Diseases of the Colon & Rectum最新文献

{"title":"Rectal Prolapse Repair Improves Bowel Symptoms in Women With Psychiatric Disorders: A Cohort Analysis of a Single-Center Registry.","authors":"Charlotte M Rajasingh, Michelle Earley, Nouf Akeel, Caitlin Bungo, Sydni Au Hoy, Dany Lamothe, Leila Neshatian, Brooke H Gurland","doi":"10.1097/DCR.0000000000003964","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003964","url":null,"abstract":"<p><strong>Background: </strong>Psychiatric disorders are prevalent in patients with rectal prolapse. While psychiatric disorders are associated with poor surgical outcomes and worse health in general, it is unknown how they impact rectal prolapse repair.</p><p><strong>Objective: </strong>To determine rectal prolapse symptom severity in patients with psychiatric disorders and how surgical repair modified these symptoms.</p><p><strong>Design: </strong>Retrospective analysis of a prospectively maintained database.</p><p><strong>Settings: </strong>Academic colorectal practice.</p><p><strong>Patients: </strong>Female patients with and without psychiatric comorbidities who underwent rectal prolapse repair with preoperative and 1-year postoperative Pelvic Floor Distress Inventory (PFDI-20) scores.</p><p><strong>Main outcome measure: </strong>One-year change in PFDI-20 score.</p><p><strong>Results: </strong>Of 365 female patients in our registry, 146 met inclusion criteria. 54 (36%) had a psychiatric disorder. Depression (66%) and anxiety (44%) were the most prevalent conditions. Patients with a psychiatric disorder were significantly younger (median [IQR] age: 61 [48, 67] vs. 70 [60,77], p<0.001) but otherwise had a similar prevalence of comorbidities such as cardiac disease. Preoperative symptom profile was similar, but patients with psychiatric disorders reported higher PFDI-20 scores reflecting greater prolapse-related distress (mean [SD]: 146 [70] vs 115 [55], p = 0.01). Postoperatively, PFDI-20 scores improved significantly in both groups (adjusted mean change from baseline for patients with rectal prolapse repair: psychiatric disorders: -88 [-130, -47] vs. no psychiatric disorders: -44 [-68, -19]). Models did not reveal statistically significant differential improvement between groups, though patients with psychiatric disorders tended to have greater improvement in their scores compared to patients without psychiatric disorders.</p><p><strong>Limitations: </strong>Single-center study with limited data on psychiatric comorbidity severity and disease control.</p><p><strong>Conclusions: </strong>Rectal prolapse patients with psychiatric disorders suffer from prolapse-related distress at baseline but experience significant improvement after surgical repair, suggesting that appropriate management of rectal prolapse can improve their quality of life. Long-term durability of symptom improvement should be the focus of further work. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085431","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":"Being a Diagnostician.","authors":"James Church","doi":"10.1097/DCR.0000000000003942","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003942","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079839","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":"Fazio's 10 Commandments of Reoperative Surgery: Part I.","authors":"Maher A Abbas, Emre Gorgun","doi":"10.1097/DCR.0000000000003962","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003962","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079793","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":"Learning Colonoscopy…Catching the Wind.","authors":"James Church","doi":"10.1097/DCR.0000000000003937","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003937","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079775","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":"The Retrograde Transanal Total Mesorectal Excision Based on a Non-gas Transanal Surgical Platform for Rectal Cancer.","authors":"Xialin Yan, Yushan Yue, Chang Xu","doi":"10.1097/DCR.0000000000003891","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003891","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069366","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":"Risk of Distant Metastasis After Total Neoadjuvant Therapy: Local Regrowth Versus Surgery After Total Neoadjuvant Therapy With Pathologic Near-Complete Response in Rectal Cancer.","authors":"Salih Karahan, Metincan Erkaya, Mustafa Oruc, Scott Steele, David Rosen, Joshua Sommavilla, David Liska, Emre Gorgun","doi":"10.1097/DCR.0000000000003941","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003941","url":null,"abstract":"<p><strong>Background: </strong>In rectal cancer patients with a clinical complete response managed nonoperatively, local regrowth occurs in up to 35%. Although prior studies suggest a higher metastatic risk after regrowth, most data are derived from conventional chemoradiotherapy cohorts. The risk in a total neoadjuvant therapy setting remains unclear.</p><p><strong>Objective: </strong>To assess whether local regrowth after clinical complete response in patients treated with total neoadjuvant therapy increases the risk of distant metastasis, and to evaluate if the risk could be reduced by upfront surgery performed after total neoadjuvant therapy.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single tertiary care center.</p><p><strong>Patients: </strong>Patients with locally advanced rectal cancer treated with total neoadjuvant therapy between 2018 and 2024 who achieved a clinical complete response, were managed nonoperatively, developed local regrowth, and subsequently underwent salvage total mesorectal excision, compared with those who underwent upfront total mesorectal excision after total neoadjuvant therapy, with final pathology demonstrating a near-complete response.</p><p><strong>Intervention: </strong>Total neoadjuvant therapy followed by either watch & wait and salvage total mesorectal excision or upfront total mesorectal excision.</p><p><strong>Main outcome measures: </strong>The primary outcome was distant metastasis. Secondary outcomes included distant metastasis-free survival and independent predictors of distant spread.</p><p><strong>Results: </strong>Seventy-four patients were included (median age: 58 years [IQR, 51-67]; 58% male): 32 with local regrowth managed by salvage total mesorectal excision and 42 with upfront total mesorectal excision. The distant metastasis-free survival was comparable between groups, and local regrowth was not independently associated with distant metastasis (OR, 0.99; 95% CI, 0.25-4.00). ypT3-4 stage was independently associated with increased risk of distant metastasis (OR, 5.8; 95% CI, 1.3-25.3), while complete mesorectal excision was protective (OR, 0.08; 95% CI, 0.01-0.59).</p><p><strong>Limitations: </strong>Retrospective design, small sample size, and limited follow-up.</p><p><strong>Conclusion: </strong>Patients treated with total neoadjuvant therapy who developed local regrowth and underwent salvage total mesorectal excision achieved distant metastasis rates comparable to those who underwent upfront surgery after total neoadjuvant therapy and demonstrated a pathologic near-complete response. High-quality salvage surgery and close surveillance are essential for optimizing oncologic outcomes. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039353","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":"Pilot Study: Identification of the T Cell Tumor Microenvironment of Premalignant and Malignant Anal Lesions.","authors":"Cynthia Araradian, Mariah Erlick, Shaun Goodyear, Adel Kardosh, Brian Mau, Nima Nabavizadeh, Rebekka Duhen, Sandy Fang","doi":"10.1097/DCR.0000000000003947","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003947","url":null,"abstract":"<p><strong>Background: </strong>Anal squamous cell cancer incidence has risen 2.2% each year over the past decade. Current screening includes anal cytology and high-resolution anoscopy but is burdened with sampling error and patient discomfort.</p><p><strong>Objective: </strong>Analyze the T cell microenvironment of normal, premalignant, including low- and high-grade squamous intraepithelial lesions, and cancer.</p><p><strong>Design: </strong>IRB-approved prospective study of patients with anal dysplasia and cancer. Normal, dysplastic and/or cancer tissue are obtained from patients. Tissue is digested to obtain a single cell suspension. Flow cytometry analysis is performed on matched patient samples to evaluate T cell biomarkers.</p><p><strong>Settings: </strong>A single tertiary-care academic center.</p><p><strong>Patients: </strong>Over the age of 18 and scheduled to undergo high resolution anoscopy, examination under anesthesia, or abdominoperineal resection.</p><p><strong>Main outcome measures: </strong>Descriptive statistics are utilized to understand differences in the tumor microenvironment of normal, premalignant, and malignant tissue.</p><p><strong>Results: </strong>Twenty patients underwent immunophenotyping. Normal tissue was characterized by the presence of few infiltrating lymphocytes. Anal cancers contained 30-50% regulatory T cells, which were infrequent in dysplasia. In anal cancer, conventional CD4+ T cells expressed high levels of ICOS and PD-1, reflective of tumor antigen recognition. In premalignant lesions, CD4+ conventional T cells also expressed ICOS and PD-1 but lacked coexpression of chronic activation and proliferation markers. CD8+ T cells with a CD103+CD39+ phenotype, indicative of chronic stimulation and tissue residency, were increased in anal cancer.</p><p><strong>Limitations: </strong>This study is limited by its small sample size. Results may not be generalizable to a larger population.</p><p><strong>Conclusions: </strong>The data demonstrates that T cell infiltrates differ between normal, premalignant, and malignant lesions - with tissue from anal squamous cell cancer containing activated, chronically stimulated T cells. Future clinical diagnostic technology would yield a T cell pathological footprint to differentiate between premalignant and malignant lesions, in addition to the creation of a less invasive serum T cell biomarker test. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023039","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":"LIGATION OF INTERSPHINCTERIC FISTULA TRACT.","authors":"Anne Mongiu, Don Colvin","doi":"10.1097/DCR.0000000000003959","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003959","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014154","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":"Understanding the Long-term Psychosocial and Healthcare Needs of Adults with Congenital Colorectal and Pelvic Malformations.","authors":"U Zeynep Bilgili, Ana Sofia Ore, Stalin Canizares, Rodrigo Arean Sanz, Daniel Wong, Kristen T Crowell, Evangelos Messaris, Thomas E Cataldo","doi":"10.1097/DCR.0000000000003951","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003951","url":null,"abstract":"<p><strong>Background: </strong>Individuals born with anorectal and pelvic malformations require lifelong management. Although initially cared for by pediatric providers, these conditions continue to impact patients' health and quality of life into adulthood.</p><p><strong>Objective: </strong>To assess the prevalence of psychiatric disorders and substance use among adults with congenital colorectal and pelvic malformations, and to explore their distribution across demographic and clinical variables.</p><p><strong>Design: </strong>Single-center retrospective cohort study.</p><p><strong>Settings: </strong>Academic tertiary-care hospital in the United States.</p><p><strong>Patients: </strong>Adults aged 18 years and older with a diagnosis of Hirschsprung disease, anorectal malformations, cloacal deformities, or VACTERL association, identified through International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) codes.</p><p><strong>Main outcome measures: </strong>Prevalence of psychiatric diagnoses (depression and/or anxiety) and substance use disorders, and their associations with demographic and clinical characteristics.</p><p><strong>Results: </strong>A total of 81 patients were included. The median age was 47.0 years (interquartile range, 38.0-64.0), and 44.4% were male. A psychiatric diagnosis was documented in 51.9% of patients, and 30.9% had a history of substance use disorder. Among those with a psychiatric diagnosis, 28.6% also had documented substance use. Substance use was significantly more prevalent among patients with psychiatric conditions compared to those without (40.5% vs. 20.5%, p = 0.002).</p><p><strong>Limitations: </strong>Retrospective design, small sample size, and reliance on provider-documented diagnoses, which may underestimate the true prevalence.</p><p><strong>Conclusions: </strong>Adults with congenital colorectal and pelvic malformations demonstrate a high burden of psychiatric disorders and substance use. These findings highlight the need for multidisciplinary care models that incorporate mental health services into the long-term management of this growing patient population, starting from pediatric care and continuing through adult transitions. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014235","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":"Further Evidence of the Increased Rate of Anastomotic Leak Following Colorectal Resection in the Unprepped Patient.","authors":"William C Cirocco","doi":"10.1097/DCR.0000000000003957","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003957","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999928","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}