Diseases of the Colon & Rectum最新文献

Background: Pilonidal sinus disease impacts patient's quality of life. In the Netherlands, it is often treated with excision and secondary healing, which is associated with high recurrence rates and poor wound healing. The Bascom cleft lift, an alternative technique, has shown favorable healing times and recurrence rates.

Objective: The present study aims to compare successful wound healing, time to healing, complications, and recurrence rate between excision with secondary wound healing and Bascom cleft lift.

Design: This is a multicenter retrospective study.

Settings: Three institutions in the Rotterdam region of the Netherlands participated in the study.

Patients: Patients who underwent excision with secondary healing or Bascom Cleft Lift between July 2015 and August 2021 were included.

Main outcome measures: Primary endpoints included the rate of successful wound healing and the time to achieve healing. Secondary endpoints included postoperative complications and recurrence rate within twelve months after surgery.

Results: Out of 272 patients, 128 underwent Bascom cleft lift and 144 patients excision and secondary healing. Recurrent PSD (47.7% vs 22.2%) and abscess history (53.1% vs 40.3%) were more common in the Bascom cleft lift group compared to excision with secondary wound healing. The median follow-up period at the outpatient clinic was 43 days. Wound healing was 84.4% after Bascom cleft lift vs. 32.6% after excision and secondary healing (p < 0.001), with median time to wound healing of 55 days and 101 days, respectively (p < 0.001). Complications were 28.9% for Bascom cleft lift vs. 13.2% for excision and secondary healing (p = 0.003). Recurrent disease was 6.3% after Bascom Cleft Lift and 11.8% after excision and secondary healing (p = 0.113).

Limitations: It has a retrospective design which makes it prone to selection bias and residual confounding. Additionally, the study's short follow-up period further adds to these limitations as longer follow-up may better identify true recurrence rates. Finally, a deficiency is the absence of collected patient satisfaction data, which is nowadays a common scientific issue.

Conclusions: This retrospective study shows that Bascom cleft lift is superior to excision and secondary healing given the higher percentage of patients with successful wound healing within a shorter time. See Video Abstract.

Background: Although attempts have been made in the past to establish consensus regarding the definitions and grading of the severity of colorectal anastomotic leakage, widespread adoption has remained limited.

Objective: A systematic review of the literature was conducted with the objective of examining the various elements used to report and define anastomotic leakage in colorectal cancer resections.

Data sources and study selection: A systematic review, using the PubMed, Embase, and Cochrane Library Database, of all published randomized controlled trials, systematic reviews, and meta-analyses containing data related to adult patients undergoing colorectal cancer surgery and reporting anastomotic leakage as a primary or secondary outcome, with a definition of anastomotic leakage included.

Outcomes: Definitions of anatomotic leakage, clinical symptoms, radiological modalities and findings, findings at reoperation, as well as grading terminology or classifications for anastomotic leakage.

Results: Of the 471 articles reporting anastomotic leakage as a primary or secondary outcome, a definition was reported in 95 studies (45 randomized controlled trials, 13 systematic reviews, and 37 meta-analyses), involving a total of 346,140 patients. Of these 95 articles, 68% reported clinical signs and symptoms of anastomotic leakage, 26% biochemical criteria, 63% radiological modalities, 62% radiological findings, and 13% findings at reintervention. Only 45% (n = 43) of included studies reported grading of anastomotic leakage severity or leak classification, and 41% (n = 39) included a timeframe for reporting.

Limitations: There was a high heterogeneity between the included studies.

Conclusion: This evidence synthesis confirmed incomplete and inconsistent reporting of anastomotic leakage across the published colorectal cancer literature. There is a great need for the development and implementation of a consensus framework for defining, grading, and reporting anastomotic leakage.

Registration: Prospectively registered at PROSPERO ID 454660.

Background: Concerns persist regarding the effectiveness of robotic proctectomy when compared with open proctectomy for locally advanced rectal cancer with a high risk of circumferential resection margin involvement.

Objective: Comparison of surrogate cancer outcomes following robotic versus open proctectomy in this subpopulation.

Design: Retrospective cohort study.

Setting: Three academic hospitals (Mayo Clinic Arizona, Florida, and Rochester) through the Mayo Data Explorer platform.

Patients: Patients at high risk of circumferential resection margin involvement were selected based on the magnetic resonance imaging-based definition from Mercury I and II trials.

Primary and secondary outcome measures: Rate of pathologic circumferential resection margin involvement (≤1 mm), mesorectal grading, rate of distal margin involvement.

Results: Out of 413 patients, 125 (30%) underwent open and 288 (70%) robotic proctectomy. Open proctectomy was significantly associated with a greater proportion of cT4 tumors (39.3% vs. 24.8%, p = 0.021), multivisceral/concomitant resections (40.8% vs. 18.4%, p < 0.001) and less frequent total neoadjuvant therapy use (17.1% vs. 47.1%, p = 0.001). Robotic proctectomy was less commonly associated with pathologic circumferential resection margin involvement (7.3% vs. 17.6%, p = 0.002), including after adjustment for cT stage, neoadjuvant therapy, and multivisceral resection (OR 0.326, 95% CI, 0.157-0.670, p = 0.002). Propensity score-matching on 66 patients per group and related multivariable analysis no longer indicated any reduction of circumferential positive margin rate associated with robotic surgery (p = 0.86 and p = 0.18). Mesorectal grading was comparable (incomplete mesorectum in 6% RP patients vs. 11.8% OP patients, p = 0.327). All cases had negative distal resection margins.

Limitation: Retrospective design.

Conclusion: In patients with locally advanced rectal cancer at high risk of circumferential resection margin involvement, robotic proctectomy is an effective approach and could be pursued when technically possible as an alternative to open proctectomy. See Video Abstract.