Diseases of the Colon & Rectum最新文献

{"title":"Diagnosis and Management of Rectocele.","authors":"Yeqian Huang, Cherry E Koh","doi":"10.1097/DCR.0000000000003992","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003992","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328480","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":"Retroperitoneal Approach for Total Colectomy in Minimally Invasive Treatment of Synchronous Multiple Colon Cancer.","authors":"Sergey K Efetov, Arina K Rychkova, Yaroslav P Krasnov","doi":"10.1097/DCR.0000000000003982","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003982","url":null,"abstract":"<p><strong>Background: </strong>The retroperitoneal approach is an innovative, minimally invasive technique that may benefit patients with colorectal cancer who have significant comorbidities such as cardiovascular disease, obesity, or extensive intra-abdominal adhesions.</p><p><strong>Impact of innovation: </strong>We present a novel retroperitoneal approach for the minimally invasive surgical treatment of synchronous multiple colon cancers.</p><p><strong>Technology materials and methods: </strong>An interfascial dissection through the retroperitoneal space was performed on the left side in the medial direction. The left ureter and gonadal vessels served as the primary landmarks. The inferior mesenteric vessels were identified, clipped, and cut. The horizontal portion of the duodenum served as the cranial landmark for dissection. Dissection continued medially through the embryonic layers to identify the roots of the ileocolic artery and vein. The vessels were exposed to the surrounding tissue, clipped, and cut. Laparoscopic mobilization of the entire colon was performed.</p><p><strong>Preliminary results: </strong>The operation lasted 510 min, with the retroperitoneal step requiring 205 min. Total blood loss was 200 mL. The postoperative pain intensity was low, and recovery was uneventful. The patient was discharged on postoperative day 7.</p><p><strong>Conclusion and future directions: </strong>The retroperitoneal approach appears to be a feasible and minimally invasive option for total colectomy in selected patients with multiple synchronous colon cancers. Further studies are warranted to assess the safety, reproducibility, and long-term oncologic outcomes. See New Technology Report Video.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328442","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":"LIGATION OF INTERSPHINCTERIC FISTULA TRACT FOR PERIANAL FISTULA: LONG-TERM RESULTS, FUNCTIONAL OUTCOMES, AND PREDICTORS OF FAILURE.","authors":"Solveig Elmer, David Zuk, Mattias Soop, Jonas Nygren, Henrik Oppelstrup, Britt Husberg, Josefin Segelman","doi":"10.1097/DCR.0000000000003985","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003985","url":null,"abstract":"<p><strong>Background: </strong>Ligation of intersphincteric fistula tract is a sphincter-preserving procedure for anal fistula. Most studies evaluating the operation are small with a limited follow-up.</p><p><strong>Objective: </strong>To evaluate the long-term success rate and functional outcomes following ligation of intersphincteric fistula tract.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>The study was conducted at a tertiary referral center for coloproctology.</p><p><strong>Patients: </strong>One hundred and thirty-nine participants with cryptoglandular or Crohn's perianal fistula were included.</p><p><strong>Interventions: </strong>Ligation of intersphincteric fistula tract.</p><p><strong>Main outcome measures: </strong>The primary endpoint was clinical healing without recurrence following ligation of intersphincteric fistula tract. Clinical healing was defined as healing of the external fistula opening and intersphincteric incision. Secondary endpoints were long-term healing at last follow-up and functional outcomes measured using the St. Marks Incontinence score. Predictors of non-healing were also evaluated.</p><p><strong>Results: </strong>One hundred thirty-nine patients were included with a median follow-up of 28 months (range, 20-59). Ten had Crohn's disease and 52 had complex fistulas. Sixty-nine (50%) patients experienced healing without recurrence, 4 healed but recurred, and 66 participants failed to heal after the primary procedure. Patients without initial healing were managed with additional surgical procedures (median 2), most of them minor such as curettage of a remaining external sinus. At the end of the follow-up period, 126 (91%) of patients had a closed fistula. No statistically significant predictors of non-healing were identified. The majority of the participants with persistent healing following the primary operation had a postoperative total St. Mark's incontinence score below 5.</p><p><strong>Limitations: </strong>The retrospective design introduces the possibility of residual confounding and selection bias.</p><p><strong>Conclusions: </strong>The initial healing rate after LIFT was moderate, but following additional mainly minor procedures, the final healing rate of 91% was achieved. Recurrence following initial healing was rare. Evaluation of anal function indicated a good continence. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328532","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":"Evaluation of TU-100 (Daikenchuto), a Traditional Japanese Kampo Medicine, As an Adjunct to Enhanced Recovery After Surgery, for Acceleration of Gastrointestinal Recovery After Bowel Resection - Results of a Proof-of-Concept, Phase 2, Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"Srdjan S Nedeljkovic, Jennifer D Silinsky, Deborah Nagle, Sang W Lee, Sabry Ayad, Alvaro M Segura-Vasi, Phillip R Fleshner, Michael A Choti, Sherry M Wren, Kosaka Jun, Yu Tanaka, Yuping Li, Amy W Rachfal, Lee M Techner, Tong J Gan, Alessandro Fichera, Fabrizio Michelassi","doi":"10.1097/DCR.0000000000003990","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003990","url":null,"abstract":"<p><strong>Background: </strong>A transient inhibition of gastrointestinal motility (postoperative ileus) can occur after colorectal surgery and may lead to complications and prolonged hospitalization.</p><p><strong>Objective: </strong>To examine the effect of TU-100, Japanese herbal medicine, on acceleration of gastrointestinal recovery after bowel resection.</p><p><strong>Design: </strong>Proof-of-concept, randomized, double-blind, placebo-controlled Phase 2 trial (NCT04742907).</p><p><strong>Settings: </strong>Thirty-six United States hospital sites.</p><p><strong>Patients: </strong>Patients undergoing elective bowel resection.</p><p><strong>Interventions: </strong>Placebo, TU-100 7.5g/day, or TU-100 15 g/day orally from postoperative day 1 for ≤10 days while hospitalized.</p><p><strong>Main outcome measures: </strong>The primary endpoint was time to gastrointestinal recovery, a composite representing upper (first toleration of clear liquids) and lower ([first bowel movement] or [absence of distension and presence of bowel sounds and flatus]) gastrointestinal motility. Multiple gastrointestinal- and discharge-related outcomes were also evaluated.</p><p><strong>Results: </strong>A total of 392 patients received ≥1 dose. TU-100 7.5 g/day was not associated with a statistically significant difference for gastrointestinal recovery (hazard ratio = 1.17 [95% CI: 0.91, 1.50]). But a higher proportion of patients in the 7.5 g/day group achieved gastrointestinal recovery by postoperative day 2 vs placebo (78.1% vs 66.9%, p = 0.047). Median length of stay was significantly shorter in the 7.5 g/day (2 days) vs placebo (3 days [p = 0.03]). Patient-reported nausea and abdominal bloating bothersomeness were lower in the early postoperative period for 7.5 g/day vs placebo. Overall, no significant differences between 15 g/day and placebo were noted.</p><p><strong>Limitations: </strong>Limited dosing and short evaluation window (short hospital stay).</p><p><strong>Conclusions: </strong>Compared with placebo, TU-100 7.5 g/day was associated with consistent, encouraging trends for efficacy outcomes, including more patients achieving gastrointestinal recovery by postoperative day 2 with less bothersome gastrointestinal symptoms. A statistically significant difference in hospital stay for 7.5 g/day vs placebo was noted despite relatively short stays, drug administration not begun until postoperative day 1, and use with enhanced recovery after surgery pathways. Further studies are warranted. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328454","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":"Conventional Versus High-Complexity Total Pelvic Exenteration For Locally Advanced and Locally Recurrent Rectal Cancer: An International Multicenter Study.","authors":"Celine Garrett, Kilian G M Brown, Michael J Solomon, Paul A Sutton, Cherry E Koh, Samuel Aguiar, Tiago S Bezerra, Hamish W Clouston, Ashwin Desouza, Eric J Dozois, Amanda L Ersryd, Frank Frizelle, Jonas A Funder, Julio Garcia-Aguilar, Richard Garfinkle, Tamara Glyn, Alexander Heriot, Yukihide Kanemitsu, Chia Y Kong, Helle Ø Kristensen, Songphol Malakorn, David M Mens, Per J Nilsson, Gabriella J Palmer, Emmanouil Pappou, Martha Quinn, Aaron J Quyn, Chucheep Sahakitrungruang, Avanish Saklani, Arne M Solbakken, Jim P Tiernan, Cornelis Verhoef, Daniel Steffens","doi":"10.1097/DCR.0000000000003986","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003986","url":null,"abstract":"<p><strong>Background: </strong>Pelvic exenteration is the treatment of choice for selected patients with locally advanced primary and recurrent rectal cancer. Involvement of major pelvic neurovascular structures and bone were historically considered contraindications due to unacceptably high rates of morbidity and low R0 resection rates.</p><p><strong>Objective: </strong>To compare the outcomes of these \"high-complexity\" exenterative resections to those of \"conventional\" pelvic exenteration.</p><p><strong>Design: </strong>International multicenter retrospective cohort study.</p><p><strong>Settings: </strong>Sixteen specialized exenteration centers.</p><p><strong>Patients: </strong>Those who underwent total pelvic exenteration for locally advanced primary and recurrent rectal cancer between 2018 and 2023 at participating centers.</p><p><strong>Main outcome measures: </strong>Perioperative resource utilization, morbidity, mortality and R0 resection rates were reported.</p><p><strong>Results: </strong>763 patients underwent total pelvic exenteration, of which 478 (63%) and 285 patients (37%) required conventional and high-complexity procedures, respectively. High-complexity pelvic exenteration was associated with longer operating time (600 vs 480 mins, p < 0.001 for locally advanced primary rectal cancer, 623 vs 480 mins, p < 0.001 for locally recurrent rectal cancer), intensive care stay (2 vs 1 day, p < 0.001 and 3 vs 1 day, p < 0.001), hospital stay (19 vs 15 days, p = 0.008 and 23 vs 15 days, p < 0.001) and higher blood loss (2000 vs 1236 mL, p < 0.001 and 3000 vs 1600 mL, p < 0.001). Morbidity and mortality outcomes, and R0 resection rates were similar between the groups.</p><p><strong>Limitations: </strong>Generalizability of findings outside of expert units.</p><p><strong>Conclusions: </strong>High-complexity pelvic exenteration for the treatment of rectal cancer is associated with similar morbidity, mortality, and R0 resection rates, but significantly higher operative time, blood loss, and hospital resource utilization compared to conventional pelvic exenteration. In high volume, specialized centers, these techniques are considered the standard of care for appropriately selected patients with tumors that involve major pelvic bone or neurovascular structures. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328497","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":"Thank you.","authors":"","doi":"10.1097/DCR.0000000000003989","DOIUrl":"10.1097/DCR.0000000000003989","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291472","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":"Global Use and Outcomes of Endoscopic Stenting in Acute Malignant Left-Sided Colonic Obstruction: A Secondary Analysis of APOLLO, An International, Prospective Cohort Study.","authors":"","doi":"10.1097/DCR.0000000000003960","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003960","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic colonic stents are an alternative to surgical decompression for obstructing colorectal cancer.</p><p><strong>Objective: </strong>To characterize the global use of endoscopic stents in the setting of acute left-sided colonic obstruction.</p><p><strong>Design: </strong>A prospective, international, multicenter cohort study.</p><p><strong>Settings: </strong>At 179 centers performing colorectal surgery across 37 countries.</p><p><strong>Patients: </strong>This study enrolled consecutive adult patients presenting acutely with colorectal cancer between January and June 2023 with malignant left-sided obstruction.</p><p><strong>Interventions: </strong>Patients were managed nonoperatively, with endoscopic stenting, or with surgery.</p><p><strong>Main outcome measures: </strong>The primary outcome was 90-day mortality, and the secondary outcomes were days alive and out of hospital at 90 days (DAOH90) and 90-day unplanned readmission. Propensity score matching and multilevel multivariable regression were used.</p><p><strong>Results: </strong>Of 516 patients that presented acutely with obstructing left-sided colon cancer (median age 69 years; 44% female; median Clinical Frailty Score 3.0), 47 (9.1%) were managed nonoperatively, 54 (10.5%) were managed with colonic stenting, and 415 (80.4%) were managed surgically. Stenting was predominantly performed in high income countries (96.3%). After stenting, 5 (9.3%) patients had immediate complications, and a further 4 (7.4%) patients had stent-related complications within 90-days (compared to a 20.5% major postoperative complications rate after surgery). On univariable analysis, there was no difference in 90-day mortality (14.8% after stenting vs 11.6% after surgery; difference: 3.25%, 95% CI: -4.7% to 15.4%), with clinically similar DAOH90 (median 82 vs 79 days). After propensity score matching and multilevel, multivariable adjustment, the stenting group had a statistically similar hazard of mortality compared to the surgery group (adjusted hazard ratio [HR] 0.34, 95% CI: 0.08-1.36).</p><p><strong>Limitations: </strong>These were observational data, subject to selection bias. In addition, confidence intervals around survival estimates were wide.</p><p><strong>Conclusions: </strong>Endoscopic stenting is rarely used outside high-income countries but offers lower short-term morbidity and comparable 90-day outcomes to surgery. See Video Abstract.ClinicalTrials.gov No: NCT05641129.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274122","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":"Medial Psoas Space Approach For Robotic En-Bloc Pelvic Lymph Node Dissection For Anal Canal Melanoma.","authors":"Yogesh Bansod, Ashwin Desouza, Avanish Saklani","doi":"10.1097/DCR.0000000000003807","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003807","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238051","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":"Right Colectomy Utilizing Single-Port Robotic Platform.","authors":"Fred Kobylarz, Salvatore Parascandola, Aimal Khan","doi":"10.1097/DCR.0000000000003791","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003791","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238076","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}