Diseases of the Colon & Rectum最新文献

{"title":"Mechanical Bowel Preparation's Influence on the Microbiome in Anastomotic Leak.","authors":"Simon Keely, Emily C Hoedt, Peter Pockney","doi":"10.1097/DCR.0000000000003956","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003956","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":"144999951","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 \"Neoadjuvant Chemotherapy Without Radiation for Locally Advanced Rectal Cancer: A Meta-Analysis of Surgical Outcomes after Total Mesorectal Excision\".","authors":"Susanna S Hill","doi":"10.1097/DCR.0000000000003948","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003948","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991738","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":"Neoadjuvant Chemotherapy Without Radiation for Locally Advanced Rectal Cancer: A Meta-analysis of Surgical Outcomes after Total Mesorectal Excision.","authors":"Richard Garfinkle, Saba Balvardi, Marylise Boutros, Dean A Fergusson","doi":"10.1097/DCR.0000000000003946","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003946","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemotherapy alone (with radiation omission) for locally advanced rectal cancer has been evaluated in several randomized controlled trials. While oncologic outcomes have been well described, the impact of this treatment strategy on surgical outcomes is unknown.</p><p><strong>Objective: </strong>To evaluate how important surgical outcomes were reported in previous trials comparing neoadjuvant chemotherapy to chemoradiation for locally advanced rectal cancer and to perform a meta-analysis of available data.</p><p><strong>Data sources: </strong>A systematic review was conducted using MEDLINE, Embase, and the Cochrane Library Databases.</p><p><strong>Study selection: </strong>All published randomized controlled trials that compared neoadjuvant chemotherapy to chemoradiation for MRI-staged rectal adenocarcinoma.</p><p><strong>Interventions: </strong>Neoadjuvant chemotherapy alone (with radiation omission).</p><p><strong>Main outcome measures: </strong>Postoperative surgical outcomes, including anastomotic leak, diverting ostomy use, ostomy non-reversal, 30-day postoperative morbidity, and postoperative bowel function.</p><p><strong>Results: </strong>Four randomized controlled trials met eligibility criteria and were included for data analysis. Oncologic outcomes demonstrated that neoadjuvant chemotherapy was equivalent or non-inferior to chemoradiation. Anastomotic leak and use of diverting ostomy were reported in 3 of 4 trials while 30-day postoperative morbidity and ostomy non-reversal were only reported in 2 of 4 trials. Bowel function was measured in 3 of 4 trials but was measured and/or reported differently in each trial. On meta-analysis, neoadjuvant chemotherapy was associated with a significant reduction in anastomotic leak (RR: 0.54, 95% 0.35-0.81), use of diverting ostomy (RR: 0.79, 95% 0.70-0.88), and ostomy non-reversal (RR: 0.37, 95% 0.15-0.93). There was no association between neoadjuvant chemotherapy and 30-day postoperative morbidity (RR: 0.88, 0.53-1.45).</p><p><strong>Limitations: </strong>Small number of included trials with heterogeneity in outcome definitions.</p><p><strong>Conclusions: </strong>Important surgical outcomes were not reported in trials comparing neoadjuvant chemotherapy alone to chemoradiation for locally advanced rectal cancer. Based on the limited data available, chemotherapy alone was associated with reduced risk of anastomotic leak, diverting ostomy use, and ostomy non-reversal. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991699","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":"Kraske Procedure: Oldie but Goodie.","authors":"Murat Sen, Ozgen Isik","doi":"10.1097/DCR.0000000000003854","DOIUrl":"10.1097/DCR.0000000000003854","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946718","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":"Easier Complete Mesocolic Excision and D3 Dissection in Robotic Right Colectomy for Obese Patients: Gastrocolic (Henle's) Trunk Approach First.","authors":"Ming-Yin Shen, William Tsu-Liang Chen","doi":"10.1097/DCR.0000000000003776","DOIUrl":"10.1097/DCR.0000000000003776","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946699","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":"Cost-Effectiveness of Rubber Band Ligation Versus Hemorrhoidectomy for the Treatment of Grade III Hemorrhoids: Analysis Using Evidence From the HOLLAND Randomized Controlled Trial.","authors":"Justin Y van Oostendorp, Lisette Dekker, Susan van Dieren, Ruben Veldkamp, Willem A Bemelman, Ingrid J M Han-Geurts","doi":"10.1097/DCR.0000000000003832","DOIUrl":"10.1097/DCR.0000000000003832","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hemorrhoids significantly impact quality of life and health care costs. Although rubber band ligation and hemorrhoidectomy are common treatments for grade III hemorrhoids, comparative cost-effectiveness data are limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the cost-effectiveness and cost-utility of rubber band ligation compared to hemorrhoidectomy from a societal perspective within the context of the HOLLAND trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Cost-effectiveness and cost-utility analyses using data from a multicenter, randomized controlled trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings: &lt;/strong&gt;Ten Dutch hospitals participating in the HOLLAND trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adults with symptomatic grade III hemorrhoids randomly assigned to receive rubber band ligation or hemorrhoidectomy treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Rubber band ligation (up to 2 sessions) or excisional hemorrhoidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Cost per quality-adjusted life year gained and cost per recurrence avoided over 24 months from a societal perspective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventy-nine patients were analyzed (33 for hemorrhoidectomy and 46 for rubber band ligation). Hemorrhoidectomy resulted in better clinical outcomes with a quality-adjusted life year difference of 0.08 (95% CI, 0.04-0.13) and a recurrence difference of 33.5% (95% CI, 15.3%-51.7%). Hospital costs were higher for hemorrhoidectomy (€1364; 95% CI, 895-1834; p &lt; 0.001), as were societal costs (€1984; 95% CI, -132 to 4101; p = 0.066). The incremental cost-utility ratio for hemorrhoidectomy was €24,042 per quality-adjusted life year gained, and the incremental cost-effectiveness ratio was €5918 per recurrence avoided. The probability of hemorrhoidectomy being cost-effective was 45.5% at €20,000 per quality-adjusted life year and 83.9% at €50,000 per quality-adjusted life year. For recurrence avoidance, probabilities were 98.3% and 99.8%, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The small sample size may limit generalizability and the ability to detect rare but costly complications. Procedural costs were based on average hospital prices, which is a pragmatic approach but is less detailed than bottom-up costing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In patients with grade III hemorrhoids, hemorrhoidectomy provides better long-term clinical outcomes, including higher quality of life and lower recurrence rates compared to rubber band ligation. However, its cost-effectiveness varies depending on societal willingness-to-pay thresholds. Caution is warranted before discarding it as a first-line treatment solely based on health care costs or limited operating room availability. See Video Abstract .&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical trial registration number: &lt;/strong&gt;NCT04621695.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Costoefectividad de la ligadura con banda elstica versus hemorroidectoma para el tratamiento de hemorroides de grado iii anlisis utilizando eviden","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1100-1111"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257609","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":"Right and Left Colectomies.","authors":"Kelly M Tyler, Don B Colvin","doi":"10.1097/DCR.0000000000003819","DOIUrl":"10.1097/DCR.0000000000003819","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1037"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990505","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":"International Prospective Quality of Life in Patients With Colorectal Peritoneal Metastases Treated by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the United Kingdom and Australia.","authors":"Daniel Steffens, Suzanne Alves, Cherry E Koh, Nabila Ansari, Michael J Solomon, Thomas D Cecil, Nima Ahmadi, Kate E McBride, Kate L Mahon, Faheez Mohamed, Brendan John Moran","doi":"10.1097/DCR.0000000000003823","DOIUrl":"10.1097/DCR.0000000000003823","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are widely accepted treatment options for patients presenting with colorectal peritoneal metastases; however, evidence on quality-of-life outcomes is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess quality-of-life trajectories and surgical outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 2 peritoneal malignancy units in Australia and the United Kingdom.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Prospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings: &lt;/strong&gt;The Royal Prince Alfred Hospital (Australia) and Basingstoke and North Hampshire Hospital (United Kingdom).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases from June 2019 to March 2023 were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;The primary outcome was quality of life, assessed using the Short-Form 36 Survey and the Functional Assessment of Cancer Therapy-Colorectal at baseline, before discharge, and 3, 6, and 12 months postsurgery. Secondary outcomes included surgical parameters and the impact of peritoneal cancer index on primary outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 193 patients (99 from Australia and 94 from the United Kingdom) were included. Compared with patients in the United Kingdom, Australian patients were younger (median 54.0 vs 61.0 years; p = 0.005) and had higher peritoneal cancer index scores (median 10.0 vs 5.0; p &lt; 0.001), consequently having longer operations, intensive care unit stays, and hospital stays and more postoperative complications (all p &lt; 0.001). Quality of life returned to baseline levels within 3 to 6 months postsurgery and was practically identical in both countries. Overall survival was better in the United Kingdom cohort ( p = 0.035), but recurrence rates were similar. Higher peritoneal cancer index scores were associated with worse surgical and survival outcomes, but patients with a peritoneal cancer index of more than 15 still demonstrated a 36-month survival rate of 45.7%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Potential recall bias and missing data at longer follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy lead to temporary quality of life decline with recovery to baseline within 3 to 6 months for most patients with colorectal peritoneal metastases. Although quality-of-life trajectories were similar between countries, patients with a peritoneal cancer index of more than 15 demonstrated poorer quality of life at 6 to 12 months, particularly with disease recurrence. Future research should focus on strategies to maintain long-term quality-of-life improvements, especially in high-risk patients. See Video Abstract .&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Estudio prospectivo internacional sobre la calidad de vida en pacientes con metstasis peritoneales colorrect","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1074-1084"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257610","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 Factors for Stricture After Endoscopic Submucosal Dissection of Large Rectal Neoplasms.","authors":"Daniel Tavares Rezende, Fabio S Kawaguti, Cintia M S Kimura, Caio S R Nahas, Rodrigo A Pinto, Adriana V Safatle-Ribeiro, Fauze Maluf-Filho, Ulysses Ribeiro, Sergio C Nahas, Carlos F S Marques","doi":"10.1097/DCR.0000000000003827","DOIUrl":"10.1097/DCR.0000000000003827","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although acute adverse events after endoscopic submucosal dissection, such as perforation and bleeding, are well documented, studies on stricture are scarce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to identify risk factors for rectal stricture and symptomatic stricture after endoscopic submucosal dissection and to evaluate patient outcomes in a Western tertiary cancer center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Single-center retrospective study from a prospectively collected database of rectal endoscopic submucosal dissections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings: &lt;/strong&gt;Reference cancer center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Patients undergoing endoscopic submucosal dissection for rectal neoplasms from July 2010 to January 2020. Exclusion criteria included incomplete resections, referral for low anterior resection, proximal diversions (in the symptomatic group), and loss to follow-up. A specific follow-up protocol was established for patients with lesions occupying more than 90% of the rectal circumference.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Rectal strictures were classified as complete or partial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Assessment of risk factors for stricture after rectal endoscopic submucosal dissection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 109 rectal lesions resected, 94 cases were included. Twenty patients (21.3%) developed strictures (13 complete and 7 partial stricture). Univariate analysis identified distance from the anal verge &lt;5 cm, larger size, and circumferential mucosal defect of more than 90% as significantly associated with stricture ( p &lt; 0.05). Multivariable analysis showed that only a circumferential mucosal defect of 90% or more was significantly associated with stricture ( p &lt; 0.001). None of the patients with partial stricture were symptomatic, whereas 11 of 13 with complete stricture were symptomatic. All symptomatic patients underwent serial dilations, either with balloon or digitally, with symptom resolution occurring within 1 to 8 months (mean of 7.8 sessions of dilation procedures).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Single-center retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Circumferential mucosal defect of 90% or more was the only significant risk factor for stricture after extensive rectal endoscopic submucosal dissection procedures on multivariable analysis. All patients with symptomatic stricture were successfully treated with dilation sessions. See Video Abstract .&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Factores de riesgo asociados a estenosis tras la diseccin submucosa endoscpica de neoplasias rectales voluminosas: &lt;/strong&gt;ANTECEDENTES:Si bien los eventos adversos agudos tras la disección submucosa endoscópica, como la perforación y el sangrado, están bien documentados, los estudios sobre estenosis son escasos.OBJETIVO:Este estudio busca identificar factores de riesgo para las estenosis rectales y estenosis sintomáticas tras la disección submucosa endoscópica, y evaluar l","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1112-1119"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283033","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":"Transformations.","authors":"Susan Galandiuk","doi":"10.1097/DCR.0000000000003871","DOIUrl":"10.1097/DCR.0000000000003871","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 9","pages":"1023-1024"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871965","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}