International Journal of Colorectal Disease最新文献

Background: Inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gastrointestinal tract with increasing global incidence. This meta-analysis aims to systematically evaluate the relationship between ATP-binding cassette subfamily B member 1 (ABCB1) rs2032582 polymorphism and IBD susceptibility.

Methods: A comprehensive literature search was conducted across Web of Science, PubMed, Embase, Google Scholar, Wanfang, and CNKI databases to identify eligible case-control studies published up to March 2025. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated under multiple genetic models to assess the association between ABCB1 rs2032582 and IBD. Subgroup analyses were performed based on ethnicity and disease type. Heterogeneity was evaluated using the Q test and I² statistics, and publication bias was assessed using Egger's test and Begg's funnel plot. We utilized data from SNPedia ( https://www.snpedia.com/ ) to illustrate the distribution of the ABCB1 rs2032582 polymorphism across diverse populations. The mRNA expression levels of ABCB1 in IBD tissues were analyzed using the IBDTransDB database ( https://abbviegrc.shinyapps.io/ibdtransdb/ ).

Results: A total of 19 publications comprising 31 study subgroups (some studies provided the data for both UC and CD subgroups) were included, encompassing 6,721 IBD cases and 8,155 healthy controls. In the overall analysis, ABCB1 rs2032582 polymorphism was significantly associated with IBD in specific populations. Subgroup analysis revealed a significant association in Asian and African populations, particularly in CD, while no significant association was found in Caucasian populations. The allelic model and recessive model showed significant associations with IBD in Asian and African populations (P < 0.05). Sensitivity analyses confirmed the robustness of the findings, and no significant publication bias was detected. The ABCB1 rs2032582 polymorphism shows different distribution across ethnic groups, with the potentially harmful homozygosity for the mutant allele present in 30.4% of Asians, 18.4% of Caucasians, and only 1.9% of Africans. ABCB1 expression was consistently reduced in patients with IBD compared to healthy controls.

Conclusion: This meta-analysis provides evidence that ABCB1 rs2032582 polymorphism is associated with IBD susceptibility, particularly in Asian and African populations, with a more pronounced effect in CD. These findings highlight the potential role of ABCB1 in IBD pathogenesis and suggest that ethnic-specific genetic variations may contribute to disease susceptibility. Further large-scale, multi-ethnic studies are required to validate these findings and explore the underlying mechanisms.

Purpose: The optimal vascular ligation strategy and lymphadenectomy level in oncological sigmoidectomy remain controversial, with inconsistent definitions and a lack of standardized postoperative assessment. This study aimed to anatomically and radiologically define D2 and D3 lymphadenectomy in sigmoid colon cancer and to develop an objective multimodal protocol for postoperative classification of vascular ligation and recurrence patterns.

Methods: A three-phase multimodal anatomical study was conducted. Phase 1 involved cadaveric dissections simulating D2 lymphadenectomy and D3 dissection with either low or high ligation of the inferior mesenteric artery (IMA). Phase 2 retrospectively assessed 14 patients with pre- and postoperative contrast-enhanced CT scans to classify vascular ligation type and recurrence pattern. Phase 3 validated these findings through AI-assisted computational segmentation and 3D reconstruction.

Results: In cadaveric simulation, each vascular strategy (D2, D3-low tie, D3-high tie) was anatomically characterized in terms of arterial division point, venous drainage control, and residual mesocolon, allowing systematic differentiation of the three approaches. Radiological evaluation successfully identified the level of vascular ligation in all cases. Among patients with recurrence (n = 5), the classification protocol distinguished mesenteric from non-mesenteric recurrences based on vascular territory. The 3D reconstruction phase showed full concordance between the radiological classification and the 3D model regarding both the level of inferior mesenteric artery ligation and the anatomical localization of locoregional recurrence.

Conclusion: This standardized anatomical-radiological workflow, integrating cadaveric dissection, CT-based vascular analysis, and AI-assisted 3D reconstruction, provides an objective tool to classify the level of vascular ligation performed in oncological sigmoidectomy and to anatomically categorize locoregional recurrence, establishing a foundation for future surgical audit and outcome studies, and representing a step toward AI-supported surgical audit systems capable of standardizing vascular ligation classification and recurrence mapping.

Purpose: Recent evidence suggests that the local recurrence (LR) rate after local excision of pT1 rectal adenocarcinoma may be higher than previously estimated, particularly in large cohorts with extended follow-up. This study aimed to evaluate the LR rate and long-term oncological outcomes in patients with pT1 rectal adenocarcinoma treated with transanal endoscopic surgery (TES).

Method: Observational cohort study including 824 consecutive patients who underwent TES at a single tertiary center between 2004 and 2021. Among them, 104 patients (12.6%) were diagnosed with pT1 rectal adenocarcinoma. Patients were excluded if they had received neoadjuvant or adjuvant chemoradiotherapy, had non-rectal tumors, a follow-up of less than 40 months, or were treated with surgical techniques other than TES.

Results: With a median follow-up of 91 months (IQR: 84), 17 patients (16.3%) developed LR and 14 (13.5%) developed distant recurrence. Five-year rectal cancer-specific and overall survival rates were 95% and 74%, respectively. Among the 88 patients without histopathological or surgical high-risk factors, 13 (14.8%) experienced LR and 9 (10.2%) distant recurrence. Their five-year disease-free and overall survival rates were 95% and 74%, Multivariate analysis identified flat-ulcerated morphology as the only independent predictor of LR (OR 6.8; 95% CI 1.5-30.4; p = 0.01).

Conclusion: TES for pT1 rectal adenocarcinoma resulted in a 16.3% overall LR rate, and 14.8% among patients without known risk factors, emphasizing the need for improved patient selection and novel prognostic and therapeutic tools. These findings warrant confirmation in multicenter studies with standardized criteria and prolonged follow-up.

Purpose: To investigate the association between preoperative phase angle (PhA), measured by bioelectrical impedance analysis, and short-term postoperative complications in patients with Crohn's disease (CD) undergoing ileocolic resection.

Methods: This retrospective cohort study included consecutive patients with CD who underwent ileocolic resection between April 2021 and December 2024. Baseline demographic, clinical, and nutritional data were analyzed. Univariable and multivariable logistic regression models were employed to identify predictors of postoperative complications. The discriminative ability of PhA was evaluated using receiver operating characteristic (ROC) curve analysis, with additional stratification by sex.

Results: Among 119 patients (median age 28 years; 72.3% male; median BMI 18.0 kg/m²), 25 (21.0%) experienced postoperative complications. Mean preoperative PhA was significantly lower in patients with complications compared with those without (4.1 ± 0.5° vs 4.8 ± 0.7°, P < 0.001). In multivariable analysis, higher preoperative PhA was independently associated with reduced odds of complications (OR = 0.203, 95% CI = 0.085-0.487, P < 0.001), whereas elevated C-reactive protein on postoperative day 3 was associated with increased odds (OR = 1.017, 95% CI = 1.007-1.028, P = 0.002). PhA demonstrated good overall discrimination (AUC 0.772, 95% CI 0.657-0.863). Sex-stratified analysis revealed superior discrimination in females (AUC 0.864, 95% CI 0.689-1.000; cut-off 3.9°) compared with males (AUC 0.748, 95% CI 0.625-0.857; cut-off 4.5°).

Conclusion: Lower preoperative PhA values were associated with a higher risk of short‑term postoperative complications after ileocolic resection for CD. Findings support the potential incorporation of PhA into preoperative risk assessment to help identify higher‑risk patients and guide perioperative optimization.

Introduction: Personalized treatment strategies in rectal cancer aim to balance escalation and de-escalation based on recurrence risk. Accurately identifying which patients will benefit from each approach is essential for optimizing outcomes and guiding follow-up. However, current clinical methods lack the precision needed to reliably predict response and long-term prognosis.

Methods: In this feasibility study, we evaluated the prognostic utility of a novel methylation-specific droplet digital PCR (MS-ddPCR) multiplex assay in 56 patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant treatment (nT)  and surgery. Circulating tumor DNA (ctDNA) was analyzed at four time points (baseline, during nT, preoperatively, 6 months post-surgery). Associations between ctDNA status and dynamics with tumor regression grade (TRG), disease recurrence, and overall survival (OS) were assessed using receiver operating characteristics (ROC) analyses and survival statistics.

Results: ctDNA was detected in 59% of the patients at baseline. Preoperative ctDNA had limited discriminative value for pathologic response, AUC 0.60 (95% CI 0.45-0.76). In contrast, ctDNA positivity 6 months postoperatively was strongly associated with recurrence within 2 years following surgery, AUC 0.96 (95% CI, 0.91-1.00). CtDNA positivity 6 months post-surgery was associated with inferior 2-year DFS (38% vs 94%, p for log-rank < 0.001) and 3-year OS (63% vs 100%, p for log-rank < 0.001).

Conclusion: With this MS-ddPCR assay, preoperative ctDNA showed limited prognostic value, whereas ctDNA 6 months postoperatively was strongly associated with recurrence and overall survival. The absence of an immediate postoperative sample limited assessment of early molecular response-a time point critical for guiding treatment decisions and follow-up strategies-underscoring the need for earlier sampling in future studies to optimize ctDNA-guided management. Given the small cohort and exploratory design, these findings are hypothesis-generating and support further validation of the assay in larger, prospective trials.

Background: Most patients with Crohn's disease (CD) experience disease progression and will eventually undergo surgery. However, the risks of progression and surgery exhibit significant regional heterogeneity. We conducted a cohort study to explore the risks and associated factors for disease progression, surgery, and postoperative recurrence in CD patients from Yunnan, a plateau province in southwestern China, and compared these data with data from Asian and Western countries.

Methods: In this study, data from a multicentre cohort from Yunnan Province were collected and analyzed. The cumulative risks of disease progression, surgery, and postoperative recurrence were analyzed. Univariate and multivariate analyses were performed to explore the independent risk factors associated with these outcomes. Finally, the distinct clinical profile of CD in our Yunnan cohort was compared with those of populations in Asian and Western countries, as reported in the literature.

Results: Among 252 patients with CD, disease behaviour and location progressed in 19.87% and 16.67% of the cohort, respectively. A total of 42.9% of the patients underwent surgery. The cumulative risk of postoperative recurrence at 3 years after primary surgery was 53.8%. Intestinal complications (HR = 2.798; P < 0.001) were independent risk factors for primary surgery, whereas the use of glucocorticoids (HR = 0.411; P = 0.002) and the use of biologics (HR = 0.300; P < 0.001) were protective factors. A delayed diagnosis (> 1 year) was an independent risk factor for reresection and postoperative recurrence. The cumulative risk of progression of disease behaviour was 34.5% at 5 years in Yunnan CD patients, which was greater than those reported in Western (14-15%) and Asian countries (15-30.7%). Similarly, the cumulative risk of surgery was 36.1% at 5 years, which exceeded the risks observed in the Western (17.4-35.1%) and Asian (10.7-16.5%) cohorts.

Conclusion: Compared with those in Asian and Western countries, CD patients in Yunnan exhibit an increased propensity for disease progression and surgical intervention. Intestinal complications and delayed diagnosis (> 1 year) are risk factors for surgery and postoperative recurrence.

Background: Higher surgical trainees often struggle to attain endoscopy competencies. We aimed to obtain a national picture of higher surgical trainees' endoscopy experience, highlight barriers to training, and explore potential solutions.

Methods: A 40-point electronic questionnaire was designed and disseminated to higher surgical trainees across the UK. Anonymous responses were collected and recorded from 26/10/2020 to 11/06/2021.

Results: A total of 139 higher surgical trainees from 16 out of the 19 regional UK deaneries responded. 75.9% (82/108) had some endoscopy training, and 19.4% (21/108) had no endoscopic training. 27.8% (30/108) had performed over 200 procedures. 77.8% (105/135) were not made aware of endoscopy training requirements by their Training Programme Directors (TPDs). 59.6% (65/109) had no named endoscopy supervisor. Only 49.1% (53/108) felt supported by their endoscopy trainers. Joint Advisory Group on GI Endoscopy (JAG) certification was infrequent, and the highest levels, 14.4% (15/104), were achieved in oesophagogastroduodenoscopy (OGD). Only 55.8% (24/43) of JAG-certified trainees felt competent in that procedure. 50.0% (7/14) of ST8 (final year trainee) respondents were not JAG certified in any procedure. 90.6% (96/106) faced challenges in gaining endoscopy training. The most common obstacles were the COVID-19 pandemic 87.9% (94/107), on-call commitments 80.2% (85/106), lack of allocated endoscopy sessions 80.2% (85/106), insufficient endoscopy training lists 76.4% (81/106), and competition with non-surgical trainees 64.2% (68/106).

Conclusions: Our survey provides detailed evidence of the challenges faced by surgical trainees in gaining endoscopy training. Suggested solutions include allocated endoscopy trainers, dedicated endoscopy-only training blocks, and early guidance about endoscopy training and certification.

Background and objective: Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC.

Methods: A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model.

Results: Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade.

Conclusion: IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.

Purpose: Although rare, septic shock can develop following the closure of an ileostomy created during colorectal cancer surgery. In such cases, bacterial translocation (BT) is considered the primary diagnosis, and appropriate treatment is provided. Herein, we investigated the risk factors of BT following ileostomy closure after colorectal cancer surgery.

Methods: A retrospective analysis was conducted using the colorectal cancer database of Nagasaki University, focusing on 91 patients who received ileostomy closure after colorectal cancer surgery. The patients were divided into two groups based on the occurrence of BT, defined as fever exceeding 38 °C without an identifiable cause, and data regarding patient background, surgical factors, and postoperative factors were assessed.

Results: BT occurred in 12 of 91 patients. No significant differences were observed between the groups of patients in terms of background factors but C-reactive protein levels on postoperative days 3 and 7 were significantly higher in the BT group than in the non-BT group (BT group vs. non-BT group [median], day 3: 6.64 mg/dL vs. 3.79 mg/dL, p = 0.0026; day 7: 5.10 mg/dL vs. 1.52 mg/dL, p = 0.0007). Additionally, the rate of postoperative adjuvant chemotherapy administration was significantly higher in the BT than in the non-BT group (BT group vs. non-BT group: 83.3% vs. 43.0%, p = 0.0123). The pathological findings from resected specimens showed that mucosal height was lower in the anal side than in the oral side.

Conclusion: Adjuvant chemotherapy may significantly increase the risk of BT after ileostomy closure following colorectal cancer surgery.

Purpose: Colorectal cancer (CRC) is becoming increasingly common in adults ≥ 60 years old, yet postoperative prognosis of curative-intent surgery for the advanced elderly (≥ 80 years) remains controversial.

Methods: A retrospective cohort study included 971 CRC patients aged ≥ 60 years who underwent curative-intent surgery from January 2018 to December 2023 in Beijing Chaoyang Hospital. Patients were stratified into "ordinary elderly group" (OE) (60-79 years, n = 800) and "advanced elderly group" (AE) (≥ 80 years, n = 171). Clinicopathological variables, 30-day morbidity/mortality, disease-free survival (DFS), and overall survival (OS) were collected and analyzed the differences between the two groups. The study was presented in accordance with the STROBE reporting checklist.

Results: The AE had more right-sided CRC (P < 0.001) and higher rate of preoperative obstruction (P < 0.001). They underwent more emergency (P = 0.002) and open procedures (P < 0.001), resulting in longer postoperative stays P = 0.030). Overall, 30-day morbidity was comparable (P = 0.76), but perioperative mortality rate was higher in AE (P = 0.041). The median follow-up was 36.1 ± 22.1 months, and recurrence rates (P = 0.58) and 5-year DFS (log-rank P = 0.42) did not differ between groups. Multivariate analysis identified TNM stage, perineural invasion, vascular invasion, preoperative intestinal obstruction, and proficient Mismatch Repair (pMMR) as independent predictors of DFS; age ≥ 80 years was not prognostic (p = 0.81).

Conclusions: Despite a higher burden of comorbidities and increased perioperative mortality, no statistically significant difference in long-term oncological outcomes was observed between AE and OE following rigorous patient selection and perioperative management in CRC patients. Advanced age alone should not preclude standard curative resection.