International Journal Of Colorectal Disease[JOURNAL]
Sun
200 papers
Consensus statement on the management of metastatic colorectal cancer beyond the second-line therapy in Saudi Arabia.
Bazarbashi S, Alsharm A, Alshehri A … +9 more , Ibnshamsah F, Tashkandi E, Alshammari K, Al-Hajeili M, Mahrous M, Alghmadi M, Aljubran A, Alkhayyat S, Elsamany S
Int J Colorectal Dis · 2026 May · PMID 42159627 · Publisher ↗
BACKGROUND: The burden of metastatic colorectal cancer (mCRC) is considerable in Saudi Arabia, with an increased incidence rate and lower overall survival (OS) rate and characterized by earlier age of onset, more aggress...
BACKGROUND: The burden of metastatic colorectal cancer (mCRC) is considerable in Saudi Arabia, with an increased incidence rate and lower overall survival (OS) rate and characterized by earlier age of onset, more aggressive disease, and limited access to molecular diagnostics and advanced therapies in some regions. While international guidelines provide general management pathways, regional differences necessitate tailored recommendations for patients progressing beyond second-line treatment in Saudi Arabia. METHODS: A three-step modified Delphi method was adopted to develop the expert consensus on the management of mCRC beyond second-line therapy in Saudi Arabia. Ten medical oncologists from leading national cancer centers participated in the process, which included literature review, two voting rounds, and a panel discussion. RESULTS: The present consensus consisted of 56 statements reaching predefined agreement levels. The statements provided recommendations regarding the factors affecting treatment selection beyond second-line therapy, treatment sequencing in third and later lines of therapy, dosing modifications, management of toxicities, and the role of combination regimens in third and later lines. The consensus also underscores systemic disparities in drug access and the lack of real-world data or registries in Saudi Arabia. CONCLUSION: This consensus provides contextualized, evidence-based guidance to Saudi oncologists managing mCRC beyond second-line therapy. It emphasizes individualized treatment, toxicity control, and the need for national registries and biomarker research. The recommendations aim to improve consistency of care while acknowledging infrastructural and epidemiological challenges unique to the region.
Efficacy analysis of the Turnbull-Cutait procedure in refractory perianal Crohn's disease: a two-centre retrospective study.
Tu Q, Hu H, Zhang M … +6 more , Luo K, Wan S, Li D, Li Y, Ke J, Ding Z
Int J Colorectal Dis · 2026 May · PMID 42149270 · Publisher ↗
PURPOSE: Patients with refractory perianal Crohn's disease (RpCD) often face rectal resection and permanent ostomy as a final resort. The Turnbull-Cutait (TC) pull-through procedure offers a potential sphincter-preservin...
PURPOSE: Patients with refractory perianal Crohn's disease (RpCD) often face rectal resection and permanent ostomy as a final resort. The Turnbull-Cutait (TC) pull-through procedure offers a potential sphincter-preserving alternative, yet evidence supporting its use in RpCD remains scarce. This study evaluated the therapeutic efficacy of the TC procedure in this setting. METHODS: A retrospective analysis was conducted on ten patients with RpCD who planned to undergo TC surgery at Zhongnan Hospital of Wuhan University and the Sixth Affiliated Hospital of Sun Yat-sen University from January 2020 to June 2025; ultimately, eight patients completed the surgery. The median follow-up duration was 14.5 months. RESULTS: In the per-protocol analysis (n = 8), the incidence of postoperative complications during follow-up was 37.5%, including 1 case of anal fistula recurrence, 1 case of anal incontinence, and 1 case of rectovaginal fistula recurrence. Five patients achieved short-term technical success, yielding a short-term technical success rate of 62.5%. Their median gastrointestinal quality of life index (GIQLI) score was 138 points, indicating an overall high quality of life. CONCLUSION: The TC procedure may serve as a salvage option to avoid permanent stoma in strictly selected patients with RpCD. Although short-term clinical improvement was observed in some patients, the relatively high complication rate and an uncertain long-term efficacy warrant cautious application and careful patient selection.
Effect of prolonged interval between neoadjuvant chemoradiotherapy and surgery on pathological and oncological outcomes in locally advanced rectal cancer: a randomized controlled trial.
Sileika E, Cerkauskaite D, Bausys A … +9 more , Bernotaite V, Stulpinas R, Mickys U, Zilevice L, Suziedelis K, Aleinikov A, Smolskas E, Urbonas V, Dulskas A
Int J Colorectal Dis · 2026 May · PMID 42128940 · Publisher ↗
BACKGROUND: The optimal interval between neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME) in locally advanced rectal cancer (LARC) remains controversial. This randomized controlled trial evaluated...
BACKGROUND: The optimal interval between neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME) in locally advanced rectal cancer (LARC) remains controversial. This randomized controlled trial evaluated whether prolonging the interval between nCRT and surgery improves pathological response and oncological outcomes. METHODS: Adult patients with histologically confirmed, MRI-staged II-III rectal adenocarcinoma located within 12 cm of the anal verge were randomized to undergo surgery at 8 weeks or 12 weeks after completion of long-course nCRT (50 Gy with concurrent 5-fluorouracil). The primary endpoint was pathological complete response (pCR; Dworak grade 4). Secondary endpoints included postoperative complications, surgical quality, disease-free survival (DFS), overall survival (OS), and patterns of recurrence. RESULTS: A total of 124 patients were analyzed (61 in the 8-week group and 63 in the 12-week group). Median time to surgery was 72 days (10.3 weeks) and 93 days (13.3 weeks), respectively. pCR was achieved in 14.8% vs 14.5% (p = 0.904). There were no significant differences in ypT stage, ypN stage, CRM positivity, or TME quality. Anastomotic leakage was numerically higher in the 12-week group (15.9% vs 4.9%). Three-year OS (76.3% vs 80.0%, p = 0.657) and DFS (62.9% vs 62.2%, p = 0.838) were comparable. Adjuvant chemotherapy was administered more frequently in the 8-week group (61.7% vs 39.7%, p = 0.015). CONCLUSION: Extending the surgical interval from 8 to 12 weeks did not improve pathological response or oncological outcomes. These results should be interpreted cautiously in the context of evolving total neoadjuvant therapy (TNT) strategies. TRIAL REGISTRATION: Clinicaltrialtrials.gov No. NCT03607370.
Training and credentialing in robotic general surgery.
Harris M, Mohan H, Martins BAA … +3 more , Essani R, Saklani A, Harji D
Int J Colorectal Dis · 2026 May · PMID 42115403 · Publisher ↗
INTRODUCTION: Robotic-assisted surgery is now embedded across many domains of general surgery; however, training and credentialing frameworks have not evolved at the same pace as technological adoption. As a result, sign...
INTRODUCTION: Robotic-assisted surgery is now embedded across many domains of general surgery; however, training and credentialing frameworks have not evolved at the same pace as technological adoption. As a result, significant variability exists in access to training, definitions of competency and proficiency, assessment standards, and institutional credentialing practices. These inconsistencies raise concerns regarding patient safety, equity of access, and workforce preparedness, particularly in the context of expanding robotic platforms and parallel learning curves among trainees and established surgeons. METHODS: This narrative review aims to (1) clarify and define key concepts relevant to robotic surgical training, including competency, proficiency, benchmarking, and credentialing; (2) synthesise current barriers to effective robotic training across the surgical career continuum; and (3) propose a structured, standardised, and platform-agnostic credentialing pathway for robotic general surgery. Drawing on published literature and international consensus work, we identify challenges related to system access, lack of standardisation, training capacity, service pressures, and limited use of objective performance metrics and feedback mechanisms. RESULTS: We propose a competency-based credentialing framework incorporating simulation-based foundational training, modular procedural progression, non-technical skills development, structured mentorship, and objective assessment using validated metrics. The pathway is designed to be adaptable across institutions and applicable to both surgical trainees and consultants, while remaining independent of vendor-specific credentialing models. CONCLUSION: Establishing a standardised approach to robotic training and credentialing is essential to ensure safe implementation, support proficiency development, and enable equitable access to robotic surgery. Coordinated action from professional bodies, training institutions, and healthcare systems will be required to deliver a future-ready robotic surgical workforce.
Early-onset colorectal cancer: a comprehensive review reframing hypotheses and defining research priorities.
Catani G, O'Connor JM, Spinelli A … +1 more , Perea J
Int J Colorectal Dis · 2026 May · PMID 42115377 · Publisher ↗
PURPOSE: Early-onset colorectal cancer (EOCRC), defined as colorectal cancer diagnosed before the age of 50 years, is increasing worldwide and represents a growing clinical and public health challenge. Whether EOCRC cons...
PURPOSE: Early-onset colorectal cancer (EOCRC), defined as colorectal cancer diagnosed before the age of 50 years, is increasing worldwide and represents a growing clinical and public health challenge. Whether EOCRC constitutes a biologically distinct entity remains uncertain, and current diagnostic and therapeutic strategies are largely extrapolated from late-onset disease. METHODS: This narrative review summarizes recent evidence on EOCRC biology, diagnosis, and management, focusing on molecular and genomic features, tumor microenvironment, exposome-related factors, diagnostic pathways, treatment paradigms, and emerging strategies for early detection. We critically examine the gap between biological insights and real-world clinical practice and outline priorities for future research. RESULTS: EOCRC displays a heterogeneous molecular landscape that substantially overlaps with late-onset colorectal cancer. Although advances in multiomics profiling, liquid biopsy, and microbiome research have improved biological understanding, these findings have not yet translated into EOCRC-specific diagnostic or therapeutic approaches. Diagnosis remains delayed due to age-based screening paradigms and symptom misattribution, resulting in advanced-stage presentation. Younger patients frequently receive intensified treatment despite limited age-specific evidence and insufficient attention to long-term toxicity, fertility, and survivorship. CONCLUSION: EOCRC underdiagnosis is likely multifactorial. While limitations in biological knowledge and diagnostic tools may play a role, the discrepancy between current paradigms and the age-specific risk profiles of younger patients likely represents an important contributing factor. Progress will require biology-informed, risk-adapted screening strategies and EOCRC-focused clinical research.
Effect of antibiotic therapy versus no antibiotics on nonoperative management outcomes in uncomplicated appendicitis: A systematic review and meta-analysis.
Lin WT, Huang YN, Wang JH … +1 more , Lin YK
Int J Colorectal Dis · 2026 May · PMID 42105101 · Full text
PURPOSE: Although antibiotics are a recognized alternative to appendectomy for uncomplicated appendicitis, their specific benefit over observation alone remains unclear. This systematic review and meta-analysis aimed to...
PURPOSE: Although antibiotics are a recognized alternative to appendectomy for uncomplicated appendicitis, their specific benefit over observation alone remains unclear. This systematic review and meta-analysis aimed to isolate the antibiotic effect by directly contrasting antibiotics with observation in patients receiving nonoperative management (NOM) for uncomplicated appendicitis. METHODS: We systematically searched PubMed, Embase (Ovid), the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the International Clinical Trials Registry Platform, and the International Standard Randomized Controlled Trial Number Registry from inception to October 5, 2025, to identify randomized or quasi-randomized trials comparing antibiotics versus observation (no antibiotics) for NOM. We defined treatment success at 30 days as the primary endpoint. To assess the potential risk-of-bias (ROB), the Cochrane RoB 2 instrument was employed, while the overall certainty of our findings was determined through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. RESULTS: Three trials involving 437 participants were included: two randomized controlled trials (RCTs) and one quasi-RCT. Analysis restricted to RCTs demonstrated no significant effect of antibiotics on initial treatment success (RR: 1.03, 95% CI: 0.92-1.15). Analysis across three studies showed no significant differences in recurrence (RR: 1.38, 95% CI: 0.68-2.80) or the need for appendectomy during follow-up (RR: 0.98, 95% CI: 0.66-1.47). Evidence certainty was low for the primary outcome and very low for secondary outcomes. CONCLUSION: Current evidence is insufficient to determine whether antibiotics provide additional benefit over observation for uncomplicated appendicitis. Larger, adequately powered trials are needed to establish the comparative effectiveness of these approaches.
Perioperative and oncological outcomes of extended surgery for colorectal cancer in younger patients: a propensity score-matched study.
Ogawa K, Miyamoto Y, Kawata A … +7 more , Akiyama T, Arima K, Kosumi K, Eto K, Hadara K, Hiyoshi Y, Iwatsuki M
Int J Colorectal Dis · 2026 May · PMID 42098394 · Full text
BACKGROUND: Extended surgery, including multivisceral resection, synchronous metastasectomy, and concomitant procedures for coexisting diseases, is occasionally required to achieve oncological clearance in patients with...
BACKGROUND: Extended surgery, including multivisceral resection, synchronous metastasectomy, and concomitant procedures for coexisting diseases, is occasionally required to achieve oncological clearance in patients with colorectal cancer. However, the perioperative and oncological impact of extended surgery in younger patients remains unclear. This study aimed to evaluate short- and long-term outcomes of extended surgery in younger patients with colorectal cancer. METHODS: We conducted a single-center retrospective study of patients aged ≤ 65 years who underwent colorectal cancer surgery between 2014 and 2023. Extended surgery was defined as multivisceral resection for locally advanced tumors, resection of synchronous metastatic lesions, or concomitant surgery for coexisting diseases. Propensity score matching was performed to compare short-term postoperative outcomes and overall survival between extended and standard surgery. A secondary analysis compared younger and elderly patients who underwent extended surgery. The primary endpoint was overall survival. RESULTS: After matching, 41 patients who underwent extended surgery were compared with 42 who underwent standard surgery. Extended surgery was associated with longer operative time and greater blood loss. However, rates of anastomotic leakage, major postoperative complications, and mortality were comparable between groups. Overall survival did not differ significantly between extended and standard surgery in younger patients. In addition, postoperative outcomes and overall survival were similar between younger and elderly patients undergoing extended surgery. CONCLUSIONS: Extended surgery was associated with increased operative invasiveness but did not adversely affect perioperative outcomes or overall survival in appropriately selected younger patients with colorectal cancer. These findings suggest that extended surgery may be considered when indicated by oncological factors, irrespective of chronological age.
Trans-Pfannenstiel sigmoidectomy for sigmoid volvulus: description of a novel surgical technique and initial experience from a retrospective case series.
Murzi V, Podda M, Balestra F … +7 more , Pisano M, Saba A, Dessì A, Sanna R, Silanos E, Puledda M, Pisanu A
Int J Colorectal Dis · 2026 May · PMID 42096074 · Full text
PURPOSE: Sigmoid volvulus is a recurrent cause of large bowel obstruction that predominantly affects elderly and frail patients. After successful endoscopic detorsion, elective sigmoid resection is recommended to prevent...
PURPOSE: Sigmoid volvulus is a recurrent cause of large bowel obstruction that predominantly affects elderly and frail patients. After successful endoscopic detorsion, elective sigmoid resection is recommended to prevent recurrence. This study describes a new, trans-Pfannenstiel approach for sigmoidectomy and reports the initial clinical experience with this technique. METHODS: This study was designed as a single-center retrospective case series. Adult patients surgically treated for sigmoid volvulus between 2024 and 2025 were included. All patients underwent successful endoscopic detorsion and decompression followed by planned surgical resection. The primary outcome was postoperative complications within 30 days. Surgical technique, perioperative outcomes and short-term follow-up were analyzed. RESULTS: Eleven patients were included, with a median age of 71 years (IQR 51-79); five patients (45.4%) were classified as ASA III, and nine patients (63.6%) had experienced two or more previous episodes of volvulus. Median operative time was 105 min (IQR 90-125). No patient required postoperative intensive care or reoperation. Postoperative complications occurred in four patients (36.4%), with one Clavien-Dindo grade IIIa complication managed non-operatively with CT-guided percutaneous drainage. Median length of hospital stay was 6 days (IQR 5-6). Three patients (27.3%) required early readmission for medical complications (one Clavien-Dindo IIIa and two Clavien-Dindo II complications). No postoperative mortality or recurrence of sigmoid volvulus was observed during a median follow-up of 394 days (IQR 246-434). CONCLUSIONS: Trans-Pfannenstiel sigmoidectomy is a feasible, safe, and reproducible technique for the surgical management of sigmoid volvulus in selected patients. When performed after endoscopic decompression in a planned setting, it allows definitive treatment while limiting abdominal wall trauma in a fragile population.
Development and validation of web-based prediction models for major low anterior resection syndrome at 3 and 6 months after sphincter-preserving surgery in patients with rectal cancer.
Sun L, Zhang X, Zhou Q … +8 more , Wang J, Shen M, Ding Y, Zhu Z, Yang J, Wang X, Huang J, Fang H
Int J Colorectal Dis · 2026 May · PMID 42091725 · Full text
OBJECTIVE: To analyse the factors influencing major low anterior resection syndrome (LARS) at 3 months and 6 months after surgery in rectal cancer patients undergoing sphincter-preserving procedures, and separately devel...
OBJECTIVE: To analyse the factors influencing major low anterior resection syndrome (LARS) at 3 months and 6 months after surgery in rectal cancer patients undergoing sphincter-preserving procedures, and separately develop and validate risk prediction models for the 3-month and 6-month postoperative periods. METHODS: This study enrolled patients who underwent radical sphincter-preserving surgery for rectal cancer at the First Affiliated Hospital of the University of Science and Technology of China between August 2017 and September 2024. The LARS scale was used to assess bowel function at 3 months and 6 months postoperatively. In total, 794 patients at 3 months postoperatively and 749 patients at 6 months postoperatively were included and randomly allocated to a training set and a validation set in a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression were used to identify factors influencing major LARS at 3 months and 6 months postoperatively, and to separately develop risk prediction models for the two time points. Receiver operating characteristic (ROC) curves, calibration curves, and clinical decision curve analysis were applied to evaluate the discrimination, calibration, and clinical applicability of the two models. RESULTS: Multivariable logistic regression demonstrated that preoperative chemotherapy, preoperative radiotherapy, and tumour distance from the anal verge were common risk factors associated with major LARS at 3 months and 6 months postoperatively in rectal cancer patients undergoing sphincter-preserving surgery. Anastomotic leakage was identified as a risk factor specific to 3 months postoperatively, whereas prophylactic stoma was a risk factor specific to 6 months postoperatively. Based on these findings, risk prediction models for major LARS at 3 months and 6 months postoperatively were developed, and interactive web-based calculators were developed using the RShiny platform, accessible at https://zhang13579.shinyapps.io/Postoperative_3-Month/ and https://zhang13579.shinyapps.io/Postoperative_6-Month/ , respectively. Both models demonstrated good predictive performance in the training cohort and the validation cohort, as assessed by discrimination, calibration, and clinical applicability. CONCLUSION: The risk prediction models for major LARS at 3 months and 6 months postoperatively in rectal cancer patients undergoing sphincter-preserving procedures developed in this study demonstrated good predictive performance and can assist clinical healthcare professionals in identifying patients at high risk of major LARS.
Intravenous sedation combined with local anesthesia versus spinal anesthesia for hemorrhoidectomy with rubber band ligation: A retrospective cohort study.
Ling L, Lu C, Mongardini FM … +10 more , Liu Z, Bao L, Ji X, Luo Y, Deng Q, Yu F, Docimo L, Mongardini M, Yu S, Zheng W
Int J Colorectal Dis · 2026 May · PMID 42082779 · Full text
BACKGROUND: Evidence comparing intravenous sedation combined with local anesthesia (IV + LA) versus spinal anesthesia (SA) for hemorrhoidectomy with concomitant rubber band ligation (RBL) is limited, particularly in the...
BACKGROUND: Evidence comparing intravenous sedation combined with local anesthesia (IV + LA) versus spinal anesthesia (SA) for hemorrhoidectomy with concomitant rubber band ligation (RBL) is limited, particularly in the context of ambulatory-oriented pathways. METHODS: We conducted a single-center retrospective cohort study including consecutive adults undergoing hemorrhoidectomy with RBL between January 2024 and January 2026. Patients were grouped by anesthetic technique (IV + LA vs SA). The primary outcome was postoperative pain at 24 h measured by the numerical rating scale (NRS). Secondary outcomes included early pain at 6 h, rescue analgesia within 24 h, recovery metrics (time to meet discharge criteria), and anesthesia-related adverse events. Multivariable regression adjusted for prespecified confounders (age, sex, body mass index, American Society of Anesthesiologists class, operative time, extent of hemorrhoidectomy, number of bands, and year of surgery). Propensity-score inverse probability of treatment weighting (IPTW) and an additional sensitivity analysis stratified by calendar period were performed to assess the robustness of the findings. RESULTS: Among 220 screened patients, 146 were included (IV + LA, n = 72; SA, n = 74). NRS at 24 h was lower with IV + LA than with SA (1.2 ± 1.1 vs 2.1 ± 1.2; mean difference - 0.9, 95% CI - 1.27 to - 0.53; P < 0.001), although the magnitude of this difference was modest. Patients receiving SA required 5.5 ± 1.3 h to meet discharge criteria, compared with 2.8 ± 0.9 h in the IV + LA group (P < 0.001). Urinary retention requiring catheterization within 6 h occurred in 17 of 74 patients (23.0%) in the SA group and in none of the 72 patients in the IV + LA group (absolute risk difference, - 23.0 percentage points; P < 0.001). Because no urinary retention events occurred in the IV + LA group, the corresponding adjusted odds ratio should be interpreted cautiously owing to model instability from complete separation. In multivariable analysis, SA remained independently associated with higher NRS at 24 h (β = 0.92, 95% CI 0.56-1.26; P < 0.001), whereas higher odds of hypoxemia/oxygen supplementation were observed in the IV + LA group (adjusted OR 3.89, 95% CI 1.13-13.37; P = 0.014). IPTW diagnostics suggested improved covariate balance and adequate propensity-score overlap, and the direction of the association for the primary outcome was unchanged in sensitivity analyses stratified by calendar period. CONCLUSIONS: For hemorrhoidectomy with RBL, IV + LA and SA were associated with different perioperative trade-offs. Compared with SA, IV + LA was associated with modestly lower 24-h pain scores, faster discharge readiness, and fewer early urinary retention events requiring catheterization, but more frequent hypoxemia/oxygen supplementation. Given the retrospective design, temporal practice change, potential residual confounding, and non-standardized anesthetic protocols, these findings should not be interpreted as proof of superiority and should instead inform individualized anesthetic decision-making pending prospective confirmation.
Complete pathologic response surrogacy for survival and its predictors in locally advanced rectal cancer: a retrospective cohort study.
Ghalehtaki R, Abyaneh R, Salarvand S … +23 more , Rezaei S, Sharifian A, Bagheri F, Nazari R, Nabian N, Naseri S, Hoseini SM, Nouranifar A, Javid HR, Mohammadi N, Darzikolaee NM, Behboudi B, Tafti MA, Fazeli M, Keshvari A, Kazemeini A, Keramati M, Pak H, Babaei M, Farhan F, Saraee E, Aghili M, Kolahdouzan K
Int J Colorectal Dis · 2026 May · PMID 42082690 · Full text
BACKGROUND: Improved treatment techniques in locally advanced rectal cancer (LARC) with neoadjuvant chemoradiation and total mesorectal excision have resulted in higher rates of tumor downstaging and complete pathologic...
BACKGROUND: Improved treatment techniques in locally advanced rectal cancer (LARC) with neoadjuvant chemoradiation and total mesorectal excision have resulted in higher rates of tumor downstaging and complete pathologic response (pCR). We aimed to explore the association of pCR with survival outcomes and its predictors. METHODS: We retrospectively enrolled 478 LARC patients referred to a tertiary cancer center from July 2008 to October 2023 who had received neoadjuvant long-course chemoradiation followed by definitive surgery. The patients were followed up, and the association of pCR with disease-free survival (DFS) and overall survival (OS), as well as its predictors, was analyzed. RESULTS: Ninety-one (22.5%) patients achieved a pCR and 167 (39.9%) patients were downstaged to ypTypN. The 5-year OS and DFS rates were 64.1% and 56% in patients without a pCR and 90.3% and 91.8% in patients with a pCR, respectively (p-value < 0.001). Receipt of adjuvant chemotherapy in patients who did not achieve a pCR did not improve either DFS or OS (p-value 0.44 and 0.73, respectively). Clinical N2 and preoperative carcinoembryonic antigen (CEA) > 5ng/mL independently predicted for pCR. CONCLUSIONS: Our study underscores the importance of pCR as an independent predictor of survival in LARC. Patients with higher nodal burden as well as an abnormal preoperative CEA are less likely to achieve a pCR.
Development and validation of a predictive scoring model for post-ESD coagulation syndrome in elderly with colorectal LSTs.
Zhang Q, Zang F, He B … +6 more , Feng Y, Wang Z, Xu X, Chen J, Liu L, Diao W
Int J Colorectal Dis · 2026 May · PMID 42069995 · Full text
BACKGROUND: Post-endoscopic submucosal dissection (ESD) electrocoagulation syndrome (PEECS) is a known complication in colorectal laterally spreading tumors (LSTs), but its risk factors in elderly patients remain unclear...
BACKGROUND: Post-endoscopic submucosal dissection (ESD) electrocoagulation syndrome (PEECS) is a known complication in colorectal laterally spreading tumors (LSTs), but its risk factors in elderly patients remain unclear. This study aimed to develop and validate a risk-stratification scoring system for PEECS in elderly ESD patients. METHODS: A multicenter retrospective study (2020-2025) enrolled 506 elderly patients with colorectal LSTs undergoing ESD, randomly allocated to training (TC, n = 354) and validation (VC, n = 152) cohorts (7:3). Synthetic minority over-sampling technique (SMOTE) was used in the TC to identify risk factors and construct a predictive model, which was validated in the VC. RESULTS: The incidence of post-ESD PEECS was 8.1% (41 cases). After applying the SMOTE, multivariate analysis identified sex, lesion with fibrosis, and intraoperative bleeding as independent risk factors. The scoring system assigned: 1 point for female sex, 3 points for lesion with fibrosis, and 2 points for intraoperative bleeding. In the VC, the model demonstrated an area under the curve (AUC) of 0.921, with a specificity of 0.949 and an accuracy of 0.908. Following risk stratification, the low-risk group (0-4 points) showed a PEECS incidence of 10.1% in the TC and 5.1% in the VC, while the high-risk group (5-6 points) exhibited 94.5% in the TC and 53.3% in the VC. CONCLUSION: In elderly patients with colorectal LSTs undergoing ESD, female sex, fibrotic lesions, and intraoperative bleeding were identified as independent predictors of PEECS. The proposed scoring system demonstrated good discriminatory ability in both cohorts and may be useful for risk stratification in this population.
Development and external validation of an interpretable multimodal deep learning model for 5-year mortality in high-risk stage ii colorectal cancer.
Li X, Liang L, Liu ZH … +5 more , Wang C, Alburiahi TAH, Yang ZY, Xu N, Yang J
Int J Colorectal Dis · 2026 May · PMID 42069945 · Full text
PURPOSE: High-risk stage II colorectal cancer (CRC) shows heterogeneous outcomes despite adjuvant chemotherapy. We developed and validated an interpretable multimodal deep learning model integrating clinical data, serum...
PURPOSE: High-risk stage II colorectal cancer (CRC) shows heterogeneous outcomes despite adjuvant chemotherapy. We developed and validated an interpretable multimodal deep learning model integrating clinical data, serum biomarkers, and venous-phase CT to predict 5-year CRC-specific mortality in high-risk stage II CRC. METHODS: This retrospective, multicenter cohort included 778 high-risk stage II CRC patients from three centers, all treated with adjuvant chemotherapy and with complete preoperative clinical, biomarker, and venous-phase CT data. Patients were split into a development cohort (Centers A + B, n = 720) and an external testing cohort (Center C, n = 58). A multimodal model combining numerical (clinical + biomarker) and imaging (CT) inputs was developed and internally validated using tenfold cross-validation in the development cohort and evaluated in the external cohort. Interpretability was assessed using SHAP and Grad-CAM. RESULTS: In the development cohort, the multimodal model showed superior discrimination (AUC 0.89; 95% CI, 0.87-0.91) versus numerical-only (AUC 0.76) and imaging-only (AUC 0.69). In the external testing cohort (9/58 CRC-specific deaths), the multimodal model achieved an AUC of 0.88 (95% CI, 0.76-0.96). SHAP and Grad-CAM consistently highlighted age, CA125, and tumor regions on CT as key contributors. CONCLUSION: This interpretable multimodal approach, using routine clinical, biomarker, and CT data, improves 5-year mortality risk stratification in high-risk stage II CRC and may inform risk-adapted surveillance and clinical decision support; prospective validation is warranted before treatment modification.
Endoscopic direct-vision therapy vs. antibiotics for acute uncomplicated appendicitis: a retrospective cohort study.
Chen LP, Zhou F, Cheng Q … +1 more , Feng YL
Int J Colorectal Dis · 2026 Apr · PMID 42056469 · Full text
BACKGROUND: Endoscopic direct-vision appendicitis therapy (EDAT) is an emerging ultra-minimally invasive technique for acute uncomplicated appendicitis (AUA). Its comparative effectiveness against antibiotic therapy rema...
BACKGROUND: Endoscopic direct-vision appendicitis therapy (EDAT) is an emerging ultra-minimally invasive technique for acute uncomplicated appendicitis (AUA). Its comparative effectiveness against antibiotic therapy remains unclear. PURPOSE: To compare short-term outcomes and recurrence rates of EDAT versus antibiotic therapy in AUA. METHODS: This retrospective cohort study included 92 AUA patients (41 EDAT, 51 antibiotics). Outcomes included symptom relief, hospital stay, inflammatory markers, treatment success, and recurrence. Subgroup analyses were performed based on fecalith presence and baseline inflammation severity. RESULTS: Baseline characteristics were comparable between groups (all P > 0.05), except for a significantly higher prevalence of fecaliths in the EDAT group (43.9% vs. 21.6%, P = 0.022). EDAT was associated with significantly faster abdominal pain relief [median 12.0 (IQR 12.0-24.0) h vs. 24.0 (12.0-36.0) h, P = 0.008], shorter hospital stay [3.0 (2.0-3.5) days vs. 4.0 (3.0-5.0) days, P < 0.001], and lower postoperative inflammatory markers (WBC =6.83 ± 1.39 vs. 8.53 ± 1.87 × 10/L, P < 0.001; CRP =7.89 ± 2.98 vs. 21.16 ± 12.21 mg/L, P < 0.001). Initial treatment success was 100% in both groups (EDAT = 41/41, antibiotics = 51/51; P = 1.000). At a mean follow-up of 7.88 ± 3.52 months (EDAT) and 14.92 ± 2.61 months (antibiotics), recurrence rates were 7.3% (3/41) vs. 27.5% (14/51), respectively (P = 0.014). Subgroup analyses confirmed that EDAT's advantages were consistent across patients with and without fecaliths, as well as across different levels of baseline inflammation severity. CONCLUSION: In selected patients with AUA, EDAT offers faster symptom resolution, better early inflammatory control, and significantly lower recurrence rates compared with antibiotic therapy. The presence of fecaliths and elevated baseline CRP predicts a higher risk of antibiotic failure, suggesting that EDAT may be particularly valuable in these subgroups. Further prospective studies are warranted to clarify the role of EDAT relative to surgical appendectomy.
Disclosure of mesh origin in rectopexy: an under-recognized component of informed consent.
Gialamas E, Ris F, Garoufalia Z … +1 more , Meurette G
Int J Colorectal Dis · 2026 Apr · PMID 42050161 · Full text
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Multidisciplinary team-guided combined endoscopic laparoscopic surgery for complex colonic lesions: a single-center retrospective cohort study.
Bulut M, Knuhtsen S, Eriksen JR … +2 more , Bremholm L, Gögenur I
Int J Colorectal Dis · 2026 Apr · PMID 42050006 · Full text
PURPOSE: Combined endoscopic laparoscopic surgery (CELS) is a minimally invasive alternative treatment for complex colonic polyps that can reduce surgical overtreatment. We report implementing a standardized treatment st...
PURPOSE: Combined endoscopic laparoscopic surgery (CELS) is a minimally invasive alternative treatment for complex colonic polyps that can reduce surgical overtreatment. We report implementing a standardized treatment strategy with patients selected for CELS procedures via multidisciplinary team (MDT) conferences. METHODS: This observational cohort study included 97 consecutive patients treated with CELS between 2016 and 2022. All cases were discussed by either a benign or malignant MDT. Two CELS techniques were employed: endoscopically assisted wedge resection (EA-WR) and laparoscopically assisted endoscopic mucosal resection (LA-EMR). Patients with suspected malignancies underwent step-up segmental resection (SR) if necessary. Primary outcomes were morbidity and mortality; secondary outcomes included adherence to MDT decisions, procedure durations, length of stay (LOS), histopathology, recurrence, and follow-up. RESULTS: The approach decided by the MDT was unchanged in 81% of cases (79/97). Median age was 70 years and 43% were female. Lesions had a mean size of 31 mm and were predominantly located in the right colon. Technical success for lesion removal during the index procedure was 98% (95/97), with 93% completed by CELS alone. Median operative durations were shorter for EA-WR (52 min) and LA-EMR (73 min) than for SR (163 min, p < 0.001). Median LOS was 1 day for CELS and 5 days for SR (p < 0.001). Eleven patients (11.3%) experienced complications; four required re-interventions. Adenocarcinomas were found in 15 patients (15/97, 12.6%), with treatment individualized based on intraoperative and histological findings. The recurrence rate for benign lesions was 4%; these recurrences were exclusively in the LA-EMR group. CONCLUSION: An MDT-guided strategy incorporating CELS, with optional intraoperative step-up, is an individualized and organ-preserving approach to managing complex colonic lesions that minimizes unnecessary surgical resections. This strategy has the potential to improve clinical decision-making and should be validated in multicenter settings.
Correspondence for the article titled: "Effectiveness and safety of 3% polidocanol foam sclerotherapy in hemorrhoidal disease: a multicenter, prospective study".
Malik MMUD, Jayaswal RP
Int J Colorectal Dis · 2026 Apr · PMID 42043448 · Full text
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Navigating long-term patient-reported outcomes after colorectal cancer surgery in older adults: ostomy, nutritional status, and living conditions as determinants in a prospective cohort study.
Teraishi F, Itagaki S, Mitsuhashi T … +8 more , Tamura R, Matsuoka Y, Shoji R, Kanaya N, Matsumi Y, Kondo Y, Shigeyasu K, Fujiwara T
Int J Colorectal Dis · 2026 Apr · PMID 42032127 · Full text
PURPOSE: To elucidate determinants of long-term patient-reported outcomes (PROs) following colorectal cancer (CRC) surgery in older adults, focusing on the impact of ostomy creation, nutritional status, and living condit...
PURPOSE: To elucidate determinants of long-term patient-reported outcomes (PROs) following colorectal cancer (CRC) surgery in older adults, focusing on the impact of ostomy creation, nutritional status, and living conditions on functional independence and quality of life (QoL). METHODS: This single-center, prospective observational study included patients aged ≥ 75 years who underwent elective CRC resection between July 2020 and December 2023. Comprehensive geriatric assessments were performed preoperatively, and PROs-including Instrumental Activities of Daily Living (IADL), EQ-5D, and EQ-VAS-were reassessed more than one year postoperatively. The primary outcomes were postoperative changes in IADL and QoL. Modified Poisson regression identified independent determinants of long-term decline in each PRO domain. RESULTS: Sixty patients (median age 79 years; 60% female) completed one-year follow-up. IADL declined in 35.6% of patients, EQ-5D in 26.6%, and EQ-VAS in 43.3%. Multivariate analysis revealed that stoma formation was independently associated with IADL decline (adjusted RR = 3.37, 95% CI 1.50-7.54, p = 0.003), whereas living alone postoperatively correlated with preserved IADL (adjusted RR = 0.14, 95% CI 0.02-0.87, p = 0.035). Low preoperative BMI (< 20 kg/m) was significantly associated with EQ-5D deterioration (adjusted RR = 5.25, 95% CI 1.20-22.94, p = 0.027). No significant predictors were identified for EQ-VAS decline. CONCLUSION: Among older CRC patients, stoma creation predicts long-term functional decline, while low BMI predicts QoL deterioration. Conversely, independent living appears protective for functional maintenance. Integrating PROs into perioperative assessment and tailoring surgical, nutritional, and social interventions may enhance survivorship outcomes in this aging population.
Chemoradiotherapy and transanal endoscopic surgery versus transanal endoscopic surgery alone in T1N0M0 rectal cancer: a multicenter, randomized, controlled, phase III clinical trial (TAUTEM-T1 study).
Serra-Aracil X, Nonell A, Gener-Jorge C … +19 more , Pericay C, Golda T, Kreisler E, Espin-Basany E, Pallisera A, Badia-Closa J, Espina B, Borda-Arrizabalaga N, Reina A, Guadalajara-Labajo H, Otero A, Delgado S, Kraft M, Querol R, Flor B, Pellino G, Biondo S, Caro-Tarrago A, TAUTEM-T1 collaborative group
Int J Colorectal Dis · 2026 Apr · PMID 42026347 · Full text
PURPOSE: For clinical (c) T1N0M0 rectal adenocarcinoma without adverse pathological features, local excision by transanal endoscopic surgery (TEM) is standard; however, contemporary series still report local recurrence (...
PURPOSE: For clinical (c) T1N0M0 rectal adenocarcinoma without adverse pathological features, local excision by transanal endoscopic surgery (TEM) is standard; however, contemporary series still report local recurrence (LR) rates of 15-20%. Preoperative unfavorable histopathologic features cannot reliably identify high-risk pT1 disease, and both completion total mesorectal excision (TME) and salvage TME for LR carry relevant morbidity and functional impairment. Building on our prior phase III trial in T2-T3abN0M0 (TAUTEM study), showing that preoperative chemoradiotherapy (CRT) followed by TEM achieved a 7.4% LR with improved postoperative outcomes, we hypothesize that CRT + TEM will increase rectal preservation in cT1N0M0 without compromising oncologic safety or quality of life. The TAUTEM-T1 trial tests this hypothesis. METHODS: Multicenter, prospective, randomized, controlled, phase III superiority trial. Adults with biopsy-proven rectal low or moderate grade adenocarcinoma ≤ 4 cm, located < 10 cm from the anal verge, staged as cT1N0M0, are randomized (1:1) to: CRT (long-course radiotherapy with concurrent capecitabine) followed by TEM at week 10, or TEM alone. The primary endpoint is rectal preservation at 3 years. Secondary endpoints include postoperative morbidity/mortality, CRT-related adverse events, quality of life and anorectal function, and long-term oncologic outcomes (local/distant recurrence, overall and disease-free survival). Planned sample size: 106 patients. RESULTS: This manuscript describes the rationale and design of the TAUTEM-T1 randomized trial. CONCLUSION: TAUTEM-T1 will assess whether preoperative CRT followed by TEM increases rectal preservation in cT1N0M0 rectal cancer without compromising oncologic safety, quality of life, or bowel function. TRIAL REGISTRATION: ClinicalTrials.gov, NCT06450574.
Preoperative carbohydrate loading in elective colorectal surgery: postoperative complications and outcomes, a systematic review and meta-analysis.
Nikitaras A, Pramateftakis MG, Perivoliotis K … +4 more , Tsoti SM, Christodoulou P, Ioannidis O, Tzovaras G
Int J Colorectal Dis · 2026 Apr · PMID 42000931 · Full text
PURPOSE: This study aimed to evaluate the clinical impact of preoperative carbohydrate loading in elective colorectal surgery. METHODS: The review followed the Cochrane Handbook for Systematic Reviews of Interventions an...
PURPOSE: This study aimed to evaluate the clinical impact of preoperative carbohydrate loading in elective colorectal surgery. METHODS: The review followed the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. A systematic search was conducted in MEDLINE (via PubMed), Scopus and Cochrane CENTRAL (via Wiley) to 1 August 2025. All randomised controlled trials (RCTs) investigating preoperative carbohydrate loading in elective colorectal surgery were assessed. The primary outcome was overall postoperative complications; secondary outcomes included specific types of complications, gastrointestinal recovery time, independent mobilisation, and length of stay (LOS). RESULTS: A total of 3,483 citations were screened, yielding 13 RCTs with 996 patients (469 received preoperative carbohydrate loading, 198 consumed water and 329 followed overnight fasting). Carbohydrate loading did not significantly affect overall complications or mortality. Secondary outcomes suggested reduced respiratory infections (OR 0.35; p = 0.04), shorter time to first flatus (MD - 0.60; p < 0.01), earlier defecation (MD - 0.58; p = 0.01), shorter LOS (MD - 0.98; p < 0.01) and earlier mobilisation (MD - 0.49; p < 0.01). CONCLUSION: Preoperative carbohydrate loading was not associated with a statistically significant reduction in overall postoperative complications. Sensitivity analyses suggested limited robustness of the primary outcome. Secondary outcomes suggested faster gastrointestinal recovery, fewer respiratory infections, earlier mobilisation and shorter length of stay; however, these findings should be interpreted cautiously given heterogeneity across trials and variability in perioperative pathways. Further high-quality multicentre randomised controlled trials are needed to confirm these effects in contemporary ERAS pathways.
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