International Journal of Colorectal Disease最新文献

Purpose: The study aimed to evaluate the efficacy of ultrasound-guided pudendal nerve block (PNB) versus local anesthetic infiltration (LAI) in managing the pain.

Methods: This is a prospective, randomized, double-blinded trial, 78 patients undergoing procedure for prolapse and hemorrhoids (PPH) were randomly allocated to receive either ultrasound-guided PNB or LAI. Primary outcomes were postoperative pain scores using the visual analogue scale at multiple time points within the first 48 h. Secondary outcomes included tramadol consumption, incidence of postoperative nausea and vomiting, and quality of recovery-15 (QoR-15) scores.

Results: The trial ultimately involved 71 patients. Results showed that the PNB group had significantly lower pain scores at 6, 12, and 18 h postoperatively compared with the LAI group (all P < 0.01), with no significant differences noted at 24 and 48 h. PNB group also had fewer patients requiring supplemental tramadol (5/36) than the LAI group (12/35) (P < 0.05) and experienced a delayed onset of pain (13.83 ± 11.21 h vs. 6.94 ± 2.88 h; P < 0.001). Furthermore, the incidence of anal sphincter spasms was lower in the PNB group (5/36) compared with the LAI group (12/35) (P < 0.04). QoR-15 scores at 24 h postoperatively were significantly higher in the PNB group (119.11 ± 5.87) compared with the LAI group (112.03 ± 7.04) (P < 0.05), indicating a better early recovery experience. Patient satisfaction was higher in the PNB group (28/36 vs. 22/35, P < 0.05).

Conclusion: Ultrasound-guided PNB was more effective than LAI in pain control and recovery quality. It can be considered an effective method for postoperative pain management in patients undergoing PPH surgery.

Trial registration: This study was registered with the Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ , Registration No. ChiCTR-IPR-15006427) on May 21^st, 2015.

Purpose: Urinary dysfunction (UD) is still a major complication after lower rectal cancer (LRC) surgery. Untreated UD is an independent risk factor for renal dysfunction due to repeated urinary reflux and urinary tract infections. However, the relationship between postoperative UD and renal function following LRC surgery remains unclear. In this study, we investigated the impact of UD on renal function post-surgery.

Methods: We retrospectively evaluated 83 patients with LRC who underwent curative resection at our tertiary referral center between April 2015 and December 2018. UD was diagnosed as a post-void residual urine volume ≥ 50 mL using uroflowmetry tests after discharge. We compared the estimated glomerular filtration rate (eGFR) and the incidence of chronic kidney disease (CKD)-defined as an eGFR < 60 mL/min/1.73 m²-at 3 years after LRC surgery between the UD and non-UD groups. Patient selection was based on the criteria that excluded those with a history of urogenital interventions or incomplete postoperative follow-up. Statistical analysis used the Mann-Whitney U test for continuous variables, Fisher's test for categorical data, and multivariate logistic regression to adjust for potential confounders.

Results: Of the 83 patients, 21 (25%) had UD. Patients with UD were older, underwent more extensive surgery, and had significantly longer operation times than those without UD. Within 3 years post-surgery, the UD group experienced a higher incidence of urinary tract complications and CKD, with a notable decrease in eGFR. Additionally, a history of hypertension and UD were identified as independent risk factors for CKD at 3 years post-surgery.

Conclusions: Patients with UD showed a significant decrease in eGFR and were more likely to progress to CKD at 3 years after LRC surgery. These findings indicated that postoperative UD might adversely affect renal function in patients with LRC.

Background: The role of intraabdominal drains in minimally invasive right hemicolectomy with complete mesocolic excision (CME) remains controversial. This study evaluates the impact of drain placement on perioperative outcomes using a propensity score-matched analysis in a single-center cohort.

Methods: Data from 185 patients who underwent minimally invasive right hemicolectomy with complete mesocolic excision and central vascular ligation at our institution from 2016 to November 2024 were analyzed, including 62 without drains and 123 with drains. After propensity score matching, 50 patients from each group were compared. Postoperative outcomes were assessed between the groups and multivariate analysis was performed to identify risk factors for postoperative morbidity.

Results: Postoperative complications, including morbidity (18% vs. 24%, p = 0.624), anastomotic leakage (2% vs. 2%, p = 1.000), surgical site infections (4% vs. 4%, p = 1.000) and re-surgery rate (2% vs. 6%, p = 0.617), did not differ significantly. However, the drain group showed delayed recovery milestones: longer time to first stool (2.1 vs. 2.7 days, p = 0.041), completion of meal plan (4.0 vs. 4.3 days, p = 0.038) and prolonged hospital stay (7 vs. 8 days, p = 0.045). Enhanced recovery rates were higher in the no-drain group (48% vs. 28%; p = 0.039). Multivariate analysis identified preoperative hemoglobin level ≤ 13 g/dl as a significant risk factor of postoperative complications (OR 9.8; 95% CI 2.0-48.7; p = 0.005), while drain placement was not significantly associated (p = 0.341).

Conclusion: In minimally invasive right hemicolectomy with CME, routine drain placement does not reduce postoperative morbidity but may delay recovery milestones and prolong hospital stay. These findings suggest that selective rather than routine use of drains should be considered.

Purpose: The purpose of this study was to comprehensively assess the efficacy of lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) in predicting survival outcomes in non-elderly locally advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (NCRT).

Methods: The 1643 non-elderly LARC patients undergoing NCRT between 2010 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and were randomly assigned at a ratio of 7:3. We used Cox regression models to identify independent prognostic factors, then constructed nomogram models to predict cancer-specific survival (CSS) and overall survival (OS). The relative weight in nomogram models, receiver operating characteristic (ROC), area under the curve (AUC), concordance index (C-index), calibration curve, and decision curve analysis (DCA) were performed to evaluate and compare the predictive performance between LNR and LODDS.

Results: The distribution of LNR and LODDS showed that LODDS exhibited a more detailed stratification when LNR was equal to the extreme value. In predicting CSS, the LNR (hazard ratio (HR), 1.987; 95% confidence interval (CI), 1.375-2.872) and LODDS (HR, 1.568; 95% CI, 1.154-2.131) were independent risk factors in corresponding nomogram models. Regarding OS, the LODDS (HR, 1.387; 95% CI, 1.060-1.816) showed an independent predictive value. All evaluation methods confirmed the reliability of both models. Although the LNR-based model showed better performance for short-term CSS and the LODDS-based model demonstrated slightly better prediction for long-term CSS and OS, these two models showed largely comparable predictive ability.

Conclusions: The LNR and LODDS can provide complementary prognostic value in survival prediction, offering clinicians a comprehensive basis for clinical decision-making.

Purpose: The purpose of the case series analysis is to explore the multifactorial causes of recurrent fistula-in-ano, highlighting the limitations of conventional treatment methods, and to evaluate the potential of the IFTAK (Interception of the Fistulous Tract with Application of Ksharsutra) technique. By addressing challenges such as incontinence and relapse associated with recurrent fistulas, the study aims to demonstrate how the IFTAK approach, with its sphincter-sparing and healing-promoting properties, offers an effective and sustainable solution for better management and reduced recurrence rates.

Methods: This retrospective study involved 10 patients with recurrent fistula-in-ano, consecutively selected on the basis of the date of intervention and treated using the IFTAK technique. Preoperative imaging and clinical assessments identified the fistulous tract. Intraoperatively, the tract was intercepted at the inter-sphincteric plane, followed by Ksharasutra application. Postoperative care included sitz baths, dressing changes, and weekly thread replacement until healing.

Results: Among 10 patients (8 males, 2 females; average age 39 years), cut-through was achieved in 2-3 months, depending on the fistula complexity. Weekly follow-ups ensured healing, with no recurrence observed in 10 patients over 12 months (1 year).

Conclusion: IFTAK is a minimally invasive and effective technique for managing complex and recurrent fistula-in-ano, offering reduced recurrence, sphincter preservation, and faster recovery. Further randomized trials are needed to establish its long-term efficacy with an extended follow-up period and universal applicability.

Objective: The current study seeks to investigate the clinical outcomes of combining immune checkpoint blockade, anti-angiogenesis, and chemotherapy in neoadjuvant treatment for individuals diagnosed with locally advanced (high-risk Stage III or initially unresectable Stage III) or resectable/unresectable Stage IV colorectal cancer, including metastatic cases.

Methods: A total of 120 individuals diagnosed with advanced colorectal cancer (stage III: n = 65; stage IV: n = 55; metastatic sites: liver n = 30, lung n = 15, peritoneal n = 10) were enrolled at three hospitals between February 2021 and December 2022. All patients underwent biopsy and pathology confirmation. Based on the treatment plan, patients were categorized into a control group (n = 60) receiving standard FOLFOX/FOLFIRI chemotherapy and an experimental group (n = 60) receiving a combination of pembrolizumab (200 mg IV q3w), bevacizumab (5 mg/kg IV q2w), and FOLFOX regimen (oxaliplatin 85 mg/m², leucovorin 400 mg/m², 5-fluorouracil 400 mg/m² bolus followed by 2400 mg/m² infusion over 46 h). VEGF and bFGF levels were assessed using ELISA before and after treatment. Flow cytometry analyzed CD4 + levels and the CD4 + /CD8 + ratio, while serum tumor markers Cancer antigen 199 (CA 19-9) and Carcinoembryonic antigen (CEA) were measured by chemiluminescence immunoassay. Therapeutic outcomes, median OS, and median PFS were compared between the two groups using Kaplan-Meier analysis and log-rank tests (normality confirmed via Shapiro-Wilk test).

Results: After a 6-week treatment period, the experimental group showed a more significant reduction in VEGF (Δ = 132.0 pg/mL vs. 57.9 pg/mL) and bFGF (Δ = 51.4 pg/mL vs. 20.1 pg/mL) compared to the control group (P < 0.001). The experimental group demonstrated higher CD4 + /CD8 + ratios post-treatment (1.65 vs. 1.23, P < 0.01) and greater reductions in CA 19-9 (Δ = 42.5 U/mL vs. 23.8 U/mL) and CEA (Δ = 12.6 ng/mL vs. 6.9 ng/mL) (P < 0.01). Response rates (CR + PR: 40.0% (Experimental: 8.3% CR + 31.7% PR) vs. 18.4% (Control: 1.7% CR + 16.7% PR); DCR: 46.7% vs. 25.0%) and survival outcomes (median OS: 32.26 vs. 28.55 months; median PFS: 6.37 vs. 4.58 months) were superior in the experimental group (P < 0.05).

Conclusion: Combining neoadjuvant therapy with immune checkpoint blockade, anti-angiogenesis, and chemotherapy significantly improves tumor downstaging (as evidenced by pathologic complete response rates of 18% in the experimental group vs. 5% in the control group among resected patients) and survival outcomes, presenting a promising therapeutic approach for locally advanced and oligometastatic colorectal cancer.

Purpose: Primary objective was to compare the rates of parastomal hernia (PH) at 2 years after the creation of a terminal colostomy using two types of fascial incision: cross-shaped and reinforced longitudinal. Secondary objectives included the evaluation of postoperative complications, readmissions, reoperations for PH, and patients' quality of life.

Methods: This was a multicenter superiority clinical trial conducted at 5 hospitals involving patients with rectal cancer and definitive colostomy. Patients were randomized into two groups: cross incision (n = 42) or reinforced longitudinal incision (n = 52), for the exteriorization of the colon in terminal colostomy. PH at 2 years was determined by physical examination, computed tomography (CT), and symptoms. Baseline data on risk factors for PH, postoperative complications, readmissions, reoperations for symptomatic PH, and quality of life were recorded.

Results: A total of 95 patients were included: cross (n = 42) and reinforced longitudinal (n = 52). Demographic characteristics, risk factors for PH, and surgical factors were similar between the two groups. No significant differences were found in the clinical PH rate between the cruciate versus longitudinal incision groups (48.60% vs. 45.20%; p = 0.770), radiological PH (54.30% vs. 53.70%; p = 0.956), or symptomatic PH (14.30% vs. 19%; p = 0.579). The comprehensive complication index (CCI), readmissions, and reoperation rates for symptomatic PH (8.6% vs. 7.1%; p = 0.816) were similar in both groups. No significant differences were observed in the three health aspects evaluated using the EORTC QLQ-C30 scale.

Conclusion: The reinforcement of a longitudinal fascial incision as an isolated surgical technique does not reduce the incidence of PH after a 2-year follow-up.

Purpose: Robotic ventral rectopexy (RVR) has gained acceptance as a minimally invasive approach for treating rectal prolapse and rectocele. Although numerous surgical videos have been published, their educational quality remains underexplored. This study aimed to evaluate the overall quality, adherence to reporting guidelines, and educational value of the most-viewed RVR videos on YouTube, as rated by surgical trainees, fellows, and senior surgeons.

Methods: The 25 most-viewed YouTube videos on RVR were selected and assessed for adherence to LAP-VEGaS and consensus reporting guidelines, overall quality, and educational value. Surgeons' performance was evaluated using the Global Evaluative Assessment of Robotic Skills (GEARS) scale. A Bayesian ordinal regression model analyzed factors influencing video quality and utility ratings.

Results: Video quality and educational value varied significantly among viewer groups. Only 40% of videos underwent peer review before publication. Adherence to reporting guidelines was low (median conformity rate: 13.5%-16.7%). Inter-rater reliability differed across GEARS domains, with senior surgeons rating video quality and utility more critically than trainees and fellows. Videos with more likes and shorter online duration were more likely to be rated as high-quality.

Conclusions: Online surgical videos on RVR offer easily accessible but potentially unreliable educational resources and exhibit significant variability in quality and guideline adherence. Structured, peer-reviewed video-based educational programs and standardized reporting practices are crucial for improving the educational impact of online surgical videos.

Purpose: This study aims to evaluate the prognostic influence of different metastatic sites and the effect of surgical resection on survival. Additionally, it explores how anatomical location influences prognosis before and after metastasectomy.

Methods: This retrospective study included 999 mCRC patients treated at Taipei Veterans General Hospital from 2013 to 2019. Survival outcomes across liver, lung, peritoneal, and distant lymph node (LN) metastases were analyzed using Kaplan-Meier and Cox regression models.

Results: Prognosis varied significantly by metastatic site. For single-site metastases, distant LN metastases had the longest OS (36.8 months), followed by lung (35.5 months), liver (26.5 months), and peritoneal metastases (21.5 months; p = 0.001). Lung metastases showed the longest PFS (11.7 months), followed by distant LN (10.8 months), peritoneal (9.8 months), and liver (9.1 months; p = 0.031). Surgical resection significantly improved OS (HR = 0.477, p < 0.001). With metastasectomy, OS was comparable for liver, lung, and distant LN metastases (p = 0.288), while peritoneal metastases had significantly poorer outcomes (HR = 2.208, p = 0.001). In patients without surgery, OS was significantly poorer across all metastatic sites, with lung metastases demonstrating the most favorable prognosis (OS = 31.9 months) and statistically significant differences compared to liver, peritoneal, and distant LN metastases (p < 0.001).

Conclusion: The prognosis of mCRC varies by metastatic site. Surgical resection significantly improves survival for liver, lung, and distant LN metastases but is less effective for peritoneal metastases. Surgery reduces the prognostic disparity among resectable sites except for peritoneal seeding.