International Journal Of Colorectal Disease[JOURNAL]
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200 papers
Paediatric caecal volvulus, a rare presentation of african degenerative leiomyopathy - a case report.
Palmisani F, Trovalusci E, Zulu S … +3 more , Chung SH, Hartford L, Brisighelli G
Int J Colorectal Dis · 2026 Jan · PMID 41586926 · Full text
BACKGROUND: Caecal volvulus is a rare condition with an unknown prevalence, particularly in paediatric patients. Predisposing factors include fixation anomalies of the colon (with or without malrotation) and significant...
BACKGROUND: Caecal volvulus is a rare condition with an unknown prevalence, particularly in paediatric patients. Predisposing factors include fixation anomalies of the colon (with or without malrotation) and significant intestinal distension due to conditions such as chronic constipation, post-operative ileus, Hirschsprung disease (HD), or paediatric intestinal pseudo-obstruction (PIPO). African degenerative leiomyopathy (ADL) is a regional variant of visceral myopathy characterised by a fibrotic "tiger-striped" degeneration of the muscular layers of the colon, which causes PIPO. It is endemic to Sub-Saharan Africa and is associated with poor outcomes. To our knowledge, this is the first case in which a caecal volvulus led to the diagnosis of ADL. CASE PRESENTATION: An 11-year-old female, previously healthy, presented with a 2-day history of abdominal distension, bilious vomiting, and constipation. Abdominal radiography and a computed tomography (CT) scan were suggestive of a colonic volvulus. Endoscopic reduction was unsuccessful, and exploratory laparotomy revealed a caecal volvulus. A limited right hemicolectomy and end ileostomy were performed. Histology revealed the typical myopathic changes with "tiger-striped" fibrosis and atrophy. Postoperatively, she experienced recurrent episodes of bowel pseudo-obstruction. A full-thickness rectal biopsy confirmed the presence of ganglion cells, excluding HD and further supporting the diagnosis of ADL. The patient, unfortunately, died 6 months later due to abdominal compartment syndrome. CONCLUSIONS: ADL is a rare and often fatal condition associated with intermittent bowel obstruction and systemic complications, including cardiac and urologic abnormalities. In paediatric patients, caecal volvulus should prompt consideration of PIPO as an underlying diagnosis.
Comparative efficacy of reinforced suturing, transanal drainage tube, and no additional intervention in preventing anastomotic leakage after rectal cancer surgery: a network meta-analysis.
Lan K, Zeng H, Xue X … +4 more , Liao B, Wu B, Lin S, Xu D
Int J Colorectal Dis · 2026 Jan · PMID 41586921 · Full text
BACKGROUND: Anastomotic leakage (AL) is a severe complication after rectal cancer surgery. This network meta-analysis (NMA) compares reinforced suturing (RS), transanal drainage tube (TDT), and no additional intervention...
BACKGROUND: Anastomotic leakage (AL) is a severe complication after rectal cancer surgery. This network meta-analysis (NMA) compares reinforced suturing (RS), transanal drainage tube (TDT), and no additional intervention (NRT) for AL prevention. METHODS: An NMA was conducted according to PRISMA-NMA guidelines. PubMed, Web of Science, and Embase were searched for randomized controlled trials and observational studies comparing RS, TDT, or NRT in adults undergoing anterior resection for rectal cancer, with AL as the primary outcome. Secondary outcomes included Grade C AL, stricture, bleeding, ileus, and wound infection. RESULTS: 16 studies (3 RCTs, 11 RNCTs, and 2 PNCTs; n = 4562) were included. For overall AL incidence, both RS (OR 0.32, 95% CrI 0.16-0.62) and TDT (OR 0.47, 95% CrI 0.33-0.63) significantly reduced AL vs. NRT. RS ranked highest (SUCRA 0.93). Although RS had the highest SUCRA for overall AL, the RS-TDT contrast was not statistically significant(OR 1.44, 95% CrI 0.68-3.09), so ranking should not be over-interpreted as proof of superiority. For Grade C AL, RS significantly reduced risk versus both TDT (OR 5.01, 95% CrI 1.33-28.67) and NRT (OR 0.10, 95% CrI 0.02-0.32; SUCRA 0.99). No significant differences were found among interventions for anastomotic bleeding, ileus, or wound infection. TDT showed a trend toward reduced anastomotic stricture risk (SUCRA 0.73), but the effect was not statistically significant (TDT vs. NRT: OR 0.68, 95% CrI 0.19-2.27). Sensitivity analysis restricted to larger studies (≥ 100 patients/group) confirmed the robustness of primary outcomes. CONCLUSIONS: Both RS and TDT were associated with a reduction in overall AL risk compared to NRT. Network estimates suggested that RS may be more effective than TDT in preventing the more severe Grade C AL; however, this finding is based on indirect comparisons with wide credible intervals and requires confirmation in future head-to-head trials. The choice of intervention may therefore depend on patient risk profile and clinical context.
Follow-up intensity after colorectal cancer surgery in patients aged ≤ 50, 50-70 and > 70 years - an analysis within the COLOFOL randomised clinical trial.
Gutlic I, Veres K, Horváth-Puhó E … +3 more , Lydrup ML, Buchwald P, COLOFOL study group
Int J Colorectal Dis · 2026 Jan · PMID 41586910 · Full text
PURPOSE: The incidence of colorectal cancer (CRC) is increasing in individuals aged < 50 years of age. This study aimed to examine whether high-frequency follow-up after CRC surgery reduces 5-year overall mortality, canc...
PURPOSE: The incidence of colorectal cancer (CRC) is increasing in individuals aged < 50 years of age. This study aimed to examine whether high-frequency follow-up after CRC surgery reduces 5-year overall mortality, cancer-specific mortality and recurrence in patients with CRC aged ≤ 50 years. METHODS: The COLOFOL trial performed between 2006 and 2010 was used to analyse patients randomised to high-frequency (computed tomography [CT] of the abdomen and thorax and a carcinoembryonic antigen [CEA] test at 6, 12, 18, 24 and 36 months) versus low-frequency (CT and CEA at 12 and 36 months) follow-up after curative CRC surgery. Intention-to-treat and per-protocol analyses were performed to study the primary outcomes (5-year overall mortality and cancer-specific mortality) and the secondary outcome (CRC recurrence), comparing the age groups ≤ 50, 51-70 and > 70 years. RESULTS: In total, 2,509 patients were included in the intention-to-treat analysis with 183, 1,714 and 612 patients aged ≤ 50, 51-70 and > 70 years, respectively. The 5-year overall mortality risk for patients aged ≤ 50 was 8.3% in the high-frequency group compared with 8.4% in the low-frequency group (risk difference 0.2% [95% CI, - 8.0; 8.3]). The cancer-specific mortality risk for patients aged ≤ 50 years was 7.1% in the high-frequency group compared with 7.4% in the low-frequency group (risk difference, 0.3% [95% CI, - 7.4; 8.0]). The cancer-specific recurrence risk for patients aged ≤ 50 years was 12.9% in the high-frequency group compared with 21.0% in the low-frequency group (risk difference 8.1% [95% CI, - 2.6; 18.7]). CONCLUSION: Among individuals aged ≤ 50 years with stage II-III CRC, there was no reduction in overall mortality, cancer-specific mortality and cancer-specific recurrence with more intensive follow-up using CT and CEA.
Metronidazole is an effective method of analgesia following haemorrhoidectomy: a systematic review and meta-analysis.
O'Mahony A, Cullinane C, MacCurtain BM … +4 more , Peirce C, Condon E, Coffey JC, Fleming CA
Int J Colorectal Dis · 2026 Jan · PMID 41586878 · Full text
BACKGROUND: Haemorrhoids are one of the most frequently encountered benign anorectal conditions that negatively impact patients' quality of life. Excisional haemorrhoidectomy (closed or open) is a surgical procedure rese...
BACKGROUND: Haemorrhoids are one of the most frequently encountered benign anorectal conditions that negatively impact patients' quality of life. Excisional haemorrhoidectomy (closed or open) is a surgical procedure reserved for the treatment of third- and fourth-degree haemorrhoids, with considerable post-procedure pain reported. The aim of this study was to clarify the association between post operative metronidazole use (both oral and topical) and post-haemorrhoidectomy pain scores through systematic review and meta-analysis of randomised controlled trials (RCTs). METHODS: This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Prospective registration was performed on PROSPERO (CRD42024580928). A systematic review was performed for RCTs reporting post-haemorrhoidectomy pain scores between patients who received metronidazole and patients who received placebo. Meta-analysis was performed using RevMan version 5.4. RESULTS: Seventeen RCTs including 1297 participants were eligible for inclusion. Metronidazole administration was associated with significantly lower post-operative visual analogue scores (VAS) on day 1 (-1.18, p < 0.00001), day 2 (-1.15, p = 0.003), day 3 (-0.86, p < 0.00001), and day 7 post-operatively with a mean pain score difference of -1.72 (95% CI -2.27 to -1.18) (p < 0.00001). A significant difference in pain scores was seen on day 3 favouring topical metronidazole in comparison to the oral route (1.38, 95% CI [0.44, 2.32], p = 0.004). CONCLUSION: This review synthesises the best available evidence to support the use of metronidazole to reduce pain after excisional haemorrhoidectomy. While both oral and topical forms appear to be beneficial, topical administration appears to have a more effective analgesic effect from post-operative day 3.
Technical proficiency assessment of robotic intracorporeal single-stapling colorectal anastomosis using video-based RA-CUSUM.
Huang SF, Tan YL, Hsu CW … +3 more , Tseng HP, Miskovic D, Wu CC
Int J Colorectal Dis · 2026 Jan · PMID 41586850 · Full text
BACKGROUND: This study aimed to evaluate the learning curve of robotic intracorporeal single-stapling anastomosis (RiSSA) using risk-adjusted cumulative sum (RA-CUSUM) analysis based on standardized procedural intervals....
BACKGROUND: This study aimed to evaluate the learning curve of robotic intracorporeal single-stapling anastomosis (RiSSA) using risk-adjusted cumulative sum (RA-CUSUM) analysis based on standardized procedural intervals. METHODS: We retrospectively analyzed 36 consecutive patients who underwent robotic left-sided colorectal resection with RiSSA by a single surgeon. Eight intraoperative timepoints were annotated from surgical videos to define two composite metrics: pure RiSSA interval and total purse-string suture time. RA-CUSUM analysis was applied to assess technical proficiency over time. RESULTS: The RA-CUSUM curve showed an inflection point at case 17 for the pure RiSSA interval and at case 11 for purse-string suture time, indicating earlier acquisition of suture skills compared to overall procedural fluency. Two Clavien-Dindo grade ≥ III complications occurred in the late phase, including one anastomotic leak (5.3%, 1/19), whereas no major complications were observed during the early phase, although the limited sample size precludes any definitive safety interpretation. Technical metrics, including console time, pure RiSSA interval, and total purse-string suture duration, significantly improved after the inflection point. CONCLUSIONS: In this single-surgeon cohort, RiSSA demonstrated a definable learning trajectory, with technical efficiency stabilizing after approximately 17 cases. The occurrence of major complications after the learning phase highlights that technical proficiency does not eliminate procedural risks. The pure RiSSA interval offers a reproducible metric to evaluate anastomotic proficiency and could support skill assessment frameworks in robotic colorectal procedures. Studies involving multiple surgeons and institutions are warranted to determine the generalizability of these findings.
Early evaluation of the low anterior resection syndrome after sphincter sparing rectal cancer surgery and prompt treatment: a cohort study protocol.
Sguinzi R, Bafumi L, Gremaud B … +2 more , Bühler L, Adamina M
Int J Colorectal Dis · 2026 Jan · PMID 41586826 · Publisher ↗
INTRODUCTION: Low anterior resection syndrome (LARS) is a common complication following sphincter-sparing rectal cancer surgery, affecting 30-80% of patients and significantly reducing quality of life. Treatment options...
INTRODUCTION: Low anterior resection syndrome (LARS) is a common complication following sphincter-sparing rectal cancer surgery, affecting 30-80% of patients and significantly reducing quality of life. Treatment options such as pelvic floor physiotherapy, transanal irrigation and sacral neuromodulation are available, yet the optimal treatment sequence and their overall efficacy remain uncertain. This study aims to assess the effectiveness of an integrative management pathway, including preoperative physiotherapy, for the prevention and treatment of LARS at our institution. METHODS: This cohort study will include patients undergoing low anterior resection for rectal cancer at Fribourg Cantonal Hospital over 24 months; patient's inclusion will start on February 2026. Preoperative assessment includes LARS and EQ-5D questionnaires, and anal manometry to establish baseline functional status. Postoperative LARS and EQ-5D scores will be collected at six weeks. Based on LARS severity, patients will follow a progressive treatment pathway consisting of physiotherapy, transanal irrigation, and sacral neuromodulation. Questionnaires will be repeated after each treatment stage to assess symptom progression and quality of life. Statistical analysis will include Wilcoxon Mann-Whitney tests for score comparisons and logistic regression for identifying risk factors such as neoadjuvant therapy, tumor location, and anastomotic technique. RESULTS: We hypothesize that this integrative approach will lead to a significant reduction in LARS severity and improvement in quality of life compared to retrospective data collected in 2022. CONCLUSIONS: This study protocole aims to refine postoperative management of LARS through a structured, evidence-based protocol, to identify modifiable risk factors, and to enhance overall patient outcomes following rectal cancer surgery.
Global bibliometric analysis of comorbid depression and anxiety in inflammatory bowel disease (2010-2024).
Wang R, Jiang J, Feng S … +3 more , Chang Y, Li H, Guo J
Int J Colorectal Dis · 2026 Jan · PMID 41580579 · Full text
BACKGROUND: Inflammatory bowel disease (IBD) is an intestinal inflammatory disease of unknown etiology. Depression and anxiety are prevalent mental symptoms associated with IBD. Although numerous studies have explored th...
BACKGROUND: Inflammatory bowel disease (IBD) is an intestinal inflammatory disease of unknown etiology. Depression and anxiety are prevalent mental symptoms associated with IBD. Although numerous studies have explored the potential relationship between IBD and these psychological conditions, a bibliometric analysis on this topic has yet to be conducted. METHODS: We screened 420 relevant articles from the Web of Science Core Collection (WoSCC) database from 2010 to 2024 and analyzed them using software such as CiteSpace, VOSviewer, Pajek, and Tableau. RESULTS: The USA (98 papers), the University of Manitoba (24 papers), Inflammatory Bowel Diseases (56 papers), and Charles N. Bernstein (20 papers) were the most productive country, institution, journal, and author, respectively. High-frequency keywords in this field include "quality-of-life," "symptoms," "prevalence," "comorbidity," "association," "therapy," and "management." Additionally, emerging research frontiers encompass topics such as "mouse model," "remission," "disorder," and "gut microbiota." CONCLUSIONS: Over the past 14 years, there has been a notable increase in research focused on depression and anxiety associated with inflammatory bowel disease. Key areas such as "mouse models," "remission," "disorder," and "gut microbiota" are poised to become focal points of future investigations. These findings may offer new avenues for researchers to explore.
Anastomotic configurations and early endoscopic recurrence following ileocolonic resection in Crohn's disease: systematic review and meta-analysis.
Vignali A, Gallo G, Selvaggi F … +24 more , Gravante G, De Simone V, Foppa C, Allocca M, Armuzzi A, Carvello M, Cavestro GM, De Nardi P, Elmore U, Furfaro F, Fuschillo G, Gravina AG, Massaro D, Mineccia M, Oddis L, Pellino G, Romano FM, Selvaggi L, Siragusa L, Spinelli A, Rosati R, Danese S, Bemelman W, Sileri P
Int J Colorectal Dis · 2026 Jan · PMID 41579213 · Full text
PURPOSE: Crohn's disease (CD) frequently requires surgery, with ileocolonic resection being the most common procedure. Postoperative endoscopic recurrence remains a major concern, and the role of anastomotic configuratio...
PURPOSE: Crohn's disease (CD) frequently requires surgery, with ileocolonic resection being the most common procedure. Postoperative endoscopic recurrence remains a major concern, and the role of anastomotic configuration is still debated. This systematic review and meta-analysis aimed to evaluate the impact of different anastomotic techniques on early endoscopic recurrence following ileocolonic resection for CD. METHODS: A systematic search of PubMed, Embase, and Web of Science was performed up to July 2025. Studies comparing stapled side-to-side anastomosis (SSA), handsewn end-to-end anastomosis (EEA), and Kono-S anastomosis (KSA) with postoperative endoscopic follow-up at 6-12 months were included. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled analyses were conducted to compare recurrence rates across anastomotic types. RESULTS: Eleven studies were included (four comparing SSA vs. EEA; seven comparing KSA vs. SSA), for a total of 1505 patients. Most were retrospective, with three randomised controlled trials available. In pooled analysis, no significant difference was found between SSA and EEA (48.5% vs. 46.7%, test for overall effect Z = 0.41, p = 0.6795). KSA showed a trend towards lower recurrences compared with SSA (31.8% vs. 39.8%, test for overall effect Z = -1.96, p = 0.0495), although heterogeneity in study design, definitions, and postoperative management limits firm conclusions. CONCLUSIONS: Current evidence does not support a difference in early endoscopic recurrence between SSA and EEA and a potential but weak overall association with lower recurrences for KSA compared to SSA. Large, high-quality prospective trials with standardised definitions, postoperative medical therapy, and follow-up protocols are warranted to clarify the true impact of anastomotic configuration on outcomes in CD.
Functional, oncologic and clinical outcomes of robotic rectal resection using the Hugo™ RAS system versus laparoscopic surgery: A comparative cohort study.
Arroyo A, López-de-Lerma C, Perea M … +8 more , Sánchez-Romero A, López-Rodríguez-Arias F, Alcaide MJ, Serrano-Navidad M, Barber X, Miranda E, Muñoz-Rodes JL, Sánchez-Guillén L
Int J Colorectal Dis · 2026 Jan · PMID 41571968 · Full text
BACKGROUND: To evaluate the functional, short-term oncologic and clinical outcomes of robotic rectal resection using the Hugo™ RAS (Robotic-assisted surgery) system compared with those of conventional laparoscopic surger...
BACKGROUND: To evaluate the functional, short-term oncologic and clinical outcomes of robotic rectal resection using the Hugo™ RAS (Robotic-assisted surgery) system compared with those of conventional laparoscopic surgery. METHODS: This retrospective cohort study was based on a prospectively maintained database. Baseline demographics, perioperative variables, postoperative complications (Clavien‒Dindo), and both functional (LARS score, pain, urinary and sexual function) and oncologic outcomes were compared. Functional outcomes were assessed at one, three and six months postoperatively. RESULTS: A total of 40 consecutive patients with rectal cancer who underwent surgery were included. 25 patients underwent laparoscopic resections and the remaining 15 patients received robotic resections using the Hugo™ RAS system. Baseline characteristics were comparable between the groups. At the six-month follow-up compared to the laparoscopic group, the robotic group had significantly lower mean LARS scores (19.2 vs. 9.8; p = 0.008), a greater proportion without LARS (53% vs. 85%; p = ns), and lower pain levels (not significant pain: 71% vs. 93%; p = 0.019). Male patients who underwent robotic surgery had significantly better sexual function at 6 months (p = 0.045). No statistically significant differences were found in terms of complications, but differences in anastomotic leakage (12% vs. 0%), paralytic ileus (16% vs. 6.7%) or Clavien‒Dindo 3-5 (24% vs. 13.4%) were clinically significant in favour of the robotic group. CONCLUSION: Robotic surgery with the Hugo™ RAS system is a feasible and safe alternative to conventional laparoscopic resection for rectal cancer, achieving comparable short-term oncologic outcomes while providing improved functional recovery. Ethics Committee of the General University Hospital of Elche (PI 60/2024). CLINICALTRIALS ID: NCT06512480.
Social and psychological effects of a stoma on the sexuality and self-image of patients.
Fischer M, Büntzel J, Hübner J
Int J Colorectal Dis · 2026 Jan · PMID 41559477 · Full text
PURPOSE: Examining the psychosocial impact of stoma surgery on quality of life, sexual health, and body image, and analyzing demographic factors associated with these outcomes. METHODS: This cross-sectional study include...
PURPOSE: Examining the psychosocial impact of stoma surgery on quality of life, sexual health, and body image, and analyzing demographic factors associated with these outcomes. METHODS: This cross-sectional study included 214 adults with a stoma. Validated instruments, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the Colorectal Cancer Module (EORTC QLQ-CR29), and the Sexual Health Module (EORTC QLQ-SH22), were used to assess quality of life, body image, and sexual function. Associations between demographic variables and patient-reported outcomes were tested using analysis of variance (ANOVA). RESULTS: Participants reported considerable impairments with fatigue, emotional well-being, sexual interest, and body image. Global health status was significantly lower in women (p = 0.037); female participants also expressed significantly greater concerns regarding partner satisfaction (p = 0.027). Fatigue was significantly associated with age and gender (p = 0.032). Reduced sexual interest was reported by 36.9% of respondents, while 47.7% reported body image dissatisfaction. CONCLUSION: Stoma surgery is associated with substantial psychosocial and sexual health challenges, particularly in women and older adults. These findings underline the need for tailored postoperative support focusing on emotional well-being, intimacy, and body image.
Role of MRI radiomics in deep learning-based prediction of intestinal diseases.
Yan L, Gao S, Gu C … +1 more , Wei B
Int J Colorectal Dis · 2026 Jan · PMID 41559237 · Full text
BACKGROUND: Magnetic resonance imaging (MRI) is widely used for the diagnosis, evaluation, and follow-up of intestinal diseases. With advances in artificial intelligence, MRI radiomics and deep learning have emerged as p...
BACKGROUND: Magnetic resonance imaging (MRI) is widely used for the diagnosis, evaluation, and follow-up of intestinal diseases. With advances in artificial intelligence, MRI radiomics and deep learning have emerged as promising tools for prognostic assessment and treatment guidance. This review synthesizes current evidence on MRI radiomics and deep learning for prognostic assessment of intestinal diseases, with a focus on inflammatory bowel disease and colorectal cancer. METHODS: We conducted a narrative review of studies published between January 2005 and March 2025, retrieved from PubMed/MEDLINE, Web of Science, and Embase. Eligible studies applied deep learning or radiomics approaches to MRI data to predict treatment response, recurrence, metastasis, or survival outcomes. Methodological quality and clinical relevance were critically appraised with reference to established artificial intelligence-specific evaluation frameworks. RESULTS: The reviewed studies indicate that deep learning models, including convolutional neural networks, vision transformers, and multimodal fusion approaches, can effectively exploit multiparametric MRI data to improve prognostic prediction across multiple clinical endpoints. These applications encompass image preprocessing, treatment planning, prediction of therapeutic response, disease relapse, and survival outcomes. MRI-based deep learning models generally outperform conventional imaging and traditional radiomics methods, particularly when integrated with clinical variables. However, most studies remain retrospective, with limited external validation and challenges related to interpretability and generalizability. CONCLUSIONS: MRI-based radiomics and deep learning hold substantial potential for enhancing precision medicine in intestinal diseases. Future progress will depend on standardized imaging protocols, multicenter prospective validation, and the development of explainable and clinically trustworthy artificial intelligence models.
Short-term outcomes of minimally invasive surgery in older colorectal cancer patients in the era of enhanced recovery after surgery: is a "one-size-fits-all" strategy sufficient?
Yu ZH, Jong BK, Hsu YJ … +4 more , You JF, Cheng CC, Liao CK, Chern YJ
Int J Colorectal Dis · 2026 Jan · PMID 41555061 · Full text
BACKGROUND: An enhanced recovery protocol (ERP) comprises a series of elements aimed at optimizing and standardizing perioperative care. Therefore, in this study, we aimed to evaluate the safety and feasibility of a modi...
BACKGROUND: An enhanced recovery protocol (ERP) comprises a series of elements aimed at optimizing and standardizing perioperative care. Therefore, in this study, we aimed to evaluate the safety and feasibility of a modified enhanced recovery after surgery (ERAS) protocol following colorectal surgery in older adults aged ≥ 65 years. MATERIALS AND METHODS: Patients aged ≥ 65 years who underwent minimally invasive colorectal cancer surgery at a tertiary referral hospital in Taiwan between 2018 and 2022 were reviewed retrospectively. Patients were divided into ERAS and traditional care groups according to the perioperative care strategy. The primary outcome was the short-term complication rate. However, the secondary outcomes were postoperative hospital stay, reoperation, readmission, and 30-day mortality rates. RESULTS: Overall, 1392 patients were enrolled, including 550 and 842 in the ERAS and traditional care groups, respectively. Demographic characteristics, including comorbidities, perioperative characteristics, and pathological staging, were not statistically significant. The patients' short-term complication rate was lower in the ERAS group (aged 65-80 years) than in the traditional care group (29 (7.2%) vs. 75 (11.5%), P = 0.026). However, the short-term complication rate did not differ between patients aged > 80 years (24 (16%) vs. 36 (19%), P = 0.438). In addition, the mean postoperative hospital stay was shorter in the ERAS group (7.5 ± 8.9 days vs 9.7 ± 10.0 days, P < 0.001). However, there were no differences in other secondary outcomes, including reoperation, readmission, and 30-day mortality rates. CONCLUSION: Minimally invasive colorectal cancer surgery within the ERAS program is safe and effective in patients aged 65-80 years.
Correspondence for the article titled - "Risk factors for bacterial translocation after loop ileostomy closure in patients with colorectal cancer''.
Ahmed R, Bhatia M
Int J Colorectal Dis · 2026 Jan · PMID 41540213 · Full text
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Prognostic impact of myosteatosis on postoperative outcomes and survival in colorectal cancer: a systematic review.
Han C, Zhang J, Kokelaar R … +2 more , Wei MY, Yeung JM
Int J Colorectal Dis · 2026 Jan · PMID 41535658 · Full text
PURPOSE: To characterise (1) the definition and measurement methods of myosteatosis, (2) the impact of myosteatosis on post-operative complications (overall, severe complications defined as Clavien-Dindo 3 and above, ana...
PURPOSE: To characterise (1) the definition and measurement methods of myosteatosis, (2) the impact of myosteatosis on post-operative complications (overall, severe complications defined as Clavien-Dindo 3 and above, anastomotic leak, length of stay) in both non-metastatic and metastatic colorectal cancer (CRC) patients and (3) the impact of myosteatosis on long-term survival outcomes in non-metastatic CRC (overall survival, cancer-specific survival, disease-free survival). METHODS: A systematic search of Medline, Embase and Cochrane Central databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in 2024. RESULTS: A total of 4410 publications were initially retrieved; 54 studies fulfilled the inclusion criteria. A variety of measurement methods of myosteatosis were found. There was good quality evidence to support a negative correlation between myosteatosis and overall survival (OS). Colon cancer was more consistently associated with OS and DFS compared to rectal cancer. Myosteatosis was found to significantly impact severe (Clavien-Dindo 3 and above) postoperative complications in colon cancer. Other postoperative outcomes were limited by inconsistency and an overall paucity in volume and quality. CONCLUSION: Myosteatosis has a negative association with OS, with consistent effects observed in colon cancer. There is a negative association with severe postoperative outcomes, particularly in colon cancer. These results are limited by the risk of bias and heterogeneity in measurement methods and statistical analysis. Future work is required to clarify the scan acquisition protocol and diagnostic criteria.
A single-center retrospective study of prophylactic loop ileostomies and transverse end colostomies after laparoscopic radical resection for rectal cancer: a comparison of safety and functional outcomes.
Li Y, Gao Z, Yue C … +9 more , Wang Y, Qiao X, Gao R, Shen H, Zhang X, She J, Fan W, Zhang Y, Li X
Int J Colorectal Dis · 2026 Jan · PMID 41535631 · Full text
OBJECTIVE: This study compared the safety and functional outcomes of prophylactic loop ileostomy (LI) versus transverse end colostomy (TEC) after laparoscopic radical resection for rectal cancer. METHODS: In this single-...
OBJECTIVE: This study compared the safety and functional outcomes of prophylactic loop ileostomy (LI) versus transverse end colostomy (TEC) after laparoscopic radical resection for rectal cancer. METHODS: In this single-center retrospective study, 171 patients requiring a prophylactic stoma were divided into LI (n = 93) and TEC (n = 78) groups. Primary endpoints were anastomotic leakage (AL) and AL-related reoperation rates within 3 months. RESULTS: The AL rate was comparable between groups (LI 2.2% vs TEC 1.3%, p = 1.0). However, all leaks in the LI group required reoperation, versus none in the TEC group. The overall complication rate was higher in the LI group (39% vs 15%, p < 0.05), driven mainly by electrolyte disturbances (32% vs 11%, p < 0.05). LI was associated with shorter operative times for both initial stoma creation and subsequent reversal (both p < 0.05). Among the 144 patients who underwent stoma reversal, incisional hernia occurred only in the LI group (4/78 vs 0/66, p = 0.12). CONCLUSION: TEC is a non-inferior alternative associated with a lower reoperation risk for AL and fewer metabolic complications, whereas LI offers shorter operative times. The choice depends on weighing procedural efficiency against long-term stoma-related risks.
Mucosal fungal dysbiosis is associated with early postoperative endoscopic recurrence after bowel resection for Crohn's disease.
Zheng L, Zhao L, Zhang J … +5 more , Zhu F, Li S, Yu Z, Zhang T, Gong J
Int J Colorectal Dis · 2026 Jan · PMID 41535621 · Full text
PURPOSE: Anastomotic recurrence after ileocolectomy for Crohn's disease may be related to the gut microbiota, but the role of mycobiota remains unclear. This study aimed to investigate associations between mucosal mycobi...
PURPOSE: Anastomotic recurrence after ileocolectomy for Crohn's disease may be related to the gut microbiota, but the role of mycobiota remains unclear. This study aimed to investigate associations between mucosal mycobiota at resection and early postoperative endoscopic recurrence, and assess their predictive potential. METHODS: We recruited 55 Crohn's disease patients undergoing bowel resection (October 2022-February 2024) with one-year endoscopic follow-up. Mucosal samples obtained during surgery underwent fungal internal transcribed spacer 1 sequencing to characterize the fungal communities. Multivariate analysis identified risk factors for early postoperative endoscopic recurrence. Predictive model performance was evaluated using receiver operating characteristic curve analysis. RESULTS: Twenty patients (36.4%) developed early postoperative endoscopic recurrence and were assigned to the recurrence group. Multivariate analysis identified preoperative low serum albumin level and elevated postoperative neutrophil-to-lymphocyte ratio as independent risk factors. The recurrence group exhibited an increased relative abundance of Basidiomycota, an elevated Basidiomycota/Ascomycota ratio, and heightened relative abundances of Malassezia restricta and Debaryomyces hansenii. A combined predictive model integrating three potential fungal biomarkers demonstrated superior predictive performance for early postoperative endoscopic recurrence. CONCLUSION: Early postoperative endoscopic recurrence in Crohn's disease is significantly associated with mucosal fungal dysbiosis during bowel resection. Integrating mycobial factors can more effectively predict early postoperative endoscopic recurrence.
Comparison and analysis of the immune landscape at the tumour invasion front in patients with pMMR/MSI-H and pMMR/MSS colorectal cancer.
Shen M, Chen G, Cai F … +3 more , Ren Y, Zhang Y, Shi J
Int J Colorectal Dis · 2026 Jan · PMID 41535577 · Full text
OBJECTIVES: This study aims to compare and analyse the immune landscape at the tumour invasion front in patients with colorectal cancer (CRC) with proficient mismatch repair (pMMR) and deficient mismatch repair (dMMR). M...
OBJECTIVES: This study aims to compare and analyse the immune landscape at the tumour invasion front in patients with colorectal cancer (CRC) with proficient mismatch repair (pMMR) and deficient mismatch repair (dMMR). METHODS: A total of 51 patients with CRC were included, comprising 32 patients with pMMR and 19 patients with dMMR. Immunohistochemistry, fluorescence PCR and capillary electrophoresis were used to detect the expression status of MLH1, PMS2, MSH2 and MSH6 proteins to identify patients with pMMR/MSI-H and pMMR/MSS. Multiplex immunofluorescence technology was employed to stain and analyse immune cells at the tumour invasion front. RESULTS: In patients with dMMR CRC, the proportion of CD8⁺ T cells at the tumour invasion front was significantly higher than that in patients with pMMR (26.84% ± 3.17% vs. 6.29% ± 1.62%, p < 0.001), whereas the proportion of CD4⁺ T cells was significantly lower (19.02% ± 2.81% vs. 37.71% ± 3.52%, p < 0.001). Regarding NK cells, the proportion of CD56 bright⁺ cells at the tumour invasion front in patients with dMMR was significantly higher than that in patients with pMMR (6.69% ± 1.04% vs. 1.93% ± 0.48%, p < 0.001). There was no significant difference in the total number of NK cells at the tumour invasion front between the two groups. CONCLUSION: There are significant differences in the infiltration and distribution of immune cells at the tumour invasion front between pMMR/MSI-H and pMMR/MSS CRC. The higher infiltration of CD8⁺ T cells and CD56 bright⁺ cells at the tumour invasion front in patients with dMMR CRC may partly explain their better response to immune therapy. However, these findings require validation in larger cohorts.
Long-term outcomes of stapled haemorrhoidopexy versus conventional haemorrhoidectomy: An updated systematic review, meta-analysis and trial-sequential analysis of randomized controlled trials.
Lauricella S, Brucchi F, Mascianà G … +6 more , Sandri GBL, Banchini F, Dionigi G, Cassini D, Casati M, Cirocchi R
Int J Colorectal Dis · 2026 Jan · PMID 41535511 · Full text
PURPOSE: Stapled haemorrhoidopexy (SH) offers well-established short-term advantages over conventional haemorrhoidectomy (CH), but its long-term effectiveness remains controversial. This systematic review and meta-analys...
PURPOSE: Stapled haemorrhoidopexy (SH) offers well-established short-term advantages over conventional haemorrhoidectomy (CH), but its long-term effectiveness remains controversial. This systematic review and meta-analysis aimed to compare long-term outcomes of SH versus CH in adult patients with grade II-IV haemorrhoids, incorporating Trial Sequential Analysis (TSA). METHODS: MEDLINE, EMBASE and CENTRAL were searched from January 2001 to October 2025 for randomized controlled trials (RCTs) comparing SH and CH with a minimum follow-up of 12 months. Two reviewers independently performed study selection, data extraction and risk-of-bias assessment (RoB-2). Primary outcomes included recurrence, reintervention, anal function, and quality of life (QoL). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. TSA was applied to overall recurrence. RESULTS: Seventeen RCTs including 1,041 SH and 1,031 CH patients were analysed. SH was associated with a higher risk of overall recurrence compared with CH (RR = 1.56,95%CI = 1.00-2.44;I = 48%). TSA showed that the accrued information size (1,913 patients) did not reach the required information size (2,608 patients), indicating that current evidence remains underpowered. Prolapse-related recurrence was significantly more frequent after SH (RR = 3.28,95%CI = 1.49-7.25;I = 12%), whereas bleeding-related recurrence did not differ between groups (RR = 1.20,95%CI = 0.63-2.26;I = 23%). No significant differences were found for reintervention, persistent anal pain, functional impairment or QoL. CONCLUSION: SH is associated with a higher risk of long-term recurrence, particularly prolapse-related recurrence, compared with CH, while long-term pain, functional outcomes and QoL appear broadly comparable. These findings suggest that, although SH may remain an option for selected patients, CH provides more durable anatomical correction, and procedural choice should balance early recovery against long-term durability.
Improving dietary fiber intake is associated with a declining burden of early-onset colorectal cancer: a three-decade comparative analysis in China and globally.
Cui G, Jing K, Li Y … +2 more , Gu J, Li F
Int J Colorectal Dis · 2026 Jan · PMID 41535499 · Full text
BACKGROUND: The global incidence of early-onset colorectal cancer (EOCRC) is rising. We compared trends in dietary fiber intake, a key modifiable risk factor, and its attributable EOCRC burden among young adults in China...
BACKGROUND: The global incidence of early-onset colorectal cancer (EOCRC) is rising. We compared trends in dietary fiber intake, a key modifiable risk factor, and its attributable EOCRC burden among young adults in China versus globally from 1990 to 2021. METHODS: Using data from the GDD and GBD 2021 for adults aged 25-49, we analyzed age-standardized mean fiber intake, summary exposure value (SEV) for low intake, and attributable EOCRC mortality and disability-adjusted life years (DALYs). Trends were quantified using the estimated annual percentage change (EAPC). RESULTS: Between 1990 and 2018, China's mean dietary fiber intake increased dramatically from 5.0 to 23.3 g/day (EAPC 5.73%), substantially outpacing the global increase (EAPC 1.41%). This led to a profound reversal in risk exposure; China's SEV for low fiber declined at nearly twice the global rate (EAPC -2.14% vs -1.15%), falling below the global benchmark after 2005. Consequently, the attributable age-standardized mortality rate in China dropped from 0.15 per 100,000 to converge with the global level of 0.05 by 2021 (EAPC -3.81% vs -2.17% globally). Similar rapid declines occurred for DALYs and were more pronounced in women. Favorable epidemiological changes were the primary driver of this reduction. CONCLUSION: China's success in reducing its EOCRC burden from low dietary fiber highlights nutritional improvement as a potent primary prevention strategy, reinforcing the urgent need to promote fiber-rich diets globally.
Machine learning-based integration of tumor deposit molecular signatures improves prognostic stratification in colon adenocarcinoma.
Wu J, Wu J, Zheng Z … +1 more , Chen S
Int J Colorectal Dis · 2026 Jan · PMID 41514121 · Full text
BACKGROUND: Colon adenocarcinoma (COAD) remains a leading cause of cancer-related mortality worldwide. Although tumor deposits (TDs) are established prognostic indicators, their molecular characteristics and potential fo...
BACKGROUND: Colon adenocarcinoma (COAD) remains a leading cause of cancer-related mortality worldwide. Although tumor deposits (TDs) are established prognostic indicators, their molecular characteristics and potential for improving risk stratification remain unexplored. METHODS: We performed an integrative analysis of transcriptomic and clinical data from TCGA and GEO databases to identify TD-associated molecular signatures. A hybrid ML framework combining random survival forest and stepwise Cox regression was developed to construct a risk stratification model. Model performance was validated through survival analysis, time-dependent ROC curves, and multivariate analyses. Gene set enrichment analysis explored underlying mechanisms and therapeutic implications. RESULTS: The integrated molecular signature-based model demonstrated superior prognostic accuracy, effectively stratifying patients into risk groups with distinct survival outcomes (P < 0.001) and clinicopathological features. High-risk patients exhibited enhanced immune evasion mechanisms and differential drug sensitivity patterns. Pathway analysis revealed significant alterations in ECM receptor interaction, PPAR signaling, and neuroactive ligand-receptor interaction pathways. CONCLUSIONS: Our machine learning-based integration of TD molecular signatures establishes a robust risk stratification model for COAD patients, offering improved prognostic accuracy and valuable insights for personalized treatment strategies. Our findings highlight the potential of interpretable machine learning in molecular oncology risk modeling.
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