Diseases of the Colon & Rectum最新文献

{"title":"3-Dimensional Pouchography: A Video Tutorial.","authors":"Stefan D Holubar","doi":"10.1097/DCR.0000000000003505","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003505","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799770","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":"Increased Utilizing Magnetic Resonance Enterography in Crohn's Disease.","authors":"Muhammed Bahaddin Durak","doi":"10.1097/DCR.0000000000003610","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003610","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799771","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":"Response to \"Specialization Reduces Cost Associated with Colon Cancer Care: A Cost Analysis\".","authors":"Fred C Kobylarz, Dwight D Eisenhower, Alice Lee, Pamela L Burgess","doi":"10.1097/DCR.0000000000003621","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003621","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799772","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":"Management of Anal Dysplasia: A Pragmatic Summary of the Current Evidence and Definition of Clinical Practices for Prevention, Diagnosis, and Treatment.","authors":"Marco Bertucci Zoccali, Cintia Mayumi Sakurai Kimura, Brandon C Chapman, Tamzin Cuming, Carmen Fong, Naomi Jay, Jennifer Kaplan, Michelle J Khan, Craig A Messick, Vlad V Simianu, Jeremy J Sugrue, Luis F Barroso","doi":"10.1097/DCR.0000000000003444","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003444","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784477","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":"Effectiveness of Organ Preservation for Locally Advanced Rectal Cancer With Complete Clinical Response After Neoadjuvant Chemoradiotherapy: Bayesian Network Meta-analysis.","authors":"Kaibo Ouyang, Zifeng Yang, Yuesheng Yang, Zejian Lyu, Junjiang Wang, Yong Li","doi":"10.1097/DCR.0000000000003484","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003484","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemoradiotherapy followed by radical surgery is the common treatment for patients with locally advanced rectal cancer. Presently, for patients with complete clinical response after neoadjuvant chemoradiotherapy, organ preservation (\"watch-and-wait\" and local excision strategies) has been increasingly favored. However, the optimal treatment for patients with complete clinical response remains still unclear.</p><p><strong>Objective: </strong>This study aimed to use Bayesian meta-analysis to determine the best treatment for patients with locally advanced rectal cancer with complete clinical response among radical surgery, local excision, and watch and wait strategies.</p><p><strong>Data sources: </strong>PubMed, Web Of Science, Cochrane Library and Embase(Ovid) were searched until December 31, 2023.</p><p><strong>Study selection: </strong>Studies that compared two or more treatments for patients with complete clinical response were included.</p><p><strong>Intervention: </strong>The analysis was completed via Bayesian meta-analysis using random-effects model.</p><p><strong>Main outcomes: </strong>Surgery-related complications, local recurrence, distant metastasis, 5-year overall and disease-free survival rate.</p><p><strong>Result: </strong>Eleven articles met inclusion criteria. The groups of watch and wait and local excision exhibited a higher rate of tumor recurrence compared to radical surgery group (OR [95% CI]: watch and wait VS radical surgery: 9.10 [3.30, 32.3], local excision VS radical surgery: 2.93 [1.05, 9.95]). The distant metastasis, overall and disease-free survival rates of 3 treatments were not statistically different. The radical surgery group had the most number of stoma, and had the greatest risk of morbidity than the watch and wait group (OR[95%CI]: watch and wait VS radical surgery: 0.00 [0.00, 0.12]).</p><p><strong>Limitations: </strong>The study included only 1 randomized controlled trial compared to 10 observational studies, which could affect overall quality. Funnel plots of disease-free survival rates and stoma suggest significant publication bias among studies which compared radical surgery with watch and wait strategy.</p><p><strong>Conclusion: </strong>The watch and wait strategy could be optimal for patients with locally advanced rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784474","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":"Sexual Dysfunction After Pelvic Radiation.","authors":"Alexandra N Jones, Hillary L Simon","doi":"10.1097/DCR.0000000000003618","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003618","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767375","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":"Deciphering Early Onset Colorectal Cancer: Molecular Profiling of the Tumor Microenvironment.","authors":"Munir H Buhaya, Emina H Huang","doi":"10.1097/DCR.0000000000003447","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003447","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767194","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":"Has the Use of Enhanced Recovery Protocols in Colorectal Surgery Increased Postoperative Bleeding Complications?","authors":"Eyal Aviran, Dan Assaf, Karen Zaghiyan, Phillip Fleshner","doi":"10.1097/DCR.0000000000003581","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003581","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways shown to improve postoperative complications and decrease length of stay after surgery. A critical component of an enhanced recovery after surgery protocol is the use of multimodal non-opiate analgesia using non-steroidal anti-inflammatory drugs and COX-2 inhibitors.</p><p><strong>Objective: </strong>To compare the incidence of postoperative gastrointestinal bleeding between patients treated with and without an enhanced recovery after surgery protocol.</p><p><strong>Design: </strong>Retrospective review of a prospective maintained colorectal registry.</p><p><strong>Settings: </strong>Large colorectal referral center.</p><p><strong>Patients: </strong>Preoperative elective colorectal surgery requiring an anastomosis.</p><p><strong>Intervention: </strong>Standardized enhanced recovery after surgery protocol included celecoxib and ketorolac.</p><p><strong>Main outcome: </strong>Postoperative outcomes included bleeding (+/- sequelae), reduction in hematocrit after operation, intervention for bleeding (transfusion, endoscopy or surgery), length of stay and hospital readmission.</p><p><strong>Results: </strong>The enhanced recovery after surgery group (n = 630) and non-enhanced recovery after surgery groups (n = 739) were comparable in baseline clinical features except for surgical indication, with more inflammatory bowel disease and less malignant disease in the enhanced recovery after surgery group. Minimally invasive surgery was more commonly performed in the enhanced recovery after surgery group. Both bleeding with sequelae (p < 0.0001) and bleeding without sequelae (p = 0.0004) were significantly more common in the enhanced recovery after surgery group compared to the non-enhanced recovery after surgery group. In addition, there was a significantly larger hematocrit decline after operation noted in the enhanced recovery after surgery group (p < 0.0001). Both the need for transfusion and intervention for bleeding however did not significantly differ between patient groups. Factors associated with bleeding were the use of an enhanced recovery after surgery protocol (OR = 2.96; 95% CI, 1.57-5.58; p < 0.001) and performing a small to large bowel anastomosis (OR= 2.68; 95% CI, 1.49-4.81; p < 0.001).</p><p><strong>Limitation: </strong>Retrospective observational design and inability to determine which component of the enhanced recovery after surgery protocol caused the bleeding.</p><p><strong>Conclusion: </strong>Use of an enhanced recovery after surgery protocol in patients undergoing colorectal surgery with an anastomosis is associated with an increased incidence of bleeding without significant difference in the need for transfusion or intervention. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767343","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":"Insights Into the Group of Surgically Resectable but Nonoperable Patients with Colorectal Cancer.","authors":"Ilze Ose, Adile Orhan, Sule Eraslan, Enise Gögenur, Christina Alexandersen, Angelina Astrid Righult, Emine Ceren Ayhan, Amalie Thomsen Nielsen, Ida Kolukisa Saqi, Ismail Gögenur","doi":"10.1097/DCR.0000000000003580","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003580","url":null,"abstract":"<p><strong>Background: </strong>The incidence of colorectal cancer is expected to increase, particularly among patients with significant frailty and comorbidities. A subgroup of these patients may not be suitable for surgery due to the high risk of postoperative morbidity and mortality.</p><p><strong>Objective: </strong>The aim of this study was to characterize the clinical outcomes, management, social status, and survival of patients deemed nonoperable due to comorbidity and/or frailty.</p><p><strong>Design: </strong>This was a retrospective cohort study.</p><p><strong>Settings: </strong>Overall survival was estimated using the Kaplan-Meier method. Cox proportional-hazards model was used to estimate hazard ratios and 95% confidence intervals for mortality associated modifiable risk factors.</p><p><strong>Patients: </strong>Patients diagnosed with resectable colorectal cancer but deemed nonoperable due to comorbidity and/or frailty by a multidisciplinary team between January 1, 2020, and April 30, 2024, were included in this study.</p><p><strong>Main outcome measures: </strong>The primary outcome was to describe the current population, investigate mortality, and explore mortality-related risk factors in the current population.</p><p><strong>Results: </strong>During the study period, 69 out of 1667 patients were potentially resectable but were deemed nonoperable and included in the study population. The rate of 90-days and 1-year mortality was 20% and 52%, respectively. Three-years after the diagnosis 12% of the patients were alive. At the time of diagnosis, anemia was found in 73% of female patients and 71% of male patients. Additionally, 77% of the patients had hypoalbuminemia. Lower albumin levels were associated with poor survival, hazard ratio of 0.92 (95% confidence interval: 0.88-0.98, p = 0.007).</p><p><strong>Limitations: </strong>The retrospective nature and small sample size inherently limit the generalizability of the study's findings.</p><p><strong>Conclusions: </strong>Mortality in the current population was high. However, our findings highlight potential areas for improvements in the management of these patients. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767349","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":"Survival Outcomes in Patients Undergoing Pelvic Exenteration for Pelvic Mucosal Melanomas: Retrospective Single Institution Australian Study.","authors":"Tae-Jun Kim, Elan Novis, Peter J M Lee, Sascha Karunaratne, Mollie Cahill, Kirk K S Austin, Christopher M Byrne, Michael J Solomon","doi":"10.1097/DCR.0000000000003588","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003588","url":null,"abstract":"<p><strong>Background: </strong>Pelvic mucosal melanomas, including anorectal and urogenital melanomas, are rare and aggressive with a median overall survival of up to 20 months. Pelvic mucosal melanomas behave differently to its cutaneous counterparts and presents late with locoregional disease, making pelvic exenteration its only curative surgical option.</p><p><strong>Objective: </strong>This study aimed to evaluate the survival outcomes post pelvic exenteration in pelvic mucosal melanomas at Royal Prince Alfred Hospital.</p><p><strong>Design: </strong>Retrospective case series from a prospectively collected pelvic exenteration database from October 1994 to November 2023.</p><p><strong>Setting: </strong>Royal Prince Alfred Hospital (quaternary institution), Camperdown, New South Wales, Australia.</p><p><strong>Patients: </strong>Seven patients undergoing pelvic exenteration for pelvic mucosal melanoma.</p><p><strong>Main outcome measures: </strong>Overall survival, disease-free survival, and complication rates.</p><p><strong>Results: </strong>Of the seven patients, most were female (n = 5, 71.4%) and had a median age of 65 years (range, 36-79). Five patients (71.4%) underwent pelvic exenteration for primary pelvic mucosal melanoma; 3 of which were anorectal and 2 vaginal melanomas. Two patients (28.6%) had recurrent anorectal melanoma and received neoadjuvant radiotherapy following an initial wide local excision. Three patients (42.9%) required total pelvic exenteration, while 2 required a central pelvic exenteration (28.6%). The remaining procedures were a central and lateral pelvic exenteration; along with anterior, central and lateral pelvic exenteration. Median length of hospital stay was 19.7 days. Five patients had postoperative complications with one major complication (Clavien-Dindo IIIa). At the study's completion, there were 4 mortalities. Mean survival was 23.6 months (range, 2-100) with a recurrence rate of 83%. Median time to recurrence was 3 months, despite 6 patients (85.7%) having R0 resections. Distant recurrence, i.e. to bone, lung and liver was most common.</p><p><strong>Limitations: </strong>Small study cohort due to rarity of disease, limiting generalizability.</p><p><strong>Conclusion: </strong>Pelvic exenteration for pelvic mucosal melanoma appears to help control local disease as recurrence is most commonly distant or regional. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767384","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}