International Journal of Colorectal Disease最新文献

Objectives: Crohn's disease (CD), ulcerative colitis (UC), intestinal Behçet's disease (BD), intestinal tuberculosis (ITB), and primary intestinal lymphoma (PIL) are major intestinal disorders that frequently present with mucosal ulceration. Accurate differentiation among these conditions is challenging due to overlapping clinical, endoscopic, and imaging characteristics. Accordingly, this study aimed to develop an artificial intelligence (AI)-assisted endoscopic diagnostic system to accurately identify these five diseases.

Methods: This multicenter prospective study used endoscopic images from patients diagnosed with pathologically confirmed CD, UC, BD, ITB, and PIL to develop an AI system that uses convolutional neural networks (CNNs) and transformer architectures. It was validated across multiple centers compared with endoscopist performance, and assessed prospectively. In addition, clinical data were integrated to construct a comprehensive diagnostic model.

Results: Internal validation revealed that the AI system achieved an accuracy of 96.8%, with sensitivities for the five ulcerative diseases ranging from 76.9% to 97.8%. In the multicenter test (Test A + Test B3), diagnostic accuracy reached 83.4%, outperforming endoscopists. Prospective evaluation revealed that AI system demonstrated significantly higher accuracy than senior endoscopists (83.4% versus 59.4%, P < 0.001). Moreover, the optimal comprehensive model, which combined clinical and endoscopic data, achieved an accuracy of 76.3%.

Conclusions: An AI-assisted endoscopic diagnostic system that accurately differentiates CD, UC, BD, ITB, and PIL was developed, which may contribute to improving diagnostic precision for colorectal ulcerative diseases.

Purpose: Preoperative radiotherapy (pRT) for rectal cancer (RC) reduces local recurrence rates. However, treatment-induced side effects may compromise patient-reported quality of life (QoL). This study aimed to report longitudinal QoL and physician-assessed toxicity in RC patients receiving preoperative intensity modulated radiotherapy (IMRT).

Methods: This prospective cohort study included 123 RC patients treated with short-course (SCRT) or long-course chemoradiotherapy (LCRT). Patient-reported outcomes (PRO) were assessed using the EORTC QLQ-C30 and CR29 questionnaires at pretreatment, end of treatment, preoperatively, and at 1-year follow-up. Physician-reported toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE). Longitudinal changes in PROs were analysed using mixed-effects regression modelling. CTCAE grades were reported as frequencies, and symptom transitions illustrated using Sankey diagrams.

Results: For EORTC C30 items, pRT-induced transient declines were observed for Global Health, physical, role and social functioning, fatigue, and pain, with scores recovering at preoperative assessment, except for persistent worsening for fatigue. At 1-year, Global Health remained stable; emotional functioning improved; fatigue and social functioning showed minor persistent worsening. Bowel and bladder symptoms peaked during pRT and gradually resolved or improved at 1Y. CTCAE grades were predominantly mild; diarrhoea and rectal bleeding improved over time, while urinary dysfunction and fatigue increased modestly. Sankey plots illustrate symptom transitions. Discrepancies were noted between physician- and patient-reported outcomes.

Conclusion: IMRT-based pRT was associated with largely preserved QoL at 1Y. Reported trajectories of PRO and CTCAE scores provide complementary insights to support physician-patient communication, with differences underlining the importance of integrating both perspectives.

The purpose of the present study was to perform a systematic review and meta-analysis of the available literature on the surgical management of Hinchey III diverticulitis comparing laparoscopic lavage with surgical resection.

Methods: A PubMed and EMBASE search using well-defined mesh terms was used. All identified papers were screened for possible inclusion in the study by initial review of abstracts. Only randomized trials were included in the meta-analysis.

Results: The search resulted in 23 studies available for closer investigation. We managed to identify 3 separate randomized trials comparing the outcome after laparoscopic lavage and sigmoid resection for Hinchey III diverticulitis. Early and late results of these trials have been reported in 7 scientific papers constituting the basis of the present systematic review and meta-analysis. For the different endpoints, pooled data from between 292 and 380 patients randomized to either sigmoid resection or laparoscopic lavage was available for analysis. Ninety-day mortality was similar between the groups (OR = 0.69 (0.32-1.49)), but the risk of severe complications and of recurrent diverticulitis was lower among patients randomized to sigmoid resection (OR = 0.61 (0.38-0.98) and OR = 0.15 (0.05-0.44), respectively). The risk of having a stoma after 1 year was higher among patients randomized to resection (OR = 2.97 (1.30-6.81)). No significant differences were identified regarding the need for reoperation. Subsequent analysis of data from two of the randomized trials showed that smoking and use of immunosuppressant medications were associated with a poorer outcome after laparoscopic lavage.

Conclusions: Laparoscopic lavage has certain advantages when compared to resection for Hinchey III diverticulitis, but should be used with caution in smokers and patients taking immunosuppressants. After lavage, recurrent diverticulitis (often uncomplicated) is likely to occur. Resection with primary anastomosis is a good option in stable and fit patients when surgical expertise is available, but for a number of patients, resection with formation of a stoma seems to be the safest option.

Introduction: Colorectal carcinoma (CC) is a rare disease in the pediatric population, with an annual incidence of 1 in 10 million adolescents, and it accounts for approximately 1% of pediatric solid neoplasms. It is the most common primary gastrointestinal malignancy in children with the vast majority of CCs being adenocarcinoma (CA). Unfortunately, the proportion of poorly differentiated, mucinous type, signet-ring cell containing carcinomas is higher in younger patients than in adults. Moreover, due to the low awareness of the disease, diagnosis is usually delayed until advanced stages, resulting in an extremely poor prognosis. Surgery is the only curative modality for localized CAs, whereas adjuvant chemotherapy is the standard of care for patients with stage III cancer to eradicate micro-metastases.

Patients and methods: In the last 10 years, we treated 3 patients diagnosed with CA: a 14-year-old female, a 15-year-old male, and a 15-year-old female. All patients presented to our Emergency Department with nonspecific symptoms of abdominal pain and vomiting.

Results: All patients were subjected to laparoscopic tumor resection to relief intestinal obstruction. In the male patient, laparoscopy was converted to laparotomy to safely assess the anatomy because of strong peritoneal adhesions. No stomas were created, in order to improve quality of life. Oxaliplatin and 5-fluorouracil-based regimens were among the most commonly used chemotherapy combinations. The 15-year-old female and the 15-year-old male died 1 year after the surgical resection, while the 14-year-old female is still on follow-up.

Conclusions: CAs behave aggressively in children; they not only show a poorer response to chemotherapy, but are also associated with extensive intramural spread and peritoneal carcinomatosis. Lack of awareness and timely intervention remain the main challenges for early diagnosis and improved prognosis of CA.

Purpose: To compare perioperative outcomes and safety between the novel single-port robotic systems (SPRS) and the da Vinci Xi robotic system (DVRS) in radical colorectal cancer resection.

Methods: In this retrospective cohort study, 59 patients who underwent curative colorectal resection were assigned to either the SPRS group (n = 21) or the DVRS group (n = 38). Intraoperative metrics, postoperative recovery parameters, and complications were compared between groups.

Results: All procedures were successfully completed without open conversion and the number of lymph nodes harvested was comparable. The SPRS group demonstrated significantly longer operative times (298.86 ± 76.08 min vs. 227.84 ± 70.20 min; p < 0.001). No significant differences were observed in estimated blood loss, time of gastrointestinal recovery(first flatus), time of dietary resumption (liquid/soft diet), or 30-day readmission rates (p > 0.05). The DVRS group exhibited prolonged median postoperative hospitalization (10.00 days [IQR 8.00-11.75] vs. 8.00 days [IQR 7.00-9.00]; p < 0.05). Patients in the SPRS group reported significantly higher satisfaction scores regarding the cosmetic appearance of postoperative scars compared to those in the DVRS group(7.71 ± 1.01 vs. 6.66 ± 0.91; p < 0.001). Complication rates showed no statistical difference (p > 0.05). All complications were Clavien-Dindo grade I-II managed conservatively, except one SPRS case requiring endoscopic intervention for grade IIIa gastrointestinal hemorrhage.

Conclusions: The novel single-port robotic systems are safe and feasible for radical colorectal cancer surgery. They achieve short-term outcomes comparable to the da Vinci Xi system, with the advantages of a shorter hospitalization and better cosmetic outcomes but at the expense of a longer operative time.

Purpose: Early colorectal cancer (CRC) detection is crucial for effective treatment; however, traditional screening methods face challenges. Colonoscopy, though highly effective, has limited availability, and fecal immunochemical tests (FIT) are more accessible and cost-effective but suffer from low adherence. Our retrospective study aimed to develop a transparent artificial-intelligence model leveraging routine CBC data as a cost-effective method for CRC detection.

Methods: We conducted a retrospective analysis of 28,450 individuals aged 45-75 who underwent colonoscopy within six months of a complete blood count (CBC) test. Among them, 439 (1.8%) had CRC, 2,955 (11.8%) had advanced adenomas, and 21,662 (86.5%) had benign findings on colonoscopy. The database was divided into training (70%) and testing (30%) sets. The model was developed using ridge regression.

Results: Descriptive analysis revealed significant differences between CRC cases and controls across most CBC markers, CBC-derived ratios, and age (P < 0.001), except for lymphocytes. The model, based on red cell distribution width (RDW), systemic inflammation response index (SIRI), hemoglobin, and age, achieved an AUC of 0.77 (95% CI: 0.75-0.77) for CRC, comparable to a deep learning model (TabPFN). Interpretability analysis revealed that older age, elevated RDW and SIRI, and low hemoglobin were associated with CRC. In a subgroup (7.25%) with FIT results, FIT showed higher sensitivity for CRC (88%) than the model (64%), but lower specificity (77% vs. 81%).

Conclusion: Given CBC's widespread use and accessibility, this approach may be a scalable pre-screening tool to improve CRC risk stratification and optimize resource allocation, demonstrating how explainable AI may augment existing CRC screening programs.

Purpose: Antibiotic therapy may be an alternative in the treatment of uncomplicated appendicitis. The primary concern about antibiotic therapy is the need for appendectomy due to recurrent acute appendicitis after treatment. The optimal antibiotic choice, route of administration, and duration of treatment remain controversial. We aimed to demonstrate the long-term success of oral antibiotic therapy in uncomplicated appendicitis.

Methods: This was a single-center retrospective study including all patients diagnosed with uncomplicated acute appendicitis between January 2020 and December 2022, who were discharged from the emergency department on oral antibiotics without hospitalization. Treatment success was defined as the absence of appendectomy during follow-up. We reported long-term treatment success rates of oral antibiotic therapy. In addition, factors that may affect treatment success were evaluated.

Results: A total of 99 patients were included in the study. At 1 year, the treatment success rate was 76% (95% CI = 66-83%). At a median follow-up of 34 months, 70% (95% CI = 60-78%) remained free of surgery. The Kaplan-Meier analysis revealed that 80% of appendectomies due to recurrent acute appendicitis occurred within the first 10 months. There were no significant differences between patients who required appendectomy and those who did not regarding age, sex, WBC count, neutrophil-to-lymphocyte ratio, appendix diameter, or previous intravenous antibiotic use.

Conclusion: With a median follow-up of 34 months, oral antibiotic-only treatment prevented appendectomy in 70% of patients. Larger, prospective randomized studies are needed to identify factors influencing treatment success.

Purpose: The study aims to evaluate the correlation between visceral adiposity, fatty liver, and survival in patients with metastatic colorectal cancer (mCRC).

Methods: The study included 131 adult patients with treatment-naive mCRC. The visceral and liver fat content was measured using baseline computed tomography (CT) images. The analysis used the 50th percentile (131.80 HU) visceral adiposity value as a cutoff. The visceral and liver fat content association with patient characteristics and outcomes was assessed.

Results: In the overall cohort, neither visceral adiposity (median OS 37.8 vs 36.7 months, HR = 0.83; p = 0.428) nor liver steatosis (median OS 46.0 vs 33.9 months, HR = 0.81; p = 0.370) showed significant association with OS. However, in patients with BMI ≥ 25 kg/m², liver steatosis was associated with significantly shorter survival (median OS 35.2 vs 59.5 months; adjusted HR = 0.49; p = 0.040). Visceral adiposity remained non-significant across BMI subgroups.

Conclusion: We observed a possible association between liver steatosis and OS in patients with mCRC in the high BMI subgroup. Prospective studies are essential to validate these findings and the role of liver steatosis in the prognostic assessment of mCRC patients.

Purpose: Current diagnostic modalities lack sufficient sensitivity for detecting omental metastasis (OM), often underestimating metastatic burden. Unlike traditional statistical model, machine learning (ML) model is designed to detect subtle variable interactions and model nonlinear patterns that traditional statistics overlook, enhancing the reliability of OM risk evaluation in clinical practice. The aim of the study was to build a ML model in preoperatively predicting OM in right-sided colon cancer (RCC) patients using a multicenter dataset.

Methods: This retrospective multicenter study included 1798 RCC patients: 1206 from Zhejiang Cancer Hospital (training set n = 804, test set n = 402) and 592 from the Second Affiliated Hospital of Harbin Medical University (validation set). OM status, tumor location, preoperative CEA level, preoperative CA199 level, Grade, histology, tumor size and age of patients were recorded. Six ML models including extreme gradient boosting (XGB), artificial neural network (ANN), logistic regression (LR), random forest (RF), support vector machine (SVM) and decision tree (DT) were developed for the OM prediction in RCC. The area under the receiver operator characteristic (ROC) curve (AUC), accuracy, sensitivity, specificity, precision, F1 score and decision curve analysis (DCA) were analyzed for judging predictive performance.

Results: The OM rates in training set, test set and validation set were 10.4%, 9.5% and 10.0%, respectively. The XGB model outperforming five other algorithms (ANN, RF, LR, SVM, and DT) across training set (AUC = 0.924, 0.096 gain vs LR), internal test (AUC = 0.868, 0.038 gain vs LR) and validation set (AUC = 0.766, 0.065 gain vs LR). The comparison of accuracy, sensitivity, specificity, precision and F1 score revealed the XGB model exhibited the best performance. The DCA curve also suggested that XGB had better clinical decision-making capability than the other five models. Feature importance analysis highlighted preoperative CEA level and tumor location as key predictors.

Conclusion: Our study developed and validated an XGB-based machine learning model that could accurately predict OM in RCC patients using routine preoperative variables. This model demonstrates strong discriminative ability and clinical utility, assisting personalized risk stratification and appropriate treatment decisions.

Purpose: Treatment strategies for early and locally advanced rectal cancer are evolving, particularly with the increasing use of non-operative management and multidisciplinary decision-making. The aim of this study is to establish an expert-based consensus on the preferred treatment strategies for early and locally advanced rectal cancer.

Methods: A 12-member steering committee was established to conduct a modified Delphi consensus process on rectal cancer management. The committee performed a systematic literature review (2014-2024) to inform survey development. A 49-question survey, including open-ended and multiple-choice items, was developed and refined. A panel of 44 colorectal surgery experts was selected based on academic contributions, and two Delphi rounds were conducted anonymously. Consensus was defined as ≥ 70% agreement. Based on panel responses, 29 consensus statements were formulated.

Results: The panel reached consensus on the importance of multidisciplinary evaluation and surgical expertise in total mesorectal excision. Structured MRI reporting was recommended. Total neoadjuvant therapy was preferred for high-risk tumors. Non-operative management was recommended in cases of clinical complete response, with defined surveillance strategies. The role of biopsy in near-complete responders was also addressed.

Conclusions: This international consensus provides structured guidance on the management of rectal cancer, emphasizing multidisciplinary planning, the role of total neoadjuvant therapy in organ preservation, and rigorous surveillance protocols in non-operative management. These recommendations aim to standardize care and support evidence-informed clinical decision-making.