International Journal Of Colorectal Disease[JOURNAL]
Sun
200 papers
Change in faecal incontinence pattern after gastric bypass surgery: related to change in anal sphincter thickness?
Wennerlund J, Thalén D, Östevind A … +2 more , Gunnarsson U, Strigård K
Int J Colorectal Dis · 2026 Jan · PMID 41514072 · Full text
PURPOSE: Faecal incontinence is common in persons with severe obesity. Little is known about how the thicknesses of the internal anal sphincter (IAS) and the external anal sphincter (EAS) change in relation to weight los...
PURPOSE: Faecal incontinence is common in persons with severe obesity. Little is known about how the thicknesses of the internal anal sphincter (IAS) and the external anal sphincter (EAS) change in relation to weight loss following metabolic bariatric surgery (MBS). This study aims to investigate any change in IAS and EAS thickness 6 months after Roux-en-Y gastric bypass surgery (RYGB) and to determine whether any such change correlates with a change in faecal incontinence pattern. METHODS: Thirty-one patients underwent three-dimensional endoanal ultrasound to measure anal sphincter thickness before and 6 months after RYGB. Patients completed the validated Wexner and LARS (low anterior resection syndrome) questionnaires at the same time to evaluate any change in faecal incontinence and urgency symptoms following surgery. RESULTS: No significant change in the thicknesses of the IAS and EAS was seen. The Wexner score decreased from 18 to 13 (less incontinence). Conversely, the number of patients with LARS increased from 10 to 15 six months after surgery (more urgency). CONCLUSION: RYGB had no effect on the thickness of the anal sphincter 6 months after surgery. However, the pattern of faecal incontinence changed, with a decrease in leakage and whole faecal incontinence and an increase in urgency.
Endoscopic submucosal dissection versus endoscopic mucosal resection for the treatment of rectal tumors extending to the dentate line: a systematic review and meta-analysis.
Ding C, Yang J, Yang J … +5 more , Zhou Y, Wang H, Xu S, Shen H, Liu Q
Int J Colorectal Dis · 2026 Jan · PMID 41514031 · Full text
PURPOSE: We performed a systematic review and meta-analysis to compare the efficacy and safety of endoscopic submucosal dissection (ESD) with those of endoscopic mucosal resection (EMR) for rectal tumors extending to the...
PURPOSE: We performed a systematic review and meta-analysis to compare the efficacy and safety of endoscopic submucosal dissection (ESD) with those of endoscopic mucosal resection (EMR) for rectal tumors extending to the dentate line (RTDLs). METHODS: We searched the PubMed, Embase, Web of Science and the Cochrane Library databases up to July 2025 for studies that reported the clinical outcomes of EMR or ESD for RTDLs. RESULTS: Fifteen studies (237 for EMR and 564 for ESD) were included in this meta-analysis. The en bloc resection rate (0.961 vs. 0.097; p = 0.000) was significantly greater in the ESD group than in the EMR group, and the local recurrence rate (0.023 vs. 0.188; p = 0.000) was significantly lower in the ESD group. No significant differences in the complete resection rate (0.793 vs. 0.823, p = 0.869) were noted between the ESD and EMR groups. In terms of adverse events, there were no differences in the postoperative bleeding rate (0.067 vs. 0.082; p = 0.677), perforation rate (0 vs.0; p = 0.605) or stricture rate (0.022 vs. 0.042; p = 0.378) between the ESD and EMR groups. CONCLUSION: ESD and EMR are effective and safe treatments for RTDLs; however, compared with EMR, ESD is associated with a higher en bloc resection rate and a lower local recurrence rate.
An interpretable machine learning model based on MRI radiomics and GAME score for predicting early recurrence after thermal ablation in colorectal liver metastases.
Kong Y, Wan L, Yue X … +2 more , Tang F, Zhou X
Int J Colorectal Dis · 2026 Jan · PMID 41513849 · Full text
OBJECTIVE: To develop and validate machine learning models based on preoperative magnetic resonance imaging(MRI) and baseline clinical characteristics for predicting early recurrence(ER) in patients with colorectal liver...
OBJECTIVE: To develop and validate machine learning models based on preoperative magnetic resonance imaging(MRI) and baseline clinical characteristics for predicting early recurrence(ER) in patients with colorectal liver metastases(CRLM) treated with thermal ablation(TA). MATERIALS AND METHODS: Patients with CRLM who underwent TA between January 2016 and December 2021 at two hospitals in China were allocated. Clinical and MRI data were used to develop and validate the clinical model, radiomics machine learning (R-ML) model, and combined clinical-radiomics model to predict ER after TA. The prognostic performance of the genetic and morphological evaluation (GAME) score and the Fong score was also compared (Supplementary Material). The best-performing algorithm among eight machine learning methods was selected to establish the R-ML model. Model performance was assessed through receiver operating characteristic (ROC) curve analysis, calibration plots, decision curve analysis (DCA), and survival analyses. RESULTS: A total of 187 consecutive patients were enrolled (114 for the training cohort, 48 for the testing cohort, and 25 for the external test cohort). The GAME score showed better prognostic performance than the Fong score (Supplementary Material). The largest diameter of liver metastases (OR: 5.760, 95% CI: 2.130-16.700; P < 0.001) and the GAME group (OR: 0.093, 95% CI: 0.007-0.985; P = 0.040) were independent risk factors for ER. The XGBoost-based R-ML model performed best across cohorts. In external validation, the combined model (AUC = 0.772, P = 0.015) demonstrated superior predictive capacity to both the clinical (AUC = 0.647, P = 0.380) and R-ML models (AUC = 0.743, P = 0.056). CONCLUSION: The combined model incorporating preoperative MRI-derived radiomics features and clinical parameters serves as a valuable tool for predicting ER risk in patients with CRLM undergoing TA therapy.
The Levator Hiatus Area detected by 3D-TPUS as an indicator of rectal prolapse severity.
Shao D, Qiu J, Yu J … +3 more , Diao X, Su D, Liu G
Int J Colorectal Dis · 2026 Jan · PMID 41513835 · Full text
PURPOSE: Rectal prolapse (RP) is a clinically significant condition with vaginal delivery as a major risk factor, especially in elderly females, needs precise evaluation for guiding treatment. Given the limitations of cu...
PURPOSE: Rectal prolapse (RP) is a clinically significant condition with vaginal delivery as a major risk factor, especially in elderly females, needs precise evaluation for guiding treatment. Given the limitations of current diagnostic methods in terms of convenience, this study aims to develop an improved measure for RP. METHODS: A retrospective analysis of 181 female patients undergoing both dynamic three-dimensional transperineal ultrasound (3D-TPUS) and radiographic (X-ray or MRI) defecography (X-ray and MRI) was conducted to investigate the correlation between 3D-TPUS parameters and RP severity. RESULTS: Relative to mild RP cases, severe RP patients were older, had heavier neonatal birth weight, and less nulliparous individuals. Significant differences in severe RP cases were demonstrated by 3D-TPUS quantification, greater levator hiatal area enlargement (LHA), increased bladder neck descent (BND), and deeper rectal ampulla position (RAP) compared to mild cases. Significant predictors of severe RP identified by univariable logistic regression included age, vaginal parity, RAP, and LHA. Multivariable logistic regression analysis exhibited that age and LHA during Valsalva were the most influential indicators of severe RP. Receiver operating characteristic (ROC) curve analysis revealed that an LHA ≥ 17.5 cm is indicative for screening (sensitivity 90%, specificity 16.7%), and an LHA ≥ 32.5 cm serves as a reference threshold for surgical referral (sensitivity 26.8%, specificity 90%). CONCLUSIONS: Dynamic 3D-TPUS-measured LHA associated with with RP severity and could serve as a quantifiable marker for pelvic floor dysfunction in RP. This study introduces an adjunctive indicator for the severity of RP, improving diagnostic convenience and patient management.
The subtype identification of colorectal cancer and construction of the risk model based on cholesterol synthesis-related genes to predict prognosis and guide immunotherapy.
Sun Q, Sun R, He B … +2 more , Meng H, Jin J
Int J Colorectal Dis · 2026 Jan · PMID 41511578 · Full text
BACKGROUND: Colorectal cancer (CRC) is a common malignant tumor worldwide. The cholesterol synthesis (CS) pathway is crucial in the occurrence and development of cancer. This study aims to predict the prognosis of CRC pa...
BACKGROUND: Colorectal cancer (CRC) is a common malignant tumor worldwide. The cholesterol synthesis (CS) pathway is crucial in the occurrence and development of cancer. This study aims to predict the prognosis of CRC patients based on the cholesterol synthesis-related genes (CSRGs). METHODS: The patient data of CRC were downloaded from the TCGA and GEO databases, and the CSRGs were downloaded from Genecards. In the TCGA-CRC training set, univariate Cox regression analysis was conducted on the CSRGs, and subtype classification was performed through consensus clustering. Combined with the PPI network and regression analysis, key CSRGs were identified to establish a prognostic model. ROC curves and Kaplan-Meier survival analysis were used to evaluate the model and validate it in the GSE17538 validation set. At the same time, immune analysis and drug sensitivity analysis were conducted. Finally, the functions of these characteristic genes were investigated in an in vitro cell model. RESULTS: The TCGA-CRC was divided into two subtypes. A 10-gene Cholesterol Synthesis-related Risk Signature (CSRS) was constructed. The patients were grouped according to the median value of the CSRS. The high-CSRS group had a poorer prognosis, and the abundance of macrophages, neutrophils, and TIL was higher in this group. The drug sensitivity prediction indicated that several candidate drugs (such as Linsitinib) might affect the progression of CRC through unique mechanisms. In vitro experiments demonstrated that EEF1A2 could promote the malignant progression of tumors. CONCLUSION: The results of this project provide some guidance for elucidating potential CS-related biomarkers for predicting prognosis in CRC patients.
Preoperative chemotherapy for colon cancer and short-term outcomes-a nationwide cohort study.
Delorme M, Agger E, Jörgren F … +3 more , Lydrup ML, Hagman H, Buchwald P
Int J Colorectal Dis · 2026 Jan · PMID 41511558 · Full text
PURPOSE: High-risk colon cancer may benefit from preoperative chemotherapy (preCHT), but evidence on its short-term safety and outcome is limited. Population-based evidence before its incorporation into national guidelin...
PURPOSE: High-risk colon cancer may benefit from preoperative chemotherapy (preCHT), but evidence on its short-term safety and outcome is limited. Population-based evidence before its incorporation into national guidelines is lacking. METHODS: Patients with final weighted stage II-III colon cancer undergoing elective resection between 2007 and 2017 were identified in the Swedish Colorectal Cancer Registry. Patients planned for preCHT, irrespective of intention, were compared with those undergoing upfront surgery. Primary outcomes were 30- and 90-day mortality and 30-day major morbidity, defined as all medical and surgical complications classified as Clavien-Dindo (CD) ≥ 3 grade. Subgroup analyses examined cT4 disease, and multivariable logistic regression was performed. RESULTS: Among 20,185 eligible patients, 299 (1.5%) received preCHT. Postoperative mortality was comparable (1.7% vs. 1.7%, p = 1.00 at 30 days and 3.0% vs. 2.8%, p = 0.82 at 90 days). Overall and surgical postoperative morbidity (CD ≥ 3) was higher in the preCHT group (34.1 vs. 25.0%, p < 0.001 and 17.4% vs. 13.1%, p < 0.001), rates of anastomotic leakage were similar (3.3% vs. 3.6%, p = 0.85). Compared to upfront surgery, the preCHT group was more likely to undergo multivisceral resections (53.9% vs. 13.6%, p < 0.001), with a higher rate of R1 resections (6.4% vs. 3.2%, p < 0.001), reflecting more advanced disease (cT4: 59.5% vs. 10.5%, p < 0.001; cN1-2: 54.9% vs. 28.6%, p < 0.001). In the cT4 subgroup, short-term outcomes were comparable, and regression analyses found no independent association between preCHT and mortality or major morbidity. CONCLUSION: PreCHT appeared feasible in cT4N0-2M0 colon cancer, with short-term outcomes comparable to upfront surgery despite more advanced primary tumour and greater surgical extent.
Association between serum lipids and colorectal polyps: a retrospective cross-sectional study.
He M, Tian S, Wang S … +1 more , Huo R
Int J Colorectal Dis · 2026 Jan · PMID 41507680 · Full text
BACKGROUND: The relationship between serum lipids and colorectal polyps (CP) remains unclear due to inconsistent findings across prior studies. This study aimed to comprehensively explore the relationship between serum l...
BACKGROUND: The relationship between serum lipids and colorectal polyps (CP) remains unclear due to inconsistent findings across prior studies. This study aimed to comprehensively explore the relationship between serum lipid levels and CP risk by using real-world clinical data. METHODS: By utilizing retrospective data from a tertiary hospital from 2015 to 2024, multivariate logistic regression, restricted cubic spline (RCS), and subgroup analyses were performed to assess the association between serum lipids and CP. Additionally, the mediating role of inflammation-related indices in the relationship between serum lipids and CP was examined. RESULTS: Triglyceride (TG) and total cholesterol (TC) were positively associated with CP risk (P < 0.05). RCS analysis revealed a nonlinear dose-response relationship between TG and CP risk (P for overall < 0.001, nonlinear P < 0.05), with a threshold value of 0.93 mmol/L. Significant interaction effects were observed between TG and TC and gender in relation to CP development. Inflammation-related indices mediated the association between high-density lipoprotein cholesterol and TC with CP risk (P < 0.05). CONCLUSION: This study highlights the potential clinical utility of TG and TC as modifiable biomarkers for CP risk. Future prospective studies are warranted to validate these findings and to explore targeted lipid-modifying interventions for high-risk populations.
Multidimensional impact analysis of interactive video health intervention on quality of life and clinical rehabilitation indicators in patients with early postoperative bowel obstruction: a randomized controlled trial.
Yao L, Wu D, Liu J … +2 more , Zhang X, Zhang L
Int J Colorectal Dis · 2026 Jan · PMID 41507597 · Full text
OBJECTIVE: To investigate the multiple effects of interactive video health intervention on the quality of life and clinical rehabilitation indexes of patients with early intestinal obstruction. METHODS: This study includ...
OBJECTIVE: To investigate the multiple effects of interactive video health intervention on the quality of life and clinical rehabilitation indexes of patients with early intestinal obstruction. METHODS: This study included two phases: (1) questionnaire validation (January 2019-December 2020): 152 patients with early postoperative bowel obstruction were enrolled to develop and test the reliability/validity of the Postoperative Quality of Life Assessment Scale for Early Intestinal Obstruction. (2) Randomized controlled trial (January 2021-January 2025): 310 eligible patients (18-75 years, basic cognitive ability, diagnosed with early postoperative bowel obstruction after abdominal surgery) were randomly assigned to a control group (conventional care: condition monitoring, basic treatment, and non-structured health education, n = 132) or a study group (conventional care plus an interactive video health intervention-5 modular videos covering disease knowledge, rehabilitation, and diet, initiated 24 h post-surgery, n = 178). Outcomes included QoL (via the validated scale), clinical rehabilitation indicators (obstruction relief time, hospitalization duration), electrogastrogram parameters, and gut microbiota diversity (16S rRNA sequencing). RESULTS: The validated QoL scale had good reliability (Cronbach's α = 0.821-0.937) and validity (AVE > 0.5, CR > 0.7). In the trial, the study group showed significantly better QoL scores (physiological function: 13.82 ± 5.67 vs. 22.45 ± 3.57; total score: 50.60 ± 6.44 vs. 36.67 ± 7.93; P < 0.001) and clinical outcomes (hospitalization duration: 8.78 ± 1.39 vs. 10.13 ± 1.41 days; P < 0.001) than the control group. The study group also had improved electrogastrogram parameters (e.g., gastric antrum slow-wave amplitude: 194.59 ± 20.76 vs. 151.34 ± 21 µV; P < 0.001) and intestinal microbiota evenness (Shannon index: P = 0.0070) compared to the control group. CONCLUSION: The disease-specific QoL scale is valid for assessing patients with early postoperative bowel obstruction. The interactive video health intervention effectively improves their QoL and clinical rehabilitation, providing a feasible clinical tool. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07258017 (September 24, 2025).
Exploring perceptual disparities: A study on the level of understanding of colorectal cancer care among patients and healthcare professionals.
Christodoulis E, Ntellas P, Simpson L … +13 more , Dadouli K, Connell J, Lim KHJ, Williams J, Hasan J, Adamou M, Mullamitha S, Anderson D, Marti Marti F, Braun M, Saunders M, Gillham T, Kamposioras K
Int J Colorectal Dis · 2026 Jan · PMID 41507502 · Full text
BACKGROUND: Emotional engagement, family support and personal beliefs can influence how patients and healthcare professionals (HCPs) perceive cancer differently. This study examined the extent to which the views of patie...
BACKGROUND: Emotional engagement, family support and personal beliefs can influence how patients and healthcare professionals (HCPs) perceive cancer differently. This study examined the extent to which the views of patients and HCPs on cancer care align, and identified factors that may underlie disparities. METHODS: Participants with colorectal cancer (CRC) were asked to describe their perception of their disease (i.e. whether they felt it was under control (DC), was progressing (PD), or was of an unknown status) and to complete psychometric assessments of anxiety, depression, PTSD and well-being. Two HCPs, who were blinded to the patients' responses, examined the case files to determine the stage of treatment at which the patients were enrolled in the study. The concordance of perceptions between patients and HCPs was examined, along with associations with clinical variables and psychometric health outcomes, using both univariate and multivariate analyses. RESULTS: A total of 205 patients with CRC were included in the study. The mean age was 65 years, with 58% of patients being male. Overall, a significant difference in perception was observed between HCPs and patients (p < 0.001), particularly for patients identified by HCPs as having PD. Significant discrepancies were observed among patients receiving palliative care (p < 0.001), whereas those in the adjuvant or neo-adjuvant pathway appeared to align more closely with HCPs' perceptions (p = 0.99). Neither demographic nor psychological factors were significant determinants of concordance between HCPs and patients' understanding of cancer status in this population. In multivariate analysis, patients perceiving PD or expressing uncertainty were found to have significantly higher levels of depression than those with DC (OR 6.42, p = 0.001 and OR 3.86, p = 0.009, respectively). CONCLUSIONS: This study reveals significant differences in how cancer is perceived by HCPs and patients, particularly among those without disease control or undergoing palliative care. This highlights the importance of effective communication in addressing patients' needs and their psychological well-being.
Risk factors for non-reversal of diverting ileostomies: a retrospective analysis of 456 patients.
Civil O, Sakoglu N, Tekin A … +1 more , Kement M
Int J Colorectal Dis · 2026 Jan · PMID 41507466 · Full text
PURPOSE: Diverting ileostomies are routinely created during low rectal cancer surgery, yet 15-30% remain permanent. Understanding predictors of non-reversal is essential for informed patient counseling. This study invest...
PURPOSE: Diverting ileostomies are routinely created during low rectal cancer surgery, yet 15-30% remain permanent. Understanding predictors of non-reversal is essential for informed patient counseling. This study investigated factors preventing ileostomy closure following colorectal surgery, primarily for rectal malignancy. METHODS: This retrospective cohort study analyzed prospectively collected data from patients undergoing diverting ileostomy creation (January 2015-December 2020). Exclusions included early postoperative mortality (within 30 days), follow-up less than 6 months, or missing primary outcome data. Demographics, surgical details, and reversal outcomes were analyzed. Multivariable logistic regression identified independent predictors of non-reversal. RESULTS: Of 508 patients, 456 met inclusion criteria (mean age 58.9 ± 13.2 years, 63.8% male). Malignancy accounted for 96.7% of cases, with low anterior resection performed in 83.8%. Ileostomy closure was achieved in 364 patients (79.8%) at a median of 6 months (mean 7.4 ± 5.3). The non-reversal rate was 20.2% (92 patients). Main reasons included mortality (35.8%), metastatic disease (23.9%), and anastomotic complications (22.8%). Multivariable analysis identified ASA score 3-4 (OR 2.68, 95% CI 1.58-4.54, p < 0.001) and malignant pathology (OR 5.12, 95% CI 1.23-21.3, p = 0.025) as independent predictors of non-reversal. Age showed statistical but limited clinical significance. CONCLUSION: One in five patients with diverting ileostomies will not undergo reversal. High ASA scores, malignant disease, mortality, metastatic progression, and anastomotic complications are primary barriers. These findings emphasize the need for realistic preoperative counseling regarding permanent stoma risk.
Transverse blowhole colostomy versus Hartmann's for urgent management of large bowel obstruction secondary to diverticular stricture.
Liefeld HR, Coleman KL, Lawrence K … +1 more , Ogilvie JW
Int J Colorectal Dis · 2026 Jan · PMID 41504949 · Full text
PURPOSE: Sigmoid resection with end colostomy (Hartmann's procedure) is the procedure of choice when a large bowel obstruction secondary to diverticular disease requires surgery. Less morbid alternatives are less common....
PURPOSE: Sigmoid resection with end colostomy (Hartmann's procedure) is the procedure of choice when a large bowel obstruction secondary to diverticular disease requires surgery. Less morbid alternatives are less common. This study compares a transverse blowhole colostomy as a first-stage intervention in diverticular-associated obstruction. Our primary aim was to compare colostomy reversal rates and postoperative outcomes between blowhole colostomy and Hartmann's procedure. METHODS: This is a single-center, retrospective cohort study. An institutional database was utilized to retrospectively identify adult patients who underwent Hartmann's procedure or blowhole colostomy for diverticular strictures with obstruction between 2012 and 2023. RESULTS: Thirty-nine patients underwent Hartmann's procedure for diverticular strictures with obstruction and 15 patients underwent blowhole colostomy. The blowhole colostomy group had a significantly shorter postoperative length of stay (median 5 vs. 8 days, p = 0.01). Colostomy reversal was more frequent in the blowhole group (81.3% vs. 56.4%, p = 0.08), with a shorter median time to reversal (3 months vs. 4.7 months, p = 0.01). A significant increase in reversals performed using a minimally invasive approach (84.6% vs. 50%, p < 0.01) occurred in the blowhole colostomy group. No significant differences were observed in other postoperative outcomes, including proximal diversion after colostomy reversal. CONCLUSIONS: Blowhole colostomy may be a viable alternative to a Hartmann's procedure for diverticular-associated large bowel obstruction, offering potential benefits such as shorter hospital stays, higher rates of colostomy reversal, and a greater likelihood of minimally invasive reversal. Further prospective studies are needed to confirm these findings.
Correspondence for the article titled - "Prognostic impact of metastatic sites and its metastasectomy in colorectal cancer: a retrospective analysis from a single institution".
Bhatia M, Kostadinov D
Int J Colorectal Dis · 2026 Jan · PMID 41493591 · Full text
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Clinical utility of longitudinal ctDNA monitoring by multiplex MS-ddPCR for risk stratification and follow-up in rectal cancer.
Lauridsen ED, Do Canto LM, Timm S … +5 more , Havelund BM, Lindebjerg J, Jensen LH, Andersen RF, Hansen TF
Int J Colorectal Dis · 2026 Jan · PMID 41484474 · Full text
INTRODUCTION: Personalized treatment strategies in rectal cancer aim to balance escalation and de-escalation based on recurrence risk. Accurately identifying which patients will benefit from each approach is essential fo...
INTRODUCTION: Personalized treatment strategies in rectal cancer aim to balance escalation and de-escalation based on recurrence risk. Accurately identifying which patients will benefit from each approach is essential for optimizing outcomes and guiding follow-up. However, current clinical methods lack the precision needed to reliably predict response and long-term prognosis. METHODS: In this feasibility study, we evaluated the prognostic utility of a novel methylation-specific droplet digital PCR (MS-ddPCR) multiplex assay in 56 patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant treatment (nT) and surgery. Circulating tumor DNA (ctDNA) was analyzed at four time points (baseline, during nT, preoperatively, 6 months post-surgery). Associations between ctDNA status and dynamics with tumor regression grade (TRG), disease recurrence, and overall survival (OS) were assessed using receiver operating characteristics (ROC) analyses and survival statistics. RESULTS: ctDNA was detected in 59% of the patients at baseline. Preoperative ctDNA had limited discriminative value for pathologic response, AUC 0.60 (95% CI 0.45-0.76). In contrast, ctDNA positivity 6 months postoperatively was strongly associated with recurrence within 2 years following surgery, AUC 0.96 (95% CI, 0.91-1.00). CtDNA positivity 6 months post-surgery was associated with inferior 2-year DFS (38% vs 94%, p for log-rank < 0.001) and 3-year OS (63% vs 100%, p for log-rank < 0.001). CONCLUSION: With this MS-ddPCR assay, preoperative ctDNA showed limited prognostic value, whereas ctDNA 6 months postoperatively was strongly associated with recurrence and overall survival. The absence of an immediate postoperative sample limited assessment of early molecular response-a time point critical for guiding treatment decisions and follow-up strategies-underscoring the need for earlier sampling in future studies to optimize ctDNA-guided management. Given the small cohort and exploratory design, these findings are hypothesis-generating and support further validation of the assay in larger, prospective trials.
The Malone antegrade continence enema for treating adult constipation and fecal incontinence: a systematic review of the literature.
Gallo G, De Simone V, Bellocchia AB … +7 more , Sorrenti S, Luc AR, Clerico G, Sorge R, Sileri P, Trompetto M, Gravante G
Int J Colorectal Dis · 2026 Jan · PMID 41483410 · Full text
PURPOSE: The Malone antegrade continence enema (MACE) offers a minimally invasive and potentially reversible option for managing chronic constipation and fecal incontinence (FI). This systematic review evaluates its effi...
PURPOSE: The Malone antegrade continence enema (MACE) offers a minimally invasive and potentially reversible option for managing chronic constipation and fecal incontinence (FI). This systematic review evaluates its efficacy, safety, and long-term outcomes in adults. METHODS: A comprehensive search was conducted across PubMed, EMBASE, and CENTRAL databases up to April 2025 to identify studies on MACE in adults. Study quality was assessed using the Newcastle-Ottawa scale. The primary outcome was the proportion of patients continuing MACE at follow-up (treatment success); failure was defined as conversion to definitive colostomy. RESULTS: Seventeen studies with 404 patients were included. Study quality was rated moderate to good. The most common indications were neurological disorders (25.8%), prior surgeries (16.8%), idiopathic constipation (14.2%), and traumatic spinal injuries (11.6%). Techniques included terminal ileal loop (37.9%), percutaneous endoscopic cecostomy (26.0%), and appendicostomy (24.8%). Minor stoma-related complications were most frequent (39.1%), followed by fecal leakage (16.2%) and stoma stenosis (11.3%). Median follow-up was 28.5 months. At final follow-up, 75.1% of patients continued using MACE, while 9.8% required colostomy. Satisfactory outcomes were reported by 60%-83% of patients, with improvements in symptoms and quality of life. CONCLUSIONS: MACE is a safe and effective option for adults with refractory constipation or FI, especially in those aiming to avoid a permanent colostomy.
Is it feasible for surgical trainees to acquire JAG endoscopy accreditation by CCT? National online survey of UK trainees.
Ahmad AN, Zaman S, Ayeni A … +5 more , Ishaq S, Waterland P, Kumar P, Mills S, Akingboye A
Int J Colorectal Dis · 2026 Jan · PMID 41483409 · Full text
BACKGROUND: Higher surgical trainees often struggle to attain endoscopy competencies. We aimed to obtain a national picture of higher surgical trainees' endoscopy experience, highlight barriers to training, and explore p...
BACKGROUND: Higher surgical trainees often struggle to attain endoscopy competencies. We aimed to obtain a national picture of higher surgical trainees' endoscopy experience, highlight barriers to training, and explore potential solutions. METHODS: A 40-point electronic questionnaire was designed and disseminated to higher surgical trainees across the UK. Anonymous responses were collected and recorded from 26/10/2020 to 11/06/2021. RESULTS: A total of 139 higher surgical trainees from 16 out of the 19 regional UK deaneries responded. 75.9% (82/108) had some endoscopy training, and 19.4% (21/108) had no endoscopic training. 27.8% (30/108) had performed over 200 procedures. 77.8% (105/135) were not made aware of endoscopy training requirements by their Training Programme Directors (TPDs). 59.6% (65/109) had no named endoscopy supervisor. Only 49.1% (53/108) felt supported by their endoscopy trainers. Joint Advisory Group on GI Endoscopy (JAG) certification was infrequent, and the highest levels, 14.4% (15/104), were achieved in oesophagogastroduodenoscopy (OGD). Only 55.8% (24/43) of JAG-certified trainees felt competent in that procedure. 50.0% (7/14) of ST8 (final year trainee) respondents were not JAG certified in any procedure. 90.6% (96/106) faced challenges in gaining endoscopy training. The most common obstacles were the COVID-19 pandemic 87.9% (94/107), on-call commitments 80.2% (85/106), lack of allocated endoscopy sessions 80.2% (85/106), insufficient endoscopy training lists 76.4% (81/106), and competition with non-surgical trainees 64.2% (68/106). CONCLUSIONS: Our survey provides detailed evidence of the challenges faced by surgical trainees in gaining endoscopy training. Suggested solutions include allocated endoscopy trainers, dedicated endoscopy-only training blocks, and early guidance about endoscopy training and certification.
More severe natural course of Crohn's disease in Yunnan province compared with Asian and Western countries.
Tao Y, Li M, Li H … +11 more , Sun Z, Wu J, Yang L, Ma Y, Chen X, Chen L, Liang H, Wen Y, Miao Y, Zhang F, Niu J
Int J Colorectal Dis · 2026 Jan · PMID 41483251 · Full text
BACKGROUND: Most patients with Crohn's disease (CD) experience disease progression and will eventually undergo surgery. However, the risks of progression and surgery exhibit significant regional heterogeneity. We conduct...
BACKGROUND: Most patients with Crohn's disease (CD) experience disease progression and will eventually undergo surgery. However, the risks of progression and surgery exhibit significant regional heterogeneity. We conducted a cohort study to explore the risks and associated factors for disease progression, surgery, and postoperative recurrence in CD patients from Yunnan, a plateau province in southwestern China, and compared these data with data from Asian and Western countries. METHODS: In this study, data from a multicentre cohort from Yunnan Province were collected and analyzed. The cumulative risks of disease progression, surgery, and postoperative recurrence were analyzed. Univariate and multivariate analyses were performed to explore the independent risk factors associated with these outcomes. Finally, the distinct clinical profile of CD in our Yunnan cohort was compared with those of populations in Asian and Western countries, as reported in the literature. RESULTS: Among 252 patients with CD, disease behaviour and location progressed in 19.87% and 16.67% of the cohort, respectively. A total of 42.9% of the patients underwent surgery. The cumulative risk of postoperative recurrence at 3 years after primary surgery was 53.8%. Intestinal complications (HR = 2.798; P < 0.001) were independent risk factors for primary surgery, whereas the use of glucocorticoids (HR = 0.411; P = 0.002) and the use of biologics (HR = 0.300; P < 0.001) were protective factors. A delayed diagnosis (> 1 year) was an independent risk factor for reresection and postoperative recurrence. The cumulative risk of progression of disease behaviour was 34.5% at 5 years in Yunnan CD patients, which was greater than those reported in Western (14-15%) and Asian countries (15-30.7%). Similarly, the cumulative risk of surgery was 36.1% at 5 years, which exceeded the risks observed in the Western (17.4-35.1%) and Asian (10.7-16.5%) cohorts. CONCLUSION: Compared with those in Asian and Western countries, CD patients in Yunnan exhibit an increased propensity for disease progression and surgical intervention. Intestinal complications and delayed diagnosis (> 1 year) are risk factors for surgery and postoperative recurrence.
Preoperative phase angle and postoperative complications in Crohn's disease patients undergoing ileocolic resection: a retrospective cohort study.
Qi W, Liu H, Liang H … +5 more , Liu W, Ye L, Cao Q, Ge X, Zhou W
Int J Colorectal Dis · 2026 Jan · PMID 41483196 · Full text
PURPOSE: To investigate the association between preoperative phase angle (PhA), measured by bioelectrical impedance analysis, and short-term postoperative complications in patients with Crohn's disease (CD) undergoing il...
PURPOSE: To investigate the association between preoperative phase angle (PhA), measured by bioelectrical impedance analysis, and short-term postoperative complications in patients with Crohn's disease (CD) undergoing ileocolic resection. METHODS: This retrospective cohort study included consecutive patients with CD who underwent ileocolic resection between April 2021 and December 2024. Baseline demographic, clinical, and nutritional data were analyzed. Univariable and multivariable logistic regression models were employed to identify predictors of postoperative complications. The discriminative ability of PhA was evaluated using receiver operating characteristic (ROC) curve analysis, with additional stratification by sex. RESULTS: Among 119 patients (median age 28 years; 72.3% male; median BMI 18.0 kg/m), 25 (21.0%) experienced postoperative complications. Mean preoperative PhA was significantly lower in patients with complications compared with those without (4.1 ± 0.5° vs 4.8 ± 0.7°, P < 0.001). In multivariable analysis, higher preoperative PhA was independently associated with reduced odds of complications (OR = 0.203, 95% CI = 0.085-0.487, P < 0.001), whereas elevated C-reactive protein on postoperative day 3 was associated with increased odds (OR = 1.017, 95% CI = 1.007-1.028, P = 0.002). PhA demonstrated good overall discrimination (AUC 0.772, 95% CI 0.657-0.863). Sex-stratified analysis revealed superior discrimination in females (AUC 0.864, 95% CI 0.689-1.000; cut-off 3.9°) compared with males (AUC 0.748, 95% CI 0.625-0.857; cut-off 4.5°). CONCLUSION: Lower preoperative PhA values were associated with a higher risk of short‑term postoperative complications after ileocolic resection for CD. Findings support the potential incorporation of PhA into preoperative risk assessment to help identify higher‑risk patients and guide perioperative optimization.
Living 20 years with perineal colostomy and dynamic graciloplasty - a case report discussing the role of this approach.
Rosen H, Sebesta CG, Sebesta M … +1 more , Sebesta C
Int J Colorectal Dis · 2026 Jan · PMID 41483180 · Full text
BACKGROUND: Despite advances in neoadjuvant therapies and surgical techniques, abdominoperineal excision of the rectum (APER) is still necessary in a considerable number of cases, often requiring the creation of a perman...
BACKGROUND: Despite advances in neoadjuvant therapies and surgical techniques, abdominoperineal excision of the rectum (APER) is still necessary in a considerable number of cases, often requiring the creation of a permanent colostomy, which can significantly impact a patient's quality of life (QOL). Total anorectal reconstruction (TAR) with dynamic graciloplasty has emerged as a reconstructive option for patients undergoing APER, aiming to restore continence by avoiding a permanent abdominal colostomy and improving quality of life. However, this approach presents several challenges, including technical complexity and variable long-term outcomes. CASE REPORT: We present the case of a 34-year-old female patient who underwent APER with extended resection (rectum and vaginal wall) due to low rectal adenocarcinoma infiltrating the posterior vaginal wall. Following a prolonged postoperative course and the decision against living with an abdominal colostomy, the patient underwent secondary TAR with reconstruction of the posterior vaginal wall and dynamic graciloplasty in 2001. The procedure included creating a neorectum using a myocutaneous flap for vaginal reconstruction and a gracilis muscle wrap with neurostimulation as a neosphincter. Despite early postoperative complications, the patient achieved satisfactory continence with regular transanal irrigation and lived with the reconstruction for over 20 years. In 2024, the patient returned for management due to the obsolescence of her neurostimulator, which was subsequently removed without deterioration in her continence function. CONCLUSION: This case highlights the complex and prolonged management challenges associated with TAR and dynamic graciloplasty for patients with severe anorectal dysfunction following APER. While dynamic graciloplasty has been shown to offer some level of continence in patients with faecal incontinence, the need for additional interventions, such as regular irrigation, is often required to maintain quality of life after TAR following APER. The durability of this reconstructive approach and the patient's long-term satisfaction underline its potential as a viable, though technically demanding, alternative to conventional colostomy in selected patients. However, the role of electrically induced muscle fiber transformation ("dynamic graciloplasty") needs to be discussed.
Deep impact analysis of surgical strategy changes guided by indocyanine green fluorescence angiography in laparoscopic low anterior resection for rectal cancer.
Qiu X, Kashchenko VA, Zavrazhnov AA … +4 more , Lankov TS, Ye L, Strizheletsky VV, Smirnov GA
Int J Colorectal Dis · 2026 Jan · PMID 41483178 · Full text
PURPOSE: This study investigated the patient factors leading to ICG fluorescence angiography (ICG-FI)-guided surgical plan changes during rectal cancer surgery and evaluated the impact of these changes on anastomotic hei...
PURPOSE: This study investigated the patient factors leading to ICG fluorescence angiography (ICG-FI)-guided surgical plan changes during rectal cancer surgery and evaluated the impact of these changes on anastomotic height and postoperative bowel function. METHODS: In a retrospective analysis of 302 patients undergoing laparoscopic low anterior resection, we compared 28 patients requiring perfusion-based plan changes (Change group) to 274 without changes (No-Change group). We analyzed demographics, anastomotic height, and 6-month LARS scores. RESULTS: The Change group had significantly older age, higher BMI, more neoadjuvant therapy, and lower tumor height. Their final anastomoses were higher (8.0 vs. 6.0 cm, p < 0.001). This group also had better bowel function, with lower LARS scores (18 vs. 25, p = 0.007) and fewer major LARS cases (14.3% vs. 32.1%, p = 0.041). Anastomotic leakage rates were similar. CONCLUSIONS: ICG-FI identifies patients with perfusion risk factors (age, obesity, neoadjuvant therapy, low tumors) who benefit from surgical plan modification. Guiding the proximal resection margin based on ICG assessment to create a higher, well-perfused anastomosis significantly improves functional outcomes, underscoring its role in personalized surgery. TRIAL REGISTRATION: The study was registered in the clinical trials registry with registration number NCT06270745.
Histopathological assessment to detect colorectal ovarian micrometastasis following prophylactic salpingo-oophorectomy in postmenopausal patients.
van Zon JFJA, Heijmans MHM, Bosch SL … +3 more , Bloemen J, Leclercq WKG, Roumen RMH
Int J Colorectal Dis · 2026 Jan · PMID 41483176 · Full text
INTRODUCTION: Colorectal cancer (CRC) is one of the most prevalent malignancies and often leads to metastatic disease. Ovarian metastasis occurs in approximately 4% of all female CRC patients. Metastatic disease recurren...
INTRODUCTION: Colorectal cancer (CRC) is one of the most prevalent malignancies and often leads to metastatic disease. Ovarian metastasis occurs in approximately 4% of all female CRC patients. Metastatic disease recurrence after intentional curative resection of primary colorectal tumour could be explained by the presence of micrometastases. The present study aims to investigate the prevalence of CRC (micro)metastases in tubo-ovarian tissue following prophylactic salpingo-oophorectomy (PSO) in postmenopausal patients. MATERIAL AND METHODS: Analyses of both adnexa of postmenopausal CRC patients who underwent primary tumour resection and concurrent PSO were conducted retrospectively. Tissue blocks with formalin fixed paraffin embedded ovarian tissue were sectioned at five levels, and both routine histopathological and additional immunohistochemical staining for CK20 and CDx2 were performed. The primary outcome measure was the incidence of CRC micrometastases (%). RESULTS: Ovaries of 100 consecutive CRC patients who underwent surgery at two Dutch teaching hospitals were analysed (age 72.7 ± 7.6 years, pT0-2 (43%), and pN0 (65%)). Overall, ovarian malignancies were found in 4% of patients. Immunohistochemical analysis revealed no additional CRC (micro)metastases. DISCUSSION: Additional immunohistochemical assessment did not reveal CRC ovarian (micro)metastases in an unselected patient cohort. The absence of micrometastases could be attributed to patient selection criteria and/or sampling error. Future research should focus on identifying a subgroup at high risk of developing ovarian metastasis and on the improvement of diagnostic and therapeutic strategies.
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