International Journal of Colorectal Disease最新文献

{"title":"Prognostic impact of metastatic sites and its metastasectomy in colorectal cancer: a retrospective analysis from a single institution.","authors":"Sheng-Chieh Huang, Shih-Ching Chang, Jeng-Kai Jiang, Yi-Tien Su","doi":"10.1007/s00384-025-04943-5","DOIUrl":"10.1007/s00384-025-04943-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate the prognostic influence of different metastatic sites and the effect of surgical resection on survival. Additionally, it explores how anatomical location influences prognosis before and after metastasectomy.</p><p><strong>Methods: </strong>This retrospective study included 999 mCRC patients treated at Taipei Veterans General Hospital from 2013 to 2019. Survival outcomes across liver, lung, peritoneal, and distant lymph node (LN) metastases were analyzed using Kaplan-Meier and Cox regression models.</p><p><strong>Results: </strong>Prognosis varied significantly by metastatic site. For single-site metastases, distant LN metastases had the longest OS (36.8 months), followed by lung (35.5 months), liver (26.5 months), and peritoneal metastases (21.5 months; p = 0.001). Lung metastases showed the longest PFS (11.7 months), followed by distant LN (10.8 months), peritoneal (9.8 months), and liver (9.1 months; p = 0.031). Surgical resection significantly improved OS (HR = 0.477, p < 0.001). With metastasectomy, OS was comparable for liver, lung, and distant LN metastases (p = 0.288), while peritoneal metastases had significantly poorer outcomes (HR = 2.208, p = 0.001). In patients without surgery, OS was significantly poorer across all metastatic sites, with lung metastases demonstrating the most favorable prognosis (OS = 31.9 months) and statistically significant differences compared to liver, peritoneal, and distant LN metastases (p < 0.001).</p><p><strong>Conclusion: </strong>The prognosis of mCRC varies by metastatic site. Surgical resection significantly improves survival for liver, lung, and distant LN metastases but is less effective for peritoneal metastases. Surgery reduces the prognostic disparity among resectable sites except for peritoneal seeding.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"150"},"PeriodicalIF":2.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553485","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: Combined linaclotide and polyethylene glycol electrolyte for colonoscopy preparation: a network meta‑analysis of 14 randomized controlled trials.","authors":"Mohamed S Elgendy, Islam Rajab, Qasi Najah, Mohamed A Faheem, Omar K Elsawy, Hosam I Taha, Mariam Elewidi, Abdalhakim Shubietah, Dhruv Patel, Alisa Farokhian, Mohamed Abuelazm, Walid Baddoura","doi":"10.1007/s00384-025-04946-2","DOIUrl":"10.1007/s00384-025-04946-2","url":null,"abstract":"","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"149"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527838","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":"A comparison of organ preservation in older adults with stage I rectal cancer.","authors":"Annmarie Butare, Scarlett Hao, Anas Taha, Michael Drew Honaker","doi":"10.1007/s00384-025-04940-8","DOIUrl":"10.1007/s00384-025-04940-8","url":null,"abstract":"<p><strong>Background: </strong>Total mesorectal excision (TME) remains the primary recommended treatment for high-risk T1 and T2 rectal cancer. However, growing evidence suggests preoperative therapy may lead to eligibility for organ preservation (OP), avoiding the morbidity of major resection, which may be beneficial in older adults. The primary aim of the study was to compare rates of OP in adults 70 years of age and older to those less than 70 with T1 lesions rectal cancers with high-risk features and T2 rectal cancers.</p><p><strong>Methods: </strong>A retrospective, cohort study of patients with high-risk stage 1 rectal cancer was identified within the National Cancer Database (NCDB). Primary outcome was the association of age with receipt of organ preservation. Multivariate analysis was conducted to examine the effect of covariates on the outcome.</p><p><strong>Results: </strong>Out of 38,714 patients, 34.4% were ≥ 70 years, 42.3% were female, and 75.6% had a Charlson Deyo comorbidity score of 0. Older adults were more likely to received OP compared to younger patients (45.6% vs 30.6%, p < 0.001). This persisted on adjusted analysis (OR 1.9, p < 0.001). Other factors predictive of receiving OP include non-Hispanic Black race/ethnicity (OR 1.5, p < 0.001), lack of insurance (OR 1.5, p < 0.001), increased comorbidity score (OR 1.7 for CDCC of 3, p < 0.001), treatment at a community facility compared to academic facility (OR 1.4, p < 0.001), and female sex (OR 1.2, p < 0.001).</p><p><strong>Conclusions: </strong>Although current guideline recommendations for high-risk T1 and T2 rectal cancer is TME, a significantly higher proportion of older adult patients undergo organ preservation. This is more pronounced in comorbid and disadvantaged patients.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"148"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527829","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":"Clinical characteristics and survival outcomes of rectal cancer patients across different mrT3 substages determined by rectal MRI.","authors":"Ganbin Li, Xiao Zhang, Xiaoyuan Qiu, Lai Xu, Junyang Lu, Bin Wu, Yi Xiao, Guole Lin","doi":"10.1007/s00384-025-04935-5","DOIUrl":"10.1007/s00384-025-04935-5","url":null,"abstract":"<p><strong>Purpose: </strong>Locally advanced rectal cancer (LARC) staged as mrT3 could be further subdivided into mrT3a to T3d based on depth of tumor invasion through the muscularis propria. Limited evidence exists to compare the differences across subgroups.</p><p><strong>Methods: </strong>Clinical data from patients between January 2018 and 2022 were collected. The study included patients with mrT3 LARC who received neoadjuvant chemoradiotherapy (NCRT). Based on depth of invasion through muscularis propria, patients were categorized into three groups: mrT3a (< 5 mm), mrT3b (5~10 mm), mrT3c~d group (> 10 mm). The outcomes were disease-free survival (DFS), pathological complete response (pCR), tumor recurrence and metastasis.</p><p><strong>Results: </strong>A total of 295 patients were identified, including 65 (22.0%) in mrT3a, 155 (52.5%) in mrT3b, and 75 (25.5%) in mrT3c~d group. The tumor vertical diameter was larger in mrT3c/d group (46.3 ± 13.7 mm), compared to mrT3a (39.4 ± 14.3 mm) and mrT3b (39.8 ± 12.1 mm) groups (P < 0.001). The positive rates of mesorectal fascia (61.3% vs. 30.3% vs. 7.7%, P < 0.001) and extramural vascular invasion (62.7% vs. 40.0% vs. 27.7%, P < 0.001) were significantly higher in mrT3c/d group compared to mrT3a and mrT3b groups. The estimated pCR rates were 33.9% for mrT3a, 32.3% for mrT3b, and 21.3% for mrT3c/d group (P = 0.172). The median follow-up time was 43 (29-58) months. The metastasis and local recurrence rates were 8.8% and 2.4%. The 3y-DFS rates were 92.2% for mrT3a, 87.7% for mrT3b, and 86.2% for mrT3c/d (P = 0.549).</p><p><strong>Conclusion: </strong>Despite mrT3c/d patients presenting with more aggressive baseline features, standardized NCRT followed by radical surgery effectively mitigated survival disparities across mrT3 substages. These findings suggest that mrT3 subclassification may not independently predict long-term survival outcomes when patients receive optimal multimodal therapy.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"147"},"PeriodicalIF":2.5,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511849","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 impact and independent significance of tumor deposits in early-stage colon cancer: a population-based cohort study.","authors":"Bilal Turan, Ahmet Necati Sanli, Deniz Esin Tekcan Sanli, Serdar Acar","doi":"10.1007/s00384-025-04908-8","DOIUrl":"10.1007/s00384-025-04908-8","url":null,"abstract":"<p><strong>Background: </strong>Tumor deposits (TD) are well-established prognostic markers in advanced-stage colorectal cancer (CRC), but their independent significance in early-stage disease remains unclear. Current staging systems do not account for TD in node-negative CRC, despite emerging evidence suggesting a potential impact on survival. This study aimed to assess the prognostic impact of TD in early-stage (T1-T3, N0) colon cancer using a large population-based cohort and advanced statistical methods.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the SEER database (2010-2021), including 111,106 patients with early-stage (T1-T3) colon cancer, of whom 4055 (3.6%) were TD-positive. To minimize baseline imbalances, propensity score matching (1:3 nearest-neighbor; caliper = 0.2) was applied. Overall survival (OS) and disease-specific survival (DSS) were assessed using the Kaplan-Meier analysis and compared with log-rank tests. Multivariate Cox regression was performed to evaluate the independent prognostic impact of TD status in both unmatched and matched cohorts.</p><p><strong>Results: </strong>TD-positive patients demonstrated significantly worse overall survival (OS) and disease-specific survival (DSS) compared to TD-negative patients (log-rank p < 0.001). In the unmatched cohort, TD positivity was independently associated with reduced OS (HR: 1.56, 95% CI: 1.48-1.65) and DSS (HR: 2.33, 95% CI: 2.14-2.54; both p < 0.001). These associations remained significant after propensity score matching (OS: HR: 1.44, 95% CI: 1.35-1.54; DSS: HR: 2.17, 95% CI: 1.97-2.40; both p < 0.001).</p><p><strong>Conclusion: </strong>TD is an independent prognostic factor in early-stage colon cancer, warranting closer surveillance and reconsideration of treatment strategies. These findings suggest that TD should be integrated into risk stratification models, challenging current staging paradigms.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"146"},"PeriodicalIF":2.5,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496149","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":"Current status of fertility rates and modes of delivery after restorative proctocolectomy with ileal pouch-anal anastomosis.","authors":"Hideaki Kimura, Kenichiro Toritani, Reiko Kunisaki, Koki Goto, Hirosuke Kuroki, Kenji Tatsumi, Kazutaka Koganei, Akira Sugita, Itaru Endo","doi":"10.1007/s00384-025-04938-2","DOIUrl":"10.1007/s00384-025-04938-2","url":null,"abstract":"<p><strong>Purpose: </strong>After restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA), fertility rates decline, and cesarean section (CS) has been the preferred mode of delivery. We aimed to assess the current trends and outcomes of pregnancy and delivery in patients who underwent RPC with IPAA.</p><p><strong>Methods: </strong>This retrospective cohort study included 386 patients who underwent RPC with IPAA for UC between 2007 and 2023. Clinical data were collected through a chart review. Surgical techniques were mainly one- or modified two-stage RPC with stapled IPAA. The fallopian tube traction technique was applied to prevent adhesions. Fertility rates and delivery outcomes were also examined.</p><p><strong>Results: </strong>Among 83 females of < 40 years of age, 18 attempted pregnancy after surgery. Natural conception was achieved in 14 cases (78%), and 2 cases were conceived through in vitro fertilization, resulting in a total of 16 pregnancies (89%). Among the 15 births, 11 (73%) were vaginal deliveries (VD), and 4 (27%) were CS. The reasons for CS included breech presentation (2 cases), prior CS (1 case), and a history of rectovaginal fistula (1 case). One VD case required episiotomy and the other experienced a perineal tear. However, there were no significant differences in postpartum defecation between the VD and CS groups.</p><p><strong>Conclusion: </strong>Fertility after RPC with IPAA appears to have improved compared to previous reports, possibly due to the prevention of fallopian tube adhesions. After a stapled IPAA, VD is a feasible option, and CS is not universally required solely because of the history of IPAA.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"145"},"PeriodicalIF":2.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336418","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":"Combined linaclotide and polyethylene glycol electrolyte for colonoscopy preparation: a network meta-analysis of 14 randomized controlled trials.","authors":"Mohamed S Elgendy, Islam Rajab, Qasi Najah, Mohamed A Faheem, Omar K Elsawy, Hosam I Taha, Mariam Elewidi, Abdalhakim Shubietah, Dhruv Patel, Alisa Farokhian, Mohamed Abuelazm, Walid Baddoura","doi":"10.1007/s00384-025-04931-9","DOIUrl":"10.1007/s00384-025-04931-9","url":null,"abstract":"<p><strong>Purpose: </strong>Recent evidence supports linaclotide (Lin) for colonoscopy preparation. This network meta-analysis evaluates the combination of different pill numbers of Lin with polyethylene glycol (PEG) (high and low volumes in liters (L)) for bowel cleansing.</p><p><strong>Methods: </strong>This systematic review and frequentist network meta-analysis, conducted in October 2024, assessed randomized controlled trials (RCTs) from Scopus, PubMed, Cochrane, WOS, and Embase. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated for categorical and continuous outcomes.</p><p><strong>Prospero id: </strong>CRD42024618272.</p><p><strong>Results: </strong>Fourteen RCTs with 4,764 participants showed that total Boston Bowel Preparation Scale improved significantly with 2L PEG + 2Lin (MD = 2.03, 95%CI: [0.30:3.76], P = 0.0217), 3L-PEG + 3Lin (MD = 1.30, 95%CI: [0.42:2.18], P = 0.0038), and 4L-PEG (MD = 1.11, 95%CI: 0.23-1.98, P = 0.0129). Adenoma detection was highest with 3L-PEG + 3Lin (RR = 1.60, 95%CI: [1.05:2.43], P = 0.0280), while polyp detection improved with 2L PEG + 3Lin (RR = 1.72, 95%CI: [1.13:2.62], P = 0.0114) and 3L-PEG + 3Lin (RR = 1.33, 95%CI: [1.00:1.77], P = 0.0505). Procedure times were significantly reduced with 3L-PEG + 3Lin (MD = -4.6, 95%CI: [-6.24:-3.24], P < 0.0001), 3L-PEG + 1Lin (P = 0.035), and 4L-PEG (P < 0.01). Abdominal pain and abdominal bloating decreased with 2L PEG + 1Lin (P < 0.01) and 2L PEG + 2Lin (P = 0.021) but increased with 4L-PEG (P = 0.0178).</p><p><strong>Conclusions: </strong>Combining PEG with Lin improves bowel cleanliness compared to 3L-PEG, with 2L PEG + 2Lin being the most effective and well-tolerated. Despite some heterogeneity, the findings suggest that adding Lin may enhance bowel preparation with comparable safety, warranting consideration of individual patient factors.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"143"},"PeriodicalIF":2.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316856","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":"Clinical outcomes of conventional versus extended mesenteric resection in limited ileo-colonic Crohn's disease: a systematic review and meta-analysis.","authors":"Omar E S Mostafa, Shafquat Zaman, Maymunah Malik, Prajeesh Kumar, Lalit Kumar, Akinfemi Akingboye, Diwakar Sarma, Rajeev Peravali","doi":"10.1007/s00384-025-04937-3","DOIUrl":"10.1007/s00384-025-04937-3","url":null,"abstract":"<p><strong>Background: </strong>The role of intestinal mesentery and the extent of its resection as a determinant of outcomes post-bowel resection in Crohn's disease (CD) remains a subject of debate. We evaluated outcomes of conventional mesenteric resection (CMR) and compared it with extended mesenteric resection (EMR) in patients undergoing ileo-colic excision for limited ileo-colonic CD.</p><p><strong>Methods: </strong>A comprehensive search was conducted in accordance with PRISMA guidelines using Medline, Embase, PubMed, and Cochrane databases. Comparative studies of patients with limited ileo-colonic CD undergoing CMR and EMR for ileo-colic resection were included. Studies comparing anastomotic techniques, single-arm, case reports/series, study protocols and editorials were excluded. Primary outcomes were disease recurrence and re-operation. Secondary outcomes included post-operative complications, intra-operative blood loss, length of stay, total operative time and re-admission rate. Meta-analysis was performed using Cochrane RevMan Web on outcomes reported by two or more studies. Combined overall effect sizes were calculated using random-effects model and the Newcastle-Ottawa Scale and Cochrane risk-of-bias tools were used to assess bias.</p><p><strong>Results: </strong>Five studies met our inclusion criteria (four retrospective cohort studies; one randomised controlled trial (RCT)) with a total of 4,358 patients (EMR: 993 vs. CMR: 3,365). No statistical difference was observed across any of the analysed outcomes: disease recurrence [OR: 0.49 CI 0.21-1.16, P = 0.10], re-operation [OR: 0.33 CI 0.06-1.65, P = 0.17], intra-operative blood loss [MD: -18.71 CI -76.65-39.23, P = 0.53], anastomotic leak [OR: 0.98 CI 0.34-2.82, P = 0.97], length of stay [MD: -0.06 CI -0.59-0.48, P = 0.83], post-operative morbidity [OR: 1.01 CI 0.82-1.24, P = 0.95], blood transfusion [OR: 1.16 CI 0.84-1.59, P = 0.36], Clavien-Dindo III + complications [OR: 0.83 CI 0.5-1.38, P = 0.47], post-operative ileus [OR: 0.97 CI 0.27-3.50, P = 0.96], intra-abdominal bleeding [OR: 0.85 CI 0.22-3.26, P = 0.81], re-admission [OR: 0.65 CI 0.24-1.78, P = 0.40], surgical site infection [OR: 1.00 CI 0.77-1.30, P = 0.99], post-operative adjuvant or prophylactic therapy [OR: 0.90 CI 0.54-1.51, P = 0.69] and total operative time [MD: 0.38 CI -4.42-5.19, P = 0.88].</p><p><strong>Conclusion: </strong>Performing EMR during ileo-colic resection for patients with limited ileo-colonic CD does not seem to confer any additional benefit to conventional (limited resection) approaches. Robust, well-designed, large-scale RCTs are needed to better compare these techniques and demonstrate superiority in clinical outcomes.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"144"},"PeriodicalIF":2.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316855","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":"Survival outcomes in patients with sigmoid volvulus.","authors":"Rosa D E Bock, Peter G Vaughan-Shaw, A J Clark, M Collie, D Collins, M Duff, S Goodbrand, J Mander, N T Ventham, H M Paterson, M A Potter, C Reddy, D Speake, F V N Din, M G Dunlop, G Smith","doi":"10.1007/s00384-025-04920-y","DOIUrl":"10.1007/s00384-025-04920-y","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to assess management pathways and outcomes in sigmoid volvulus (SV).</p><p><strong>Methods: </strong>A retrospective review was performed on patients first admitted with SV between 2019 and 2023 within a tertiary-level colorectal service. Demographic, management, and outcome data, including frailty, ASA (American Society of Anaesthesiologists), and National Emergency Laparotomy Audit (NELA) score, were collected. Comparative statistics were used to compare baseline demographics between those operated on and those not and to identify factors associated with survival.</p><p><strong>Results: </strong>A total of 72 patients were included, median age of 78 years, with 25 undergoing surgery. After index discharge without surgery, 50 patients (88%) were re-admitted with SV at least once, with a total of 212 hospital admissions and 1952 hospital bed days at the end of follow-up. A trend towards lower age, NELA score, ASA score and frailty score was seen in those undergoing surgery, with only two deaths observed during postoperative follow-up. In those who were not palliated at first admission but did not undergo surgery at any point, the mortality rate was 42% (n = 16, median survival 545 days, median age 79), with causes of death generally reflecting conditions of frailty and not volvulus itself.</p><p><strong>Conclusions: </strong>This study demonstrates the burden of sigmoid volvulus in an elderly population with significant mortality and morbidity. While survival was better in those undergoing surgery, this likely represents appropriate case selection reflecting underlying frailty and comorbidities in those not offered surgery rather than a protective effect of surgery. While surgery should be considered and documented at index admission, it should not be considered a panacea for the elderly and frail population. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: This study highlights the burden of sigmoid volvulus in an ageing population, emphasising complex management challenges. Non-operative treatments showed high recurrence and poor survival, while surgery yielded excellent outcomes in selected patients. The findings advocate for a cautious, individualised approach, balancing frailty and risks, rather than universal reliance on surgery.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"142"},"PeriodicalIF":2.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316857","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":"Frailty is a prognostic marker of mortality and sepsis in patients ≥ 70 years with acute left-sided colonic diverticulitis.","authors":"Vito Laterza, Marcello Covino, Carlo Alberto Schena, Davide Della Polla, Andrea Russo, Sara Salini, Nicola de'Angelis, Giuseppe Quero, Carla Recupero, Claudio Fiorillo, Antonella Risoli, Caterina Cina, Francesco Franceschi, Sergio Alfieri, Fausto Rosa","doi":"10.1007/s00384-025-04933-7","DOIUrl":"10.1007/s00384-025-04933-7","url":null,"abstract":"<p><strong>Background: </strong>Acute left-sided colonic diverticulitis (ALCD) has a more complicated course in older patients. Rather than age, frailty may be crucial in ALCD prognosis in this heterogeneous population. This study aims to define the influence of the Clinical Frailty Scale (CFS) on mortality and clinical outcomes in patients aged 70 or older with ALCD.</p><p><strong>Methods: </strong>All patients aged ≥ 70 years admitted to the emergency department for ALCD between January 2018 and December 2022 were included. Frailty was assessed through the CFS, and three groups of patients were identified accordingly: non-frail patients (CFS 1-3); moderately frail patients (CFS 4-6); and severely frail patients (CFS 7-9). The endpoints were: 30-day mortality, sepsis onset, 30-day readmission, and length of hospital stay (LOS).</p><p><strong>Results: </strong>A total of 1127 patients were enrolled. Severely frail patients had a significantly higher rate of sepsis onset, mortality, and longer LOS at univariate analysis. Higher CFS scores were significantly associated with mortality, both as a continuous (OR 1.42) and discrete variable (OR 12.47), and sepsis, both as a continuous (OR 1.5) and discrete variable (OR 6.52) at multivariate analysis.</p><p><strong>Conclusion: </strong>A higher CFS score, rather than age, is associated with higher rates of mortality, sepsis, and longer LOS. After adjusting for covariates, higher CFS scores were significantly associated with increased risk of 30-day mortality and sepsis. A comprehensive frailty assessment using the CFS should be considered to predict the need for closer monitoring and guiding appropriate care goals for older patients.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"141"},"PeriodicalIF":2.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309832","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}