Diseases of the Colon & Rectum最新文献

{"title":"Incidence and Risk Factors for Venous Thromboembolism Events After Rectal Prolapse Surgery.","authors":"Sarah B Jochum, Mikhael Belkovsky, Sarah Kirschling, Stefan D Holubar, Tracy L Hull, David R Rosen, Anna R Spivak, Scott R Steele, Kristen A Ban","doi":"10.1097/DCR.0000000000003838","DOIUrl":"10.1097/DCR.0000000000003838","url":null,"abstract":"<p><strong>Background: </strong>The most common cause of preventable death in hospitalized patients in the United States is venous thromboembolism. Although pelvic organ prolapse surgery in urogynecology literature reports rates less than 1%, the rate of venous thromboembolism for rectal prolapse surgery remains undescribed. We hypothesized that the rate of venous thromboembolism with rectal prolapse surgery would be low and that risk factors would include surgical approach, BMI, longer operative time, older age, renal failure, and functional status.</p><p><strong>Objective: </strong>Define the incidence and identify risk factors associated with venous thromboembolism events in the 30-day postoperative period after rectal prolapse surgery.</p><p><strong>Data sources: </strong>A retrospective analysis of the American College of Surgeons-National Surgical Quality Improvement Program between 2005 and 2021.</p><p><strong>Study selection: </strong>Patients with Current Procedural Terminology codes to identify rectal prolapse procedures.</p><p><strong>Main outcome measures: </strong>Incidence of venous thromboembolism and risk factors.</p><p><strong>Results: </strong>A total of 19,197 rectal prolapse procedures were analyzed. Overall, 61 patients (0.32%) developed venous thromboembolism within 30 days of surgery. More than 60% (37) of the venous thromboemboli developed within 2 weeks of the operation. On multivariable analysis, dependent functional status was an independent risk factor for venous thromboembolism after surgery for rectal prolapse (OR 2.62 [1.31-4.87]), and longer length of stay (OR 1.048 [1.028-1.65]), postoperative surgical site infections (OR 3.59 [1.61-7.17]), and bleeding (OR 4.35 [1.864-8.92]) were associated with venous thromboembolism.</p><p><strong>Limitations: </strong>Unable to assess perioperative chemoprophylaxis use.</p><p><strong>Conclusions: </strong>The overall incidence of venous thromboembolism after rectal prolapse repair is very low, similar to that reported in the literature examining venous thromboembolism after pelvic organ prolapse repair. Most venous thromboembolic events occurred within the first 2 weeks of surgery. Preoperative dependent functional status, postoperative bleeding, and surgical site infection were identified as independent risk factors for venous thromboembolism. See Video Abstract.</p><p><strong>Incidencia y factores de riesgo de eventos tromboemblicos venosos tras ciruga de prolapso rectal: </strong>ANTECEDENTES:La causa más común de muerte evitable en pacientes hospitalizados en los Estados Unidos es la tromboembolia venosa. Si bien la literatura sobre uroginecología indica que la tasa de prolapso de órganos pélvicos es <1 %, la tasa de tromboembolia venosa en la cirugía de prolapso rectal sigue sin describirse. Nuestra hipótesis era que la tasa de tromboembolia venosa en la cirugía de prolapso rectal sería baja y que los factores de riesgo incluirían el abordaje quirúrgico, el índice de masa","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1215-1223"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224725","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":"Partial Responders to Neoadjuvant Therapy and the Risk of Distant Metastases: Longer Intervals to Definitive Resection Is Not a Risk Factor.","authors":"Laura M Fernandez, Bruna Borba Vailati, Guilherme Pagin São Julião, Leonardo Ervolino Corbi, Fernanda Elias, Angelita Habr-Gama, José Moreira Azevedo, Inês A Santiago, Oriol Parés, Amjad Parvaiz, Véronique Vendrely, Anne Rullier, Eric Rullier, Quentin Denost, Rodrigo O Perez","doi":"10.1097/DCR.0000000000003834","DOIUrl":"10.1097/DCR.0000000000003834","url":null,"abstract":"<p><strong>Background: </strong>The timing of resection after neoadjuvant therapy for rectal cancer remains a debated topic. Longer intervals from radiation completion have been associated with increased rates of clinical and pathological complete response, but concerns remain regarding partial responders and the risk of distant metastasis.</p><p><strong>Objective: </strong>To evaluate whether the interval between the end of neoadjuvant chemoradiation therapy and surgical resection affects the development of distant metastases in patients with an excellent partial response.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Multicenter analysis from 3 institutions: Angelita and Joaquim Gama Institute, Champalimaud Foundation, and University Hospital Bordeaux.</p><p><strong>Patients: </strong>A total of 165 patients with rectal cancer who achieved either a near-complete pathological response or a clinical complete response followed by local regrowth.</p><p><strong>Interventions: </strong>Patients underwent total mesorectal excision or were managed by watch and wait with salvage surgery for local regrowth. The timing of surgery after neoadjuvant chemoradiation therapy was analyzed.</p><p><strong>Main outcome measures: </strong>The primary outcome was the development of distant metastases.</p><p><strong>Results: </strong>Thirty-four patients developed distant metastases. There was no significant difference in the time to resection between those who developed metastases and those who did not (9.2 vs 10.6 months, p = 0.55). A secondary analysis of patients with local regrowth also showed no significant difference in metastasis development based on resection timing (14.4 vs 17.9 months, p = 0.26).</p><p><strong>Limitations: </strong>The study is limited by its retrospective nature and the subjective definition of excellent response in clinical settings.</p><p><strong>Conclusions: </strong>In patients with an excellent partial response to neoadjuvant chemoradiation therapy, the interval between radiation completion and surgical resection does not appear to influence the risk of distant metastases. This finding suggests that factors other than time may play a role in the development of distant metastases in this population. See Video Abstract .</p><p><strong>Respuesta parcial al tratamiento neoadyuvante y riesgo de metstasis a distancialos intervalos ms largos hasta la reseccin definitiva no son un factor de riesgo: </strong>ANTECEDENTES:El momento de la resección tras la terapia neoadyuvante para el cáncer rectal sigue siendo un tema controvertido. Los intervalos más largos tras la finalización de la radioterapia se han asociado con mayores tasas de respuesta clínica y patológica completa, pero siguen existiendo preocupaciones con respecto a los pacientes con respuesta parcial y el riesgo de metástasis a distancia.OBJETIVO:Evaluar si el intervalo entre el final de la quimiorradioterapia neoadyuvante y la resecció","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1154-1161"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316171","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 Left Lateral Pelvic Lymph Node Dissection in Woman.","authors":"Subhathira Manohkaran, Akash Mor, Avanish Saklani","doi":"10.1097/DCR.0000000000003745","DOIUrl":"10.1097/DCR.0000000000003745","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e1832"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332637","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":"Watch and Wait for Rectal Cancer: Insights From American Society of Colon and Rectal Surgeons Members.","authors":"Racquel S Gaetani, Tara A Russell, Kera L Kwan, Keren Ladin, Jonathan S Abelson","doi":"10.1097/DCR.0000000000003862","DOIUrl":"10.1097/DCR.0000000000003862","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1135-1138"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607824","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":"Nodal Downstaging in Patients With Rectal Cancer: Survival Is Promising if YpN0 Is Achieved.","authors":"Haigui Wan, Jingrong Weng, Jinlin Cai, Zhenghua Chen, Peisi Li, Junyi Han, Ziming Li, Zixiao Wan, Ze Yuan, Yingguo Gan, Mingzhe Huang, Xuan Li, Tuoyang Li, Xiaoxia Liu, Xiaolin Wang, Huichuan Yu, Binbin Liu, Jinxin Lin, Yanxin Luo","doi":"10.1097/DCR.0000000000003846","DOIUrl":"10.1097/DCR.0000000000003846","url":null,"abstract":"<p><strong>Background: </strong>Locally advanced rectal cancer is a critical health concern, with neoadjuvant therapy emerging as a pivotal strategy to enhance survival rates.</p><p><strong>Objective: </strong>This study aims to evaluate the prognostic value of achieving ypN0 status after neoadjuvant therapy in patients with locally advanced rectal cancer, comparing survival outcomes among natural N0, downstaged N0, and ypN + groups.</p><p><strong>Design: </strong>We conducted a post hoc analysis of the FOWARC trial (neoadjuvant FOLFOX6 chemotherapy with or without radiation) using Kaplan-Meier survival analysis and Cox regression models to assess overall survival, disease-free survival, and locoregional recurrence-free survival.</p><p><strong>Settings: </strong>The multicenter, randomized phase III FOWARC trial was conducted across 15 hospitals in China, adhering to the highest ethical standards.</p><p><strong>Patients: </strong>Our cohort included 449 patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy followed by total mesorectal excision.</p><p><strong>Interventions: </strong>Neoadjuvant chemoradiotherapy followed by total mesorectal excision.</p><p><strong>Main outcome measures: </strong>The primary end point was 5-year overall survival, with secondary end points being 3-year disease-free survival and 3-year locoregional recurrence-free survival.</p><p><strong>Results: </strong>The 5-year overall survival rates for natural N0 and downstaged N0 groups were 88% and 89%, respectively, significantly higher than the 73% observed in the ypN + group ( p = 0.0034). The complete pathological response rate was markedly lower in the ypN + group. Multivariable analysis revealed that the ypN stage is an independent prognostic factor for overall survival.</p><p><strong>Limitations: </strong>The study's retrospective design may introduce potential biases in patient selection and preoperative staging.</p><p><strong>Conclusions: </strong>Achieving ypN0 status via neoadjuvant chemoradiotherapy significantly improves survival in patients with locally advanced rectal cancer, regardless of ypT or cN status. This status not only serves as an independent prognostic factor but may also help guide hypothesis-driven, individualized postoperative treatment strategies. See Video Abstract .</p><p><strong>Clinical trial registration: </strong>NCT01211210.</p><p><strong>Reduccin del estadio nodal en pacientes con cncer rectal la supervivencia es prometedora si se alcanza ypn: </strong>ANTECEDENTES:El cáncer rectal localmente avanzado es un problema de salud crítico, y la terapia neoadyuvante se está imponiendo como una estrategia fundamental para mejorar las tasas de supervivencia.OBJETIVO:El objetivo de este estudio es evaluar el valor pronóstico de alcanzar el estado ypN0 tras la terapia neoadyuvante en pacientes con cáncer rectal localmente avanzado, comparando los resultados de supervivencia entre los grupos N0 natural, N0 en estad","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1162-1171"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583390","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":"Is Low Compliance a Red Flag or a Rational Rejection of Extended Venous Thromboembolism Prophylaxis?","authors":"Lauren Weaver, Alexander Troester, Imran Hassan, Nicholas D Klemen, Paolo Goffredo","doi":"10.1097/DCR.0000000000003902","DOIUrl":"10.1097/DCR.0000000000003902","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e1838"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689534","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":"Transanal Endoscopic Submucosal Dissection for Large Rectal Lesions.","authors":"Matheus M M M D E Meyer, Peterson M Neves, Henrique A Lima","doi":"10.1097/DCR.0000000000003682","DOIUrl":"10.1097/DCR.0000000000003682","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e1831"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332640","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 Office-Based Hemorrhoid Treatment and Complications.","authors":"Marianne V Cusick","doi":"10.1097/DCR.0000000000003901","DOIUrl":"10.1097/DCR.0000000000003901","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1152-1153"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674138","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":"Expanding Organ Preservation in Locally Advanced Rectal Cancer After Total Neoadjuvant Therapy With Endoscopic Submucosal Dissection.","authors":"Emre Gorgun, Kamil Erozkan, Salih N Karahan, Metincan Erkaya, Ali Alipouriani, Lukas Schabl, Tracy L Hull, Hermann Kessler, David Liska, Scott R Steele, Joshua Sommovilla","doi":"10.1097/DCR.0000000000003839","DOIUrl":"10.1097/DCR.0000000000003839","url":null,"abstract":"<p><strong>Background: </strong>In the management of locally advanced rectal cancer, organ preservation after total neoadjuvant therapy requires complete clinical response and close surveillance. Patients with near-complete response or tumor regrowth during watch and wait are recommended to undergo total mesorectal excision. Selective use of local resection procedures, such as endoscopic submucosal dissection, may expand organ preservation in these patients.</p><p><strong>Objective: </strong>To assess the feasibility, safety, and outcomes of endoscopic submucosal dissection for patients with near-complete response or tumor regrowth after total neoadjuvant therapy.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Single tertiary care center.</p><p><strong>Patients: </strong>Patients with locally advanced rectal cancer treated with total neoadjuvant therapy between 2015 and 2024 and who underwent endoscopic submucosal dissection for near-complete response or tumor regrowth during active surveillance.</p><p><strong>Interventions: </strong>Endoscopic submucosal dissection for near-complete response and tumor regrowth during watch and wait.</p><p><strong>Main outcome measures: </strong>Organ preservation and regrowth rates after endoscopic submucosal dissection.</p><p><strong>Results: </strong>Twenty patients were included (40% women, mean age 59.1 ± 13.1 years). Although 10 patients underwent endoscopic submucosal dissection for near-complete response with endoluminal lesions after total neoadjuvant therapy completion, 10 underwent endoscopic submucosal dissection due to tumor regrowth during watch and wait. The median time for tumor regrowth was 12.5 months. Pathologic examination of specimens showed no invasive cancer in 14 patients (70%). Total mesorectal excision was performed in 5 patients in whom invasive adenocarcinoma was found on endoscopic submucosal dissection. The 1 remaining patient refused proctectomy. One patient with dysplasia, after an additional watch-and-wait period after endoscopic submucosal dissection, underwent total mesorectal excision to address a second regrowth. Fourteen patients, including the one who refused surgery, have been closely monitored to date, with no evidence of disease for a mean of 27.7 months.</p><p><strong>Limitations: </strong>Retrospective design and small sample size.</p><p><strong>Conclusions: </strong>Selective use of endoscopic submucosal dissection can be feasible and safe for organ preservation in highly selected patients with locally advanced rectal cancer after total neoadjuvant therapy. Larger prospective trials with longer follow-up are needed to validate its value. See Video Abstract.</p><p><strong>Ampliacin de la preservacin de rganos en el cncer rectal localmente avanzado tras terapia neoadyuvante total con diseccin endoscpica submucosa: </strong>ANTECEDENTES:En el tratamiento del cáncer rectal localmente avanzado, la preservación del órgano tras una","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 10","pages":"1172-1182"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069342","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":"Integrating ctDNA and iRECIST to Guide Surgery After Immunotherapy in MSI-H Colorectal Cancer.","authors":"Alpaslan Sahin","doi":"10.1097/DCR.0000000000003981","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003981","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191405","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}