Diseases of the Colon & Rectum最新文献

{"title":"National Analysis of Over 48,000 Veterans With HIV Demonstrates CD4/CD8 Ratio as a Risk Marker for Anal Intraepithelial Lesions and Anal Cancer.","authors":"Austin Hewitt, Matthew J Freeman, Glen Leverson, Howard H Bailey, Evie Carchman, Rob Striker, Cristina B Sanger","doi":"10.1097/DCR.0000000000003611","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003611","url":null,"abstract":"<p><strong>Background: </strong>Anal squamous intraepithelial lesions are identifiable and treatable precancerous lesions that lack defined risk factors determining screening necessity.</p><p><strong>Objective: </strong>Assess the prevalence and risk factors associated with low- and high-grade anal squamous intraepithelial lesions and anal squamous cell carcinoma.</p><p><strong>Design: </strong>Retrospective cohort analysis of veterans with HIV between 1999-2023.</p><p><strong>Settings: </strong>National multicenter study of the Department of Veterans Affairs.</p><p><strong>Patients: </strong>Veterans with HIV who had >1 year of follow-up and no anal squamous intraepithelial lesions or anal cancer diagnosis prior to the study period.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes include the prevalence, disease-free survival rates, and hazard ratios associated with risk factors for developing anal squamous intraepithelial lesions and/or anal cancer.</p><p><strong>Results: </strong>48,368 patients were analyzed. The average age of patients at study initiation was 47.8 years with a mean follow-up of 12.3 years. 7,572 (16%) patients had at least one anal cytopathology or histopathology result. Prevalence of anal disease was recorded for low-grade disease (n = 1,513, 3.1%), high-grade disease (n = 1,484, 3.1%), and cancer (n = 664, 1.4%). Mean times to first incident low-grade disease, high-grade disease, and cancer were 8.5 (SD = 6.0), 9.1 (SD = 6.0), and 9.7 (SD = 6.2) years, respectively. 5-year, 10-year, and 20-year disease-free survival rates for development of low-grade disease, high-grade disease, or cancer were 97.5%, 94.5%, and 88.4%, respectively. Cox regression modeling demonstrated CD4/CD8 ratios <0.5 were associated with increased risk of anal cancer (HR: 3.93, 95% CI: 3.33-4.63, p < 0.001).</p><p><strong>Limitations: </strong>Retrospective study that focuses almost exclusively on male U.S. veterans. Results might not apply to non-male, non-U.S. populations.</p><p><strong>Conclusions: </strong>National analysis of over 48,000 veterans with HIV demonstrates 16% had anal cytopathology or histopathology results with an anal cancer prevalence of 1.4%. CD4/CD8 ratios <0.5 correlate strongly with severity of anal disease and can help identify patients at highest risk for anal cancer to prioritize screening efforts. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913572","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":"Endoscopic and Transanal Management of Anastomotic Leak.","authors":"Grace M Crouch, Amanda McClure","doi":"10.1097/DCR.0000000000003635","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003635","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913571","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":"TEMPOUR: A Randomized Controlled Trial Assessing Perioperative Use of An Alpha-1-Blocker to Reduce Postoperative Urinary Retention Following Transanal Endoscopic Microsurgery Procedures.","authors":"Thomas Couture, Claudya Morin, Janyssa Charbonneau, Émilie Papillon-Dion, Alexandre Bouchard, François Rouleau-Fournier, Philippe Bouchard, François Letarte, Alexis F Turgeon","doi":"10.1097/DCR.0000000000003623","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003623","url":null,"abstract":"<p><strong>Background: </strong>Transanal endoscopic microsurgery is a treatment option for a wide range of rectal lesions. Postoperative urinary retention is a frequently associated complication. Some studies have suggested that the use of alpha-1-blockers may reduce the risk of postoperative urinary retention after hernia and colorectal surgery, but evidence is lacking.</p><p><strong>Objective: </strong>This trial aims to evaluate if prophylactic use of an alpha-1-blocker reduces the rate of postoperative urinary retention following transanal endoscopic microsurgery.</p><p><strong>Design: </strong>Double-blind, placebo-controlled trial.</p><p><strong>Settings: </strong>Single high-volume Canadian colorectal center.</p><p><strong>Patients: </strong>Adult male patients awaiting transanal endoscopic microsurgery and not on alpha-1-blocker were included.</p><p><strong>Intervention: </strong>Patients were allocated to either Tamsulosin or placebo from 5 days prior to surgery to 2 days postoperatively.</p><p><strong>Main outcomes measures: </strong>The primary outcome was the incidence of post-operative urinary retention. Secondary outcomes were urinary retention-related hospitalization, time to removal of bladder catheter and International Prostate Symptom Score, before and after treatment, and adverse events.</p><p><strong>Results: </strong>158 patients were randomized between October 2017 and July 2022. There was no significant difference in postoperative urinary retention between groups (23% vs 14%; p = 0.16) respectively in the tamsolusin and placebo groups. Time to removal of bladder catheter was not statistically different between groups (4.8 vs 8.6 days, p = 0.26). No failure of same-day discharge, nor readmissions related to urinary retention occurred. International Prostate Symptom Scores were not significantly different at the time of surgery (3.8 vs 5.4; p = 0.11) and reported adverse events did not differ between groups.</p><p><strong>Limitations: </strong>We cannot exclude a potential type II error.</p><p><strong>Conclusion: </strong>Prophylactic use of an alpha-1-blocker for patients undergoing transanal endoscopic microsurgery was not associated with a reduction in post-operative urinary retention. See Video Abstract.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03314025.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913902","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":"To Pimp or Not to Pimp: That Is the Question.","authors":"Lester Gottesman","doi":"10.1097/DCR.0000000000003546","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003546","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913905","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":"EndoRobotic Submucosal Dissection After Total Neoadjuvant Treatment in Rectal Cancer.","authors":"Kamil Erozkan, Metincan Erkaya, Mehmet Ayhan Kuzu, Emre Gorgun","doi":"10.1097/DCR.0000000000003591","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003591","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913569","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 \"Impact of Surgeon Specialization on Outcomes in Emergency Colorectal Surgery: A Systematic Review and Meta-analysis\".","authors":"Vlad V Simianu","doi":"10.1097/DCR.0000000000003557","DOIUrl":"10.1097/DCR.0000000000003557","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"31"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460465","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":"Is Dilip's Transmucosal Internal Sphincterotomy a Modification of Closed Lateral Internal Sphincterotomy?","authors":"Vipul D Yagnik, Kaushik Bhattacharya, Pankaj Garg","doi":"10.1097/DCR.0000000000003567","DOIUrl":"10.1097/DCR.0000000000003567","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e7"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497002","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":"Comparing the Management Recommendations of Large Language Model and Colorectal Cancer Multidisciplinary Team: A Pilot Study.","authors":"Nir Horesh, Sameh Hany Emile, Shashank Gupta, Zoe Garoufalia, Rachel Gefen, Peige Zhou, Giovanna da Silva, Steven D Wexner","doi":"10.1097/DCR.0000000000003504","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003504","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Management of anorectal cancers requires a multidisciplinary team approach. Recently, large language models have been suggested as potential tools for various applications in health care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Assess suggested management recommendations provided by a generative artificial intelligence chatbot with those of a colorectal cancer multidisciplinary team to evaluate applicability in clinical settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Comparative pilot study where management recommendations from a generative artificial intelligence chatbot for patients with anal or colorectal cancers were compared against historical consensus decisions from multidisciplinary team meetings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single referral tertiary center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Fifteen patients (mean age of 66.5 years; 53.5% woman) were included; 80% were primarily diagnosed with rectal cancer, predominantly stage II and III disease (46.6%). The mean tumor height from the anal verge was 4 cm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;From a generative artificial intelligence chatbot, we generated management recommendations for each patient, which were subsequently compared to historical decisions from a multidisciplinary team to gauge concordance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Primary outcomes included a degree of concordance between generative artificial intelligence chatbot recommendations and the multidisciplinary team decisions, assessed on a scale from 1 (complete disagreement) to 5 (complete agreement), and justification was evaluated by 3 experienced colorectal surgeons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A generative artificial intelligence chatbot achieved a high concordance rate with multidisciplinary team decisions, with an average concordance rating of 4.08. Multidisciplinary team treatment strategies included neoadjuvant therapy for 33.3% of patients, upfront surgery for 26.6%, and further diagnostic assessment for 20%. Interrater agreement on concordance was found to be moderate (κ coefficient range, 0.333-0.577), whereas agreement on decision justification was slight (κ coefficient range, 0.047-0.094).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Retrospective study with small sample size.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The findings indicate a high level of concordance between generative artificial intelligence chatbot recommendations and the decisions from a colorectal cancer multidisciplinary team, suggesting the potential of large language models to support clinical decision-making in the management of anal and colorectal cancers. See Video Abstract.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Comparacin entre recomendaciones de manejo del modelo extenso de lenguaje y el equipo multidisciplinario de cncer colorrectal un estudio piloto: &lt;/strong&gt;ANTECEDENTES:El manejo de los cánceres anorrectales requiere un enfoque de equipo multidisciplinario. Recientemente, se han sugerido modelos extensos de lenguaje como he","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 1","pages":"41-47"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827842","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 Surgeon Specialization on Outcomes in Emergency Colorectal Surgery: A Systematic Review and Meta-analysis.","authors":"Zachary Bunjo, Luke Traeger, Ishraq Murshed, Sergei Bedrikovetski, Nagendra N Dudi-Venkata, Christopher Dobbins, Tarik Sammour","doi":"10.1097/DCR.0000000000003418","DOIUrl":"10.1097/DCR.0000000000003418","url":null,"abstract":"<p><strong>Background: </strong>Colorectal emergencies represent a large proportion of acute general surgical workload and carry significant mortality.</p><p><strong>Objective: </strong>Identify the influence of surgeon specialization on mortality and other outcomes in emergency colorectal surgery.</p><p><strong>Data sources: </strong>Systematic searches of Ovid MEDLINE, Ovid Embase, and Cochrane electronic databases were performed for studies published from January 1, 1990, to August 27, 2023.</p><p><strong>Study selection: </strong>Studies investigating outcomes in emergency colorectal surgery for adults, comparing colorectal against noncolorectal surgeon specialization, were included. Exclusion criteria were: 1) publications studying primarily pediatric populations; 2) studies incorporating patients who had undergone surgery before 1990; and 3) studies only published in abstract form or non-English language.</p><p><strong>Main outcome measures: </strong>Primary outcomes were 30-day mortality and in-hospital mortality. Secondary outcomes were rates of anastomotic leak, reintervention, primary anastomosis, and laparoscopic approach.</p><p><strong>Results: </strong>Of 7676 studies identified, 155 were selected for full-text review and 21 were included for quantitative analysis. Eleven studies showed improved 30-day (OR 0.64; 95% CI, 0.60-0.68; p < 0.0001) and in-hospital mortality (OR 0.66; 95% CI, 0.49-0.89; p = 0.007) with colorectal specialization. There was a significantly higher rate of primary anastomosis (OR 2.95; 95% CI, 2.02-4.31; p < 0.0001) and use of laparoscopic surgery (OR 2.38; 95% CI, 1.42-4.00; p = 0.001) among specialized colorectal surgeons. Specialization was also associated with a significant reduction in any stoma formation (OR 0.52; 95% CI, 0.28-0.98; p = 0.04). No significant difference was observed for anastomotic leak (OR 0.70; 95% CI, 0.45-1.07; p = 0.10) or reintervention rates (OR 0.78; 95% CI, 0.55-1.10; p = 0.16).</p><p><strong>Limitations: </strong>Heterogeneity exists within the included patient populations and definitions of colorectal specialization observed in different countries.</p><p><strong>Conclusions: </strong>Emergency colorectal surgery undertaken by specialized colorectal surgeons is associated with significantly improved postoperative mortality, lower rates of stoma formation, and increased rates of primary anastomosis and minimally invasive surgery.</p><p><strong>Prospero registration: </strong>CRD42022300541.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"14-30"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460452","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":"Known Knowns and Unknown Unknowns.","authors":"Lester Gottesman","doi":"10.1097/DCR.0000000000003376","DOIUrl":"10.1097/DCR.0000000000003376","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"6-8"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460453","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}