Diseases of the Colon & Rectum最新文献

Background: Further development of sphincter-preserving techniques in the treatment of complex anal fistula disease is needed.

Objective: To study anal fistula closure achieved exclusively with autologous platelet-rich plasma in a large cohort.

Design: Retrospective cohort study.

Settings: Referral center for anal fistula disease, Sweden.

Patients: Cohort of 90 consecutive patients with complex anal fistulas at a referral center between October 2021 and June 2025. Patient age was from 14 to 72 years. No patient group or fistula-type was excluded. Intervention treatment sequence: (a) Clinical fistula and incontinence evaluation including endoanal 3D-ultrasound at surgical outpatient clinic; (b) outpatient surgery fistula examination under anesthesia including endoanal 3D-ultrasound and seton placement; (c) Outpatient surgery fistula occlusion with autologous platelet-rich plasma after three months; (d) follow-up at surgical outpatient clinic with clinical examination, endoanal 3D-ultrasound and incontinence evaluation. Endoanal 3D-ultrasound has completely replaced MRI in this setting.

Main outcome measures: Primary outcome was closure rate, assessed both clinically and with endoanal 3D-ultrasound. Secondary outcomes were complication rate, anal continence and whether or not patient age has effect on the healing rate.

Results: Fistula healing was achieved in 57 patients (63%) after a single closure-operation. Ten patients (11%) healed after a second closure-operation and a further six patients (7%) after a third procedure. We saw no complications or postoperative anal incontinence. Statistical analysis showed that age is a weak predictor of healing outcome in this dataset lacking significance.

Limitations: Retrospective study; no control group. All patient contacts and operations carried out by a single surgeon.

Conclusions: The technique is relatively easy to learn, safe and effective. Because of its very low destructiveness it can easily be repeated until fistula closure is achieved. Sixty-three percent of patients had successful fistula closure after one operation. Eighty-one percent after one or two additional operations. These are very promising results in a difficult-to-treat patient group. See Video Abstract.

Background: Stoma-free survival represents a key quality-of-life outcome following surgery for locally advanced rectal cancer. Despite advances in neoadjuvant and surgical management, up to 30% of patients ultimately require a permanent fecal diversion.

Objective: To evaluate stoma-free survival and identify factors associated with permanent stoma formation in patients with locally advanced rectal cancer undergoing coloanal anastomosis.

Design: Retrospective cohort study.

Settings: Single tertiary referral center, 2017-2021.

Patients: A total of 126 patients with clinical stage II-III rectal adenocarcinoma who received neoadjuvant therapy and underwent curative-intent resection with coloanal anastomosis were included.

Intervention: Curative-intent resection with coloanal anastomosis.

Main outcome measures: The primary outcome was stoma-free survival. Secondary analyses examined factors associated with permanent fecal diversion.

Results: One hundred twenty-six patients were analyzed, comprising 62.5% males, with a mean age of 54 ± 10 years and a median body mass index of 27.7 kg/m 2 (interquartile range: 24.5-31.4 kg/m 2). At a median follow-up of 53.0 months, the 5-year stoma-free survival rate was 88.9%. Univariate Cox-regression analysis showed that body mass index ≥ 35 kg/m 2 (Hazard Ratio=3.80, 95% confidence interval:1.04-13.91, p = 0.044) and handsewn coloanal anastomosis with mucosectomy compared to stapled coloanal anastomosis without mucosectomy (Hazard Ratio=5.58, 95% confidence interval:1.71-18.14, p = 0.004), as well as local recurrence (Hazard Ratio=6.51, 95% confidence interval:1.44-29.46) were associated with worse stoma-free survival. The 30-day major morbidity rate was 7.9% following the index surgery. Sixteen patients required permanent fecal diversion due to bowel dysfunction (n = 11), disease recurrence (n = 4), bowel obstruction (n = 1).

Limitations: Retrospective, single-institution design with limited generalizability.

Conclusion: Coloanal anastomosis in the total neoadjuvant therapy era resulted in favorable 5-year stoma-free survival. Body mass index ≥ 35 kg/m2 handsewn coloanal anastomosis with mucosectomy, and local recurrence were associated with worse stoma-free survival. See Video Abstract.