International Journal of Colorectal Disease最新文献

Purpose: Examining the psychosocial impact of stoma surgery on quality of life, sexual health, and body image, and analyzing demographic factors associated with these outcomes.

Methods: This cross-sectional study included 214 adults with a stoma. Validated instruments, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the Colorectal Cancer Module (EORTC QLQ-CR29), and the Sexual Health Module (EORTC QLQ-SH22), were used to assess quality of life, body image, and sexual function. Associations between demographic variables and patient-reported outcomes were tested using analysis of variance (ANOVA).

Results: Participants reported considerable impairments with fatigue, emotional well-being, sexual interest, and body image. Global health status was significantly lower in women (p = 0.037); female participants also expressed significantly greater concerns regarding partner satisfaction (p = 0.027). Fatigue was significantly associated with age and gender (p = 0.032). Reduced sexual interest was reported by 36.9% of respondents, while 47.7% reported body image dissatisfaction.

Conclusion: Stoma surgery is associated with substantial psychosocial and sexual health challenges, particularly in women and older adults. These findings underline the need for tailored postoperative support focusing on emotional well-being, intimacy, and body image.

Background: Magnetic resonance imaging (MRI) is widely used for the diagnosis, evaluation, and follow-up of intestinal diseases. With advances in artificial intelligence, MRI radiomics and deep learning have emerged as promising tools for prognostic assessment and treatment guidance. This review synthesizes current evidence on MRI radiomics and deep learning for prognostic assessment of intestinal diseases, with a focus on inflammatory bowel disease and colorectal cancer.

Methods: We conducted a narrative review of studies published between January 2005 and March 2025, retrieved from PubMed/MEDLINE, Web of Science, and Embase. Eligible studies applied deep learning or radiomics approaches to MRI data to predict treatment response, recurrence, metastasis, or survival outcomes. Methodological quality and clinical relevance were critically appraised with reference to established artificial intelligence-specific evaluation frameworks.

Results: The reviewed studies indicate that deep learning models, including convolutional neural networks, vision transformers, and multimodal fusion approaches, can effectively exploit multiparametric MRI data to improve prognostic prediction across multiple clinical endpoints. These applications encompass image preprocessing, treatment planning, prediction of therapeutic response, disease relapse, and survival outcomes. MRI-based deep learning models generally outperform conventional imaging and traditional radiomics methods, particularly when integrated with clinical variables. However, most studies remain retrospective, with limited external validation and challenges related to interpretability and generalizability.

Conclusions: MRI-based radiomics and deep learning hold substantial potential for enhancing precision medicine in intestinal diseases. Future progress will depend on standardized imaging protocols, multicenter prospective validation, and the development of explainable and clinically trustworthy artificial intelligence models.

Background: An enhanced recovery protocol (ERP) comprises a series of elements aimed at optimizing and standardizing perioperative care. Therefore, in this study, we aimed to evaluate the safety and feasibility of a modified enhanced recovery after surgery (ERAS) protocol following colorectal surgery in older adults aged ≥ 65 years.

Materials and methods: Patients aged ≥ 65 years who underwent minimally invasive colorectal cancer surgery at a tertiary referral hospital in Taiwan between 2018 and 2022 were reviewed retrospectively. Patients were divided into ERAS and traditional care groups according to the perioperative care strategy. The primary outcome was the short-term complication rate. However, the secondary outcomes were postoperative hospital stay, reoperation, readmission, and 30-day mortality rates.

Results: Overall, 1392 patients were enrolled, including 550 and 842 in the ERAS and traditional care groups, respectively. Demographic characteristics, including comorbidities, perioperative characteristics, and pathological staging, were not statistically significant. The patients' short-term complication rate was lower in the ERAS group (aged 65-80 years) than in the traditional care group (29 (7.2%) vs. 75 (11.5%), P = 0.026). However, the short-term complication rate did not differ between patients aged > 80 years (24 (16%) vs. 36 (19%), P = 0.438). In addition, the mean postoperative hospital stay was shorter in the ERAS group (7.5 ± 8.9 days vs 9.7 ± 10.0 days, P < 0.001). However, there were no differences in other secondary outcomes, including reoperation, readmission, and 30-day mortality rates.

Conclusion: Minimally invasive colorectal cancer surgery within the ERAS program is safe and effective in patients aged 65-80 years.

Purpose: To characterise (1) the definition and measurement methods of myosteatosis, (2) the impact of myosteatosis on post-operative complications (overall, severe complications defined as Clavien-Dindo 3 and above, anastomotic leak, length of stay) in both non-metastatic and metastatic colorectal cancer (CRC) patients and (3) the impact of myosteatosis on long-term survival outcomes in non-metastatic CRC (overall survival, cancer-specific survival, disease-free survival).

Methods: A systematic search of Medline, Embase and Cochrane Central databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in 2024.

Results: A total of 4410 publications were initially retrieved; 54 studies fulfilled the inclusion criteria. A variety of measurement methods of myosteatosis were found. There was good quality evidence to support a negative correlation between myosteatosis and overall survival (OS). Colon cancer was more consistently associated with OS and DFS compared to rectal cancer. Myosteatosis was found to significantly impact severe (Clavien-Dindo 3 and above) postoperative complications in colon cancer. Other postoperative outcomes were limited by inconsistency and an overall paucity in volume and quality.

Conclusion: Myosteatosis has a negative association with OS, with consistent effects observed in colon cancer. There is a negative association with severe postoperative outcomes, particularly in colon cancer. These results are limited by the risk of bias and heterogeneity in measurement methods and statistical analysis. Future work is required to clarify the scan acquisition protocol and diagnostic criteria.

Purpose: Anastomotic recurrence after ileocolectomy for Crohn's disease may be related to the gut microbiota, but the role of mycobiota remains unclear. This study aimed to investigate associations between mucosal mycobiota at resection and early postoperative endoscopic recurrence, and assess their predictive potential.

Methods: We recruited 55 Crohn's disease patients undergoing bowel resection (October 2022-February 2024) with one-year endoscopic follow-up. Mucosal samples obtained during surgery underwent fungal internal transcribed spacer 1 sequencing to characterize the fungal communities. Multivariate analysis identified risk factors for early postoperative endoscopic recurrence. Predictive model performance was evaluated using receiver operating characteristic curve analysis.

Results: Twenty patients (36.4%) developed early postoperative endoscopic recurrence and were assigned to the recurrence group. Multivariate analysis identified preoperative low serum albumin level and elevated postoperative neutrophil-to-lymphocyte ratio as independent risk factors. The recurrence group exhibited an increased relative abundance of Basidiomycota, an elevated Basidiomycota/Ascomycota ratio, and heightened relative abundances of Malassezia restricta and Debaryomyces hansenii. A combined predictive model integrating three potential fungal biomarkers demonstrated superior predictive performance for early postoperative endoscopic recurrence.

Conclusion: Early postoperative endoscopic recurrence in Crohn's disease is significantly associated with mucosal fungal dysbiosis during bowel resection. Integrating mycobial factors can more effectively predict early postoperative endoscopic recurrence.

Background: The global incidence of early-onset colorectal cancer (EOCRC) is rising. We compared trends in dietary fiber intake, a key modifiable risk factor, and its attributable EOCRC burden among young adults in China versus globally from 1990 to 2021.

Methods: Using data from the GDD and GBD 2021 for adults aged 25-49, we analyzed age-standardized mean fiber intake, summary exposure value (SEV) for low intake, and attributable EOCRC mortality and disability-adjusted life years (DALYs). Trends were quantified using the estimated annual percentage change (EAPC).

Results: Between 1990 and 2018, China's mean dietary fiber intake increased dramatically from 5.0 to 23.3 g/day (EAPC 5.73%), substantially outpacing the global increase (EAPC 1.41%). This led to a profound reversal in risk exposure; China's SEV for low fiber declined at nearly twice the global rate (EAPC -2.14% vs -1.15%), falling below the global benchmark after 2005. Consequently, the attributable age-standardized mortality rate in China dropped from 0.15 per 100,000 to converge with the global level of 0.05 by 2021 (EAPC -3.81% vs -2.17% globally). Similar rapid declines occurred for DALYs and were more pronounced in women. Favorable epidemiological changes were the primary driver of this reduction.

Conclusion: China's success in reducing its EOCRC burden from low dietary fiber highlights nutritional improvement as a potent primary prevention strategy, reinforcing the urgent need to promote fiber-rich diets globally.

Purpose: Stapled haemorrhoidopexy (SH) offers well-established short-term advantages over conventional haemorrhoidectomy (CH), but its long-term effectiveness remains controversial. This systematic review and meta-analysis aimed to compare long-term outcomes of SH versus CH in adult patients with grade II-IV haemorrhoids, incorporating Trial Sequential Analysis (TSA).

Methods: MEDLINE, EMBASE and CENTRAL were searched from January 2001 to October 2025 for randomized controlled trials (RCTs) comparing SH and CH with a minimum follow-up of 12 months. Two reviewers independently performed study selection, data extraction and risk-of-bias assessment (RoB-2). Primary outcomes included recurrence, reintervention, anal function, and quality of life (QoL). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. TSA was applied to overall recurrence.

Results: Seventeen RCTs including 1,041 SH and 1,031 CH patients were analysed. SH was associated with a higher risk of overall recurrence compared with CH (RR = 1.56,95%CI = 1.00-2.44;I² = 48%). TSA showed that the accrued information size (1,913 patients) did not reach the required information size (2,608 patients), indicating that current evidence remains underpowered. Prolapse-related recurrence was significantly more frequent after SH (RR = 3.28,95%CI = 1.49-7.25;I² = 12%), whereas bleeding-related recurrence did not differ between groups (RR = 1.20,95%CI = 0.63-2.26;I² = 23%). No significant differences were found for reintervention, persistent anal pain, functional impairment or QoL.

Conclusion: SH is associated with a higher risk of long-term recurrence, particularly prolapse-related recurrence, compared with CH, while long-term pain, functional outcomes and QoL appear broadly comparable. These findings suggest that, although SH may remain an option for selected patients, CH provides more durable anatomical correction, and procedural choice should balance early recovery against long-term durability.

Objectives: This study aims to compare and analyse the immune landscape at the tumour invasion front in patients with colorectal cancer (CRC) with proficient mismatch repair (pMMR) and deficient mismatch repair (dMMR).

Methods: A total of 51 patients with CRC were included, comprising 32 patients with pMMR and 19 patients with dMMR. Immunohistochemistry, fluorescence PCR and capillary electrophoresis were used to detect the expression status of MLH1, PMS2, MSH2 and MSH6 proteins to identify patients with pMMR/MSI-H and pMMR/MSS. Multiplex immunofluorescence technology was employed to stain and analyse immune cells at the tumour invasion front.

Results: In patients with dMMR CRC, the proportion of CD8⁺ T cells at the tumour invasion front was significantly higher than that in patients with pMMR (26.84% ± 3.17% vs. 6.29% ± 1.62%, p < 0.001), whereas the proportion of CD4⁺ T cells was significantly lower (19.02% ± 2.81% vs. 37.71% ± 3.52%, p < 0.001). Regarding NK cells, the proportion of CD56 bright⁺ cells at the tumour invasion front in patients with dMMR was significantly higher than that in patients with pMMR (6.69% ± 1.04% vs. 1.93% ± 0.48%, p < 0.001). There was no significant difference in the total number of NK cells at the tumour invasion front between the two groups.

Conclusion: There are significant differences in the infiltration and distribution of immune cells at the tumour invasion front between pMMR/MSI-H and pMMR/MSS CRC. The higher infiltration of CD8⁺ T cells and CD56 bright⁺ cells at the tumour invasion front in patients with dMMR CRC may partly explain their better response to immune therapy. However, these findings require validation in larger cohorts.

Objective: This study compared the safety and functional outcomes of prophylactic loop ileostomy (LI) versus transverse end colostomy (TEC) after laparoscopic radical resection for rectal cancer.

Methods: In this single-center retrospective study, 171 patients requiring a prophylactic stoma were divided into LI (n = 93) and TEC (n = 78) groups. Primary endpoints were anastomotic leakage (AL) and AL-related reoperation rates within 3 months.

Results: The AL rate was comparable between groups (LI 2.2% vs TEC 1.3%, p = 1.0). However, all leaks in the LI group required reoperation, versus none in the TEC group. The overall complication rate was higher in the LI group (39% vs 15%, p < 0.05), driven mainly by electrolyte disturbances (32% vs 11%, p < 0.05). LI was associated with shorter operative times for both initial stoma creation and subsequent reversal (both p < 0.05). Among the 144 patients who underwent stoma reversal, incisional hernia occurred only in the LI group (4/78 vs 0/66, p = 0.12).

Conclusion: TEC is a non-inferior alternative associated with a lower reoperation risk for AL and fewer metabolic complications, whereas LI offers shorter operative times. The choice depends on weighing procedural efficiency against long-term stoma-related risks.