International Journal of Colorectal Disease最新文献

{"title":"The impact of neoadjuvant therapy on the prognostic value of preoperative neutrophil-to-lymphocyte ratio for colorectal liver metastases: a multi-center cohort study.","authors":"Xiang-Yu Wang, Jie-Liang Zuo, Hong Fu, Chong Zhang, Qing-Qi Fan, Bo Zhang, Bao-Rui Tao, Zhen-Mei Chen, Jia-Hao Han, Yi-Tong Li, Yue Ma, Xiao-Chen Ma, Rui Zhang, Ying Zhu, Wen-Wei Zhu, Lu Lu, Ming-Xu Yu, Jin-Hong Chen","doi":"10.1007/s00384-024-04800-x","DOIUrl":"10.1007/s00384-024-04800-x","url":null,"abstract":"<p><strong>Background: </strong>Neutrophil-to-lymphocyte ratio (NLR) is a promising prognostic marker for patients undergoing hepatectomy for colorectal liver metastases (CRLM). However, its prognostic value in patients receiving neoadjuvant therapy (NAT) has not been sufficiently addressed.</p><p><strong>Methods: </strong>From 2013 to 2023, a cohort of 692 patients with CRLM receiving hepatectomy were enrolled in five centers. Clinicopathological characteristics were obtained from a prospectively maintained multi-center database. The effect of NLR (> 2 versus ≤ 2) on overall survival (OS) and recurrence-free survival was estimated by Kaplan-Meier analysis. Univariable and multivariable Cox regression analysis was applied to investigate the influence of individual clinicopathological parameters on OS.</p><p><strong>Results: </strong>In the entire cohort, the median NLR level was 2.11 (0.30-16.33). There were 307 (44.4%) patients receiving NAT followed by hepatectomy, while 385 (55.6%) patients undergoing upfront surgery. Notably, patients in the NAT group showed significantly lower NLR level than those in the upfront surgery group (1.83 versus 2.32, P < 0.001). In the upfront surgery group, high NLR was significantly associated with worse OS, independent of other factors (HR = 1.49, 95% CI 1.08-2.05, P = 0.02). In the NAT group, there was no significant difference in OS between the high NLR and low NLR group.</p><p><strong>Conclusion: </strong>The prognostic value of NLR in surgically resected CRLM is potentially influenced by NAT in the modern era.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"10"},"PeriodicalIF":2.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948434","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":"Treatment outcomes and prognostic factors in patients with colorectal cancer and synchronous lung metastases in the conversion therapy era.","authors":"Hiroaki Nozawa, Nobumi Suzuki, Tatsuya Tsushima, Koji Murono, Kazuhito Sasaki, Shigenobu Emoto, Mitsuhiro Fujishiro, Masaaki Sato, Soichiro Ishihara","doi":"10.1007/s00384-024-04799-1","DOIUrl":"10.1007/s00384-024-04799-1","url":null,"abstract":"<p><strong>Purpose: </strong>The Japanese Grade Classification based on the status of pulmonary and mesenteric nodal metastases and the presence of extrapulmonary metastases had a prognostic value in patients with colorectal lung metastases previously. Because the survival of such patients has improved in the era of conversion therapy, this classification needs to be reaudited.</p><p><strong>Methods: </strong>This study reviewed the treatment sequences of 126 colorectal cancer patients with synchronous lung metastases between 2010 and 2022 at our hospital. Patients were divided into Japanese Classification Grade A, B, and C. Prognostic factors for overall survival (OS) were analyzed.</p><p><strong>Results: </strong>Thirty patients were initially diagnosed with resectable disease. Among these, 6 (35%) of 17 patients who were scheduled to undergo upfront surgery developed unresectable disease. In contrast, 3 (23%) of 13 patients receiving neoadjuvant therapy could not undergo curative resection. Twelve (13%) of 96 patients with initially unresectable metastases underwent conversion to complete resection after systemic therapy. On multivariate analysis, curative resection and H3 (> 5 liver metastases and maximum diameter > 5 cm) at diagnosis were independent prognostic factors, whereas the Japanese Grade Classification was not associated with OS.</p><p><strong>Conclusion: </strong>Instead of the Japanese classification, a new prognostic classification incorporating H3 should be established.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"9"},"PeriodicalIF":2.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948438","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":"Sport practice and hemorrhoidal disease: results from a self-assessment questionnaire among athletes.","authors":"Lucia Romano, Antonio Giuliani, Federico Paniccia, Francesco Masedu, Leonardo Tersigni, Martina Padula, Renato Pietroletti, Marco Clementi, Fabio Vistoli","doi":"10.1007/s00384-024-04797-3","DOIUrl":"10.1007/s00384-024-04797-3","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhoidal disease (HD) is a common proctologic disease. Dietary and lifestyle play a role in the genesis of the disease or in its progression to more severe forms, although the exact mechanism is still not fully understood. We performed a pilot observational cross-sectional analytical association study to evaluate the possible association between sport activities and HD.</p><p><strong>Methods: </strong>We included subjects aged 18 years old or more, competitive and non-competitive, practicing at least one sport activity, at least twice a week. Data were collected using an online questionnaire, developed on the Microsoft Teams communication platform.</p><p><strong>Results: </strong>Out of the 312 study participants, 34% reported HD. Among subjects who practiced cycling or horseback riding, 57% reported suffering from HD; among those practicing bodybuilding, 48% complained of HD. In the multivariate logistic regression analysis, age and bodybuilding practice showed a statistically significant association with HD.</p><p><strong>Conclusions: </strong>Some sport activities could play a role in the onset or worsening of HD. Our results showed a positive association between cycling, horseback riding, bodybuilding, and HD occurrence. Given the numerous health benefits of physical activity, patients should be provided with correct information regarding the practice of sports in relation to their pathology.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"8"},"PeriodicalIF":2.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948430","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 transrectal ultrasound and radiomics model for evaluating the therapeutic effects of neoadjuvant chemoradiotherapy in locally advanced rectal cancer.","authors":"Dilimire Abuliezi, Yufen She, Zhongfan Liao, Yuan Luo, Yin Yang, Qin Huang, Anqi Tao, Hua Zhuang","doi":"10.1007/s00384-024-04792-8","DOIUrl":"https://doi.org/10.1007/s00384-024-04792-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to explore a combined transrectal ultrasound (TRUS) and radiomics model for predicting tumor regression grade (TRG) after neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC).</p><p><strong>Methods: </strong>Among 190 patients with LARC, 53 belonged to GRG and 137 to PRG. Eight TRUS parameters were identified as statistically significant (P < 0.05) for distinguishing between the groups, including PSV_pre, LD_post, TD_post, CEUS-IG_post, LD change rate, TD change rate, RI change rate, and CEUS-IG downgrade. The accuracies of these individual parameters in predicting TRG were 0.42, 0.62, 0.56, 0.68, 0.67, 0.70, 0.63, and 0.71, respectively. The AUC values were 0.596, 0.597, 0.630, 0.752, 0.686, 0.660, 0.650, and 0.666, respectively. The multi-parameter ultrasonic logistic regression (MPU-LR) model achieved an accuracy of 0.816 and an AUC of 0.851 (95% CI: [0.792-0.909]). The optimal pre- and post-treatment radiomics models were RF (Mean-PCA-RFE-6) and AE (Zscore-PCA-RFE-12), with accuracies of 0.563 and 0.596 and AUCs of 0.601 (95% CI: [0.561-0.641]) and 0.662 (95% CI: [0.630-0.694]), respectively. The combined model (US-RAD_pre-RAD_post) showed the highest predictive power with accuracy and AUC of 0.863 and 0.913.</p><p><strong>Conclusions: </strong>The combined model based on TRUS and radiomics demonstrated remarkable predictive capability for TRG after NCRT. It serves as a precision tool for assessing NCRT response in patients with LARC, impacting treatment strategies.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"7"},"PeriodicalIF":2.5,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948427","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":"Predicting treatment response and survival in rectal cancer: insights from 18 FDG-PET/MRI post-neoadjuvant therapy.","authors":"Valentina Ferri, Emilio Vicente, Yolanda Quijano, Hipolito Duran, Eduardo Diaz, Isabel Fabra, Luis Malave, Pablo Ruiz, Luca Ballelli, Alessandro Broglio, Lina Garcia Cañamaque, Andrea Verdu Segui, Virginia Perez Dueñas, Riccardo Caruso","doi":"10.1007/s00384-024-04803-8","DOIUrl":"https://doi.org/10.1007/s00384-024-04803-8","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate identification of patients with pathologic complete response (pCR) following neoadjuvant radiochemotherapy (RCT) for locally advanced rectal cancer (LARC) is essential. 18-FDG PET/MRI provides metabolic information that complements the morphological assessment of standard MRI, potentially enhancing the differentiation between fibrotic and tumorous tissues post-treatment. This study aims to evaluate the performance of 18-FDG PET/MRI in assessing treatment response compared to standard MRI.</p><p><strong>Materials and methods: </strong>A prospective study was conducted at HM Sanchinarro University Hospital, Madrid, from 2018 to 2021. Patients with LARC undergoing RCT were included and staged at diagnosis and restaged 8-12 weeks post-neoadjuvant treatment using 18-FDG PET/MRI. The primary outcome was to compare the performance of PET/MRI and standard MRI in detecting pCR and tumor regression grade (TRG) confirmed via histopathological examination. Quantitative analysis assessed the apparent diffusion coefficient (ADC) and standardized uptake value (SUV). A secondary outcome included survival analysis using the Kaplan-Meier method and Cox regression analysis for radiological and pathological prognostic markers.</p><p><strong>Results: </strong>Among 33 patients, pCR was observed in 45% (14/33). PET/MRI demonstrated sensitivity, specificity, and accuracy values of 0.88, 0.80, and 0.84, respectively, for detecting pCR, compared to 0.82, 0.50, and 0.67 for standard MRI (p < 0.001). PET/MRI accurately identified TRG stages in 72% of cases, compared to 50% for standard MRI. Post-SUV, post-ADC, and delta-ADC were the most precise PET/MRI predictors for pCR, with AUC values of 0.81, 0.75, and 0.55, respectively. Patients with mrEMVI and mrTRG showed worse disease-free survival (DFS).</p><p><strong>Conclusion: </strong>18-FDG PET/MRI emerges as a promising imaging tool for predicting response to neoadjuvant treatment in rectal cancer, with superior diagnostic accuracy compared to standard MRI. Radiological findings, such as EMVI, can identify high-risk patients, offering valuable prognostic insights.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"6"},"PeriodicalIF":2.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current approaches to the surgical management of Crohn's disease in Australia and New Zealand.","authors":"Sophie Zheng, Aleksandra Edmundson, David A Clark","doi":"10.1007/s00384-024-04778-6","DOIUrl":"10.1007/s00384-024-04778-6","url":null,"abstract":"<p><strong>Purpose: </strong>Given the evolving literature regarding the optimal surgical approach to mitigate post-operative recurrence of Crohn's disease (CD), this survey study aimed to elucidate the practices and preferences of colorectal surgeons in Australia and New Zealand (ANZ) in their surgical management of CD.</p><p><strong>Methods: </strong>Colorectal surgical consultants and fellows (n = 337) registered with the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) were invited by email in April 2022 to participate in a cross-sectional survey consisting of basic demographics and 12 questions relating to their usual surgical practice and preferred operative strategy.</p><p><strong>Results: </strong>A total of 135 responses were received (39.9%). Regarding anastomotic configuration, 47% (n = 68) preferred the side-to-side anastomosis (STSA), 19% (n = 28) the end-to-end anastomosis (ETEA), and 15% (n = 21) the Kono S anastomosis. Most respondents preferred to resect at the proximal junction of the abnormal mesentery (75%, n = 97), while radical resection of the mesentery was preferred in 10% (n = 13) and close intestinal resection through abnormal mesentery in 15% (n = 20). The preferred surgical approach was by far laparoscopic (93%, n = 125) with extraction from the midline peri-umbilical port (80%, n = 108).</p><p><strong>Conclusion: </strong>Amongst participating colorectal surgeons, there was a clear consensus on the approach, where the dominant practice was laparoscopy with a midline peri-umbilical extraction. Similarly, most respondents preferred some degree of mesenteric resection. However, anastomotic configuration and technique were domains of resection in CD lacking unanimity despite clear guidelines, highlighting an area requiring further attention.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"4"},"PeriodicalIF":2.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11698757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921660","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 adjuvant chemotherapy on survival in ypT0-2 N0 rectal cancer.","authors":"Mohamed Osama Alorabi, Abdelrahman Gouda, Mohammed Abdeen, Ahmed Said, Moamen Abdelaal, Reem Eid, Maha Yahia","doi":"10.1007/s00384-024-04781-x","DOIUrl":"10.1007/s00384-024-04781-x","url":null,"abstract":"<p><strong>Purpose: </strong>The role of adjuvant chemotherapy in rectal cancer patients downstaged to ypT0-2 N0 after neoadjuvant chemoradiotherapy (CRT), and surgery is still debated. This study investigates the impact of adjuvant chemotherapy on survival outcomes in this patient population.</p><p><strong>Methods: </strong>This retrospective study analyzed hospital records of rectal cancer cases from Shefa Al Orman Cancer Hospital between January 2016 and December 2020, focusing on patients downstaged to ypT0-2 N0 after neoadjuvant CRT and surgery. Patients were divided into two groups based on whether they received adjuvant chemotherapy. Baseline characteristics, DFS, and OS were compared, and survival factors were analyzed using univariate and multivariate Cox regression.</p><p><strong>Results: </strong>Eighty-five patients met the inclusion criteria; 55 received adjuvant chemotherapy, and 30 did not. The median age was 52, but those receiving adjuvant therapy were younger (47 vs. 60 years, P = 0.006). No significant differences were observed in sex, tumor location, or pathology between groups. Although adjuvant chemotherapy showed a trend toward better 3-year DFS (89.5% vs. 81.9%, P = 0.153) and OS (88.1% vs. 84.6%, P = 0.654), these differences were not statistically significant. Univariate and multivariate analyses confirmed no significant effect of adjuvant chemotherapy on DFS or OS, nor were any other variables significantly associated with survival.</p><p><strong>Conclusion: </strong>Adjuvant chemotherapy did not significantly improve DFS or OS in rectal cancer patients downstaged to ypT0-2 N0 following neoadjuvant CRT and surgery. Further studies are needed to define the role of adjuvant therapy in this group.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"5"},"PeriodicalIF":2.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11698752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921662","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":"Laparoscopic surgery is associated with increased risk of postoperative peritoneal metastases in T4 colon cancer: a propensity score analysis.","authors":"Shu-Yuan Li, Ye-Wang, Cheng-Xin, Li-Qiang Ji, Shi-Hao Li, Wen-Di Jiang, Chen-Ming Zhang, Wei Zhang, Zheng Lou","doi":"10.1007/s00384-024-04773-x","DOIUrl":"10.1007/s00384-024-04773-x","url":null,"abstract":"<p><strong>Background: </strong>This study aims to evaluate the postoperative safety, long-term survival, and postoperative peritoneal metastases (PPM) rate associated with laparoscopic surgery (LS) for T4 colon cancer.</p><p><strong>Materials and methods: </strong>After propensity score matching, there were 68 patients in each of the LS and Open surgery groups. The primary outcomes were the 3-year OS, DFS, and PPM rates.</p><p><strong>Results: </strong>After matching, 68 patients in each of the groups. The LS group had a higher cumulative 3-year peritoneal metastasis rate (19.8% vs. 6.7%, P = .036), while the 3-year OS (82.3% vs. 83.8%, P = .750) and 2-year DFS (69.0% vs. 75.7%, P = .310) showed no significant difference, compared to the open surgery group. The LS group had a significantly longer operation time (201 ± 85.7 min vs. 164 ± 65.9 min, P = .008) but less postoperative complications (P = .036). Additionally, patients in the LS group removed gastric tube more quickly (1.91 ± 1.18 days vs. 2.69 ± 2.41 days, P = .048). The multivariate analysis revealed that LS (HR = 3.496, 95% CI = 1.108-11.030, P = .033), underweight (HR = 11.650, 95% CI = 2.155-62.990, P = .004), and lymphovascular invasion (HR = 3.123, 95% CI = 1.010-9.664, P = .048) were all predictive factors of PPM. For the pN + subgroup, the 3-year cumulative PPM rate was 29.6% in the LS group, significantly higher than 15.3% in the open group (P = .029), but there was no significant difference after PSM (P = .100).</p><p><strong>Conclusion: </strong>LS offers faster postoperative recovery and comparable long-term survival outcomes. Therefore, it should remain a viable option for locally advanced T4 colon cancer. However, it is crucial to fully recognize the potential risk of increased PPM associated with LS, especially in patients with preoperative suspicion of positive lymph nodes. Further multicenter prospective studies are necessary to validate the potential risks of LS and gain insight into treatment efficacy in different patient populations. In addition, future studies should assess prognosis based on the grade and extent of peritoneal dissemination to provide a more nuanced understanding.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"2"},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914491","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":"Women's preferences regarding the use of chaperones during proctological examinations conducted by male physicians: a randomised clinical trial.","authors":"Daniel C Damin, Paulo C Contu, Ricardo Francalacci Savaris, Bruna Biazi","doi":"10.1007/s00384-024-04796-4","DOIUrl":"10.1007/s00384-024-04796-4","url":null,"abstract":"<p><strong>Purpose: </strong>The presence of chaperones during intimate physical examinations is a matter of ongoing debate. While most guidelines recommend the use of chaperones in all cases, there are no clinical trials specifically investigating intimate exams performed on women by male physicians. We aimed to evaluate female patients' perceptions regarding the presence or absence of chaperones during proctological examinations conducted by male physicians.</p><p><strong>Methods: </strong>In this randomised clinical trial, patients were assigned, unaware that they were participating in a study, to either Group 1 (without a chaperone during their proctological exam) or Group 2 (with a chaperone). After the appointment, they completed a questionnaire regarding the examination they had just undergone. The study was conducted at two hospitals in Southern Brazil.</p><p><strong>Results: </strong>Ninety-five patients were included in each group. The mean (SD) comfort score was 8.3 (2.9) with a chaperone and 8.8 (2.5) without a chaperone (P = 0.25). When asked if they would want the exam performed the same way in the future, 72.6% in Group 1 answered 'yes', compared to 58.9% in Group 2 (P = 0.046). In Group 2, 48.4% of patients did not feel more protected by the chaperone, while none of the patients in Group 1 felt less protected without one.</p><p><strong>Conclusions: </strong>Forgoing chaperones during proctological examinations of women, when the physician is male, is well accepted by most patients. Preferences regarding chaperones are complex, demanding a selective approach. The use of chaperones should remain a recommendation, not a requirement, to accommodate individual needs while maintaining the doctor-patient relationship.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov number, NCT03615586.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"3"},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914506","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":"Advancements in immunotherapy for colorectal cancer treatment: a comprehensive review of strategies, challenges, and future prospective.","authors":"Vaishak Kaviyarasan, Alakesh Das, Dikshita Deka, Biki Saha, Antara Banerjee, Neeta Raj Sharma, Asim K Duttaroy, Surajit Pathak","doi":"10.1007/s00384-024-04790-w","DOIUrl":"10.1007/s00384-024-04790-w","url":null,"abstract":"<p><strong>Purpose: </strong>Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide. Metastatic colorectal cancer (mCRC) continues to present significant challenges, particularly in patients with proficient mismatch repair/microsatellite stable (pMMR/MSS) tumors. This narrative review aims to provide recent developments in immunotherapy for CRC treatment, focusing on its efficacy and challenges.</p><p><strong>Methods: </strong>This review discussed the various immunotherapeutic strategies for CRC treatment, including immune checkpoint inhibitors (ICIs) targeting PD-1 and PD-L1, combination therapies involving ICIs with other modalities, chimeric antigen receptor T-cell (CAR-T) cell therapy, and cancer vaccines. The role of the tumor microenvironment and immune evasion mechanisms was also explored to understand their impact on the effectiveness of these therapies.</p><p><strong>Results: </strong>This review provides a comprehensive update of recent advancements in immunotherapy for CRC, highlighting the potential of various immunotherapeutic approaches, including immune checkpoint inhibitors, combination therapies, CAR-T therapy, and vaccination strategies. The results of checkpoint inhibitors, particularly in patients with MSI-H/dMMR tumors, which have significant improvements in survival rates have been observed. Furthermore, this review also addresses the challenges faced in treating pMMR/MSS CRC, which remains resistant to immunotherapy.</p><p><strong>Conclusion: </strong>Immunotherapy plays a significant role in the treatment of CRC, particularly in patients with MSI-H/dMMR tumors. However, many challenges remain, especially in treating pMMR/MSS CRC. This review discussed the need for further research into combination therapies, biomarker development, CAR-T cell therapy, and a deeper understanding of immune evasion mechanisms for CRC treatment.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"1"},"PeriodicalIF":2.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11682016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894189","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}