International Journal of Colorectal Disease最新文献

Background: Caecal volvulus is a rare condition with an unknown prevalence, particularly in paediatric patients. Predisposing factors include fixation anomalies of the colon (with or without malrotation) and significant intestinal distension due to conditions such as chronic constipation, post-operative ileus, Hirschsprung disease (HD), or paediatric intestinal pseudo-obstruction (PIPO). African degenerative leiomyopathy (ADL) is a regional variant of visceral myopathy characterised by a fibrotic "tiger-striped" degeneration of the muscular layers of the colon, which causes PIPO. It is endemic to Sub-Saharan Africa and is associated with poor outcomes. To our knowledge, this is the first case in which a caecal volvulus led to the diagnosis of ADL.

Case presentation: An 11-year-old female, previously healthy, presented with a 2-day history of abdominal distension, bilious vomiting, and constipation. Abdominal radiography and a computed tomography (CT) scan were suggestive of a colonic volvulus. Endoscopic reduction was unsuccessful, and exploratory laparotomy revealed a caecal volvulus. A limited right hemicolectomy and end ileostomy were performed. Histology revealed the typical myopathic changes with "tiger-striped" fibrosis and atrophy. Postoperatively, she experienced recurrent episodes of bowel pseudo-obstruction. A full-thickness rectal biopsy confirmed the presence of ganglion cells, excluding HD and further supporting the diagnosis of ADL. The patient, unfortunately, died 6 months later due to abdominal compartment syndrome.

Conclusions: ADL is a rare and often fatal condition associated with intermittent bowel obstruction and systemic complications, including cardiac and urologic abnormalities. In paediatric patients, caecal volvulus should prompt consideration of PIPO as an underlying diagnosis.

Purpose: Crohn's disease (CD) frequently requires surgery, with ileocolonic resection being the most common procedure. Postoperative endoscopic recurrence remains a major concern, and the role of anastomotic configuration is still debated. This systematic review and meta-analysis aimed to evaluate the impact of different anastomotic techniques on early endoscopic recurrence following ileocolonic resection for CD.

Methods: A systematic search of PubMed, Embase, and Web of Science was performed up to July 2025. Studies comparing stapled side-to-side anastomosis (SSA), handsewn end-to-end anastomosis (EEA), and Kono-S anastomosis (KSA) with postoperative endoscopic follow-up at 6-12 months were included. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled analyses were conducted to compare recurrence rates across anastomotic types.

Results: Eleven studies were included (four comparing SSA vs. EEA; seven comparing KSA vs. SSA), for a total of 1505 patients. Most were retrospective, with three randomised controlled trials available. In pooled analysis, no significant difference was found between SSA and EEA (48.5% vs. 46.7%, test for overall effect Z = 0.41, p = 0.6795). KSA showed a trend towards lower recurrences compared with SSA (31.8% vs. 39.8%, test for overall effect Z = -1.96, p = 0.0495), although heterogeneity in study design, definitions, and postoperative management limits firm conclusions.

Conclusions: Current evidence does not support a difference in early endoscopic recurrence between SSA and EEA and a potential but weak overall association with lower recurrences for KSA compared to SSA. Large, high-quality prospective trials with standardised definitions, postoperative medical therapy, and follow-up protocols are warranted to clarify the true impact of anastomotic configuration on outcomes in CD.

Background: Inflammatory bowel disease (IBD) is an intestinal inflammatory disease of unknown etiology. Depression and anxiety are prevalent mental symptoms associated with IBD. Although numerous studies have explored the potential relationship between IBD and these psychological conditions, a bibliometric analysis on this topic has yet to be conducted.

Methods: We screened 420 relevant articles from the Web of Science Core Collection (WoSCC) database from 2010 to 2024 and analyzed them using software such as CiteSpace, VOSviewer, Pajek, and Tableau.

Results: The USA (98 papers), the University of Manitoba (24 papers), Inflammatory Bowel Diseases (56 papers), and Charles N. Bernstein (20 papers) were the most productive country, institution, journal, and author, respectively. High-frequency keywords in this field include "quality-of-life," "symptoms," "prevalence," "comorbidity," "association," "therapy," and "management." Additionally, emerging research frontiers encompass topics such as "mouse model," "remission," "disorder," and "gut microbiota."

Conclusions: Over the past 14 years, there has been a notable increase in research focused on depression and anxiety associated with inflammatory bowel disease. Key areas such as "mouse models," "remission," "disorder," and "gut microbiota" are poised to become focal points of future investigations. These findings may offer new avenues for researchers to explore.

Background: To evaluate the functional, short-term oncologic and clinical outcomes of robotic rectal resection using the Hugo™ RAS (Robotic-assisted surgery) system compared with those of conventional laparoscopic surgery.

Methods: This retrospective cohort study was based on a prospectively maintained database. Baseline demographics, perioperative variables, postoperative complications (Clavien‒Dindo), and both functional (LARS score, pain, urinary and sexual function) and oncologic outcomes were compared. Functional outcomes were assessed at one, three and six months postoperatively.

Results: A total of 40 consecutive patients with rectal cancer who underwent surgery were included. 25 patients underwent laparoscopic resections and the remaining 15 patients received robotic resections using the Hugo™ RAS system. Baseline characteristics were comparable between the groups. At the six-month follow-up compared to the laparoscopic group, the robotic group had significantly lower mean LARS scores (19.2 vs. 9.8; p = 0.008), a greater proportion without LARS (53% vs. 85%; p = ns), and lower pain levels (not significant pain: 71% vs. 93%; p = 0.019). Male patients who underwent robotic surgery had significantly better sexual function at 6 months (p = 0.045). No statistically significant differences were found in terms of complications, but differences in anastomotic leakage (12% vs. 0%), paralytic ileus (16% vs. 6.7%) or Clavien‒Dindo 3-5 (24% vs. 13.4%) were clinically significant in favour of the robotic group.

Conclusion: Robotic surgery with the Hugo™ RAS system is a feasible and safe alternative to conventional laparoscopic resection for rectal cancer, achieving comparable short-term oncologic outcomes while providing improved functional recovery. Ethics Committee of the General University Hospital of Elche (PI 60/2024).

Clinicaltrials id: NCT06512480.

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.

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.