Diseases of the Colon & Rectum最新文献

{"title":"Management of Colorectal Anastomotic Leaks with Endoluminal Vacuum Therapy: A Pragmatic Summary of the Evidence and Definition of Clinical Practices for Patient Selection, Technique, and Follow-up.","authors":"Antonio Caycedo-Marulanda, Nimalan A Jeganathan, Luca Morelli, Simone Guadagni, Nawar Alkhamesi, Raul Eduardo Pinilla-Morales, Anne Fabrizio, Luca C Milone, David R Baquero, Sam B Atallah, Patricia Sylla","doi":"10.1097/DCR.0000000000003935","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003935","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854843","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":"A Predictive Model for Anastomotic Complications After Sphincter-Preserving Surgery for Rectal Cancer: Integrating Clinical and Anatomical Risk Factors.","authors":"Chih-Yu Kuo, Chen-Yin Lee, Ching-Huei Kung, James Chi-Yong Ngu, Li-Jen Kuo","doi":"10.1097/DCR.0000000000003938","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003938","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer surgery presents a technical challenge due to the intricate anatomy of the pelvis, contributing to an increased risk of postoperative complications.</p><p><strong>Objective: </strong>The aim of this study was to assess the prognostic value of clinical and anatomical factors in predicting anastomotic complications after sphincter-preserving surgery for rectal cancer.</p><p><strong>Design: </strong>Retrospective analysis.</p><p><strong>Settings: </strong>Taipei Medical University Hospital.</p><p><strong>Patients: </strong>A total of 527 patients with rectal cancer.</p><p><strong>Interventions: </strong>Robotic or laparoscopic total mesorectal excision between 2012 and 2023.</p><p><strong>Main outcome measures: </strong>Preoperative clinical parameters and magnetic resonance imaging-derived anatomical measurements were subjected to multivariate analysis to develop a predictive model for postoperative anastomotic complications.</p><p><strong>Results: </strong>Over a mean period of 66.2 (6-149) months, the incidence of anastomotic complications following sphincter-preserving surgery was 15.8%. Multivariate logistic regression identified six predictors of anastomotic complications: tumor-to-anal verge distance (p = 0.003), interspinous diameter (p = 0.030), clinical N stage (p = 0.047), angle α (p = 0.015), carcinoembryonic antigen level (p = 0.046), and American Society of Anesthesiologists classification (p = 0.015). These variables were incorporated into the final model, with an area under the receiver operating characteristic curve of 0.70 (95% confidence interval: 0.60-0.78). The top three predictors of anastomotic complications were tumor-to-anal verge distance, interspinous diameter, and clinical N stage.</p><p><strong>Limitations: </strong>All data were obtained from a single institution, the study was retrospective, all pelvimetric measurements were obtained manually (introducing the possibility of interobserver variability and measurement error), and the parameters analyzed were limited to two-dimensional measurements.</p><p><strong>Conclusions: </strong>These findings highlight the role of clinical variables and pelvimetry in predicting anastomotic complications after minimally invasive rectal surgery. The developed regression model is a practical tool for refining preoperative planning and informed decision-making. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854908","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":"Research Perspective on \"Role of Neoadjuvant Immune Checkpoint Inhibitors in Locally Advanced Rectal Cancer: A Systematic Review of Currently Available Studies\".","authors":"William C Chapman","doi":"10.1097/DCR.0000000000003936","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003936","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816016","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":"How Frequently Is Colorectal Cancer Recurrence Detected in Clinic?","authors":"Gajan Srikumar, Scott J P McLaughlin, Jaxon Jebbink, Naeun Hwang, Jackson Teh, Matthew J McGuinness, Ian P Bissett, Christopher Harmston","doi":"10.1097/DCR.0000000000003934","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003934","url":null,"abstract":"<p><strong>Background: </strong>Outpatient clinic follow-up has been standard practice for decades following resection of colorectal cancer, however recent evidence regarding its efficacy in oncological detection is limited. With increasing health limitations and rising numbers of colorectal cancer patients, the role of clinic follow-up may need re-evaluation.</p><p><strong>Objective: </strong>The aim of this study is to determine the frequency of clinical examination compared to other modalities in identification of colorectal cancer recurrence in Northland.</p><p><strong>Design: </strong>Retrospective review of detection modalities for recurrence in colorectal cancer.</p><p><strong>Setting: </strong>Northland region of New Zealand between January 2013 and December 2022.</p><p><strong>Patients: </strong>Stage I - IV who underwent curative-intent surgery for colorectal adenocarcinoma.</p><p><strong>Main outcome measures: </strong>The primary outcome was frequency of the initial mode of recurrence detection (computed tomography, carcinoembryonic antigen, colonoscopy, clinical examination and other modalities). Secondary outcomes were frequency of symptomatic presentation, detecting clinician, site, timing, and survival compared by mode of detection.</p><p><strong>Results: </strong>From 747 patients with a median follow-up of 4.3 years, 157 (21.0%) had recurrence. The most frequent mode of detection was computed tomography (n = 85, 54%), followed by carcinoembryonic antigen (n = 43, 27%), colonoscopy (n = 9, 6%), other modalities (n = 16, 10%) and clinical examination (n = 4, 3%). There were 45 (29%) symptomatic presentations. Two examination recurrences were detected by the general practitioner and two at outpatient clinic, with three out of four being symptomatic. Recurrence detected by colonoscopy had significantly better 5-year overall survival (77.8%, p = 0.022) than computed tomography (30.9%) or carcinoembryonic antigen (38.3%), but most colonoscopy-detected recurrences were locoregional.</p><p><strong>Conclusions: </strong>Outpatient clinic examination in identifying recurrence, particularly asymptomatic, made up only a very small proportion of recurrence detection methods. Given the minimal oncological benefit, alternative resource-saving strategies for clinic follow-up need consideration. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816015","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":"Role of Neoadjuvant Immune Checkpoint Inhibitors in Locally Advanced Rectal Cancer: A Systematic Review of Currently Available Studies.","authors":"Milton Mui, Joseph Ch Kong, Michael Michael, Robert Ramsay, Nicholas Clemons, Alexander G Heriot","doi":"10.1097/DCR.0000000000003927","DOIUrl":"10.1097/DCR.0000000000003927","url":null,"abstract":"<p><strong>Background: </strong>Over the last few decades, the standard of care for locally advanced rectal cancer, involving neoadjuvant chemoradiation followed by surgery, is associated with a pathological complete response rate of only 10-20%. Combination therapy with immune checkpoint inhibitors may improve treatment response.</p><p><strong>Objective: </strong>This systematic review examines the current evidence regarding neoadjuvant immune checkpoint inhibitors in locally advanced rectal cancer in terms of treatment efficacy, impact on surgical outcomes, and potential adverse events.</p><p><strong>Data sources: </strong>A literature search was conducted using the Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Library databases from start of database records to October 31, 2024.</p><p><strong>Study selection: </strong>All studies that reported outcomes in patients with locally advanced rectal cancer who received immune checkpoint inhibitors as part of their neoadjuvant treatment were included for examination.</p><p><strong>Main outcome measures: </strong>Primary outcome was pathological complete response rate. Secondary outcomes were major pathological response rate, clinical complete response rate, complete response rate, R0 resection rate, and sphincter preservation rate. Safety data were included where available. Potential biomarkers of treatment response were identified.</p><p><strong>Results: </strong>Twelve studies were reviewed. All were prospective phase I/II clinical trials. The overall pathological complete response rate ranged from 25-62.5% (50% for dMMR/MSI-H; 25-62.5% for pMMR/MSS). The clinical complete response rate ranged from 10.9-100% (56-100% for dMMR/MSI-H; 16.4-48% for pMMR/MSS). The complete response rate ranged from 44-75% (75% for dMMR/MSI-H; 44-56.5% for pMMR/MSS). The R0 resection rate ranged from 94-100% and sphincter preservation rate from 59.4-100%. Majority of adverse events were Grades 1 & 2.</p><p><strong>Limitations: </strong>Our review was limited by a small number of mostly single-arm studies with lack of long-term survival outcomes, as well as marked clinical and methodological heterogeneity among included studies.</p><p><strong>Conclusion: </strong>Combination therapy with immune checkpoint inhibitors in locally advanced rectal cancer appears to improve treatment response but high-level evidence and long-term data are still lacking.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815983","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":"Time to Reconsider the Mechanism of Hemorrhoidectomy Pain.","authors":"Mina Sarofim","doi":"10.1097/DCR.0000000000003931","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003931","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793714","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":"Anterior Quadrant Extended Total Mesorectal Excision: Indications and Technique for Seminal Vesicle Excision.","authors":"Akash Mor, Avanish Saklani","doi":"10.1097/DCR.0000000000003761","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003761","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793713","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 of Anal Cancer Screening Practices Among a National Cohort of Veterans with HIV.","authors":"Austin J Hewitt, Matthew J Freeman, Dana M Hayden, Evie H Carchman, Marin L Schweizer, Cristina B Sanger","doi":"10.1097/DCR.0000000000003928","DOIUrl":"10.1097/DCR.0000000000003928","url":null,"abstract":"<p><strong>Background: </strong>When available, anal cytology is used for initial anal cancer screening, whereas diagnostic histology is typically performed after abnormal cytology or in symptomatic individuals.</p><p><strong>Objective: </strong>Analyze index anal evaluations (cytology vs. histology) in veterans with HIV.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>One hundred thirty Department of Veterans Affairs medical centers.</p><p><strong>Patients: </strong>Veterans with HIV who received care from 1999-2023.</p><p><strong>Main outcomes and measures: </strong>Distribution of index anal evaluations as cytology or histology, annual incidence rates of index evaluations, and regional anal cancer prevalence and screening rates.</p><p><strong>Results: </strong>Among 48,368 veterans with HIV, 7,127 (15%) had at least one anal evaluation. Index evaluations were cytology in 4,477 (63%) and histology in 2,650 (37%). The mean annual rate of index anal evaluations was 1.04%, with a relative decrease in 2020 and beyond. Among patients with anal evaluations, the Pacific region had the highest proportion of index cytology (77%), comprising 77% of evaluations, and the Continental region had the lowest (37%,p<0.001). Conversely, the lowest and highest rates of anal cancer were observed in the Pacific and Continental regions, respectively (4.7% vs. 9.4%, p < 0.001). However, this trend did not translate into differences in anal cancer rates between the two regions when comparing all veterans with HIV (1.01% vs. 0.90%, p = 0.52).</p><p><strong>Limitations: </strong>Retrospective data.</p><p><strong>Conclusions: </strong>In this national analysis of veterans with HIV, 15% had an anal evaluation, despite recommendations for annual screening. The majority of index evaluations were screening assessments with cytology (63%). There was a relative decrease in index evaluations after 2020. Regional screening differences were observed among patients with anal evaluations. Higher anal cancer detection was seen in the region with the lowest screening and lower detection in the region with the highest screening. Interestingly, this correlation did not persist when examining the overall regional populations of veterans with HIV, including those never evaluated. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788482","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":"Geographic Disparities by Income in Pelvic Floor Physical Therapy Locations in Philadelphia, Pennsylvania.","authors":"Stephanie Regis, Takshaka Patel, Emily Rockenbach, Edward Brown, Matthew Philp, Juan L Poggio, Joceline Vu","doi":"10.1097/DCR.0000000000003929","DOIUrl":"10.1097/DCR.0000000000003929","url":null,"abstract":"<p><strong>Background: </strong>Pelvic floor dysfunction impacts 1 in 4 women and can be disabling. Colorectal surgeons treat many of these conditions, including fecal incontinence, pelvic constipation, and rectal prolapse. Pelvic floor physical therapy can be an effective nonsurgical treatment for pelvic floor dysfunction. However, utilization remains limited, with insurance noncoverage, geographic constraints, and lack of availability cited as barriers to care.</p><p><strong>Objective: </strong>Evaluate the relationship between income and geographic distance to pelvic floor physical therapy locations in Philadelphia, Pennsylvania, a socioeconomically diverse city.</p><p><strong>Design: </strong>Pelvic floor physical therapy locations within Philadelphia were identified and contacted by telephone. A semi-structured script was used to interview staff and obtain characteristics of each site and its treated patients. We used census tracts as a geographic unit and calculated the distance of each tract to the nearest pelvic floor physical therapy location. We used linear regression to identify the association of median income with distance to the nearest physical therapy location, adjusting for population size of each tract.</p><p><strong>Settings: </strong>Philadelphia, Pennsylvania.</p><p><strong>Main outcome measures: </strong>Distance of each census tract to the nearest pelvic floor physical therapy location.</p><p><strong>Results: </strong>Nineteen sites offered pelvic floor physical therapy, primarily located in areas of high median income. Distance to a pelvic floor physical therapist decreased as median income increased. People from the lowest quartile of income lived farthest from a physical therapy location (2.1 miles), compared to people from the highest quartile (1.0 miles, p<0.001). Urogynecologic or postpartum conditions were treated most often, with only 3 sites reporting expertise in anorectal disease.</p><p><strong>Limitations: </strong>Generalizability given focus on one city.</p><p><strong>Conclusions: </strong>Pelvic floor physical therapy remains underutilized and primarily focused on urogynecologic and postpartum conditions. In Philadelphia, we found that pelvic floor physical therapy was primarily located in areas of high median income, suggesting geographic access barriers for poorer patients. See Abstract Video .</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788483","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":"Reply.","authors":"Eyal Aviran","doi":"10.1097/DCR.0000000000003786","DOIUrl":"10.1097/DCR.0000000000003786","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e1165"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991678","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}