Diseases of the Colon & Rectum最新文献

{"title":"Research Perspective on \" Evaluating the Impact of Induction and Consolidation Total Neoadjuvant Therapies Compared to Conventional Chemoradiotherapy for Locally Advanced Rectal Cancer\".","authors":"Thomas Peponis","doi":"10.1097/DCR.0000000000003733","DOIUrl":"10.1097/DCR.0000000000003733","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"702-703"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596568","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":"Persistent Sitting and Walking Difficulties After Abdominoperineal Excision and Anterior Resection: Results From the Quality of Life in Rectal Cancer Study.","authors":"Lina Björklund Sand, Charlotta Larsson, Rode Grönkvist, Eva Haglind, Eva Angenete","doi":"10.1097/DCR.0000000000003710","DOIUrl":"10.1097/DCR.0000000000003710","url":null,"abstract":"<p><strong>Background: </strong>The main surgical resection options in rectal cancer are anterior resection for tumors in the mid- or upper rectum and abdominoperineal excision for tumors in the lower rectum. A previous study showed long-term persistent perineal symptoms and sitting difficulties after abdominoperineal excision.</p><p><strong>Objective: </strong>To examine the prevalence and extent of sitting and walking difficulties after abdominoperineal excision compared with anterior resection.</p><p><strong>Design: </strong>An observational, prospective, longitudinal, multicenter, international study.</p><p><strong>Settings: </strong>Data were collected from participants in the quality of life in rectal cancer study. Participants answered questionnaires about bodily functions, symptoms, and quality of life at baseline and at 1 and 2 years after diagnosis.</p><p><strong>Patients: </strong>Patients with newly diagnosed rectal cancer, regardless of stage, were included. The study included 1024 patients, of whom 64% underwent anterior resection and 36% underwent abdominoperineal excision.</p><p><strong>Main outcome measures: </strong>The primary objective was to estimate the prevalence and ORs of sitting or walking difficulties between the 2 surgical procedure groups: abdominoperineal excision and anterior resection.</p><p><strong>Results: </strong>In the group of patients who underwent abdominoperineal excision, 29% had sitting difficulties after 2 years compared with 12% in the group who underwent anterior resection (OR, 2.65; 95% CI, 1.71-4.09; p < 0.0001). Walking difficulties after 2 years were reported by 35% after abdominoperineal excision compared with 24% after anterior resection (OR, 1.50; 95% CI, 1.02-2.22; p = 0.04).</p><p><strong>Limitations: </strong>The observational nature of the study could be regarded as a limitation.</p><p><strong>Conclusions: </strong>Abdominoperineal excision was associated with both sitting and walking difficulties among patients with rectal cancer at significantly higher rates compared with anterior resection. It is probable that attention from health care could improve the situation of the patients through enhanced rehabilitation. See Video Abstract .</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov (NCT01477229).</p><p><strong>Dificultades persistentes para sentarse y caminar posterior a la escisin abdominoperineal y reseccin anterior resultados del estudio qolirect: </strong>ANTECEDENTES:Las principales opciones de resección quirúrgica en el cáncer de recto son la resección anterior para los tumores en el recto medio o superior y la escisión abdominoperineal para los tumores en el recto inferior. Un estudio previo mostró síntomas perineales persistentes a largo plazo y dificultades para la sedestación posterior a la escisión abdominoperineal.OBJETIVO:Examinar la prevalencia y el grado de dificultades para sentarse y caminar después de la escisión abdominoperineal en comparación con ","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"704-712"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624048","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":"Corrigendum.","authors":"Martin M Bertrand, Luca Theuil, Christophe Demattei, Michel Prudhomme","doi":"10.1097/DCR.0000000000003712","DOIUrl":"10.1097/DCR.0000000000003712","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e1040"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515054","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 Diagnosis and Management of Common Stomal Complications.","authors":"Jennifer S Davids","doi":"10.1097/DCR.0000000000003717","DOIUrl":"10.1097/DCR.0000000000003717","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"685-686"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566430","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":"Circulating Markers of Systemic Inflammation, Measured After Completion of Neoadjuvant Therapy, Associated With Response in Locally Advanced Rectal Cancer.","authors":"Ross K McMahon, Sean M O'Cathail, Colin W Steele, Harikrishnan S Nair, Jonathan J Platt, Donald C McMillan, Paul G Horgan, Campbell S Roxburgh","doi":"10.1097/DCR.0000000000003660","DOIUrl":"10.1097/DCR.0000000000003660","url":null,"abstract":"<p><strong>Background: </strong>The extent of neoadjuvant therapy response, before surgery, is an important prognosticator in locally advanced rectal cancer. A spectrum of response exists, with a dearth of reliable measurements. The host response to treatment remains unexplored. Within operable colorectal cancer, circulating markers of elevated systemic inflammation are associated with poor survival. Studies have suggested that elevated pre-neoadjuvant inflammatory markers, including the modified Glasgow prognostic score and the neutrophil:lymphocyte ratio, are associated with a poorer response.</p><p><strong>Objective: </strong>This study aimed to comprehensively evaluate hematological markers of inflammation before and after neoadjuvant therapy.</p><p><strong>Design: </strong>Longitudinal cohort study.</p><p><strong>Settings: </strong>Single health board from a prospectively maintained regional cancer database.</p><p><strong>Patients: </strong>Consecutive patients with locally advanced rectal cancer who underwent curative-intent neoadjuvant therapy between June 2016 and July 2021.</p><p><strong>Main outcome measures: </strong>Elevated markers of the systemic inflammatory response before and after neoadjuvant therapy.</p><p><strong>Results: </strong>A total of 278 patients (67.3% men, median age 65 years) were identified. A complete response (clinical or pathological complete response) was achieved in 27.34%, and good tumor regression was achieved in 37.05% (tumor regression grading 0-1). No pre-neoadjuvant marker was found to be associated with response or regression. Multivariate analysis of post-neoadjuvant variables revealed an elevated modified Glasgow prognostic score (OR 2.8; 95% CI, 1.22-6.41; p = 0.015), and an elevated CEA (OR 4.09; 95% CI, 1.6-10.44; p = 0.003) was found to be independently associated with incomplete response. An elevated post-neoadjuvant modified Glasgow prognostic score (OR 2.14; 95% CI, 1.08-4.23; p = 0.029) was also independently associated with poor tumor regression on multivariate analysis.</p><p><strong>Limitations: </strong>Retrospective design and slight variation in the timing of post-neoadjuvant blood tests were limitations.</p><p><strong>Conclusions: </strong>We report that post-neoadjuvant modified Glasgow prognostic score is associated with poorer response and regression, potentially indicating that radiation resistance is associated with the development of a protumor inflammatory environment. Further work is required to define the local intratumoral processes associated with response and their interrelationship with systemic parameters. Ultimately, there may be a rationale for testing anti-inflammatory strategies in combination with radiotherapy as an option for optimizing treatment response. See Video Abstract .</p><p><strong>Los marcadores circulantes de inflamacin sistmica, medidos despus de completar la terapia neoadyuvante, se asocian con la respuesta en el cncer rectal localmente avanzado: </stron","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"713-725"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603525","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":"Ileus After Colectomy in the Modern Era: A Population-Based Analysis.","authors":"Grace M Crouch, Samantha Hendren, Kara K Brockhaus, Wenjing Weng, Jami Boyd, Cheryl Rocker, Robert K Cleary","doi":"10.1097/DCR.0000000000003825","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003825","url":null,"abstract":"<p><strong>Background: </strong>Postoperative ileus after colectomy is common and associated with increased healthcare costs and patient morbidity. While most Michigan hospitals have implemented enhanced recovery pathways, we hypothesized that ileus would still be clinically relevant.</p><p><strong>Objective: </strong>To understand the current burden of, and risk factors for postoperative ileus.</p><p><strong>Design: </strong>Retrospective analysis of patients undergoing elective colectomy. Patient, hospital, perioperative care, and surgical risk factors were tested for association. Multivariable logistic regression was performed to identify independent risk factors for ileus. Risk-adjusted hospital rates of ileus were compared.</p><p><strong>Setting: </strong>Seventy hospitals in Michigan Surgical Quality Collaborative.</p><p><strong>Patients: </strong>Prospective database between 2018-2023.</p><p><strong>Main outcome measure: </strong>The primary outcome was postoperative ileus defined as \"no oral intake ≥4 postoperative days or the need for nasogastric tube insertion within 30 days after surgery.\"</p><p><strong>Results: </strong>Of 9,571 patients who underwent elective colectomy, there were 9,393 partial and 178 total colectomies. Ileus was diagnosed in 6.56% of the cohort, and hospital crude rates ranged from 0.79% to 22.0%. Ileus was associated with other complications (29.62% vs 7.68%, p < 0.0001), mortality (1.75% vs 0.59%, p = 0.0006), reoperation (16.72% vs 4.92%, p < 0.0001), and readmissions (27.39% vs 6.50%, p < 0.0001). Multivariable analysis showed risk factors for ileus were total (27.5%) versus partial (6.2%) colectomy, hospital size >500 beds, male sex, immunosuppressant medications, non-white race, COPD, sleep apnea, and age >65 years. Factors associated with decreased ileus included minimally invasive (5.2%) versus open (10.1%) surgical approach, alvimopan, ambulation within 24 postoperative hours, and diverticular disease. There was significant hospital variation in risk-adjusted ileus rates.</p><p><strong>Limitations: </strong>Retrospective study design.</p><p><strong>Conclusion: </strong>The low observed rate of ileus may reflect the modern era of enhanced recovery and minimally invasive colectomy. Total colectomy is associated with high rate of ileus compared to partial colectomy. Increased implementation of minimally invasive surgery, perioperative alvimopan, and early ambulation might further reduce ileus rates. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119106","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":"Twenty Years of Disease Modifying Anti-Inflammatory Bowel Disease Drug Use Preceding Colectomy for Refractory Inflammatory Bowel Disease-Associated Colitis.","authors":"Olivia Ziegler, Caroline J Soderman, Alicia C Greene, Michael J Deutsch, Jeffrey S Scow, Matthew D Coates, Walter A Koltun, Audrey S Kulaylat","doi":"10.1097/DCR.0000000000003826","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003826","url":null,"abstract":"<p><strong>Background: </strong>Disease modifying anti-inflammatory bowel disease drugs (DMAIDs), such as infliximab, have altered treatment of inflammatory bowel disease. Despite increasing availability of disease modifying anti-inflammatory bowel disease drugs, many individuals with inflammatory bowel disease still require surgical resection and the role of disease modifying anti-inflammatory bowel disease drugs in delaying colectomy are limited.</p><p><strong>Objective: </strong>To assess use patterns of disease modifying anti-inflammatory bowel disease drugs use preceding colectomy for refractory inflammatory bowel disease.</p><p><strong>Design: </strong>Retrospective analysis of institutional data.</p><p><strong>Setting: </strong>Academic tertiary medical center from 2003-2022.</p><p><strong>Patients: </strong>Patients with Crohn's disease or ulcerative colitis who underwent total abdominal colectomy or proctocolectomy for medically refractory disease.</p><p><strong>Main outcome measures: </strong>Number and type of disease modifying anti-inflammatory bowel disease drugs used prior to colectomy and use of disease modifying anti-inflammatory bowel disease drugs over time.</p><p><strong>Results: </strong>A total of 487 patients met inclusion criteria, most of whom had ulcerative colitis (77.8%) and were male (57.1%), mean age at diagnosis of 32.1 years. 280 patients' first DMAID was an anti-TNF agent. We found no significant difference in time from diagnosis to colectomy when comparing those who initially received an anti-tumor necrosis factor versus a non-anti-tumor necrosis agent (8.29 years vs. 8.86 years, p = 0.39). Linear regression demonstrated that, with each decade, patients used about 1.5 additional disease modifying anti-inflammatory bowel disease drugs (p < 0.01) prior to surgery. Mean time between diagnosis and colectomy was 8.6 years. Accelerated failure time modeling demonstrated each additional DMAID was associated with a non-significant 5% increase in time between diagnosis and colectomy (1.05 [0.96-1.13], p = 0.25).</p><p><strong>Limitations: </strong>Single-center, retrospective.</p><p><strong>Conclusions: </strong>Over a 20-year period, patients with inflammatory bowel disease-associated colitis who ultimately required colectomy received increasing numbers of disease modifying anti-inflammatory bowel disease drugs; however, each additional disease modifying anti-inflammatory bowel disease drugs used did not significantly delay time to colectomy, nor did initial non-anti-TNF agent choice. These data suggest that a subset of patients are using increasing numbers of disease modifying anti-inflammatory bowel disease drugs that do not afford them meaningful time in delaying colectomy. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110147","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 Small Bowel Adenocarcinoma.","authors":"Floriano Marchetti","doi":"10.1097/DCR.0000000000003831","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003831","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092025","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 and Management of Small Bowel Adenocarcinoma.","authors":"Rita Pedroso de Lima, Artur C Silva","doi":"10.1097/DCR.0000000000003830","DOIUrl":"10.1097/DCR.0000000000003830","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076579","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":"Integrity: Let Us Rise to the Highest Standards.","authors":"Susan Galandiuk","doi":"10.1097/DCR.0000000000003822","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003822","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958599","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}