Diseases of the Colon & Rectum最新文献

{"title":"The Impact of Operative Time on Morbidity in Synchronous Colorectal Cancer and Liver Metastasis Resections.","authors":"Reena S Suresh, Sophia Diaz, Miloslawa Stem, Lawrence B Brown, Michael S Consul, Haniee Chung, Andrea C Bafford, Alodia Gabre-Kidan","doi":"10.1097/DCR.0000000000003896","DOIUrl":"10.1097/DCR.0000000000003896","url":null,"abstract":"<p><strong>Background: </strong>Prolonged operative time during synchronous colorectal cancer with liver metastases resections may increase postoperative morbidity.</p><p><strong>Objective: </strong>To evaluate the relationship between operative time and 30-day morbidity in synchronous colorectal cancer with liver metastases resections, and to identify the optimal operative time cutoff that may inform the decision to pursue a staged surgical approach.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Data were collected from the American College of Surgeons National Surgical Quality Improvement Program database for the years 2013 through 2022.</p><p><strong>Patients: </strong>Adult patients undergoing simultaneous colorectal cancer and liver metastasis resection were included.</p><p><strong>Main outcome measures: </strong>Rates of 30-day overall and serious morbidity.</p><p><strong>Results: </strong>Among 2306 patients, 58.1% were men, 64.7% were of White race, and the median age was 60 years. Most procedures were open (79.4%). The median operative time was 306 minutes (372 for robotic, 318.5 for laparoscopic, and 301 minutes for open surgeries). The 30-day overall morbidity rate was 36.6% (29.7% for minimally invasive surgeries and 38.4% for open surgeries), with serious morbidity at 20.1%. Based on the continuous (Youden Index) and binary (area under the curve) exploration of optimal operative time cutoff, the following operative time categories were created: <5, 5 to 6, 6 to 7, 7 to 8, and ≥8 hours. Multivariable analysis revealed increased risk of morbidity for operative durations >6 hours (OR 1.48; 95% CI, 1.13-1.96; p = 0.004), which rose with rising operative times. Minimally invasive cases had an increased risk of morbidity starting at ≥8 hours, whereas open resections demonstrated increased risk starting at 6 hours. Additional factors linked with morbidity included age 70 years or older, ASA classification III or IV, functional dependence, smoking, steroid use, and open approach.</p><p><strong>Limitations: </strong>Retrospective design and limitations of data from the American College of Surgeons National Surgical Quality Improvement Program database.</p><p><strong>Conclusions: </strong>This study demonstrates that 30-day morbidity increases after 6 hours in colorectal cancer with liver metastases resections, with a 2-hour difference in risk threshold between minimally invasive surgeries and open cases. These results highlight the need to manage operative duration and approach to improve outcomes for these patients. See Video Abstract .</p><p><strong>El impacto del tiempo quirrgico en la morbilidad en resecciones sincrnicas de cncer colorrectal y metstasis hepticas: </strong>ANTECEDENTES:El tiempo quirúrgico prolongado durante la resección de cáncer colorrectal sincrónico con metástasis hepáticas puede aumentar la morbilidad posoperatoria.OBJETIVO:Evaluar la relación entre el tiempo quirúrgico y l","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1197-1206"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Office-Based Hemorrhoid Treatment and Complications.","authors":"Kaitlyn Oldewurtel, Robert J Plummer","doi":"10.1097/DCR.0000000000003900","DOIUrl":"10.1097/DCR.0000000000003900","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1149-1151"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply.","authors":"Colleen A Donahue, Thomas Curran","doi":"10.1097/DCR.0000000000003903","DOIUrl":"10.1097/DCR.0000000000003903","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e1839"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Maroon DCR Website Banner: A Cache of Valuable Content-Part I.","authors":"Susan Galandiuk","doi":"10.1097/DCR.0000000000003909","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003909","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 10","pages":"1127-1129"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"October 2025 Translations.","authors":"","doi":"10.1097/DCR.0000000000003949","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003949","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 10","pages":"e1843-e1878"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anal Sphincteroplasty for Fecal Incontinence.","authors":"Amanda Pereira Lima, Rodrigo Âmbar Pinto, Isaac José Felippe Corrêa Neto","doi":"10.1097/DCR.0000000000003758","DOIUrl":"10.1097/DCR.0000000000003758","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e1829-e1830"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Fortunate Surgeon.","authors":"Neil Mortensen","doi":"10.1097/DCR.0000000000003873","DOIUrl":"10.1097/DCR.0000000000003873","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1139-1147"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Expansion of Organ Preservation.","authors":"Eva Angenete","doi":"10.1097/DCR.0000000000003893","DOIUrl":"10.1097/DCR.0000000000003893","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1130-1131"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Initiation of Comfort Care After Elective Colectomy for Colon Cancer.","authors":"Rebecca Tang, Sarah E Rudasill, Christy E Cauley, Robert N Goldstone, Grace C Lee, Hiroko Kunitake, Rocco Ricciardi","doi":"10.1097/DCR.0000000000003898","DOIUrl":"10.1097/DCR.0000000000003898","url":null,"abstract":"<p><strong>Background: </strong>Risk factors for mortality after elective colorectal surgery are used to guide surgical decision-making and counseling. Initiation of comfort care reflects a more patient-oriented outcome of complicated postoperative pathways and decision-making.</p><p><strong>Objective: </strong>This study aims to identify factors associated with initiation of comfort care after elective colectomy for colon cancer.</p><p><strong>Design: </strong>Retrospective analysis of prospectively collected quality improvement data.</p><p><strong>Settings: </strong>Adults undergoing elective colectomies for colon adenocarcinoma were queried from the American College of Surgeons National Surgical Quality Improvement Program and its colectomy-targeted participant use files (2021-2022).</p><p><strong>Patients: </strong>Adults undergoing elective colectomies for colon adenocarcinoma.</p><p><strong>Main outcome measures: </strong>Factors associated with initiation of comfort care were identified using univariate analysis and multivariable logistic regression. Mediation analysis was performed.</p><p><strong>Results: </strong>Of 33,167 patients, 311 (0.9%) initiated comfort care. On multivariable analysis, risk factors for initiation of comfort care included older age (adjusted OR 1.68, p = 0.026), dependent functional status (adjusted OR 2.93, p < 0.001), ASA classification of III or higher (adjusted OR 4.14, p < 0.001), open approach (adjusted OR 2.19, p < 0.001), and postoperative complications including delirium (adjusted OR 1.84, p = 0.036), pneumonia (adjusted OR 3.28, p < 0.001), reintubation (adjusted OR 6.24, p < 0.001), renal failure requiring dialysis (adjusted OR 2.27, p = 0.043), septic shock (adjusted OR 6.06, p < 0.001), anastomotic leak (adjusted OR 3.86, p < 0.001), and reoperation (adjusted OR 1.80, p = 0.041). 41.9% of the variance in initiation of comfort care was explained by preoperative factors, 6.5% by operative factors, and 51.6% by postoperative factors.</p><p><strong>Limitations: </strong>The retrospective design limits the granularity of analysis and inferences of causal pathways.</p><p><strong>Conclusions: </strong>More than half of patients who died within 30 days of elective colectomy for colon cancer initiated comfort care. Most of the variance in initiation of comfort care was explained by factors unknown during preoperative decision-making. Goals of care should be revisited when major postoperative complications occur. Patients and families should also be counseled that their goals of care may change as the postoperative course evolves. See Video Abstract .</p><p><strong>Factores asociados con el inicio de cuidados paliativos tras una colectoma electiva por cncer de colon: </strong>ANTECEDENTES:Los factores de riesgo de mortalidad tras una cirugía colorrectal electiva se utilizan para orientar la toma de decisiones quirúrgicas y el asesoramiento. El inicio de los cuidados paliativos refleja un resultado más orientado","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1183-1190"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selected Abstracts.","authors":"Sean J Langenfeld, Shankar Raman, Irena Gribovskaja-Rupp","doi":"10.1097/DCR.0000000000003879","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003879","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 10","pages":"1224-1230"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}