Diseases of the Colon & Rectum最新文献

{"title":"Barriers to Colonoscopy Quality Measurement in Rural Wisconsin.","authors":"Jessica R Schumacher, Jennifer M Weiss, Jill S Ties, Nicholas J Kitowski, Jeremy P Levin, Matthew Gigot, Jeanette C May, Daniel R Pung, Elise H Lawson","doi":"10.1097/DCR.0000000000003528","DOIUrl":"10.1097/DCR.0000000000003528","url":null,"abstract":"<p><strong>Background: </strong>Patients in rural areas have limited colonoscopy access, which is critical for colorectal cancer prevention. General surgeons perform most colonoscopies in rural areas. The Surgical Collaborative of Wisconsin's Rural Task Force identified colonoscopy as a high-priority initiative due to high volume and lack of access to quality measurement, which is necessary to assess and ultimately improve colonoscopy performance.</p><p><strong>Objective: </strong>Assess the capacity for colonoscopy quality measurement and improvement in rural Wisconsin hospitals.</p><p><strong>Design: </strong>From October 2019 to January 2020, the Surgical Collaborative of Wisconsin, Rural Wisconsin Health Cooperative, and Wisconsin Collaborative for Healthcare Quality collaborated to design and distribute a survey to 44 Rural Wisconsin Health Cooperative hospitals. Descriptive statistics summarized survey items. Surgeons from 6 rural hospitals participated in stakeholder interviews.</p><p><strong>Setting: </strong>Rural Wisconsin Health Cooperative hospitals.</p><p><strong>Main outcome measures: </strong>Colonoscopy providers, procedure volume/capacity, informatics and quality measurement infrastructure, barriers to quality measurement, and improvement.</p><p><strong>Results: </strong>Twenty-five surveys (57%) were completed. Most colonoscopy providers in rural hospitals were surgeons (66.3%), followed by family/internal medicine physicians (20.0%) and gastroenterologists (13.8%). The average hospital volume/week was 19.9 colonoscopies (SD = 13.4). Hospitals reported operating at ~75% capacity. Withdrawal time was the most tracked measure (44.0%), followed by adenoma detection (36.0%) and cecal intubation (28.0%) rates. Approximately one-third of hospitals (36.0%) used procedure-reporting software. Most hospitals (80.0%) did not have access to on-site pathology. Surgeons reported barriers to quality measurement/improvement, including insufficient resources for electronic medical record-based reporting and the need for targeted educational opportunities that do not require travel.</p><p><strong>Limitations: </strong>Single state may not represent the experience of all rural hospitals.</p><p><strong>Conclusions: </strong>The lack of access to colonoscopy quality measures suggests the opportunity to develop a flexible approach that considers reporting software availability and electronic medical record differences. Improving access to measures and education/training opportunities may improve the availability of high-quality colonoscopies for patients in rural Wisconsin. See Video Abstract .</p><p><strong>Barreras para la medicin de la calidad de la colonoscopia en las zonas rurales de wisconsin: </strong>ANTECEDENTES:Los pacientes de las zonas rurales tienen un acceso reducido a la colonoscopia, que es fundamental para la prevención del cáncer colorrectal. Los cirujanos generales realizan la mayoría de las colonoscopias en las zonas rurales. El S","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"373-379"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Anus By Any Other Name….","authors":"Lester Gottesman","doi":"10.1097/DCR.0000000000003503","DOIUrl":"10.1097/DCR.0000000000003503","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"261-263"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806198","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 Intracorporeal Fully Stapled Modified Kono-S Anastomosis: A Technical Demonstration.","authors":"Joseph K Micheal, Nathaniel J Schwartz, Matthew P Zeller, Jessica M Felton, Joshua H Wolf","doi":"10.1097/DCR.0000000000003492","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003492","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 3","pages":"e104-e106"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467263","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":"Has the Use of Enhanced Recovery Protocols in Colorectal Surgery Increased Postoperative Bleeding Complications?","authors":"Eyal Aviran, Dan Assaf, Karen N Zaghiyan, Phillip Fleshner","doi":"10.1097/DCR.0000000000003581","DOIUrl":"10.1097/DCR.0000000000003581","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery protocols are multimodal perioperative care pathways shown to improve postoperative complications and decrease the length of stay after surgery. A critical component of an enhanced recovery after surgery protocol is the use of multimodal nonopiate analgesia using nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors.</p><p><strong>Objective: </strong>To compare the incidence of postoperative GI bleeding between patients treated with and without an enhanced recovery after surgery protocol.</p><p><strong>Design: </strong>Retrospective review of a prospectively maintained colorectal registry.</p><p><strong>Settings: </strong>Large colorectal referral center.</p><p><strong>Patients: </strong>Preoperative elective colorectal surgery requiring an anastomosis.</p><p><strong>Intervention: </strong>Standardized enhanced recovery after surgery protocol included celecoxib and ketorolac.</p><p><strong>Main outcome: </strong>Postoperative outcomes included bleeding (±sequelae), reduction in hematocrit after the operation, intervention for bleeding (transfusion, endoscopy, or surgery), length of stay, and hospital readmission.</p><p><strong>Results: </strong>The enhanced recovery after surgery group (n = 630) and nonenhanced recovery after surgery group (n = 739) were comparable in baseline clinical features except for surgical indication, with more IBD and less malignant disease in the enhanced recovery after surgery group. Minimally invasive surgery was more commonly performed in the enhanced recovery after surgery group. Both bleeding with sequelae ( p < 0.0001) and bleeding without sequelae ( p = 0.0004) were significantly more common in the enhanced recovery after surgery group compared to the nonenhanced recovery after surgery group. In addition, a significantly larger hematocrit decline after the operation was noted in the enhanced recovery after surgery group ( p < 0.0001). However, both the need for transfusion and intervention for bleeding did not significantly differ between patient groups. Factors associated with bleeding were the use of an enhanced recovery after surgery protocol (OR 2.96; 95% CI, 1.57-5.58; p < 0.001) and performing a small to large bowel anastomosis (OR 2.68; 95% CI, 1.49-4.81; p < 0.001).</p><p><strong>Limitations: </strong>Retrospective observational design and inability to determine which component of the enhanced recovery after surgery protocol increased the risk of bleeding.</p><p><strong>Conclusions: </strong>Use of an enhanced recovery after surgery protocol in patients undergoing colorectal surgery with an anastomosis is associated with an increased incidence of bleeding without significant difference in the need for transfusion or intervention. See Video Abstract .</p><p><strong>El uso de protocolos de recuperacin mejorada en ciruga colorrectal ha aumentado las complicaciones hemorrgicas postoperatorias: </strong>ANTECEDENTES:Los protocolos d","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"366-372"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767343","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":"Insights Into the Group of Surgically Resectable But Nonoperable Patients With Colorectal Cancer.","authors":"Ilze Ose, Adile Orhan, Sule Eraslan, Enise Gögenur, Christina Alexandersen, Angelina Astrid Righult, Emine Ceren Ayhan, Amalie Thomsen Nielsen, Ida Kolukisa Saqi, Ismail Gögenur","doi":"10.1097/DCR.0000000000003580","DOIUrl":"10.1097/DCR.0000000000003580","url":null,"abstract":"<p><strong>Background: </strong>The incidence of colorectal cancer is expected to increase, particularly among patients with significant frailty and comorbidities. A subgroup of these patients may not be suitable for surgery because of the high risk of postoperative morbidity and mortality.</p><p><strong>Objective: </strong>The aim of this study was to characterize the clinical outcomes, management, social status, and survival of patients deemed nonoperable because of comorbidity and/or frailty.</p><p><strong>Design: </strong>This was a retrospective cohort study.</p><p><strong>Settings: </strong>Overall survival was estimated using the Kaplan-Meier method. The Cox proportional-hazards model was used to estimate HRs and 95% CIs for mortality-associated modifiable risk factors.</p><p><strong>Patients: </strong>Patients diagnosed with resectable colorectal cancer but deemed nonoperable because of comorbidity and/or frailty by a multidisciplinary team between January 1, 2020, and April 30, 2024, were included in this study.</p><p><strong>Main outcome measures: </strong>The primary outcome was to describe the current population, investigate mortality, and explore mortality-related risk factors in the current population.</p><p><strong>Results: </strong>During the study period, 69 of 1667 patients who had colorectal cancer that was potentially resectable but who were deemed nonoperable were included in the study population. The rate of 90-day and 1-year mortality was 20% and 52%, respectively. Three years after the diagnosis, 12% of the patients were alive. At the time of diagnosis, anemia was found in 73% of female patients and 71% of male patients. In addition, 77% of the patients had hypoalbuminemia. Lower albumin levels were associated with poor survival (HR, 0.92; 95% CI, 0.88-0.98; p = 0.007).</p><p><strong>Limitations: </strong>The retrospective nature and small sample size inherently limit the generalizability of the study findings.</p><p><strong>Conclusions: </strong>Mortality in the current population was high. However, our findings highlight potential areas for improvement in the management of these patients. See Video Abstract .</p><p><strong>Informacin sobre el grupo de pacientes con cncer colorrectal resecables quirrgicamente pero no operables: </strong>ANTECEDENTES:Se espera que la incidencia del cáncer colorrectal aumente, en particular entre los pacientes con fragilidad y comorbilidades significativas. Un subgrupo de estos pacientes puede no ser apto para la cirugía debido al alto riesgo de morbilidad y mortalidad posoperatorias.OBJETIVO:El objetivo de este estudio fue caracterizar los resultados clínicos, el tratamiento, el estado social y la supervivencia de los pacientes considerados no operables debido a la comorbilidad y/o fragilidad.DISEÑO:Este fue un estudio de cohorte retrospectivo.ESTABLECIMIENTOS:La supervivencia general se estimó utilizando el método de Kaplan-Meier. Se utilizó el modelo de riesgos proporcionales de Cox para","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"351-358"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767349","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":"Survival Outcomes in Patients Undergoing Pelvic Exenteration for Pelvic Mucosal Melanomas: Retrospective Single Institution Australian Study.","authors":"Tae-Jun Kim, Elan Novis, Peter J M Lee, Sascha Karunaratne, Mollie Cahill, Kirk K S Austin, Christopher M Byrne, Michael J Solomon","doi":"10.1097/DCR.0000000000003588","DOIUrl":"10.1097/DCR.0000000000003588","url":null,"abstract":"<p><strong>Background: </strong>Pelvic mucosal melanomas, including anorectal and urogenital melanomas, are rare and aggressive, with a median overall survival of up to 20 months. Pelvic mucosal melanomas behave differently from their cutaneous counterparts and present late with locoregional disease, making pelvic exenteration its only curative surgical option.</p><p><strong>Objective: </strong>This study aimed to evaluate the survival outcomes after pelvic exenteration in pelvic mucosal melanomas at Royal Prince Alfred Hospital.</p><p><strong>Design: </strong>Retrospective case series from a prospectively collected pelvic exenteration database from October 1994 to November 2023.</p><p><strong>Setting: </strong>Royal Prince Alfred Hospital (quaternary institution), Camperdown, New South Wales, Australia.</p><p><strong>Patients: </strong>Seven patients undergoing pelvic exenteration for pelvic mucosal melanoma.</p><p><strong>Main outcome measures: </strong>Overall survival, disease-free survival, and complication rates.</p><p><strong>Results: </strong>Of the 7 patients, most were women (n = 5; 71.4%) and had a median age of 65 years (range, 36-79). Five patients (71.4%) underwent pelvic exenteration for primary pelvic mucosal melanoma, 3 of which were anorectal and 2 vaginal melanomas. Two patients (28.6%) had recurrent anorectal melanoma and received neoadjuvant radiotherapy after an initial wide local excision. Three patients (42.9%) required total pelvic exenteration, whereas 2 required a central pelvic exenteration (28.6%). The remaining procedures included central and lateral pelvic exenteration and anterior, central, and lateral pelvic exenteration. The median length of hospital stay was 19.7 days. Five patients had postoperative complications with 1 major complication (Clavien-Dindo grade IIIa). At the completion of the study, there were 4 mortalities. Mean survival was 23.6 months (range, 2-100) with a recurrence rate of 83%. The median time to recurrence was 3 months, despite 6 patients (85.7%) having R0 resections. Distant recurrence, specifically to bone, the lungs, and the liver, was most common.</p><p><strong>Limitations: </strong>Small study cohort due to rarity of disease, limiting generalizability.</p><p><strong>Conclusions: </strong>Pelvic exenteration for pelvic mucosal melanoma appears to help control local disease as recurrence is most commonly distant or regional. See Video Abstract .</p><p><strong>Resultados de supervivencia en pacientes sometidos a exenteracin plvica por melanomas de la mucosa plvica estudio retrospectivo australiano de una sola institucin: </strong>ANTECEDENTES:Los melanomas de la mucosa pélvica (MM), incluidos los melanomas anorrectales y urogenitales, son raros y agresivos, con una supervivencia global media de hasta 20 meses. Los melanomas de la mucosa pélvica se comportan de manera diferente a sus contrapartes cutáneas y se presentan tardíamente con enfermedad locoregional, lo que hace que la exenteraci","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"359-365"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767384","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":"Increased Use of Magnetic Resonance Enterography in Crohn's Disease.","authors":"Muhammed Bahaddin Durak","doi":"10.1097/DCR.0000000000003610","DOIUrl":"10.1097/DCR.0000000000003610","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e108"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799771","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":"V Prasad Poola, Samuel Eisenstein, Shankar Raman, Mayin Lin","doi":"10.1097/DCR.0000000000003619","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003619","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 3","pages":"380-384"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467290","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":"Features of Lateral Pelvic Lymph Nodes Associated With Pathological Involvement After Total Neoadjuvant Therapy in Patients Undergoing Lateral Pelvic Lymph Node Dissection.","authors":"Tatsuki Noguchi, Takashi Akiyoshi, Takashi Sakamoto, Shimpei Matsui, Toshiki Mukai, Tomohiro Yamaguchi, Masamichi Koyama, Senzo Taguchi, Eiji Shinozaki, Hiroshi Kawachi, Yosuke Fukunaga","doi":"10.1097/DCR.0000000000003590","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003590","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of consensus regarding treating involved lateral pelvic lymph nodes in rectal cancer.</p><p><strong>Objective: </strong>This study aimed to evaluate the clinical and MRI-based factors associated with pathological lateral pelvic lymph node metastasis in patients undergoing total neoadjuvant therapy and lateral pelvic lymph node dissection.</p><p><strong>Design: </strong>This is a retrospective study.</p><p><strong>Settings: </strong>This study was conducted at a single comprehensive cancer center.</p><p><strong>Patients: </strong>A total of 107 patients with advanced low rectal cancer with pretreatment enlarged lateral pelvic lymph nodes (≥7 mm in long axis) undergoing total neoadjuvant therapy with long-course chemoradiotherapy, followed by total mesorectal excision and lateral pelvic lymph node dissection, were enrolled.</p><p><strong>Main outcome measures: </strong>Pathological lateral pelvic lymph node metastasis and survival.</p><p><strong>Results: </strong>Among 107 patients, short-axis lateral node diameter at baseline was <7 mm in 48 patients and ≥7 mm in 59 patients. The ≥7 mm group showed significantly higher rates of pathological lateral pelvic lymph node metastasis (44.1% vs 2.1%; p < 0.0001). In this group, pathological lateral pelvic lymph node metastasis was independently associated with pretreatment malignant features and posttreatment short-axis diameter ≥4 mm. Five-year relapse-free survival was significantly lower in patients with posttreatment lateral node diameter ≥4 mm than those with <4 mm (71.1% vs 86.2%, p = 0.0364). Patients with pathological lateral pelvic lymph node metastasis had significantly lower overall survival, relapse-free survival, and local recurrence-free survival rates.</p><p><strong>Limitations: </strong>Selection bias exists in a retrospective analysis.</p><p><strong>Conclusions: </strong>Pathological lateral pelvic lymph node metastasis is rare in patients with pretreatment short-axis diameter <7 mm. In patients with pretreatment short-axis diameter ≥7 mm, pretreatment malignant features and posttreatment short-axis diameter are both associated with pathological lateral pelvic lymph node metastasis. These factors should be considered when deciding whether to proceed with lateral pelvic lymph node dissection after total neoadjuvant therapy. See Video Abstract.</p><p><strong>Caractersticas de los ganglios linfticos plvicos laterales asociados con afectacin patolgica despus de la terapia neoadyuvante total en pacientes sometidos a diseccin lateral de ganglios linfticos plvicos: </strong>ANTECEDENTES:No existe consenso sobre el tratamiento de los ganglios linfáticos pélvicos laterales afectados en el cáncer rectal.OBJETIVO:Este estudio tuvo como objetivo evaluar los factores clínicos y basados en imágenes de resonancia magnética asociados con la metástasis patológica de los ganglios linfáticos pélvicos laterales en pacientes sometidos a terapia neoadyuvante tota","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 3","pages":"316-326"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467255","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":"Prognostic Significance of Desmoplastic Reaction After Neoadjuvant Chemoradiotherapy in Advanced Rectal Cancer.","authors":"Shuhei Sano, Takashi Akiyoshi, Noriko Yamamoto, Tatsuki Noguchi, Takashi Sakamoto, Shimpei Matsui, Toshiki Mukai, Tomohiro Yamaguchi, Akinobu Taketomi, Yosuke Fukunaga, Naoki Miyazaki, Hiroshi Kawachi","doi":"10.1097/DCR.0000000000003589","DOIUrl":"10.1097/DCR.0000000000003589","url":null,"abstract":"<p><strong>Background: </strong>Desmoplastic reaction is recognized as a prognostic factor in colorectal cancer. However, its significance in locally advanced rectal cancer after neoadjuvant chemoradiotherapy remains underexplored.</p><p><strong>Objective: </strong>To assess the prognostic value of desmoplastic reaction in specimens from patients with advanced rectal cancer after chemoradiotherapy.</p><p><strong>Design: </strong>This was a retrospective study.</p><p><strong>Settings: </strong>This study was conducted at a single comprehensive cancer center.</p><p><strong>Patients: </strong>The study included 255 patients with advanced rectal cancer who underwent fluoropyrimidine-based chemoradiotherapy followed by total mesorectal excision from 2005 to 2014. Desmoplastic reaction was classified into mature, intermediate, and immature categories based on histological analysis.</p><p><strong>Main outcome measures: </strong>The primary outcomes were recurrence-free survival and overall survival.</p><p><strong>Results: </strong>Desmoplastic reaction was classified as mature (69.0%), intermediate (5.5%), or immature (25.5%). The mature group had a higher percentage of good responders (34.1%) compared with the intermediate (0%) and immature (4.6%) groups ( p < 0.0001). The mature group correlated with better outcomes, with a higher 5-year recurrence-free survival (85.4%) and overall survival (93.0%) as compared with intermediate (45.1% and 76.2%, respectively) and immature (65.8% and 88.8%, respectively) groups. In the multivariable analysis, intermediate/immature desmoplastic reaction was significantly associated with poorer recurrence-free survival ( p = 0.03). Among poor responders, intermediate/immature desmoplastic reaction was associated with poorer recurrence-free survival ( p = 0.03). Adjuvant chemotherapy did not significantly improve the 5-year recurrence-free survival rate for the mature group (adjuvant chemotherapy vs no chemotherapy, 86.4% vs 84.8%; p = 0.64), with worse trends observed in the intermediate/immature combined group (55.9% vs 69.4%, respectively, p = 0.27).</p><p><strong>Limitations: </strong>The limitations include the subjective nature of the desmoplastic reaction assessment and the retrospective design of the study.</p><p><strong>Conclusions: </strong>Desmoplastic reaction in surgical specimens after chemoradiotherapy is associated with responses to chemoradiotherapy and serves as a significant prognostic factor in advanced rectal cancer, particularly for those responding poorly to chemoradiotherapy. See Video Abstract .</p><p><strong>Importancia pronstica de la reaccin desmoplsica tras la quimiorradioterapia neoadyuvante en el cncer rectal avanzado: </strong>ANTECEDENTES:La reacción desmoplásica se reconoce como un factor pronóstico en el cáncer colorrectal. Sin embargo, su importancia en el cáncer rectal localmente avanzado después de la quimiorradioterapia neoadyuvante sigue sin explorarse.OBJETIVO:Evaluar el valor pron","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"327-337"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767369","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}