Diseases of the Colon & Rectum最新文献

Background: Low anterior resection syndrome can disrupt health-related quality of life for survivors of rectal cancer.

Objective: 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.

Design: Single site, single arm prospective pre-post pilot feasibility intervention.

Settings: This study was conducted at a single academic institution via telehealth.

Patients: Patients with stage I-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.

Interventionss: Twenty-four patients completed 12 weekly one-on-one physical activity counseling sessions with a health coach.

Main outcome measures: 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, daily step counts.

Results: 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 helped them cope with their symptoms. At 12 weeks, 7.27% (p = 0.002) and 16.5% (p ≤ 0.0001) improvements in bowel function, as measured by the bowel function instrument and low anterior resection syndrome score, respectively were demonstrated. 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 twelve-week follow-up. Daily steps increased by 17.5% during the intervention (p = 0.035).

Limitations: Pre-post study design.

Conclusions: Delivering a telehealth counseling intervention is feasible and satisfactory for survivors of rectal cancer with LARS. This intervention has positive implications for bowel health and health-related quality of life. See Video Abstract.

Clinical trial registration: NCT06435975.

Background: There is dispute regarding the necessity of infrapyloric lymph nodes dissection in right hemicolectomy for hepatic flexure colon cancer.

Objective: To evaluate the risk factors for infrapyloric lymph nodes metastasis and prognostic role of infrapyloric lymph nodes dissection in patients with hepatic flexure colon cancer and identify the population who would benefit from infrapyloric lymph nodes dissection.

Design: Retrospective multi-center propensity score matching study to minimize heterogenity between 2 groups.

Settings: This study was conducted at three medical centers.

Patients: A total of 531 patients who underwent curative resection for hepatic flexure colon cancer were included.

Main outcome and measure: Logistic analysis was used to evaluate risk factors for infrapyloric lymph nodes metastasis and Kaplan-Meier analysis was used to evaluate overall survival.

Results: The metastasis rate of infrapyloric lymph nodes among patients undergoing infrapyloric lymph nodes dissection was 11.8% (26/221). Cox multivariate analysis confirmed that infrapyloric lymph nodes dissection was an independent prognostic factor after propensity score matching (hazard ratio 0.60, 95% CI, 0.38 to 0.84; p = 0.007). A proposed flow chart for infrapyloric lymph nodes dissection based on preoperative factors was created. Based on the proposed flow chart, patients with preoperative serum CEA level ≤5.0 ng/ml, cN+, and tumor size ≥5 cm, and patients with preoperative serum CEA level >5.0 ng/ml were defined as high-priority infrapyloric lymph nodes dissection group. The metastasis rate of infrapyloric lymph nodes in the high-priority group was 16.0% (20/125). In the high-priority group, patients undergoing infrapyloric lymph nodes dissection had better survival outcomes than those not undergoing infrapyloric lymph nodes dissection (p = 0.005).

Limitations: This study is limited by its retrospective nature.

Conclusions: This study suggests that infrapyloric lymph nodes dissection should be performed in specific patients with hepatic flexure colon cancer. See Video Abstract.

Background: Neoadjuvant chemoradiotherapy followed by radical surgery is the common treatment for patients with locally advanced rectal cancer. Presently, for patients with complete clinical response after neoadjuvant chemoradiotherapy, organ preservation ("watch-and-wait" and local excision strategies) has been increasingly favored. However, the optimal treatment for patients with complete clinical response remains still unclear.

Objective: This study aimed to use Bayesian meta-analysis to determine the best treatment for patients with locally advanced rectal cancer with complete clinical response among radical surgery, local excision, and watch and wait strategies.

Data sources: PubMed, Web Of Science, Cochrane Library and Embase(Ovid) were searched until December 31, 2023.

Study selection: Studies that compared two or more treatments for patients with complete clinical response were included.

Intervention: The analysis was completed via Bayesian meta-analysis using random-effects model.

Main outcomes: Surgery-related complications, local recurrence, distant metastasis, 5-year overall and disease-free survival rate.

Result: Eleven articles met inclusion criteria. The groups of watch and wait and local excision exhibited a higher rate of tumor recurrence compared to radical surgery group (OR [95% CI]: watch and wait VS radical surgery: 9.10 [3.30, 32.3], local excision VS radical surgery: 2.93 [1.05, 9.95]). The distant metastasis, overall and disease-free survival rates of 3 treatments were not statistically different. The radical surgery group had the most number of stoma, and had the greatest risk of morbidity than the watch and wait group (OR[95%CI]: watch and wait VS radical surgery: 0.00 [0.00, 0.12]).

Limitations: The study included only 1 randomized controlled trial compared to 10 observational studies, which could affect overall quality. Funnel plots of disease-free survival rates and stoma suggest significant publication bias among studies which compared radical surgery with watch and wait strategy.

Conclusion: The watch and wait strategy could be optimal for patients with locally advanced rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy.