International Journal of Colorectal Disease最新文献

Objective: To develop and validate machine learning models based on preoperative magnetic resonance imaging(MRI) and baseline clinical characteristics for predicting early recurrence(ER) in patients with colorectal liver metastases(CRLM) treated with thermal ablation(TA).

Materials and methods: Patients with CRLM who underwent TA between January 2016 and December 2021 at two hospitals in China were allocated. Clinical and MRI data were used to develop and validate the clinical model, radiomics machine learning (R-ML) model, and combined clinical-radiomics model to predict ER after TA. The prognostic performance of the genetic and morphological evaluation (GAME) score and the Fong score was also compared (Supplementary Material). The best-performing algorithm among eight machine learning methods was selected to establish the R-ML model. Model performance was assessed through receiver operating characteristic (ROC) curve analysis, calibration plots, decision curve analysis (DCA), and survival analyses.

Results: A total of 187 consecutive patients were enrolled (114 for the training cohort, 48 for the testing cohort, and 25 for the external test cohort). The GAME score showed better prognostic performance than the Fong score (Supplementary Material). The largest diameter of liver metastases (OR: 5.760, 95% CI: 2.130-16.700; P < 0.001) and the GAME group (OR: 0.093, 95% CI: 0.007-0.985; P = 0.040) were independent risk factors for ER. The XGBoost-based R-ML model performed best across cohorts. In external validation, the combined model (AUC = 0.772, P = 0.015) demonstrated superior predictive capacity to both the clinical (AUC = 0.647, P = 0.380) and R-ML models (AUC = 0.743, P = 0.056).

Conclusion: The combined model incorporating preoperative MRI-derived radiomics features and clinical parameters serves as a valuable tool for predicting ER risk in patients with CRLM undergoing TA therapy.

Purpose: Rectal prolapse (RP) is a clinically significant condition with vaginal delivery as a major risk factor, especially in elderly females, needs precise evaluation for guiding treatment. Given the limitations of current diagnostic methods in terms of convenience, this study aims to develop an improved measure for RP.

Methods: A retrospective analysis of 181 female patients undergoing both dynamic three-dimensional transperineal ultrasound (3D-TPUS) and radiographic (X-ray or MRI) defecography (X-ray and MRI) was conducted to investigate the correlation between 3D-TPUS parameters and RP severity.

Results: Relative to mild RP cases, severe RP patients were older, had heavier neonatal birth weight, and less nulliparous individuals. Significant differences in severe RP cases were demonstrated by 3D-TPUS quantification, greater levator hiatal area enlargement (LHA), increased bladder neck descent (BND), and deeper rectal ampulla position (RAP) compared to mild cases. Significant predictors of severe RP identified by univariable logistic regression included age, vaginal parity, RAP, and LHA. Multivariable logistic regression analysis exhibited that age and LHA during Valsalva were the most influential indicators of severe RP. Receiver operating characteristic (ROC) curve analysis revealed that an LHA ≥ 17.5 cm² is indicative for screening (sensitivity 90%, specificity 16.7%), and an LHA ≥ 32.5 cm² serves as a reference threshold for surgical referral (sensitivity 26.8%, specificity 90%).

Conclusions: Dynamic 3D-TPUS-measured LHA associated with with RP severity and could serve as a quantifiable marker for pelvic floor dysfunction in RP. This study introduces an adjunctive indicator for the severity of RP, improving diagnostic convenience and patient management.

Purpose: We performed a systematic review and meta-analysis to compare the efficacy and safety of endoscopic submucosal dissection (ESD) with those of endoscopic mucosal resection (EMR) for rectal tumors extending to the dentate line (RTDLs).

Methods: We searched the PubMed, Embase, Web of Science and the Cochrane Library databases up to July 2025 for studies that reported the clinical outcomes of EMR or ESD for RTDLs.

Results: Fifteen studies (237 for EMR and 564 for ESD) were included in this meta-analysis. The en bloc resection rate (0.961 vs. 0.097; p = 0.000) was significantly greater in the ESD group than in the EMR group, and the local recurrence rate (0.023 vs. 0.188; p = 0.000) was significantly lower in the ESD group. No significant differences in the complete resection rate (0.793 vs. 0.823, p = 0.869) were noted between the ESD and EMR groups. In terms of adverse events, there were no differences in the postoperative bleeding rate (0.067 vs. 0.082; p = 0.677), perforation rate (0 vs.0; p = 0.605) or stricture rate (0.022 vs. 0.042; p = 0.378) between the ESD and EMR groups.

Conclusion: ESD and EMR are effective and safe treatments for RTDLs; however, compared with EMR, ESD is associated with a higher en bloc resection rate and a lower local recurrence rate.

Background: Colorectal cancer (CRC) is a common malignant tumor worldwide. The cholesterol synthesis (CS) pathway is crucial in the occurrence and development of cancer. This study aims to predict the prognosis of CRC patients based on the cholesterol synthesis-related genes (CSRGs).

Methods: The patient data of CRC were downloaded from the TCGA and GEO databases, and the CSRGs were downloaded from Genecards. In the TCGA-CRC training set, univariate Cox regression analysis was conducted on the CSRGs, and subtype classification was performed through consensus clustering. Combined with the PPI network and regression analysis, key CSRGs were identified to establish a prognostic model. ROC curves and Kaplan-Meier survival analysis were used to evaluate the model and validate it in the GSE17538 validation set. At the same time, immune analysis and drug sensitivity analysis were conducted. Finally, the functions of these characteristic genes were investigated in an in vitro cell model.

Results: The TCGA-CRC was divided into two subtypes. A 10-gene Cholesterol Synthesis-related Risk Signature (CSRS) was constructed. The patients were grouped according to the median value of the CSRS. The high-CSRS group had a poorer prognosis, and the abundance of macrophages, neutrophils, and TIL was higher in this group. The drug sensitivity prediction indicated that several candidate drugs (such as Linsitinib) might affect the progression of CRC through unique mechanisms. In vitro experiments demonstrated that EEF1A2 could promote the malignant progression of tumors.

Conclusion: The results of this project provide some guidance for elucidating potential CS-related biomarkers for predicting prognosis in CRC patients.

Purpose: High-risk colon cancer may benefit from preoperative chemotherapy (preCHT), but evidence on its short-term safety and outcome is limited. Population-based evidence before its incorporation into national guidelines is lacking.

Methods: Patients with final weighted stage II-III colon cancer undergoing elective resection between 2007 and 2017 were identified in the Swedish Colorectal Cancer Registry. Patients planned for preCHT, irrespective of intention, were compared with those undergoing upfront surgery. Primary outcomes were 30- and 90-day mortality and 30-day major morbidity, defined as all medical and surgical complications classified as Clavien-Dindo (CD) ≥ 3 grade. Subgroup analyses examined cT4 disease, and multivariable logistic regression was performed.

Results: Among 20,185 eligible patients, 299 (1.5%) received preCHT. Postoperative mortality was comparable (1.7% vs. 1.7%, p = 1.00 at 30 days and 3.0% vs. 2.8%, p = 0.82 at 90 days). Overall and surgical postoperative morbidity (CD ≥ 3) was higher in the preCHT group (34.1 vs. 25.0%, p < 0.001 and 17.4% vs. 13.1%, p < 0.001), rates of anastomotic leakage were similar (3.3% vs. 3.6%, p = 0.85). Compared to upfront surgery, the preCHT group was more likely to undergo multivisceral resections (53.9% vs. 13.6%, p < 0.001), with a higher rate of R1 resections (6.4% vs. 3.2%, p < 0.001), reflecting more advanced disease (cT4: 59.5% vs. 10.5%, p < 0.001; cN1-2: 54.9% vs. 28.6%, p < 0.001). In the cT4 subgroup, short-term outcomes were comparable, and regression analyses found no independent association between preCHT and mortality or major morbidity.

Conclusion: PreCHT appeared feasible in cT4N0-2M0 colon cancer, with short-term outcomes comparable to upfront surgery despite more advanced primary tumour and greater surgical extent.

Purpose: Faecal incontinence is common in persons with severe obesity. Little is known about how the thicknesses of the internal anal sphincter (IAS) and the external anal sphincter (EAS) change in relation to weight loss following metabolic bariatric surgery (MBS). This study aims to investigate any change in IAS and EAS thickness 6 months after Roux-en-Y gastric bypass surgery (RYGB) and to determine whether any such change correlates with a change in faecal incontinence pattern.

Methods: Thirty-one patients underwent three-dimensional endoanal ultrasound to measure anal sphincter thickness before and 6 months after RYGB. Patients completed the validated Wexner and LARS (low anterior resection syndrome) questionnaires at the same time to evaluate any change in faecal incontinence and urgency symptoms following surgery.

Results: No significant change in the thicknesses of the IAS and EAS was seen. The Wexner score decreased from 18 to 13 (less incontinence). Conversely, the number of patients with LARS increased from 10 to 15 six months after surgery (more urgency).

Conclusion: RYGB had no effect on the thickness of the anal sphincter 6 months after surgery. However, the pattern of faecal incontinence changed, with a decrease in leakage and whole faecal incontinence and an increase in urgency.

Background: Colon adenocarcinoma (COAD) remains a leading cause of cancer-related mortality worldwide. Although tumor deposits (TDs) are established prognostic indicators, their molecular characteristics and potential for improving risk stratification remain unexplored.

Methods: We performed an integrative analysis of transcriptomic and clinical data from TCGA and GEO databases to identify TD-associated molecular signatures. A hybrid ML framework combining random survival forest and stepwise Cox regression was developed to construct a risk stratification model. Model performance was validated through survival analysis, time-dependent ROC curves, and multivariate analyses. Gene set enrichment analysis explored underlying mechanisms and therapeutic implications.

Results: The integrated molecular signature-based model demonstrated superior prognostic accuracy, effectively stratifying patients into risk groups with distinct survival outcomes (P < 0.001) and clinicopathological features. High-risk patients exhibited enhanced immune evasion mechanisms and differential drug sensitivity patterns. Pathway analysis revealed significant alterations in ECM receptor interaction, PPAR signaling, and neuroactive ligand-receptor interaction pathways.

Conclusions: Our machine learning-based integration of TD molecular signatures establishes a robust risk stratification model for COAD patients, offering improved prognostic accuracy and valuable insights for personalized treatment strategies. Our findings highlight the potential of interpretable machine learning in molecular oncology risk modeling.

Purpose: Sigmoid resection with end colostomy (Hartmann's procedure) is the procedure of choice when a large bowel obstruction secondary to diverticular disease requires surgery. Less morbid alternatives are less common. This study compares a transverse blowhole colostomy as a first-stage intervention in diverticular-associated obstruction. Our primary aim was to compare colostomy reversal rates and postoperative outcomes between blowhole colostomy and Hartmann's procedure.

Methods: This is a single-center, retrospective cohort study. An institutional database was utilized to retrospectively identify adult patients who underwent Hartmann's procedure or blowhole colostomy for diverticular strictures with obstruction between 2012 and 2023.

Results: Thirty-nine patients underwent Hartmann's procedure for diverticular strictures with obstruction and 15 patients underwent blowhole colostomy. The blowhole colostomy group had a significantly shorter postoperative length of stay (median 5 vs. 8 days, p = 0.01). Colostomy reversal was more frequent in the blowhole group (81.3% vs. 56.4%, p = 0.08), with a shorter median time to reversal (3 months vs. 4.7 months, p = 0.01). A significant increase in reversals performed using a minimally invasive approach (84.6% vs. 50%, p < 0.01) occurred in the blowhole colostomy group. No significant differences were observed in other postoperative outcomes, including proximal diversion after colostomy reversal.

Conclusions: Blowhole colostomy may be a viable alternative to a Hartmann's procedure for diverticular-associated large bowel obstruction, offering potential benefits such as shorter hospital stays, higher rates of colostomy reversal, and a greater likelihood of minimally invasive reversal. Further prospective studies are needed to confirm these findings.

Background: The relationship between serum lipids and colorectal polyps (CP) remains unclear due to inconsistent findings across prior studies. This study aimed to comprehensively explore the relationship between serum lipid levels and CP risk by using real-world clinical data.

Methods: By utilizing retrospective data from a tertiary hospital from 2015 to 2024, multivariate logistic regression, restricted cubic spline (RCS), and subgroup analyses were performed to assess the association between serum lipids and CP. Additionally, the mediating role of inflammation-related indices in the relationship between serum lipids and CP was examined.

Results: Triglyceride (TG) and total cholesterol (TC) were positively associated with CP risk (P < 0.05). RCS analysis revealed a nonlinear dose-response relationship between TG and CP risk (P for overall < 0.001, nonlinear P < 0.05), with a threshold value of 0.93 mmol/L. Significant interaction effects were observed between TG and TC and gender in relation to CP development. Inflammation-related indices mediated the association between high-density lipoprotein cholesterol and TC with CP risk (P < 0.05).

Conclusion: This study highlights the potential clinical utility of TG and TC as modifiable biomarkers for CP risk. Future prospective studies are warranted to validate these findings and to explore targeted lipid-modifying interventions for high-risk populations.

Purpose: Diverting ileostomies are routinely created during low rectal cancer surgery, yet 15-30% remain permanent. Understanding predictors of non-reversal is essential for informed patient counseling. This study investigated factors preventing ileostomy closure following colorectal surgery, primarily for rectal malignancy.

Methods: This retrospective cohort study analyzed prospectively collected data from patients undergoing diverting ileostomy creation (January 2015-December 2020). Exclusions included early postoperative mortality (within 30 days), follow-up less than 6 months, or missing primary outcome data. Demographics, surgical details, and reversal outcomes were analyzed. Multivariable logistic regression identified independent predictors of non-reversal.

Results: Of 508 patients, 456 met inclusion criteria (mean age 58.9 ± 13.2 years, 63.8% male). Malignancy accounted for 96.7% of cases, with low anterior resection performed in 83.8%. Ileostomy closure was achieved in 364 patients (79.8%) at a median of 6 months (mean 7.4 ± 5.3). The non-reversal rate was 20.2% (92 patients). Main reasons included mortality (35.8%), metastatic disease (23.9%), and anastomotic complications (22.8%). Multivariable analysis identified ASA score 3-4 (OR 2.68, 95% CI 1.58-4.54, p < 0.001) and malignant pathology (OR 5.12, 95% CI 1.23-21.3, p = 0.025) as independent predictors of non-reversal. Age showed statistical but limited clinical significance.

Conclusion: One in five patients with diverting ileostomies will not undergo reversal. High ASA scores, malignant disease, mortality, metastatic progression, and anastomotic complications are primary barriers. These findings emphasize the need for realistic preoperative counseling regarding permanent stoma risk.