International Journal of Colorectal Disease最新文献

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.

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.