Pub Date : 2025-04-01Epub Date: 2025-01-07DOI: 10.1097/DCR.0000000000003636
Mesut Tez
{"title":"Artificial Intelligence in Clinical Decision-Making: Is It Problem Free?","authors":"Mesut Tez","doi":"10.1097/DCR.0000000000003636","DOIUrl":"10.1097/DCR.0000000000003636","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e161"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-01-07DOI: 10.1097/DCR.0000000000003640
Donald B Colvin, Kelly M Tyler
{"title":"Corrigendum.","authors":"Donald B Colvin, Kelly M Tyler","doi":"10.1097/DCR.0000000000003640","DOIUrl":"10.1097/DCR.0000000000003640","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e162"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2024-12-27DOI: 10.1097/DCR.0000000000003613
Jennifer K Vu, Kilian G M Brown, Michael J Solomon, Kheng-Seong Ng, Kate Mahon, Bernard K Le, Sarah Sutherland, Peter J Lee, Christopher M Byrne, Kirk K S Austin, Daniel Steffens
<p><strong>Background: </strong>The treatment of locally recurrent rectal cancer has evolved dramatically in recent decades. As the boundaries of exenterative surgery continue to be pushed, one of the unanswered and controversial questions is the role of radical salvage surgery for locally recurrent rectal cancer in the setting of oligometastatic disease.</p><p><strong>Objective: </strong>To investigate the impact of synchronous or previously treated distant metastases on survival after pelvic exenteration for locally recurrent rectal cancer.</p><p><strong>Design: </strong>Retrospective analysis of a prospectively maintained database.</p><p><strong>Settings: </strong>A high-volume specialist exenteration center.</p><p><strong>Patients: </strong>Consecutive adult patients undergoing pelvic exenteration with curative intent for locally recurrent rectal cancer between 1994 and 2023.</p><p><strong>Main outcome measures: </strong>Overall survival from time of pelvic exenteration.</p><p><strong>Results: </strong>Of the 300 patients included, 193 (64%) were men, and the median age at the time of pelvic exenteration was 62 years (range, 29-86). The median time from primary rectal cancer surgery to pelvic exenteration was 35 months (range, 4-191). In total, 56 patients (19%) had a history of metastatic disease, of whom 42 (14%) had previously treated metastases and 18 patients (6%) had synchronous metastatic disease (including 4 patients with both synchronous and previously treated metastases). Five-year overall survival rate and median overall survival was 41% and 45 months, respectively. There was a trend toward poorer 5-year overall survival in patients with a history of metastatic disease compared to those without (25% vs 45%); however, this did not reach statistical significance ( p = 0.110), possibly due to a lack of statistical power. Five-year overall survival was 27%, 25%, and 45% for patients with synchronous metastases, previously treated metastases, and no history of metastases, respectively ( p = 0.260).</p><p><strong>Limitations: </strong>Findings may not be applicable beyond highly selected patients treated at specialized exenteration centers.</p><p><strong>Conclusions: </strong>Long-term survival is achievable in highly selected patients with locally recurrent rectal cancer and synchronous or previously treated distant metastases. Therefore, oligometastatic disease should not be considered an absolute contraindication to exenterative surgery. See Video Abstract .</p><p><strong>La enfermedad oligometastsica no es una contraindicacin absoluta para la exenteracin plvica en pacientes seleccionados con cncer rectal localmente recurrente: </strong>ANTECEDENTES:El tratamiento del cáncer rectal localmente recurrente ha evolucionado drásticamente en las últimas décadas. A medida que se siguen ampliando los límites de la cirugía exenterativa, una de las preguntas sin respuesta y controvertidas es el papel de la cirugía radical de rescate para el cán
背景：近几十年来，局部复发性直肠癌的治疗发生了巨大的变化。随着切除手术的界限不断被推进，其中一个悬而未决的和有争议的问题是根治性挽救性手术治疗局部复发直肠癌在低转移性疾病中的作用。目的：探讨同步或既往治疗过的远处转移对局部复发直肠癌盆腔切除术后生存率的影响。设计：对前瞻性维护数据库进行回顾性分析。设置：一个高容量的专家切除中心。患者：1994年至2023年间连续接受盆腔切除术治疗局部复发性直肠癌的成年患者。主要观察指标：盆腔切除后的总生存率。结果：纳入的300例患者中，男性193例（64%），中位年龄62岁（29-86岁）。从原发性直肠癌手术到盆腔切除的中位时间为35个月（范围4-191）。总共56例患者（19%）有转移性疾病史；其中42例（14%）曾接受过转移治疗，18例（6%）患有同步转移性疾病（包括4例同时接受过转移治疗和同步转移的患者）。5年和中位总生存期分别为41%和45个月。与无转移病史的患者相比，有转移病史患者的5年总生存率有较差的趋势（25% vs 45%）；然而，这并没有达到统计学意义（p = 0.110），可能是由于缺乏统计能力。同步转移患者、既往治疗过的转移患者和无转移史患者的5年总生存率分别为27%、25%和45% （p = 0.260）。局限性：研究结果可能不适用于在专业拔牙中心治疗的高度选定的患者。结论：高度选择性的局部复发直肠癌和同步或既往治疗过的远处转移患者可以实现长期生存。因此，少转移性疾病不应被视为绝对禁忌症。参见视频摘要。
{"title":"Oligometastatic Disease Is Not an Absolute Contraindication to Pelvic Exenteration in Selected Patients With Locally Recurrent Rectal Cancer.","authors":"Jennifer K Vu, Kilian G M Brown, Michael J Solomon, Kheng-Seong Ng, Kate Mahon, Bernard K Le, Sarah Sutherland, Peter J Lee, Christopher M Byrne, Kirk K S Austin, Daniel Steffens","doi":"10.1097/DCR.0000000000003613","DOIUrl":"10.1097/DCR.0000000000003613","url":null,"abstract":"<p><strong>Background: </strong>The treatment of locally recurrent rectal cancer has evolved dramatically in recent decades. As the boundaries of exenterative surgery continue to be pushed, one of the unanswered and controversial questions is the role of radical salvage surgery for locally recurrent rectal cancer in the setting of oligometastatic disease.</p><p><strong>Objective: </strong>To investigate the impact of synchronous or previously treated distant metastases on survival after pelvic exenteration for locally recurrent rectal cancer.</p><p><strong>Design: </strong>Retrospective analysis of a prospectively maintained database.</p><p><strong>Settings: </strong>A high-volume specialist exenteration center.</p><p><strong>Patients: </strong>Consecutive adult patients undergoing pelvic exenteration with curative intent for locally recurrent rectal cancer between 1994 and 2023.</p><p><strong>Main outcome measures: </strong>Overall survival from time of pelvic exenteration.</p><p><strong>Results: </strong>Of the 300 patients included, 193 (64%) were men, and the median age at the time of pelvic exenteration was 62 years (range, 29-86). The median time from primary rectal cancer surgery to pelvic exenteration was 35 months (range, 4-191). In total, 56 patients (19%) had a history of metastatic disease, of whom 42 (14%) had previously treated metastases and 18 patients (6%) had synchronous metastatic disease (including 4 patients with both synchronous and previously treated metastases). Five-year overall survival rate and median overall survival was 41% and 45 months, respectively. There was a trend toward poorer 5-year overall survival in patients with a history of metastatic disease compared to those without (25% vs 45%); however, this did not reach statistical significance ( p = 0.110), possibly due to a lack of statistical power. Five-year overall survival was 27%, 25%, and 45% for patients with synchronous metastases, previously treated metastases, and no history of metastases, respectively ( p = 0.260).</p><p><strong>Limitations: </strong>Findings may not be applicable beyond highly selected patients treated at specialized exenteration centers.</p><p><strong>Conclusions: </strong>Long-term survival is achievable in highly selected patients with locally recurrent rectal cancer and synchronous or previously treated distant metastases. Therefore, oligometastatic disease should not be considered an absolute contraindication to exenterative surgery. See Video Abstract .</p><p><strong>La enfermedad oligometastsica no es una contraindicacin absoluta para la exenteracin plvica en pacientes seleccionados con cncer rectal localmente recurrente: </strong>ANTECEDENTES:El tratamiento del cáncer rectal localmente recurrente ha evolucionado drásticamente en las últimas décadas. A medida que se siguen ampliando los límites de la cirugía exenterativa, una de las preguntas sin respuesta y controvertidas es el papel de la cirugía radical de rescate para el cán","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"408-416"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2024-12-27DOI: 10.1097/DCR.0000000000003625
Irena Gribovskaja-Rupp, Samuel Eisenstein, Carla F Justiniano, Shankar Raman, V Prasad Poola
{"title":"Selected Abstracts.","authors":"Irena Gribovskaja-Rupp, Samuel Eisenstein, Carla F Justiniano, Shankar Raman, V Prasad Poola","doi":"10.1097/DCR.0000000000003625","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003625","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 4","pages":"491-496"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-01-02DOI: 10.1097/DCR.0000000000003617
Naveen Manisundaram, Christopher P Childers, Chung-Yuan Hu, Abhineet Uppal, Tsuyoshi Konishi, Brian K Bednarski, Michael G White, Oliver Peacock, Y Nancy You, George J Chang
<p><strong>Background: </strong>Minimally invasive surgery is associated with improved short-term outcomes and similar long-term oncologic outcomes for patients with colorectal cancer compared with open surgery. Although the robotic approach has ergonomic and technical benefits, how it has impacted the utilization of traditional laparoscopic surgery and minimally invasive surgery overall is unclear.</p><p><strong>Objective: </strong>Describe trends in open, robotic, and laparoscopic approaches for colorectal cancer resections and examine factors associated with minimally invasive surgery.</p><p><strong>Design: </strong>Retrospective cohort study using data from the National Cancer Database from 2010 to 2020.</p><p><strong>Setting: </strong>Commission on Cancer-accredited US facilities.</p><p><strong>Patients: </strong>Patients diagnosed with nonmetastatic colon or rectal adenocarcinoma.</p><p><strong>Main outcome measures: </strong>Surgical approach rates (open, robotic, and laparoscopic).</p><p><strong>Results: </strong>We identified 475,001 patients diagnosed with nonmetastatic colorectal adenocarcinoma, of whom 192,237 (40.5%) underwent open surgery, 64,945 (13.7%) underwent robotic surgery, and 217,819 (45.9%) underwent laparoscopic surgery. For colon cancer, laparoscopic minimally invasive surgery use steadily increased, with a peak prevalence of 54.0% in 2016, and total minimally invasive surgery (robotic + laparoscopic) was performed more often than open surgery from 2013 through 2020. For rectal cancer, laparoscopic minimally invasive surgery had a peak prevalence of 37.2% in 2014 and declined from 2014 through 2020; robotic surgery prevalence increased throughout the study period (5.5% in 2010, 24.7% in 2015, and 48.8% in 2020). Minimally invasive surgery use increased in facilities performing robotic surgery every year during the study period. For both colon and rectal cancer, the use of open surgery decreased across all facilities throughout the study period.</p><p><strong>Limitations: </strong>This study used the National Cancer Database, which may not be generalizable to non-Commission on Cancer institutions.</p><p><strong>Conclusions: </strong>Minimally invasive surgery steadily increased across all facilities from 2010 through 2020. Open resections declined, laparoscopic resections plateaued, and robotic resections increased for colon and rectal cancer. Minimally invasive surgery increases may be driven by increases in robot-assisted surgery. See Video Abstract.</p><p><strong>El aumento de la ciruga mnimamente invasiva para el cncer colorrectal se asocia con la adopcin a la ciruga robtica: </strong>ANTECEDENTES:La cirugía mínimamente invasiva se asocia con mejores resultados a corto plazo y resultados oncológicos similares a largo plazo para pacientes con cáncer colorrectal en comparación con la cirugía abierta. Aunque el abordaje robótico tiene beneficios ergonómicos y técnicos, no está claro cómo ha afectado la utilización de la
{"title":"Rise in Minimally Invasive Surgery for Colorectal Cancer Is Associated With Adoption of Robotic Surgery.","authors":"Naveen Manisundaram, Christopher P Childers, Chung-Yuan Hu, Abhineet Uppal, Tsuyoshi Konishi, Brian K Bednarski, Michael G White, Oliver Peacock, Y Nancy You, George J Chang","doi":"10.1097/DCR.0000000000003617","DOIUrl":"10.1097/DCR.0000000000003617","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery is associated with improved short-term outcomes and similar long-term oncologic outcomes for patients with colorectal cancer compared with open surgery. Although the robotic approach has ergonomic and technical benefits, how it has impacted the utilization of traditional laparoscopic surgery and minimally invasive surgery overall is unclear.</p><p><strong>Objective: </strong>Describe trends in open, robotic, and laparoscopic approaches for colorectal cancer resections and examine factors associated with minimally invasive surgery.</p><p><strong>Design: </strong>Retrospective cohort study using data from the National Cancer Database from 2010 to 2020.</p><p><strong>Setting: </strong>Commission on Cancer-accredited US facilities.</p><p><strong>Patients: </strong>Patients diagnosed with nonmetastatic colon or rectal adenocarcinoma.</p><p><strong>Main outcome measures: </strong>Surgical approach rates (open, robotic, and laparoscopic).</p><p><strong>Results: </strong>We identified 475,001 patients diagnosed with nonmetastatic colorectal adenocarcinoma, of whom 192,237 (40.5%) underwent open surgery, 64,945 (13.7%) underwent robotic surgery, and 217,819 (45.9%) underwent laparoscopic surgery. For colon cancer, laparoscopic minimally invasive surgery use steadily increased, with a peak prevalence of 54.0% in 2016, and total minimally invasive surgery (robotic + laparoscopic) was performed more often than open surgery from 2013 through 2020. For rectal cancer, laparoscopic minimally invasive surgery had a peak prevalence of 37.2% in 2014 and declined from 2014 through 2020; robotic surgery prevalence increased throughout the study period (5.5% in 2010, 24.7% in 2015, and 48.8% in 2020). Minimally invasive surgery use increased in facilities performing robotic surgery every year during the study period. For both colon and rectal cancer, the use of open surgery decreased across all facilities throughout the study period.</p><p><strong>Limitations: </strong>This study used the National Cancer Database, which may not be generalizable to non-Commission on Cancer institutions.</p><p><strong>Conclusions: </strong>Minimally invasive surgery steadily increased across all facilities from 2010 through 2020. Open resections declined, laparoscopic resections plateaued, and robotic resections increased for colon and rectal cancer. Minimally invasive surgery increases may be driven by increases in robot-assisted surgery. See Video Abstract.</p><p><strong>El aumento de la ciruga mnimamente invasiva para el cncer colorrectal se asocia con la adopcin a la ciruga robtica: </strong>ANTECEDENTES:La cirugía mínimamente invasiva se asocia con mejores resultados a corto plazo y resultados oncológicos similares a largo plazo para pacientes con cáncer colorrectal en comparación con la cirugía abierta. Aunque el abordaje robótico tiene beneficios ergonómicos y técnicos, no está claro cómo ha afectado la utilización de la ","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"426-436"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2024-11-13DOI: 10.1097/DCR.0000000000003603
Ahmed Farag, Mohamed Yehia Elbarmalgi
{"title":"TNMF Vs TNM in Staging of Colorectal Cancer.","authors":"Ahmed Farag, Mohamed Yehia Elbarmalgi","doi":"10.1097/DCR.0000000000003603","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003603","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 4","pages":"e157"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2024-12-10DOI: 10.1097/DCR.0000000000003505
Stefan D Holubar
{"title":"3-Dimensional Pouchography: A Video Tutorial.","authors":"Stefan D Holubar","doi":"10.1097/DCR.0000000000003505","DOIUrl":"10.1097/DCR.0000000000003505","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e153-e155"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-01-07DOI: 10.1097/DCR.0000000000003638
Martin Rutegård, Josefin Segelman, Peter Matthiessen, Marie-Louise Lydrup, Jennifer M Park
{"title":"Rectal Cancer Surgery Can Be Tailored to Reduce Morbidity.","authors":"Martin Rutegård, Josefin Segelman, Peter Matthiessen, Marie-Louise Lydrup, Jennifer M Park","doi":"10.1097/DCR.0000000000003638","DOIUrl":"10.1097/DCR.0000000000003638","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e160"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2024-12-23DOI: 10.1097/DCR.0000000000003583
Ariel Nehemiah, Erica N Pettke, Scott Appel, David O Garcia, Jennifer W Bea, Cynthia A Thomson, Virginia Sun, Robert S Krouse
<p><strong>Background: </strong>Low anterior resection syndrome can disrupt health-related quality of life for survivors of rectal cancer.</p><p><strong>Objective: </strong>To assess the feasibility, satisfaction with, and benefit of a pilot telehealth physical activity counseling intervention for survivors of rectal cancer with low anterior resection syndrome.</p><p><strong>Design: </strong>Single-site, single-arm prospective pre-postintervention pilot feasibility study.</p><p><strong>Settings: </strong>This study was conducted at a single academic institution via telehealth.</p><p><strong>Patients: </strong>Patients with stage I to III rectal or rectosigmoid cancer and low anterior resection syndrome who were 3 months to 5 years post-low anterior resection alone or with diverting loop ileostomy and subsequent reversal were included.</p><p><strong>Interventionss: </strong>Twenty-four patients completed 12 weekly one-to-one physical activity counseling sessions with a health coach.</p><p><strong>Main outcome measures: </strong>Feasibility, participant satisfaction, low anterior resection syndrome score, Memorial Sloan Kettering Cancer Center Bowel Function Instrument, International Physical Activity Questionnaire, City of Hope Quality of Life Survey-Colorectal Cancer, and daily step counts.</p><p><strong>Results: </strong>Twenty-seven patients enrolled in the study and 24 (89%) completed the intervention. Every intervention participant attended all telehealth coaching sessions. Through exit interviews, participants expressed satisfaction with the study, said it positively impacted their mental health, and said it helped them cope with their symptoms. At 12 weeks, bowel function improved by 7.27% ( p = 0.002) and 16.5% ( p ≤ 0.0001) as measured by the bowel function instrument and low anterior resection syndrome score, respectively. Quality of life improved by 9.8% at 12 weeks ( p = 0.009), with the social domain having the greatest improvement (22%, p < 0.0001). These improvements persisted at a 12-week follow-up. Daily steps increased by 17.5% during the intervention ( p = 0.035).</p><p><strong>Limitations: </strong>Pre-postintervention study design.</p><p><strong>Conclusions: </strong>Delivering a telehealth counseling intervention is feasible and satisfactory for survivors of rectal cancer with low anterior resection syndrome. This intervention has positive implications for bowel health and health-related quality of life. See Video Abstract .</p><p><strong>Trial registration: </strong>NCT06435975.</p><p><strong>Estudio piloto de viabilidad de la actividad fsica para el tratamiento de la disfuncin intestinal en sobrevivientes de cncer de recto: </strong>ANTECEDENTES:El síndrome de resección anterior baja (LARS, por sus siglas en inglés) puede afectar la calidad de vida relacionada con la salud de los sobrevivientes de cáncer rectal.OBJETIVO:Evaluar la viabilidad, la satisfacción y el beneficio de una intervención piloto de asesoramiento sobre a
{"title":"Pilot Feasibility Study of Physical Activity to Manage Bowel Dysfunction in Survivors of Rectal Cancer.","authors":"Ariel Nehemiah, Erica N Pettke, Scott Appel, David O Garcia, Jennifer W Bea, Cynthia A Thomson, Virginia Sun, Robert S Krouse","doi":"10.1097/DCR.0000000000003583","DOIUrl":"10.1097/DCR.0000000000003583","url":null,"abstract":"<p><strong>Background: </strong>Low anterior resection syndrome can disrupt health-related quality of life for survivors of rectal cancer.</p><p><strong>Objective: </strong>To assess the feasibility, satisfaction with, and benefit of a pilot telehealth physical activity counseling intervention for survivors of rectal cancer with low anterior resection syndrome.</p><p><strong>Design: </strong>Single-site, single-arm prospective pre-postintervention pilot feasibility study.</p><p><strong>Settings: </strong>This study was conducted at a single academic institution via telehealth.</p><p><strong>Patients: </strong>Patients with stage I to III rectal or rectosigmoid cancer and low anterior resection syndrome who were 3 months to 5 years post-low anterior resection alone or with diverting loop ileostomy and subsequent reversal were included.</p><p><strong>Interventionss: </strong>Twenty-four patients completed 12 weekly one-to-one physical activity counseling sessions with a health coach.</p><p><strong>Main outcome measures: </strong>Feasibility, participant satisfaction, low anterior resection syndrome score, Memorial Sloan Kettering Cancer Center Bowel Function Instrument, International Physical Activity Questionnaire, City of Hope Quality of Life Survey-Colorectal Cancer, and daily step counts.</p><p><strong>Results: </strong>Twenty-seven patients enrolled in the study and 24 (89%) completed the intervention. Every intervention participant attended all telehealth coaching sessions. Through exit interviews, participants expressed satisfaction with the study, said it positively impacted their mental health, and said it helped them cope with their symptoms. At 12 weeks, bowel function improved by 7.27% ( p = 0.002) and 16.5% ( p ≤ 0.0001) as measured by the bowel function instrument and low anterior resection syndrome score, respectively. Quality of life improved by 9.8% at 12 weeks ( p = 0.009), with the social domain having the greatest improvement (22%, p < 0.0001). These improvements persisted at a 12-week follow-up. Daily steps increased by 17.5% during the intervention ( p = 0.035).</p><p><strong>Limitations: </strong>Pre-postintervention study design.</p><p><strong>Conclusions: </strong>Delivering a telehealth counseling intervention is feasible and satisfactory for survivors of rectal cancer with low anterior resection syndrome. This intervention has positive implications for bowel health and health-related quality of life. See Video Abstract .</p><p><strong>Trial registration: </strong>NCT06435975.</p><p><strong>Estudio piloto de viabilidad de la actividad fsica para el tratamiento de la disfuncin intestinal en sobrevivientes de cncer de recto: </strong>ANTECEDENTES:El síndrome de resección anterior baja (LARS, por sus siglas en inglés) puede afectar la calidad de vida relacionada con la salud de los sobrevivientes de cáncer rectal.OBJETIVO:Evaluar la viabilidad, la satisfacción y el beneficio de una intervención piloto de asesoramiento sobre a","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"483-490"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-01-02DOI: 10.1097/DCR.0000000000003611
Austin J Hewitt, Matthew J Freeman, Glen E Leverson, Howard H Bailey, Evie H Carchman, Rob Striker, Cristina B Sanger
<p><strong>Background: </strong>Anal squamous intraepithelial lesions are identifiable and treatable precancerous lesions that lack defined risk factors determining screening necessity.</p><p><strong>Objective: </strong>Assess the prevalence and risk factors associated with low- and high-grade anal squamous intraepithelial lesions and anal squamous-cell carcinoma.</p><p><strong>Design: </strong>Retrospective cohort analysis of veterans with HIV between 1999 and 2023.</p><p><strong>Settings: </strong>National multicenter study of the Department of Veterans Affairs.</p><p><strong>Patients: </strong>Veterans with HIV who had >1 year of follow-up and no anal squamous intraepithelial lesions or anal cancer diagnosis before the study period.</p><p><strong>Main outcome measures: </strong>Primary outcomes include the prevalence, disease-free survival rates, and HRs associated with risk factors for developing anal squamous intraepithelial lesions and/or anal cancer.</p><p><strong>Results: </strong>A total of 48,368 patients were analyzed. The mean age of patients at study initiation was 47.8 years, with a mean follow-up of 12.3 years. Seven thousand five hundred seventy-two patients (16%) had at least 1 anal cytopathology or histopathology result. The prevalence of anal disease was recorded for low-grade disease (n = 1513; 3.1%), high-grade disease (n = 1484; 3.1%), and cancer (n = 664; 1.4%). Mean (SD) times to first incident low-grade disease, high-grade disease, and cancer were 8.5 (6.0), 9.1 (6.0), and 9.7 (6.2) years, respectively. Five-year, 10-year, and 20-year disease-free survival rates for the development of low-grade disease, high-grade disease, or cancer were 97.5%, 94.5%, and 88.4%, respectively. Cox regression modeling demonstrated that CD4/CD8 ratios of <0.5 were associated with an increased risk of anal cancer (HR, 3.93; 95% CI, 3.33-4.63; p < 0.001).</p><p><strong>Limitations: </strong>Retrospective study that focused almost exclusively on male US veterans. Results might not apply to non-male, non-US populations.</p><p><strong>Conclusions: </strong>National analysis of more than 48,000 veterans with HIV demonstrates that 16% had anal cytopathology or histopathology results with an anal cancer prevalence of 1.4%. CD4/CD8 ratios of <0.5 correlate strongly with the severity of anal disease and can help identify patients at the highest risk for anal cancer to prioritize screening efforts. See Video Abstract.</p><p><strong>Anlisis nacional de ms de veteranos con vih demuestra que la relacin cd/cd es un marcador de riesgo de lesiones intraepiteliales anales y cncer anal: </strong>ANTECEDENTES:Las lesiones intraepiteliales escamosas anales son lesiones precancerosas identificables y tratables que carecen de factores de riesgo definidos que determinen la necesidad de detección.OBJETIVO:Evaluar la prevalencia y los factores de riesgo asociados con las lesiones intraepiteliales escamosas anales de grado bajo y alto y el carcinoma de células escamos
{"title":"National Analysis of More Than 48,000 Veterans With HIV Demonstrates CD4/CD8 Ratio as a Risk Marker for Anal Intraepithelial Lesions and Anal Cancer.","authors":"Austin J Hewitt, Matthew J Freeman, Glen E Leverson, Howard H Bailey, Evie H Carchman, Rob Striker, Cristina B Sanger","doi":"10.1097/DCR.0000000000003611","DOIUrl":"10.1097/DCR.0000000000003611","url":null,"abstract":"<p><strong>Background: </strong>Anal squamous intraepithelial lesions are identifiable and treatable precancerous lesions that lack defined risk factors determining screening necessity.</p><p><strong>Objective: </strong>Assess the prevalence and risk factors associated with low- and high-grade anal squamous intraepithelial lesions and anal squamous-cell carcinoma.</p><p><strong>Design: </strong>Retrospective cohort analysis of veterans with HIV between 1999 and 2023.</p><p><strong>Settings: </strong>National multicenter study of the Department of Veterans Affairs.</p><p><strong>Patients: </strong>Veterans with HIV who had >1 year of follow-up and no anal squamous intraepithelial lesions or anal cancer diagnosis before the study period.</p><p><strong>Main outcome measures: </strong>Primary outcomes include the prevalence, disease-free survival rates, and HRs associated with risk factors for developing anal squamous intraepithelial lesions and/or anal cancer.</p><p><strong>Results: </strong>A total of 48,368 patients were analyzed. The mean age of patients at study initiation was 47.8 years, with a mean follow-up of 12.3 years. Seven thousand five hundred seventy-two patients (16%) had at least 1 anal cytopathology or histopathology result. The prevalence of anal disease was recorded for low-grade disease (n = 1513; 3.1%), high-grade disease (n = 1484; 3.1%), and cancer (n = 664; 1.4%). Mean (SD) times to first incident low-grade disease, high-grade disease, and cancer were 8.5 (6.0), 9.1 (6.0), and 9.7 (6.2) years, respectively. Five-year, 10-year, and 20-year disease-free survival rates for the development of low-grade disease, high-grade disease, or cancer were 97.5%, 94.5%, and 88.4%, respectively. Cox regression modeling demonstrated that CD4/CD8 ratios of <0.5 were associated with an increased risk of anal cancer (HR, 3.93; 95% CI, 3.33-4.63; p < 0.001).</p><p><strong>Limitations: </strong>Retrospective study that focused almost exclusively on male US veterans. Results might not apply to non-male, non-US populations.</p><p><strong>Conclusions: </strong>National analysis of more than 48,000 veterans with HIV demonstrates that 16% had anal cytopathology or histopathology results with an anal cancer prevalence of 1.4%. CD4/CD8 ratios of <0.5 correlate strongly with the severity of anal disease and can help identify patients at the highest risk for anal cancer to prioritize screening efforts. See Video Abstract.</p><p><strong>Anlisis nacional de ms de veteranos con vih demuestra que la relacin cd/cd es un marcador de riesgo de lesiones intraepiteliales anales y cncer anal: </strong>ANTECEDENTES:Las lesiones intraepiteliales escamosas anales son lesiones precancerosas identificables y tratables que carecen de factores de riesgo definidos que determinen la necesidad de detección.OBJETIVO:Evaluar la prevalencia y los factores de riesgo asociados con las lesiones intraepiteliales escamosas anales de grado bajo y alto y el carcinoma de células escamos","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"399-407"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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