International Journal of Colorectal Disease最新文献

Purpose: Ulcerative colitis (UC) is a chronic, nonspecific inflammatory bowel disease primarily affecting the colorectal mucosa. The disease is characterized by a relapsing-remitting course and is currently incurable. Its pathogenesis is multifactorial, involving genetic predisposition, environmental triggers, immune dysregulation, and alterations in gut microbiota. The appendix plays a role in modulating intestinal immunity and maintaining microbial homeostasis. Left-sided colitis with appendiceal orifice inflammation (AOI) or periappendiceal erythematous patch (PARP) is a common endoscopic finding in UC. However, whether AOI in UC patients requires intervention remains debated.

Methods: Here, we report a rare case of a UC with AOI.

Results: By means of cholangioscope-assisted endoscopic retrograde appendicitis therapy (ERAT), copious purulent secretions were discovered and flushed out of the appendiceal cavity, resulting in clinical remission and endoscopic mucosal healing of UC.

Conclusion: Our case indicates that there may be some correlation between the appendix and the pathogenesis of ulcerative colitis. For refractory left-sided UC patients with AOI, ERAT-based management of appendiceal lumen inflammation may benefit patients.

Purpose: The purpose of this study is to compare short-term outcomes and 1-year incisional hernia rates between intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right hemicolectomy for management of right-sided colonic cancer. The primary outcome was the complication rate assessed by the comprehensive complication index (CCI). Secondary outcomes included time to bowel movement, length of hospital stay, 30-day readmission rate, early warning scores, and 1-year incisional hernia rate.

Method: This was a single-center, prospective cohort study. Patients with right-sided colonic cancer eligible for laparoscopic surgery with primary anastomosis were consecutively included. Patients included in the first period underwent EA, while those in the second underwent IA. Clinical data were collected during the hospital admission up to 30 days postoperatively. Complications were evaluated by the CCI. A routine 1-year CT-scan was used to assess hernias.

Results: One hundred three patients (51 in the EA and 52 in the IA groups) were included. Demographics were similar between the two groups. No significant difference in the CCI-score was found (EA: 17.9 (23.9) vs. IA: 15.0 (17.4), p = 0.85). The mean length of hospital stay was significantly shorter in the IA group (EA 6.6 days, IA 3.9 days, p = 0.02). The groups had no significant differences regarding other outcomes, including hernia rates (p = 0.12).

Conclusion: Laparoscopic right hemicolectomy with IA significantly reduced the length of hospital stay without increasing complication rates compared to EA.

Trial registration: The study is registered at ClinicalTrials.gov (NCT05039762).

Purpose: Anastomotic leakage following rectal cancer resection is a serious complication. Despite efforts to prevent it, the risk remains high. Obsidian®ASG, an AUTOLOGOUS fibrin matrix with thrombocytes derived from the patient's blood, shows promise but has not been thoroughly tested in rectal anastomosis. The aim of this study was to assess the feasibility of using Obsidian®ASG as a supplement in rectal anastomosis creation during minimally invasive rectal cancer resection.

Methods: This prospective IDEAL stage 2a development cohort study included 50 patients undergoing rectal cancer resection with anastomosis using minimally invasive surgery at Aarhus University Hospital, Denmark. Obsidian®ASG application was assessed using a predefined rating scale: "Complete" (applied in all three prescribed steps), "Almost complete" (applied in at least the first or second step), and "Incomplete" (all others). Feasibility required "Complete" or "Almost complete" application in at least 90% of patients.

Results: Obsidian®ASG application was "Complete" in 15 cases (30%) and "Almost complete" in 35 cases (70%), meeting feasibility criteria in all patients. No "Incomplete" applications occurred. Difficulties in achieving "Complete" application included anatomical constraints, material depletion, machine error, and time constraints.

Conclusion: Obsidian®ASG was successfully applied in all patients undergoing minimally invasive rectal cancer surgery. These findings suggest its feasibility, but further large-scale, multi-center randomized trials are needed to fully assess its potential benefits for patient outcomes.

Objective: This study aimed to investigate the relationship between colonic diverticulosis, colorectal polyps, and colorectal cancer.

Material and methods: A total of 648 patients (275 females, 373 males) who underwent complete colonoscopy between January 2016 and June 2020 were retrospectively analyzed. The presence and localization of diverticula, polyps, and cancer were recorded, and the association between diverticular disease and the formation of polyps and cancer was evaluated.

Results: Diverticula were identified in 53 patients (8.2%), while 595 patients (91.8%) had no diverticula. Polyps were detected in 148 patients (22.8%), and no polyps were found in 500 patients (77.2%). Adenocarcinoma was diagnosed in 67 patients (10.3%), with no malignancy observed in 581 patients (89.7%). The mean age of patients with polyps was 59.5 years, compared to 53.3 years in those without polyps (p < 0.001). Multivariate logistic regression analysis revealed that diverticulum status did not significantly influence the risk of polyp formation, whereas advanced age was identified as a significant risk factor (p < 0.001).

Conclusion: Advanced age is a significant risk factor for colorectal polyp formation, whereas diverticulosis is not an independent risk factor. These findings highlight the importance of age-based screening strategies for colorectal neoplasia.

Purpose: Pelvic exenteration (PE) is a complex surgical procedure used to treat patients with recurrent or locally advanced rectal cancer (LARC) as a final recourse. Thus, minimally invasive surgery (MIS) has emerged as an alternative to the traditional open PE as it may reduce surgical trauma and improve recovery. This meta-analysis compared the clinical outcomes between MIS and open PE in patients with LARC.

Methods: A systematic review and meta-analysis were conducted following PRISMA and AMSTAR guidelines. Six retrospective studies comprising 368 patients (179 MIS patients; 189 open patients) were included. Data on operative parameters along with short-term and long-term outcomes, including the 3-year overall (OS) and disease-free survival (DFS), were extracted. Risk ratios (RRs) and odds ratios (ORs) were calculated for binary outcomes, while standardised mean differences (SMDs) were calculated for continuous outcomes. All measures were reported with 95% confidence intervals (CIs) using random-effects models.

Results: MIS was associated with significantly reduced blood loss (standardised mean difference (SMD), - 1.57; 95% CI, - 2.27 to - 0.88; p < 0.00001), shorter hospital stays (SMD, - 6.46; 95% CI, - 12.21 to - 0.71; p = 0.03), and quicker diet resumption (SMD: - 0.79; 95% CI, - 1.36 to - 0.21; p = 0.008) than open PE. MIS was associated with a borderline reduction in total complications (OR, 0.45; 95% CI, 0.20-1.00; p = 0.05) and lower rates of abdominal wound complications (OR, 0.22; 95% CI, 0.11 to 0.45; p < 0.0001). No significant differences were observed in R0 resection rates, major complications, or mortality. For long-term outcomes, MIS demonstrated significantly improved 3-year OS (RR, 1.19; 95% CI, 1.01 to 1.41; p = 0.04), whereas 3-year DFS showed no significant difference (RR, 1.02; 95% CI, 0.79 to 1.41; p = 0.87).

Conclusion: MIS offers significant short-term advantages over open PE, including reduced blood loss, faster recovery, and fewer complications while demonstrating improved 3-year OS. These findings support MIS PE as a safe, effective, and viable option for patients with recurrent or LARC.

Purpose: Sacral neuromodulation (SNM) is an established treatment for faecal incontinence. This study analyses patient experience with SNM beyond quality of life and incontinence scores to better understand patient expectations and improve patient selection.

Methods: Patients receiving SNM for faecal incontinence at three Australian sites from 2013 to 2023 were subject to cohort analysis. St. Mark's Incontinence Score (SMIS) and Rapid Assessment of Faecal Incontinence Score (RAFIS) assessed incontinence and quality of life. Thematic analysis of structured interviews qualitatively assessed patient experience.

Results: Seventy-one patients aged 52-86 years (M = 69) experienced SNM and 56 agreed to interview at median 6-year post-procedure. Forty-five (63%) proceeded to permanent SNM and progression was not influenced by age, sex, culture, insurance status or presence of anal sphincter defect. Thirty-nine (87%) retained their neuromodulator with battery life M = 6.5 years, 95% CI [5.2, 7.8]. Permanent SNM improved incontinence (P < 0.01) and quality of life (P < 0.01). Forty-eight (86%) patients desired 30-min education pre- and post-procedure. Thirty-seven (86%) desired follow-ups at 1 month, 12 months and at battery depletion. Twenty (36%) had initial reservations which resolved in all but one patient. Twenty-one (54%) remained dependent on others for neuromodulator customisation and this dependence increased with age (P = 0.02). Fifty (89%) recommend SNM to others, despite 8 (14%) regretting their personal experience.

Conclusion: SNM continues to improve faecal incontinence and quality of life. Initial reservations usually resolve and most patients recommend it to others. While adequate patient education and follow-up is not onerous to achieve, most patients remain dependent for neuromodulator customisation.

Background: To explore the lateral mesorectum structures and develop a nomogram model for predicting the prognosis of rectal cancer (RC) patients using preoperative high-resolution magnetic resonance imaging (MRI).

Methods: Patients who underwent radical resection of RC in our hospital from January 2017 to December 2018 were retrospectively analyzed. Imaging data and postoperative 3-year prognosis data of patients were collected. The lateral mesorectum was observed, and related parameters were investigated: lateral interruption of the mesorectal fascia (LI-MRF), type of the middle rectal artery (MRA), and the maximum diameter of the MRA. The impact of lateral mesorectum parameters on prognosis was determined using Cox analysis and Kaplan-Meier (KM) survival curves. A nomogram combining lateral mesorectum parameters with clinical data was constructed and its predictive performance was validated.

Results: A total of 260 patients were included in this study. In preoperative high-resolution MRI, LI-MRF and MRA were observed bilaterally in all patients. Multivariate Cox regression analysis showed that the maximum diameter of the right MRA (P = 0.001) and right LI-MRF (P = 0.016) were predictive factors for postoperative 3-year overall survival (OS). Additionally, gender (P = 0.015), mrT stage (P = 0.025), and the maximum diameter of the right MRA (P = 0.002) were predictive factors for postoperative 3-year disease-free survival (DFS). The concordance indexes (C-index) of the predictive nomogram were 0.737 for OS and 0.685 for DFS.

Conclusion: Preoperative high-resolution MRI revealed that the lateral mesorectum and MRA were inherent. The right LI-MRF and the maximum diameter of the right MRA were risk factors for poor postoperative survival in RC patients.

Purpose: Although chemoradiotherapy is considered an efficacious treatment option for patients with locally advanced rectal cancer, the associated radiological toxicities and late anal dysfunction are concerning issues. Herein, we examined the efficacy and safety of folinic acid, 5-fluorouracil, oxaliplatin, and irinotecan (FOLFOXIRI) as upfront therapy for marginally unresectable local rectal cancers without distant metastasis.

Methods: This multicenter, prospective, observational study was designed by the Yokohama Colorectal Cancer Study Group. The primary endpoint was the conversion rate. Secondary endpoints were the R0 resection rate, response rate, pathological response rate, postoperative complication rate, relapse-free survival, local progression-free rate, and circumferential resection margin-negative rate.

Results: Twenty patients were enrolled in this study. The study achieved its primary endpoint; the R0 resection rate was 80% (95% confidence interval, 56.3 to 94.3). Major grade ≥ 3 adverse effects included neutropenia in 7 (35%) patients, anemia in 3 (15%), fatigue in 2 (10%), enterocolitis in 2 (10%), febrile neutropenia in 1 (5%), leukopenia in 1 (5%), diarrhea in 1 (5%), fever in 1 (5%), and urinary tract infection in 1 (5%).

Conclusion: FOLFOXIRI therapy was well tolerated and showed comparable efficacy results, providing potential R0 resection in patients with marginally unresectable locally advanced rectal cancer without distant metastasis.

Trial registration: UMIN Clinical Trials Registry (UMIN000040275).

Purpose: The purpose of this study is to review the application of the da Vinci® Single-Port system (DVSP) in colorectal surgery, with a view to assessing its safety and feasibility, and investigating its clinical and oncological outcomes.

Methods: A comprehensive search of the scientific literature was conducted across three major databases (PubMed, Web of Science, and Cochrane) up to November 2024. The study was registered in PROSPERO (CRD42024612762) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies pertained to the utilisation of DVSP in the domain of colorectal surgery.

Results: Eleven articles were included in the final analysis. No randomized controlled trials were identified. A total of 396 patients (199 men, 197 women) underwent robotic colorectal surgery using the DVSP. Surgical resections were indicated for benign pathology in 56 patients, colon carcinoma in 194 cases, and rectal carcinoma in 146 cases. The median incision length for Uniport placement was 4 cm. The median docking time was 5.96 min (IQR, 9.33 min), and the median console time was 105 min (IQR, 62.51 min). The mean operative time was 186.3 min (IQR, 77.65 min). Intraoperative complications were rare, with only two cases reported (0.47%). Postoperative complications occurred in 12.47% of patients, with ileus being the most common. No patients were readmitted for complications within 30 days. Short-term oncological outcomes seemed promising, with a median of 24.59 lymph nodes retrieved. There were no reported deaths within 30 days. The median follow up time was 11.4 months (IQR, 11.76 months).

Conclusion: This study shows that the use of DVSP in colorectal surgery is both feasible and safe. Short-term clinical and oncological outcomes seem promising. However, longer follow-up data and larger patient cohorts are needed to fully assess the long-term efficacy of this novel technique.

Prospero registry: Registration number CRD42024612762.