International Journal of Colorectal Disease最新文献

Background: Diverticular disease is one of the most common benign colorectal conditions and often requires elective resection for recurrent or complicated presentations. Enhanced Recovery After Surgery (ERAS) programmes have demonstrated benefits in mixed colorectal populations; however, evidence in purely benign diverticular cohorts remains limited. This study evaluated the impact of a standardised ERAS pathway on postoperative outcomes following elective colorectal resection for diverticular disease.

Methods: This retrospective multicentre cohort study included consecutive adults undergoing elective left-sided colorectal resection for diverticular disease between 2009 and 2024 in Northern Italy. Patients treated within an ERAS pathway were compared with those receiving conventional care. The primary outcome was length of hospital stay. Secondary outcomes included postoperative morbidity, gastrointestinal recovery, pain, mobilisation, and readmissions. Continuous variables were analysed with the Mann-Whitney U test and categorical variables with χ² or Fisher's exact test. A propensity score-matched analysis was performed to account for baseline and temporal confounding.

Results: A total of 421 patients were included: 329 in the ERAS group and 92 in the non-ERAS group. Baseline characteristics were similar. ERAS adherence was associated with faster gastrointestinal recovery (median time to first flatus: 1 vs 2 days; stool: 1 vs 2 days), lower pain on POD 1 (VAS 2 vs 4), earlier mobilisation (12 h vs 21 h), and earlier solid diet introduction (POD 1 vs POD 2). Overall morbidity was lower in the ERAS group (6.6% vs 14%), without increases in severe complications or readmissions. Median LOS was reduced (4 vs 6 days). Propensity score matching (88 pairs) confirmed these findings.

Conclusion: ERAS implementation in elective colorectal resection for diverticular disease is safe, feasible, and associated with accelerated recovery, reduced morbidity, and shorter hospital stay.

Background: SUMO-specific peptidase 3 (SENP3), as a de-SUMOylating enzyme, renders the process of protein SUMOylation reversible. It has been demonstrated to play either promoting or inhibitory roles in several cancers. However, research on its function in colorectal cancer (CRC) remains absent.

Methods: Tissue samples from CRC patients were analyzed to measure the expression level of SENP3. Proliferation and viability assays were performed to assess the role of SENP3 in cell growth. The mouse model was established to evaluate the effect of SENP3 on the growth of xenografts derived from CRC cells. To investigate the mechanisms of SENP3 in CRC, proteomic analysis was conducted.

Results: We identified an elevated expression of SENP3 in cancerous tissues, which correlated with a reduced survival rate in CRC patients. SENP3 promoted cell growth in vitro and boosted tumorigenicity in vivo as a potential oncogenic factor. In terms of mechanism, proteomic analysis revealed that growth differentiation factor 15 (GDF15) is a downstream effector of SENP3. Treatment with MG132 confirmed that SENP3 enhances the stability of GDF15. Through a series of cellular functional experiments and mouse model establishment, we demonstrated that SENP3 regulates CRC progression by acting on GDF15.

Conclusion: Based on our findings, we define a key role for SENP3 in colorectal cancer progression and suggest it as a viable target for therapeutic intervention.

Background: Robotic surgery is a well-validated treatment option for colorectal cancer (CRC). We aimed to evaluate the efficacy and safety of the Weigao (WG) robotic system compared with those of the da Vinci (DV) platform for the surgical resection of CRC.

Method: We retrospectively analyzed patients with stage I-III CRC who underwent robotic CRC resection using the Weigao or da Vinci Surgical System. Statistical analysis of perioperative clinical data, including preoperative, intraoperative, and postoperative parameters was conducted.

Result: A total of 103 patients were included and divided into the WG (n = 65) and DV (n = 38) groups. All patients achieved surgical success, and there were no significant differences in preoperative baseline characteristics. However, the WG group demonstrated a significantly longer operative time. Patients in the WG group experienced a shorter time to first flatus and a low incidence of postoperative deep vein thrombosis. Notably, the total hospitalization cost was significantly lower when the Weigao Surgical System was used.

Conclusion: This study demonstrated that the Weigao robotic system was comparable to the da Vinci system in terms of safety and efficacy for CRC surgery. Moreover, the total hospitalization cost was significantly reduced with the Weigao Surgical System, highlighting its potential as a cost-effective surgical option.

Aim: A new robotic platform, the Hugo™ robotic-assisted surgery (RAS) system, has been introduced to the market, featuring innovations such as modular arms and an open console, distinguishing it from the Da Vinci system. These differences highlight the need to establish specific, standardized training, credentialing criteria, and clinical guidelines for the use of this platform. To date, this represents the first international expert consensus on the Hugo™ RAS system.

Methods: Eleven European colorectal experts with experience using the Hugo™ RAS platform were invited to participate in this Delphi study. Seventy-seven questions related to this robotic platform were grouped into six domains: (1) required knowledge, (2) technical skills, (3) nontechnical skills, (4) assessment of competency/proficiency during training, (5) credentialing and clinical outcome data, and (6) setups and surgical technique. A three-round Delphi process was conducted. Participants were asked to indicate their agreement or disagreement using a Likert scale (0-5) regarding the proposed themes. Consensus was reached, with a minimum agreement level of 0.80 (80%).

Results: All the experts completed the three Delphi rounds, ensuring a 100% response rate throughout the process. Of the 78 statements evaluated, 33 (42%) achieved consensus agreement (> 80%) and were considered consensus recommendations, while 15 statements showed consensus disagreement (< 20%). The remaining items reflected areas of uncertainty.

Conclusions: The first consensus statement on robotic colorectal surgery with the Hugo™ RAS platform, developed by a European panel of experts, represents an important milestone and provides recommendations for colorectal surgeons considering the adoption of this new robotic platform.

Purpose: Postoperative acute pain is a major obstacle to archiving key goals in modern perioperative treatment concepts such as ERAS® (enhanced recovery after surgery). Despite a multimodal pain management concept, some patients continue to suffer from severe pain. The aim of this analysis is to identify predictors of severe postoperative pain following elective minimally invasive intestinal surgery.

Methods: Data from 49 patients, who underwent intestinal resection between April 2021 and March 2022 were used for this purpose. Various pre- and intraoperative characteristics were examined for their influence on pain in the morning in a univariate and multivariate analysis. Increased postoperative pain is defined by a NRS (numerical rating scale) of at least 4 at rest.

Results: It was found that patients with severe postoperative pain (n = 16) on the first postoperative day (POD) had a significantly higher BDI (Beck Depression Index) score of 16.1 (± 10.46) compared to patients without severe postoperative pain (n = 33) with 8.89 (± 7.03) (p = 0.007). In the multivariate analysis, the BDI score was also significant with an Odds Ratio of 1.14 (CI 95% 1.02-1.29, p = 0.002). On POD 2, patients with increased pain (n = 10) were significantly younger (53.1 years (± 16.40)) than patients without increased pain (n = 39) (65.8 years (± 12.64)) (p = 0.01). This was also confirmed in the multivariate analysis with an Odds Ratio of 1.12 (CI 95% 1.02-1.24, p = 0.019).

Conclusion: It was demonstrated that a younger age, higher BDI score and the presence of IBD are significant predictors of severe postoperative pain despite multimodal pain management.

Purpose: Magnetoelectric biofeedback therapy (MEBFT) is an emerging intervention for moderate rectocele-associated obstructed defecation syndrome (ODS); however, its efficacy and mechanisms remain unclear. This study compared MEBFT with conventional biofeedback therapy (BFT) and developed a 3D high-resolution anorectal manometry (HR-ARM)-based predictive model for clinical decision-making.

Methods: In this prospective, single-blind, randomized controlled trial, 68 female patients with defecography-confirmed moderate rectocele-associated ODS were treated in the outpatient department of Tianjin Union Medical Center from January 2019 to June 2024). Patients were randomly assigned in a 1:1 ratio to either the MEBFT or BFT group. Primary outcomes included 3D HR-ARM parameters, Glazer surface electromyography, and patient-reported outcomes (Cleveland Clinic Constipation and Patient Assessment of Constipation Quality of Life scores) at baseline and 3 months. The secondary outcomes included predictive indicators derived from the Hosmer-Rothman model and treatment response stratification.

Results: MEBFT significantly improved fast-twitch fiber recruitment, anorectal function, and quality of life compared to BFT (all P < 0.01). The Hosmer-Rothman model identified a negative MRP-MTV interaction (synergy index = 0.20), with the R₁₁ phenotype (MRP < 80 mmHg-MTV < 135 cc) predicting an 82.35% response to MEBFT after 3 months of treatment (area under the curve [AUC] = 0.72). Phenotypic stratification-guided management: R₁₁ for MEBFT, R₀₀ (elevated MRP-MTV) for surgical evaluation, and R₁₀/R₀₁ for extended MEBFT with surgical backup.

Conclusions: MEBFT demonstrated superior clinical effectiveness, anorectal functional recovery, and quality of life compared with BFT after 3 months of treatment. The exploratory Hosmer-Rothman model may provided a moderate-accuracy phenotype-based approach using 3D HR-ARM parameters to stratify treatment response and optimize the individualized management of moderate rectocele-associated ODS.

Trial registration: 1. Date of registration (needs to be before the Date of the First Patient): December 26, 2023. 2. Date of initial participant enrollment: January 9, 2019. 3. Clinical trial identification number: ChiCTR2300079173. 4. URL of the registration site: http://www.chictr.org.cn/.

Purpose: This study aimed to examine the pudendal nerve in the context of tumors involving the pudendal canal and to clarify its anatomical course and the structural composition of Alcock's canal, while elucidating the relationships among the obturator internus nerve, sacrotuberous ligament, and fascia of the obturator internus muscle.

Methods: Six cadavers (12 pelvic halves) were dissected. The dissections focused on the pudendal canal, particularly the positions and interrelationships of the fasciae, muscles, ligaments, and surrounding fascial structures from medial and posterior perspectives.

Results: The sacrotuberous ligament comprised two distinct layers, with the pudendal canal located within its structure. The proper fascia was distinguishable and situated on the muscle side of the obturator internus muscle. The pudendal nerve was traced within the fascia of the sacrotuberous ligament, whereas the obturator internus nerve coursed between the obturator internus muscle and its proper fascia. Coronal section examination of the right pelvis confirmed that the pudendal nerve was enveloped by fascia. The obturator internus nerve ran along the muscle side of the obturator internus fascia, occupying a layer distinct from that of the pudendal nerve.

Conclusions: The pudendal nerve travels within the fascia derived from the sacrotuberous ligament and does not pass through the fascia of the obturator internus. The proper fascia of the obturator internus muscle is located relatively close to the muscle, and the obturator internus nerve courses between the obturator internus muscle and its own fascia. These findings describe the anatomy of the pudendal canal and may provide a foundation for future surgical investigation.

Purpose: The LARS score is a practical tool to screen for bowel dysfunction after rectal cancer surgery. However, clinical experience suggests that it may overlook relevant symptoms and/or overestimate impact in some patients. This study aimed to explore whether the International Consensus Definition of LARS complements the LARS score in identifying patients with bowel dysfunction.

Methods: We conducted a cross-sectional study including patients treated for rectal cancer across two hospitals between January 2021 and December 2024. Demographic and clinical data were collected retrospectively. Functional outcomes were assessed during outpatient follow-up using both the LARS score and the International Consensus Definition criteria.

Results: Sixty-two patients were included. According to the LARS score, 39 (62.9%) had "no LARS", 10 (16.1%) "minor LARS" and 13 (21%) "major LARS". Using the International Consensus Definition, 24 (38.7%) met the criteria for LARS. Nine patients (14.5%) were classified differently by the two tools. Five patients classified as "no LARS" by the LARS score met the International Consensus Definition due to unpredictable bowel function and emptying difficulties with a reported impact on daily life. In contrast, four patients with "minor or major LARS" did not meet the International Consensus Definition criteria because no consequences were reported.

Conclusion: In this exploratory cross-sectional cohort, the International Consensus Definition did not identify substantially more patients than the LARS score but provided complementary information by linking symptoms to their perceived consequences. Combining both tools may offer a more comprehensive appraisal of LARS until newer multidimensional instruments become available.