Colorectal Disease最新文献

{"title":"What influences emergency general surgeons' treatment preferences for patients requiring nutritional support? A discrete choice experiment","authors":"Daniel L. Ashmore,&nbsp;Jenna L. Morgan,&nbsp;Timothy R. Wilson,&nbsp;Vanessa Halliday,&nbsp;Matthew J. Lee","doi":"10.1111/codi.70081","DOIUrl":"https://doi.org/10.1111/codi.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Identifying and managing malnourished emergency general surgery (EGS) patients can be difficult. There are many tools available, a range of barriers to overcome and variety of guidelines at a surgeon's disposal. This study aimed to determine the impact of key variables on surgeon preference to start nutritional support in EGS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A discrete choice experiment was used to determine the impact of six variables on surgeons' treatment preferences for commencing nutritional support in EGS. Twenty-five hypothetical scenarios regarding a patient with adhesional small bowel obstruction were disseminated electronically. Binomial logistic regression was used to identify significant associations. Ethical approval was obtained (UREC 050436).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In all, 148 participants responded providing 3700 scenario responses. Completion rate was 52.1% (148/284) with an approximately even split of consultants and non-consultants (50.7% vs. 49.3%) and intestinal failure (IF) experience (46.6% experienced vs. 53.4% not experienced). Consultants favoured starting nutritional support (77.7%; 1443/1875) more often than non-consultants (71.8%; 1310/1825). Forming an anastomosis, hypoalbuminaemia, underweight (body mass index &lt;18.5 kg/m²), unintentional weight loss (&gt;10%), ≥5 days without oral intake until now and ≥5 days likely to be without oral intake from now were statistically more likely to be associated with treatment preference, but obesity (body mass index &gt;30 kg/m²) was not. Overall, experience of IF (OR 1.093, 95% CI 0.732–1.631; <i>P</i> = 0.663) and seniority of surgeon (OR 0.711, 95% CI 0.473–1.068; <i>P</i> = 0.100) significantly influenced the results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There are many variables that impact the decision to start nutritional support in EGS, but seniority of the surgeon and IF experience do not.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial April 2025: The protocolisation of evidence synthesis: The good, the bad and the ugly","authors":"Yasuko Maeda,&nbsp;Sue Clark","doi":"10.1111/codi.70100","DOIUrl":"https://doi.org/10.1111/codi.70100","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol update for the UK cohort study to investigate the prevention of parastomal hernia (the CIPHER study)","authors":"Barnaby C. Reeves,&nbsp;Lucy Ellis,&nbsp;Emily Farrow,&nbsp;Amr Abushawaly,&nbsp;Sam Granger,&nbsp;Ben Griffiths,&nbsp;Niroshini Rajaretnam,&nbsp;Neil J. Smart","doi":"10.1111/codi.70091","DOIUrl":"https://doi.org/10.1111/codi.70091","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of an anastomotic risk score for use in a randomized clinical trial on defunctioning stoma use in low anterior resection for rectal cancer","authors":"Martin Rutegård,&nbsp;Ida Hed Myrberg,&nbsp;Caroline Nordenvall,&nbsp;Kalle Landerholm,&nbsp;Fredrik Jörgren,&nbsp;Peter Matthiessen,&nbsp;Jennifer Park,&nbsp;Josefin Segelman,&nbsp;Pamela Buchwald,&nbsp;Jenny Häggström","doi":"10.1111/codi.70089","DOIUrl":"https://doi.org/10.1111/codi.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The selective use of defunctioning stomas in anterior resection for rectal cancer hinges on accurately predicting anastomotic leakage. The aim of this study was to develop a prediction model for use in a prospective randomized clinical trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Colorectal Cancer Database (CRCBaSe) Sweden was used to identify patients who underwent low anterior resection for rectal cancer 2007–2021. Eligibility criteria mirrored the forthcoming SELective defunctioning Stoma Approach in low anterior resection for rectal cancer (SELSA) trial, including patients &lt;80 years of age and with American Society of Anaesthesiologists' (ASA) physical status grade of &lt;III; further, patients without a defunctioning stoma were excluded. The outcome comprised anastomotic leakage within 30 days or in-hospital. Candidate predictors included age, sex, ASA grade, cardiovascular disease, diabetes, body mass index (BMI), tumour stage, tumour height, and neoadjuvant therapy. Seven models were developed and internally validated using bootstrapping. A threshold of a predicted leakage risk of ≤10% was chosen for trial implementation. Validation was conducted using chart-reviewed data from a nested cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 2727 eligible patients, 199 (7.3%) were registered with an anastomotic leakage. All models demonstrated similar performance, with prediction instability observed for risks exceeding 12.5%. The preferred model included three significant predictors: male sex (OR 2.00; 95% CI: 1.45–2.75), BMI &gt;30 kg/m² (OR 1.82; 95% CI: 1.21–2.74), and radiotherapy (OR 1.90; 95% CI: 1.35–2.69). The bootstrapped area under the curve (AUC) was 0.64 (95% CI: 0.62–0.65), with a negative predictive value of 94.6% (95% CI: 93.7%–95.6%). For the validation cohort, the corresponding estimates were 0.66 (95% CI: 0.59–0.74) and 89.5% (95% CI: 86.2%–92.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Accuracy of anastomotic leakage prediction using registry-based data is moderate; however, the model's ability to rule out a &gt;10% risk is considered appropriate for trial use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive transanal approach for SM1 rectal adenocarcinoma — A video vignette","authors":"Lucas José Caram,&nbsp;Esteban Gonzalez Salazar,&nbsp;Juan Campana,&nbsp;Ricardo Mentz,&nbsp;Gustavo Rossi","doi":"10.1111/codi.70090","DOIUrl":"https://doi.org/10.1111/codi.70090","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does endoscopic management have a role in chronic radiation proctopathy: A systematic review","authors":"Chyu Lai Yan Naing,&nbsp;Jayden Gittens,&nbsp;Matthew Fok,&nbsp;Hayley Fowler,&nbsp;Dale Vimalachandran,&nbsp;Rachael E. Clifford","doi":"10.1111/codi.70086","DOIUrl":"https://doi.org/10.1111/codi.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Chronic radiation proctopathy (CRP) is a significant side-effect of radiotherapy, and poses a challenge in clinical management, necessitating effective and standardized therapeutic approaches. The aim of this review is to investigate the role of endoscopic interventions for CRP, focusing on argon plasma coagulation (APC) and formalin application.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A literature search was undertaken for studies that investigated the clinical responses to endoscopic management in patients with CRP. A systematic review was performed in accordance with PRISMA guidelines, and a meta-analysis of proportions was conducted with a random-effects model. ROBINS-I and the Cochrane Collaboration's tool were used to assess risk of bias in cohort studies and randomized control trials, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 82 studies met the inclusion criteria, including 11 randomized control trials, 20 systematic reviews, one cohort study and 50 case series. A robust 89% (95% CI 84%–92%, <i>p</i> &lt; 0.01 and 95% CI 84%–93%, <i>p</i> = 0.03) pooled response rate was demonstrated for both APC and formalin therapies, respectively. Adverse effects were generally minimal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Endoscopic therapies, particularly APC and formalin, exhibit commendable clinical response rates in the management of CRP. However, the lack of standardized treatment protocols highlights the need for larger prospective studies. Clear guidelines, informed by defined outcomes and quality-of-life assessments, are imperative for enhancing patient outcomes and minimizing the morbidity associated with CRP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nitpicking the pit picking","authors":"Matthew J. Lee","doi":"10.1111/codi.70095","DOIUrl":"https://doi.org/10.1111/codi.70095","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified robotic assisted Frykman–Goldberg procedure with mesh implant for severe pelvic organ prolapse--A Video Vignette","authors":"S. Veleda Belanche,&nbsp;J. López-Herreros,&nbsp;J. Sánchez González,&nbsp;J. L. Maestro de Castro,&nbsp;E. Choolani Bhojwani,&nbsp;V. Simó Fernández","doi":"10.1111/codi.70087","DOIUrl":"https://doi.org/10.1111/codi.70087","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does timing of ileostomy closure impact postoperative morbidity?","authors":"Maxwell D. Mirande,&nbsp;Katherine A. Bews,&nbsp;Justin T. Brady,&nbsp;Dorin T. Colibaseanu,&nbsp;Sherief F. Shawki,&nbsp;William R. Perry,&nbsp;Kevin T. Behm,&nbsp;Kellie L. Mathis,&nbsp;Nicholas P. McKenna","doi":"10.1111/codi.70088","DOIUrl":"https://doi.org/10.1111/codi.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Reversal of diverting loop ileostomy (DLI) traditionally occurs at ≥12 weeks after formation. Early closure has been performed in attempts to reduce DLI-associated morbidity. Therefore, the aim of this study was to determine whether time to stoma reversal impacts postoperative morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective review was conducted using institutional-level American College of Surgeons National Surgical Quality Improvement Program data for adult patients who underwent DLI closure between January 2012 and December 2021 across a multistate health system. Time to DLI closure was stratified into three groups: ≤12, 12–24 or 24–36 weeks. Additional data were obtained from the electronic medical record. The primary outcome was major morbidity after DLI closure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 482 patients underwent DLI closure. Eighty four patients underwent closure at ≤12 weeks (17.4%), 300 at 12–24 weeks (62.2%) and 98 at 24–36 weeks (20.3%). The most common diagnosis at DLI formation was cancer (<i>n</i> = 211, 43.8%). Patients in the ≤12 weeks closure group more commonly had ulcerative colitis or diverticular disease and a lower American Society of Anesthesiologists class than patients with closure at 24–36 weeks (<i>p</i> &lt; 0.05). There were no significant differences in complication severity, overall major morbidity or its individual components amongst the time to DLI closure groups. There were no differences in anastomotic leaks or need for laparotomy. On multivariable analysis, immunosuppressive therapy and preoperative haematocrit &lt;30% were significant risk factors for major morbidity after DLI closure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Major morbidity did not differ by time to DLI closure group, indicating that closure at ≤12 weeks is safe in selected patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventral mesh rectopexy: Variations in technique and care process. A multicentre study","authors":"Ellen Coeckelberghs,&nbsp;Ahmed M. Chaoui,&nbsp;Mohamed Abasbassi,&nbsp;Gabriele Bislenghi,&nbsp;Katrien Boon,&nbsp;Michel Goethals,&nbsp;Tom Hendrickx,&nbsp;Bert Houben,&nbsp;Marc Krick,&nbsp;Frederic Meekers,&nbsp;Paul Pattyn,&nbsp;Pieter Pletinckx,&nbsp;Deborah Seys,&nbsp;Jasper Stijns,&nbsp;Sylvie Van den Broeck,&nbsp;Bart Van Geluwe,&nbsp;Yves Pirenne,&nbsp;Albert M. Wolthuis,&nbsp;Kris Vanhaecht,&nbsp;André D'Hoore","doi":"10.1111/codi.70084","DOIUrl":"https://doi.org/10.1111/codi.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of this improvement collaborative is to explore the variation in care within and between Flemish hospitals in preoperative assessment, surgical indications, perioperative management and surgical technique for ventral mesh rectopexy (VMR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This observational, cross-sectional multicentre study was performed in 14 Flemish hospitals. Twenty consecutive patients per hospital undergoing primary VMR in 2022 were included. Quality of care was assessed via predefined perioperative disease-specific quality indicators (QIs) by means of structured questionnaires. Data were collected from electronic patient files.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 280 patients were included. All patients were female and their mean age was 62 ± 14 years. Significant intra- and interhospital variation was observed in preoperative work-up, indications, operative technique and postoperative management. Total rectal prolapse was the indication for VMR in only 17.5% of the patients. The surgical approach was minimally invasive in all cases, with 40% via a robotic and 60% a laparoscopic approach. Fifteen per cent of patients had mechanical bowel preparation. All centres used a synthetic polypropylene mesh to perform a VMR, and in 85.6% (<i>n</i> = 238) of all patients a lightweight mesh was used. Diverging practices were noted as to type of mesh fixation to the rectum. In one third of patients a nonresorbable suture was combined with biological glue (<i>n</i> = 89, 31.8%). The overall mean length of stay was 2.1 (± 2.7) days. Only 3% of the procedures were performed as same day discharge, 47% of the patients remained for 1 day and 50% for ≥2 days. Only four patients were readmitted within 30 days after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study shows a significant variation in the perioperative management and surgical technique for VMR between hospitals, ongoing controversies and a lack of standardization. This collaborative can serve as a structured feedback tool to define minimum QIs and minimum outcome reporting parameters. Consensus building and adherence to evidence-based guidelines should reduce variation in care processes and lead to improved patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}