Journal of the Anus Rectum and Colon最新文献

{"title":"Long-term Outcomes of Endoscopic and Surgical Resection for High-risk pT1 Colorectal Cancer in Elderly Patients.","authors":"Yoshihiro Kishida, Toshio Kuwai, Takeshi Takasago, Akiyoshi Tsuboi, Hidenori Tanaka, Ken Yamashita, Yuichi Hiyama, Hidehiko Takigawa, Yuji Urabe, Manabu Shimomura, Hideki Ohdan, Shiro Oka","doi":"10.23922/jarc.2025-095","DOIUrl":"10.23922/jarc.2025-095","url":null,"abstract":"<p><strong>Objectives: </strong>Surgical resection (SR) is recommended for pT1 colorectal cancer (CRC) with high-risk histological features for lymph node metastasis. However, endoscopic resection (ER) alone without additional SR is sometimes chosen for elderly patients due to surgical tolerance. Comparative studies on outcomes and prognosis between ER and SR remain limited.</p><p><strong>Methods: </strong>This retrospective study evaluated the outcomes of ER alone or SR in elderly patients (≥80 years) with high-risk pT1 CRC between 2008 and 2021.</p><p><strong>Results: </strong>A total of 59 patients were included, with 23 in the ER group and 36 in the SR group (additional SR after ER: 21, initial SR: 15). In the ER/SR groups, median age was 83 years, and the male ratio was 52%/64%, respectively. Median of Prognostic Nutritional Index (PNI) was 46.9/51.0. Median lesion size was 20 mm in both groups. Pathological findings showed pT1b in 96%/92%, lymphovascular invasion in 35%/33%, and budding grade ≥2 in 22%/28%. Treatment-related complications occurred in 7%/8% in each procedure, with one surgery-related death. Over a median follow-up of 57/63 months, no recurrences or disease-specific deaths were observed. The 5-year survival rates were 90%/81%, with no significant difference in overall survival (<i>P</i> = 0.12). PNI <43.4 was identified as a prognostic risk factor, and in the ER group, patients with low PNI showed significantly worse survival.</p><p><strong>Conclusion: </strong>There was no significant difference between the outcomes of ER alone and SR among elderly patients with high-risk pT1 CRC. PNI can be a valuable predictor of prognosis in the ER group.</p>","PeriodicalId":56349,"journal":{"name":"Journal of the Anus Rectum and Colon","volume":"10 3","pages":"325-333"},"PeriodicalIF":1.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological Features and Prognostic Impact of Colorectal Signet-Ring Cell Carcinoma: The Prognostic Impact of Metastatic Lymph Node Histology.","authors":"Gen Tsujio, Yusuke Tanaka, Akio Shiomi, Shoichi Manabe, Shunsuke Kasai, Tadahiro Kojima, Takahiro Igaki, Yukihiro Mori, Takuma Oishi","doi":"10.23922/jarc.2025-125","DOIUrl":"10.23922/jarc.2025-125","url":null,"abstract":"<p><strong>Objectives: </strong>Colorectal signet-ring cell carcinoma (SRCC) is a rare histological subtype, accounting for only 0.2-0.9% of all colorectal cancers, and is often diagnosed at an advanced stage with a poor prognosis. However, the clinicopathological and prognostic characteristics of colorectal cancers with SRCC components remain poorly defined.</p><p><strong>Methods: </strong>We retrospectively analyzed 35 patients who underwent surgical resection for primary colorectal cancer containing SRCC components between September 2002 and December 2022 at the Shizuoka Cancer Center. The patients were divided into two groups according to the predominant histological subtype: SRCC (n = 7) and adenocarcinoma with a signet-ring cell component (AC with SRC; n = 28). Clinicopathological features and survival outcomes were compared between the groups. Among the patients with lymph node metastasis, survival was compared according to the presence of SRCC in the metastatic lymph nodes (LNM SRCC+, n = 13; LNM SRCC-, n = 13).</p><p><strong>Results: </strong>Of the 35 patients, 7 were classified as having SRCC and 28 as having AC with SRC. Most cases were T3 or deeper tumors (85.7%), with frequent lymphatic invasion (82.9%) and lymph node metastasis (74.3%). The prognosis did not differ between SRCC and AC with SRC, whereas the presence of SRCC in metastatic lymph nodes was associated with significantly poorer overall and relapse-free survival (P = 0.048 and 0.012, respectively).</p><p><strong>Conclusions: </strong>Colorectal cancers with SRCC components are typically advanced and aggressive. The presence of SRCC components confers a poor prognosis, and SRCC in metastatic lymph nodes represents an important adverse prognostic indicator.</p>","PeriodicalId":56349,"journal":{"name":"Journal of the Anus Rectum and Colon","volume":"10 3","pages":"334-342"},"PeriodicalIF":1.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thin Membranous Connective Tissue Encasing the Superior Mesenteric Vessels as an Objective Landmark for Robotic D3 Lymphadenectomy in Right-sided Colon Cancer: A Histological Study and Intraoperative Video Review.","authors":"Ken Nagata, Keiichi Shiokawa, Issei Takeshita, Kurumi Sahara, Taro Munechika, Hideki Nagano, Hiroyuki Takahashi, Yoshiko Matsumoto, Hiroshi Kida, Suguru Hasegawa","doi":"10.23922/jarc.2026-018","DOIUrl":"10.23922/jarc.2026-018","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to histologically identify and validate a consistent perivascular membranous structure encasing the superior mesenteric vessels and to evaluate its intraoperative visibility as an objective landmark for standardizing robotic central (D3) lymphadenectomy with central vascular ligation in right-sided colon cancer (RSCC).</p><p><strong>Methods: </strong>This translational anatomic study comprised (i) cadaveric histology of the superior mesenteric artery and vein (n = 5), (ii) validation using surgical resection specimens from RSCC (n = 5), and (iii) retrospective review of non-edited intraoperative videos from 78 consecutive robotic D3 procedures. Two skill-qualified surgeons, who were blinded to pathological outcomes, independently graded visibility and assessed associations with body mass index (BMI) and surgeon experience.</p><p><strong>Results: </strong>Histology consistently showed a collagenous and elastic membranous layer encasing the superior mesenteric vessels and separating them from mesenteric lymphofatty tissue; this is termed the thin membranous connective tissue (TMCT). Of 78 cases, TMCT has clear visibility in 69 (88%) and poor visibility in 9 (12%), with no association with BMI (<i>p</i> = 0.55) or surgeon experience (<i>p</i> = 0.32). No central vascular injuries occurred. Estimated blood loss and lymph node yield did not significantly differ between cases with clear versus poor TMCT identification.</p><p><strong>Conclusions: </strong>TMCT, a histologically defined perivascular layer that is usually identifiable during robotic surgery, provides an objective boundary to delineate the optimal central dissection plane around the superior mesenteric vessels and supports safer, more reproducible robotic D3 lymphadenectomy for RSCC.</p>","PeriodicalId":56349,"journal":{"name":"Journal of the Anus Rectum and Colon","volume":"10 3","pages":"401-409"},"PeriodicalIF":1.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aggressive Angiomyxoma in the Anus of Elderly Male.","authors":"Shigeyuki Kosaka, Takahisa Hirokawa, Tatsuya Kawai, Hajime Ushigome, Takuya Suzuki, Yushi Yamakawa, Hiroki Takahashi, Yoichi Matsuo, Shuji Takiguchi","doi":"10.23922/jarc.2025-088","DOIUrl":"10.23922/jarc.2025-088","url":null,"abstract":"<p><p>Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor characterized by local invasion and a high recurrence rate, primarily affecting the pelvic-perineal region in women. It is extremely rare in men. Although male-onset cases are typically reported in the scrotum or buttocks, there have been no previously reported cases involving the anus. We report the first such case in a 71-year-old man initially diagnosed with prolapsed internal hemorrhoids (Goligher grade IV). The patient underwent surgical treatment; however, histological analysis of the specimen unexpectedly revealed AAM, with positive findings for CD34 (+), desmin (+), and partially positive ER (ER [partial +]). The postoperative course was complicated by hemorrhage, requiring hemostasis via vascular embolization. Despite the high recurrence rate of AAM, the patient has remained disease-free for over five years.</p>","PeriodicalId":56349,"journal":{"name":"Journal of the Anus Rectum and Colon","volume":"10 3","pages":"495-499"},"PeriodicalIF":1.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Performance of Non-Colonographic Routine CT for Detecting Advanced Colorectal Cancer.","authors":"Kohei Suzuki, Kenichi Utano, Natsuki Ishizaki, Kakeru Otomo, Masato Aizawa, Kana Tamazawa, Jun Wada, Yuka Utano, Tadayuki Takagi, Kazutomo Togashi","doi":"10.23922/jarc.2025-127","DOIUrl":"10.23922/jarc.2025-127","url":null,"abstract":"<p><strong>Objectives: </strong>Advanced-stage colorectal cancers (CRCs) are occasionally detected on routine abdominal CT scans performed in daily clinical practice. This study aimed to evaluate the diagnostic performance of routine CT scans for detecting advanced CRCs.</p><p><strong>Methods: </strong>We studied patients who underwent routine CT examinations for gastrointestinal symptoms or abnormalities between March 2015 and April 2025, and who subsequently underwent colonoscopy within six months. CT images were interpreted by two radiologists as part of routine clinical practice. Colonoscopic and pathological findings were used as reference standards for advanced CRC (p-T2 or deeper). Diagnostic performance was expressed as percentages with 95% confidence intervals.</p><p><strong>Results: </strong>A total of 350 patients were reviewed (female 44.6%; mean age 64.6 ± 17.2 years; intravenous contrast administration 44.6%). Colonoscopy identified 46 advanced CRCs (median size 56 mm; range 16-105 mm; T2 n=1, T3 n=16, T4 n=18, unknown n=11; proximal colon n=13, distal colon n=16, rectum n=17). Except for one CRC obscured by a large gastric gastrointestinal stromal tumor, all remaining 45 CRCs were suspected on CT (sensitivity 97.8% [88.5-99.9]). Among 304 patients without advanced CRC, 292 were correctly classified as negative (specificity 96.1% [93.2-97.9]). The positive predictive value, negative predictive value, and overall accuracy were 78.9% [66.1-88.6], 99.7% [98.1-100], and 96.3% [93.7-98.0], respectively. In subgroup analysis stratified by contrast enhancement, diagnostic accuracy was 96.8% [92.7-99.0] with contrast and 95.9% [92.0-98.2] without contrast (p=0.65).</p><p><strong>Conclusions: </strong>Routine abdominal CT without colonographic technique demonstrated excellent diagnostic performance for detecting advanced CRC.</p>","PeriodicalId":56349,"journal":{"name":"Journal of the Anus Rectum and Colon","volume":"10 3","pages":"429-436"},"PeriodicalIF":1.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-center Experience with Comprehensive Genomic Profiling Using Circulating Tumor DNA for Metastatic Colorectal Cancer.","authors":"Kazuma Ito, Kozo Kataoka, Yoshiko Muroi, Mizuki Koba, Yuko Fukumoto, Ayako Imada, Song Jihyung, Zhenxin Rao, Hiroki Osumi, Motoi Uchino, Kei Kimura, Masataka Ikeda","doi":"10.23922/jarc.2026-003","DOIUrl":"10.23922/jarc.2026-003","url":null,"abstract":"<p><p>Comprehensive genomic profiling (CGP) using circulating tumor DNA (ctDNA) has recently become available in Japan, but its clinical utility in daily practice remains unclear. We retrospectively evaluated 19 patients with metastatic colorectal cancer (mCRC) who underwent plasma-based CGP (Guardant360 CDx) between November 2023 and May 2025. ctDNA was detected in 18 of 19 patients (95%) with previously treated mCRC. The median turnaround time from blood collection to result was 11 days (range: 7-15). The median number of gene alterations was 5 (range: 1-29), and pathogenic/likely pathogenic alterations were identified in 15 patients (79%). ctDNA was preferentially selected over tissue CGP in patients with small tumor burden, lack of contemporary tumor sample, or double cancer (considering spatial and temporal heterogeneity). Three patients initially identified with <i>RAS</i> mutant tumors by tissue were subsequently identified as <i>RAS</i> wild-type by plasma CGP. Those were treated with anti-epidermal growth factor receptor (EGFR) therapy, resulting in partial response or stable disease. These observations suggest that plasma-based CGP may provide additional molecular information that could be clinically informative in mCRC in a real-world setting. Although the findings should be interpreted as exploratory, re-evaluation of molecular profiles using ctDNA enabled the exploratory identification of Neo<i>RAS</i> wild-type patients, who could potentially benefit from anti-EGFR therapy.</p>","PeriodicalId":56349,"journal":{"name":"Journal of the Anus Rectum and Colon","volume":"10 3","pages":"507-515"},"PeriodicalIF":1.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Radiotherapy as a Major Risk Factor for Pelvic Abscess after Abdominoperineal Resection and Total Pelvic Exenteration: A Retrospective Study.","authors":"Tomoaki Kaneko, Shuichiro Matoba, Mitsunori Ushigome, Satoru Kagami, Yasuo Nagashima, Kimihiko Yoshida, Yasuyuki Miura, Takayuki Suzuki, Kentaro Watanabe, Kimihiko Funahashi, Yuichiro Otsuka","doi":"10.23922/jarc.2025-121","DOIUrl":"10.23922/jarc.2025-121","url":null,"abstract":"<p><strong>Objectives: </strong>Pelvic abscess, alongside perineal wound infection, is a major postoperative complication after abdominoperineal resection (APR) and total pelvic exenteration (TPE). Because the underlying mechanisms of these two complications differ, separate evaluation is warranted. This study aimed to identify risk factors specifically associated with pelvic abscess.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent APR or TPE at our institution between December 2004 and August 2025. Patients were divided into abscess and non-abscess groups, and patient characteristics and surgical variables were compared using univariate and multivariate analyses.</p><p><strong>Results: </strong>Among 215 patients, 187 (87%) underwent APR and 28 (13.0%) underwent TPE. The incidence of pelvic abscess was 18.1% (39/215). Univariate analysis identified significantly higher abscess rates in patients receiving preoperative radiotherapy (28.2% vs. 8.5%, p = 0.002) and in those with greater blood loss (894.0 vs. 390.0 mL, p = 0.015). Multivariate analysis confirmed preoperative radiotherapy as an independent predictor (p = 0.002). No difference in pelvic abscess incidence was found among patients who underwent APR with or without combined resection of adjacent pelvic organs.</p><p><strong>Conclusion: </strong>Preoperative radiotherapy is a significant risk factor for pelvic abscess after APR and TPE. Future studies should refine preventive strategies and develop targeted approaches for high-risk patients.</p>","PeriodicalId":56349,"journal":{"name":"Journal of the Anus Rectum and Colon","volume":"10 3","pages":"421-428"},"PeriodicalIF":1.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic and Predictive Value of Lymph Node Ratio in Stage III Colon Cancer in the Era of Molecular Biomarkers.","authors":"Zhenxin Rao, Kozo Kataoka, Ayako Imada, Kazuma Ito, Yuko Fukumoto, Kei Kimura, Jihyung Song, Yuki Horio, Ryuichi Kuwahara, Motoi Uchino, Wim Ceelen, Masataka Ikeda","doi":"10.23922/jarc.2025-129","DOIUrl":"10.23922/jarc.2025-129","url":null,"abstract":"<p><strong>Background: </strong>The prognostic and predictive value of the lymph node ratio (LNR; metastatic/harvested nodes) in stage III colon cancer (CC) remains unclear, particularly in combination with molecular profiles such as RAS, BRAF, and microsatellite instability (MSI) status.</p><p><strong>Methods: </strong>We retrospectively analyzed stage III CC patients who underwent curative resection with D3 lymph node dissection (2013-2023). Optimal LNR cutoffs were determined using maximally selected rank statistics. Cox models assessed the prognostic impact of LNR adjusted for clinicopathological and molecular factors. The effect of adjuvant chemotherapy (ACT) on recurrence-free (RFS) and overall survival (OS) was evaluated by LNR subgroup.</p><p><strong>Results: </strong>Among 361 patients, optimal LNR cutoffs for RFS and OS were 0.16 and 0.21, respectively. Based on the cutoffs of 0.2, the RFS and OS were longer in patients with low LNR than those with high LNR. Multivariate analysis identified RAS and BRAF mutation, venous invasion, LNR and ACT as independent factors for RFS, while RAS mutation, lymphatic invasion, ACT and LNR were significant for OS. In patients with low LNR (≤0.2), ACT improved RFS (HR 0.57 (95% CI 0.33-0.99)) and OS (HR 0.48 (95% CI 0.28-0.85)) and similar tendency was observed in those with high LNR (>0.2) (RFS: HR 0.56 (95% CI: 0.29-1.09), OS: HR 0.51 (95%CI 0.23-1.13)).</p><p><strong>Conclusion: </strong>After adjustment for multiple biomarkers, LNR remained an independent predictor of OS in stage III CC. ACT was associated with improved survival regardless of LNR, with a consistent trend observed even in patients with high LNR.</p>","PeriodicalId":56349,"journal":{"name":"Journal of the Anus Rectum and Colon","volume":"10 3","pages":"392-400"},"PeriodicalIF":1.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Salvage Underwater Endoscopic Mucosal Resection for Early Colorectal Cancer with Unclear Horizontal and Vertical Margin after Cold Snare Polypectomy: Two Case Reports.","authors":"Fumihiko Nakamura, Kentaro Ishii, Masahiko Kuroda, Yukako Nemoto","doi":"10.23922/jarc.2025-098","DOIUrl":"10.23922/jarc.2025-098","url":null,"abstract":"<p><p>We sometimes encounter a case of early colorectal cancer with positive or unidentified margin after cold snare polypectomy (CSP). Case 1 was a 70-year-old woman who underwent total colonoscopy at our center. An 8-mm lesion classified as 0-IIa+IIc in the Paris classification was detected in the descending colon and removed with CSP. Case 2 was a 60-year-old man who underwent total colonoscopy at our center. A 6-mm lesion classified as 0-Is in the Paris classification was detected in the rectum and removed with CSP. Both lesions resulted in well-differentiated adenocarcinoma with unidentified horizontal and vertical margins pathologically. We safely performed underwater endoscopic mucosal resection (UEMR) for the post-CSP scar because residual cancer could not be ruled out completely. Pathological results showed that there was no residual cancer in either case. We report two cases of successful salvage UEMR for early colorectal cancer with unidentified horizontal and vertical margins after CSP. Salvage UEMR after CSP in the early stage may facilitate the exploration of residual cancer or the resection of residual cancer.</p>","PeriodicalId":56349,"journal":{"name":"Journal of the Anus Rectum and Colon","volume":"10 3","pages":"500-506"},"PeriodicalIF":1.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Doppler Ultrasonography with Superb Microvascular Imaging for Intestinal Perfusion Assessment in Colorectal Cancer Surgery: A Prospective Pilot Study.","authors":"Atsushi Hirata, Gaku Ohira, Satoko Arai, Tetsuro Maruyama, Toru Tochigi, Koichiro Okada, Koichi Hayano, Masaya Uesato, Shunsuke Kainuma, Michihiro Maruyama","doi":"10.23922/jarc.2025-087","DOIUrl":"10.23922/jarc.2025-087","url":null,"abstract":"<p><strong>Objectives: </strong>Intraoperative indocyanine green fluorescence imaging (ICG-FI) reduces anastomotic leakage, but has limitations related to contrast agent use, repeatability, and timing-dependent interpretation. We conducted an exploratory trial of a Doppler ultrasonography method using a high-frequency probe with superb microvascular imaging (SMI) to assess intestinal perfusion during colorectal cancer surgery.</p><p><strong>Methods: </strong>In this single-center prospective pilot study, we enrolled patients undergoing colorectal cancer resection with anastomosis. Intraoperatively, SMI assessed intramural microvascular flow to determine the perfusion boundary, followed by ICG-FI. The SMI boundary was defined as the line where vertical vessels penetrating the muscularis propria were no longer visible. The primary endpoint was the difference in blood flow boundaries between ICG-FI and SMI. The secondary endpoints were inter-observer reproducibility of SMI boundary identification and safety within 30 days.</p><p><strong>Results: </strong>Seven patients were analyzed for efficacy (one excluded because of invalid SMI data) and eight for safety. The median difference in blood flow boundaries between ICG-FI and SMI was -4 mm (range, -60 to 0 mm), with SMI identifying a more proximal boundary. Inter-observer variability for SMI boundary detection showed a median absolute difference of 2 mm (range, 0-4 mm). No procedure-related adverse events occurred.</p><p><strong>Conclusions: </strong>Our findings revealed differences in perfusion boundary location between SMI and ICG-FI, and intraoperative SMI acquisition and boundary identification were technically feasible. Analyzable data were obtained in seven of eight patients, with high inter-observer reproducibility and no procedure-related adverse events. Further prospective validation with standardized SMI acquisition and interpretation is required before clinical implementation.</p>","PeriodicalId":56349,"journal":{"name":"Journal of the Anus Rectum and Colon","volume":"10 3","pages":"410-420"},"PeriodicalIF":1.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}