International Journal Of Colorectal Disease[JOURNAL]
Sun
200 papers
A DWI histogram-based nomogram for preoperative prediction of pathogens and antibiotic resistance in perianal abscesses.
Wang J, Li C, Li Y … +6 more , Tang Z, Jiang N, Sun G, Wang Y, Huang B, Lu W
Int J Colorectal Dis · 2026 Feb · PMID 41711896 · Full text
PURPOSE: To develop nomograms based on diffusion-weighted imaging (DWI) histogram parameters and clinical features to preoperatively predict pathogen type and extended-spectrum β-lactamase (ESBL) infection in perianal ab...
PURPOSE: To develop nomograms based on diffusion-weighted imaging (DWI) histogram parameters and clinical features to preoperatively predict pathogen type and extended-spectrum β-lactamase (ESBL) infection in perianal abscesses. METHODS: We retrospectively analyzed 157 surgically confirmed patients, stratified by pathogen type (Escherichia coli, n = 110; Klebsiella pneumoniae, n = 47) and ESBL test results (ESBL-negative, n = 91; ESBL-positive, n = 30). Ninety-seven apparent diffusion coefficient (ADC) histogram parameters were extracted. Histogram features selected using least absolute shrinkage and selection operator (LASSO) regression, together with clinical variables identified by univariate logistic regression, were incorporated into multivariate logistic regression models to construct nomograms. Internal validation used 1,000 bootstrap resamples. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow test, calibration curves, and decision curve analysis (DCA). RESULTS: The pathogen discrimination model, integrating an ADC-derived composite score (ADC_Score) based on 20 retained histogram features with age, diabetes, and hypertension, achieved an AUC of 0.897, sensitivity of 0.872, and specificity of 0.809. The ESBL prediction model, incorporating ADC_Score based on 13 retained features together with white blood cell count (WBC) and age, yielded an AUC of 0.823, sensitivity of 0.867, and specificity of 0.659. Calibration curves and the Hosmer-Lemeshow test indicated good agreement between predicted and observed probabilities, and DCA suggested potential net benefit for both models within the internally validated cohort. CONCLUSION: DWI histogram-based nomograms demonstrated promising performance for pathogen prediction in perianal abscesses, while the incremental value for ESBL prediction was limited. These models represent an internally validated development study and require external validation before clinical application.
Assessing the role of CT imaging in identifying candidates for neoadjuvant chemotherapy in right colon cancer: a critical analysis.
Lopes JL, Soares ASS, Mendes B … +6 more , Tomada EP, Cunha M, Fernandez LM, Amorim E, Azevedo J, Parvaiz A
Int J Colorectal Dis · 2026 Feb · PMID 41697391 · Full text
BACKGROUND AND PURPOSE: Standard treatment for localized right colon cancer is radical surgery, followed by adjuvant chemotherapy for stage III or intermediate MSS and high-risk stage II tumours. Recent studies suggest a...
BACKGROUND AND PURPOSE: Standard treatment for localized right colon cancer is radical surgery, followed by adjuvant chemotherapy for stage III or intermediate MSS and high-risk stage II tumours. Recent studies suggest a benefit from neoadjuvant chemotherapy (NAC), particularly for T4b and/or N + tumours. Patient selection for NAC relies on CT-based clinical staging, but the accuracy of CT in detecting high-risk features is variable, raising concerns about potential overtreatment. The study aims to demonstrate the accuracy of CT staging of the right colon with the purpose of indicating neoadjuvant CT. METHODS: Patients undergoing curative right hemicolectomy between 2013 and 2023 at two Portuguese institutions were included. All had preoperative CT; those receiving NAC were excluded. Sensitivity, specificity, positive predictive value, and negative predictive value of CT in identifying T4b and N + tumours were calculated by comparing clinical (cTNM) and pathological (pTNM) staging. RESULTS: Among 165 patients (48% male, mean age 70.5 years), CT showed low sensitivity (26%) but high specificity (91%) for pT4b tumours, with a tendency toward understaging. For nodal disease, sensitivity was 87% and specificity 41%. Only 57% of cT4b and/or cN + cases confirmed at least one unfavorable pathological factor, implying potential overtreatment in 43% of patients if NAC were applied solely based on CT findings. CONCLUSION: CT remains the standard for clinical staging but demonstrates limited accuracy in identifying high-risk right colon cancers. NAC decisions should integrate additional criteria beyond CT findings to avoid overtreatment.
Utilisation of intramuscular and intermuscular fat to develop a new skeletal muscle grading score which can predict treatment outcomes for locally advanced rectal cancer.
Besson A, Cao K, Rouse M … +4 more , Yeung J, Reid F, Gibbs P, Yeung JM
Int J Colorectal Dis · 2026 Feb · PMID 41692917 · Full text
BACKGROUND: Sarcopenia has been widely studied in rectal cancer with increasing evidence to suggest that other body composition parameters, in particular adipose tissue, have an important role. Advances in artificial int...
BACKGROUND: Sarcopenia has been widely studied in rectal cancer with increasing evidence to suggest that other body composition parameters, in particular adipose tissue, have an important role. Advances in artificial intelligence (AI) now allow 3D body composition analysis of intermuscular/intramuscular adipose tissue (IMAT) from CT scans. This study aimed to develop and evaluate a skeletal muscle score (SMS), utilising skeletal muscle (SM) and IMAT measurements, to predict treatment response and survival outcomes for rectal cancer patients. METHODS: A retrospective analysis was performed on 226 patients with localised rectal adenocarcinoma treated at Western Health between 2013 and 2024. Body composition metrics, including SM and IMAT volume and density from the L1-S5 vertebral region, were extracted using validated AI software. A SMS (0-4) was developed to predict overall complete response (oCR). The primary endpoint was oCR, defined as pathological complete response or sustained clinical complete response for at least 3 years. Secondary outcomes included overall, cancer-specific, and disease-free survival. RESULTS: An oCR was achieved in 25.7% of patients and was significantly associated with a lower MRI T stage, increased age at diagnosis, and a better SMS, whilst active smoking decreased oCR in a multivariable analysis. Patients with an SMS of zero had a 0% oCR rate, whilst patients with a SMS of four had oCR rate of 60%. A higher SMS correlated with improved overall, cancer-specific, and disease-free survival. CONCLUSION: The SMS is a novel, AI-derived body composition assessment that is strongly correlated with treatment response and survival in rectal cancer patients. This scoring system could provide clinicians with individualised risk stratification to enhance patient counselling.
EMVI as an independent predictor of recurrence and the role of chemotherapy in N0 colonic adenocarcinoma: retrospective Cox regression analysis (2015-2022).
Bhanderi S, Delaney M, Khan H … +2 more , O'Neill R, Patel A
Int J Colorectal Dis · 2026 Feb · PMID 41670736 · Full text
PURPOSE: Extramural venous invasion (EMVI) is a high-risk pathological feature in colorectal cancer, yet its role in guiding adjuvant chemotherapy in node-negative colon cancer remains uncertain. This study evaluates EMV...
PURPOSE: Extramural venous invasion (EMVI) is a high-risk pathological feature in colorectal cancer, yet its role in guiding adjuvant chemotherapy in node-negative colon cancer remains uncertain. This study evaluates EMVI as a predictor of recurrence in patients undergoing colon cancer resection and investigates whether adjuvant chemotherapy affects recurrence in node-negative, EMVI-positive (N0/EMVI +) patients. METHODS: A retrospective cohort study was conducted on adults undergoing surgery for colon cancer at a single UK cancer centre between 2015 and 2022. Patients with rectal tumours or metastatic disease at presentation were excluded. Cox proportional hazards models were used to assess predictors of recurrence. Kaplan-Meier survival curves were generated to visualise recurrence-free survival (RFS) stratified by EMVI and chemotherapy status. RESULTS: Among 675 patients, EMVI was present in 361 (53%). EMVI was independently associated with increased recurrence (HR: 1.80, 95% CI: 1.14-2.84, p=0.011). In the N0/EMVI+ subgroup (n=124), chemotherapy was not significantly associated with reduced recurrence: partial chemotherapy (HR: 1.36, 95% CI: 0.30-6.20, p=0.69), full chemotherapy (HR: 1.53, 95% CI: 0.46-5.12, p=0.49). Kaplan-Meier analysis revealed five-year RFS of 80.9% for no chemotherapy, 60.6% for partial chemotherapy, and 41.6% for full chemotherapy (p=0.69). Survival differences were not statistically significant. CONCLUSION: EMVI is a predictor of recurrence in patients undergoing surgery for colon cancer. However, in node-negative patients with EMVI, chemotherapy was not significantly associated with improved recurrence-free survival. These findings highlight the need for larger, prospective studies to better define the role of EMVI in guiding adjuvant therapy in stage II colon cancer.
Correction to: Retrospective analysis on the efficacy of botulinum toxin alone versus combined botulinum toxin and topical diltiazem.
Arslan C, Karagoz E, Altintas T … +3 more , Pekuz C, Yildirim Y, Oncel M
Int J Colorectal Dis · 2026 Feb · PMID 41665729 · Full text
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Management of a rare entity; a intramuscular caecal epidermoid cyst, in the robotic surgery era: a video case report.
Keating T, Giblin K, Ipadeola O … +3 more , Cullinane C, Eltyeb H, Fleming C
Int J Colorectal Dis · 2026 Feb · PMID 41653209 · Full text
This case "Management of an intramuscular caecal epidermoid cyst in the robotic surgery era" documents the work-up and management of a rare entity, with the aid of the robotic surgery platform. There are 12 reported case...
This case "Management of an intramuscular caecal epidermoid cyst in the robotic surgery era" documents the work-up and management of a rare entity, with the aid of the robotic surgery platform. There are 12 reported cases in the literature of epidermoid cysts arising from the caecum since 1961. Ranging from 8- to 75-year-olds, four of the epidermoid cysts were intramuscular, with six being subserosal. Given the rarity of this entity and the pre-operative diagnostic uncertainty, often both CT and MRI are used during pre-operative work-up. To our knowledge, this is the first reported case of intramuscular caecal epidermoid cyst excised using a robotic surgery approach.
Colonic metastasis from breast carcinoma: A case report and systematic review of a rare clinical scenario.
Matteucci M, Barone G, Zampino L … +7 more , Codecà C, Dinuzzi VP, Battista A, Rivolta U, Yen M, Galliano M, Bertoglio CL
Int J Colorectal Dis · 2026 Feb · PMID 41652066 · Full text
PURPOSE: Colonic metastasis from breast cancer is extremely rare, with an incidence of only 0.1%. Diagnosis is often difficult and guidelines are not yet established. The aim of our review is investigating the latency fr...
PURPOSE: Colonic metastasis from breast cancer is extremely rare, with an incidence of only 0.1%. Diagnosis is often difficult and guidelines are not yet established. The aim of our review is investigating the latency from the primary tumor, the common symptoms, the diagnostic and therapeutic strategies and the role of surgery for this rare clinical scenario. MATERIALS: We report the case of a 57-year-old woman with multiple colonic metastasis from primary breast tumor, who underwent laparoscopic left hemicolectomy. A systematic review of 64 case reports was also conducted. RESULTS: Lobular carcinoma is more frequently associated with gastro-intestinal (GI) metastasis than ductal carcinoma. The median age at diagnosis is 65.5 (IQR = 15) years with colonic metastases typically occurring after a median of 8 years (IQR = 13) from the primary tumor diagnosis. The most frequent symptoms are abdominal pain (34.4%), bowel habit changes (26.6%), and intestinal obstruction (9.4%). In 25% of cases, metastases were incidentally discovered during follow-up. The median disease-free survival was 12 months (IQR = 27.5). Thirteen studies reported death at a median of 12 months (IQR = 20), while 24 did not report follow-up data. CONCLUSIONS: The poor prognosis is mainly due to long latency between primary diagnosis and metastasis onset, as well as to non-specific symptoms. Immuno-histochemical is crucial for diagnosis, although not sufficient to determine tumor origin definitively. Patients with history of breast cancer presenting with GI symptoms should undergo prompt endoscopic evaluation, although routine surveillance remains controversial. Surgery may be considered in selected cases, but systemic therapies remain the cornerstone of treatment.
Management of pT1N0M0 rectal cancer: the central role of pathology in therapeutic decisions.
Serra-Aracil X, Gener-Jorge C, Pellino G
Int J Colorectal Dis · 2026 Feb · PMID 41644741 · Full text
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Interpretable AI-driven prediction of early postoperative recurrence in locally advanced rectal cancer using the Systemic Inflammatory-Nutritional Index (SINTI): A multi-center study and clinical web tool.
Pan Z, Peng T, Wang Y … +5 more , Chen B, Zhuang Z, Lu X, Li S, Guan G
Int J Colorectal Dis · 2026 Feb · PMID 41642373 · Full text
BACKGROUND: Patients with locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (NCRT) and subsequently experience early recurrence (ER) within two years post-surgery tend to have unfavorable pr...
BACKGROUND: Patients with locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (NCRT) and subsequently experience early recurrence (ER) within two years post-surgery tend to have unfavorable prognoses. Therefore, the accurate prediction of ER in LARC is of paramount importance. PURPOSE: This study aimed to develop and validate an explainable artificial intelligence (AI) model, based on the systemic inflammation-nutritional tumor biomarker index (SINTI) derived from routine blood biomarkers, to predict ER in patients with LARC. METHODS: We conducted a multicenter retrospective analysis involving two distinct patient cohorts: Cohort A (n = 715; from February 2011 to September 2017) and Cohort B (n = 224; spanning June 2020 to June 2023). Feature selection was executed utilizing the least absolute shrinkage and selection operator (LASSO) regularization to construct SINTI, effectively addressing multicollinearity. Predictive modeling incorporated ten different machine learning architectures, with hyperparameter optimization achieved through a randomized search complemented by nested tenfold cross-validation. Model performance was thoroughly evaluated using multiple metrics, including the area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (AUPRC), clinical utility curves, and calibration plots. The interpretability of the model was enhanced through SHAP value analysis, followed by its deployment as a clinical decision support web application. RESULTS: The study included 715 patients from Center One and 224 from Center Two, identifying six key biomarkers as the core components of the SINTI model. Multivariable analysis confirmed that SINTI, clinical N stage, clinical T stage, and tumor size are independent predictors of early recurrence. The XGBoost algorithm exhibited robust discrimination during training cohort cross-validation, achieving a mean AUC of 0.860 (SD ± 0.021) and demonstrating consistent performance across validation datasets, with an internal AUC of 0.842 and an external AUC of 0.840. SHAP value interpretation revealed monotonic relationships between predictor variables and recurrence risk, with SINTI accounting for 36.1% of the total predictive weight. For clinical implementation, we deployed the optimized model as a web-based decision support tool, which can be accessed at https://p7toqbsdfbhlahdrugj4ra.streamlit.app/ . CONCLUSION: This interpretable AI framework demonstrates the potential to bridge data-driven modeling and clinical decision support, offering a transparent, potentially deployable solution for post-NCRT recurrence risk prediction following further prospective validation.
Integrative bioinformatics and machine learning approaches identify novel diagnostic signatures for oxaliplatin-resistant colorectal cancer.
Chen X, Zheng Z, Liu K
Int J Colorectal Dis · 2026 Feb · PMID 41642369 · Full text
BACKGROUND: Oxaliplatin resistance significantly impairs therapeutic outcomes in colorectal cancer. However, reliable diagnostic markers for early detection of resistance remain limited. This study aimed to identify nove...
BACKGROUND: Oxaliplatin resistance significantly impairs therapeutic outcomes in colorectal cancer. However, reliable diagnostic markers for early detection of resistance remain limited. This study aimed to identify novel diagnostic signatures through integrative bioinformatics and machine learning approaches. METHODS: We performed comprehensive bioinformatics analyses combining transcriptomics data from multiple cohorts. The diagnostic signatures were identified and validated using machine learning algorithms. Weighted gene co-expression network analysis (WGCNA) was employed to explore resistance-associated gene modules. Multiple computational methods including functional enrichment, protein-protein interaction networks, and immune infiltration assessment were conducted to comprehensively characterize the molecular features of oxaliplatin resistance. RESULTS: Through integrative analysis and machine learning, we identified an 8-gene diagnostic signature (CHFR, TGFBRAP1, RPS4Y1, CYP26B1, NR4A2, FLJ20021, TNFSF9, CAV2) that demonstrated robust performance in distinguishing resistant cases (AUC = 0.868). Functional characterization revealed significant enrichment in metabolic reprogramming, DNA repair mechanisms, and immune modulation pathways. Systematic evaluation of tumor-immune interactions demonstrated distinct patterns of immune cell infiltration between resistant and sensitive groups, particularly in Natural killer cells and Activated CD8 T cells. Computational drug screening identified Glycidamide and orciprenaline as promising candidates, with favorable binding profiles against key resistance-associated targets. CONCLUSIONS: Our study establishes a novel multi-gene diagnostic signature for oxaliplatin resistance through integrative bioinformatics and machine learning approaches. The comprehensive molecular characterization and identification of potential therapeutic candidates provide new insights into resistance mechanisms and clinical management strategies for oxaliplatin-resistant colorectal cancer.
Anoscrotal fistulas: causes and management in a 10-year French case series.
Gialamas E, Fathallah N, Skoufou M … +8 more , Haouari MA, Alam AA, Aubert M, Pommaret E, Roland D, Michaud C, Durand X, de Parades V
Int J Colorectal Dis · 2026 Feb · PMID 41639437 · Full text
PURPOSE: Anoscrotal fistula is a rare variant of anal fistula, often mimicking primary scrotal disease and causing diagnostic delay. Unlike typical cryptoglandular fistulas, anoscrotal extensions are frequently linked to...
PURPOSE: Anoscrotal fistula is a rare variant of anal fistula, often mimicking primary scrotal disease and causing diagnostic delay. Unlike typical cryptoglandular fistulas, anoscrotal extensions are frequently linked to Crohn's disease, tuberculosis, hidradenitis suppurativa, or actinomycosis. Published data remain scarce, especially in Europe. This study aimed to describe the clinical features, etiologies, imaging findings, management, and outcomes of anoscrotal fistulas treated in a French tertiary center. METHODS: We retrospectively reviewed all men managed for anoscrotal fistula at the Institute of Proctology, Paris Saint-Joseph Hospital, between 2014 and 2024. Demographic, clinical, radiological, surgical, and outcome data were analyzed. Healing was defined as closure of all fistula openings without recurrence at last follow-up. RESULTS: Twenty-nine patients were included (mean age 48.2 years). Initial presentation was abscess in 55% and purulent discharge in 45%. External scrotal openings were present in 90%. Magnetic resonance imaging (MRI) identified complex tracts in 59% of cases. Etiologies were cryptoglandular (63%), Crohn's disease (15%), hidradenitis (11%), tuberculosis (7%), and actinomycosis (4%). Nineteen patients (66%) had prior anorectal surgery. Most (72%) underwent initial seton drainage, followed by fistulotomy (31%), advancement flap (12%), or other sphincter-preserving techniques. A urologist was involved in 31% of cases. After a median follow-up of 22 months, 59% healed, 28% had persistent disease, and none recurred once healed. Continence was preserved, and 73% of patients were highly satisfied. No predictors of healing were identified. CONCLUSION: This series represents one of the largest European experiences with anoscrotal fistula. Findings emphasize frequent non-cryptoglandular causes, the key role of MRI, and the need for multidisciplinary, individualized management.
Impact of gross tumor morphology on the clinical outcomes of colon cancer: multicenter retrospective cohort study.
Han SJ, Lee HS, Jang BI … +7 more , Kim JH, Kim HG, Baek IH, Lee J, Kim B, Kim DB, Park JJ
Int J Colorectal Dis · 2026 Feb · PMID 41639274 · Full text
PURPOSE: While histopathological features are established prognostic factors in colorectal cancer, the prognostic significance of gross tumor morphology remains unclear. We investigated whether endoscopic gross morpholog...
PURPOSE: While histopathological features are established prognostic factors in colorectal cancer, the prognostic significance of gross tumor morphology remains unclear. We investigated whether endoscopic gross morphology is associated with clinical outcomes in colon cancer. METHODS: We performed a multicenter retrospective analysis of 1,177 patients with colon cancer who underwent curative-intent endoscopic or surgical resection between 2010 and 2019. Tumors were categorized based on endoscopic images as flat/ulceroinfiltrative (n = 345) or fungating/ulcerofungating (n = 832). Kaplan-Meier analysis assessed survival outcomes, and Cox proportional hazards models identified independent prognostic factors, adjusting for age, sex, family history, diabetes, CEA, and AJCC 7th edition stage. RESULTS: Patients with flat/ulceroinfiltrative tumors had significantly shorter overall survival (OS, p = 0.001) and disease-free survival (DFS, p = 0.024) than those with fungating/ulcerofungating tumors. In stage II patients, the difference in OS by morphology was more pronounced (p = 0.004). Multivariate analysis confirmed flat/ulceroinfiltrative morphology as an independent predictor of poor OS (HR 1.61; 95% CI 1.122-2.335; p = 0.010). Other significant predictors included older age (≥ 65 years, HR 1.533; p = 0.021), poor histologic grade (PD vs. WD/MD, HR 5.308; p < 0.001), and advanced stage. CONCLUSIONS: Gross endoscopic morphology is an independent prognostic factor in colon cancer. Flat/ulceroinfiltrative tumors are associated with worse outcomes, especially in stage II disease. Gross morphology, readily identifiable at diagnosis, may aid risk stratification and inform decisions regarding adjuvant therapy.
A novel caudal-dorsal approach for laparoscopic right hemicolectomy with complete mesocolic excision.
Jiao Y, Xie H, Zhou X … +4 more , Kong X, Liu C, Mongardini FM, Li J
Int J Colorectal Dis · 2026 Feb · PMID 41634476 · Full text
PURPOSE: We aimed to demonstrate a novel caudal-dorsal approach laparoscopic right hemicolectomy (LRH) for a patient diagnosed with right colon carcinoma. METHOD: We performed a LRH with a caudal-dorsal approach. We star...
PURPOSE: We aimed to demonstrate a novel caudal-dorsal approach laparoscopic right hemicolectomy (LRH) for a patient diagnosed with right colon carcinoma. METHOD: We performed a LRH with a caudal-dorsal approach. We started the operation from the distal root of the small intestine mesentery and the backside of the ascending colon. The ileocolic artery and vein were transected at the dorsal side of the mesocolon. The superior mesenteric vein (SMV) and the gastrocolic trunk were dissected from the dorsal approach. The study adhered to the IDEAL. We followed the recommendations of the LAP-VEGaS Consensus for the reporting of Laparoscopic Videos [1]. RESULTS: The operation lasted approximately 120 min, with an intraoperative blood loss of only 10 mL. Postoperative pathology showed pT1N0M0 (18 lymph nodes resected, all negative for metastasis). The patient was discharged on postoperative day 5 without complications. CONCLUSION: The caudal-dorsal approach for LRH represents a novel surgical method, and we believe it offers several advantages over traditional approaches.
Long-term outcomes of Kono-S anastomosis for ileocecal resections in Crohn's disease: a comparative analysis.
Vojta M, Hermann M, Kienle P … +4 more , Reißfelder C, Weiß C, Hardt J, Seyfried S
Int J Colorectal Dis · 2026 Feb · PMID 41629511 · Full text
OBJECTIVE: This long-term follow-up study evaluates clinical and functional outcomes after ileocecal resection with either Kono-S or conventional anastomosis techniques in patients with Crohn's disease. The goal was to d...
OBJECTIVE: This long-term follow-up study evaluates clinical and functional outcomes after ileocecal resection with either Kono-S or conventional anastomosis techniques in patients with Crohn's disease. The goal was to determine whether the Kono-S approach confers a long-term advantage in preventing disease recurrence and improving quality of life. While the Kono-S anastomosis has shown promise in reducing recurrence rates in Crohn's disease following surgery, most existing evidence stems from short- to medium-term follow-up. High-quality long-term data remain scarce, particularly in real-world clinical settings. This study aims to fill that gap. METHODS: A retrospective-prospective cohort analysis was performed including patients who underwent ileocecal resection for Crohn's disease between 2015 and 2017 at a single academic center. Patients were grouped according to anastomosis technique (Kono-S vs. conventional). Long-term follow-up data were obtained via chart review, imaging studies, and patient-reported questionnaires, including the Gastrointestinal Quality of Life Index (GIQLI). Primary outcomes included recurrence rates, postoperative complications, and quality of life. RESULTS: Seventy patients were included in the final analysis (Kono-S: n = 31; conventional: n = 39). The median follow-up duration was 8.1 years (interquartile range = 6.9-8.8 years). No significant differences were observed between groups regarding endoscopic inflammation (Kono-S = 19.4%, conventional = 25.6%, p = 0.39), restenosis (Kono-S = 9.7%, conventional = 2.6%, p = 0.34), or GIQLI scores (Kono-S: median 116 vs. 110, p = 0.08). Rehospitalization rates were numerically higher in the Kono-S group (16.1% vs. 2.6%, p = 1.0), but not statistically significant. Importantly, approximately 40% of all patients retrospectively stated they would have preferred earlier surgical intervention, independent of the anastomotic technique. CONCLUSION: After more than 7 years of follow-up, the Kono-S anastomosis demonstrates comparable long-term outcomes to conventional techniques in terms of recurrence, complications, and quality of life. Patient reflections suggest a potential benefit of earlier surgical intervention, highlighting the need for more proactive surgical referral in gastroenterological practice.
Tolerability and impact on postoperative morbidity of preoperative bowel preparation in Crohn's disease patients: results of prospective observational study.
Iesalnieks I, Schmitz A, Hinrichs N … +4 more , Ivanecka D, Kala Z, Grolich T, Kunovsky L
Int J Colorectal Dis · 2026 Feb · PMID 41627485 · Full text
BACKGROUND: Preoperative mechanical bowel preparation (MBP) and oral antibiotics (OA) are widely used to decrease the risk of postoperative septic complications after colorectal resections. Unfortunately, it is not clear...
BACKGROUND: Preoperative mechanical bowel preparation (MBP) and oral antibiotics (OA) are widely used to decrease the risk of postoperative septic complications after colorectal resections. Unfortunately, it is not clear whether bowel preparation can lead to symptoms of small bowel obstruction, which might even increase the risk of postoperative morbidity. METHODS: Consecutive Crohn's disease patients undergoing bowel resections with formation of ileocolic or colocolic anastomosis were included in the present prospective observational study. Urgent surgery, surgery without preoperative MBP, colorectal cancer, and fecal diversion were exclusion criteria. A polyethylene glycol solution (2 L) was used for MBP. OA consisted of paramomycin and metronidazole taken at 7 p.m. and 11 p.m. at the evening before surgery. Occurrence of complications at the anastomotic site (leakage, peritonitis, abscess, or fistula in direct proximity to the anastomosis) was a primary outcome measure. Complications of MBP were recorded. Mechanical bowel preparation was defined as "incomplete" when patients took a lesser amount of MBP solution than scheduled. RESULTS: Between 2016 and 2024, ileocolic or colorectal resections with formation of an anastomosis were performed in 284 patients with Crohn's disease. Nausea, vomiting, or abdominal pain occurred during the MBP in 29% of patients (n = 78), leading to termination of intake in 53 patients (19%). Women (p < 0.001), patients hospitalized urgently because of acute abdominal pain (p = 0.008), patients presenting with severe anemia before surgery (p = 0.007), and patients scheduled for resections completed by ileocolic anastomosis as opposed to colocolic or colorectal anastomosis (p = 0.01) demonstrated a significantly increased risk of incomplete MBP. Thirty-two percent of patients demonstrated apparent dilatation of small bowel at the time of surgery. The incidence of anastomotic complications was 4% in patients who were able to complete MBP and 7.5% after an incomplete MBP (p = 0.27). There were no deaths. The conversion rate from laparoscopy to open surgery was increased in patients with small bowel dilatation (17% vs. 6%); however, the difference was not statistically significant (p = 0.13). CONCLUSION: There is a considerable incidence of obstructive symptoms after preoperative mechanical bowel preparation in Crohn's disease patients. Nevertheless, an incomplete MBP is not associated with increased risk of intra- or postoperative complications and can be used safely in that particular population.
A comprehensive scoring system for defecation disorders derived by merging various validated patient-reported outcome measures for fecal incontinence, chronic constipation, and obstructed defecation.
Ratto C, Simonelli I, Campennì P … +4 more , Litta F, Pagano M, Parello A, Marra AA
Int J Colorectal Dis · 2026 Jan · PMID 41612062 · Full text
PURPOSE: Currently, too many Patient-Reported Outcome Measures (PROMs) with redundant and repetitive domains are adopted to assess defecation disorders, resulting in more extended clinical visits and increased patient bu...
PURPOSE: Currently, too many Patient-Reported Outcome Measures (PROMs) with redundant and repetitive domains are adopted to assess defecation disorders, resulting in more extended clinical visits and increased patient burden. The aim of this study was to develop a new comprehensive Defecation Disorders Scoring System (DDSS) by incorporating all items of the most commonly used and validated PROMs. METHODS: This is a prospective observational study on patients waiting for rectal prolapse and defecation disorders surgery. Preoperatively, each patient completed seven different authoritative PROMs, two questionnaires assessing constipation, two questionnaires for obstructed defecation, two questionnaires to evaluate fecal incontinence, and one questionnaire aiming to assess both. Spearman's correlation and Principal Component Analysis with varimax rotation were applied. Internal consistency was evaluated using Cronbach's α. RESULTS: A total of 127 female patients completed all 57 items across the seven validated PROMs and were included. Several items highly correlated with others expressing the same concept were reconsidered and excluded. A final set of 19 items was identified and arranged into DDSS, encompassing five core components regarding specific aspects of incontinence, bowel movements/defecation frequency, evacuation effort and duration, type of assistance, and abdominal discomfort. Regarding internal consistency, the derived DDSS and its five components demonstrated satisfactory results. CONCLUSIONS: This study highlights the potential for reducing item redundancy across existing PROMs for defecation disorders. Despite some limitations, the proposed DDSS could potentially provide a concise, comprehensive tool for assessing multiple aspects of defecation disorders, potentially available in electronic format. Future studies will be required to further evaluate and validate DDSS across different patient populations.
Optimising response assessment to neoadjuvant therapy in rectal cancer to reduce the incidence of ypT0N0 resection.
Hew J, Mohtashami A, Mastrocostas K … +8 more , Skinner T, De Silva K, Pavlakis N, Hruby G, Evans J, Salama Y, Kneebone A, Chang KH
Int J Colorectal Dis · 2026 Jan · PMID 41612034 · Full text
PURPOSE: Assessment of local response to neo-adjuvant therapy for rectal cancer incorporates digital rectal exam (DRE), endoscopy and pelvic MRI. Despite this process patients are mistakenly identified with tumour persis...
PURPOSE: Assessment of local response to neo-adjuvant therapy for rectal cancer incorporates digital rectal exam (DRE), endoscopy and pelvic MRI. Despite this process patients are mistakenly identified with tumour persistence or recurrence resulting in overtreatment. This retrospective cohort study aimed to investigate the assessment of patients who had a complete pathological response (ypT0N0) after neo-adjuvant treatment for rectal cancer and evaluate clinical decision making. METHOD: ypT0N0 cases were identified from a cohort of patients discussed at the Royal North Shore Hospital Colorectal Cancer Multidisciplinary Meeting (MDT) treated for rectal cancer from January 2016 to December 2024. The medical record was accessed to retrieve clinical information. Decision making was assessed from MDT discussion records. RESULTS: 110 patients were treated with neo-adjuvant therapy during the study period, with 71 proceeding to surgery. Twelve patients (17%) had ypT0N0 pathology. The decision to resect was prompted by concerning tumour signal on MRI (10/11), endoscopic evidence of tumour (3/6), palpable disease on DRE (3/9) and biopsy (2/3). Discordant investigations were common. The sensitivity and specificity of MDT decisions for complete clinical response were 61% and 95% respectively. Patients underwent either abdominal perineal resection or ultralow anterior resection; (6/12) experienced Clavien-Dindo 3 or 4 complications. CONCLUSIONS: The clinical assessment of response to neo-adjuvant therapy in patients with rectal cancer is an area that requires improvement due to overtreatment. ypT0N0 patients often have discordant investigations. Management decisions based on the concordance of investigations may reduce the number of ypT0N0 resections.
Assessing quality of life in anal fistula patients after Seton placement using different knot types: Randomized controlled trial.
Özgü K, Kutlu B, Koç MA … +3 more , Ersöz Ş, Gökmen D, Akyol C
Int J Colorectal Dis · 2026 Jan · PMID 41612009 · Full text
PURPOSE: Perianal fistula is a common disease that significantly affects the quality of life of patients. Several treatment options are available; loose seton is one of the most popular options. Aim of this study was to...
PURPOSE: Perianal fistula is a common disease that significantly affects the quality of life of patients. Several treatment options are available; loose seton is one of the most popular options. Aim of this study was to evaluate the relationships between quality of life and different types of knots used during the application of anal fistula. METHODS: Patients who presented with anal fistulas between 2021 and 2024 were included in this study. Patients were divided into 3 groups on the basis of the type of knot used for treatment. In group A, the seton ends were tied in the alpha configuration. In group B, a ring-like seton with overlapping ends was used. In group C, a knotless seton was applied. All patients completed the quality of life assessment with the Anal Fistula Questionnaire at 15, 30, and 90 days after surgery. RESULTS: Sixty-three patients were randomized. A total of 52 men were included. Median age was 43 years. Three patients in group C and five patients in group B experienced complications, including abscess, anal pain, loss of seton, and second fistula. Physical and mental component scores revealed that postoperative quality of life was similar among the three groups. CONCLUSION: No differences in postoperative quality of life among groups were observed at 15, 30, or 90 days after surgery. Physical and mental component scores of quality of life in patients in Anal Fistula Questionnaire revealed that quality of life improved over time in all three groups. CLINICAL TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (Study ID: NCT05348473, date: 04/29/2022).
Surgical outcomes in pelvic reconstruction using robot-assisted rectus abdominis muscle flaps: a systematic review.
Alexandersen C, Righult AA, Zahid JA … +3 more , Orhan A, Krezdorn N, Gögenur I
Int J Colorectal Dis · 2026 Jan · PMID 41606384 · Full text
PURPOSE: Pelvic cancer resections increase the risk of pelvic dead space, which increases the risk of postoperative complications. Robot-assisted pelvic reconstruction surgeries are a novel approach that may be beneficia...
PURPOSE: Pelvic cancer resections increase the risk of pelvic dead space, which increases the risk of postoperative complications. Robot-assisted pelvic reconstruction surgeries are a novel approach that may be beneficial, but it is unclear what impact it has on surgical outcomes in pelvic reconstruction with rectus abdominis muscle flaps. The aim of the study was to systematically review the surgical outcomes of robot-assisted pelvic reconstruction using rectus abdominis muscle flaps in patients with any pelvic cancers. METHOD: A systematic search of the literature was conducted in PubMed, Web of Science, Cochrane Library, and Embase following the PRISMA guidelines, and the final search on all databases was performed on the 13th of May 2024. Studies reporting surgical outcomes of robot-assisted pelvic reconstruction with rectus abdominis muscle flaps were eligible based on predefined criteria. Two reviewers independently screened the literature, extracted data, and assessed risk of bias of included studies. RESULTS: Five studies, including 143 patients in total, met the inclusion criteria, comprising two retrospective cohort studies and three case series. Of these, 36 patients underwent robot-assisted pelvic reconstruction using rectus abdominis flaps. All studies reported wound complications, which were lower in the robot-assisted groups compared to open surgery groups. One study reported shorter length of stay. Two studies reported better visualization and avoidance of excessive blood loss when performing robot-assisted surgery. CONCLUSIONS: Early reports indicate that robot-assisted surgery with flaps in pelvic reconstruction could improve postoperative outcomes. Further research should investigate the potential benefits through larger and controlled patient groups.
The ultrasonographic measure of postoperative day 2 gastric volume may be a useful tool to improve the management of colorectal surgery patients: results of an ancillary study.
Venara A, Paisant A, Gillet J … +3 more , Morgado L, Rebmann E, Hamel JF
Int J Colorectal Dis · 2026 Jan · PMID 41588201 · Full text
PURPOSE: Postoperative ileus(POI) occurs in 10-19% of colorectal surgeries. The identification of patients at-risk for POI is a key for nasogastric tube(NGT) placement. Point-of-care ultrasound(POCUS) has shown potential...
PURPOSE: Postoperative ileus(POI) occurs in 10-19% of colorectal surgeries. The identification of patients at-risk for POI is a key for nasogastric tube(NGT) placement. Point-of-care ultrasound(POCUS) has shown potential in predicting POI by assessing gastric volume, but its role has never been explored. The aim was to evaluate the association between the ratio of gastric volume on postoperative day (POD)2/POD0, measured by Point-of-care ultrasound(POCUS), and the risk of vomiting, postoperative ileus(POI) and the need for nasogastric tube(NGT) insertion after colorectal surgery. METHODS: This prospective monocentric study included 112 patients who underwent colorectal resection with or without anastomosis between August 2020 and April 2023. Gastric volume was measured using POCUS at POD0 and POD2. The primary outcome was the ratio of POD2/POD0. Area under the ROC curve based on multivariate model was estimated for the prediction of the need for NGT insertion was calculated. RESULTS: Among the 112 patients included in the study, 22 had postoperative nausea (19.6%), 16 experimented POI (14.3%) and 13 needed postoperative NGT insertion(11.6%). A larger POD2/POD0 ratio was significantly associated with nausea, POI and postoperative NGT insertion. In multivariate analysis, the POD2/POD0 ratio was an independent factor associated with the risk of postoperative nausea and postoperative NGT insertion. Finally, the POD2/POD0 ratio predicted the risk for postoperative NGT insertion with an area under ROC curve at 0.79(95%CI:0.67-0.91). CONCLUSION: POCUS of the gastric volume is a promising tool to select patient requiring NGT insertion after colorectal surgery. CLINICAL TRIAL REGISTRY: NCT04461067.
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