Diseases of the Colon & Rectum最新文献

{"title":"Prehabilitation for Colorectal Cancer Surgery.","authors":"Jennifer K Vu, Cherry E Koh","doi":"10.1097/DCR.0000000000003456","DOIUrl":"10.1097/DCR.0000000000003456","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626297","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":"Far From Checkmate: Gastrointestinal Neoplasia Risk in Patients With Pathogenic Variants in CHEK2.","authors":"Joshua Sommovilla, Carol A Burke, David Liska","doi":"10.1097/DCR.0000000000003449","DOIUrl":"10.1097/DCR.0000000000003449","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497392","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":"October 2024 Translations.","authors":"","doi":"10.1097/DCR.0000000000003522","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003522","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282034","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":"Efficacy of Traditional Acupuncture Compared to Biofeedback Therapy in Fecal Incontinence: A Randomized Controlled Trial.","authors":"Yvonne Y Ng, Koon Yaw Tan, Yun Zhao, Isaac Seow-En, Aik Yong Chok, Julia Chuang, Megan S Loy, Emile K Tan","doi":"10.1097/DCR.0000000000003357","DOIUrl":"10.1097/DCR.0000000000003357","url":null,"abstract":"<p><strong>Background: </strong>Fecal incontinence has a devastating impact on quality of life and imposes a substantial socioeconomic burden. Best medical therapy, including biofeedback therapy, improves mild symptoms with minimal impact on moderate to severe symptoms. Surgical management for incontinence carries a degree of morbidity, resulting in low uptake and acceptability. Although acupuncture is common practice in Singapore for numerous medical conditions, its role in fecal incontinence is relatively novel. In our local context, however, acupuncture is accessible, inexpensive, and potentially well accepted as a treatment strategy.</p><p><strong>Objective: </strong>To determine the effectiveness of traditional Chinese medicine acupuncture, compared to biofeedback therapy, in the treatment of fecal incontinence. The secondary aim is to investigate the differences in quality of life after treatment.</p><p><strong>Design: </strong>Randomized controlled trial.</p><p><strong>Setting: </strong>Prospective, single-institution study.</p><p><strong>Patients: </strong>Patients with 2 or more episodes of fecal incontinence per week or St. Mark's incontinence score of 5 or higher were recruited. Patients were randomly assigned into biofeedback therapy, which included 3 sessions over 10 weeks, or 30 sessions of acupuncture over 10 weeks.</p><p><strong>Main outcome measures: </strong>Incontinence episodes, St. Mark's score, and fecal incontinence quality-of-life scale.</p><p><strong>Results: </strong>Eighty-five patients were randomly assigned to biofeedback therapy (n = 46) or acupuncture (n = 39). Demographics and baseline clinical characteristics were not different ( p > 0.05). Overall median incontinence episodes were reduced in both, with the acupuncture arm reporting significantly fewer episodes at week 15 ( p < 0.001). Acupuncture also improved quality of life, with improvement in lifestyle, coping, depression, and embarrassment at week 15 ( p < 0.05). Although the St. Mark's score was significantly reduced in both arms at week 15 ( p < 0.001), the acupuncture arm's score was significantly lower ( p = 0.002).</p><p><strong>Limitations: </strong>Longer follow-up is required.</p><p><strong>Conclusions: </strong>Acupuncture is clinically effective and improves the quality of life in patients with fecal incontinence. See Video Abstract .</p><p><strong>Clinical trial registration: </strong>Clinicaltrials.gov : NCT04276350.</p><p><strong>Eficacia de la acupuntura tradicional comparada con la terapia de biorretroalimentacin en la incontinencia fecal un ensayo controlado aleatorio: </strong>ANTECEDENTES:La incontinencia fecal tiene un impacto devastador en la calidad de vida e impone una carga socioeconómica sustancial. La mejor terapia médica, incluida la terapia de biorretroalimentación, mejora los síntomas leves, con un impacto mínimo sobre los síntomas moderados a graves. El tratamiento quirúrgico de la incontinencia conlleva un grado de morbilidad qu","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491308","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":"Just Read the &#%!@?$ Instructions!","authors":"Lester Gottesman","doi":"10.1097/DCR.0000000000003305","DOIUrl":"10.1097/DCR.0000000000003305","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558312","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":"Early Postoperative Prediction of Complications and Readmission After Colorectal Cancer Surgery Using an Artificial Neural Network.","authors":"Annamaria Agnes, Sa T Nguyen, Tsuyoshi Konishi, Oliver Peacock, Brian K Bednarski, Y Nancy You, Craig A Messick, Matthew M Tillman, John M Skibber, George J Chang, Abhineet Uppal","doi":"10.1097/DCR.0000000000003253","DOIUrl":"10.1097/DCR.0000000000003253","url":null,"abstract":"<p><strong>Background: </strong>Early predictors of postoperative complications can risk-stratify patients undergoing colorectal cancer surgery. However, conventional regression models have limited power to identify complex nonlinear relationships among a large set of variables. We developed artificial neural network models to optimize the prediction of major postoperative complications and risk of readmission in patients undergoing colorectal cancer surgery.</p><p><strong>Objective: </strong>This study aimed to develop an artificial neural network model to predict postoperative complications using postoperative laboratory values and compare the accuracy of models to standard regression methods.</p><p><strong>Design: </strong>This retrospective study included patients who underwent elective colorectal cancer resection between January 1, 2016, and July 31, 2021. Clinical data, cancer stage, and laboratory data from postoperative days 1 to 3 were collected. Complications and readmission risk models were created using multivariable logistic regression and single-layer neural networks.</p><p><strong>Setting: </strong>National Cancer Institute-Designated Comprehensive Cancer Center.</p><p><strong>Patients: </strong>Adult patients with colorectal cancer.</p><p><strong>Main outcome measures: </strong>The accuracy of predicting postoperative major complications, readmissions, and anastomotic leaks using the area under the receiver operating characteristic curve.</p><p><strong>Results: </strong>Neural networks had larger areas under the curve for predicting major complications compared to regression models (neural network 0.811; regression model 0.724, p < 0.001). Neural networks also showed an advantage in predicting anastomotic leak ( p = 0.036) and readmission using postoperative day 1 to 2 values ( p = 0.014).</p><p><strong>Limitations: </strong>Single-center, retrospective design limited to cancer operations.</p><p><strong>Conclusions: </strong>In this study, we generated a set of models for the early prediction of complications after colorectal surgery. The neural network models provided greater discrimination than the models based on traditional logistic regression. These models may allow for early detection of postoperative complications as early as postoperative day 2. See the Video Abstract .</p><p><strong>Prediccin post operatoria temprana de complicaciones y reingreso despus de la ciruga de cncer colorrectal mediante una red neuronal artificial: </strong>ANTECEDENTES:Los predictores tempranos de complicaciones postoperatorias pueden estratificar el riesgo de los pacientes sometidos a cirugía de cáncer colorrectal. Sin embargo, los modelos de regresión convencionales tienen un poder limitado para identificar relaciones no lineales complejas entre un gran conjunto de variables. Desarrollamos modelos de redes neuronales artificiales para optimizar la predicción de complicaciones postoperatorias importantes y riesgo de reingreso en pacientes somet","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497391","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":"Clinicopathological Characteristics and Outcomes of Colorectal Cancer With Heterogenous Staining of Mismatch Repair Protein.","authors":"Xian Zhang, Yu-Jue Wang, Lin-Yong Sun, Yin-Xia Tu, Yue Li, Dan Jiang","doi":"10.1097/DCR.0000000000003527","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003527","url":null,"abstract":"<p><strong>Background: </strong>Scant data are available on heterogenous staining of mismatch repair protein in colorectal cancer.</p><p><strong>Objective: </strong>This study aimed to improve insights into clinicopathologic features and prognosis of colorectal cancer harboring heterogenous mismatch repair protein staining.</p><p><strong>Design: </strong>A single-center retrospective observational study.</p><p><strong>Setting: </strong>This study was conducted in a tertiary referral center in China between 2014 and 2018.</p><p><strong>Patients: </strong>Colorectal cancers with heterogenous staining of mismatch repair protein were included.</p><p><strong>Main outcomes measures: </strong>Clinicopathologic and molecular features, and survival outcomes were analyzed.</p><p><strong>Results: </strong>A total of 151 out of 6721 colorectal cancers (2.2%) exhibited heterogenous staining for at least one mismatch repair protein, with intraglandular heterogeneity being the most common pattern (89.4%). Heterogenous MLH1 staining was significantly associated with distant metastasis (p = 0.03), while heterogenous MSH2 staining was associated with left-sided (p = 0.03) and earlier pT stage tumors (p = 0.02). The rates of microsatellite instability-high, KRAS and BRAF mutation were 12.6%, 47.3% and 3.4%, respectively. Microsatellite instability-high was significantly associated with higher intraglandular MSH6 heterogeneity frequency (p < 0.001) and decreased MSH6 expression level (< 27.5%, p = 0.01). BRAF mutation was associated with the coexistence of intraglandular and clonal heterogeneity (p = 0.003) and decreased PMS2 expression level (p = 0.01). Multivariable analysis revealed that progression-free survival was significantly associated with tumor stage (p = 0.003), stroma fraction (p = 0.004), and heterogenous PMS2 staining (p = 0.02). Overall survival was linked to tumor stage (p = 0.006) and BRAF mutation (p = 0.01).</p><p><strong>Limitations: </strong>The limitations of this study include the absence of testing for MLH1 promoter methylation and mismatch repair gene mutations, its retrospective design, and insufficient data related to direct comparison with deficient mismatch repair and proficient mismatch repair colorectal cancer.</p><p><strong>Conclusions: </strong>Heterogenous mismatch repair protein staining in colorectal cancer exhibits distinct associations with tumor location, stage, microsatellite instability, BRAF mutation and prognosis. It is recommended to report MSH6 heterogeneity as it may indicate microsatellite instability-high. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343664","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 Rectal Cuff and Remnant Mesorectum Are Major Preventable Causes of Ileal Pouch Failure.","authors":"Mehmet Gulmez, Pranav Hinduja, Eren Esen, Michael J Grieco, Arman Erkan, Andre da Luz Moreira, John Kirat, Feza H Remzi","doi":"10.1097/DCR.0000000000003530","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003530","url":null,"abstract":"<p><strong>Background: </strong>Long rectal cuff (>2 cm) and remnant mesorectum are known causes of pouch dysfunction due to obstructive defecation, as well as pelvic sepsis after prolonged obstruction.</p><p><strong>Objective: </strong>The aim of this study is to report the rates and the management of patients who underwent re-do ileal pouch anal anastomosis due to pouch failure associated with retained mesorectum and long rectal cuff.</p><p><strong>Design: </strong>This is a retrospective study.</p><p><strong>Settings: </strong>The investigation is based on a quaternary inflammatory bowel disease center.</p><p><strong>Patients: </strong>Patients undergoing re-do ileal pouch anal anastomosis surgery and had long rectal cuff and/or remnant mesorectum between September 2016 and September 2023 were included in the study.</p><p><strong>Main outcome measures: </strong>The main outcomes were functioning pouch rate and functional results.</p><p><strong>Results: </strong>Of the 245 patients who underwent re-do ileal pouch anal anastomosis surgery, 98 (40%) patients had long rectal cuff and/or remnant mesorectum. Re-do ileal pouch anal anastomosis in this patient group was successful (92%) at a median follow-up of 28 (18-52) months.</p><p><strong>Limitations: </strong>The retrospective nature of the study and this is the experience of a single specialized center.</p><p><strong>Conclusions: </strong>Long rectal cuff and remanent mesorectum are major causes of pouch failure which can be successfully managed with re-do ileal pouch anal anastomosis surgery. Nearly half of pouch failure patients who had successful re-do ileal pouch anal anastomosis surgery initially received unnecessary biologic therapy before coming to our center. See Video abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343665","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":"Quality of Life, Functional Outcomes, and Recurrence After Resection Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse Repair.","authors":"Anna R Spivak, Marianna Maspero, Rebecca Y Spivak, Jessica Sankovic, Stephanie Norman, Caitlyn Deckard, Scott R Steele, Tracy L Hull","doi":"10.1097/DCR.0000000000003467","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003467","url":null,"abstract":"<p><strong>Background: </strong>Resection rectopexy and ventral mesh rectopexy are widely accepted surgical options for the treatment of rectal prolapse, however reports on long-term recurrence rates and functional outcomes are lacking.</p><p><strong>Objective: </strong>We compared quality of life, long-term functional outcomes and prolapse recurrence after resection rectopexy versus ventral mesh rectopexy.</p><p><strong>Design: </strong>We retrospectively reviewed our prospectively collected rectal prolapse surgery database.</p><p><strong>Settings: </strong>Patients who underwent resection rectopexy or ventral mesh rectopexy at our center between 2009 and 2016 were included.</p><p><strong>Patients: </strong>Two hundred twenty patients were included, of which 208 (94%) female; 85 (39%) underwent resection rectopexy, 135 (61%) ventral mesh rectopexy.</p><p><strong>Main outcomes measure: </strong>Prolapse recurrence.</p><p><strong>Results: </strong>The resection rectopexy group was younger (median 52 vs 60 years old, p = 0.02) and had more open procedures (20% vs 9%, p < 0.001). After a median follow-up of 110 (IQR 94 - 146) months for resection rectopexy and 113 (87 - 137) for ventral mesh rectopexy, recurrences occurred in 21 (26%) in the resection rectopexy and 50 (39%) in the ventral mesh rectopexy group (p = 0.041). Median time to recurrence was 44 (18 - 80) months in the resection rectopexy group and 28.5 (11 - 52.5) in the ventral mesh rectopexy group (p = 0.14). There were no differences in the recurrence rate for primary prolapses in resection rectopexy vs ventral mesh rectopexy. Recurrence rate for re-do prolapses was higher in the ventral mesh rectopexy group 63% at 10 years, versus 25% in resection rectopexy group (p = 0.006). Functional outcomes were similar between the two groups.</p><p><strong>Limitations: </strong>Retrospective review, recall bias.</p><p><strong>Conclusion: </strong>Long-term quality of life and functional outcomes after resection rectopexy and ventral mesh rectopexy were comparable. Ventral mesh rectopexy was associated with a higher prolapse recurrence rate after recurrent rectal prolapse repair. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343666","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":"Retroperitoneal Approach to D3-Lymph Node Dissection With Left Colic Artery Preservation in the Treatment of Sigmoid Cancer.","authors":"Sergey K Efetov,Arina K Rychkova,Yaroslav P Krasnov","doi":"10.1097/dcr.0000000000003354","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003354","url":null,"abstract":"BACKGROUNDLaparoscopic approaches and robot-assisted operations are used for colorectal cancer surgery because of their minimal invasiveness.1 However, changes in intra-abdominal pressure during laparoscopy can lead to cardiovascular complications in compromised patients;2 obesity and intraabdominal adhesions may further interfere with laparoscopic procedures. The retroperitoneal approach may facilitate minimally invasive surgery, even in patients with comorbidities. The technique for high ligation of the inferior mesenteric artery has been described in left colonic surgeries.3 However, complete termination of the blood supply through this artery may lead to a higher frequency of anastomotic leakage.4.IMPACT OF INNOVATIONWe present a novel retroperitoneal approach for D3-lymph node dissection with low ligation of the inferior mesenteric artery and preservation of the left colic artery. This method can reduce the duration of laparoscopic procedures for compromised patients and meet the standards for extended lymph node dissection with tumor-specific mesocolic excision.5,6.TECHNOLOGY MATERIALS AND METHODSThe procedure started with the installation of a paraumbilical optical trocar to introduce a 30-degree optical system. The SILS™ Port (Covidien, Medtronic) was inserted into the retroperitoneal space via a 4-cm incision, made 2 cm below and parallel to the anterior superior iliac spine in the left flank under the control of the optical system. The horizontal aspect of the duodenum served as the cranial landmark during interfascial dissection, with the dissection proceeding in a cranial and medial direction. During the dissection, the left ureter was the primary landmark, passing medial to the gonadal vessels and Gerota's fascia.The aorta was exposed medially and the inferior mesenteric artery was identified. The inferior mesenteric artery was skeletonized from its origin until the branching of the left colic artery and the sigmoid artery. The left colic artery was skeletonized until the passage of the inferior mesenteric vein, and the apical lymphatic nodes with mesocolic tissue were mobilized and excised. The inferior mesenteric artery was cut below the left colic artery.The final step was performed laparoscopically. The parietal fascia along Toldt's line was cut laterally to complete the mesocolon excision. The parietal fascia was cut along the right side of the aorta to free the mesocolonic medial border. The sigmoid mesocolon was dissected at the proximal and distal resection margins.Following mobilization, the colon was cut 10 cm distal to the tumor margin using a linear stapler. The specimen was then extracted using an SILS incision. The sigmorectal anastomosis was made. Atypical hepatic resection was performed using two additional trocars.PRELIMINARY RESULTSThe incidence of pain syndrome in the early postoperative period was low. Blood loss reached 100 mL. The duration of the surgery was 300 min. The retroperitoneal step took 63 min. Metasta","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259740","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}