International Journal of Colorectal Disease最新文献

Purpose: Extramural venous invasion (EMVI) is a high-risk pathological feature in colorectal cancer, yet its role in guiding adjuvant chemotherapy in node-negative colon cancer remains uncertain. This study evaluates EMVI as a predictor of recurrence in patients undergoing colon cancer resection and investigates whether adjuvant chemotherapy affects recurrence in node-negative, EMVI-positive (N0/EMVI +) patients.

Methods: A retrospective cohort study was conducted on adults undergoing surgery for colon cancer at a single UK cancer centre between 2015 and 2022. Patients with rectal tumours or metastatic disease at presentation were excluded. Cox proportional hazards models were used to assess predictors of recurrence. Kaplan-Meier survival curves were generated to visualise recurrence-free survival (RFS) stratified by EMVI and chemotherapy status.

Results: Among 675 patients, EMVI was present in 361 (53%). EMVI was independently associated with increased recurrence (HR: 1.80, 95% CI: 1.14-2.84, p=0.011). In the N0/EMVI+ subgroup (n=124), chemotherapy was not significantly associated with reduced recurrence: partial chemotherapy (HR: 1.36, 95% CI: 0.30-6.20, p=0.69), full chemotherapy (HR: 1.53, 95% CI: 0.46-5.12, p=0.49). Kaplan-Meier analysis revealed five-year RFS of 80.9% for no chemotherapy, 60.6% for partial chemotherapy, and 41.6% for full chemotherapy (p=0.69). Survival differences were not statistically significant.

Conclusion: EMVI is a predictor of recurrence in patients undergoing surgery for colon cancer. However, in node-negative patients with EMVI, chemotherapy was not significantly associated with improved recurrence-free survival. These findings highlight the need for larger, prospective studies to better define the role of EMVI in guiding adjuvant therapy in stage II colon cancer.

Purpose: Colonic metastasis from breast cancer is extremely rare, with an incidence of only 0.1%. Diagnosis is often difficult and guidelines are not yet established. The aim of our review is investigating the latency from the primary tumor, the common symptoms, the diagnostic and therapeutic strategies and the role of surgery for this rare clinical scenario.

Materials: We report the case of a 57-year-old woman with multiple colonic metastasis from primary breast tumor, who underwent laparoscopic left hemicolectomy. A systematic review of 64 case reports was also conducted.

Results: Lobular carcinoma is more frequently associated with gastro-intestinal (GI) metastasis than ductal carcinoma. The median age at diagnosis is 65.5 (IQR = 15) years with colonic metastases typically occurring after a median of 8 years (IQR = 13) from the primary tumor diagnosis. The most frequent symptoms are abdominal pain (34.4%), bowel habit changes (26.6%), and intestinal obstruction (9.4%). In 25% of cases, metastases were incidentally discovered during follow-up. The median disease-free survival was 12 months (IQR = 27.5). Thirteen studies reported death at a median of 12 months (IQR = 20), while 24 did not report follow-up data.

Conclusions: The poor prognosis is mainly due to long latency between primary diagnosis and metastasis onset, as well as to non-specific symptoms. Immuno-histochemical is crucial for diagnosis, although not sufficient to determine tumor origin definitively. Patients with history of breast cancer presenting with GI symptoms should undergo prompt endoscopic evaluation, although routine surveillance remains controversial. Surgery may be considered in selected cases, but systemic therapies remain the cornerstone of treatment.

This case "Management of an intramuscular caecal epidermoid cyst in the robotic surgery era" documents the work-up and management of a rare entity, with the aid of the robotic surgery platform. There are 12 reported cases in the literature of epidermoid cysts arising from the caecum since 1961. Ranging from 8- to 75-year-olds, four of the epidermoid cysts were intramuscular, with six being subserosal. Given the rarity of this entity and the pre-operative diagnostic uncertainty, often both CT and MRI are used during pre-operative work-up. To our knowledge, this is the first reported case of intramuscular caecal epidermoid cyst excised using a robotic surgery approach.

Background: Patients with locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (NCRT) and subsequently experience early recurrence (ER) within two years post-surgery tend to have unfavorable prognoses. Therefore, the accurate prediction of ER in LARC is of paramount importance.

Purpose: This study aimed to develop and validate an explainable artificial intelligence (AI) model, based on the systemic inflammation-nutritional tumor biomarker index (SINTI) derived from routine blood biomarkers, to predict ER in patients with LARC.

Methods: We conducted a multicenter retrospective analysis involving two distinct patient cohorts: Cohort A (n = 715; from February 2011 to September 2017) and Cohort B (n = 224; spanning June 2020 to June 2023). Feature selection was executed utilizing the least absolute shrinkage and selection operator (LASSO) regularization to construct SINTI, effectively addressing multicollinearity. Predictive modeling incorporated ten different machine learning architectures, with hyperparameter optimization achieved through a randomized search complemented by nested tenfold cross-validation. Model performance was thoroughly evaluated using multiple metrics, including the area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (AUPRC), clinical utility curves, and calibration plots. The interpretability of the model was enhanced through SHAP value analysis, followed by its deployment as a clinical decision support web application.

Results: The study included 715 patients from Center One and 224 from Center Two, identifying six key biomarkers as the core components of the SINTI model. Multivariable analysis confirmed that SINTI, clinical N stage, clinical T stage, and tumor size are independent predictors of early recurrence. The XGBoost algorithm exhibited robust discrimination during training cohort cross-validation, achieving a mean AUC of 0.860 (SD ± 0.021) and demonstrating consistent performance across validation datasets, with an internal AUC of 0.842 and an external AUC of 0.840. SHAP value interpretation revealed monotonic relationships between predictor variables and recurrence risk, with SINTI accounting for 36.1% of the total predictive weight. For clinical implementation, we deployed the optimized model as a web-based decision support tool, which can be accessed at https://p7toqbsdfbhlahdrugj4ra.streamlit.app/ .

Conclusion: This interpretable AI framework demonstrates the potential to bridge data-driven modeling and clinical decision support, offering a transparent, potentially deployable solution for post-NCRT recurrence risk prediction following further prospective validation.

Background: Oxaliplatin resistance significantly impairs therapeutic outcomes in colorectal cancer. However, reliable diagnostic markers for early detection of resistance remain limited. This study aimed to identify novel diagnostic signatures through integrative bioinformatics and machine learning approaches.

Methods: We performed comprehensive bioinformatics analyses combining transcriptomics data from multiple cohorts. The diagnostic signatures were identified and validated using machine learning algorithms. Weighted gene co-expression network analysis (WGCNA) was employed to explore resistance-associated gene modules. Multiple computational methods including functional enrichment, protein-protein interaction networks, and immune infiltration assessment were conducted to comprehensively characterize the molecular features of oxaliplatin resistance.

Results: Through integrative analysis and machine learning, we identified an 8-gene diagnostic signature (CHFR, TGFBRAP1, RPS4Y1, CYP26B1, NR4A2, FLJ20021, TNFSF9, CAV2) that demonstrated robust performance in distinguishing resistant cases (AUC = 0.868). Functional characterization revealed significant enrichment in metabolic reprogramming, DNA repair mechanisms, and immune modulation pathways. Systematic evaluation of tumor-immune interactions demonstrated distinct patterns of immune cell infiltration between resistant and sensitive groups, particularly in Natural killer cells and Activated CD8 T cells. Computational drug screening identified Glycidamide and orciprenaline as promising candidates, with favorable binding profiles against key resistance-associated targets.

Conclusions: Our study establishes a novel multi-gene diagnostic signature for oxaliplatin resistance through integrative bioinformatics and machine learning approaches. The comprehensive molecular characterization and identification of potential therapeutic candidates provide new insights into resistance mechanisms and clinical management strategies for oxaliplatin-resistant colorectal cancer.

Purpose: Anoscrotal fistula is a rare variant of anal fistula, often mimicking primary scrotal disease and causing diagnostic delay. Unlike typical cryptoglandular fistulas, anoscrotal extensions are frequently linked to Crohn's disease, tuberculosis, hidradenitis suppurativa, or actinomycosis. Published data remain scarce, especially in Europe. This study aimed to describe the clinical features, etiologies, imaging findings, management, and outcomes of anoscrotal fistulas treated in a French tertiary center.

Methods: We retrospectively reviewed all men managed for anoscrotal fistula at the Institute of Proctology, Paris Saint-Joseph Hospital, between 2014 and 2024. Demographic, clinical, radiological, surgical, and outcome data were analyzed. Healing was defined as closure of all fistula openings without recurrence at last follow-up.

Results: Twenty-nine patients were included (mean age 48.2 years). Initial presentation was abscess in 55% and purulent discharge in 45%. External scrotal openings were present in 90%. Magnetic resonance imaging (MRI) identified complex tracts in 59% of cases. Etiologies were cryptoglandular (63%), Crohn's disease (15%), hidradenitis (11%), tuberculosis (7%), and actinomycosis (4%). Nineteen patients (66%) had prior anorectal surgery. Most (72%) underwent initial seton drainage, followed by fistulotomy (31%), advancement flap (12%), or other sphincter-preserving techniques. A urologist was involved in 31% of cases. After a median follow-up of 22 months, 59% healed, 28% had persistent disease, and none recurred once healed. Continence was preserved, and 73% of patients were highly satisfied. No predictors of healing were identified.

Conclusion: This series represents one of the largest European experiences with anoscrotal fistula. Findings emphasize frequent non-cryptoglandular causes, the key role of MRI, and the need for multidisciplinary, individualized management.

Purpose: While histopathological features are established prognostic factors in colorectal cancer, the prognostic significance of gross tumor morphology remains unclear. We investigated whether endoscopic gross morphology is associated with clinical outcomes in colon cancer.

Methods: We performed a multicenter retrospective analysis of 1,177 patients with colon cancer who underwent curative-intent endoscopic or surgical resection between 2010 and 2019. Tumors were categorized based on endoscopic images as flat/ulceroinfiltrative (n = 345) or fungating/ulcerofungating (n = 832). Kaplan-Meier analysis assessed survival outcomes, and Cox proportional hazards models identified independent prognostic factors, adjusting for age, sex, family history, diabetes, CEA, and AJCC 7th edition stage.

Results: Patients with flat/ulceroinfiltrative tumors had significantly shorter overall survival (OS, p = 0.001) and disease-free survival (DFS, p = 0.024) than those with fungating/ulcerofungating tumors. In stage II patients, the difference in OS by morphology was more pronounced (p = 0.004). Multivariate analysis confirmed flat/ulceroinfiltrative morphology as an independent predictor of poor OS (HR 1.61; 95% CI 1.122-2.335; p = 0.010). Other significant predictors included older age (≥ 65 years, HR 1.533; p = 0.021), poor histologic grade (PD vs. WD/MD, HR 5.308; p < 0.001), and advanced stage.

Conclusions: Gross endoscopic morphology is an independent prognostic factor in colon cancer. Flat/ulceroinfiltrative tumors are associated with worse outcomes, especially in stage II disease. Gross morphology, readily identifiable at diagnosis, may aid risk stratification and inform decisions regarding adjuvant therapy.

Purpose: We aimed to demonstrate a novel caudal-dorsal approach laparoscopic right hemicolectomy (LRH) for a patient diagnosed with right colon carcinoma.

Method: We performed a LRH with a caudal-dorsal approach. We started the operation from the distal root of the small intestine mesentery and the backside of the ascending colon. The ileocolic artery and vein were transected at the dorsal side of the mesocolon. The superior mesenteric vein (SMV) and the gastrocolic trunk were dissected from the dorsal approach. The study adhered to the IDEAL. We followed the recommendations of the LAP-VEGaS Consensus for the reporting of Laparoscopic Videos [1].

Results: The operation lasted approximately 120 min, with an intraoperative blood loss of only 10 mL. Postoperative pathology showed pT1N0M0 (18 lymph nodes resected, all negative for metastasis). The patient was discharged on postoperative day 5 without complications.

Conclusion: The caudal-dorsal approach for LRH represents a novel surgical method, and we believe it offers several advantages over traditional approaches.