International Journal of Colorectal Disease最新文献

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.

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.

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: 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.

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.

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.