International Journal of Colorectal Disease最新文献

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.

Purpose: This study evaluated whether total neoadjuvant therapy (TNT), compared to neoadjuvant chemoradiotherapy (nCRT), improves response and prognosis in magnetic resonance imaging (MRI)-defined high-risk patients with locally advanced rectal cancer (LARC).

Methods: This retrospective cohort study ultimately included 791 patients with pathologically confirmed rectal cancer who underwent baseline rectal MRI at our institution between 2015 and 2022. Independent MRI-based prognostic risk factors were identified through multivariable Cox regression analysis. Propensity score matching (PSM) was employed to control for confounding variables, followed by survival and treatment response analyses between groups.

Results: The Cox model revealed that MR-based T4 stage and extramural venous invasion (EMVI) status significantly impacted overall survival (OS), whereas tumor location and mesorectal fascia invasion (MRF) status served as important predictors of disease-free survival (DFS). After PSM, the MRI-defined TNT group exhibited a significantly higher clinical complete response (cCR) rate (25.8% vs. 4.0%, p < 0.001), thus leading to more frequent adoption of the watch and wait (W&W) strategy. Furthermore, Kaplan-Meier (KM) curve analysis ultimately confirmed that, compared with the nCRT group, the TNT group exhibited superior OS (HR = 0.48, 95% CI 0.27-0.86) and DFS (HR = 0.62, 95% CI 0.39-1).

Conclusion: In MRI-defined high-risk LARC patients, TNT could improve the survival trend while increasing the likelihood of organ preservation without exacerbating surgical complexity. These findings emphasize the fact that TNT should be prioritized for the high-risk MRI-defined population to achieve enhanced local tumor control, sustained therapeutic efficacy, and prolonged survival.

Background: We investigated the relationship between sarcopenia (low skeletal muscle index, SMI) and myosteatosis (high intermuscular adipose tissue, IMAT) accompanied by post-surgical adverse events and recurrence-free survival (RFS) in patients with colon cancer (CC) undergoing radical resection.

Methods: This retrospective study included 475 patients from the Affiliated Hospital of Qingdao University (original cohort) and 209 patients from Weihai Central Hospital Affiliated to Qingdao University (validation cohort) with CC who underwent radical surgical resection. Cox proportional hazards and logistic regression models were used to analyze the correlation between body composition and postoperative complications, as well as RFS. A nomogram was developed based on independent predictors of RFS, and its performance was evaluated.

Result: The original cohort comprised 475 patients (272 males, 203 females; mean age 64.8 ± 11.9 years). Postoperative complications occurred in 85 patients (17.8%). Multivariate analysis revealed low SMI (P = 0.025) and hypoalbuminemia (P = 0.048) were independent risk variables for these complications. The median follow-up was 51 months (IQR, 37.5-62.25). Low IMAT (HR 2.919, 95% CI: 1.423-5.985, P = 0.003) and high SMI (HR 0.450, 95% CI: 0.247-0.821, P = 0.009) were independent prognostic variables for RFS. Considering the original cohort, the AUCs for 1-, 3-, and 5-year RFS were 0.885, 0.867, and 0.868, and for the validation cohort, the AUCs for 1-, 3-, and 5-year RFS were 0.784, 0.817, and 0.897. The nomogram demonstrated strong predictive performance for RFS.

Conclusion: Sarcopenia is a standalone predictor for postoperative complications and RFS in patients with CC, whereas myosteatosis independently predicts RFS. The nomogram provides valuable support for clinical decision-making and holds the potential to improve patient outcomes.

Purpose: The role of mesenteric excision in Crohn's Disease (CD) remains uncertain. We aimed to evaluate the impact of extended vs. limited mesenteric excisions on intra- and postoperative outcomes in patients undergoing primary ileocolic resection for CD.

Methods: A systematic search was conducted in PubMed, EMBASE, Web of Science, ClinicalTrials.gov, and ISRCTN up to February 2025. Randomized controlled trials (RCTs), non-RCTs, and retrospective studies comparing extended and limited mesenteric excision in primary ileocolic resections for CD were included. The primary outcome was endoscopic CD recurrence (Rutgeerts score ≥ i2). Secondary outcomes included severe endoscopic recurrence (≥ i2b or ≥ i3), surgical recurrence, anastomotic leaks, operative time, conversion to open surgery, severe postoperative complications, and length of hospital stay.

Results: Over the 2588 records initially screened, 4 studies were included, involving a total of 632 patients. Pooled analysis showed no significant difference in endoscopic recurrence rates between extended and limited resections (48.2% vs. 54.1%; RR: 0.91; 95% CI: 0.70-1.18; p = 0.46; I² = 57%). Additionally, there were no significant differences in the risk of anastomotic leak (3.8% vs. 2.6%; RR: 1.35; 95% CI: 0.14-12.88; p = 0.80; I² = 52%) or any other analyzed outcomes.

Conclusion: Extended mesenteric excision does not appear to significantly reduce endoscopic recurrence compared with limited excision in primary ileocolic resections for CD. Until further high-quality evidence is available, surgical teams should adhere to their established practice and refrain from implementing extended resections outside well-designed prospective studies.

Registration: PROSPERO (CRD42025644791).

Background: Tumor necrosis factor (TNF) antagonists are central to the management of inflammatory bowel disease (IBD), but concerns regarding long-term safety, infection risk, and costs have prompted interest in treatment de-escalation. Whether discontinuing TNF therapy in patients with sustained remission is safe remains uncertain.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TNF antagonist withdrawal with continuation in IBD patients in sustained remission. Databases including MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched through July 2025. Eligible trials enrolled adults with Crohn's disease or ulcerative colitis in clinical remission. Primary outcomes were relapse risk and sustained remission. Data were pooled using a random-effects model.

Results: Four RCTs comprising 485 patients were included. TNF antagonist withdrawal was associated with a significantly higher risk of relapse compared with continuation (RR: 3.00, 95% CI: 1.47-6.11). Time to relapse was also shorter in the withdrawal group (HR: 5.34, 95% CI: 2.05-13.92). Sustained clinical remission did not differ significantly between groups (RR: 0.83, 95% CI: 0.55-1.27). Withdrawal reduced infection risk (RR: 0.47, 95% CI: 0.25-0.90), while rates of gastrointestinal and serious adverse events were comparable.

Conclusions: Discontinuation of TNF antagonists in IBD patients in remission substantially increases the risk and accelerates the timing of relapse, though it lowers infection risk. Careful patient selection and close monitoring are essential if withdrawal is considered.

Purpose: The surgical treatment of perianal fistulas is challenging, especially in complex cases. Many surgical options may cause impairment of the anal sphincter with subsequent incontinence or may be less effective with a high number of relapses or the persistence of the pathology. New techniques, such as the use of mesenchymal stem cells, are becoming increasingly important because of their effectiveness and lower risk of complications.

Methods: In this single-centre prospective observational study, patients with complex perianal fistulas were treated via the infiltration of mesenchymal stem cells that had been purified using the Lipogems® system.

Results: This study included 63 patients with complex perianal fistulas who were treated with mesenchymal stem cells extracted from adipose tissue. Successful clinical healing was observed in 43 (68.25%) patients. Eleven (17.4%) patients presented recurrence after treatment, and 9 (14.3%) had persistent incomplete healing. Minor postoperative complications were observed in six (9.5%) patients, which were related to adipose tissue harvesting in three patients. In the majority of patients, postoperative pain was mild or not present.

Conclusions: Mesenchymal stem cells offer an innovative therapeutic tool for treating perianal fistulas. This study confirms their safety and efficacy in treating complex perianal fistulas. Nevertheless, more extensive patient follow-up is necessary, as demonstrated by the most recent literature on related techniques.

Objectives: Crohn's disease (CD), ulcerative colitis (UC), intestinal Behçet's disease (BD), intestinal tuberculosis (ITB), and primary intestinal lymphoma (PIL) are major intestinal disorders that frequently present with mucosal ulceration. Accurate differentiation among these conditions is challenging due to overlapping clinical, endoscopic, and imaging characteristics. Accordingly, this study aimed to develop an artificial intelligence (AI)-assisted endoscopic diagnostic system to accurately identify these five diseases.

Methods: This multicenter prospective study used endoscopic images from patients diagnosed with pathologically confirmed CD, UC, BD, ITB, and PIL to develop an AI system that uses convolutional neural networks (CNNs) and transformer architectures. It was validated across multiple centers compared with endoscopist performance, and assessed prospectively. In addition, clinical data were integrated to construct a comprehensive diagnostic model.

Results: Internal validation revealed that the AI system achieved an accuracy of 96.8%, with sensitivities for the five ulcerative diseases ranging from 76.9% to 97.8%. In the multicenter test (Test A + Test B3), diagnostic accuracy reached 83.4%, outperforming endoscopists. Prospective evaluation revealed that AI system demonstrated significantly higher accuracy than senior endoscopists (83.4% versus 59.4%, P < 0.001). Moreover, the optimal comprehensive model, which combined clinical and endoscopic data, achieved an accuracy of 76.3%.

Conclusions: An AI-assisted endoscopic diagnostic system that accurately differentiates CD, UC, BD, ITB, and PIL was developed, which may contribute to improving diagnostic precision for colorectal ulcerative diseases.

Purpose: Preoperative radiotherapy (pRT) for rectal cancer (RC) reduces local recurrence rates. However, treatment-induced side effects may compromise patient-reported quality of life (QoL). This study aimed to report longitudinal QoL and physician-assessed toxicity in RC patients receiving preoperative intensity modulated radiotherapy (IMRT).

Methods: This prospective cohort study included 123 RC patients treated with short-course (SCRT) or long-course chemoradiotherapy (LCRT). Patient-reported outcomes (PRO) were assessed using the EORTC QLQ-C30 and CR29 questionnaires at pretreatment, end of treatment, preoperatively, and at 1-year follow-up. Physician-reported toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE). Longitudinal changes in PROs were analysed using mixed-effects regression modelling. CTCAE grades were reported as frequencies, and symptom transitions illustrated using Sankey diagrams.

Results: For EORTC C30 items, pRT-induced transient declines were observed for Global Health, physical, role and social functioning, fatigue, and pain, with scores recovering at preoperative assessment, except for persistent worsening for fatigue. At 1-year, Global Health remained stable; emotional functioning improved; fatigue and social functioning showed minor persistent worsening. Bowel and bladder symptoms peaked during pRT and gradually resolved or improved at 1Y. CTCAE grades were predominantly mild; diarrhoea and rectal bleeding improved over time, while urinary dysfunction and fatigue increased modestly. Sankey plots illustrate symptom transitions. Discrepancies were noted between physician- and patient-reported outcomes.

Conclusion: IMRT-based pRT was associated with largely preserved QoL at 1Y. Reported trajectories of PRO and CTCAE scores provide complementary insights to support physician-patient communication, with differences underlining the importance of integrating both perspectives.

The purpose of the present study was to perform a systematic review and meta-analysis of the available literature on the surgical management of Hinchey III diverticulitis comparing laparoscopic lavage with surgical resection.

Methods: A PubMed and EMBASE search using well-defined mesh terms was used. All identified papers were screened for possible inclusion in the study by initial review of abstracts. Only randomized trials were included in the meta-analysis.

Results: The search resulted in 23 studies available for closer investigation. We managed to identify 3 separate randomized trials comparing the outcome after laparoscopic lavage and sigmoid resection for Hinchey III diverticulitis. Early and late results of these trials have been reported in 7 scientific papers constituting the basis of the present systematic review and meta-analysis. For the different endpoints, pooled data from between 292 and 380 patients randomized to either sigmoid resection or laparoscopic lavage was available for analysis. Ninety-day mortality was similar between the groups (OR = 0.69 (0.32-1.49)), but the risk of severe complications and of recurrent diverticulitis was lower among patients randomized to sigmoid resection (OR = 0.61 (0.38-0.98) and OR = 0.15 (0.05-0.44), respectively). The risk of having a stoma after 1 year was higher among patients randomized to resection (OR = 2.97 (1.30-6.81)). No significant differences were identified regarding the need for reoperation. Subsequent analysis of data from two of the randomized trials showed that smoking and use of immunosuppressant medications were associated with a poorer outcome after laparoscopic lavage.

Conclusions: Laparoscopic lavage has certain advantages when compared to resection for Hinchey III diverticulitis, but should be used with caution in smokers and patients taking immunosuppressants. After lavage, recurrent diverticulitis (often uncomplicated) is likely to occur. Resection with primary anastomosis is a good option in stable and fit patients when surgical expertise is available, but for a number of patients, resection with formation of a stoma seems to be the safest option.