Diseases of the Colon & Rectum最新文献

{"title":"Area Deprivation, Fragmented Care, and Colectomy Case Acuity in the Veterans Health Administration.","authors":"Robert A Tessler, Mary S Vaughan Sarrazin, Yubo Gao, Michael A Jacobs, Carly A Jacobs, Leslie R M Hausmann, Daniel E Hall","doi":"10.1097/DCR.0000000000003659","DOIUrl":"10.1097/DCR.0000000000003659","url":null,"abstract":"<p><strong>Background: </strong>Colectomy for benign or malignant disease may be elective, urgent, or emergent. Data suggest successively worse outcomes for nonelective colectomy. Limited data exist regarding the contribution of high area deprivation index and care fragmentation to nonelective colectomy.</p><p><strong>Objective: </strong>Determine the association between area deprivation and nonelective colectomy in the Veterans Health Administration and assess whether accounting for differences in care fragmentation alters the association across indications and for benign and malignant conditions separately.</p><p><strong>Design: </strong>Retrospective cohort with multivariable multinomial logit models to evaluate associations between high-deprivation care fragmentation and the adjusted odds of nonelective colectomy. We calculated total, direct, and indirect effects to assess whether the association varied by levels of care fragmentation.</p><p><strong>Setting: </strong>Veterans receiving care in the private sector and Veterans Health Administration.</p><p><strong>Patients: </strong>Veterans aged 65 years or older undergoing colectomy between 2013 and 2019 were included.</p><p><strong>Main outcome measures: </strong>Colectomy case acuity.</p><p><strong>Results: </strong>We identified 6538 colectomy patients, of whom 3006 (46.0%) were identified for malignancy. The odds of emergent colectomy were higher for patients in high-deprivation areas when the indication was for benign pathology (adjusted OR 1.51; 95% CI, 1.15-2.00). For malignant indications, there was no association between high deprivation and nonelective colectomy. More fragmented care was associated with higher odds of urgent and emergent colectomy for both benign and malignant indications, but the association between deprivation and nonelective colectomy did not vary by care fragmentation.</p><p><strong>Limitations: </strong>Inherent to large administrative retrospective databases.</p><p><strong>Conclusions: </strong>Veterans living in high-deprivation areas are at higher risk for emergent colectomy for benign conditions. Care fragmentation is also associated with a higher risk of emergent colectomy across indications. Efforts to reduce care fragmentation and promote early detection of IBD and diverticular disease in high-deprivation neighborhoods may lower the risk for nonelective colectomy in veterans. See Video Abstract .</p><p><strong>Privacin de rea, atencin fragmentada y agudeza de los casos de colectoma en la administracin de salud para veteranos: </strong>ANTECEDENTES:La colectomía por enfermedad benigna o maligna puede ser electiva, urgente o de emergencia. Los datos sugieren resultados cada vez peores para la colectomía no electiva. Existen pocos datos sobre la contribución del alto índice de privación de área y la fragmentación de la atención a la colectomía no electiva.OBJETIVO:Determinar la asociación entre la privación de área y la colectomía no electiva en la Administr","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"627-636"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390430","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":"In Response to \"Enhancing LARS Management: Learnings and Challenges From the SANLARS Study\".","authors":"Franco Marinello, Gianluca Pellino, Eloy Espin-Basany","doi":"10.1097/DCR.0000000000003693","DOIUrl":"10.1097/DCR.0000000000003693","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e212"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363861","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":"Impact of Low Ligation on Bowel Perfusion and Anastomotic Leakage in Minimally Invasive Rectal Cancer Surgery: A Post Hoc Analysis of a Randomized Controlled Trial.","authors":"Kei Kimura, Jun Watanabe, Yusuke Suwa, Masanori Kotake, Shingo Noura, Hirokazu Suwa, Mitsuyoshi Tei, Yoshinao Takano, Koji Munakata, Shuichiro Matoba, Shigeru Yamagishi, Masayoshi Yasui, Takeshi Kato, Mayumi Ozawa, Manabu Shiozawa, Yoshiyuki Ishii, Taichi Yabuno, Toshikatsu Nitta, Shuji Saito, Naoki Nagata, Daisuke Ichikawa, Suguru Hasegawa, Goutaro Katsuno, Hiroki Takahashi, Kenji Kawai, Tomohisa Furuhata, Toru Tonooka, Akiyoshi Kanazawa, Yoshiaki Kuriu, Kazuhiro Sakamoto, Tatsuya Kinjo, Hideo Otsuka, Mamoru Uemura, Toshifumi Watanabe, Kazuki Ueda, Masataka Ikeda, Ichiro Takemasa","doi":"10.1097/DCR.0000000000003669","DOIUrl":"10.1097/DCR.0000000000003669","url":null,"abstract":"<p><strong>Background: </strong>Whether the level of the inferior mesenteric artery ligation affects the incidence of anastomotic leakage remains unclear.</p><p><strong>Objective: </strong>To assess the impact of the level of inferior mesenteric artery ligation on blood flow to the anastomotic site and the incidence of anastomotic leakage using indocyanine green fluorescence imaging.</p><p><strong>Design: </strong>A post hoc analysis of the EssentiAL trial.</p><p><strong>Settings: </strong>This study was conducted at 41 tertiary referral centers in Japan.</p><p><strong>Patients: </strong>A total of 839 patients with rectal cancer (<12 cm from the anal verge) were included.</p><p><strong>Main outcome measures: </strong>The incidence of anastomotic leakage and perfusion status were compared between the high and low ligation groups.</p><p><strong>Results: </strong>The median fluorescence time was similar at 25 seconds in both groups (p = 0.74). Although no statistical difference was noted, the high ligation group was more likely to have greater outliers in fluorescence time compared to the low ligation group. The high ligation group demonstrated higher poor perfusion rates than the low ligation group (2.8% vs 1.5%). In the high ligation group, anastomotic leakage occurred in 1 case of poor perfusion where additional resection was not performed by the surgeon's intraoperative judgment. In addition, the additional resection rate nearly doubled with the use of indocyanine green fluorescence imaging. After propensity score matching (129 patients per group), the overall anastomotic leakage rate was 13.2% in the high ligation group and 10.9% in the low ligation group ( p = 0.57).</p><p><strong>Limitations: </strong>This study was a post hoc analysis, the sample size was small, and the anastomosis methods varied.</p><p><strong>Conclusions: </strong>The level of inferior mesenteric artery ligation did not affect blood flow at the anastomotic site or the incidence of anastomotic leakage statistically, but assessing bowel perfusion using indocyanine green fluorescence imaging can offer clinical benefits, optimizing patient outcomes. See Video Abstract .</p><p><strong>Trial registration: </strong>The Japan Registry of Clinical Trials (jRCTs-CRB3180007), the Japanese Clinical Trials Registry (UMIN-CTR000030240).</p><p><strong>Impacto de la ligadura baja en la perfusin intestinal y la fuga anastomtica en la ciruga mnimamente invasiva del cncer rectal un anlisis post hoc de un ensayo controlado aleatorizado: </strong>ANTECEDENTES:No está claro si el nivel de la ligadura de la arteria mesentérica inferior afecta la incidencia de fuga anastomótica.OBJETIVO:Evaluar el impacto del nivel de ligadura de la arteria mesentérica inferior en el flujo sanguíneo al sitio de la anastomosis y la incidencia de fuga anastomótica mediante imágenes de fluorescencia con verde de indocianina.DISEÑO:Análisis post hoc del ensayo EssentiAL.ESCENARIO:Este estudio se realizó en 41 centro","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"544-552"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363620","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":"May 2025 Translations.","authors":"","doi":"10.1097/DCR.0000000000003757","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003757","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 5","pages":"e993-e1030"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972998","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":"Stepwise Approach to Robotic Anterior Resection.","authors":"Rasa Sadoughi, Andrew R Wells, Najaf Siddiqi","doi":"10.1097/DCR.0000000000003498","DOIUrl":"10.1097/DCR.0000000000003498","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e206-e208"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363873","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 to Write a Systematic Review and Meta-analysis.","authors":"Richard L Nelson","doi":"10.1097/DCR.0000000000003692","DOIUrl":"10.1097/DCR.0000000000003692","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"503-504"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188447","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":"Unpacking the Path to Colon and Rectal Surgery Residency.","authors":"Emily Steinhagen","doi":"10.1097/DCR.0000000000003686","DOIUrl":"10.1097/DCR.0000000000003686","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"497-498"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363877","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":"Jejunal Lymphatic and Vascular Anatomy Defines Surgical Principles for Treatment of Jejunal Tumors.","authors":"Teodor Vasic, Milena B Stimec, Bojan V Stimec, Erik Kjæstad, Dejan Ignjatovic","doi":"10.1097/DCR.0000000000003644","DOIUrl":"10.1097/DCR.0000000000003644","url":null,"abstract":"<p><strong>Background: </strong>The jejunum has a wide lymphatic drainage field, making radical surgery difficult.</p><p><strong>Objective: </strong>Extrapolate results from 2 methodologies to define jejunal artery lymphatic clearances and lymphovascular bundle shapes for radical bowel-sparing surgery.</p><p><strong>Design: </strong>Two cohort studies.</p><p><strong>Settings: </strong>The first data set comprised dissections of cadavers at the University of Geneva. The second data set incorporated preoperative 3-dimensional CT vascular reconstructions of patients included in the \"Surgery with Extended (D3) Mesenterectomy for Small Bowel Tumors\" clinical trial.</p><p><strong>Patients: </strong>Eight cadavers were dissected. The 3-dimensional CT data set included 101 patients.</p><p><strong>Main outcome measures: </strong>Lymph vessels ran parallel and interlaced with jejunal arteries. Lymphatic clearance was minimal at the jejunal artery's origin, radially spreading thereafter. Jejunal arteries were categorized into 3 groups based on position to the middle colic artery origin on 3-dimensional CT: group A: jejunal artery origins lie cranially and caudally to the middle colic artery; group B: jejunal artery origins lie caudal to the middle colic artery; and group C: jejunal artery origins lie cranial to the middle colic artery. Jejunal veins were classified into 3 groups based on their trajectories to the superior mesenteric artery (dorsally/ventrally/combined).</p><p><strong>Results: </strong>Lymph vessel clearances were 1.5 ± 1.0 mm at jejunal artery origins. Group A was present in 81 cases (80.2%), group B in 13 cases (12.9%), and group C in 7 cases (6.9%). Jejunal artery median was 4. Fifty-seven jejunal veins (56.4%) ran dorsally to the superior mesenteric artery, 16 (15.8%) ran ventrally, and 28 (27.8%) had a combined course.</p><p><strong>Limitations: </strong>Lymph nodes were not counted during dissection because the main observation was the position of lymph vessels.</p><p><strong>Conclusions: </strong>Minimal jejunal artery lymphatic clearance implies ligating tumor-feeding vessels at the origin. The intermingled jejunal artery lymphatics imply lymph node dissection along the proximal and distal vessels to the level of the first arcade. Classifying jejunal arteries and veins could simplify the anatomy for surgeons. See Video Abstract.</p><p><strong>Clinical trial registration number: </strong>NCT05670574.</p><p><strong>La anatoma linftica y vascular del yeyuno define los principios quirrgicos para el tratamiento de los tumores del yeyuno: </strong>ANTECEDENTES:El yeyuno tiene un amplio campo de drenaje linfático, lo que dificulta la cirugía radical.OBJETIVO:Extrapolar los resultados de dos metodologías para definir los aclaramientos linfáticos de la arteria yeyunal y las formas de los haces linfovasculares para la cirugía radical de conservación intestinal.DISEÑO:Dos estudios de cohorte.ESCENARIO:El primer conjunto de datos comprendía dise","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"553-561"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398641","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":"Expert Commentary on the Management of Obstetric Anal Sphincter Injuries.","authors":"Liliana Bordeianou","doi":"10.1097/DCR.0000000000003698","DOIUrl":"10.1097/DCR.0000000000003698","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"513-514"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364107","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":"Ventral Rectopexy: An International Expert Panel Consensus and Review of Contemporary Literature.","authors":"William R G Perry, Peter Christensen, Rowan J Collinson, Julie A Cornish, André D'Hoore, Brooke H Gurland, Anders Mellgren, Carlo Ratto, Frederic Ris, Andrew R L Stevenson, Liliana Bordeianou","doi":"10.1097/DCR.0000000000003656","DOIUrl":"10.1097/DCR.0000000000003656","url":null,"abstract":"<p><strong>Background: </strong>Ventral rectopexy has become increasingly used in the surgical management of rectal prolapse. There is a need for a contemporary evaluation of the role of the procedure and a description of its use in clinical practice.</p><p><strong>Objective: </strong>To create an international consensus on ventral rectopexy.</p><p><strong>Design: </strong>An expert panel undertook a scoping review of the literature to identify subject domains of interest. Literature reviews were completed for each domain with subsequent development of evidence-based and practice-based statements. These statements were compiled and reviewed by the group over a total of 9 meetings. Once statements were confirmed, supportive text was finalized, and an anonymous vote was completed using Research Electronic Data Capture to record consensus.</p><p><strong>Setting: </strong>An international expert panel comprising colorectal surgeons who perform ventral rectopexy in a high-volume center.</p><p><strong>Main outcome measures: </strong>Statements and associated expert consensus.</p><p><strong>Results: </strong>Eleven experts identified 10 domains for review: indications, contraindications, assessment and planning, consent, operative details, prostheses, complications, follow-up, recurrence and reoperative surgery, and specific considerations. After round table review, there were 17 resultant statements for consideration. Experts agreed unanimously with 13 of the statements and their accompanying text, with different experts disagreeing regarding the remaining 4 statements (91% consensus each).</p><p><strong>Limitations: </strong>Paucity of high-quality data.</p><p><strong>Conclusions: </strong>This international group developed 17 statements with high consensus. These statements provide an up-to-date summary of the literature, identify key areas for research development, and provide a reference point for colon and rectal surgeons who undertake ventral rectopexy as part of their practice. See Video Abstract .</p><p><strong>Rectopexia ventral consenso de un panel internacional de expertos y revisin de la literatura contempornea: </strong>ANTECEDENTES:La rectopexia ventral se ha utilizado cada vez más en el tratamiento quirúrgico del prolapso rectal. Es necesario realizar una evaluación contemporánea del rol del procedimiento y una descripción de su uso en la práctica clínica.OBJETIVO:Crear un consenso internacional sobre la rectopexia ventral.DISEÑO:Un panel de expertos realizó una revisión exhaustiva de la literatura para identificar los dominios temáticos de interés. Se completaron revisiones de la literatura para cada dominio con el desarrollo de declaraciones basadas en la evidencia y la práctica. Estas fueron compiladas y revisadas por el grupo a lo largo de un total de nueve reuniones. Una vez que se confirmaron las declaraciones, se finalizó el texto de apoyo y se completó una votación anónima utilizando REDCap para registrar el consenso.ESCENARIO:Un","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"593-607"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064181","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}