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Corrigendum: Current Position of Sacral Neuromodulation in Treatment of Fecal Incontinence. 更正:骶神经调控在治疗大便失禁中的当前地位。
IF 1.2 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-20 eCollection Date: 2021-01-01 DOI: 10.1055/s-0044-1788698
Binit Katuwal, Jasneet Bhullar

[This corrects the article DOI: 10.1055/s-0040-1714247.].

[此处更正了文章 DOI:10.1055/s-0040-1714247]。
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引用次数: 0
Current Trends in the Management of a Complex Polyp: Endoscopy versus Surgery 复杂息肉治疗的当前趋势:内镜与手术
IF 1.4 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-03 DOI: 10.1055/s-0044-1787892
Mahnoor Khan, Kavel Visrodia, Amrita Sethi

Many colorectal cancers arise from either adenomatous polyps or sessile serrated lesions. However, due to the implementation of screening guidelines at the age of 45 years and the ability to perform therapeutic endoscopic polyp resections, the incidence and mortality of colorectal cancer has been decreasing in the United States. Polyps can be distinguished not only by pathology, but characterized by their complexity depending on the size, location, and morphology. Historically, polyps that were endoscopically more challenging to resect were referred for surgical resection. However, due to rapid advancement in endoscopic techniques and availability of tools, many of these complex polyps can be safely and effectively resected endoscopically. In this section, we review the different methods and potential challenges associated with endoscopic resection techniques including endoscopic mucosal resection, endoscopic submucosal dissection, or endoscopic full-thickness resection of a complex polyp.

许多大肠癌都源于腺瘤性息肉或无柄锯齿状病变。然而,由于实施了 45 岁筛查指南以及能够进行治疗性内镜息肉切除术,美国的结直肠癌发病率和死亡率都在下降。息肉不仅可以通过病理学来区分,还可以根据其大小、位置和形态的复杂性来区分。从历史上看,内镜下切除难度较大的息肉会被转到外科手术切除。然而,由于内镜技术的快速发展和工具的普及,许多复杂的息肉都可以在内镜下安全有效地切除。在本节中,我们将回顾与内镜切除技术相关的不同方法和潜在挑战,包括内镜粘膜切除、内镜粘膜下剥离或内镜全厚切除复杂息肉。
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引用次数: 0
Hereditary Colorectal Cancer: From Diagnosis to Surgical Options 遗传性结直肠癌:从诊断到手术选择
IF 1.4 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-03 DOI: 10.1055/s-0044-1787884
Rami James N. Aoun, Matthew F. Kalady

Hereditary colorectal cancer (CRC) syndromes account for up to 5% of CRC. Patients have an increased risk of CRC and extracolonic cancers, both of which develop at an early age. The main polyposis syndromes include familial adenomatous polyposis, MYH-associated polyposis, Peutz-Jeghers syndrome, juvenile polyposis syndrome, and PTEN hamartoma syndrome. The non-polyposis syndromes include Lynch syndrome and familial colorectal cancer type X. Each of the syndromes have distinct but sometimes overlapping phenotypes. Clinical evaluation and ultimately the underlying germline genetic pathogenic variants define the syndromes. Each syndrome has polyp, CRC, and extracolonic risks and management is based on early and timely surveillance with therapeutic and often extended prophylactic surgery. Surgical intervention strategies are individualized, considering not only the earlier onset of malignancies and heightened risks for metachronous cancers but also the patient's needs and quality of life. This article reviews the different diagnostic approaches to hereditary CRC and highlights subsequent disease-specific management and surgical decision-making strategies.

遗传性结直肠癌(CRC)综合征占 CRC 的 5%。患者罹患 CRC 和结肠外癌的风险都会增加,这两种癌症都会在患者幼年时发病。主要的息肉病综合征包括家族性腺瘤性息肉病、MYH 相关性息肉病、Peutz-Jeghers 综合征、幼年息肉病综合征和 PTEN 仓瘤综合征。非息肉病综合征包括林奇综合征(Lynch Syndrome)和家族性结直肠癌 X 型。临床评估和潜在的种系遗传致病变异最终确定了这些综合征。每种综合征都有息肉、结肠癌和结肠外风险,管理的基础是早期和及时监测,并进行治疗性手术,通常还包括延长的预防性手术。手术干预策略因人而异,不仅要考虑恶性肿瘤发病较早和近代癌症风险较高的因素,还要考虑患者的需求和生活质量。本文回顾了遗传性 CRC 的不同诊断方法,并重点介绍了随后的特定疾病管理和手术决策策略。
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引用次数: 0
The Young: Early-Onset Colon Cancer 年轻人早期结肠癌
IF 1.4 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-02 DOI: 10.1055/s-0044-1787883
David Cohen, Caitlin Rogers, Joel Gabre, Beatrice Dionigi

Early-onset colorectal cancer (EO-CRC), characterized by diagnosis before the age of 50 years, has emerged as a significant healthcare challenge with increasing global incidence. While traditional risk factors such as family history and inherited syndromes contribute to EO-CRC, a substantial proportion of cases remain sporadic, necessitating further investigation into additional etiological factors. Molecular studies reveal heterogeneity in EO-CRC, with distinct mutational profiles compared to late-onset CRC. Clinical management presents unique considerations, including challenges in early detection and treatment strategies tailored to younger patients. Addressing EO-CRC requires a multidisciplinary approach integrating epidemiological, molecular, and clinical insights to improve prevention, diagnosis, and therapeutic outcomes. Emerging research avenues explore novel biomarkers and therapeutic targets, offering promise for advancing understanding and management of this disease in contemporary oncology practice.

早发结直肠癌(EO-CRC)的特点是在 50 岁之前确诊,随着全球发病率的不断上升,它已成为一项重大的医疗挑战。虽然家族史和遗传综合征等传统风险因素是导致 EO-CRC 的原因之一,但相当一部分病例仍为散发性,因此有必要进一步研究其他病因。分子研究揭示了 EO-CRC 的异质性,与晚发性 CRC 相比,EO-CRC 具有不同的突变特征。临床管理需要考虑一些独特的因素,包括早期检测的挑战和针对年轻患者的治疗策略。应对 EO-CRC 需要多学科方法,整合流行病学、分子学和临床见解,以改善预防、诊断和治疗效果。新出现的研究途径探索了新型生物标记物和治疗靶点,为在当代肿瘤学实践中促进对这种疾病的理解和管理提供了希望。
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引用次数: 0
The Old: Is There Any Role for Screening Colonoscopy after the Age of 75? The Surgeon's Perspective 老年人75 岁以后还需要进行结肠镜筛查吗?外科医生的视角
IF 1.4 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-27 DOI: 10.1055/s-0044-1787893
Imran Khan, Mikhael Belkovsky, Emre Gorgun

Guidelines recommend individualized decision making for screening colonoscopy for colorectal cancer (CRC) in patients after the age of 75 years due to low additional benefits. That should be taken with a grain of salt, as these recommendations are based on expert opinion and simulation models which do not consider (1) the differences in pathogenesis and cancer biology of CRC in elderly; (2) the risks of colonoscopy in this patient population; (3) and the impact of new surgical and nonsurgical therapies for CRC. In this review, our goal is to bring a surgeon's perspective to understand the role of screening colonoscopy in patients older than 75 years.

由于额外获益较少,指南建议对 75 岁以后的患者进行结肠镜检查以筛查结肠直肠癌(CRC)做出个体化决策。这些建议都是基于专家意见和模拟模型,并没有考虑到:(1)老年人 CRC 的发病机制和癌症生物学特性的差异;(2)结肠镜检查在这一患者群体中的风险;(3)以及新的手术和非手术疗法对 CRC 的影响。在这篇综述中,我们旨在从外科医生的角度来理解结肠镜筛查在 75 岁以上患者中的作用。
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引用次数: 0
Colon Cancer and Pregnancy 结肠癌与怀孕
IF 1.4 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-26 DOI: 10.1055/s-0044-1787890
Olivia A. Sacks, Jennifer S. Davids

As the incidence of colorectal cancer (CRC) in the younger population increases and women start their childbearing journey at later ages, CRC in pregnancy will become an increasingly relevant and decreasingly rare occurrence. Unfortunately, there is a dearth of data on this subject given its historical rarity. CRC is often diagnosed at a late stage in pregnancy because of the conflation of symptoms of pregnancy with symptoms of CRC. A major branch point for the diagnosis and treatment of CRC in pregnancy is whether it is diagnosed early or late in pregnancy. The workup for cancer is similar for pregnant and nonpregnant populations and includes endoscopy and staging computed tomography. Treatment is dependent on the stage of cancer and term of pregnancy. This review summarizes the current evidence for diagnosis, workup, and treatment of CRC during pregnancy and explores issues of fertility after a diagnosis of CRC.

随着年轻群体中结直肠癌(CRC)发病率的增加,以及女性开始生育年龄的推迟,妊娠期结直肠癌将变得越来越重要,而且越来越罕见。遗憾的是,鉴于其历史罕见性,这方面的数据十分匮乏。由于妊娠症状与 CRC 症状相混淆,CRC 通常在妊娠晚期才被诊断出来。妊娠期 CRC 诊断和治疗的一个主要分支是在妊娠早期还是晚期确诊。妊娠期和非妊娠期癌症的检查方法类似,包括内窥镜检查和分期计算机断层扫描。治疗取决于癌症的分期和妊娠期。本综述总结了目前有关妊娠期 CRC 诊断、检查和治疗的证据,并探讨了确诊 CRC 后的生育问题。
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引用次数: 0
Systemic Therapy for Metastatic Colon Cancer: New Frontiers 转移性结肠癌的系统疗法:新领域
IF 1.4 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-25 DOI: 10.1055/s-0044-1787826
Yoanna S. Pumpalova

We have made steady gains in improving overall survival in patients with metastatic, unresectable, colon cancer in the last 5 to 10 years. The backbone of systemic treatment for most patients remains combination chemotherapy, but the field is becoming increasingly biomarker driven, with exciting new targeted therapies on the horizon. This review is organized in sections corresponding to currently relevant biomarkers in colon cancer and will summarize first-, second-, and third-line standard of care for metastatic, unresectable, colon cancer. The last section is intended to introduce the reader to promising agents and novel therapeutic strategies currently under investigation.

过去 5 到 10 年间,我们在提高转移性、不可切除结肠癌患者的总生存率方面取得了稳步进展。对大多数患者来说,全身治疗的支柱仍然是联合化疗,但这一领域正日益受到生物标志物的驱动,令人兴奋的新靶向疗法即将问世。本综述按照结肠癌目前相关的生物标记物分为几个部分,并将总结治疗转移性、不可切除结肠癌的一线、二线和三线标准疗法。最后一部分旨在向读者介绍目前正在研究的有前景的药物和新型治疗策略。
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引用次数: 0
Colorectal Cancer and Inflammatory Bowel Disease 大肠癌和炎症性肠病
IF 1.4 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-24 DOI: 10.1055/s-0044-1787891
Maysoon Gamaleldin, Taha Qazi, Tracy Hull

Colorectal cancer (CRC) in patients with ulcerative colitis (UC) and Crohn's disease accounts for ∼5% of all cases of CRC. Although it only accounts for a fraction of CRC cases, inflammatory bowel disease (IBD)-related CRC is a serious consequence of chronic inflammation that needs attention. There is a better understanding today about the pathogenesis contributing to IBD-CRC and the role of genetics and gut microbiota. Guidelines recommend timely screening and surveillance of UC and Crohn's patients, and it is usually timed from the initial diagnosis. This helps with early detection of dysplasia and CRC in this subset of patients, thus allowing for earlier intervention. However, dysplasia is not always easy to discern and management of CRC in each patient may differ. A multidisciplinary approach should be adopted in managing CRC in IBD. Although the oncologic principles of managing sporadic CRC and IBD-CRC are the same, surgical resection should be tailored to each patient.

溃疡性结肠炎(UC)和克罗恩病患者的结直肠癌(CRC)占所有 CRC 病例的 5%。虽然它只占 CRC 病例的一小部分,但与炎症性肠病(IBD)相关的 CRC 是慢性炎症的一个严重后果,需要引起重视。如今,人们对导致 IBD-CRC 的发病机制以及遗传学和肠道微生物群的作用有了更深入的了解。指南建议对 UC 和克罗恩病患者进行及时筛查和监测,筛查时间通常从最初诊断开始。这有助于在这部分患者中早期发现发育不良和 CRC,从而尽早进行干预。然而,发育不良并不总是很容易辨别,对每位患者的 CRC 处理也可能不同。在管理 IBD 患者的 CRC 时应采用多学科方法。虽然处理散发性 CRC 和 IBD-CRC 的肿瘤学原则相同,但手术切除应根据每位患者的具体情况而定。
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引用次数: 0
The Ugly: Metastatic Colon Cancer—Surgical Options 丑陋转移性结肠癌--手术选择
IF 1.4 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-18 DOI: 10.1055/s-0044-1787825
Fahima Dossa, Martin R. Weiser

Over 50% of patients with colorectal cancer develop metastatic disease. Although systemic therapy remains the backbone of palliative treatment, select patients may be candidates for surgical resection with curative intent. Given increasing evidence of the association between metastasectomy and prolonged survival, surgery has acquired an increasingly central role in the management of liver, lung, and peritoneal metastases. This is compounded by accumulating advances in local and systemic treatments that have allowed for expansion of the resectability pool, bringing the potential for curative surgical treatment to increasing numbers of patients with stage IV disease. However, as the boundaries of resectability are pushed, patient selection and consideration of tumor-related and technical factors are imperative to the identification of patients for whom surgery would be of the greatest benefit.

50%以上的结直肠癌患者会出现转移性疾病。虽然全身治疗仍是姑息治疗的主要手段,但部分患者可能需要进行根治性手术切除。鉴于越来越多的证据表明转移灶切除术与延长生存期之间存在关联,手术在治疗肝、肺和腹膜转移灶方面发挥着越来越重要的作用。此外,局部和全身治疗的不断进步也扩大了可切除范围,为越来越多的 IV 期患者带来了治愈性手术治疗的可能性。然而,随着可切除性界限的不断扩大,患者的选择以及肿瘤相关因素和技术因素的考虑对于确定哪些患者可通过手术获得最大益处至关重要。
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引用次数: 0
Closing the Gap: Approaches to Improving Colorectal Surgery Care for the Uninsured and Underinsured 缩小差距:改善无保险和保险不足人群结直肠外科护理的方法
IF 1.4 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-15 DOI: 10.1055/s-0044-1786398
Erin Isenberg, Calista Harbaugh

Health insurance plays a critical role in access to and delivery of health care in the United States. As the only industrialized nation without universal health coverage, Americans without adequate insurance (i.e., uninsured or underinsured individuals) face numerous obstacles to obtaining necessary health care. In this article, we review the mechanisms by which inadequate insurance leads to worse clinical outcomes in patients with common benign and malignant colorectal pathologies. We then discuss several evidence-based solutions for improving access to optimal colorectal care for these patients. These include increasing access to and affordability of health insurance, mitigating disparities between differently insured populations, strengthening the health care safety net, and tailoring outreach and clinical decision-making for the uninsured and underinsured. By exploring the nuance and impact of inadequate insurance coverage, we ultimately seek to highlight critical opportunities for future research and advocacy within the realm of insurance design and policy.

在美国,医疗保险在获取和提供医疗服务方面发挥着至关重要的作用。作为唯一一个没有全民医保的工业化国家,没有足够保险的美国人(即未投保或投保不足的人)在获得必要的医疗服务方面面临着重重障碍。在这篇文章中,我们回顾了保险不足导致常见良性和恶性结直肠病变患者临床治疗效果变差的机制。然后,我们讨论了几种基于证据的解决方案,以改善这些患者获得最佳结直肠护理的机会。这些方案包括提高医疗保险的可及性和可负担性、缩小不同投保人群之间的差距、加强医疗安全网以及为无保险和保险不足的人群量身定制外展和临床决策。通过探讨保险覆盖面不足的细微差别和影响,我们最终将寻求在保险设计和政策领域突出未来研究和宣传的关键机会。
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引用次数: 0
期刊
Clinics in Colon and Rectal Surgery
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