Diseases of the Colon & Rectum最新文献

{"title":"Optimal Timing for Rectal Cancer Surgery After Total Neoadjuvant Therapy: When Does Surgery Get Really Challenging?","authors":"Salih N Karahan, Mustafa Oruc, Kamil Erozkan, Michael Valente, Anuradha Bhama, Scott Steele, Hermann Kessler, David Liska, Emre Gorgun","doi":"10.1097/DCR.0000000000003940","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003940","url":null,"abstract":"<p><strong>Background: </strong>Total neoadjuvant therapy is increasingly utilized for locally advanced rectal cancer. However, the optimal interval between total neoadjuvant therapy and surgery remains unclear. Existing trials report intervals ranging from 2-4 weeks to 11-18 weeks, and many surgeons believe surgery becomes more difficult after a certain point, but the exact timing and its impact on complications are unknown.</p><p><strong>Objective: </strong>To identify the time point after total neoadjuvant therapy when surgery becomes more challenging and define an optimal window for minimizing postoperative complications in patients proceeding directly to resection.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Single tertiary care center.</p><p><strong>Patients: </strong>Patients with locally advanced rectal cancer who completed total neoadjuvant therapy between 2015 and 2023 and underwent surgery due to primary disease or regrowth during a watch-and-wait strategy.</p><p><strong>Intervention: </strong>Total neoadjuvant therapy followed by surgery.</p><p><strong>Main outcome measures: </strong>The primary outcome was the association of time from total neoadjuvant therapy completion to surgery with postoperative complication rates. Secondary outcomes included perioperative and postoperative outcomes.</p><p><strong>Results: </strong>Among 212 patients (median age 57 [IQR 50-66], 59% male), 42% experienced complications (15% Clavien-Dindo ≥3). Restricted cubic spline analysis suggested a dip in overall morbidity around 7-12 weeks, with increased risk beyond 24 weeks. Patients operated ≥24 weeks (n = 29) had higher rates of margin positivity (17% vs. 3%, p < 0.01), reoperations (21% vs. 8%, p = 0.04), and severe complications (28% vs. 13%, p = 0.03) compared to those operated earlier (n = 183).</p><p><strong>Limitations: </strong>Single-center retrospective design, univariate spline analysis, and a relatively small subset beyond 24 weeks limit the generalizability.</p><p><strong>Conclusion: </strong>Surgical timing after total neoadjuvant therapy is associated with perioperative outcomes. Delaying surgery beyond 24 weeks is linked to greater surgical difficulty and morbidity. Further multicenter studies are needed to confirm these findings and refine timing recommendations. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946801","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":"Brave New World: Analysis of Early Clinical Experience with Molecular Sequencing in the Treatment of Rectal Cancer.","authors":"Jared T Yee, Ahmed A Eltahir, Oluseye K Oduyale, Austin R Dosch, Nathan Kau, Catherine N Zivanov, Michelle Cowan, Kerri A Ohman, Paul E Wise, Steven R Hunt, Matthew G Mutch, Matthew L Silviera, William C Chapman","doi":"10.1097/DCR.0000000000003950","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003950","url":null,"abstract":"<p><strong>Background: </strong>Advances in genetic sequencing technologies, including somatic next-generation sequencing and circulating tumor DNA assays, have significantly impacted rectal cancer management. However, the clinical implications of these technologies remain incompletely understood.</p><p><strong>Objective: </strong>To evaluate patterns and clinical utility of genetic sequencing among patients with rectal cancer.</p><p><strong>Design: </strong>Retrospective cohort analysis from a prospectively maintained institutional registry.</p><p><strong>Setting: </strong>Single National Cancer Institute-designated cancer center.</p><p><strong>Patients: </strong>A total of 251 patients diagnosed with rectal cancer between January 2017 and April 2024, who underwent genetic testing.</p><p><strong>Interventions: </strong>Somatic tumor sequencing and circulating tumor DNA analysis.</p><p><strong>Main outcome measures: </strong>Response to total neoadjuvant therapy, local recurrence, and distant metastasis.</p><p><strong>Results: </strong>Genetic testing utilization increased substantially from 2017 to 2024, with somatic next generation sequencing testing rising from 3% to 33% and circulating tumor DNA from 2% to over 45%. Tumor mutational burden did not correlate significantly with response to total neoadjuvant therapy, recurrence, or metastasis. Mutation profiles across carcinogenesis pathways showed no significant differences between complete responders and those with residual disease after adjustment (p = 0.145). After total neoadjuvant therapy, circulating tumor DNA positivity strongly correlated with residual disease (sensitivity: 76.5%, specificity: 82.4%; p = 0.0016), with tumor-agnostic circulating tumor DNA assays demonstrating significantly higher sensitivity than tumor-informed tests (100% vs. 50%, p = 0.03).</p><p><strong>Limitations: </strong>Retrospective design, potential selection bias, single-center data.</p><p><strong>Conclusions: </strong>Despite increasing adoption, somatic next generation sequencing alone lacks clear prognostic or predictive utility for rectal cancer management. In contrast, circulating tumor DNA testing demonstrated substantial promise for assessing response to total neoadjuvant therapy, particularly using tumor-agnostic platforms. Further prospective studies are needed to refine clinical guidelines and fully integrate these genetic technologies into rectal cancer care. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946781","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":"Expert Commentary on Management of Colorectal Peritoneal Metastases.","authors":"Jamie Murphy","doi":"10.1097/DCR.0000000000003944","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003944","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946768","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 Colorectal Peritoneal Metastases.","authors":"Lauren Weaver, Paolo Goffredo","doi":"10.1097/DCR.0000000000003943","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003943","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854844","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":"Safety of Hemorrhoid Procedures in Patients who are Immunocompromised: The Mayo Clinic Experience.","authors":"Roy Hajjar, Katherine A Bews, Ian S Reynolds, Sidrah Khan, Lauren Gleason, Emilio Sanchez, William Perry, Kellie L Mathis, Nicholas P McKenna","doi":"10.1097/DCR.0000000000003939","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003939","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhoidal disease and immunosuppression are prevalent. Management of hemorrhoidal disease in this patient population is challenging. Most societies recommend conservative management due to the presumed risks of morbid complications, including sepsis and impaired healing. Data on the risks of office-based and operative procedures in immunocompromised patients is scant.</p><p><strong>Objective: </strong>To evaluate postoperative outcomes after both office-based procedures and operative intervention for hemorrhoidal disease in immunocompromised patients.</p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Settings: </strong>Single-center, tertiary referral center.</p><p><strong>Patients: </strong>Adult patients with hemorrhoidal disease and primarily medication-induced immunosuppression undergoing an office-based procedure or operative intervention for hemorrhoidal disease while on immunosuppression at Mayo Clinic in Rochester between 2010 and 2023.</p><p><strong>Main outcome measures: </strong>The primary outcome was development of infectious complications or wound complications.</p><p><strong>Results: </strong>Fifty-five immunocompromised patients, with a median age of 60, underwent a total of 68 hemorrhoidal procedures during the study time frame. All patients had immunosuppression induced by medication, except for one patient with bone marrow failure syndrome. The most common reason for immunosuppression was rheumatoid arthritis, followed by prior kidney transplant. The most common medications were chronic corticosteroids and methotrexate in over a third of patients each. Of 68 total interventions, hemorrhoidectomy (32%) and excision of a thrombosed hemorrhoid (26%) were the two most common operations performed. Sixteen adverse events were reported in 14 (25%) patients. Three cases of postoperative cellulitis were documented after thrombosed external hemorrhoid excision, hemorrhoidopexy, and Whitehead hemorrhoidectomy. No postoperative intravenous antibiotics were administered. No cases of pelvic sepsis were documented.</p><p><strong>Limitations: </strong>The retrospective nature of the study and the heterogeneity of the study population.</p><p><strong>Conclusions: </strong>These data suggest that office-based and surgical procedures are safe and feasible in patients with immunosuppression. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854845","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 Colorectal Anastomotic Leaks with Endoluminal Vacuum Therapy: A Pragmatic Summary of the Evidence and Definition of Clinical Practices for Patient Selection, Technique, and Follow-up.","authors":"Antonio Caycedo-Marulanda, Nimalan A Jeganathan, Luca Morelli, Simone Guadagni, Nawar Alkhamesi, Raul Eduardo Pinilla-Morales, Anne Fabrizio, Luca C Milone, David R Baquero, Sam B Atallah, Patricia Sylla","doi":"10.1097/DCR.0000000000003935","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003935","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854843","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":"A Predictive Model for Anastomotic Complications After Sphincter-Preserving Surgery for Rectal Cancer: Integrating Clinical and Anatomical Risk Factors.","authors":"Chih-Yu Kuo, Chen-Yin Lee, Ching-Huei Kung, James Chi-Yong Ngu, Li-Jen Kuo","doi":"10.1097/DCR.0000000000003938","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003938","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer surgery presents a technical challenge due to the intricate anatomy of the pelvis, contributing to an increased risk of postoperative complications.</p><p><strong>Objective: </strong>The aim of this study was to assess the prognostic value of clinical and anatomical factors in predicting anastomotic complications after sphincter-preserving surgery for rectal cancer.</p><p><strong>Design: </strong>Retrospective analysis.</p><p><strong>Settings: </strong>Taipei Medical University Hospital.</p><p><strong>Patients: </strong>A total of 527 patients with rectal cancer.</p><p><strong>Interventions: </strong>Robotic or laparoscopic total mesorectal excision between 2012 and 2023.</p><p><strong>Main outcome measures: </strong>Preoperative clinical parameters and magnetic resonance imaging-derived anatomical measurements were subjected to multivariate analysis to develop a predictive model for postoperative anastomotic complications.</p><p><strong>Results: </strong>Over a mean period of 66.2 (6-149) months, the incidence of anastomotic complications following sphincter-preserving surgery was 15.8%. Multivariate logistic regression identified six predictors of anastomotic complications: tumor-to-anal verge distance (p = 0.003), interspinous diameter (p = 0.030), clinical N stage (p = 0.047), angle α (p = 0.015), carcinoembryonic antigen level (p = 0.046), and American Society of Anesthesiologists classification (p = 0.015). These variables were incorporated into the final model, with an area under the receiver operating characteristic curve of 0.70 (95% confidence interval: 0.60-0.78). The top three predictors of anastomotic complications were tumor-to-anal verge distance, interspinous diameter, and clinical N stage.</p><p><strong>Limitations: </strong>All data were obtained from a single institution, the study was retrospective, all pelvimetric measurements were obtained manually (introducing the possibility of interobserver variability and measurement error), and the parameters analyzed were limited to two-dimensional measurements.</p><p><strong>Conclusions: </strong>These findings highlight the role of clinical variables and pelvimetry in predicting anastomotic complications after minimally invasive rectal surgery. The developed regression model is a practical tool for refining preoperative planning and informed decision-making. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854908","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 \"Role of Neoadjuvant Immune Checkpoint Inhibitors in Locally Advanced Rectal Cancer: A Systematic Review of Currently Available Studies\".","authors":"William C Chapman","doi":"10.1097/DCR.0000000000003936","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003936","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816016","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":"How Frequently Is Colorectal Cancer Recurrence Detected in Clinic?","authors":"Gajan Srikumar, Scott J P McLaughlin, Jaxon Jebbink, Naeun Hwang, Jackson Teh, Matthew J McGuinness, Ian P Bissett, Christopher Harmston","doi":"10.1097/DCR.0000000000003934","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003934","url":null,"abstract":"<p><strong>Background: </strong>Outpatient clinic follow-up has been standard practice for decades following resection of colorectal cancer, however recent evidence regarding its efficacy in oncological detection is limited. With increasing health limitations and rising numbers of colorectal cancer patients, the role of clinic follow-up may need re-evaluation.</p><p><strong>Objective: </strong>The aim of this study is to determine the frequency of clinical examination compared to other modalities in identification of colorectal cancer recurrence in Northland.</p><p><strong>Design: </strong>Retrospective review of detection modalities for recurrence in colorectal cancer.</p><p><strong>Setting: </strong>Northland region of New Zealand between January 2013 and December 2022.</p><p><strong>Patients: </strong>Stage I - IV who underwent curative-intent surgery for colorectal adenocarcinoma.</p><p><strong>Main outcome measures: </strong>The primary outcome was frequency of the initial mode of recurrence detection (computed tomography, carcinoembryonic antigen, colonoscopy, clinical examination and other modalities). Secondary outcomes were frequency of symptomatic presentation, detecting clinician, site, timing, and survival compared by mode of detection.</p><p><strong>Results: </strong>From 747 patients with a median follow-up of 4.3 years, 157 (21.0%) had recurrence. The most frequent mode of detection was computed tomography (n = 85, 54%), followed by carcinoembryonic antigen (n = 43, 27%), colonoscopy (n = 9, 6%), other modalities (n = 16, 10%) and clinical examination (n = 4, 3%). There were 45 (29%) symptomatic presentations. Two examination recurrences were detected by the general practitioner and two at outpatient clinic, with three out of four being symptomatic. Recurrence detected by colonoscopy had significantly better 5-year overall survival (77.8%, p = 0.022) than computed tomography (30.9%) or carcinoembryonic antigen (38.3%), but most colonoscopy-detected recurrences were locoregional.</p><p><strong>Conclusions: </strong>Outpatient clinic examination in identifying recurrence, particularly asymptomatic, made up only a very small proportion of recurrence detection methods. Given the minimal oncological benefit, alternative resource-saving strategies for clinic follow-up need consideration. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816015","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":"Role of Neoadjuvant Immune Checkpoint Inhibitors in Locally Advanced Rectal Cancer: A Systematic Review of Currently Available Studies.","authors":"Milton Mui, Joseph Ch Kong, Michael Michael, Robert Ramsay, Nicholas Clemons, Alexander G Heriot","doi":"10.1097/DCR.0000000000003927","DOIUrl":"10.1097/DCR.0000000000003927","url":null,"abstract":"<p><strong>Background: </strong>Over the last few decades, the standard of care for locally advanced rectal cancer, involving neoadjuvant chemoradiation followed by surgery, is associated with a pathological complete response rate of only 10-20%. Combination therapy with immune checkpoint inhibitors may improve treatment response.</p><p><strong>Objective: </strong>This systematic review examines the current evidence regarding neoadjuvant immune checkpoint inhibitors in locally advanced rectal cancer in terms of treatment efficacy, impact on surgical outcomes, and potential adverse events.</p><p><strong>Data sources: </strong>A literature search was conducted using the Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Library databases from start of database records to October 31, 2024.</p><p><strong>Study selection: </strong>All studies that reported outcomes in patients with locally advanced rectal cancer who received immune checkpoint inhibitors as part of their neoadjuvant treatment were included for examination.</p><p><strong>Main outcome measures: </strong>Primary outcome was pathological complete response rate. Secondary outcomes were major pathological response rate, clinical complete response rate, complete response rate, R0 resection rate, and sphincter preservation rate. Safety data were included where available. Potential biomarkers of treatment response were identified.</p><p><strong>Results: </strong>Twelve studies were reviewed. All were prospective phase I/II clinical trials. The overall pathological complete response rate ranged from 25-62.5% (50% for dMMR/MSI-H; 25-62.5% for pMMR/MSS). The clinical complete response rate ranged from 10.9-100% (56-100% for dMMR/MSI-H; 16.4-48% for pMMR/MSS). The complete response rate ranged from 44-75% (75% for dMMR/MSI-H; 44-56.5% for pMMR/MSS). The R0 resection rate ranged from 94-100% and sphincter preservation rate from 59.4-100%. Majority of adverse events were Grades 1 & 2.</p><p><strong>Limitations: </strong>Our review was limited by a small number of mostly single-arm studies with lack of long-term survival outcomes, as well as marked clinical and methodological heterogeneity among included studies.</p><p><strong>Conclusion: </strong>Combination therapy with immune checkpoint inhibitors in locally advanced rectal cancer appears to improve treatment response but high-level evidence and long-term data are still lacking.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815983","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}