Diseases of the Colon & Rectum最新文献

{"title":"Stoma-Free Survival Following Low Anterior Resection With Coloanal Anastomosis for Stage II and III Rectal Cancer.","authors":"Dovile Cerkauskaite, Jyi Cheng Ng, Richard Sassun, Annaclara Sileo, Justin T Brady, Amit Merchea, Luca Stocchi, William R G Perry, Kevin T Behm, Kellie L Mathis, David W Larson","doi":"10.1097/DCR.0000000000004145","DOIUrl":"10.1097/DCR.0000000000004145","url":null,"abstract":"<p><strong>Background: </strong>Stoma-free survival represents a key quality-of-life outcome after surgery for locally advanced rectal cancer. Despite advances in neoadjuvant and surgical management, up to 30% of patients ultimately require a permanent fecal diversion.</p><p><strong>Objective: </strong>To evaluate stoma-free survival and identify factors associated with permanent stoma formation in patients with locally advanced rectal cancer undergoing coloanal anastomosis.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Single tertiary referral center (2017-2021).</p><p><strong>Patients: </strong>A total of 126 patients with clinical stage II and III rectal adenocarcinoma who received neoadjuvant therapy and underwent curative-intent resection with coloanal anastomosis were included.</p><p><strong>Intervention: </strong>Curative-intent resection with coloanal anastomosis.</p><p><strong>Main outcome measures: </strong>The primary outcome was stoma-free survival. Secondary analyses examined factors associated with permanent fecal diversion.</p><p><strong>Results: </strong>The medical records of 126 patients were analyzed, comprising 62.5% men, with a mean age of 54 ± 10 years and a median BMI of 27.7 (interquartile range 24.5-31.4). At a median follow-up of 53.0 months, the 5-year stoma-free survival rate was 88.9%. Univariate Cox regression analysis showed that BMI ≥35 (HR 3.80; 95% CI, 1.04-13.91, p = 0.044) and handsewn coloanal anastomosis with mucosectomy compared to stapled coloanal anastomosis without mucosectomy (HR 5.58; 95% CI, 1.71-18.14, p = 0.004), as well as local recurrence (HR 6.51; 95% CI, 1.44-29.46), were associated with worse stoma-free survival. The 30-day major morbidity rate was 7.9% after the index surgery. Sixteen patients required permanent fecal diversion due to bowel dysfunction (n = 11), disease recurrence (n = 4), or bowel obstruction (n = 1).</p><p><strong>Limitations: </strong>Retrospective, single-institution design with limited generalizability.</p><p><strong>Conclusions: </strong>Coloanal anastomosis in the era of total neoadjuvant therapy resulted in favorable 5-year stoma-free survival. BMI ≥35, handsewn coloanal anastomosis with mucosectomy, and local recurrence were associated with worse stoma-free survival. See Video Abstract .</p><p><strong>Supervivencia sin estoma tras una reseccin anterior baja con anastomosis coloanal para el cncer rectal en estadio iiiii: </strong>ANTECEDENTES:La supervivencia sin estoma representa un resultado clave para la calidad de vida tras la cirugía de cáncer rectal localmente avanzado. A pesar de los avances en el tratamiento neoadyuvante y quirúrgico, hasta un 30 % de los pacientes requieren finalmente una derivación fecal permanente.OBJETIVO:Evaluar la supervivencia sin estoma e identificar los factores asociados con la formación de un estoma permanente en pacientes con cáncer rectal localmente avanzado sometidos a anastomosis coloa","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"760-767"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124202","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":"Rupert B. Turnbull Jr, M.D., American Society of Colon and Rectal Surgeons President and Founder of The Cleveland Clinic Department of Colorectal Surgery.","authors":"Imran Khan, Mikhael Belkovsky, Jessica Stockheim, Tracy L Hull","doi":"10.1097/DCR.0000000000003954","DOIUrl":"10.1097/DCR.0000000000003954","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"741-749"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017830","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":"From Instability to Strength: The \"Laparoscopic Triple Compartment Sling\" Solution for Multiple Compartmental Prolapse.","authors":"Supakool Jearanai, Jirawat Pattana-Arun, Prapon Kanjanasilp","doi":"10.1097/DCR.0000000000004061","DOIUrl":"10.1097/DCR.0000000000004061","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"854-855"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910985","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":"Total and Tailored Mesorectal Excision for Rectal Cancer: Origins, Evolution, and Misconceptions.","authors":"Brendan J Moran, Soren Laurberg, Richard J Heald","doi":"10.1097/DCR.0000000000003965","DOIUrl":"10.1097/DCR.0000000000003965","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"750-754"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270070","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":"Complications and Readmissions in Diverting Loop Ileostomies and Loop Colostomies.","authors":"Kevin R Arndt, Spyridon Papadimatos, Benjamin G Allar, Kiryung Kim, Daniel J Wong, Kristen T Crowell, Thomas E Cataldo, Evangelos Messaris","doi":"10.1097/DCR.0000000000004156","DOIUrl":"10.1097/DCR.0000000000004156","url":null,"abstract":"<p><strong>Background: </strong>Fecal diversion is commonly performed for various indications; however, the optimal choice of diversion remains debated in many cases, and morbidity may differ significantly between diverting loop ileostomies and loop colostomies.</p><p><strong>Objective: </strong>This study aimed to compare readmissions and stoma-related complications between patients with diverting loop ileostomy and colostomy.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Single academic tertiary medical center.</p><p><strong>Patients: </strong>Adults aged 18 years or older who underwent temporary diverting loop ileostomy or colostomy between 2015 and 2025 were included.</p><p><strong>Main outcome measures: </strong>Readmissions, stoma-related complications, stoma revision rates, and patient-reported pouching issues were the main outcome measures.</p><p><strong>Results: </strong>A total of 515 patients were included (306 ileostomies, 209 colostomies). Patients with ileostomies had higher rates of readmissions due to stoma-related complications (23% vs 13%, p  = 0.013). Readmissions due to dehydration were significantly higher among patients with ileostomies (60% vs 11%, p  < 0.001). Administration of outpatient intravenous fluids did not prevent readmission, as 20% of patients (n = 19) who were readmitted had received outpatient intravenous fluids and 83% (n = 15) of readmitted patients who had received outpatient intravenous fluids were readmitted for dehydration. Patients with ileostomy had a higher rate of pouching issues (68% vs 43%; p  < 0.001). Patients with colostomy, however, had higher rates of prolapse (16% vs 4%; p  < 0.001) and stoma revision (12% vs 4%; p  < 0.001). In multivariable analysis, ileostomy was independently associated with higher odds of readmission (OR 3.15; 95% CI, 1.76-5.65).</p><p><strong>Limitations: </strong>As a retrospective, single-institution design, this study may not capture readmissions or complications that occurred outside our health system. The patient population may limit generalizability.</p><p><strong>Conclusions: </strong>Patients with a diverting ileostomy were more frequently readmitted compared to patients with a diverting colostomy. Indications for readmission also differed between the 2 groups. Patients with ileostomies reported more pouching issues and developed dehydration more often. Although patients with colostomies had higher prolapse rates, prolapse alone did not lead to higher revision rates. Surgeons should discuss these outcomes when reviewing potential diversion options with patients. See Video Abstract.</p><p><strong>Complicaciones y reingresos en ileostomas con asa de derivacin y colostomas con asa: </strong>ANTECEDENTES:La derivación fecal se realiza habitualmente por diversas indicaciones; sin embargo, la elección óptima de la derivación sigue siendo objeto de debate en muchos casos, y la morbilidad puede variar significativamente entr","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"826-835"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164715","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":"Single-Port Robotic Abdominoperineal Resection and Bulky Lateral Lymph Node Dissection Via a Trans-stoma Site Approach.","authors":"Takeharu Kato, Shunsuke Tsukamoto, Kohei Takura, Hiroshi Nagata, Yasuyuki Takamizawa, Konosuke Moritani, Yukihide Kanemitsu","doi":"10.1097/DCR.0000000000003996","DOIUrl":"10.1097/DCR.0000000000003996","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"852-853"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767582","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":"Can Large Language Models Be a Viable Tool for Consensus Working Groups? Experience of the Ventral Rectopexy Expert Consensus Group.","authors":"Frank G Lee, Ellen L Larson, Jane V Vermunt, Cornelius A Thiels, Peter Christensen, Rowan J Collinson, Julie A Cornish, Andre D'Hoore, Brooke H Gurland, Anders Mellgren, Carlo Ratto, Frederic Ris, Andrew R L Stevenson, Liliana G Bordeianou, William R G Perry","doi":"10.1097/DCR.0000000000004058","DOIUrl":"10.1097/DCR.0000000000004058","url":null,"abstract":"<p><strong>Background: </strong>The Ventral Rectopexy International Expert Panel recently published a consensus update on ventral rectopexy. The ability of large language models to synthesize the literature on ventral rectopexy without an explicit knowledge base was studied before the publication of the consensus.</p><p><strong>Objective: </strong>To compare the responses and citations of different large language models on ventral rectopexy using the expert panel consensus as the reference standard.</p><p><strong>Design: </strong>ChatGPT-4o, Gemini 1.5 Pro, and OpenEvidence were compared on content appropriateness (1 = inappropriate to 5 = appropriate), readability (Flesch reading ease), response length, citation fabrication, and citation quality per Oxford Levels of Evidence. The most content-appropriate chatbot response selected by the expert panel was de-identified and presented alongside the consensus text to 15 colorectal surgeons who attempted to identify the chatbot-generated text.</p><p><strong>Settings: </strong>Questions were submitted from September 18 to 19, 2024. Analysis was performed before the online publication of the consensus on January 30, 2025.</p><p><strong>Main outcome measures: </strong>The main outcome measures included content appropriateness, fabricated citation rate, citation quality, and the accuracy of identifying human versus chatbot text by colorectal surgeons.</p><p><strong>Results: </strong>OpenEvidence ranked highest for content appropriateness (mean 3.5/5), above Gemini (3.0/5) and ChatGPT (2.8/5; p < 0.001). ChatGPT was most verbose with the highest readability scores ( p = 0.021). ChatGPT fabricated 53% of citations; Gemini fabricated 12%; OpenEvidence fabricated 0% ( p < 0.001). All OpenEvidence citations were peer reviewed, with 40 of 117 (34%) citing level I to III studies compared with 46 of 94 (49%) of the references cited in the consensus ( p = 0.043). Chatbot-generated responses were identified with 28 of 51 (55%) accuracy.</p><p><strong>Limitations: </strong>Reproducibility may be affected due to the nature of large language models and the availability of the consensus after publication.</p><p><strong>Conclusions: </strong>OpenEvidence outperformed Gemini 1.5 Pro and ChatGPT-4o in content appropriateness and peer-reviewed citation quantity and quality. Chatbot-generated text was indistinguishable from expert-authored consensus to subject matter experts. Large language models, as an early-stage research tool, may be viable for future consensus working groups, provided transparent disclosure and rigorous oversight. See Video Abstract .</p><p><strong>Pueden los modelos lingsticos de gran tamao ser una herramienta viable para los grupos de trabajo de consenso la experiencia del grupo de consenso de expertos en rectopexia ventral: </strong>ANTECEDENTES:El Panel Internacional de Expertos en Rectopexia Ventral publicó recientemente una actualización consensuada sobre la rectopexia ventral. Antes de la public","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"836-846"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911030","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":"Utility of Transanal Total Mesorectal Excision in Patients With Obesity and Mid-to-Low Rectal Cancer: A Single-Center, Retrospective Cohort Study.","authors":"Masanori Sando, Yuichiro Tsukada, Koji Ikeda, Hiro Hasegawa, Yuji Nishizawa, Masaaki Ito","doi":"10.1097/DCR.0000000000004139","DOIUrl":"10.1097/DCR.0000000000004139","url":null,"abstract":"<p><strong>Background: </strong>Benefits of transanal total mesorectal excision in patients with obesity remain unclear.</p><p><strong>Objective: </strong>To evaluate the clinical utility of transanal total mesorectal excision in patients with obesity with mid-to-low rectal cancer.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Settings: </strong>A single-center study conducted between April 2015 and March 2025.</p><p><strong>Patients: </strong>Six hundred eighty-three patients with mid-to-low rectal cancer were included in the study.</p><p><strong>Intervention: </strong>Transanal total mesorectal excision for rectal cancer.</p><p><strong>Main outcome measures: </strong>Patients were categorized as nonobese (BMI <25.0), obese I (25.0-29.9), and obese II (≥30). Surgical and pathological outcomes-conversion to open surgery, sphincter preservation, and resection margin status-were compared. Results with a corrected p value of <0.05 were considered significant.</p><p><strong>Results: </strong>Overall, 485 patients (71%) were categorized as nonobese, 159 (23%) as obese I, and 39 (6%) as obese II. Clinicopathological characteristics were similar among the groups. Operative times were longer in the obese I and II groups compared with the nonobese group (218 and 265 vs 194 minutes, p < 0.05), with greater blood loss (44 and 90 vs 39 mL, p < 0.05). Sphincter-preserving surgery was performed as planned in all patients; in the nonobese, obese I, and obese II groups, conversion to open surgery (1.0%, 1.3%, and 0%, p = 0.783) was comparable, whereas anastomotic leakage was more frequent in the obese II group (4.5%, 6.3%, and 15.4%, p = 0.016). The overall circumferential resection margin-positivity rate was 3.4%, with no significant differences among the groups (3.3%, 3.1%, and 5.1%).</p><p><strong>Limitations: </strong>A single high-volume cancer center with surgeons experienced in transanal total mesorectal excision limits generalizability; a lack of a comparative cohort limits direct assessment of the efficacy of the approach; the obese II group had few patients; and the appropriateness of BMI as a surrogate for visceral fat is debated.</p><p><strong>Conclusions: </strong>Transanal total mesorectal excision appears to represent a promising strategy for patients with obesity with mid-to-low rectal cancer, offering low conversion and high sphincter preservation rates while maintaining oncologic safety. See Video Abstract .</p><p><strong>Utilidad de la extirpacin mesorrectal total transanal en pacientes con obesidad y cncer rectal bajo y medio estudio de cohorte retrospectivo en un solo centro: </strong>ANTECEDENTES:Los beneficios de la disección mesorrectal total transanal (taTME) en pacientes con obesidad siguen sin estar claros.Objetivo:Evaluar la utilidad clínica de la disección mesorrectal total transanal en pacientes con obesidad y cáncer de recto medio-bajo.Diseño:Estudio de cohorte retrospectivo.ENTORNO:Centro único, entre ","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"768-777"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017850","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":"Expert Commentary on Shared Decision-Making in Rectal Cancer.","authors":"Jessica N Cohan","doi":"10.1097/DCR.0000000000004201","DOIUrl":"10.1097/DCR.0000000000004201","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"759"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282782","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":"Shared Decision-Making in Locally Advanced Rectal Cancer.","authors":"Sungshin Na, Jonathan S Abelson","doi":"10.1097/DCR.0000000000004196","DOIUrl":"10.1097/DCR.0000000000004196","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"755-758"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218919","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}