Diseases of the Colon & Rectum最新文献

{"title":"What To Do With Suspected Nodal Regrowth on Magnetic Resonance Imaging During Follow-up in an Organ Preservation Approach for Rectal Cancer?","authors":"Barbara M Geubels,Monique Maas,Geerard L Beets,Brechtje A Grotenhuis,","doi":"10.1097/dcr.0000000000003385","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003385","url":null,"abstract":"BACKGROUNDFor nodal regrowth in patients with rectal cancer following watch-and-wait standardized protocols on diagnostic procedures and subsequent treatment are lacking.OBJECTIVEEvaluate the diagnosis and treatment of suspected nodal regrowth following an organ preservation approach.SETTINGSPatients were included from national and institutional watch-and-wait -databases.DESIGNThirty-five rectal cancer patients with suspected nodal regrowth on magnetic resonance imaging were retrospectively identified during watch-and-wait follow-up.PATIENTSTwenty-seven of 35 patients followed watch-and-wait after neoadjuvant (chemo)radiotherapy and 8/35 followed watch-and-wait schedule after local excision for early rectal cancer.MAIN OUTCOME MEASURESDiagnostic procedures, treatment and histopathological outcome.RESULTSMedian follow-up was 34 months. Median time from end of (chemo)radiotherapy or local excision to first detection of suspected nodal regrowth on magnetic resonance imaging following watch-and-wait was 9 and 10 months. After first detection, 17 of 35 patients underwent immediate treatment without further diagnostics, of whom 7 also had luminal regrowth. In 18 of 35 patients, additional diagnostic procedures were performed. In 4 of 18 patients, positron emission tomography-computed tomography or endorectal ultrasound-guided biopsy was performed and treatment was initiated based on increased nodal regrowth suspicion. In 14 of 18 patients, MRI was repeated after 8-12 weeks: growth of suspected lymph nodes was the most decisive factor to proceed to treatment. In 8 patients, repeated magnetic resonance imaging was combined with positron emission tomography-computed tomography and/or endorectal ultrasound-guided biopsy: in half of them it contributed to treatment initiation. In total, 34/35 patients were treated: 9 received (re-)irradiation and 33 underwent total mesorectal excision. In 27 of 33 patients, nodal regrowth was pathologically confirmed in the total mesorectal excision-resection specimen; 5 of 6 patients without nodal involvement had pathologically confirmed luminal regrowth.LIMITATIONSHighly selected study population.CONCLUSIONSDuring watch-and-wait follow-up of patients with rectal cancer in an organ preservation strategy, magnetic resonance imaging plays an important role in diagnosis of nodal regrowth. Repeated magnetic resonance imaging after an interval can be helpful in making treatment decisions, and the role of positron emission tomography-computed tomography and endorectal ultrasound-guided biopsy appears limited. See Video Abstract.","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201258","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}

{"title":"Radially Emitting Diode Laser Closure of Transsphincteric Fistula-in-Ano.","authors":"Scott R Kelley, Robert A Vierkant, Jennifer M Russell, Kayleigh M Cummings, Shannon R Berndt","doi":"10.1097/DCR.0000000000003501","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003501","url":null,"abstract":"<p><strong>Background: </strong>There has been a shift in the treatment of fistula-in-ano towards a focus on preservation of continence while simultaneously eradicating disease. Utilization of radially emitting diode laser catheters to ablate fistula tracks has been described since 2011 with heterogenous studies publishing success rates ranging from 20% to 89%.</p><p><strong>Objective: </strong>Present our experience managing solitary transsphincteric fistulas of cryptoglandular origin with radially emitting diode laser.</p><p><strong>Design: </strong>Prospective non-randomized single center trial with 12-month follow-up.</p><p><strong>Settings: </strong>Quaternary referral academic healthcare center.</p><p><strong>Patients: </strong>Forty-six adults with transsphincteric fistula-in-ano.</p><p><strong>Interventions: </strong>All underwent radially emitting diode laser closure of fistula-in-ano.</p><p><strong>Main outcome measures: </strong>Clinical healing and fistula recurrence.</p><p><strong>Results: </strong>Forty-six patients with a median age of 48 years (range, 26-85) underwent diode laser closure. Most were men (n = 28/60%). Twenty-four (52%) had previous fistula repairs with a median of 1.5 (range, 1-7) repairs per patient. All were followed for 12 months. Successful closure following one laser treatment occurred in 43%. Thirteen of 26 failures (50%) were able to undergo a delayed fistulotomy secondary to an anatomic change with the fistula becoming more superficial moving out of internal sphincter muscle following laser ablation, all of which healed. No patients experienced new or worsening (preexisting) fecal incontinence. Two (8%) continued treatment for abscesses / fistula branching. One (3%) experienced migration of the fistula from the base of the left labia to the introitus of the vagina and 1 experienced recurrence and worsening of their disease process with subsequent involvement of the coccyx (previous deep postanal space abscess).</p><p><strong>Limitations: </strong>Limitations to our study include its non-randomized prospective nature, single center and surgeon experience, and small patient sample size.</p><p><strong>Conclusions: </strong>Radially emitting diode laser closure is a continence preserving option to consider when treating transsphincteric fistula-in-ano. When the procedure fails it does not fail poorly (open wounds, retracted flaps, incontinence, etc.), and can be repeated. Complications can include abscess formation and fistula migration to adjacent anatomic locations (vagina). Even if not successful, following treatment the fistula can anatomically migrate distally becoming more superficial and thus providing the opportunity to proceed with a delayed fistulotomy. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139605","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}

{"title":"Localized Administration of Mesenchymal Stem Cell-Derived Exosomes for the Treatment of Refractory Perianal Fistula in Crohn's Disease Patients: A Phase II Clinical Trial.","authors":"Alireza Hadizadeh,Reza Akbari-Asbagh,Asieh Heirani-Tabasi,Masoud Soleimani,Parastou Gorovanchi,Nasser Ebrahimi Daryani,Amir Vahedi,Hengameh Nazari,Seyedeh-Parnian Banikarimi,Mahnoosh Abbaszade-Dibavar,Behnam Behboudi,Mohammad Sadegh Fazeli,Mohammad Reza Keramati,Amir Keshvari,Alireza Kazemeini,Haleh Pak,Amir-Reza Fazeli,Foroogh Alborzi,Seyed-Mohsen Ahmadi-Tafti","doi":"10.1097/dcr.0000000000003502","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003502","url":null,"abstract":"BACKGROUNDCrohn's disease perianal fistulae are often resistant to standard anti-TNF-α therapies. Mesenchymal stem cell (MSC)-derived exosomes are extracellular vesicles that have highly potent anti-inflammatory effects, and the previous phase of this study demonstrated their safety in the treatment of refractory perianal fistulas.OBJECTIVETo evaluate the efficacy of mesenchymal stem cell-derived exosomes for the treatment of refractory perianal fistulas.DESIGNNonrandomized, nonblinded single-center phase II clinical trial.SETTINGSTertiary university hospital.PATIENTSTwenty-three patients were enrolled, 20 of whom completed the study. Refractory perianal fistula was defined as resistance to at least one course of treatment with anti-tumor necrosis facto-α therapy.INTERVENTIONSAfter clinical assessment and magnetic resonance imaging, the patients were subjected to general anesthesia, and 5 mL of exosome solution was injected directly into the fistula tracts. The injections were repeated three times at 2-month intervals, and patients were followed monthly for 6 months after the last injection. Tissue samples from the tracts were obtained before each injection and subjected to immunohistopathological assessment. MRI data were obtained before and six months after the last injection.MAIN OUTCOME MEASURESThe primary outcome of this study was fistula tract closure on clinical examination and magnetic resonance imaging. The secondary outcome was an improvement in the discharge from the tracts.RESULTSFistula tracts were fully closed in 12 (60%) of the patients. Four patients showed clinical improvement, with some tracts remaining open, and four patients were completely resistant to treatment. A total of 43 fistula tracts were treated during the trial, 30 (69.7%) of which showed complete closure. Histopathological analysis revealed substantial reductions in local inflammation and signs of enhanced tissue regeneration. Immunohistochemical analysis of cluster of differentiation-68, 20 and 31 reaffirmed these results.CONCLUSIONSMSC-derived exosomes are safe and effective for treating refractory perianal fistulas in patients with Crohn's disease. See Video Abstract.","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201259","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}

{"title":"How do you code colonoscopies correctly?","authors":"Donald B Colvin, Kelly M Tyler","doi":"10.1097/DCR.0000000000003533","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003533","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139603","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}

{"title":"Introducing Colorectal Coding Corner!","authors":"Kelly M Tyler, Donald Colvin","doi":"10.1097/DCR.0000000000003532","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003532","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139604","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}

{"title":"Initial Experience With Single-Port Robotic Right Colectomies: Results of an Investigator-Initiated Investigational Device Exemption Study Using a Novel Single-Port Robotic Platform.","authors":"Ankit Sarin,Katherine E Barnes,Amy M Shui,Yukino Nakamura,Daniel B Hoffman,Fernanda Romero-Hernandez,Hueylan Chern","doi":"10.1097/dcr.0000000000003352","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003352","url":null,"abstract":"BACKGROUNDMinimally invasive surgical techniques have been widely adopted in colorectal surgery. New technological breakthroughs have led to even less invasive alternatives like single-port surgery, but this has been hindered by technical challenges such as the collision of robotic arms within a limited space. The Intuitive da Vinci Single-Port robotic platform is a novel system that overcomes some of these challenges.IMPACT OF INNOVATIONThis study aimed to assess the safety and feasibility of the Intuitive da Vinci Single-Port robotic platform in right segmental colectomies among adult patients. These findings may set the stage for more widespread use of single-port robotic surgery.TECHNOLOGY, MATERIALS, AND METHODSThe Intuitive da Vinci Single-Port robot is a system designed specifically for single-port robotic surgery. This platform enables flexible port location and efficient internal and external range of motion using a single C-shaped arm. In the present study, right colectomies were performed in adult patients using this platform between May 2022 and November 2022, and they were compared to right colectomies in adult patients performed using the standard multiport platform between January 2019 and December 2022. The main outcome measure was safety and quality event rates.PRELIMINARY RESULTSOf 30 patients, 16.7% of patients (n = 5) underwent single-port robotic right colectomy and 83.3% (n = 25) underwent multiport right colectomy. In the single-port group, 40% of patients (n = 2) developed a safety/quality event (postoperative portal vein thrombosis and excessive postoperative pain). In the multiport group, 32% of patients (n = 8) developed 1 safety/quality event and 8% (n = 2) had more than 1 event.CONCLUSIONS AND FUTURE DIRECTIONSThis preliminary study, one of the first Food and Drug Administration-approved, investigator-initiated uses of this platform in colorectal surgeries, shows that this platform is a safe and feasible option for right colectomies. On preliminary evaluation, it appears comparable in terms of relevant safety/quality events to the multiport platform.CLINICAL TRIAL REGISTRATIONClinicaltrials.gov NCT05321134.","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201260","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}

{"title":"The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Evaluation and Management of Chronic Constipation.","authors":"Karim Alavi,Amy J Thorsen,Sandy H Fang,Pamela L Burgess,Gino Trevisani,Amy L Lightner,Daniel L Feingold,Ian M Paquette,","doi":"10.1097/dcr.0000000000003430","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003430","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201261","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}

{"title":"Evaluating Compliance With National Comprehensive Cancer Network Guidelines in Lynch Syndrome.","authors":"Rohith S Raman, Benjamin Usry, Kevin S Hughes, Colleen Donahue","doi":"10.1097/DCR.0000000000003393","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003393","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132132","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}

{"title":"Neoadjuvant Therapy for Colon Cancer.","authors":"Lauren Weaver, Paolo Goffredo","doi":"10.1097/DCR.0000000000003524","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003524","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132134","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}

{"title":"Research Perspective on \"Social Determinants of Health in Diverticulitis: A Systematic Review\".","authors":"Ira L Leeds","doi":"10.1097/DCR.0000000000003469","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003469","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132140","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}