Diseases of the Colon & Rectum最新文献

{"title":"Lymph Node Harvest and Prognosis in Stage II and III Rectal Cancer in the Era of Total Neoadjuvant Therapy.","authors":"Janet S Lee, Julia Frebault, Sarah L Mott, Catherine G Tran, Imran Hassan, Wolfgang B Gaertner, Pridvi Kandagatla, Paolo Goffredo","doi":"10.1097/DCR.0000000000004383","DOIUrl":"10.1097/DCR.0000000000004383","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend the examination of a minimum of 12 lymph nodes after rectal cancer resection. However, neoadjuvant therapy is associated with reduced yield, thus questioning the significance of suboptimal nodal count in the era of total neoadjuvant therapy.</p><p><strong>Objective: </strong>To evaluate factors associated with inadequate lymph node count and its impact on survival.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>The National Cancer Database.</p><p><strong>Patients: </strong>Adult patients with single primary stage II to III rectal adenocarcinoma undergoing oncological resection (2006-2021).</p><p><strong>Intervention: </strong>Patients were categorized into 6 treatment groups: mesorectal excision alone, neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy with short-course radiation, neoadjuvant chemoradiotherapy with long-course radiation, total neoadjuvant therapy with short-course radiation, and total neoadjuvant therapy with long-course radiation.</p><p><strong>Main outcome measures: </strong>The primary outcome was inadequate lymph node harvest. The secondary outcome was overall survival.</p><p><strong>Results: </strong>Of the 44,847 patients, inadequate lymph node harvest occurred in 23%. On multivariable analysis, inadequate lymph node harvest was associated with treatment at community or integrated hospitals, public insurance, lower-income area, clinical stage II disease, poor treatment response, and abdominoperineal resection. Compared with mesorectal excision alone, total neoadjuvant therapy with long-course radiation demonstrated the highest odds of inadequate lymph node harvest (OR 3.94), followed by neoadjuvant chemoradiation with long-course radiation (OR 3.46). Short-course radiation regimens were associated with lower but still increased odds of inadequate lymph node harvest. In the adjusted survival model, inadequate nodal retrieval was independently associated with worse overall survival (HR 1.19).</p><p><strong>Limitations: </strong>Retrospective design and lack of granular clinical details.</p><p><strong>Conclusions: </strong>Inadequate lymph node harvest occurred in nearly one-quarter of rectal cancer resections and was associated with patients undergoing long-course radiation-based therapy. Despite treatment-related reduction in lymph node yield, an inadequate count was independently associated with worse prognosis, suggesting that nodal count continues to be a relevant metric in rectal cancer. See Video Abstract .</p><p><strong>Extraccin de ganglios linfticos y pronstico en el cncer de recto en estadio iiiii en la era de la terapia neoadyuvante total: </strong>ANTECEDENTES:Las guías actuales recomiendan el examen de un mínimo de 12 ganglios linfáticos tras la resección de cáncer de recto. Sin embargo, la terapia neoadyuvante se asocia con una menor tasa de biopsia, lo que cuestiona la importancia de un recuento gangli","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"2451-2461"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535453","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":"Outcomes and Molecular Correlates of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases.","authors":"Amanda G Liesegang, Halle Kisandra Powell, Anshini Jain, Michael P Flood, Helen M Mohan, Satish K Warrier, Nicholas J Clemons, Robert G Ramsay, Jeanne Tie, Michael Michael, Alexander G Heriot, Glen Guerra","doi":"10.1097/DCR.0000000000004379","DOIUrl":"10.1097/DCR.0000000000004379","url":null,"abstract":"<p><strong>Background: </strong>Colorectal peritoneal metastases occur in ~13% of colorectal cancer cases. The median survival with systemic chemotherapy alone is 10 to 18 months. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy can extend survival to ~41 months, but judicious patient selection is crucial.</p><p><strong>Objective: </strong>This study aimed to describe outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for patients with colorectal peritoneal metastases according to tumor mutational profile (variants BRAF V600E, KRAS G12V, and KRAS G12D).</p><p><strong>Design: </strong>This study is a retrospective cohort analysis of patients with colorectal peritoneal metastases who underwent this procedure between 2012 and 2024.</p><p><strong>Settings: </strong>The study was conducted at Peter MacCallum Cancer Centre, the statewide peritoneal malignancy center for Victoria and Tasmania, Australia.</p><p><strong>Patients: </strong>A total of 256 patients were included, and iterative procedures were excluded.</p><p><strong>Main outcome measures: </strong>Overall survival and disease-free survival according to molecular stratification were the primary outcomes. Secondary outcomes included length of stay and 90-day morbidity and mortality.</p><p><strong>Results: </strong>The median peritoneal cancer index score was 9 (range, 0-39). Median overall survival and disease-free survival for patients with complete cytoreductive clearance (204/256) were 43 and 10 months, respectively. The KRAS G12V variant was associated with inferior overall survival relative to the RAS/RAF wild-type group (median 34 months, p = 0.04). BRAF V600E was associated with inferior disease-free survival relative to the RAS/RAF wild-type group (median 9 months, p = 0.02). KRAS G12V mutation ( p = 0.008) was an independent prognostic factor for poorer overall survival, and BRAF V600E ( p = 0.01) was an independent prognostic factor for worse disease-free survival on multivariate analysis. Overall, anastomotic leak occurred in 3.9%, return to theater in 6.3%, and perioperative mortality in 1.2% of patients.</p><p><strong>Limitations: </strong>This study is limited by its retrospective design and single-center setting.</p><p><strong>Conclusions: </strong>BRAF V600E and KRAS G12V mutations confer poorer disease outcomes in these patients. KRAS G12D mutation appears prognostically neutral. Molecular features alongside clinical and pathological factors should guide patient selection to optimize outcomes. See Video Abstract .</p><p><strong>Resultados y correlatos moleculares de la ciruga citorreductora y la quimioterapia intraperitoneal hipertrmica para metstasis peritoneales de cncer colorrectal: </strong>ANTECEDENTES:Las metástasis peritoneales colorrectales se presentan en aproximadamente el 13 % de los casos de cáncer colorrectal. La mediana de supervivencia con quimioterapia sistémica sola es de 10 a 18 meses. La cirugía citorreductora","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"2462-2472"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535480","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":"Trends and Survival Outcomes of Adjuvant Chemotherapy in Low-Risk Stage II Colon Cancer: A National Cancer Database Analysis.","authors":"Noam Kahana, Michal Perets, Nir Horesh, Elad Boaz, Steven D Wexner, Sameh Hany Emile","doi":"10.1097/DCR.0000000000004486","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004486","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend adjuvant chemotherapy for Stage II colon cancer with high-risk features. However, real-world adherence to these recommendations remains inconsistent. It is unclear whether select low-risk patients still derive survival benefit from adjuvant chemotherapy.</p><p><strong>Objective: </strong>Evaluate trends, predictors of use, and survival outcomes associated with adjuvant chemotherapy in patients with low-risk Stage II colon cancer.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Commission on Cancer-accredited hospitals participating in the National Cancer Database.</p><p><strong>Patients: </strong>Pathological Stage II colon adenocarcinoma patients undergoing definitive resection (2010 to 22) without National Cancer Database-defined high-risk features.</p><p><strong>Interventions: </strong>Adjuvant chemotherapy.</p><p><strong>Main outcome measures: </strong>Overall survival.</p><p><strong>Results: </strong>There were 7,204/90,724 (7.9%) eligible patients who received adjuvant chemotherapy. Adjuvant chemotherapy use decreased by approximately 30% over the study period, mainly driven by decreased multiagent regimens; single-agent use remained stable. Younger age (< 50) was a significant independent predictor of adjuvant chemotherapy treatment (OR 2.25; p < 0.001), along with KRAS mutation (OR 1.39; p = 0.005) and treatment at nonacademic centers. Conversely, microsatellite instability-high tumors (OR 0.59; p = 0.001) and minimally invasive approaches were each associated with lower odds of receiving adjuvant chemotherapy. Although adjuvant chemotherapy was associated with higher 5-year overall survival in the unadjusted analysis, this association was not significant after adjustment for available covariates (HR 0.998; 95% CI: 0.709-1.404).</p><p><strong>Limitations: </strong>Retrospective design, lack of disease-specific survival data, limited chemotherapy-related details in the database.</p><p><strong>Conclusions: </strong>Although adjuvant chemotherapy use in low-risk Stage II colon cancer has decreased over time, it continues to be administered, especially among younger patients. In this retrospective analysis of low-risk Stage II colon cancer, we were unable to identify a survival advantage with chemotherapy. Guideline-defined high-risk criteria, rather than subjective clinical judgement, should remain the basis for treatment decisions. This conclusion is timely given that colorectal cancer has become the most common cause of cancer deaths in patients < 50 years. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080185","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":"Thank You to Our Reviewers and Volunteers.","authors":"","doi":"10.1097/DCR.0000000000004482","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004482","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073864","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":"Ruling Out Early Distant Recurrence in Stage III Colon Cancer: A Simple 4-Variable Machine Learning Model with External Validation.","authors":"Shih-Feng Huang, Chao-Wen Hsu, Yu-Hsun Chen, Chih-Chien Wu, Yi-Kai Kao","doi":"10.1097/DCR.0000000000004456","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004456","url":null,"abstract":"<p><strong>Background: </strong>Early distant recurrence within 18 months reflects aggressive tumor biology in Stage III colon cancer. Current anatomical staging often fails to capture this biological heterogeneity.</p><p><strong>Objective: </strong>To develop and externally validate a simple, pathology-based model for ruling out early distant recurrence within 18 months in Stage III colon cancer.</p><p><strong>Design: </strong>Retrospective model development with external validation, following current machine-learning prediction-model reporting guidelines.</p><p><strong>Settings: </strong>Derivation at a tertiary referral center; validation at an independent tertiary institution.</p><p><strong>Patients: </strong>Three hundred thirty-one patients in the derivation cohort (62 events) and 142 in the external cohort (19 events) who underwent curative-intent colectomy for Stage III colon adenocarcinoma.</p><p><strong>Main outcome measures: </strong>Early distant recurrence within 18 months. Secondary outcomes included disease-free survival and calibration performance.</p><p><strong>Results: </strong>A 4-variable XGBoost model (American Joint Committee on Cancer substage, lymph node ratio, perineural invasion, and differentiation) achieved a pooled out-of-fold area under the curve of 0.680 in the derivation cohort, comparable to conventional staging (0.625). Sensitivity (77.4%) and negative predictive value (89.8%) exceeded those of conventional staging. On external validation, the model yielded an area under the curve of 0.633 (vs 0.610 for conventional staging) and a negative predictive value of 90.8%, maintaining rule out performance of approximately 90% across both cohorts despite their differing recurrence rates. High-risk patients in the external cohort had worse disease-free survival (hazard ratio 1.83; 95% confidence interval 1.06-3.16). Exploratory subgroup analyses showed directionally consistent but statistically inconclusive results.</p><p><strong>Limitations: </strong>Retrospective design, limited molecular data, and small numbers of events in the external cohort.</p><p><strong>Conclusions: </strong>A simple 4-predictor model using routine pathological variables provides consistent rule out performance for early distant recurrence within 18months across 2 independent cohorts. The model offers a practical risk-assessment tool for early postoperative counseling where molecular testing is unavailable. A web-based calculator was developed to support early postoperative risk assessment. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037014","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":"Neighborhood Food Environment and Early-Onset Colorectal Cancer Survival.","authors":"Aishwarya Bhattacharya, Kurt S Schultz, Sang Won Yun, Michelle L Hughes, Ira L Leeds, Haddon J Pantel, Vikram B Reddy, Anne K Mongiu","doi":"10.1097/DCR.0000000000004473","DOIUrl":"10.1097/DCR.0000000000004473","url":null,"abstract":"<p><strong>Background: </strong>The mortality of colorectal cancer among adults < 50 years is rising, yet the role of neighborhood food environments in survival outcomes remains poorly understood.</p><p><strong>Objective: </strong>To examine whether unhealthy food environment is associated with overall survival across early-onset colorectal cancer cohorts.</p><p><strong>Design: </strong>Population-based retrospective cohort study.</p><p><strong>Settings: </strong>Connecticut, United States, 2010 to 23.</p><p><strong>Patients: </strong>A total of 2,650 adult patients diagnosed with colorectal cancer before age 50 (early onset colorectal cancer) were identified from the Connecticut Tumor Registry.</p><p><strong>Main outcome measures: </strong>Overall survival was defined as the time from diagnosis of early onset colorectal cancer to death from any cause. The primary exposure was a novel census tract-level Unhealthy Food Environment Index quantifying the percentage of unhealthy food retailers within a half-mile radius of each census tract.</p><p><strong>Results: </strong>In tertile-based comparisons, patients with early onset colorectal cancer residing in the unhealthiest food environments were younger and more likely to be female, uninsured, and from racial minority groups than those in healthier tertiles. In an unadjusted Kaplan-Meier analysis, overall survival differed across unhealthy food environment index tertiles, with the unhealthiest tertile showing the poorest survival (log-rank p = 0.03). When the unhealthy food environment index was modeled as a continuous exposure across the full cohort, residing in unhealthier census tracts was independently associated with worse overall survival (hazard ratio = 1.29, 95% CI: 1.01-1.65, p = 0.04) after adjusting for age, sex, social vulnerability, urbanicity, tumor behavior, treatment status, insurance, and number of additional primary tumors.</p><p><strong>Limitations: </strong>Cross-sectional food environment data may not reflect patient-level exposures leading up to or throughout the study period. Individual dietary intake was not measured.</p><p><strong>Conclusions: </strong>Unhealthy food environments were independently associated with worse survival among patients with early-onset colorectal cancer, suggesting that the neighborhood food environment may be a modifiable structural determinant of early-onset colorectal cancer outcomes. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037042","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 Early-Onset Colorectal Cancer: Contemporary Management, Immunotherapy, and Organ Preservation.","authors":"Beatric Dionigi","doi":"10.1097/DCR.0000000000004478","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004478","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024202","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 \"Measuring symptom severity and health-related quality-of-life with hemorrhoid treatments: Systematic Review\".","authors":"Calista Harbaugh","doi":"10.1097/DCR.0000000000004480","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004480","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024209","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 Delays in Diagnosis of Early-Onset Colorectal Cancer Across the United States: A Systematic Review.","authors":"Thomas Curran","doi":"10.1097/DCR.0000000000004477","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004477","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024225","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":"What Every Colorectal Surgeon Should Know About the American Society of Colon and Rectal Surgeons' Physician Compensation Survey: 2025 Compensation Data.","authors":"Kelly M Tyler, Donald B Colvin","doi":"10.1097/DCR.0000000000004475","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004475","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024230","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}