International Journal of Colorectal Disease最新文献

Purpose: The presence of chaperones during intimate physical examinations is a matter of ongoing debate. While most guidelines recommend the use of chaperones in all cases, there are no clinical trials specifically investigating intimate exams performed on women by male physicians. We aimed to evaluate female patients' perceptions regarding the presence or absence of chaperones during proctological examinations conducted by male physicians.

Methods: In this randomised clinical trial, patients were assigned, unaware that they were participating in a study, to either Group 1 (without a chaperone during their proctological exam) or Group 2 (with a chaperone). After the appointment, they completed a questionnaire regarding the examination they had just undergone. The study was conducted at two hospitals in Southern Brazil.

Results: Ninety-five patients were included in each group. The mean (SD) comfort score was 8.3 (2.9) with a chaperone and 8.8 (2.5) without a chaperone (P = 0.25). When asked if they would want the exam performed the same way in the future, 72.6% in Group 1 answered 'yes', compared to 58.9% in Group 2 (P = 0.046). In Group 2, 48.4% of patients did not feel more protected by the chaperone, while none of the patients in Group 1 felt less protected without one.

Conclusions: Forgoing chaperones during proctological examinations of women, when the physician is male, is well accepted by most patients. Preferences regarding chaperones are complex, demanding a selective approach. The use of chaperones should remain a recommendation, not a requirement, to accommodate individual needs while maintaining the doctor-patient relationship.

Trial registration: ClinicalTrials.gov number, NCT03615586.

Purpose: Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide. Metastatic colorectal cancer (mCRC) continues to present significant challenges, particularly in patients with proficient mismatch repair/microsatellite stable (pMMR/MSS) tumors. This narrative review aims to provide recent developments in immunotherapy for CRC treatment, focusing on its efficacy and challenges.

Methods: This review discussed the various immunotherapeutic strategies for CRC treatment, including immune checkpoint inhibitors (ICIs) targeting PD-1 and PD-L1, combination therapies involving ICIs with other modalities, chimeric antigen receptor T-cell (CAR-T) cell therapy, and cancer vaccines. The role of the tumor microenvironment and immune evasion mechanisms was also explored to understand their impact on the effectiveness of these therapies.

Results: This review provides a comprehensive update of recent advancements in immunotherapy for CRC, highlighting the potential of various immunotherapeutic approaches, including immune checkpoint inhibitors, combination therapies, CAR-T therapy, and vaccination strategies. The results of checkpoint inhibitors, particularly in patients with MSI-H/dMMR tumors, which have significant improvements in survival rates have been observed. Furthermore, this review also addresses the challenges faced in treating pMMR/MSS CRC, which remains resistant to immunotherapy.

Conclusion: Immunotherapy plays a significant role in the treatment of CRC, particularly in patients with MSI-H/dMMR tumors. However, many challenges remain, especially in treating pMMR/MSS CRC. This review discussed the need for further research into combination therapies, biomarker development, CAR-T cell therapy, and a deeper understanding of immune evasion mechanisms for CRC treatment.

Introduction: Rectal cancer is a prevalent disease that requires multidisciplinary management. Results of treatment of patients suffering from this malignancy in Latin America have been scarcely reported before.

Methods: A retrospective, multicenter study was conducted to report preoperative and operative characteristics of patients intervened for rectal cancer in centers from Latin America during 2015-2022, and the short-term results of treatment were analyzed. The study was open to any center receiving rectal cancer patients, irrespective of volume. The main study outcome was 30-day postoperative complications including any deviation from the normal postoperative course (Clavien Dindo I to V).

Results: A total of 2044 patients from 49 centers in 12 Latin American countries were included, with a mean age of 63 years. Twenty-five percent of patients were operated in low-volume centers. Twenty-nine percent of patients had a tumor located in the low rectum, and only 53% of patients had preoperative MRI for local staging. A total of 1052 patients (52%) received neoadjuvant therapy before surgery. Eighty-six percent of patients were operated by a specialized colorectal surgeon, and 31% of patients were intervened using a conventional approach. A total of 29.9% of patients presented a postoperative complication. The anastomotic leak rate was 8.9%. Fifty-eight percent of pathology reports had less than 12 lymph nodes harvested, and 22.9% of reports did not include mesorectal quality. In the multivariate analysis, neoadjuvant therapy (OR: 1.44, p-value: 0.023), urgent procedures (OR: 3.73, p-value: 0.049), intraoperative complications (OR: 2.21, p-value: 0.046), advanced tumors (OR: 1.39, p-value: 0.036), and prolonged surgery (OR: 1.74, p-value: 0.004) were found to be independently related to suffering postoperative complications.

Conclusions: This study includes information about the approach and results of rectal cancer management in Latin America at a large scale. In the future, this information can be used as a bridge to identify areas of improvement among rectal cancer patients' treatment in the region.

Purpose: Endoscopic resection is appropriate for selected colorectal polyp cancers, but significant variation exists in treatment. This study aims to investigate variation in management of screen-detected polyp cancers (T1), factors predicting primary endoscopic polypectomy and threshold for subsequent surgical resection.

Method: Patients with polyp cancers (T1) diagnosed by the bowel cancer screening programme (BCSP) were investigated at two screening centres (5 individual sites and 4 MDTs, 2012-2022). Patient demographics, pathological characteristics, management and outcomes were recorded. Variation in management was compared between sites. Risk factors for primary endoscopic polypectomy and the need for subsequent surgical resection were analysed using multivariable binary logistic regression models.

Results: Of 220 polyp cancers, 178 (81%) underwent primary endoscopic resection. Secondary surgical excision was required in 54 (30%). Study sites were not significantly different in their primary management for colonic or rectal polyps. Only the size of colonic polyps was associated with primary surgery rather than endoscopic polypectomy (OR 1.05 (95% CI 1.00-1.11); p = 0.038). There was a difference between study sites in the odds ratio for secondary surgery after primary polypectomy for colonic polyps (OR 3.97 (95% CI 1.20-16.0); p = 0.033) but not rectal. Other factors associated with the requirement for secondary surgery were as follows: sessile morphology for colonic polyps (OR 2.92 (95% CI 1.25-6.97); p = 0.013) and en-bloc resection for rectal polyps (OR 0.14 (0.02-0.85); p = 0.043).

Conclusion: There was significant variation in the assessment and treatment of colonic polyp cancers. Standardising pathology reporting and treatment algorithms may lead to better consistency of care and a reduction in secondary surgery.

Background: Surgical site infection (SSI) represents a significant postoperative complication in colorectal cancer (CRC). Identifying associated factors is therefore critical. We evaluated the predictive value of clinicopathological features and inflammation-based prognostic scores (IBPSs) for SSI occurrence in CRC patients.

Methods: We retrospectively analyzed data from 1445 CRC patients who underwent resection surgery at Wuhan Union Hospital between January 2015 and December 2018. We applied two algorithms, least absolute shrinkage and selector operation (LASSO) and support vector machine-recursive feature elimination (SVM-RFE), to identify key predictors. Participants were randomly divided into training (n = 1043) and validation (n = 402) cohorts. A nomogram was constructed to estimate SSI risk, and its performance was assessed by calibration, discrimination, and clinical utility.

Results: Combining the 30 clinicopathological features identified by LASSO and SVM-RFE, we pinpointed seven variables as optimal predictors for a pathology-based nomogram: obstruction, dNLR, ALB, HGB, ALT, CA199, and CA125. The model demonstrated strong calibration and discrimination, with an area under the curve (AUC) of 0.838 (95% CI 0.799-0.876) in the training cohort and 0.793 (95% CI 0.732-0.865) in the validation cohort. Decision curve analysis (DCA) showed that our models provided greater predictive benefit than individual clinical markers.

Conclusion: The model based on simplified clinicopathological features in combination with IBPSs is useful in predicting SSI for CRC patients.

Background: A postoperative surgical site infection (SSI) is a prevalent complication after loop ileostomy closure. There are few studies on the risk factors and the development of predictive models for postoperative SSIs. The aim of this study was to develop and validate a nomogram model capable of accurately predicting the occurrence of postoperative SSIs.

Methods: This retrospective analysis examined the clinical data of 369 patients who underwent loop ileostomy closure at a local hospital from January 2015 to March 2022. A logistic regression model was used to identify the potential risk factors for a postoperative SSI after loop ileostomy closure. A nomogram was established using independent risk factors, and the prediction performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC).

Results: Forty-eight (13.0%) developed postoperative SSIs after loop ileostomy closure. Multivariate logistic regression analysis revealed that a body mass index (BMI) > 25 kg/m², diabetes, linear skin closure (LSC), and a prolonged operative time were independent risk factors for SSIs, whereas the presence of a subcutaneous drainage tube was identified as an independent protective factor. The nomogram models constructed using these variables achieved AUCs of 0.833 and 0.823 on the training set and validation set, respectively. The calibration curves demonstrated excellent consistency.

Conclusion: The nomogram developed using clinical data from patients who underwent loop ileostomy closure demonstrates a robust predictive capability, offering valuable guidance to clinicians in assessing the risk of postoperative SSIs.

Background: Autophagy damage will aggravate intestinal damage caused by sepsis. Studies have shown that the activation of AQP3 and SIRT1 signals can reduce the inflammatory response of sepsis. However, their role and mechanism in intestinal injury in the late stage of sepsis are not deeply studied.

Objective: To explore whether AQP3 can mediate autophagy by regulating the SIRT1/P62 signaling pathway to alleviate intestinal epithelial cell damage caused by sepsis.

Methods: Caco-2 cells were transfected with plasmid to overexpress AQP3. Western blot and RT-qPCR were used to detect the expression of cell protein, ELISA was used to detect the level of cytokines, DCFH-DA probe was added to quantify the ROS level, and the integrity of cell barrier was evaluated by measuring the transepithelial resistance (TEER). The autophagy levels were observed by MDC staining, and the levels of ZO-1 and Occludin were detected by immunofluorescence.

Results: AQP3 was down-regulated in the Caco-2 cell injury model induced by LPS in vitro. Overexpression of AQP3 inhibited the production of inflammatory factors and ROS, thus relieving LPS-induced intestinal epithelial cell damage; restored the TEER of cells; up-regulated the expression of claudin-1, TJP-1, Occludin, and ZO-1, thus alleviating the cell barrier injury; increased autophagy bodies in cells; and increased the expression of Beclin1 and the ratio of LC3-II/LC3-I while inhibiting the expression of p62, thus restoring the autophagy level of cells. However, autophagy inhibitor 3-MA and SIRT1 inhibitor EX 527 offset these effects of AQP3 overexpression.

Conclusion: AQP3 regulated the autophagy level of Caco-2 cells induced by LPS through SIRT1/p62 signal and relieved intestinal epithelial cell damage caused by sepsis.

Purpose: Stage III colorectal cancer (CRC) is typically treated with surgery; however, it has a high recurrence rate and inconsistent benefits from postoperative chemotherapy. Inflammatory markers like the neutrophil-to-lymphocyte ratio (NLR) have shown prognostic value in various cancers. However, the prognostic significance of NLR measured before and after CRC surgery is not clear. This study aims to clarify the prognostic value of the combination of pre- and post-surgery NLR in stage III CRC patients.

Methods: Patients with stage III CRC treated between 2001 and 2022 were retrospectively analyzed using data from the Chang Gung Medical Research Database. Patients were categorized into 4 groups based on their pre- and post-operative NLR levels. Kaplan-Meier survival analysis and Cox proportional hazard models were used to assess the associations between NLR levels and overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS).

Results: Data from 2,742 patients, median age of 62 years and 54% male, were analyzed. After adjustment, patients in Group IV, with high NLR values both before and after surgery, had greater risks of worse DFS (adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI]: 1.13-1.50), OS (aHR = 1.36, 95% CI: 1.14-1.63), and CSS (aHR = 1.27, 95% CI: 1.04-1.55) compared to Group I.

Conclusions: High NLR levels before and after surgery is a strong predictor of poor outcomes in stage III CRC patients. The findings suggest that monitoring NLR at both time points can be a valuable prognostic tool, guiding postoperative care and treatment strategies to improve patient outcomes.

Purpose: We have evaluated lateral pelvic lymph node dissection (LPLND) in combination with rectal resection in the treatment of locally advanced rectal cancer in a specialized colorectal surgical department with a focus on safety and feasibility.

Methods: The study analyzed surgical-pathologic outcomes in 17 consecutive patients who underwent robotic LPLND and rectal resection between May 2018 and June 2024 at a high-volume colorectal cancer center in Denmark. Patients were selected for the procedure based on lateral lymph node (LLN) diameter ≥ 8 mm before and ≥ 5 mm after neoadjuvant treatment.

Results: Out of 17 patients (15 men and 2 females) included in this study, 13 patients (76%) had undergone neoadjuvant therapy. The median age was 63 years (range 35-79) with a median BMI of 25.6 kg/m² (range 19.4-34.5). The total median operation time was 335 min (range 182-526 min) with no conversions necessary. Additional resection of structures beyond the total mesorectal excision plane was performed in eight patients (47%). The median hospital stay was 4 days (range 2-14) and one patient was readmitted within 30 days. Seven patients experienced postoperative complications within 30 days, with only one CD complication ≥ grade 3. The median number of resected LLNs was 4 (range 0-11) per patient and malignant LLNs were verified in three patients (17.6%).

Conclusion: This study shows that simultaneous robot-assisted LPLND and rectal resection can be performed safely and effectively in selected patients with locally advanced rectal cancer, with a short hospital stay and few readmissions and postoperative complications.

Purpose: To explore the potential of circulating tumor DNA (ctDNA) as a prognostic biomarker to predict treatment response and survival outcomes in patients with metastatic colorectal cancer (mCRC).

Methods: A retrospective analysis was conducted on 134 patients with mCRC who were treated between January 2020 and December 2021. The patients were classified into ctDNA-negative and ctDNA-positive groups based on plasma ctDNA detection. Demographic, clinical, and laboratory parameters, treatment response, survival outcomes, and adverse events were recorded and analyzed.

Results: No significant differences were observed in baseline characteristics between the two groups. Compared to the ctDNA-positive patients, ctDNA-negative patients exhibited superior outcomes, including a higher objective response rate (65.22% vs. 46.15%), disease control rate (81.16% vs. 63.08%), progression-free survival (8.24 ± 1.02 vs. 7.86 ± 0.91 months), overall survival (24.58 ± 3.58 vs. 23.27 ± 3.46 months), and 1-year survival rate (73.91% vs. 55.38%). The ctDNA-positive group had a significantly higher incidence of adverse events. Correlation analyses revealed significant associations between ctDNA status, tumor markers, treatment response, and survival outcomes.

Conclusions: ctDNA is a promising noninvasive biomarker for predicting treatment response, survival, and adverse events in mCRC, potentially guiding personalized therapeutic strategies.