Diseases of the Colon & Rectum最新文献

Background: Approximately 90% of patients with anal fistulas secondary to Crohn's disease require surgical intervention. An ideal technique that achieves high cure rates with minimal complications and low recurrence has yet to be established. In other medical disciplines, platelet-rich plasma has demonstrated regenerative and healing properties, offering new therapeutic possibilities.

Objective: This study aimed to evaluate the 5-year healing rate in patients with anal fistulas due to Crohn's disease following treatment with platelet-rich plasma.

Design: This prospective observational study was conducted between 2011 and 2022. Patients with Crohn's disease and perianal fistulas who met the inclusion criteria were treated with platelet-rich plasma. Follow-up assessments were carried out at 1, 3, 6, 12, 36, and 60 months.

Settings: A single tertiary referral center.

Patients: Data from eligible patients with Crohn´s disease-associated anal fistulas were analyzed.

Main outcome measures: Primary outcomes included fistula healing and recurrence rates, continence status, and complications.

Results: A total of 42 patients (45.2% male, 54.8% female; mean age 38.6 ± 11.9 years) were included. 97.6% were receiving active treatment for Crohn´s disease. All procedures were performed on an outpatient basis. Transsphincteric fistulas accounted for 80.9% of cases, 95.2% of which were recurrent. The median time to recurrence was 55±8 months (95% CI: 38-72). Follow-up was completed by 40, 24, and 19 patients at 1, 3, and 5 years, respectively. Mild complications occurred in 23.8% of patients, and continence was preserved, except for one patient. Kaplan-Meier analysis revealed recurrence free-healing of 83.5% at 1 year, 52.5% at 3 years, and 43.8% at 5 years.

Limitations: Include its single-center design and the predominance of transsphincteric fistulas among the cases.

Conclusions: Platelet-rich plasma treatment for anal fistulas in Crohn´s disease patients is safe, feasible in an outpatient setting, and associated with high healing rates and low recurrence. (See Video Abstract).

Background: The incidence of early-onset colorectal cancer is rising, yet survivorship care guidelines rarely address concerns unique to younger adults. Although treatment for colorectal cancer can have devastating consequences to sexual function and fertility, these issues remain under-recognized and seldom addressed.

Objective: To better understand the impact of colorectal cancer diagnosis and treatment on sexual and reproductive health.

Design: Qualitative study of patients with early-onset colorectal cancer.

Settings: Semi-structured one-on-one zoom interviews of patients recruited through convenience sampling from 7 academic institutions.

Patients: Sixty-three individuals diagnosed with colorectal cancer before age 50 were interviewed between March 2021 and August 2024.

Main outcome measures: Patient perspectives of sexual and reproductive health impacts of colorectal cancer diagnosis and treatment. Data were analyzed iteratively using directed and conventional qualitative content analysis.

Results: Participants discussed sexual and reproductive health side effects resulting from surgery, chemotherapy, and radiation. These side effects ranged in severity, with some experiencing almost none and others facing significant issues. They identified several domains, including surgical and treatment side effects, psychological impacts, effects on relationships, and unmet needs. Subdomains included sexual health, reproductive health, emotional distress, body image, communication challenges, impacts on dating, informational needs, financial support, and consultations.

Limitations: Participants were recruited from academic medical centers only, and as such responses may not reflect the experiences of those cared for in non-academic settings.

Conclusion: Sexual and reproductive health are critical but often overlooked concerns among younger patients with CRC, with significant impacts on physical functioning, partner relationships, and psychological well-being. Current survivorship guidelines fail to adequately address these needs. Our findings highlight the importance of pretreatment counseling and fertility preservation as well as the need for ongoing mental health support during and after cancer treatment. (See Video Abstract).

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.