International Journal of Colorectal Disease最新文献

Aim: To evaluate the effectiveness and safety of 3% polidocanol foam sclerotherapy (PFS) injection under anoscopy in the treatment of hemorrhoidal disease (HD) compared with rubber band ligation (RBL).

Method: This was a multicenter, open-label, prospective, observational study that enrolled 222 patients with Goligher grade I, II, or III HD (internal or mixed), who were treated with 3% PFS or RBL, which depended on the physician's assessment and the patient's willingness. The primary endpoint was the clinical cure rate under anoscopy and clinical symptoms assessment at 4 weeks post-treatment.

Results: A total of 222 patients from 14 centers participated in the study, with 127 patients receiving PFS and 95 patients receiving RBL. Among the effectiveness analysis set (EAS), the clinical cure rate was 74.19% (69/93) in the PFS group and 83.13% (69/83) in the RBL group (P > 0.05). The PFS group showed quicker and better improvement in hemorrhage score post-treatment than the RBL group, with the mean (SD) changes from baseline in hemorrhage score of the two groups (P < 0.001) at 1, 4, and 12 weeks being -3.44 (1.99) vs. -1.70 (2.19), -3.85 (1.80) vs. -2.75 (2.02), and -3.81 (1.84) vs. -2.89 (2.10), respectively. The incidences of adverse events (AEs) were 2.36% (3/127) in the PFS group and 3.16% (3/95) in the RBL group, respectively, and no serious adverse events (SAEs) occurred in both groups.

Conclusion: Patients treated with PFS showed similar effectiveness and safety as those treated with RBL under anoscopy, and a quick improvement trend in hemorrhage score post-treatment was observed in patients treated with PFS, but it needs further verification.

Trial registration: This study has been registered on the website of Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ ), registration number: ChiCTR2200060325.

Objective: To describe the clinical characteristics, causes, classification, and surgical techniques used to treat anal stenosis following hemorrhoid surgery, as well as to evaluate the treatment outcomes based on specific clinical criteria.

Subjects and methods: This retrospective case series included 13 patients with anal stenosis after hemorrhoidectomy. All underwent surgical treatment at Viet Duc University Hospital between January 2022 and June 2024. Surgical techniques applied were fibrotic ring release alone, fibrotic ring release with rectal mucosal advancement, fibrotic ring release with horizontal suturing of the rectal mucosa, and fibrotic ring release with V-Y flap reconstruction. Outcomes were assessed based on patients' ability to achieve normal defecation, stool caliber, and the absence of anal pain or bleeding postoperatively. Successful treatment was defined as normalized stool passage without pain or the need for stool softeners.

Results: Surgical outcomes were favorable in 12 out of 13 patients (92.3%), with an average healing time of 2.0 ± 1.1 months. The mean follow-up was 13.3 months (range 6-24 months; minimum 6 months). Patients treated with fibrotic ring release alone experienced the longest healing time, while those who underwent mucosal advancement or V-Y flap reconstruction had shorter recovery periods. Recurrence occurred in one patient who required reoperation.

Conclusion: Anal stenosis is a rare but serious complication following hemorrhoid surgery. Surgical interventions, including fibrotic ring release and anoplasty, appeared to be effective and safe, with favorable short-term outcomes in most patients.

Purpose: Anastomotic leakage (AL) remains a serious complication following low anterior resection (LAR) for rectal cancer. Although several risk factors for AL have been identified, the role of preoperative anal sphincter function remains unexplored. We hypothesized that elevated maximum resting pressure (MRP) and maximum squeeze pressure (MSP), measured preoperatively via anorectal manometry (ARM), might increase AL risk by inducing functional outlet obstruction.

Methods: This single-center retrospective cohort study included patients who underwent LAR without a diverting stoma between January 2010 and December 2015. We analyzed the associations between preoperative ARM parameters and early major AL events. Independent predictors of AL were also identified. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of ARM parameters for AL.

Results: Among 1,396 patients, early major AL occurred in 41 (2.9%). Patients with AL demonstrated significantly higher median MRP (55.7 vs. 42.6 mm Hg, p = 0.001) and MSP (186.5 vs. 150.3 mm Hg, p = 0.008) values. Multivariable analysis revealed that higher MRP (odds ratio [OR], 1.021 per mm Hg increase; 95% confidence interval [CI], 1.004-1.039; p = 0.017) and shorter tumor distance from the anal verge (OR, 0.815 per cm; 95% CI, 0.718-0.925; p = 0.002) were independent predictors of AL. An optimal MRP cutoff value of 55.65 mm Hg yielded 53.7% sensitivity and 75.1% specificity (area under the curve, 0.657).

Conclusion: Preoperative MRP is an independent predictor of early major AL after LAR. Elevated resting anal pressure may create functional outlet obstruction, increasing intraluminal pressure at the anastomotic site and compromising healing. Preoperative ARM could identify high-risk patients who may benefit from protective interventions.

Purpose: Development of fibrosis in treated colorectal liver metastases (CRLM) could be supposedly used for the estimation of both treatment response and prognosis. This study aimed to investigate the association between post-chemotherapy, fibrosis-related progressive gadolinium enhancement of CRLM on MRI and overall survival.

Material and methods: A retrospective study of 97 CRLM patients (68 M, mean age 62.3 ± 10.71 years) who underwent between 2017 and 2022 preoperative gadobenate dimeglumine (Gd-BOPTA) - enhanced MRI after chemotherapy. Tumor and liver enhancement were quantified using Signal Intensity Change Percentages (SICP) across 5-min and 60-min delay phases, along with the Tumor-to-Liver Enhancement Index (TLEI) to estimate fibrosis within CRLM. A subset of 18 patients was evaluated for radiologic-pathologic correlation. Cox regression, Kaplan-Meier analysis, and multivariate models were used to assess overall survival (OS).

Results: High SICP (≥ 90.3%) in the 60-min delayed phase was associated with significantly lower OS (median: 37 vs. 66 months; p = 0.023). TLEI was significantly elevated in non-survivors (1.25 vs. 1.10; p = 0.007). Histopathologic correlation, available in 18 patients, confirmed fibrosis in lesions with elevated SICP, though limited sample size precluded statistical validation. In multivariate analysis, both high TLEI and elevated SICP were independent predictors of reduced OS (HR 1.38 [1.05-1.82], p = 0.023; HR 1.01 [1.00-1.01], p = 0.043, respectively). Notably, aflibercept- and FOLFOX-4-treated patients showed higher fibrosis-associated enhancement.

Conclusion: Gd-BOPTA-enhanced MRI, specifically SICP and TLEI in the delayed phase, may serve as non-invasive imaging biomarkers of fibrosis in CRLM. Contrary to prior assumptions, increased fibrosis was associated with worse prognosis, suggesting fibrosis-mediated tumor microenvironment alterations. Prospective studies with robust radiologic-pathologic validation are needed to clarify the mechanistic and prognostic implications.

Purpose: To develop nomograms based on diffusion-weighted imaging (DWI) histogram parameters and clinical features to preoperatively predict pathogen type and extended-spectrum β-lactamase (ESBL) infection in perianal abscesses.

Methods: We retrospectively analyzed 157 surgically confirmed patients, stratified by pathogen type (Escherichia coli, n = 110; Klebsiella pneumoniae, n = 47) and ESBL test results (ESBL-negative, n = 91; ESBL-positive, n = 30). Ninety-seven apparent diffusion coefficient (ADC) histogram parameters were extracted. Histogram features selected using least absolute shrinkage and selection operator (LASSO) regression, together with clinical variables identified by univariate logistic regression, were incorporated into multivariate logistic regression models to construct nomograms. Internal validation used 1,000 bootstrap resamples. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow test, calibration curves, and decision curve analysis (DCA).

Results: The pathogen discrimination model, integrating an ADC-derived composite score (ADC_Score) based on 20 retained histogram features with age, diabetes, and hypertension, achieved an AUC of 0.897, sensitivity of 0.872, and specificity of 0.809. The ESBL prediction model, incorporating ADC_Score based on 13 retained features together with white blood cell count (WBC) and age, yielded an AUC of 0.823, sensitivity of 0.867, and specificity of 0.659. Calibration curves and the Hosmer-Lemeshow test indicated good agreement between predicted and observed probabilities, and DCA suggested potential net benefit for both models within the internally validated cohort.

Conclusion: DWI histogram-based nomograms demonstrated promising performance for pathogen prediction in perianal abscesses, while the incremental value for ESBL prediction was limited. These models represent an internally validated development study and require external validation before clinical application.

Background: Sarcopenia has been widely studied in rectal cancer with increasing evidence to suggest that other body composition parameters, in particular adipose tissue, have an important role. Advances in artificial intelligence (AI) now allow 3D body composition analysis of intermuscular/intramuscular adipose tissue (IMAT) from CT scans. This study aimed to develop and evaluate a skeletal muscle score (SMS), utilising skeletal muscle (SM) and IMAT measurements, to predict treatment response and survival outcomes for rectal cancer patients.

Methods: A retrospective analysis was performed on 226 patients with localised rectal adenocarcinoma treated at Western Health between 2013 and 2024. Body composition metrics, including SM and IMAT volume and density from the L1-S5 vertebral region, were extracted using validated AI software. A SMS (0-4) was developed to predict overall complete response (oCR). The primary endpoint was oCR, defined as pathological complete response or sustained clinical complete response for at least 3 years. Secondary outcomes included overall, cancer-specific, and disease-free survival.

Results: An oCR was achieved in 25.7% of patients and was significantly associated with a lower MRI T stage, increased age at diagnosis, and a better SMS, whilst active smoking decreased oCR in a multivariable analysis. Patients with an SMS of zero had a 0% oCR rate, whilst patients with a SMS of four had oCR rate of 60%. A higher SMS correlated with improved overall, cancer-specific, and disease-free survival.

Conclusion: The SMS is a novel, AI-derived body composition assessment that is strongly correlated with treatment response and survival in rectal cancer patients. This scoring system could provide clinicians with individualised risk stratification to enhance patient counselling.

Background and purpose: Standard treatment for localized right colon cancer is radical surgery, followed by adjuvant chemotherapy for stage III or intermediate MSS and high-risk stage II tumours. Recent studies suggest a benefit from neoadjuvant chemotherapy (NAC), particularly for T4b and/or N + tumours. Patient selection for NAC relies on CT-based clinical staging, but the accuracy of CT in detecting high-risk features is variable, raising concerns about potential overtreatment. The study aims to demonstrate the accuracy of CT staging of the right colon with the purpose of indicating neoadjuvant CT.

Methods: Patients undergoing curative right hemicolectomy between 2013 and 2023 at two Portuguese institutions were included. All had preoperative CT; those receiving NAC were excluded. Sensitivity, specificity, positive predictive value, and negative predictive value of CT in identifying T4b and N + tumours were calculated by comparing clinical (cTNM) and pathological (pTNM) staging.

Results: Among 165 patients (48% male, mean age 70.5 years), CT showed low sensitivity (26%) but high specificity (91%) for pT4b tumours, with a tendency toward understaging. For nodal disease, sensitivity was 87% and specificity 41%. Only 57% of cT4b and/or cN + cases confirmed at least one unfavorable pathological factor, implying potential overtreatment in 43% of patients if NAC were applied solely based on CT findings.

Conclusion: CT remains the standard for clinical staging but demonstrates limited accuracy in identifying high-risk right colon cancers. NAC decisions should integrate additional criteria beyond CT findings to avoid overtreatment.

Purpose: Extramural venous invasion (EMVI) is a high-risk pathological feature in colorectal cancer, yet its role in guiding adjuvant chemotherapy in node-negative colon cancer remains uncertain. This study evaluates EMVI as a predictor of recurrence in patients undergoing colon cancer resection and investigates whether adjuvant chemotherapy affects recurrence in node-negative, EMVI-positive (N0/EMVI +) patients.

Methods: A retrospective cohort study was conducted on adults undergoing surgery for colon cancer at a single UK cancer centre between 2015 and 2022. Patients with rectal tumours or metastatic disease at presentation were excluded. Cox proportional hazards models were used to assess predictors of recurrence. Kaplan-Meier survival curves were generated to visualise recurrence-free survival (RFS) stratified by EMVI and chemotherapy status.

Results: Among 675 patients, EMVI was present in 361 (53%). EMVI was independently associated with increased recurrence (HR: 1.80, 95% CI: 1.14-2.84, p=0.011). In the N0/EMVI+ subgroup (n=124), chemotherapy was not significantly associated with reduced recurrence: partial chemotherapy (HR: 1.36, 95% CI: 0.30-6.20, p=0.69), full chemotherapy (HR: 1.53, 95% CI: 0.46-5.12, p=0.49). Kaplan-Meier analysis revealed five-year RFS of 80.9% for no chemotherapy, 60.6% for partial chemotherapy, and 41.6% for full chemotherapy (p=0.69). Survival differences were not statistically significant.

Conclusion: EMVI is a predictor of recurrence in patients undergoing surgery for colon cancer. However, in node-negative patients with EMVI, chemotherapy was not significantly associated with improved recurrence-free survival. These findings highlight the need for larger, prospective studies to better define the role of EMVI in guiding adjuvant therapy in stage II colon cancer.