International Journal of Colorectal Disease最新文献

Purpose: Recent evidence suggests that the local recurrence (LR) rate after local excision of pT1 rectal adenocarcinoma may be higher than previously estimated, particularly in large cohorts with extended follow-up. This study aimed to evaluate the LR rate and long-term oncological outcomes in patients with pT1 rectal adenocarcinoma treated with transanal endoscopic surgery (TES).

Method: Observational cohort study including 824 consecutive patients who underwent TES at a single tertiary center between 2004 and 2021. Among them, 104 patients (12.6%) were diagnosed with pT1 rectal adenocarcinoma. Patients were excluded if they had received neoadjuvant or adjuvant chemoradiotherapy, had non-rectal tumors, a follow-up of less than 40 months, or were treated with surgical techniques other than TES.

Results: With a median follow-up of 91 months (IQR: 84), 17 patients (16.3%) developed LR and 14 (13.5%) developed distant recurrence. Five-year rectal cancer-specific and overall survival rates were 95% and 74%, respectively. Among the 88 patients without histopathological or surgical high-risk factors, 13 (14.8%) experienced LR and 9 (10.2%) distant recurrence. Their five-year disease-free and overall survival rates were 95% and 74%, Multivariate analysis identified flat-ulcerated morphology as the only independent predictor of LR (OR 6.8; 95% CI 1.5-30.4; p = 0.01).

Conclusion: TES for pT1 rectal adenocarcinoma resulted in a 16.3% overall LR rate, and 14.8% among patients without known risk factors, emphasizing the need for improved patient selection and novel prognostic and therapeutic tools. These findings warrant confirmation in multicenter studies with standardized criteria and prolonged follow-up.

Purpose: To investigate the association between preoperative phase angle (PhA), measured by bioelectrical impedance analysis, and short-term postoperative complications in patients with Crohn's disease (CD) undergoing ileocolic resection.

Methods: This retrospective cohort study included consecutive patients with CD who underwent ileocolic resection between April 2021 and December 2024. Baseline demographic, clinical, and nutritional data were analyzed. Univariable and multivariable logistic regression models were employed to identify predictors of postoperative complications. The discriminative ability of PhA was evaluated using receiver operating characteristic (ROC) curve analysis, with additional stratification by sex.

Results: Among 119 patients (median age 28 years; 72.3% male; median BMI 18.0 kg/m²), 25 (21.0%) experienced postoperative complications. Mean preoperative PhA was significantly lower in patients with complications compared with those without (4.1 ± 0.5° vs 4.8 ± 0.7°, P < 0.001). In multivariable analysis, higher preoperative PhA was independently associated with reduced odds of complications (OR = 0.203, 95% CI = 0.085-0.487, P < 0.001), whereas elevated C-reactive protein on postoperative day 3 was associated with increased odds (OR = 1.017, 95% CI = 1.007-1.028, P = 0.002). PhA demonstrated good overall discrimination (AUC 0.772, 95% CI 0.657-0.863). Sex-stratified analysis revealed superior discrimination in females (AUC 0.864, 95% CI 0.689-1.000; cut-off 3.9°) compared with males (AUC 0.748, 95% CI 0.625-0.857; cut-off 4.5°).

Conclusion: Lower preoperative PhA values were associated with a higher risk of short‑term postoperative complications after ileocolic resection for CD. Findings support the potential incorporation of PhA into preoperative risk assessment to help identify higher‑risk patients and guide perioperative optimization.

Introduction: Personalized treatment strategies in rectal cancer aim to balance escalation and de-escalation based on recurrence risk. Accurately identifying which patients will benefit from each approach is essential for optimizing outcomes and guiding follow-up. However, current clinical methods lack the precision needed to reliably predict response and long-term prognosis.

Methods: In this feasibility study, we evaluated the prognostic utility of a novel methylation-specific droplet digital PCR (MS-ddPCR) multiplex assay in 56 patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant treatment (nT)  and surgery. Circulating tumor DNA (ctDNA) was analyzed at four time points (baseline, during nT, preoperatively, 6 months post-surgery). Associations between ctDNA status and dynamics with tumor regression grade (TRG), disease recurrence, and overall survival (OS) were assessed using receiver operating characteristics (ROC) analyses and survival statistics.

Results: ctDNA was detected in 59% of the patients at baseline. Preoperative ctDNA had limited discriminative value for pathologic response, AUC 0.60 (95% CI 0.45-0.76). In contrast, ctDNA positivity 6 months postoperatively was strongly associated with recurrence within 2 years following surgery, AUC 0.96 (95% CI, 0.91-1.00). CtDNA positivity 6 months post-surgery was associated with inferior 2-year DFS (38% vs 94%, p for log-rank < 0.001) and 3-year OS (63% vs 100%, p for log-rank < 0.001).

Conclusion: With this MS-ddPCR assay, preoperative ctDNA showed limited prognostic value, whereas ctDNA 6 months postoperatively was strongly associated with recurrence and overall survival. The absence of an immediate postoperative sample limited assessment of early molecular response-a time point critical for guiding treatment decisions and follow-up strategies-underscoring the need for earlier sampling in future studies to optimize ctDNA-guided management. Given the small cohort and exploratory design, these findings are hypothesis-generating and support further validation of the assay in larger, prospective trials.

Background: Most patients with Crohn's disease (CD) experience disease progression and will eventually undergo surgery. However, the risks of progression and surgery exhibit significant regional heterogeneity. We conducted a cohort study to explore the risks and associated factors for disease progression, surgery, and postoperative recurrence in CD patients from Yunnan, a plateau province in southwestern China, and compared these data with data from Asian and Western countries.

Methods: In this study, data from a multicentre cohort from Yunnan Province were collected and analyzed. The cumulative risks of disease progression, surgery, and postoperative recurrence were analyzed. Univariate and multivariate analyses were performed to explore the independent risk factors associated with these outcomes. Finally, the distinct clinical profile of CD in our Yunnan cohort was compared with those of populations in Asian and Western countries, as reported in the literature.

Results: Among 252 patients with CD, disease behaviour and location progressed in 19.87% and 16.67% of the cohort, respectively. A total of 42.9% of the patients underwent surgery. The cumulative risk of postoperative recurrence at 3 years after primary surgery was 53.8%. Intestinal complications (HR = 2.798; P < 0.001) were independent risk factors for primary surgery, whereas the use of glucocorticoids (HR = 0.411; P = 0.002) and the use of biologics (HR = 0.300; P < 0.001) were protective factors. A delayed diagnosis (> 1 year) was an independent risk factor for reresection and postoperative recurrence. The cumulative risk of progression of disease behaviour was 34.5% at 5 years in Yunnan CD patients, which was greater than those reported in Western (14-15%) and Asian countries (15-30.7%). Similarly, the cumulative risk of surgery was 36.1% at 5 years, which exceeded the risks observed in the Western (17.4-35.1%) and Asian (10.7-16.5%) cohorts.

Conclusion: Compared with those in Asian and Western countries, CD patients in Yunnan exhibit an increased propensity for disease progression and surgical intervention. Intestinal complications and delayed diagnosis (> 1 year) are risk factors for surgery and postoperative recurrence.

Background: Higher surgical trainees often struggle to attain endoscopy competencies. We aimed to obtain a national picture of higher surgical trainees' endoscopy experience, highlight barriers to training, and explore potential solutions.

Methods: A 40-point electronic questionnaire was designed and disseminated to higher surgical trainees across the UK. Anonymous responses were collected and recorded from 26/10/2020 to 11/06/2021.

Results: A total of 139 higher surgical trainees from 16 out of the 19 regional UK deaneries responded. 75.9% (82/108) had some endoscopy training, and 19.4% (21/108) had no endoscopic training. 27.8% (30/108) had performed over 200 procedures. 77.8% (105/135) were not made aware of endoscopy training requirements by their Training Programme Directors (TPDs). 59.6% (65/109) had no named endoscopy supervisor. Only 49.1% (53/108) felt supported by their endoscopy trainers. Joint Advisory Group on GI Endoscopy (JAG) certification was infrequent, and the highest levels, 14.4% (15/104), were achieved in oesophagogastroduodenoscopy (OGD). Only 55.8% (24/43) of JAG-certified trainees felt competent in that procedure. 50.0% (7/14) of ST8 (final year trainee) respondents were not JAG certified in any procedure. 90.6% (96/106) faced challenges in gaining endoscopy training. The most common obstacles were the COVID-19 pandemic 87.9% (94/107), on-call commitments 80.2% (85/106), lack of allocated endoscopy sessions 80.2% (85/106), insufficient endoscopy training lists 76.4% (81/106), and competition with non-surgical trainees 64.2% (68/106).

Conclusions: Our survey provides detailed evidence of the challenges faced by surgical trainees in gaining endoscopy training. Suggested solutions include allocated endoscopy trainers, dedicated endoscopy-only training blocks, and early guidance about endoscopy training and certification.

Background and objective: Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC.

Methods: A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model.

Results: Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade.

Conclusion: IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.

Purpose: Although rare, septic shock can develop following the closure of an ileostomy created during colorectal cancer surgery. In such cases, bacterial translocation (BT) is considered the primary diagnosis, and appropriate treatment is provided. Herein, we investigated the risk factors of BT following ileostomy closure after colorectal cancer surgery.

Methods: A retrospective analysis was conducted using the colorectal cancer database of Nagasaki University, focusing on 91 patients who received ileostomy closure after colorectal cancer surgery. The patients were divided into two groups based on the occurrence of BT, defined as fever exceeding 38 °C without an identifiable cause, and data regarding patient background, surgical factors, and postoperative factors were assessed.

Results: BT occurred in 12 of 91 patients. No significant differences were observed between the groups of patients in terms of background factors but C-reactive protein levels on postoperative days 3 and 7 were significantly higher in the BT group than in the non-BT group (BT group vs. non-BT group [median], day 3: 6.64 mg/dL vs. 3.79 mg/dL, p = 0.0026; day 7: 5.10 mg/dL vs. 1.52 mg/dL, p = 0.0007). Additionally, the rate of postoperative adjuvant chemotherapy administration was significantly higher in the BT than in the non-BT group (BT group vs. non-BT group: 83.3% vs. 43.0%, p = 0.0123). The pathological findings from resected specimens showed that mucosal height was lower in the anal side than in the oral side.

Conclusion: Adjuvant chemotherapy may significantly increase the risk of BT after ileostomy closure following colorectal cancer surgery.

Purpose: Colorectal cancer (CRC) is becoming increasingly common in adults ≥ 60 years old, yet postoperative prognosis of curative-intent surgery for the advanced elderly (≥ 80 years) remains controversial.

Methods: A retrospective cohort study included 971 CRC patients aged ≥ 60 years who underwent curative-intent surgery from January 2018 to December 2023 in Beijing Chaoyang Hospital. Patients were stratified into "ordinary elderly group" (OE) (60-79 years, n = 800) and "advanced elderly group" (AE) (≥ 80 years, n = 171). Clinicopathological variables, 30-day morbidity/mortality, disease-free survival (DFS), and overall survival (OS) were collected and analyzed the differences between the two groups. The study was presented in accordance with the STROBE reporting checklist.

Results: The AE had more right-sided CRC (P < 0.001) and higher rate of preoperative obstruction (P < 0.001). They underwent more emergency (P = 0.002) and open procedures (P < 0.001), resulting in longer postoperative stays P = 0.030). Overall, 30-day morbidity was comparable (P = 0.76), but perioperative mortality rate was higher in AE (P = 0.041). The median follow-up was 36.1 ± 22.1 months, and recurrence rates (P = 0.58) and 5-year DFS (log-rank P = 0.42) did not differ between groups. Multivariate analysis identified TNM stage, perineural invasion, vascular invasion, preoperative intestinal obstruction, and proficient Mismatch Repair (pMMR) as independent predictors of DFS; age ≥ 80 years was not prognostic (p = 0.81).

Conclusions: Despite a higher burden of comorbidities and increased perioperative mortality, no statistically significant difference in long-term oncological outcomes was observed between AE and OE following rigorous patient selection and perioperative management in CRC patients. Advanced age alone should not preclude standard curative resection.

Purpose: Faecal incontinence (FI) is a common and debilitating late effect of chemoradiotherapy in patients with anal cancer. While its clinical relevance is well recognized, the underlying histopathological mechanisms remain poorly understood. This exploratory study aimed to describe structural tissue changes in the anal canal following radiotherapy and assess their potential contribution to FI.

Methods: Histological specimens from patients who underwent salvage abdominoperineal excision after chemoradiotherapy for anal cancer (AC group) were compared with those from low rectal cancer patients treated surgically without neoadjuvant therapy (RC group). Degenerative changes were assessed in peritumoral regions, including evaluation of collagen fibre composition via polarized light microscopy and ImageJ software.

Results: Indicative trends were observed, with the AC group showing higher rates of muscle fibre atrophy (73% vs 27%, p = 0.049) and intramuscular edema (78% vs 22%, p = 0.015), and a non-significant increase in lamina propria fibrosis (p = 0.069). No statistically significant differences were found in collagen fibre type distribution. Due to the limited sample size, these findings should be interpreted as descriptive rather than confirmatory.

Conclusion: Radiotherapy appears to induce notable structural alterations within the anal sphincter complex, including muscle atrophy and oedema, which may contribute to post-treatment faecal incontinence. These changes seem independent of collagen fibre composition. Despite the small sample size and lack of clinical data, this study provides preliminary histological insights that warrant further investigation in larger, clinically integrated cohorts.

Background: Despite advances in minimally invasive techniques and widespread adoption of Enhanced Recovery Programs (ERPs), rectal cancer surgery continues to pose significant challenges due to anatomical limitations, risks of complications, and the potential impact on bowel, urinary, and sexual function. These complexities underline the need for clearly defined, evidence-based key interventions to assess and ensure consistent, high-quality care across institutions. The aim of this study is to identify and summarize the evidence-based key interventions relevant to rectal cancer surgery.

Methods: A focused PubMed/MEDLINE search was performed to identify key interventions in care pathways for rectal cancer surgery. The list of key interventions extracted from the literature was presented to an expert panel who evaluated their importance and relevance in a one-round Delphi process.

Results: In total, 293 papers were screened on title and abstract for relevant information. Twelve papers were retained to identify the initial set of key interventions (n = 56). The list was narrowed to 39 by excluding duplicates and outdated key interventions. This list was commented on during a 1-round Delphi, and consensus was reached for 37 key interventions regarding surgical rectal cancer treatment.

Conclusion: We propose this list of 37 key interventions as a contemporary framework for assessing rectal cancer surgery.