International Journal of Colorectal Disease最新文献

Background: Emotional engagement, family support and personal beliefs can influence how patients and healthcare professionals (HCPs) perceive cancer differently. This study examined the extent to which the views of patients and HCPs on cancer care align, and identified factors that may underlie disparities.

Methods: Participants with colorectal cancer (CRC) were asked to describe their perception of their disease (i.e. whether they felt it was under control (DC), was progressing (PD), or was of an unknown status) and to complete psychometric assessments of anxiety, depression, PTSD and well-being. Two HCPs, who were blinded to the patients' responses, examined the case files to determine the stage of treatment at which the patients were enrolled in the study. The concordance of perceptions between patients and HCPs was examined, along with associations with clinical variables and psychometric health outcomes, using both univariate and multivariate analyses.

Results: A total of 205 patients with CRC were included in the study. The mean age was 65 years, with 58% of patients being male. Overall, a significant difference in perception was observed between HCPs and patients (p < 0.001), particularly for patients identified by HCPs as having PD. Significant discrepancies were observed among patients receiving palliative care (p < 0.001), whereas those in the adjuvant or neo-adjuvant pathway appeared to align more closely with HCPs' perceptions (p = 0.99). Neither demographic nor psychological factors were significant determinants of concordance between HCPs and patients' understanding of cancer status in this population. In multivariate analysis, patients perceiving PD or expressing uncertainty were found to have significantly higher levels of depression than those with DC (OR 6.42, p = 0.001 and OR 3.86, p = 0.009, respectively).

Conclusions: This study reveals significant differences in how cancer is perceived by HCPs and patients, particularly among those without disease control or undergoing palliative care. This highlights the importance of effective communication in addressing patients' needs and their psychological well-being.

Objective: To investigate the multiple effects of interactive video health intervention on the quality of life and clinical rehabilitation indexes of patients with early intestinal obstruction.

Methods: This study included two phases: (1) questionnaire validation (January 2019-December 2020): 152 patients with early postoperative bowel obstruction were enrolled to develop and test the reliability/validity of the Postoperative Quality of Life Assessment Scale for Early Intestinal Obstruction. (2) Randomized controlled trial (January 2021-January 2025): 310 eligible patients (18-75 years, basic cognitive ability, diagnosed with early postoperative bowel obstruction after abdominal surgery) were randomly assigned to a control group (conventional care: condition monitoring, basic treatment, and non-structured health education, n = 132) or a study group (conventional care plus an interactive video health intervention-5 modular videos covering disease knowledge, rehabilitation, and diet, initiated 24 h post-surgery, n = 178). Outcomes included QoL (via the validated scale), clinical rehabilitation indicators (obstruction relief time, hospitalization duration), electrogastrogram parameters, and gut microbiota diversity (16S rRNA sequencing).

Results: The validated QoL scale had good reliability (Cronbach's α = 0.821-0.937) and validity (AVE > 0.5, CR > 0.7). In the trial, the study group showed significantly better QoL scores (physiological function: 13.82 ± 5.67 vs. 22.45 ± 3.57; total score: 50.60 ± 6.44 vs. 36.67 ± 7.93; P < 0.001) and clinical outcomes (hospitalization duration: 8.78 ± 1.39 vs. 10.13 ± 1.41 days; P < 0.001) than the control group. The study group also had improved electrogastrogram parameters (e.g., gastric antrum slow-wave amplitude: 194.59 ± 20.76 vs. 151.34 ± 21 µV; P < 0.001) and intestinal microbiota evenness (Shannon index: P = 0.0070) compared to the control group.

Conclusion: The disease-specific QoL scale is valid for assessing patients with early postoperative bowel obstruction. The interactive video health intervention effectively improves their QoL and clinical rehabilitation, providing a feasible clinical tool.

Trial registration: ClinicalTrials.gov Identifier: NCT07258017 (September 24, 2025).

Purpose: Anal incontinence (AI), characterized by involuntary leakage of gas or stool, adversely affects quality of life and is associated with various comorbidities. Limited data exist regarding its prevalence in Turkey.

Method: To assess the prevalence and implications of AI, a multicentre study encompassing seven regions of Turkey was conducted. A power analysis was conducted before the study, and it was calculated that at least 7927 individuals were required to be screened to achieve a minimum AI prevalence of 2.5%. A survey of 8844 relatively healthy persons visiting outpatient clinics was conducted by health care professionals in a face-to-face manner across seven geographical regions in Turkey. The survey utilized the Wexner incontinence scale score and collected information on surgical history, chronic diseases, gynaecological conditions, and regional variations.

Results: The prevalence of anal incontinence in Turkey was 2.3% (95% CI, 2-2.5%). The prevalence of AI increased with increasing age (65+ y/o), prolapse (p < 0.0001), and AI was also found to be associated with chronic conditions, including chronic medication usage and bowel habits (diarrhoea/constipation) (p < 0001). Vaginal delivery and prostate surgery were also associated with AI (p < 0001). Significant associations were observed between AI rates in women and certain gynaecological conditions. Additionally, regional differences in AI prevalence were also identified.

Conclusion: The results of the present study revealed that AI is more prevalent among older individuals and women and is associated with chronic illness, bowel habits, vaginal delivery, and chronic medications. Additionally, particular attention should be given to the role of gynaecological conditions in AI in women.

Background: Surgical site infection (SSI), wound-related complications, and incisional hernia are common concerns following stoma reversal. These complications can significantly impair postoperative recovery and quality of life, especially in rectal cancer patients. This study compared the clinical and patient-reported outcomes of two protective stoma reversal procedures, the gunsight and conventional linear closure techniques.

Methods: A retrospective propensity score matching (PSM) analysis was conducted on 194 patients who underwent stoma reversal between 2016 and 2023. Baseline characteristics, surgical outcomes, postoperative complications, and patient satisfaction were compared between the gunsight and conventional closure groups. A structured, self-designed questionnaire based on the principles of patient-reported outcome measures (PROMs) was administered at 6 months post-operatively to assess pain relief, wound healing, scar appearance, and functional recovery.

Results: After PSM, 97 matched pairs were analyzed. The gunsight group had significantly lower SSI rates (11.34% vs. 22.68%, p = 0.036) and reported lower postoperative pain scores on POD 1 (p < 0.001) and POD 2 (p = 0.003). No significant differences were observed in terms of operative time, hospital stay, wound dehiscence, or incidence of incisional hernia. Patient-reported satisfaction with pain relief was significantly greater in the gunsight group (p = 0.012), whereas overall satisfaction scores were comparable.

Conclusion: The gunsight closure technique reduces postoperative infections and early postoperative pain without increasing complication rates. It also improves early patient-reported outcomes, making it a safe, effective, and patient-centered alternative for stoma reversal in rectal cancer surgery.

Introduction: Colorectal cancer (CRC) is one of the most prevalent malignancies and often leads to metastatic disease. Ovarian metastasis occurs in approximately 4% of all female CRC patients. Metastatic disease recurrence after intentional curative resection of primary colorectal tumour could be explained by the presence of micrometastases. The present study aims to investigate the prevalence of CRC (micro)metastases in tubo-ovarian tissue following prophylactic salpingo-oophorectomy (PSO) in postmenopausal patients.

Material and methods: Analyses of both adnexa of postmenopausal CRC patients who underwent primary tumour resection and concurrent PSO were conducted retrospectively. Tissue blocks with formalin fixed paraffin embedded ovarian tissue were sectioned at five levels, and both routine histopathological and additional immunohistochemical staining for CK20 and CDx2 were performed. The primary outcome measure was the incidence of CRC micrometastases (%).

Results: Ovaries of 100 consecutive CRC patients who underwent surgery at two Dutch teaching hospitals were analysed (age 72.7 ± 7.6 years, pT0-2 (43%), and pN0 (65%)). Overall, ovarian malignancies were found in 4% of patients. Immunohistochemical analysis revealed no additional CRC (micro)metastases.

Discussion: Additional immunohistochemical assessment did not reveal CRC ovarian (micro)metastases in an unselected patient cohort. The absence of micrometastases could be attributed to patient selection criteria and/or sampling error. Future research should focus on identifying a subgroup at high risk of developing ovarian metastasis and on the improvement of diagnostic and therapeutic strategies.

Background: Despite advances in neoadjuvant therapies and surgical techniques, abdominoperineal excision of the rectum (APER) is still necessary in a considerable number of cases, often requiring the creation of a permanent colostomy, which can significantly impact a patient's quality of life (QOL). Total anorectal reconstruction (TAR) with dynamic graciloplasty has emerged as a reconstructive option for patients undergoing APER, aiming to restore continence by avoiding a permanent abdominal colostomy and improving quality of life. However, this approach presents several challenges, including technical complexity and variable long-term outcomes.

Case report: We present the case of a 34-year-old female patient who underwent APER with extended resection (rectum and vaginal wall) due to low rectal adenocarcinoma infiltrating the posterior vaginal wall. Following a prolonged postoperative course and the decision against living with an abdominal colostomy, the patient underwent secondary TAR with reconstruction of the posterior vaginal wall and dynamic graciloplasty in 2001. The procedure included creating a neorectum using a myocutaneous flap for vaginal reconstruction and a gracilis muscle wrap with neurostimulation as a neosphincter. Despite early postoperative complications, the patient achieved satisfactory continence with regular transanal irrigation and lived with the reconstruction for over 20 years. In 2024, the patient returned for management due to the obsolescence of her neurostimulator, which was subsequently removed without deterioration in her continence function.

Conclusion: This case highlights the complex and prolonged management challenges associated with TAR and dynamic graciloplasty for patients with severe anorectal dysfunction following APER. While dynamic graciloplasty has been shown to offer some level of continence in patients with faecal incontinence, the need for additional interventions, such as regular irrigation, is often required to maintain quality of life after TAR following APER. The durability of this reconstructive approach and the patient's long-term satisfaction underline its potential as a viable, though technically demanding, alternative to conventional colostomy in selected patients. However, the role of electrically induced muscle fiber transformation ("dynamic graciloplasty") needs to be discussed.

Purpose: The Malone antegrade continence enema (MACE) offers a minimally invasive and potentially reversible option for managing chronic constipation and fecal incontinence (FI). This systematic review evaluates its efficacy, safety, and long-term outcomes in adults.

Methods: A comprehensive search was conducted across PubMed, EMBASE, and CENTRAL databases up to April 2025 to identify studies on MACE in adults. Study quality was assessed using the Newcastle-Ottawa scale. The primary outcome was the proportion of patients continuing MACE at follow-up (treatment success); failure was defined as conversion to definitive colostomy.

Results: Seventeen studies with 404 patients were included. Study quality was rated moderate to good. The most common indications were neurological disorders (25.8%), prior surgeries (16.8%), idiopathic constipation (14.2%), and traumatic spinal injuries (11.6%). Techniques included terminal ileal loop (37.9%), percutaneous endoscopic cecostomy (26.0%), and appendicostomy (24.8%). Minor stoma-related complications were most frequent (39.1%), followed by fecal leakage (16.2%) and stoma stenosis (11.3%). Median follow-up was 28.5 months. At final follow-up, 75.1% of patients continued using MACE, while 9.8% required colostomy. Satisfactory outcomes were reported by 60%-83% of patients, with improvements in symptoms and quality of life.

Conclusions: MACE is a safe and effective option for adults with refractory constipation or FI, especially in those aiming to avoid a permanent colostomy.

Purpose: This study aimed to evaluate oncological outcomes in patients with high-risk early rectal cancer undergoing local excision, comparing those who received guideline-recommended additional treatment to those who did not, either due to comorbidities or personal preference.

Method: National data on patients treated by transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) for early rectal cancer without prior chemoradiotherapy between 2010 and 2020 were analyzed retrospectively. Patients were classified into low-risk (pT1 without risk factors for lymph node involvement) and high-risk (pT1 with risk factors and all pT2). High-risk patients receiving additional treatment (mainly completion TME, or less frequently adjuvant chemoradiotherapy for high-risk pT1) were compared to those without further treatment. Endpoints were 5-year relative survival, disease-free survival, overall survival, local recurrence, and distant recurrence.

Results: Among 298 patients, 70 (23.5%) were low-risk pT1, 153 (51.3%) were high-risk pT1, and 75 (25.2%) were pT2. Additional treatment was omitted in 93 (60.8%) of high-risk pT1 and 39 (52.2%) of pT2 cases. Compared to patients following guidelines, those not receiving additional treatment had lower 5-year disease-free survival of 53.3% vs. 80.9% (p = 0.008) and higher 5-year local recurrence rates of 22.0% vs. 7.3% (p = 0.008). Five-year overall survival was 63.9% vs. 90.6% (p = 0.013), and relative survival 81.9% vs. 97.7% (p = 0.157).

Conclusion: Omitting indicated additional treatment following TEM or TAMIS for high-risk early rectal cancer is associated with a substantially higher local recurrence rate and loss of long-term disease-free survival and overall survival.

Purpose: This study investigated the patient factors leading to ICG fluorescence angiography (ICG-FI)-guided surgical plan changes during rectal cancer surgery and evaluated the impact of these changes on anastomotic height and postoperative bowel function.

Methods: In a retrospective analysis of 302 patients undergoing laparoscopic low anterior resection, we compared 28 patients requiring perfusion-based plan changes (Change group) to 274 without changes (No-Change group). We analyzed demographics, anastomotic height, and 6-month LARS scores.

Results: The Change group had significantly older age, higher BMI, more neoadjuvant therapy, and lower tumor height. Their final anastomoses were higher (8.0 vs. 6.0 cm, p < 0.001). This group also had better bowel function, with lower LARS scores (18 vs. 25, p = 0.007) and fewer major LARS cases (14.3% vs. 32.1%, p = 0.041). Anastomotic leakage rates were similar.

Conclusions: ICG-FI identifies patients with perfusion risk factors (age, obesity, neoadjuvant therapy, low tumors) who benefit from surgical plan modification. Guiding the proximal resection margin based on ICG assessment to create a higher, well-perfused anastomosis significantly improves functional outcomes, underscoring its role in personalized surgery.

Trial registration: The study was registered in the clinical trials registry with registration number NCT06270745.