Diseases of the Colon & Rectum最新文献

{"title":"Outreach - A World of Possibilities.","authors":"Graham L Newstead","doi":"10.1097/DCR.0000000000003701","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003701","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398643","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":"Jejunal Lymphatic and Vascular Anatomy Defines Surgical Principles for Treatment of Jejunal Tumors.","authors":"Teodor Vasic, Milena B Stimec, Bojan V Stimec, Erik Kjæstad, Dejan Ignjatovic","doi":"10.1097/DCR.0000000000003644","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003644","url":null,"abstract":"<p><strong>Background: </strong>The jejunum has a wide lymphatic drainage field, making radical surgery difficult.</p><p><strong>Objective: </strong>Extrapolate results from 2 methodologies to define jejunal artery lymphatic clearances and lymphovascular bundle shapes for radical bowel-sparing surgery.</p><p><strong>Design: </strong>Two cohort studies.</p><p><strong>Settings: </strong>The first dataset comprised dissections of cadavers at the University of Geneva. The second dataset incorporated preoperative 3D-computed tomography vascular reconstructions of patients included in the \"Surgery with Extended (D3) Mesenterectomy for Small Bowel Tumors\" clinical trial.</p><p><strong>Patients: </strong>Eight cadavers were dissected. The 3D-computed tomography dataset included 101 patients.</p><p><strong>Main outcome measures: </strong>Lymph vessels ran parallel and interlaced with jejunal arteries. Lymphatic clearance was minimal at the jejunal artery's origin, radially spreading thereafter. Jejunal arteries were categorized into 3 groups based on position to the middle colic artery origin on 3D-computed tomography. Group A: jejunal artery origins lie cranially and caudally to the middle colic artery. Group B: jejunal artery origins lie caudal to the middle colic artery. Group C: jejunal artery origins lie cranial to the middle colic artery. Jejunal veins were classified into 3 groups based on their trajectories to the superior mesenteric artery (dorsally/ventrally/combined).</p><p><strong>Results: </strong>Lymph vessel clearances were 1.5 ± 1.0 mm at jejunal artery origins. Group A was present in 81 (80.2%), group B in 13 (12.9%), group C in 7 (6.9%) cases. Jejunal artery median was 4. A 57 (56.4%) of jejunal veins ran dorsally to the superior mesenteric artery, 16 (15.8%) ran ventrally, and 28 (27.8%) had combined course.</p><p><strong>Limitations: </strong>Lymph nodes weren't counted during dissection because the main observation was the position of lymph vessels.</p><p><strong>Conclusion: </strong>Minimal jejunal artery lymphatic clearance implies ligating tumor-feeding vessels at origin. The intermingled jejunal artery lymphatics imply lymph node dissection along the proximal and distal vessels to the level of the first arcade. Classifying jejunal arteries and veins could simplify the anatomy for surgeons. See Video Abstract.</p><p><strong>Clinical trial registration number: </strong>NCT05670574.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398641","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":"Robotic Masterclass: Instrument Control During Total Mesorectal Excision.","authors":"James Chi-Yong Ngu, Neng Wei Wong, Nan Zun Teo","doi":"10.1097/DCR.0000000000003479","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003479","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398646","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":"Clip-and-Lift Retraction Technique During Endoscopic Submucosal Dissection.","authors":"Kamil Erozkan, Attila Ulkucu, Lucas F Sobrado, Emre Gorgun","doi":"10.1097/DCR.0000000000003593","DOIUrl":"10.1097/DCR.0000000000003593","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398578","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":"Area Deprivation, Fragmented Care, and Colectomy Case Acuity in the Veterans Health Administration.","authors":"Robert A Tessler, Mary Vaughan Sarrazin, Yubo Gao, Michael A Jacobs, Carly A Jacobs, Leslie R M Hausmann, Daniel E Hall","doi":"10.1097/DCR.0000000000003659","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003659","url":null,"abstract":"<p><strong>Background: </strong>Colectomy for benign or malignant disease may be elective, urgent, or emergent. Data suggest successively worse outcomes for non-elective colectomy. Few data exist on the contribution of high area deprivation index and care fragmentation to non-elective colectomy.</p><p><strong>Objective: </strong>Determine the association between area deprivation and non-elective colectomy in the Veterans Health Administration and assess whether accounting for differences in care fragmentation alters the association across indications and for benign and malignant conditions separately.</p><p><strong>Design: </strong>Retrospective cohort with multivariable multinomial logit models to evaluate associations between high deprivation care fragmentation, and the adjusted odds of non-elective colectomy. We calculated total, direct, and indirect effects to assess whether the association varied by levels of care fragmentation.</p><p><strong>Setting: </strong>Veterans receiving care in the private sector and Veterans Health Administration.</p><p><strong>Patients: </strong>Veterans ≥ 65 years undergoing colectomy between 2013 and 2019.</p><p><strong>Main outcome/measures: </strong>Colectomy case acuity.</p><p><strong>Results: </strong>We identified 6538 colectomy patients, of which 3006 (46.0%) were for malignancy. The odds of emergent colectomy were higher for patients in high deprivation areas when the indication was for benign pathology (aOR 1.51 95% CI: 1.15, 2.00). For malignant indications, there was no association between high deprivation and non-elective colectomy. More fragmented care was associated with a higher odds of urgent and emergent colectomy for both benign and malignant indications but the association between deprivation and non-elective colectomy did not vary by care fragmentation.</p><p><strong>Limitations: </strong>Inherent to large administrative retrospective databases.</p><p><strong>Conclusions: </strong>Veterans living in high deprivation areas are at higher risk for emergent colectomy for benign conditions. Care fragmentation is also associated with a higher risk of emergent colectomy across indications. Efforts to reduce care fragmentation and promote early detection of inflammatory bowel disease and diverticular disease in high deprivation neighborhoods may lower the risk for non-elective colectomy in Veterans. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390430","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":"Bridging Gaps to Improve Care Models for Patients at Risk for Anal Dysplasia and Cancer: A Call to Action.","authors":"Stacy Ranson, Linnette Arroyo Roldan, Elizabeth C Wick, Valentina Robila, Bridget N Fahy, Emily B Rivet","doi":"10.1097/DCR.0000000000003582","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003582","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390502","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":"Enhanced Recovery Independently Lowers Failure to Rescue After Colorectal Surgery.","authors":"Marco Catarci, Giacomo Ruffo, Massimo Giuseppe Viola, Gianluca Garulli, Maurizio Pavanello, Marco Scatizzi, Vincenzo Bottino, Stefano Guadagni","doi":"10.1097/DCR.0000000000003655","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003655","url":null,"abstract":"<p><strong>Background: </strong>High adherence to the enhanced recovery after surgery pathway reduces morbidity and mortality rates after elective colorectal surgery.</p><p><strong>Objective: </strong>To evaluate the effect of adherence to the enhanced recovery after surgery pathway on the failure to rescue rates after elective colorectal surgery.</p><p><strong>Design: </strong>Retrospective analysis of a prospective database.</p><p><strong>Patients: </strong>Adults (≥ 18 years old) who underwent elective colorectal resection with anastomosis for benign and malignant disease.</p><p><strong>Settings: </strong>Prospective enrolment in 78 centers in Italy from 2019 to 2021.</p><p><strong>Interventions: </strong>All the outcomes were measured at 60 days after surgery. Several patient-, disease-, treatment-, hospital-, and complication-related variables were analyzed for the outcomes. After univariate analyses, independent predictors of the endpoints were identified through logistic regression analyses, presenting odds ratios and 95% confidence intervals.</p><p><strong>Main outcome measures: </strong>Failure to rescue after any adverse event, defined as the ratio between the number of deaths and the number of patients showing any adverse event; failure to rescue after any major adverse event, with the denominator represented by the number of patients showing any major adverse event.</p><p><strong>Results: </strong>An adverse event was recorded in 2,321 out of 8,359 patients (27.8%), a major adverse event in 523 patients (6.3%), and death in 88 patients (1.0%). The failure to rescue rates were 3.8% after any adverse event and 16.8% after any major adverse event. Independent predictors of primary endpoints were identified among patient- (age, American Society of Anesthesiologists class, nutritional status), treatment- (type of resection), and complication-related (anastomotic leakage, reoperation) variables. Enhanced recovery pathway adherence > 70% independently reduced failure to rescue rates.</p><p><strong>Limitations: </strong>Clustering from multicenter data, and unmeasured confounding from observational data.</p><p><strong>Conclusions: </strong>Following elective colorectal resection, adherence > 70% to the enhanced recovery pathway independently decreased failure to rescue rates, along with other patient- or treatment-related factors. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390504","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":"Cancer Incidence and Mortality in Familial Adenomatous Polyposis Syndrome.","authors":"Dan Feldman, Linda H Rodgers-Fouche, Chinedu Ukaegbu, Matthew B Yurgelun, Sapna Syngal, Daniel C Chung","doi":"10.1097/DCR.0000000000003645","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003645","url":null,"abstract":"<p><strong>Background: </strong>Risk-reducing colectomy in familial adenomatous polyposis syndrome is the standard of care. This has increased the importance of surveillance for extra-colonic malignancies in post-colectomy individuals.</p><p><strong>Objective: </strong>We sought to define the present-day incidence of all cancers and mortality in familial adenomatous polyposis.</p><p><strong>Design: </strong>Retrospective longitudinal cohort study.</p><p><strong>Settings: </strong>Two large academic hospitals.</p><p><strong>Patients: </strong>Eligible patients carried an APC pathogenic variant or met clinical criteria for familial adenomatous polyposis.</p><p><strong>Main outcomes measures: </strong>Cancer diagnosis, mortality, associated risk factors.</p><p><strong>Results: </strong>A total of 358 patients were identified. The percentage who exhibited a classic familial adenomatous polyposis phenotype was 63.7%; 21.2% were de novo, and 82.7% had a colectomy. Colorectal cancer was the most common cancer (N = 59, 16.5%). Colorectal cancer diagnoses were associated with de novo familial adenomatous polyposis (odds ratio 7.8 [95% CI 3.51-17.35; p < 0.001]). Thyroid, duodenal/small bowel, gastric, and neuroendocrine tumors were reported in 7.5%, 3.1%, 2.8%, and 2.5% of patients, respectively. Rates of cancer were similar in classic and attenuated familial adenomatous polyposis. Thirty-nine patients (10.9%) died at a mean age of 49.6±17.1 years. Twenty-six deaths were malignancy-related, and colorectal cancer was the leading cause (N = 10). All colorectal cancer-related deaths occurred in individuals with classic familial adenomatous polyposis, and 9/10 were not previously diagnosed with the syndrome. Gastric and duodenal/small bowel cancer were the second leading causes (4 deaths each), and all occurred after colectomy. Fifty-nine percent of all deaths were attributable to a familial adenomatous polyposis-related malignancy or morbidity.</p><p><strong>Limitations: </strong>Retrospective clinical data.</p><p><strong>Conclusions: </strong>Colorectal cancer remains the most common malignancy and cause of death in familial adenomatous polyposis. However, nearly all colorectal cancer-related deaths occurred in individuals unaware of their familial adenomatous polyposis diagnosis, and none occurred in the attenuated syndrome. In patients who had a colectomy, gastric and duodenal/small bowel cancers are now the leading causes of death. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390503","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":"Management of Obstetric Anal Sphincter Injuries.","authors":"Chloe Price, Ryan Cohen","doi":"10.1097/DCR.0000000000003697","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003697","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363805","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":"Laparoscopic Low Anterior Resection In Situs Inversus.","authors":"Yogesh Bansod, Ashwin Desouza, Avanish Saklani","doi":"10.1097/DCR.0000000000003495","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003495","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363800","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}