International Journal of Colorectal Disease最新文献

{"title":"Evaluation of anastomotic blood supply during digestive tract reconstruction with the use of the oxygen saturation index: A pooling up analysis.","authors":"Xiao-Qiang Zhang, Chao-Fu Zhang, Xiang-Jun Zhou, Lei-Yuan Shuai, Dong Peng, Guang-Yan Ji","doi":"10.1007/s00384-025-04864-3","DOIUrl":"10.1007/s00384-025-04864-3","url":null,"abstract":"<p><strong>Purpose: </strong>Anastomotic leakage (AL) is one of the most serious clinical complications in digestive tract reconstruction (DTR) surgery, and it is currently hypothesized that this may be related to insufficient anastomotic blood supply. Thus, Therefore, we aimed to assess the ability of tissue oxygen saturation(StO₂) as a measure to evaluate anastomotic blood supply.</p><p><strong>Methods: </strong>A comprehensive literature search was performed using Embase, PubMed and Cochrane Library. StO₂ was used as an evaluation index of anastomotic blood supply after DTR to analyze the potential association between this index and the occurrence of AL in the postoperative period.</p><p><strong>Results: </strong>A total of eleven articles involving 867 participants were included in this systematic review and meta-analysis. After pooling the standardized mean difference (SMD) and 95% confidence intervals (Cls), low StO₂ was found to be an independent risk factor for AL (P < 0.00001; 95%CI: 1.02 [0.53-1.51]). The mean StO₂ in the AL group (62.3%) was significantly lower than that in the non-AL group (74.3%); AL incidence increased with the reduction of StO₂ to a certain value to 201.8% and 338.1% respectively.</p><p><strong>Conclusion: </strong>Oxygen saturation index can be utilized in DTR to accurately and quantitatively evaluate the anastomotic blood supply to reduce the probability of postoperative AL.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"71"},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of cancer-specific survival prediction nomogram for patients with T4 stage colon cancer after surgical resection: a population-based study.","authors":"Yuncan Xing, Sirui Zhu, Liang Zhou, Jiawei Tu, Zheng Wang","doi":"10.1007/s00384-025-04856-3","DOIUrl":"10.1007/s00384-025-04856-3","url":null,"abstract":"<p><strong>Purpose: </strong>The increasing incidence of colorectal cancer has coincided with a rise in T4 stage colon cancer (CC), yet research on its prognosis remains limited. This study aimed to identify risk factors and develop a nomogram to predict cancer-specific survival (CSS), optimizing treatment strategies for different subgroups.</p><p><strong>Methods: </strong>Using data from the from the Surveillance, Epidemiology, and End Results (SEER) database, we identified risk factors in T4 stage CC patients and created a nomogram to predict CSS. Patients were divided into low- and high-risk groups, and the nomogram was validated. Propensity score matching was used to evaluate the benefits of various therapies across subgroups.</p><p><strong>Results: </strong>Independent risk factors, including T stage, N stage, tumor grade, age, and therapy sequence, were identified through Cox regression analyses and incorporated into the nomogram. The nomogram outperformed the American Joint Committee on Cancer (AJCC) 7th staging system, with a Concordance-index of 0.77 in both training and validation sets. The receiver operating characteristic curves showed area under the curve values of 0.81, 0.77, and 0.75 for 1-, 3-, and 5-year CSS, respectively. Calibration plots confirmed strong alignment between predicted and actual outcomes, and decision curve analysis highlighted the nomogram's superior clinical utility. Chemotherapy significantly improved CSS, while radiation did not. Adjuvant therapy was particularly beneficial in high-risk groups.</p><p><strong>Conclusion: </strong>This study offered a thorough prognostic analysis of T4 stage colon cancer patients and developed nomograms for predicting CSS. Subgroup analyses highlight the potential benefits of various treatment options.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"72"},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk-multicentre retrospective study.","authors":"Mohamed Talaat Issa, Emiko Sultana, Mohammed Hamid, Ali Yasen Mohamedahmed, Mohamed Albendary, Shafquat Zaman, Santosh Bhandari, William Ball, Sangara Narayanasamy, Pradeep Thomas, Najam Husain, Rajeev Peravali, Diwakar Sarma","doi":"10.1007/s00384-025-04858-1","DOIUrl":"10.1007/s00384-025-04858-1","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up.</p><p><strong>Methods: </strong>We performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant.</p><p><strong>Results: </strong>A total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51-73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3-7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations.</p><p><strong>Conclusion: </strong>The incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant lesions.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"68"},"PeriodicalIF":2.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of leptin on postoperative peritoneal adhesion formations in colorectal resection.","authors":"Takeru Maekawa, Toru Miyake, Masatsugu Kojima, Soichiro Tani, Takashi Matsunaga, Yusuke Nishina, Sachiko Kaida, Hiromitsu Maehira, Tomoharu Shimizu, Masaji Tani","doi":"10.1007/s00384-025-04851-8","DOIUrl":"10.1007/s00384-025-04851-8","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative peritoneal adhesion formation (PAF) is a distressing complication. Leptin, secreted by fat tissues, may be associated with PAF. However, the relationships between PAF and leptin are unclear. This study investigated the impact of leptin on PAF after colorectal tumor resection.</p><p><strong>Methods: </strong>A cecum cauterization mouse model was used to investigate PAF and its association with leptin. Mice adhesion score (AS) was evaluated on day 7 after treatment. The clinical study included patients who underwent elective colorectal resection with temporary ileostomy between April 2021 and December 2024. The AS was evaluated at the time of ileostomy closure. Patients with the highest AS quartile were classified into the high-AS group; clinical factors associated with PAF were examined. An enzyme-linked immunosorbent assay was used to measure human and murine serum leptin concentrations.</p><p><strong>Results: </strong>The animal experiment revealed that serum leptin levels on postoperative day 7 were negatively correlated with mice ASs (P = 0.0043, r = -0.6241). In a clinical study, eight patients had a high AS (27.6%). Visceral fat mass and preoperative serum leptin levels were higher in the high-AS group than in the low-AS group. The serum leptin ratio (postoperative value to preoperative value) on postoperative day 7 was lower in the high-AS group. In multivariate analysis, the serum leptin ratio was an independent factor for classifying into the high-AS group.</p><p><strong>Conclusions: </strong>A decrease in postoperative serum leptin levels was associated with severe PAF. Leptin may be a novel key molecule in PAF.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"67"},"PeriodicalIF":2.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI navigation surgery for T4b rectal cancer using multiple minimally invasive surgical approaches.","authors":"Madoka Hamada, Yuki Matsumi, Ryo Inada, Tomoko Matsumoto, Masato Kita, Shogen Boku, Hiroaki Kurokawa, Koji Tsuta","doi":"10.1007/s00384-025-04838-5","DOIUrl":"10.1007/s00384-025-04838-5","url":null,"abstract":"<p><strong>Background: </strong>These days, various surgical techniques such as trans-anal, trans-perineal total mesorectal excision, and transvaginal natural orifice transluminal endoscopic surgery have been utilized with flexibility, which was not possible before the laparoscopic era.</p><p><strong>Methods: </strong>From January 2014 to January 2023, 40 cases of c(yc)T4b rectal cancer underwent local curative surgery laparoscopically at Kansai Medical University Hospital. In 25 consecutive cases, we adopted multiple approaches (trans-anal total mesorectal excision, transvaginal natural orifice transluminal endoscopic surgery, trans-perineal total mesorectal excision, or prone position first abdominoperineal excision) to remove the deepest part of the tumor indicated by MRI last as the specimen-oriented surgery. The remaining 15 patients underwent top-to-bottom surgery based on standard surgery. The primary endpoint was the local recurrence rate of the specimen-oriented surgery group compared to that of the standard surgery group.</p><p><strong>Results: </strong>The specimen-oriented surgery group had a median follow-up of 3.9 (0.4-7.4) years with no local recurrence, while the standard surgery group had a median follow-up of 1.5 (0.7-3.7) years with 5 of 15 patients (33%) experiencing more local recurrence than specimen-oriented surgery group (p = 0.005). Comparison of the local recurrence ( +) and ( -) groups showed significant differences in pCRM positive rate, neoadjuvant therapy, tumor size, and approach (specimen-oriented surgery vs. standard surgery) in univariate analysis (p < 0.05). Still, no significant differences were found in the multivariate analysis.</p><p><strong>Conclusions: </strong>In the laparoscopic setting, local cure of c(yc)T4b rectal cancer requires a different strategy than open surgery, and specimen-oriented surgery may be a promising procedure.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"66"},"PeriodicalIF":2.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic proctocolectomy with ileal pouch-anal anastomosis: a hybrid approach.","authors":"Pietro Calabrese, Orsalia Mangana, Carlo Alberto Manzo, Laura Muirhead, Valerio Celentano","doi":"10.1007/s00384-025-04854-5","DOIUrl":"10.1007/s00384-025-04854-5","url":null,"abstract":"<p><strong>Purpose: </strong>Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the definitive surgical treatment for patients with ulcerative colitis or familial adenomatous polyposis. While laparoscopic surgery has been widely adopted, robotic surgery has emerged as a promising alternative, particularly for complex pelvic dissection. However, the robotic learning curve presents significant challenges. This study introduces a hybrid approach combining robotic and laparoscopic techniques to leverage the strengths of both, with a focus on the impact of the robotic learning curve and surgical training.</p><p><strong>Methods: </strong>All patients undergoing hybrid or laparoscopic proctocolectomy with IPAA for ulcerative colitis between 2022 and 2024 were included. Data on patient characteristics and postoperative outcomes were collected prospectively. Primary outcomes were operating time and 30-day morbidity. All robotic procedures were performed by a consultant surgeon within their first 100 robotic cases.</p><p><strong>Results: </strong>A total of 25 patients were included: 14 in the hybrid group and 11 in the laparoscopic group. The median operating time was 300 min for the hybrid approach versus 325 min for the laparoscopic approach. In the hybrid surgery group, between 72 and 90% of the laparoscopic part of the procedure was performed by a supervised surgical trainee.</p><p><strong>Conclusions: </strong>The hybrid robotic-laparoscopic approach offers potential benefits over pure laparoscopy by reducing operative time and postoperative complications. Additionally, it provides a structured modular training opportunity, allowing surgeons to develop both laparoscopic and robotic skills, particularly during the early stages of their robotic learning curve.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"63"},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of radiotherapy with secondary pelvic cancers in male patients with rectal cancer.","authors":"Lei Liu, Shanglong Liu, Xiaomin Xia, Longbo Zheng, Xianxiang Zhang, Jilin Hu, Yiheng Ju, Yuan Gao, Yun Lu","doi":"10.1007/s00384-025-04840-x","DOIUrl":"10.1007/s00384-025-04840-x","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to explore the risk of secondary prostate cancer (SPC) and secondary bladder cancer (SBC) in male rectal cancer (RC) patients after radiotherapy (RT) and to assess survival outcomes.</p><p><strong>Methods: </strong>This large population-based study included men with RC from nine registries in the Surveillance, Epidemiology, and End Results (SEER) database between 1973 and 2015. Fine-Gray competing risks and Poisson regression were used to assess the RT-related risk of SPC and SBC in patients who received RT versus those who did not (NRT).</p><p><strong>Results: </strong>After exclusion, 28,886 RC patients were included in further analysis, including 9763 RT-treated patients (33.8%) and 19,123 patients not treated with RT (66.2%). In competing risk regression analysis, RT was associated with a low risk of developing SPC (adjusted HR = 0.67; 95% CI = 0.64-0.82; P < 0.001) and with a high risk of developing SBC (adjusted HR = 1.44; 95% CI = 1.15-1.80; P = 0.001). In the survival analysis of SPC patients, the NRT group exhibited better 10-year OS and CSS than the RT group (OS: HR = 0.52; 95% CI = 0.43-0.64; P < 0.001; CSS: HR = 0.39; 95% CI = 0.26-0.56; P < 0.001).</p><p><strong>Conclusion: </strong>Male rectal cancer patients receiving RT had a decreased risk of SPC and an increased risk of SBC, and the prognosis of SPC patients in the RT group was worse compared to that of the NRT group. Follow-up and monitoring of SBC and SPC should not be ignored.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"65"},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of surgical site infection on short- and long-term outcomes of robot-assisted rectal cancer surgery: a two-center retrospective study.","authors":"Shuangming Lin, Hao Zeng, Xiaojie Wang, Xueyi Xue, Yushuo Chen, Baodong Liao, Ying Huang, Dongbo Xu, Pan Chi","doi":"10.1007/s00384-025-04842-9","DOIUrl":"10.1007/s00384-025-04842-9","url":null,"abstract":"<p><strong>Purpose: </strong>Robot-assisted surgery has increasingly gained recognition in the treatment of rectal cancer. This study aimed to assess the incidence of surgical site infection (SSI) that underwent robot-assisted radical rectal cancer surgery and to evaluate their influence on patient outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 360 patients who underwent robot-assisted radical rectal cancer surgery between 2017 and 2024 at Fujian Medical University Union Hospital and Longyan First Affiliated Hospital of Fujian Medical University. The patients were categorized into surgical site infection and non-surgical site infection groups based on the presence of surgical site infection. Baseline clinicopathological characteristics, perioperative details, and follow-up data were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of surgical site infection, and Cox proportional hazards regression models were utilized to evaluate factors influencing overall survival.</p><p><strong>Results: </strong>The study found that 44 out of 360 patients (12.2%) developed surgical site infection. Multivariate analysis indicated that positive perineural invasion (OR 3.59, 95% CI 1.50-8.62, P = 0.004) is an independent risk factor for SSI. Low anterior resection (OR 0.26, 95% CI 0.09-0.73, P = 0.011), preservation of the left colonic artery (OR 0.20, 95% CI 0.09-0.44, P < 0.001), and neoadjuvant therapy (OR 0.45, 95% CI 0.23-0.89, P = 0.021) were associated with reduced risks of SSI. The presence of SSI was significantly associated with a reduction in overall survival (HR 3.43, 95% CI 1.30-9.04, P = 0.012). The risk of developing surgical site infection increases with the number of risk factors, and patients with two or more risk factors have a much higher risk of developing SSI.</p><p><strong>Conclusions: </strong>This study identified perineural invasion as an independent risk factor for the development of SSI that underwent robot-assisted radical rectal cancer surgery. Low anterior resection, preservation of the left colonic artery, and neoadjuvant therapy emerged as protective factors. Moreover, the presence of surgical site infection was significantly correlated with poorer overall survival.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"64"},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study.","authors":"Tamer A A M Habeeb, Massimo Chiaretti, Igor A Kryvoruchko, Antonio Pesce, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A M Adam, Mohamed A Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H Alsayed, Esmail Tharwat Kamel Awad, Mohammed Hassan Elshafey, Mohamed Ibrahim Abo Alsaad, Abouelatta Kh Ali, Hamdi Elbelkasi, Mahmoud Ali Abou Zaid, Hoda A A Youssef, Mona Mohammad Farid Al-Zamek, Alaa Fiad, Tamer Mohamed Elshahidy, Mahmoud R Elballat, Ahmed Kamal El Taher, Mohamed Mahmoud Mokhtar Mohamed, Ahmed Khaled AboZeid, Mohamed Ibrahim Mansour, Mahmoud Abdou Yassin, Ahmed Salah Arafa, Mohamed Lotfy, Bassam Mousa, Baher Atef, Sameh Mohamed Naguib, Ibrahim A Heggy, Mohamed Elnemr, Mohamed Abdallah Zaitoun, Ehab Shehata AbdAllah, Mohamad S Moussa, Abd Elwahab M Hamed, Rasha S Elsayed","doi":"10.1007/s00384-025-04846-5","DOIUrl":"10.1007/s00384-025-04846-5","url":null,"abstract":"<p><strong>Purpose: </strong>There is no consensus on the standard approach for trans-sphincteric perianal fistulas (TPAF) in the elderly population. The most commonly used sphincter-saving procedures are ligation of the inter-sphincteric fistula tract (LIFT) and mucosal advancement flap (MAF). We aimed to evaluate the incidence and risk factors for recurrence and incontinence in elderly patients with TPAF using both approaches.</p><p><strong>Methods: </strong>This retrospective study included 257 patients who underwent LIFT (136 patients) or MAF (121 patients) for de novo and cryptoglandular TPAF between July 2018 and July 2021. Recurrent fistulas were clinically and radiologically detected using MRI. Postoperative incontinence was evaluated using the Wexner score and anorectal manometry. Logistic regression analysis was used to detect the risks of recurrence and incontinence.</p><p><strong>Results: </strong>The median ages of the patients were 68 (64, 74) and 68 (65, 74) years in the LIFT and MAF groups, respectively. Higher recurrence rates were observed after LIFT (17 (12.5%)) than after MAF (13 (10.7%)), but the difference was not statistically significant (P = 0.662). Postoperative incontinence was observed in 18 patients (13.2%) and seven patients (5.8%) in the LIFT and MAF groups, respectively (P = 0.044). The predictors for fistula recurrence were smoking (OR, 75.52; 95% CI, 1.02 to 5611.35; P = 0.049), length of tract (OR, 17.3; 95% CI, 1.49 to 201.13; P = 0.023), and CD classification (OR, 7.08; 95% CI, 1.51 to 33.14; P = 0.013). A low Charlson comorbidity index score (≤ 5) (OR, 0.68; 95% CI, 0.47 to 0.99; P = 0.046) and high postoperative mean squeeze anal pressure (OR, 0.97; 95% CI, 0.95 to 0.99; P = 0.001) were significant factors associated with reduced risk of incontinence. In particular, LIFT was associated with a significantly higher risk of incontinence than MAF (OR, 2.089; 95% CI, 1.006 to 4.33; P = 0.04).</p><p><strong>Conclusions: </strong>The healing rates of MAF and LIFT procedures did not differ significantly; however, continence was significantly better after MAF. MAF should be added to the guidelines as a good option for the treatment of TPAF in elderly patients.</p><p><strong>Trial registration: </strong>The study was registered as a clinical trial www.</p><p><strong>Clinicaltrials: </strong>gov (NCT06616662).</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"61"},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating organ preservation strategies versus radical surgery in T2N0 rectal cancer: survival outcomes and tumor size impact.","authors":"Qiuhan Yao, Wei-Yu Yang","doi":"10.1007/s00384-025-04857-2","DOIUrl":"10.1007/s00384-025-04857-2","url":null,"abstract":"","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"62"},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}