International Journal of Colorectal Disease最新文献

{"title":"Single-center experience with robotic colorectal surgery for benign indications.","authors":"Sowmiya Gunabalasingam, Krupa George, Chamaldi de Silva, Selena Tsz Wai Chang, Fang Yi Cheung, Valentin Butnari, Phakanant Chaichanavichkij, Sandeep Kaul, Matthew Hanson, Richard Boulton, Joseph Huang, Nirooshun Rajendran","doi":"10.1007/s00384-026-05179-7","DOIUrl":"10.1007/s00384-026-05179-7","url":null,"abstract":"<p><strong>Purpose: </strong>Robotic colorectal surgery is established for malignant indications, but evidence supporting its use in benign disease remains limited. We describe perioperative outcomes of 403 consecutive robotic colorectal resections across all indications at a single UK NHS center, with primary focus on safety across benign indications.</p><p><strong>Methods: </strong>Retrospective analysis of a prospectively maintained database (February 2020-November 2025). Cases were stratified by indication: malignant or highly suspected malignancy (n = 332, 82.4%) and benign (n = 71, 17.6%). Benign cases were subclassified into diverticular disease (n = 39), ulcerative colitis (n = 14), Crohn's disease (n = 13), and other (n = 5). Primary outcomes were operative time, length of stay, and Clavien-Dindo complication grade.</p><p><strong>Results: </strong>Benign patients were younger (median 53 vs. 68 years; p < 0.001) with higher rates of prior abdominal surgery (33.8% vs 19.6%; p = 0.012). Across all 403 cases, median operative time was 240 min (IQR 199-302), median LOS 5 days (IQR 4-8), and CD Grade III-IV rate 9.2%. Despite equivalent operative times (p = 0.84), benign cases converted more frequently (15.5% vs 6.9%; p = 0.031), independently predicted by age (OR 1.04; p = 0.013), and cancer indication (OR 0.31; p = 0.012). Within the benign cohort, IBD patients were younger than those with diverticular disease (p < 0.001). Procedure type and stoma rates differed significantly by subgroup (both p < 0.001), yet complication rates, operative time, and LOS were equivalent.</p><p><strong>Conclusion: </strong>Robotic colorectal surgery is safe and reproducible across malignant and benign indications within specialised colorectal robotic centers. Complication profiles matched published benchmarks. Benign cases had a higher conversion rate, but this was driven by prior surgical burden and operative complexity, not platform limitation, and it did not increase morbidity. These data constitute the largest single-center UK evidence base for robotic colorectal surgery across all indications and support the expansion of robotic commissioning into benign practice.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368197","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":"Diagnostic yield of the one-year surveillance colonoscopy after curative colorectal cancer resection.","authors":"Jenna Cross, Garrett Johnson, Harminder Singh, Farhana Shariff, Eric Hyun, Ramzi Helewa","doi":"10.1007/s00384-026-05187-7","DOIUrl":"10.1007/s00384-026-05187-7","url":null,"abstract":"<p><strong>Purpose: </strong>Guidelines recommend routine colonoscopy 1 year after curative colorectal cancer resection, despite limited evidence supporting its diagnostic yield. This study evaluated the real-world outcomes of 1-year surveillance colonoscopy following colorectal cancer resection.</p><p><strong>Methods: </strong>This is a retrospective observational study using pathology, clinic, and endoscopy data patients who underwent segmental oncologic resection for primary colon or rectal. Adenocarcinoma between January 2007 and June 2020 in Winnipeg, Manitoba. Patients were excluded if they had a total proctocolectomy, if no follow-up colonoscopy data were available, or if the date of the first surveillance scope was < 6 months or > 24 months from surgery. Colonoscopy findings were categorized as adenocarcinoma, advanced adenoma, simple adenoma or normal.</p><p><strong>Results: </strong>A total of 454 patients met the inclusion criteria. The 1-year surveillance colonoscopy detected 2 (0.44%) adenocarcinomas, 3 (0.66%) advanced adenomas, and 87 (19.2%) simple adenomas. The majority (n = 362, 79.7%) had normal colonoscopy results. Preoperative bowel preparation quality was not reported for either recurrent adenocarcinoma. Neither of the recurrent adenocarcinomas was associated with elevated carcinoembryonic antigen (CEA), abnormal imaging, or known hereditary cancer syndromes.</p><p><strong>Conclusions: </strong>Our data demonstrate a low observed rate of clinically significant findings at 1-year surveillance colonoscopy following colorectal cancer resection. Incomplete documentation of index colonoscopy quality limited assessment of whether surveillance findings represented true metachronous lesions or lesions missed at the preoperative examination. Given the low event rate and observational study design, these findings should be interpreted as descriptive real-world data regarding postoperative surveillance outcomes.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338590","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":"Malignancy as a rising contributor to mortality in patients with inflammatory bowel disease: a population-based epidemiological study.","authors":"Amr Ahmed Aly Ibrahim, Mahmoud Shaaban Abdelgalil, Sara Hosny El-Farargy, Rahma Sameh Shaheen, Moaz Yasser Darwish, Ahmad Abdelrazek, Sara Metwally, Mohamed Adel Nassef, Karim Samir Attia, Mohamed Abd-ElGawad","doi":"10.1007/s00384-026-05161-3","DOIUrl":"10.1007/s00384-026-05161-3","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is associated with increased malignancy risk. This study assessed national trends in malignancy-related mortality among United States IBD patients from 1999 to 2020 using representative data.</p><p><strong>Methods: </strong>A retrospective, population-based analysis was conducted using the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database. Deaths among individuals with IBD were identified using ICD-10 codes K50 and K51, while malignancy-related deaths were captured using codes C00-C97. Crude and Age-adjusted mortality rates (AMRs) were calculated and stratified by sex, ethnicity, region, state, and age group. Linear regression models evaluated trends and forecast malignancy-related mortality through 2030.</p><p><strong>Results: </strong>Between 1999 and 2020, 9,531 malignancy-related deaths occurred among IBD patients. Malignancy-related deaths rose significantly, increasing by 108.3% (p = 0.010, R² = 0.439). Higher AMRs were observed among males (p = 0.009), White individuals (p = 0.019), Midwest residents (p = 0.015), and patients aged ≥ 65. The largest relative increases were among females (55.2%), White individuals (55.1%), West residents (75.2%), and those aged 65-74 years (72.6%). Lung and colon cancers were the leading causes of malignancy-related deaths. Projections suggest continued rises in malignancy-related AMRs, particularly among CD patients, while UC patients remain relatively stable.</p><p><strong>Conclusion: </strong>Malignancy is an increasingly important contributor to mortality among US IBD patients, particularly older adults, males, Midwest residents and White individuals. These findings highlight the need for enhanced cancer surveillance, equitable healthcare access, and integrated long-term management of IBD populations.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"41 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338513","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":"The 'other' colonic polyposis syndromes-evolving insights and guidance for endoscopists.","authors":"Amanda Liesegang, Andy Wu, Alexander Heriot, Glen Guerra","doi":"10.1007/s00384-026-05186-8","DOIUrl":"10.1007/s00384-026-05186-8","url":null,"abstract":"<p><strong>Purpose: </strong>Polyposis syndromes contribute to a significant proportion of colorectal cancer (CRC) diagnoses. While Lynch syndrome (LS) and familial adenomatous polyposis (FAP) are well characterised, a growing number of rarer polyposis syndromes are increasingly recognised in clinical practice. These conditions often present with overlapping phenotypes and variable penetrance, posing diagnostic and management challenges for the practising clinician. The evidence base remains limited, with current guidance largely derived from small cohort studies and expert opinion. This narrative review summarises the current literature on the genetic basis, clinical manifestations, and endoscopic features of the rarer colorectal polyposis syndromes, excluding LS and FAP.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed and Ovid databases. Selected articles were evaluated for relevance and quality, and key findings were synthesised narratively to provide an overview of current knowledge and emerging trends relating to the rarer polyposis syndromes.</p><p><strong>Results: </strong>This review consolidates international recommendations for surveillance and management, with a focus on practical guidance for the endoscopist. Advances in next-generation sequencing and multigene panel testing have reshaped our understanding of polyposis genetics, leading to the identification of several novel autosomal dominant and recessive syndromes. Despite these discoveries, surveillance protocols remain heterogeneous, and gaps persist in defining cancer risk, optimal timing of intervention, and the role of chemoprevention. Greater awareness of these syndromes among clinicians is essential for timely diagnosis and personalised management.</p><p><strong>Conclusion: </strong>Collaborative registries, prospective data, and consensus-driven guidelines are urgently required to standardise care and improve outcomes for patients with rare polyposis syndromes.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317045","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":"Prognostic value of D3 lymph node dissection and nutritional status in colorectal cancer patients aged 80 years and older.","authors":"Yasuhiro Ishiyama, Yasumitsu Hirano, Sohei Akuta, Yume Minagawa, Akihito Nakanishi, Yusuke Nishi, Hisashi Hayashi, Takatsugu Fujii, Hirofumi Sugita, Chikashi Hiranuma","doi":"10.1007/s00384-026-05180-0","DOIUrl":"10.1007/s00384-026-05180-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of D3 lymph node dissection and nutritional status on outcomes in patients aged ≥80 years with colorectal cancer.</p><p><strong>Methods: </strong>We retrospectively analyzed patients aged ≥80 years who underwent curative resection for stage I-III colorectal cancer between April 2007 and February 2020. Patients were divided into D3 and non-D3 lymph node dissection groups. Propensity score matching was performed to reduce baseline differences. Short- and long-term outcomes, including overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS), were compared. Multivariate Cox regression analyses were used to identify independent prognostic factors, with particular attention to the prognostic nutritional index (PNI). Competing-risk analysis for cancer-specific death was also conducted.</p><p><strong>Results: </strong>After propensity score matching, 272 patients (136 per group) were analyzed. The D3 group showed significantly better OS (5-year: 73.5% vs. 60.0%, P = 0.0039) and DFS (5-year: 69.5% vs. 56.1%, P = 0.0099) than the non-D3 group. CSS was not significantly different on Kaplan-Meier analysis; however, competing-risk analysis demonstrated a significantly lower cumulative incidence of cancer-specific death in the D3 group (5-year: 23.0% vs. 29.6%, P = 0.024). Multivariate analysis identified D3 dissection and PNI ≥ 45 as independent favorable prognostic factors for OS, DFS, and CSS.</p><p><strong>Conclusions: </strong>In patients aged ≥80 years with colorectal cancer, D3 lymph node dissection improved OS and DFS without increasing perioperative morbidity. Preoperative PNI was a strong predictor of long-term prognosis and may aid surgical decision-making in elderly patients.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316884","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":"Emergency left side colectomy and primary anastomosis with or without diverting stoma: a comparative study.","authors":"Marco Ceresoli, Mauro Podda, Carola Anna Paolina Ferro, Stefano Piero Bernardo Cioffi, Alan Biloslavo, Valerio Cozza, Federico Coccolini","doi":"10.1007/s00384-026-05177-9","DOIUrl":"10.1007/s00384-026-05177-9","url":null,"abstract":"<p><strong>Background: </strong>Left-sided colonic perforation is a common surgical emergency. While Hartmann's procedure has traditionally been the standard treatment, growing evidence supports primary anastomosis as a safe and effective alternative. The benefit of adding a diverting ileostomy in this scenario remains uncertain. This study aimed to evaluate the clinical impact of a diverting stoma after emergency left-sided colectomy with primary anastomosis.</p><p><strong>Methods: </strong>This was a retrospective multicentre cohort study. All consecutive adult patients undergoing emergency left-sided colectomy with primary anastomosis between 2019 and 2023 were included. Patients were divided into two groups according to the use of a diverting stoma (DS) or no stoma (NS). The primary outcome was 30-day mortality. Secondary outcomes included postoperative morbidity, anastomotic leak, reoperation, readmission, and 1-year stoma-free survival.</p><p><strong>Results: </strong>A total of 211 patients were included, of whom 75 (35.2%) received a diverting stoma. While baseline demographic characteristics and comorbidities were similar between the two cohorts, patients in the DS group presented with significantly higher rates of generalized peritonitis. Thirty-day mortality did not differ (DS 2.2% vs NS 1.3%, p = 0.656). Anastomotic leak occurred in 4.0% of DS and 8.8% of NS patients (p = 0.192). Reoperations were fewer in the DS group (4.0% vs 12.5%, p = 0.044). Readmission rates were higher among patients with diversion (16.2% vs 2.3%, p < 0.001). One-year stoma-free survival favored the NS group (96.7% vs 83.1%, p = 0.003).</p><p><strong>Conclusions: </strong>Diverting stoma after emergency left-sided colectomy with primary anastomosis does not influence mortality or overall morbidity but was associated with reduced reoperations related to anastomotic leaks. Diversion is associated with higher readmission rates and delayed stoma reversal, highlighting the importance of individualized, evidence-based decision-making in emergency colorectal surgery.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316910","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 internal validation of a nomogram to predict colorectal cancer risk in patients with diverticulitis.","authors":"Muhammad Usman, Elon Correa, Wen Yuan Chung, Sayyada Nuha Farazi, Konstantinos Baronos, Lasitha Samarakoon, Sudarshan Rao Kadri","doi":"10.1007/s00384-026-05181-z","DOIUrl":"10.1007/s00384-026-05181-z","url":null,"abstract":"<p><strong>Aim: </strong>Diverticulitis, considered a benign condition, has emerging evidence linking it to colorectal cancer (CRC). Current guidelines lack standardised risk stratification tools to guide post-diverticulitis surveillance. This study aims to create and validate a nomogram to predict CRC risk in patients with diverticulitis.</p><p><strong>Method: </strong>This retrospective cohort study included 1546 patients diagnosed with diverticulitis at a UK tertiary hospital between January 2021 and December 2023. Patients aged ≥ 18 years who underwent endoscopic assessment following a diverticulitis episode were included. A logistic regression model with L2 regularisation and balanced class weights (C = 0.1) was developed to predict a binary outcome: high CRC risk (histologically confirmed cancer) versus low/moderate risk (no cancer), designed to guide referral for flexible sigmoidoscopy (FS).</p><p><strong>Results: </strong>The mean age of the cohort was 69.2 years, with near-equal sex distribution. CRC was identified in 42 patients (2.7%). Significant predictors of high CRC risk included older age, male sex, and CT-detected colonic wall thickening, whereas abdominal pain, PR bleeding, and diverticulosis were associated with lower risk. The model achieved a cross-validated mean AUC of 0.736 (95% CI 0.661-0.811) and full-sample AUC of 0.784. At the Youden-optimal threshold (0.523), sensitivity was 72.1% and specificity 73.8%.</p><p><strong>Conclusion: </strong>We developed and internally validated a nomogram to predict CRC risk in patients with diverticulitis, using a binary classification to guide FS referral. The tool demonstrated robust discriminative ability and could reduce unnecessary colonoscopies while prioritising high-risk patients for timely evaluation. Unlike existing CRC risk models targeting asymptomatic individuals, our nomogram is tailored to diverticulitis patients. External validation in multi-centre cohorts is required before adoption into routine clinical practice.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307964","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":"Correction to: Preoperative phase angle and postoperative complications in Crohn's disease patients undergoing ileocolic resection: a retrospective cohort study.","authors":"Weilin Qi, Huaying Liu, Huiping Liang, Wei Liu, Linna Ye, Qian Cao, Xiaolong Ge, Wei Zhou","doi":"10.1007/s00384-026-05176-w","DOIUrl":"10.1007/s00384-026-05176-w","url":null,"abstract":"","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"41 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301735","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":"Diversion proctitis during staged restorative proctocolectomy with ileal pouch anal anastomosis is not associated with subsequent cuffitis.","authors":"Ishaan Dharia, Michael Plietz, Sue Hahn, Sergey Khaitov, Patricia Sylla, Alexander Greenstein, Marla C Dubinsky, Maia Kayal","doi":"10.1007/s00384-026-05182-y","DOIUrl":"10.1007/s00384-026-05182-y","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study was to assess the impact of diversion proctitis (DP) between the first and second surgical stage on pouch outcomes in patients with ulcerative colitis (UC) who underwent three-stage restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA).</p><p><strong>Methods: </strong>We conducted a retrospective chart review of patients with UC who underwent three stage RPC with IPAA followed by at least one pouchoscopy at Mount Sinai Hospital between 1/2008 and 12/2020. DP was defined as the presence of mucosal atrophy and lymphoid hyperplasia on proctectomy specimen as noted by the reporting pathologist. The primary outcome was cuffitis defined as ulceration of the cuff as reported during pouchoscopy. Continuous and categorical variables were analyzed with t-tests and chi-squared tests, respectively.</p><p><strong>Results: </strong>Of the 281 patients included in this study, 68 (24.2%) were found to have DP. Age, sex, race, ethnicity, anastomosis type, and disease duration were not significant risk factors for DP development. More patients with vs without DP had evidence of severe disease pre-colectomy with admission for acute severe ulcerative colitis, steroids, and infliximab, though this did not reach statistical significance. A significantly greater proportion of patients with vs without DP required rectal therapy between the first and second surgical stages (32.4% vs 19.2%, p = 0.02). There was no significant difference in the development of cuffitis among patients with vs without DP (19.1% vs 14.1%, p = 0.32).</p><p><strong>Conclusion: </strong>The occurrence of DP between the first and second surgical stage of RPC with IPAA is significantly associated with the need for rectal therapy; however, is not associated with subsequent cuffitis.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301639","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":"Rethinking surgical strategy for margin-positive only T1 colorectal cancer: a multicenter retrospective cohort study.","authors":"Jin Hyeong Park, Chang Hwan Kim, Dae Hee Pyo, Jong Kyung Park, Chaedong Lim, Ji Hoon Kim, Bong-Hyeon Kye, Hyung Jin Kim","doi":"10.1007/s00384-026-05175-x","DOIUrl":"10.1007/s00384-026-05175-x","url":null,"abstract":"<p><strong>Purpose: </strong>Endoscopic resection is frequently performed for early T1 colorectal cancer (CRC), with additional surgery indicated when histopathological risk factors are present, such as a positive vertical margin, submucosal invasion depth greater than 1000 µm, lymphatic or vascular invasion, poorly differentiated adenocarcinoma, signet-ring cell carcinoma, mucinous carcinoma, or grade 2/3 tumor budding at the deepest invasive site. In patients undergoing radical resection for T1 CRC, the incidence of lymph node metastases(LNM) has been reported to be approximately 10%. The purpose of this study is to identify factors influencing the decision for radical resection in patients with pathologically confirmed T1 CRC following endoscopic resection and to evaluate lymph node metastasis rates according to each risk factor, with a focus on determining whether radical resection might be safely avoided in carefully selected low-risk cases.</p><p><strong>Methods: </strong>The study was designed as a retrospective multicenter comparative cohort study conducted at three tertiary referral centers in Korea. The study population consisted of patients with pathological T1 colorectal cancer who underwent radical resection following endoscopic resection between April 2019 and December 2024. The main outcome measure was the incidence of lymph node metastasis according to pathological risk factors, with a particular focus on patients with margin-positive lesions without any other risk factors. Univariate analyses were performed, and exact binomial confidence intervals were calculated for the margin-positive subgroups.</p><p><strong>Results: </strong>Among 250 patients who underwent radical surgery after endoscopic resection, 25 (10.0%) had lymph node metastasis. Lymphovascular invasion and KRAS mutation were significantly associated with lymph node metastasis. Twenty-two patients with margin positivity without any other risk factors had no LNM (0/22; 95% exact binomial confidence interval, 0-15.4%). Half (11/22) of these patients had no residual tumors on surgical specimens, whereas the remainder showed only submucosal residual tumors without nodal involvement.</p><p><strong>Conclusion: </strong>Among patients who underwent radical resection after endoscopic resection for T1 CRC, margin positivity without other recorded high-risk features was not associated with LNM in this cohort. However, given the small sample size and wide confidence interval, these findings should be considered hypothesis-generating and require further validation [1].</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294796","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}