient MMR (pMMR).
A national retrospective cohort study using the Danish Colorectal Cancer Group (DCCG) database. Patients diagnosed with new Stage I–III colon cancers undergoing potentially curative left or right hemicolectomies between 2016 and 2022 were included. The primary outcome was LNY according to MMR status.
In total of 9705 patients were included, of whom 7175 had pMMR cancers (74%). Median LNY for the whole cohort was 27. LNY <12 was seen in 178 patients (2%). dMMR cancers had higher median LNY (28 vs. 26 nodes, p < 0.001), and more patients with LNY ≥22 (73% vs. 66%, p < 0.001). No difference in the number of lymph node metastases was seen between groups. LNY <12 was associated with poorer overall survival (OS) regardless of MMR status and was independently associated with all-cause mortality. However, this effect was more marked in patients with dMMR than pMMR cancers {hazard ratio (HR) 4.23 (95% confidence interval [CI] 2.42–7.41) vs. 1.94 (1.21–3.13)}.
LNY was significantly higher in dMMR cancers, where low LNY also has a stronger association with prognosis. These findings support the theory that LNY reflects anti-tumour immunity rather than surgical quality.
High-grade squamous intraepithelial lesions (HSILs) of the anus are at risk of progression to anal squamous cell carcinoma (ASCC). However, most HSILs spontaneously regress, while treatment efficacy is debated and associated with side effects. No clear clinical predictors for anal HSIL regression have been validated to date. We aimed to identify molecular biomarkers that predict the regression of anal HSIL.
In this retrospective translational study, 79 patients who were diagnosed with anal HSIL from a prospective clinical cohort in a tertiary unit of proctology were included. We performed RNA-Seq for 63 samples and whole-exome analysis for 52 samples. HSILs were divided into two groups according to their evolution: regressors or non-regressors. We used samples for training and others for validation, in accordance with the methods of the laboratory for RNA extraction. Cox proportional hazard models were fitted to identify the main prognostic factors associated with disease evolution.
In the univariate analysis, the absence of tobacco consumption and the absence of HSIL treatment were associated with regression. The quality and quantity of the libraries were correct enough for analysis for 57.7% of the samples (30/52). A total of 162 genes were differentially expressed between the regressor and stable groups in both cohorts of training and validation. However, after adjustment for clinical factors and correction of the p-value for multiple testing, no molecular biomarker was strongly associated with disease evolution.
No robust candidate genes predictive of HSIL regression were identified in this study.
To describe a sequential minimally invasive strategy for concurrent excision of dual pararectal and perianal cystic lesions.
We report a case of concurrent pararectal and perianal cystic lesions excised during a single operation sequentially with two different approaches. A robotic transabdominal approach was used for the deep pararectal cyst, followed by a direct perianal approach for the superficial perianal cyst. The operative details and postoperative immediate outcomes were reported.
The robotic approach provided excellent visualization and precise dissection in the deep pelvic space, while the perianal approach allowed direct access for the superficial perianal cyst. Both lesions were completely excised with uneventful postoperative recovery. Histopathology confirmed benign lesions.
Sequential use of robotic and perianal approaches enables safe and complete excision of two anatomically distinct pelvic and perianal cysts in a single operation. This case underscores the importance of anatomy-based, tailored surgical planning and highlights the educational value of combining techniques for dual lesions.
Excisional haemorrhoidectomy is often associated with intense post-operative pain and delayed recovery. Bacterial colonization may contribute to this discomfort, and metronidazole has been proposed as an analgesic adjunct. This study compared the analgesic efficacy of topical metronidazole with oral metronidazole.
A systematic search was conducted in PubMed, Scopus, and the Cochrane Central Register through May 2025. Randomized controlled trials comparing topical metronidazole with oral metronidazole for post-operative pain after haemorrhoidectomy were included. Visual analogue scale (VAS) scores on post-operative days 1, 3, and 7 were pooled. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I2 statistic. Risk of bias (RoB 2) and certainty of evidence (GRADE) were evaluated.
Four RCTs involving 439 patients (218 topical, 221 oral) met inclusion criteria. No significant differences were found between topical and oral metronidazole at day 1 (MD –0.1; 95% CI –0.3 to 0.2; I2 = 25%), day 3 (MD –0.4; 95% CI –1.3 to 0.6; I2 = 94%), or day 7 (MD –0.2; 95% CI –1.0 to 0.5; I2 = 90%).
Topical and oral metronidazole showed similar short-term analgesic efficacy after haemorrhoidectomy.
Signet ring colorectal cancer (SRC) is a rare histological subtype associated with young patients and worse outcomes. Its incidence is anticipated to increase with the rising rate of early-onset colorectal cancer. There is little literature on the benefit of adjuvant systemic therapy in this patient cohort.
A systematic review of the literature was undertaken to evaluate the response of SRC to adjuvant systemic therapy. The study was pre-registered in the PROSPERO database. The MEDLINE/PubMed, EMBASE, Scopus, Web of Science and CENTRAL databases were searched for pertinent articles. Articles published from inception to June 2025 were retrieved and assessed by two independent reviewers.
Of the initial 31 studies retrieved, four were deemed eligible for inclusion, with a total number of 6900 patients. All were population-based retrospective cohort studies. All studies demonstrated a statistically significant survival benefit for adjuvant therapy in non-metastatic SRC.
Adjuvant systemic therapy has a beneficial impact on survival in Stage III SRC, and should be utilised in patients with adequate performance status. The benefit in Stage II remains unclear.
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