Diseases of the Colon & Rectum最新文献

{"title":"Laparoscopic Proctectomy, Ileoanal Pouch Creation, and Transanal Transection With Single-Stapled Anastomosis for Ulcerative Colitis.","authors":"Serena Perotti, Michela Mineccia, Paolo Massucco, Federica Gonella, Alessia Fiore, Alessandro Ferrero","doi":"10.1097/DCR.0000000000003431","DOIUrl":"10.1097/DCR.0000000000003431","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e1665"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626294","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":"Announcements.","authors":"","doi":"10.1097/01.dcr.0001081292.22288.21","DOIUrl":"https://doi.org/10.1097/01.dcr.0001081292.22288.21","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"67 11","pages":"e1738"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460468","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":"Comparative Outcomes of Robotic Versus Open Proctectomy for Rectal Cancer at High Risk of Positive Circumferential Resection Margin.","authors":"Stefano Cardelli, Luca Stocchi, Amit Merchea, Dorin T Colibaseanu, Michelle F DeLeon, Nitin Mishra, Kevin J Hancock, David W Larson","doi":"10.1097/DCR.0000000000003466","DOIUrl":"10.1097/DCR.0000000000003466","url":null,"abstract":"<p><strong>Background: </strong>Concerns persist regarding the effectiveness of robotic proctectomy compared with open proctectomy for locally advanced rectal cancer with a high risk of circumferential resection margin involvement.</p><p><strong>Objective: </strong>Comparison of surrogate cancer outcomes after robotic versus open proctectomy in this subpopulation.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Three academic hospitals (Mayo Clinic Arizona, Florida, and Rochester) with data available through the Mayo Data Explorer platform.</p><p><strong>Patients: </strong>Patients at high risk of circumferential resection margin involvement were selected on the basis of the MRI-based definition from the MERCURY I and II trials.</p><p><strong>Main outcome measures: </strong>Rate of pathologic circumferential resection margin involvement (≤1 mm), mesorectal grading, and rate of distal margin involvement.</p><p><strong>Results: </strong>Out of 413 patients, 125 (30%) underwent open and 288 (70%) underwent robotic proctectomy. Open proctectomy was significantly associated with a greater proportion of cT4 tumors (39.3% vs 24.8%, p = 0.021), multivisceral/concomitant resections (40.8% vs 18.4%, p < 0.001), and less frequent total neoadjuvant therapy use (17.1% vs 47.1%, p = 0.001). Robotic proctectomy was less commonly associated with pathologic circumferential resection margin involvement (7.3% vs 17.6%, p = 0.002), including after adjustment for cT stage, neoadjuvant therapy, and multivisceral resection (OR 0.326; 95% CI, 0.157-0.670, p = 0.002). Propensity score matching for 66 patients per group and related multivariable analysis no longer indicated any reduction of circumferential positive margin rate associated with robotic surgery ( p = 0.86 and p = 0.18). Mesorectal grading was comparable (incomplete mesorectum in 6% robotic proctectomy patients vs 11.8% open proctectomy patients, p = 0.327). All cases had negative distal resection margins.</p><p><strong>Limitation: </strong>Retrospective design.</p><p><strong>Conclusions: </strong>In patients with locally advanced rectal cancer at high risk of circumferential resection margin involvement, robotic proctectomy is an effective approach and could be pursued when technically possible as an alternative to open proctectomy. See Video Abstract .</p><p><strong>Resultados comparativos entre la proctectoma robtica y la proctectoma abierta en casos de cncer de recto con alto riesgo de mrgen de reseccin circunferencial positivo: </strong>ANTECEDENTES:Persisten preocupaciones con respecto a la efectividad de la proctectomía robótica en comparación con la proctectomía abierta en casos de cáncer de recto localmente avanzado con un alto riesgo de margen de resección circunferencial positivo.OBJETIVO:Comparar los resultados en la subpoblación de portadores de cáncer luego de una proctectomía robótica versus una proctectomía abierta.DISEÑO:Estudio retrospectivo de coho","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1475-1484"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893146","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 Role of Rehabilitation Therapy in Patients With Obstructed Defecation Syndrome Associated With Excessive Perineal Descent.","authors":"Luigi Brusciano, Francesco Saverio Lucido, Claudio Gambardella, Francesco Pizza, Salvatore Tolone, Ludovico Docimo","doi":"10.1097/DCR.0000000000003509","DOIUrl":"10.1097/DCR.0000000000003509","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e1670"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003880","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":"Hyperglycemia in Surgical Patients Without Diabetes: A Hidden Risk Factor in Current Perioperative Care.","authors":"Mattias Soop","doi":"10.1097/DCR.0000000000003458","DOIUrl":"10.1097/DCR.0000000000003458","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1359-1360"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855136","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":"Recurrence Rates and Risk Factors in the Altemeier Procedure for Rectal Prolapse: A Multicenter Study.","authors":"Lukas Schabl, Tracy L Hull, Kristen A Ban, Scott R Steele, Anna R Spivak","doi":"10.1097/DCR.0000000000003439","DOIUrl":"10.1097/DCR.0000000000003439","url":null,"abstract":"<p><strong>Background: </strong>Perineal proctosigmoidectomy (Altemeier) is a surgical procedure that is commonly used for the treatment of rectal prolapse. However, there is a diverse range of recurrence rates after Altemeier procedure repair that has been reported in the literature.</p><p><strong>Objective: </strong>To identify primary and subsequent recurrence rates after perineal proctosigmoidectomy and to define potential risk factors for recurrence.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Settings: </strong>Conducted at 6 hospitals affiliated with the Cleveland Clinic.</p><p><strong>Patients: </strong>The study included patients who were older than 18 years and were treated with the Altemeier procedure for rectal prolapse between 2007 and 2022.</p><p><strong>Main outcome measures: </strong>Primary outcomes were rates of primary and subsequent recurrences. Secondary outcomes included potential risk factors for recurrence previously mentioned in the literature.</p><p><strong>Results: </strong>We identified 182 patients, of whom 95.1% were women, with a mean age of 79 years (SD 11.4). Overall, procedures were elective in 92.1% of patients, and 14.3% had previously undergone prolapse repairs (Delorme, Thiersch, abdominal suture rectopexy, and abdominal mesh rectopexy). At a mean follow-up period of 27.5 months (SD 45.7), 37.9% of patients experienced recurrence, with 16.5% of patients having multiple recurrences. A subsequent Altemeier procedure was performed in 72.5% of instances. Other treatments included Delorme, abdominal suture rectopexy, abdominal mesh rectopexy, or conservative management. This study identified connective tissue disorders and time since surgery as significant risk factors for recurrence.</p><p><strong>Limitations: </strong>Retrospective design and varying follow-up periods.</p><p><strong>Conclusions: </strong>Perineal proctosigmoidectomy is associated with a significant risk of recurrence. The risk of recurrence increased with the presence of a connective tissue disorder and in proportion to the elapsed time since surgery. These discoveries assist health care professionals in counseling and managing patients who undergo perineal proctosigmoidectomy for rectal prolapse. See Video Abstract .</p><p><strong>Tasas de recurrencia y factores de riesgo en el procedimiento de altemeier para el prolapso rectal un estudio multicntrico: </strong>ANTECEDENTES:La proctosigmoidectomía perineal (Altemeier) es un procedimiento quirúrgico que se utiliza comúnmente para el tratamiento del prolapso rectal. Sin embargo, existe una amplia gama de tasas de recurrencia después de la reparación con el procedimiento de Altemeier que se han informado en la literatura.OBJETIVO:Nuestro objetivo fue identificar las tasas de recurrencia primaria y posterior después de la proctosigmoidectomía perineal, así como definir los posibles factores de riesgo de recurrencia.DISEÑO:Estudio de cohorte.AJUSTES:Realizado en 6 hospitales afiliados","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1465-1474"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859325","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":"November 2024 Translations.","authors":"","doi":"10.1097/DCR.0000000000003544","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003544","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"67 11","pages":"e1672-e1737"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460471","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":"ctDNA Testing for Minimal Residual Disease Assessment and Surveillance.","authors":"Srinivas J Ivatury","doi":"10.1097/DCR.0000000000003490","DOIUrl":"10.1097/DCR.0000000000003490","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"67 11","pages":"1364-1366"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460470","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 Impact of a Modular Robotic Total Mesorectal Excision Training Program on Perioperative and Oncological Outcomes in Robotic Rectal Cancer Surgery.","authors":"Samuel Stefan, Guglielmo Niccolò Piozzi, Patricia Tejedor, Christopher C L Liao, Anwar Ahmad, Nasir Z Ahmad, Syed A H Naqvi, Richard J Heald, Jim S Khan","doi":"10.1097/DCR.0000000000003370","DOIUrl":"10.1097/DCR.0000000000003370","url":null,"abstract":"<p><strong>Background: </strong>Structured training programs for robotic colorectal surgery are limited, and there are concerns about surgical outcomes and operating times.</p><p><strong>Objective: </strong>To compare perioperative and oncological outcomes of robotic total mesorectal excision for rectal cancer performed by expert consultants and surgical trainees in a modular surgical training program.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Conducted at a colorectal training referral center for robotic surgery.</p><p><strong>Patients: </strong>Consecutive robotic total mesorectal excision cases between May 2013 and December 2017 were evaluated retrospectively from a prospectively maintained institutional database and divided into 2 groups: group I comprised expert surgeons and group II comprised supervised trainees. Robotic total mesorectal excision training modules (5 modules) were performed stepwise with increasing complexity. Patients' demographic, perioperative, and oncological data were collected.</p><p><strong>Interventions: </strong>Modular robotic training.</p><p><strong>Main outcome measures: </strong>Comparable R0 resection rate, lymph node harvest, and oncological outcomes between experts and trainees, suggesting good quality in oncological resection.</p><p><strong>Results: </strong>A total of 177 robotic total mesorectal excision resections were performed (group I: n = 80, group II: n = 97). Four trainees completed 37.5 modules each. Patients' age, sex, and BMI were similar between groups. Group II had a higher ASA III score (6.3% vs 25.8%, p = 0.002). Clinical TNM and neoadjuvant chemoradiotherapy rates were similar. Group II had a longer operative time (225 [197.5-297.5] vs 250 [230-300] minutes, p = 0.004). No conversion occurred. There were no differences in intra- or postoperative outcomes between groups. The rate of R0 resection and the number of harvested lymph nodes were also similar between groups. The median follow-up was 75 (64.0-81.7) and 47 (38.0-55.0) months, respectively. Local and distant recurrence rates, 5-year overall survival (81.1% group I vs 81.3% group II, p = 0.832), and 5-year disease-free survival (79.7% group I vs 80.7% group II, p = 0.725) were similar between groups.</p><p><strong>Limitations: </strong>The groups operated in 2 consecutive periods.</p><p><strong>Conclusions: </strong>The robotic total mesorectal excision modular surgical training program maximizes training experience without significantly affecting the perioperative and oncological outcomes of patients with rectal cancer. See Video Abstract.</p><p><strong>El impacto del programa modular de entrenamiento en escisin mesorrectal total robtica en los resultados perioperatorios y oncolgicos en la ciruga robtica del cncer de recto: </strong>ANTECEDENTES:Los programas de entrenamiento estructurados para la cirugía colorrectal robótica están limitados debido a preocupaciones sobre los resultados ","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"67 11","pages":"1485-1494"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460472","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":"Long-term Outcome After Surgical Resection of Para-aortic Lymph Node Metastasis of Colorectal Cancer: A Multicenter Retrospective Study.","authors":"Sono Ito, Yusuke Kinugasa, Shinichi Yamauchi, Hiroyuki Sato, Akihiro Hirakawa, Soichiro Ishihara, Akio Shiomi, Yukihide Kanemitsu, Takeshi Suto, Hiroki Takahashi, Michio Itabashi, Manabu Shiozawa, Masaya Hiyoshi, Takaya Kobatake, Koji Komori, Hiroyuki Egi, Heita Ozawa, Tomohiro Yamaguchi, Ryo Inada, Masaaki Ito, Yasumitsu Hirano, Akinobu Furutani, Yoshitaka Tanabe, Hideki Ueno, Masayuki Ohue, Koya Hida, Kazushige Kawai, Eiji Sunami, Hideyuki Ishida, Kay Uehara, Jun Watanabe, Masanori Hotchi, Atsushi Ishibe, Yasumasa Takii, Junichiro Hiro, Masakatsu Numata, Ichiro Takemasa, Takeshi Kato, Yoshihiro Kakeji, Akira Hirata, Yoichi Ajioka","doi":"10.1097/DCR.0000000000003347","DOIUrl":"10.1097/DCR.0000000000003347","url":null,"abstract":"<p><strong>Background: </strong>The significance of resection of para-aortic lymph node metastasis in colorectal cancer is controversial.</p><p><strong>Objective: </strong>To clarify the prognosis of colorectal cancer after para-aortic lymph node metastasis resection.</p><p><strong>Design: </strong>Multicenter retrospective study.</p><p><strong>Settings: </strong>Thirty-six institutions in Japan participated in this study. Database and medical records at each institution were used for data collection.</p><p><strong>Patients: </strong>Patients with resected and pathologically proven para-aortic lymph node metastasis of colorectal cancer between 2010 and 2015 were included.</p><p><strong>Main outcome measures: </strong>Overall survival after para-aortic lymph node metastasis resection, recurrence-free survival, and recurrence patterns after R0 resection of para-aortic lymph node metastasis.</p><p><strong>Results: </strong>A total of 133 patients were included in the primary analysis population in this study. The 5-year overall survival rate (95% CI) was 41.0% (32.0-49.8), and the median survival (95% CI) was 4.1 (3.4-4.7) years. Independent prognostic factors for overall survival were the pathological T stage (pT4 vs pT1- 3, adjusted HR: 1.91, p = 0.006), other organ metastasis (present vs absent, adjusted HR: 1.98, p = 0.005), time to metastases (synchronous vs metachronous adjusted HR: 2.02, p = 0.02), and the number of para-aortic lymph node metastasis (3 or more vs less than 3, adjusted HR: 2.13, p = 0.001). The 5-year recurrence-free survival rate (95% CI) was 21.1% (13.5-29.7), with a median (95% CI) of 1.2 (0.9-1.4) years. The primary tumor location (left- vs right-sided colon, adjusted HR: 4.77, p = 0.01; rectum vs right-sided colon, adjusted HR: 5.27, p = 0.006), other organ metastasis (present vs absent, adjusted HR: 1.90, p = 0.03), number of para-aortic lymph node metastases (3 or more vs less than 3, adjusted HR: 2.20, p = 0.001), and hospital volume (less than 10 vs 10 or more, adjusted HR: 2.18, p = 0.02) were identified as independent prognostic factors for recurrence-free survival. Para-aortic lymph node recurrence was the most common at 33.3%.</p><p><strong>Limitations: </strong>Selection bias cannot be ruled out because of the retrospective nature of the study.</p><p><strong>Conclusions: </strong>Less than 3 para-aortic lymph node metastases were a favorable prognostic factor for overall and recurrence-free survival. However, para-aortic lymph node metastases were considered to be a systemic disease, and the significance of resection was limited. See Video Abstract .</p><p><strong>Resultado a largo plazo posterior a la reseccin quirrgica de metstasis en ganglios linfticos paraarticos de cncer colorrectal un estudio retrospectivo multicntrico: </strong>ANTECEDENTES:La importancia de la resección de metástasis en los ganglios linfáticos paraaórticos (PALNM) en el cáncer colorrectal (CCR) es controvertida.OBJETIVO:Aclarar el pronóst","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"1423-1436"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626295","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}