International Journal of Colorectal Disease最新文献

Purpose: Although surgery is the most effective treatment for rectal prolapse, a risk of recurrence reported in literature is 6-27%. The aim of this meta-analysis is to compare the abdominal and perineal approach for surgical treatment of recurrent external rectal prolapse.

Methods: A systematic search of PubMed and Embase was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search of PubMed and Embase was conducted from January 2000 to May 2024, for studies reporting surgery for recurrent external rectal prolapse. The primary outcome was the recurrence at the last available follow-up. Secondary endpoints included surgical complications and length of postoperative hospitalization.

Results: Nine studies, with a total of 531 patients, were included in the analysis. The overall recurrence rate among the studies was 26.3% at a mean follow-up time of 30.5 months. The proportional meta-analysis showed a recurrence rate of 27.9% (95% CI 22.54 to 33.85, I² 75.1%, p = 0.0012) after perineal surgery and of 15.6% (95% CI 11.43 to 20.64, I² 63.7%, p = 0.016) after abdominal surgery. Comparing the two approaches, the meta-analysis showed an OR of 0.66 (95% CI 0.41 to 1.17, I² 66.5%, p = 0.029). The OR for complications was 1.44 (95% CI 0.77 to 2.70, I² 0.0%, p = 0.945), while SMD for length of hospital stay was 0.49 (95% CI 0.20 to 0.79, I²- 67.9%, p = 0.077).

Conclusions: Our meta-analysis revealed that the recurrence rate for the perineal approach was almost double the recurrence rate for the abdominal approach. More randomized trials are needed to determine which is the best approach for patients with recurrent external rectal prolapse.

Objective: Colorectal cancer (CRC) is a common cancer, with chemotherapy as its major therapy. Nutritional status (NS) and adipokines implicated in CRC. We explored the impacts of NS indicators (hemoglobin, albumin, and prealbumin) and serum adipokine (visfatin, adiponectin, and resistin) level on chemotherapy efficacy in late-stage CRC patients.

Methods: Late-stage CRC patients were divided into the effective and ineffective groups based on chemotherapy efficacy, with clinical data, NS indicator, and serum adipokine levels documented. They were divided into hemoglobin, albumin, prealbumin, visfatin, adiponectin, and resistin high and low expression groups, with their relationships with clinical parameters and chemotherapy efficacy analyzed. Independent risk factors (IRFs) affecting chemotherapy efficacy in late-stage CRC patients were analyzed by logistic multivariate regression.

Results: Hemoglobin, albumin, prealbumin, and adiponectin levels were reduced, while NRS 2002 ≥ 3 proportion, visfatin, and resistin levels were increased in the ineffective group versus the effective group. Areas under receiver operating characteristic curve of hemoglobin, albumin, prealbumin, visfatin, adiponectin, and resistin in diagnosing ineffective chemotherapy were 0.80, 0.88, 0.86, 0.88, 0.83, and 0.83, respectively. NS indicator and serum adipokine levels were markedly associated with chemotherapy efficacy in late-stage CRC patients. Highly expressed albumin and prealbumin were protective factors for effective chemotherapy, and highly expressed visfatin and resistin were risk factors for effective chemotherapy.

Conclusion: NS indicators and serum adipokine level are correlated with the chemotherapy efficacy in late-stage CRC patients, and both have diagnostic value for chemotherapy efficacy. Albumin, prealbumin, visfatin, and resistin are independent influencing factors affecting chemotherapy efficacy in late-stage CRC patients.

Purpose: In this study, we investigated the progression of high-grade dysplasia (HGD)/CRC in patients with hereditary colorectal cancer syndromes (HCSS) and concomitant inflammatory bowel diseases (IBDs).

Methods: We described the natural history of a series of patients with confirmed diagnosis of hereditary colorectal cancer syndromes (HCCSs) and concomitant IBDs who were referred to the Hereditary Digestive Tumors Registry at the Fondazione IRCCS Istituto Nazionale dei Tumori of Milan.

Results: Between January 1989 and April 2024, among 450 patients with APC-associated polyposis and 1050 patients with Lynch syndrome (LS), we identified six patients with IBDs (five with UC, one with ileal penetrating CD) and concomitant HCCSs (five with LS, one with APC-associated polyposis). Three patients developed CRC (two patients with stage IIA, and one with stage IIIA); in one patient, CRC occurred over a median follow-up of 12 months after IBD diagnosis, while in two, both conditions were diagnosed simultaneously. The median age at initial diagnosis of CRC was 33 years (range 27-41). Five patients (83.3%) underwent surgical procedures (three colonic resections for carcinoma and two for other reasons). Most of them progressed to precancerous or cancerous colonic lesions at a young age. Notably, all patients with CRC had a diagnosis of UC.

Conclusion: IBD patients with coexistent HCCSs can develop early CRC onset at an advanced stage. These patients should be always referred to tertiary referral centers for strict surveillance programs and early surgical management of advanced colorectal neoplastic lesions. Noninvasive biomarkers of neoplastic changes are advocated to further improve the management of IBD patients with HCCSs.

In this article, we aim to demonstrate that thyroid carcinoma can metastasize to the small bowel. This case report involves a 66-year-old woman who underwent total thyroidectomy surgery in 2019, with histopathology revealing a 3A undifferentiated thyroid cancer. She presented with symptoms of bowel obstruction, including abdominal pain, nausea, and vomiting. Thyroid carcinoma accounts for less than 4% of all malignant neoplasms, making it the most common endocrine malignancy. The predominant type is papillary carcinoma, which generally has a favorable prognosis. In contrast, poorly differentiated thyroid cancers have a poor prognosis, with a 5-year postoperative survival rate of 66%. Common metastatic sites include the lungs, brain, and bones, with rare occurrences in organs such as the kidneys, spleen, adrenal glands, and ovaries. Intestinal metastases are extremely rare, with fewer than 15 cases of gastrointestinal localization documented in the literature. This case highlights the rare possibility of thyroid carcinoma metastasizing to the small bowel, emphasizing the need for clinicians to consider metastatic spread in patients with a history of thyroid cancer who present with gastrointestinal symptoms.

Purpose: Liver and lung metastases demonstrate distinct biological, particularly immunological, characteristics. We investigated whether preoperative complete blood count (CBC) parameters, which may reflect the immune system condition, predict early dissemination to the liver and lungs in colorectal cancer (CRC).

Methods: In this retrospective single-centre study, we included 268 resected CRC cases with complete 2-year follow-up and analysed preoperative CBC for association with early liver or lung metastasis development. Next, selected CBC and clinicopathological parameters were analysed with uni- and multivariable Cox regression. Independent factors affecting liver or lung metastasis-free survival were incorporated into composite scores, which were further evaluated with receiver operating characteristic (ROC) curves and dichotomised using a modified, specificity-focused, Youden approach to identify particularly high-risk patients.

Results: Compared to metastasis-free patients, early liver metastases were related to decreases in red blood cells, haematocrit, lymphocytes and elevated monocyte-to-lymphocyte ratio, while lung metastases to lower eosinophil counts. A composite score of independent factors (erythrocytopenia, lower lymphocyte count and pN) yielded HR of 8.01 (95% CI 3.45-18.57, p < 0.001) for liver-specific metastasis-free survival (MFS). For lung-specific MFS, the combination of eosinopenia, pN and primary tumour location showed HR of 13.69 (95% CI 4.34-43.20, p < 0.001).

Conclusion: Early CRC metastases to the liver and lungs are associated with partially divergent clinicopathological and peripheral blood features. We propose simple, clinically implementable scores, based on routinely assessed parameters, to identify patients with an increased risk of early dissemination to the liver or lungs. After validation in independent cohorts, these scores may provide easily available prognostic information.

Purpose: Chronic constipation is a common symptom. Constipation due to pelvic floor disorders remain a therapeutic challenge. Biofeedback therapy is considered as the first-choice treatment for pelvic floor disorders, whenever dedicated expertise is available. Type A botulinum toxin has been used to selectively weaken the external anal sphincter and puborectalis muscle in constipated patients.

Method: Eighty-two patients with chronic outlet obstruction constipation were treated with 100 units type A botulinum toxin, injected into the puborectalis muscle and the external anal sphincter.

Results: At the 2-month evaluation, a symptomatic improvement was noted in 69 patients. Seven (8.5%) patients had mild flatus incontinence. Stool frequency per week increased from 2.4 ± 0.9 to 5.1 ± 1.0 (P = 0.0001). Anorectal manometry demonstrated decreased tone during straining from 91 ± 28 mmHg to 61 ± 27 mmHg (P = 0.0001). Defecography after the treatment showed improvement in anorectal angle during straining, which increased from 96 ± 12° to 124 ± 14° (P = 0.0001).

Conclusion: Type A botulinum toxin relaxes the puborectalis muscle. Pressure values decline after the treatment. Transrectal ultrasonography to guide injections is a safe procedure. Repeated injections were needed to maintain the clinical improvement.

Purpose: This phase II study is designed to evaluate the combination therapy involving suvemcitug and envafolimab with FOLFIRI in microsatellite-stable or mismatch repair-proficient (MSS/pMMR) colorectal cancer (CRC) in the second-line treatment setting.

Methods: This study is a non-randomized, open-label prospective study comprising multiple cohorts (NCT05148195). Here, we only report the data from the CRC cohort. Participants received envafolimab, suvemcitug, and FOLFIRI until disease progression, unacceptable toxicity, or voluntary withdrawal. The recommended dose (RD) and objective response rate (ORR) by investigator assessment were primary endpoints. Secondary endpoints comprised progression-free survival (PFS) and duration of response (DoR). Disease control rate (DCR), overall survival (OS), and safety were also analyzed.

Results: At the data cutoff, no dose-limiting toxicity event was observed in the safety run-in stage, and 2 mg/kg Q2W was declared as RD for suvemcitug combined with envafolimab and FORFIRI. Among 20 patients, 50.0% and 10.0% had been treated with prior antiangiogenic agents and anti-EGFR agents, respectively. ORR and DCR were 25.0% (95% CI 8.7-49.1%) and 90.0% (95% CI 68.3-98.8%), and DoR was 4.1 months (95% CI 3.02, NE). The median PFS and median OS were 5.6 months (95% CI 4.0-8.3) and not reached (95% CI 8.5, NE) by the time of study closure. Neutrophil count decreased, white blood cell count decreased, and hypertension were the most common grade ≥3 treatment-related adverse events (TRAE).

Conclusions: The safety profile was manageable and the preliminary anti-tumor efficacy was observed in patients with MSS/pMMR CRC in this study, who had failed prior to one line of therapy.

Purpose: This systematic review examines the utility of deep learning algorithms in predicting pathological complete response (pCR) in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (nCRT). The primary goal is to evaluate the performance of MRI-based artificial intelligence (AI) models and explore factors affecting their diagnostic accuracy.

Methods: The review followed PRISMA guidelines and is registered with PROSPERO (CRD42024628017). Literature searches were conducted in PubMed, Embase, and Cochrane Library using keywords such as "artificial intelligence," "rectal cancer," "MRI," and "pathological complete response." Articles involving deep learning models applied to MRI for predicting pCR were included, excluding non-MRI data and studies without AI applications. Data on study characteristics, MRI sequences, AI model details, and performance metrics were extracted. Quality assessment was performed using the PROBAST tool.

Results: Out of 512 initial records, 26 studies met the inclusion criteria. Most studies demonstrated promising diagnostic performance, with AUC values for external validation typically exceeding 0.8. The use of T2W and diffusion-weighted imaging (DWI) MRI phases enhanced model accuracy compared to T2W alone. Larger datasets generally correlated with improved model performance. However, heterogeneity in model designs, MRI protocols, and the limited integration of clinical data were noted as challenges.

Conclusion: AI-enhanced MRI demonstrates significant potential in predicting pCR in rectal cancer, particularly with T2W + DWI sequences and larger datasets. While integrating clinical data remains controversial, standardizing methodologies and expanding datasets will further enhance model robustness and clinical utility.