International Journal Of Colorectal Disease[JOURNAL]
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200 papers
Gunsight closure versus conventional techniques for reversal of protective stoma after rectal cancer surgery: a propensity score matching study.
Lin S, Mao M, Chen R … +3 more , Guo L, Zhou M, Chen J
Int J Colorectal Dis · 2026 Jan · PMID 41483170 · Full text
BACKGROUND: Surgical site infection (SSI), wound-related complications, and incisional hernia are common concerns following stoma reversal. These complications can significantly impair postoperative recovery and quality...
BACKGROUND: Surgical site infection (SSI), wound-related complications, and incisional hernia are common concerns following stoma reversal. These complications can significantly impair postoperative recovery and quality of life, especially in rectal cancer patients. This study compared the clinical and patient-reported outcomes of two protective stoma reversal procedures, the gunsight and conventional linear closure techniques. METHODS: A retrospective propensity score matching (PSM) analysis was conducted on 194 patients who underwent stoma reversal between 2016 and 2023. Baseline characteristics, surgical outcomes, postoperative complications, and patient satisfaction were compared between the gunsight and conventional closure groups. A structured, self-designed questionnaire based on the principles of patient-reported outcome measures (PROMs) was administered at 6 months post-operatively to assess pain relief, wound healing, scar appearance, and functional recovery. RESULTS: After PSM, 97 matched pairs were analyzed. The gunsight group had significantly lower SSI rates (11.34% vs. 22.68%, p = 0.036) and reported lower postoperative pain scores on POD 1 (p < 0.001) and POD 2 (p = 0.003). No significant differences were observed in terms of operative time, hospital stay, wound dehiscence, or incidence of incisional hernia. Patient-reported satisfaction with pain relief was significantly greater in the gunsight group (p = 0.012), whereas overall satisfaction scores were comparable. CONCLUSION: The gunsight closure technique reduces postoperative infections and early postoperative pain without increasing complication rates. It also improves early patient-reported outcomes, making it a safe, effective, and patient-centered alternative for stoma reversal in rectal cancer surgery.
Long-term outcomes of pT1 rectal cancer after transanal endoscopic surgery: again, a word of caution on high local recurrence - a cohort study.
Serra-Aracil X, Gener-Jorge C, Nonell A … +4 more , Ferreres-Piñas JC, Espina B, Casalots A, Caro-Tarragó A
Int J Colorectal Dis · 2026 Jan · PMID 41483165 · Full text
PURPOSE: Recent evidence suggests that the local recurrence (LR) rate after local excision of pT1 rectal adenocarcinoma may be higher than previously estimated, particularly in large cohorts with extended follow-up. This...
PURPOSE: Recent evidence suggests that the local recurrence (LR) rate after local excision of pT1 rectal adenocarcinoma may be higher than previously estimated, particularly in large cohorts with extended follow-up. This study aimed to evaluate the LR rate and long-term oncological outcomes in patients with pT1 rectal adenocarcinoma treated with transanal endoscopic surgery (TES). METHOD: Observational cohort study including 824 consecutive patients who underwent TES at a single tertiary center between 2004 and 2021. Among them, 104 patients (12.6%) were diagnosed with pT1 rectal adenocarcinoma. Patients were excluded if they had received neoadjuvant or adjuvant chemoradiotherapy, had non-rectal tumors, a follow-up of less than 40 months, or were treated with surgical techniques other than TES. RESULTS: With a median follow-up of 91 months (IQR: 84), 17 patients (16.3%) developed LR and 14 (13.5%) developed distant recurrence. Five-year rectal cancer-specific and overall survival rates were 95% and 74%, respectively. Among the 88 patients without histopathological or surgical high-risk factors, 13 (14.8%) experienced LR and 9 (10.2%) distant recurrence. Their five-year disease-free and overall survival rates were 95% and 74%, Multivariate analysis identified flat-ulcerated morphology as the only independent predictor of LR (OR 6.8; 95% CI 1.5-30.4; p = 0.01). CONCLUSION: TES for pT1 rectal adenocarcinoma resulted in a 16.3% overall LR rate, and 14.8% among patients without known risk factors, emphasizing the need for improved patient selection and novel prognostic and therapeutic tools. These findings warrant confirmation in multicenter studies with standardized criteria and prolonged follow-up.
Anatomy-guided computational framework for classifying vascular ligation and lymphadenectomy in oncologic sigmoidectomy: toward AI-supported surgical auditing.
Torres-Marí N, García-Fuster ÁG, Jerí-McFarlane S … +5 more , Ochogavía-Seguí A, Díaz-Ferrando J, Gómez-Gomes G, Gamundí-Cuesta M, González-Argente FX
Int J Colorectal Dis · 2026 Jan · PMID 41483146 · Full text
PURPOSE: The optimal vascular ligation strategy and lymphadenectomy level in oncological sigmoidectomy remain controversial, with inconsistent definitions and a lack of standardized postoperative assessment. This study a...
PURPOSE: The optimal vascular ligation strategy and lymphadenectomy level in oncological sigmoidectomy remain controversial, with inconsistent definitions and a lack of standardized postoperative assessment. This study aimed to anatomically and radiologically define D2 and D3 lymphadenectomy in sigmoid colon cancer and to develop an objective multimodal protocol for postoperative classification of vascular ligation and recurrence patterns. METHODS: A three-phase multimodal anatomical study was conducted. Phase 1 involved cadaveric dissections simulating D2 lymphadenectomy and D3 dissection with either low or high ligation of the inferior mesenteric artery (IMA). Phase 2 retrospectively assessed 14 patients with pre- and postoperative contrast-enhanced CT scans to classify vascular ligation type and recurrence pattern. Phase 3 validated these findings through AI-assisted computational segmentation and 3D reconstruction. RESULTS: In cadaveric simulation, each vascular strategy (D2, D3-low tie, D3-high tie) was anatomically characterized in terms of arterial division point, venous drainage control, and residual mesocolon, allowing systematic differentiation of the three approaches. Radiological evaluation successfully identified the level of vascular ligation in all cases. Among patients with recurrence (n = 5), the classification protocol distinguished mesenteric from non-mesenteric recurrences based on vascular territory. The 3D reconstruction phase showed full concordance between the radiological classification and the 3D model regarding both the level of inferior mesenteric artery ligation and the anatomical localization of locoregional recurrence. CONCLUSION: This standardized anatomical-radiological workflow, integrating cadaveric dissection, CT-based vascular analysis, and AI-assisted 3D reconstruction, provides an objective tool to classify the level of vascular ligation performed in oncological sigmoidectomy and to anatomically categorize locoregional recurrence, establishing a foundation for future surgical audit and outcome studies, and representing a step toward AI-supported surgical audit systems capable of standardizing vascular ligation classification and recurrence mapping.
Prevalence of and risk factors for anal incontinence: a large-scale multicentre study in Turkey.
Edizsoy A, Esmer AC, Tazeoğlu D … +1 more , Çolak T
Int J Colorectal Dis · 2026 Jan · PMID 41483070 · Full text
PURPOSE: Anal incontinence (AI), characterized by involuntary leakage of gas or stool, adversely affects quality of life and is associated with various comorbidities. Limited data exist regarding its prevalence in Turkey...
PURPOSE: Anal incontinence (AI), characterized by involuntary leakage of gas or stool, adversely affects quality of life and is associated with various comorbidities. Limited data exist regarding its prevalence in Turkey. METHOD: To assess the prevalence and implications of AI, a multicentre study encompassing seven regions of Turkey was conducted. A power analysis was conducted before the study, and it was calculated that at least 7927 individuals were required to be screened to achieve a minimum AI prevalence of 2.5%. A survey of 8844 relatively healthy persons visiting outpatient clinics was conducted by health care professionals in a face-to-face manner across seven geographical regions in Turkey. The survey utilized the Wexner incontinence scale score and collected information on surgical history, chronic diseases, gynaecological conditions, and regional variations. RESULTS: The prevalence of anal incontinence in Turkey was 2.3% (95% CI, 2-2.5%). The prevalence of AI increased with increasing age (65+ y/o), prolapse (p < 0.0001), and AI was also found to be associated with chronic conditions, including chronic medication usage and bowel habits (diarrhoea/constipation) (p < 0001). Vaginal delivery and prostate surgery were also associated with AI (p < 0001). Significant associations were observed between AI rates in women and certain gynaecological conditions. Additionally, regional differences in AI prevalence were also identified. CONCLUSION: The results of the present study revealed that AI is more prevalent among older individuals and women and is associated with chronic illness, bowel habits, vaginal delivery, and chronic medications. Additionally, particular attention should be given to the role of gynaecological conditions in AI in women.
Consequences of omitting additional treatment after local excision of high-risk early rectal cancer: a national cohort.
Lossius W, Stornes T, Myklebust TÅ … +1 more , Wibe A
Int J Colorectal Dis · 2026 Jan · PMID 41483063 · Full text
PURPOSE: This study aimed to evaluate oncological outcomes in patients with high-risk early rectal cancer undergoing local excision, comparing those who received guideline-recommended additional treatment to those who di...
PURPOSE: This study aimed to evaluate oncological outcomes in patients with high-risk early rectal cancer undergoing local excision, comparing those who received guideline-recommended additional treatment to those who did not, either due to comorbidities or personal preference. METHOD: National data on patients treated by transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) for early rectal cancer without prior chemoradiotherapy between 2010 and 2020 were analyzed retrospectively. Patients were classified into low-risk (pT1 without risk factors for lymph node involvement) and high-risk (pT1 with risk factors and all pT2). High-risk patients receiving additional treatment (mainly completion TME, or less frequently adjuvant chemoradiotherapy for high-risk pT1) were compared to those without further treatment. Endpoints were 5-year relative survival, disease-free survival, overall survival, local recurrence, and distant recurrence. RESULTS: Among 298 patients, 70 (23.5%) were low-risk pT1, 153 (51.3%) were high-risk pT1, and 75 (25.2%) were pT2. Additional treatment was omitted in 93 (60.8%) of high-risk pT1 and 39 (52.2%) of pT2 cases. Compared to patients following guidelines, those not receiving additional treatment had lower 5-year disease-free survival of 53.3% vs. 80.9% (p = 0.008) and higher 5-year local recurrence rates of 22.0% vs. 7.3% (p = 0.008). Five-year overall survival was 63.9% vs. 90.6% (p = 0.013), and relative survival 81.9% vs. 97.7% (p = 0.157). CONCLUSION: Omitting indicated additional treatment following TEM or TAMIS for high-risk early rectal cancer is associated with a substantially higher local recurrence rate and loss of long-term disease-free survival and overall survival.
rs2032582 polymorphism of ATP binding cassette subfamily B member 1 affect the susceptibility of inflammatory bowel disease: a systematical meta-analysis based on 14,876 subjects.
Chen H, Zhang H, Tao G
Int J Colorectal Dis · 2026 Jan · PMID 41483013 · Full text
BACKGROUND: Inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gastrointestinal tract with increasing global incidence. This meta-a...
BACKGROUND: Inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gastrointestinal tract with increasing global incidence. This meta-analysis aims to systematically evaluate the relationship between ATP-binding cassette subfamily B member 1 (ABCB1) rs2032582 polymorphism and IBD susceptibility. METHODS: A comprehensive literature search was conducted across Web of Science, PubMed, Embase, Google Scholar, Wanfang, and CNKI databases to identify eligible case-control studies published up to March 2025. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated under multiple genetic models to assess the association between ABCB1 rs2032582 and IBD. Subgroup analyses were performed based on ethnicity and disease type. Heterogeneity was evaluated using the Q test and I statistics, and publication bias was assessed using Egger's test and Begg's funnel plot. We utilized data from SNPedia ( https://www.snpedia.com/ ) to illustrate the distribution of the ABCB1 rs2032582 polymorphism across diverse populations. The mRNA expression levels of ABCB1 in IBD tissues were analyzed using the IBDTransDB database ( https://abbviegrc.shinyapps.io/ibdtransdb/ ). RESULTS: A total of 19 publications comprising 31 study subgroups (some studies provided the data for both UC and CD subgroups) were included, encompassing 6,721 IBD cases and 8,155 healthy controls. In the overall analysis, ABCB1 rs2032582 polymorphism was significantly associated with IBD in specific populations. Subgroup analysis revealed a significant association in Asian and African populations, particularly in CD, while no significant association was found in Caucasian populations. The allelic model and recessive model showed significant associations with IBD in Asian and African populations (P < 0.05). Sensitivity analyses confirmed the robustness of the findings, and no significant publication bias was detected. The ABCB1 rs2032582 polymorphism shows different distribution across ethnic groups, with the potentially harmful homozygosity for the mutant allele present in 30.4% of Asians, 18.4% of Caucasians, and only 1.9% of Africans. ABCB1 expression was consistently reduced in patients with IBD compared to healthy controls. CONCLUSION: This meta-analysis provides evidence that ABCB1 rs2032582 polymorphism is associated with IBD susceptibility, particularly in Asian and African populations, with a more pronounced effect in CD. These findings highlight the potential role of ABCB1 in IBD pathogenesis and suggest that ethnic-specific genetic variations may contribute to disease susceptibility. Further large-scale, multi-ethnic studies are required to validate these findings and explore the underlying mechanisms.
Safety and efficacy of IL-23 inhibitors in patients with moderate to severe ulcerative colitis: a systematic review and meta-analysis of randomized controlled trials.
Amin HM, Hasan S, Abukhater R … +13 more , Lilley R, Atique A, Shoaib MS, Albustanji Q, Sadique H, Khalid SM, Hasan A, Majeed S, Shahzad MA, Shahzad M, Ahmed M, Ahmed R, Gardezi SA
Int J Colorectal Dis · 2025 Dec · PMID 41467943 · Full text
BACKGROUND AND OBJECTIVE: Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy a...
BACKGROUND AND OBJECTIVE: Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC. METHODS: A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model. RESULTS: Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade. CONCLUSION: IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.
Risk factors for bacterial translocation after loop ileostomy closure in patients with colorectal cancer.
Adachi T, Inoue Y, Okada S … +9 more , Miyoshi T, Ueki N, Kurohama H, Matsuoka Y, Soyama A, Kobayashi K, Adachi T, Kanetaka K, Eguchi S
Int J Colorectal Dis · 2025 Dec · PMID 41413677 · Full text
PURPOSE: Although rare, septic shock can develop following the closure of an ileostomy created during colorectal cancer surgery. In such cases, bacterial translocation (BT) is considered the primary diagnosis, and approp...
PURPOSE: Although rare, septic shock can develop following the closure of an ileostomy created during colorectal cancer surgery. In such cases, bacterial translocation (BT) is considered the primary diagnosis, and appropriate treatment is provided. Herein, we investigated the risk factors of BT following ileostomy closure after colorectal cancer surgery. METHODS: A retrospective analysis was conducted using the colorectal cancer database of Nagasaki University, focusing on 91 patients who received ileostomy closure after colorectal cancer surgery. The patients were divided into two groups based on the occurrence of BT, defined as fever exceeding 38 °C without an identifiable cause, and data regarding patient background, surgical factors, and postoperative factors were assessed. RESULTS: BT occurred in 12 of 91 patients. No significant differences were observed between the groups of patients in terms of background factors but C-reactive protein levels on postoperative days 3 and 7 were significantly higher in the BT group than in the non-BT group (BT group vs. non-BT group [median], day 3: 6.64 mg/dL vs. 3.79 mg/dL, p = 0.0026; day 7: 5.10 mg/dL vs. 1.52 mg/dL, p = 0.0007). Additionally, the rate of postoperative adjuvant chemotherapy administration was significantly higher in the BT than in the non-BT group (BT group vs. non-BT group: 83.3% vs. 43.0%, p = 0.0123). The pathological findings from resected specimens showed that mucosal height was lower in the anal side than in the oral side. CONCLUSION: Adjuvant chemotherapy may significantly increase the risk of BT after ileostomy closure following colorectal cancer surgery.
Impact of age on short-term outcomes and oncologic prognosis after radical surgery for colorectal cancer over 60.
Chen JJ, Li ZL, Yang Y … +1 more , Wang ZJ
Int J Colorectal Dis · 2025 Dec · PMID 41351632 · Full text
PURPOSE: Colorectal cancer (CRC) is becoming increasingly common in adults ≥ 60 years old, yet postoperative prognosis of curative-intent surgery for the advanced elderly (≥ 80 years) remains controversial. METHODS: A re...
PURPOSE: Colorectal cancer (CRC) is becoming increasingly common in adults ≥ 60 years old, yet postoperative prognosis of curative-intent surgery for the advanced elderly (≥ 80 years) remains controversial. METHODS: A retrospective cohort study included 971 CRC patients aged ≥ 60 years who underwent curative-intent surgery from January 2018 to December 2023 in Beijing Chaoyang Hospital. Patients were stratified into "ordinary elderly group" (OE) (60-79 years, n = 800) and "advanced elderly group" (AE) (≥ 80 years, n = 171). Clinicopathological variables, 30-day morbidity/mortality, disease-free survival (DFS), and overall survival (OS) were collected and analyzed the differences between the two groups. The study was presented in accordance with the STROBE reporting checklist. RESULTS: The AE had more right-sided CRC (P < 0.001) and higher rate of preoperative obstruction (P < 0.001). They underwent more emergency (P = 0.002) and open procedures (P < 0.001), resulting in longer postoperative stays P = 0.030). Overall, 30-day morbidity was comparable (P = 0.76), but perioperative mortality rate was higher in AE (P = 0.041). The median follow-up was 36.1 ± 22.1 months, and recurrence rates (P = 0.58) and 5-year DFS (log-rank P = 0.42) did not differ between groups. Multivariate analysis identified TNM stage, perineural invasion, vascular invasion, preoperative intestinal obstruction, and proficient Mismatch Repair (pMMR) as independent predictors of DFS; age ≥ 80 years was not prognostic (p = 0.81). CONCLUSIONS: Despite a higher burden of comorbidities and increased perioperative mortality, no statistically significant difference in long-term oncological outcomes was observed between AE and OE following rigorous patient selection and perioperative management in CRC patients. Advanced age alone should not preclude standard curative resection.
Histological assessment of radiotherapy-induced injury in the anal canal: an exploratory study.
Leventi A, Sibbons P, Tsigka A … +7 more , Korkolis D, Peponi E, Skafida Ε, Moorghen M, Vaizey CJ, Glynne-Jones R, Maeda Y
Int J Colorectal Dis · 2025 Dec · PMID 41339537 · Full text
PURPOSE: Faecal incontinence (FI) is a common and debilitating late effect of chemoradiotherapy in patients with anal cancer. While its clinical relevance is well recognized, the underlying histopathological mechanisms r...
PURPOSE: Faecal incontinence (FI) is a common and debilitating late effect of chemoradiotherapy in patients with anal cancer. While its clinical relevance is well recognized, the underlying histopathological mechanisms remain poorly understood. This exploratory study aimed to describe structural tissue changes in the anal canal following radiotherapy and assess their potential contribution to FI. METHODS: Histological specimens from patients who underwent salvage abdominoperineal excision after chemoradiotherapy for anal cancer (AC group) were compared with those from low rectal cancer patients treated surgically without neoadjuvant therapy (RC group). Degenerative changes were assessed in peritumoral regions, including evaluation of collagen fibre composition via polarized light microscopy and ImageJ software. RESULTS: Indicative trends were observed, with the AC group showing higher rates of muscle fibre atrophy (73% vs 27%, p = 0.049) and intramuscular edema (78% vs 22%, p = 0.015), and a non-significant increase in lamina propria fibrosis (p = 0.069). No statistically significant differences were found in collagen fibre type distribution. Due to the limited sample size, these findings should be interpreted as descriptive rather than confirmatory. CONCLUSION: Radiotherapy appears to induce notable structural alterations within the anal sphincter complex, including muscle atrophy and oedema, which may contribute to post-treatment faecal incontinence. These changes seem independent of collagen fibre composition. Despite the small sample size and lack of clinical data, this study provides preliminary histological insights that warrant further investigation in larger, clinically integrated cohorts.
Development and application of an artificial intelligence-assisted endoscopic system for automatic and accurate diagnosis of colorectal ulcers.
Yu Z, Liu X, Yu X … +3 more , Xin Y, Zhou S, Li X
Int J Colorectal Dis · 2025 Dec · PMID 41331579 · Full text
OBJECTIVES: Crohn's disease (CD), ulcerative colitis (UC), intestinal Behçet's disease (BD), intestinal tuberculosis (ITB), and primary intestinal lymphoma (PIL) are major intestinal disorders that frequently present wit...
OBJECTIVES: Crohn's disease (CD), ulcerative colitis (UC), intestinal Behçet's disease (BD), intestinal tuberculosis (ITB), and primary intestinal lymphoma (PIL) are major intestinal disorders that frequently present with mucosal ulceration. Accurate differentiation among these conditions is challenging due to overlapping clinical, endoscopic, and imaging characteristics. Accordingly, this study aimed to develop an artificial intelligence (AI)-assisted endoscopic diagnostic system to accurately identify these five diseases. METHODS: This multicenter prospective study used endoscopic images from patients diagnosed with pathologically confirmed CD, UC, BD, ITB, and PIL to develop an AI system that uses convolutional neural networks (CNNs) and transformer architectures. It was validated across multiple centers compared with endoscopist performance, and assessed prospectively. In addition, clinical data were integrated to construct a comprehensive diagnostic model. RESULTS: Internal validation revealed that the AI system achieved an accuracy of 96.8%, with sensitivities for the five ulcerative diseases ranging from 76.9% to 97.8%. In the multicenter test (Test A + Test B3), diagnostic accuracy reached 83.4%, outperforming endoscopists. Prospective evaluation revealed that AI system demonstrated significantly higher accuracy than senior endoscopists (83.4% versus 59.4%, P < 0.001). Moreover, the optimal comprehensive model, which combined clinical and endoscopic data, achieved an accuracy of 76.3%. CONCLUSIONS: An AI-assisted endoscopic diagnostic system that accurately differentiates CD, UC, BD, ITB, and PIL was developed, which may contribute to improving diagnostic precision for colorectal ulcerative diseases.
TNF antagonists withdrawal is not advised in patients with inflammatory bowel disease in remission: a systematic review and meta-analysis of randomized controlled trials.
Owolabi AA, Qazi I, Ahmed N … +12 more , Alsayed MA, Abu Zar M, Choudhry TR, Gnanendran D, Khan A, Amrutha A, Cheema HA, Alsubari AMA, Rashad E, Bhat A, Altaf F, Jalal PK
Int J Colorectal Dis · 2025 Dec · PMID 41331357 · Full text
BACKGROUND: Tumor necrosis factor (TNF) antagonists are central to the management of inflammatory bowel disease (IBD), but concerns regarding long-term safety, infection risk, and costs have prompted interest in treatmen...
BACKGROUND: Tumor necrosis factor (TNF) antagonists are central to the management of inflammatory bowel disease (IBD), but concerns regarding long-term safety, infection risk, and costs have prompted interest in treatment de-escalation. Whether discontinuing TNF therapy in patients with sustained remission is safe remains uncertain. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TNF antagonist withdrawal with continuation in IBD patients in sustained remission. Databases including MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched through July 2025. Eligible trials enrolled adults with Crohn's disease or ulcerative colitis in clinical remission. Primary outcomes were relapse risk and sustained remission. Data were pooled using a random-effects model. RESULTS: Four RCTs comprising 485 patients were included. TNF antagonist withdrawal was associated with a significantly higher risk of relapse compared with continuation (RR: 3.00, 95% CI: 1.47-6.11). Time to relapse was also shorter in the withdrawal group (HR: 5.34, 95% CI: 2.05-13.92). Sustained clinical remission did not differ significantly between groups (RR: 0.83, 95% CI: 0.55-1.27). Withdrawal reduced infection risk (RR: 0.47, 95% CI: 0.25-0.90), while rates of gastrointestinal and serious adverse events were comparable. CONCLUSIONS: Discontinuation of TNF antagonists in IBD patients in remission substantially increases the risk and accelerates the timing of relapse, though it lowers infection risk. Careful patient selection and close monitoring are essential if withdrawal is considered.
MRI-defined high-risk rectal cancer patients: comparison of treatment response and survival outcomes between total neoadjuvant therapy and neoadjuvant chemoradiotherapy-a propensity score matched analysis.
Li R, Zhao M, Ma Q … +9 more , Zhang Z, Li R, Xia F, Wang Y, Zhou Q, Zhang Z, Gu Y, Tong T, Sun Y
Int J Colorectal Dis · 2025 Dec · PMID 41331154 · Full text
PURPOSE: This study evaluated whether total neoadjuvant therapy (TNT), compared to neoadjuvant chemoradiotherapy (nCRT), improves response and prognosis in magnetic resonance imaging (MRI)-defined high-risk patients with...
PURPOSE: This study evaluated whether total neoadjuvant therapy (TNT), compared to neoadjuvant chemoradiotherapy (nCRT), improves response and prognosis in magnetic resonance imaging (MRI)-defined high-risk patients with locally advanced rectal cancer (LARC). METHODS: This retrospective cohort study ultimately included 791 patients with pathologically confirmed rectal cancer who underwent baseline rectal MRI at our institution between 2015 and 2022. Independent MRI-based prognostic risk factors were identified through multivariable Cox regression analysis. Propensity score matching (PSM) was employed to control for confounding variables, followed by survival and treatment response analyses between groups. RESULTS: The Cox model revealed that MR-based T4 stage and extramural venous invasion (EMVI) status significantly impacted overall survival (OS), whereas tumor location and mesorectal fascia invasion (MRF) status served as important predictors of disease-free survival (DFS). After PSM, the MRI-defined TNT group exhibited a significantly higher clinical complete response (cCR) rate (25.8% vs. 4.0%, p < 0.001), thus leading to more frequent adoption of the watch and wait (W&W) strategy. Furthermore, Kaplan-Meier (KM) curve analysis ultimately confirmed that, compared with the nCRT group, the TNT group exhibited superior OS (HR = 0.48, 95% CI 0.27-0.86) and DFS (HR = 0.62, 95% CI 0.39-1). CONCLUSION: In MRI-defined high-risk LARC patients, TNT could improve the survival trend while increasing the likelihood of organ preservation without exacerbating surgical complexity. These findings emphasize the fact that TNT should be prioritized for the high-risk MRI-defined population to achieve enhanced local tumor control, sustained therapeutic efficacy, and prolonged survival.
Longitudinal assessment of quality of life and symptom burden in locally advanced rectal cancer patients receiving IMRT-based preoperative radiotherapy: A prospective cohort study.
Truelsen CG, Kronborg CS, Ramlov A … +2 more , Hvid CA, Spindler KG
Int J Colorectal Dis · 2025 Dec · PMID 41331150 · Full text
PURPOSE: Preoperative radiotherapy (pRT) for rectal cancer (RC) reduces local recurrence rates. However, treatment-induced side effects may compromise patient-reported quality of life (QoL). This study aimed to report lo...
PURPOSE: Preoperative radiotherapy (pRT) for rectal cancer (RC) reduces local recurrence rates. However, treatment-induced side effects may compromise patient-reported quality of life (QoL). This study aimed to report longitudinal QoL and physician-assessed toxicity in RC patients receiving preoperative intensity modulated radiotherapy (IMRT). METHODS: This prospective cohort study included 123 RC patients treated with short-course (SCRT) or long-course chemoradiotherapy (LCRT). Patient-reported outcomes (PRO) were assessed using the EORTC QLQ-C30 and CR29 questionnaires at pretreatment, end of treatment, preoperatively, and at 1-year follow-up. Physician-reported toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE). Longitudinal changes in PROs were analysed using mixed-effects regression modelling. CTCAE grades were reported as frequencies, and symptom transitions illustrated using Sankey diagrams. RESULTS: For EORTC C30 items, pRT-induced transient declines were observed for Global Health, physical, role and social functioning, fatigue, and pain, with scores recovering at preoperative assessment, except for persistent worsening for fatigue. At 1-year, Global Health remained stable; emotional functioning improved; fatigue and social functioning showed minor persistent worsening. Bowel and bladder symptoms peaked during pRT and gradually resolved or improved at 1Y. CTCAE grades were predominantly mild; diarrhoea and rectal bleeding improved over time, while urinary dysfunction and fatigue increased modestly. Sankey plots illustrate symptom transitions. Discrepancies were noted between physician- and patient-reported outcomes. CONCLUSION: IMRT-based pRT was associated with largely preserved QoL at 1Y. Reported trajectories of PRO and CTCAE scores provide complementary insights to support physician-patient communication, with differences underlining the importance of integrating both perspectives.
Defining key interventions for rectal cancer surgery: a literature review and expert panel consensus.
Schraepen C, Bislenghi G, Vanhaecht K … +4 more , André D'Hoore, Wolthuis A, Coeckelberghs E, BIC4ReCa group
Int J Colorectal Dis · 2025 Dec · PMID 41331131 · Full text
BACKGROUND: Despite advances in minimally invasive techniques and widespread adoption of Enhanced Recovery Programs (ERPs), rectal cancer surgery continues to pose significant challenges due to anatomical limitations, ri...
BACKGROUND: Despite advances in minimally invasive techniques and widespread adoption of Enhanced Recovery Programs (ERPs), rectal cancer surgery continues to pose significant challenges due to anatomical limitations, risks of complications, and the potential impact on bowel, urinary, and sexual function. These complexities underline the need for clearly defined, evidence-based key interventions to assess and ensure consistent, high-quality care across institutions. The aim of this study is to identify and summarize the evidence-based key interventions relevant to rectal cancer surgery. METHODS: A focused PubMed/MEDLINE search was performed to identify key interventions in care pathways for rectal cancer surgery. The list of key interventions extracted from the literature was presented to an expert panel who evaluated their importance and relevance in a one-round Delphi process. RESULTS: In total, 293 papers were screened on title and abstract for relevant information. Twelve papers were retained to identify the initial set of key interventions (n = 56). The list was narrowed to 39 by excluding duplicates and outdated key interventions. This list was commented on during a 1-round Delphi, and consensus was reached for 37 key interventions regarding surgical rectal cancer treatment. CONCLUSION: We propose this list of 37 key interventions as a contemporary framework for assessing rectal cancer surgery.
Nomogram predicting short- and long-term outcomes in colon cancer based on CT body composition.
Lu Z, Yang W, Yang H … +6 more , Sui X, Liu S, Xu W, Wu W, Xu Z, Lu Y
Int J Colorectal Dis · 2025 Dec · PMID 41331116 · Full text
BACKGROUND: We investigated the relationship between sarcopenia (low skeletal muscle index, SMI) and myosteatosis (high intermuscular adipose tissue, IMAT) accompanied by post-surgical adverse events and recurrence-free...
BACKGROUND: We investigated the relationship between sarcopenia (low skeletal muscle index, SMI) and myosteatosis (high intermuscular adipose tissue, IMAT) accompanied by post-surgical adverse events and recurrence-free survival (RFS) in patients with colon cancer (CC) undergoing radical resection. METHODS: This retrospective study included 475 patients from the Affiliated Hospital of Qingdao University (original cohort) and 209 patients from Weihai Central Hospital Affiliated to Qingdao University (validation cohort) with CC who underwent radical surgical resection. Cox proportional hazards and logistic regression models were used to analyze the correlation between body composition and postoperative complications, as well as RFS. A nomogram was developed based on independent predictors of RFS, and its performance was evaluated. RESULT: The original cohort comprised 475 patients (272 males, 203 females; mean age 64.8 ± 11.9 years). Postoperative complications occurred in 85 patients (17.8%). Multivariate analysis revealed low SMI (P = 0.025) and hypoalbuminemia (P = 0.048) were independent risk variables for these complications. The median follow-up was 51 months (IQR, 37.5-62.25). Low IMAT (HR 2.919, 95% CI: 1.423-5.985, P = 0.003) and high SMI (HR 0.450, 95% CI: 0.247-0.821, P = 0.009) were independent prognostic variables for RFS. Considering the original cohort, the AUCs for 1-, 3-, and 5-year RFS were 0.885, 0.867, and 0.868, and for the validation cohort, the AUCs for 1-, 3-, and 5-year RFS were 0.784, 0.817, and 0.897. The nomogram demonstrated strong predictive performance for RFS. CONCLUSION: Sarcopenia is a standalone predictor for postoperative complications and RFS in patients with CC, whereas myosteatosis independently predicts RFS. The nomogram provides valuable support for clinical decision-making and holds the potential to improve patient outcomes.
Effect of extensive mesenteric excision on primary ileocolic resection outcomes in Crohn's disease patients: a systematic review with meta-analysis.
Martínez-Pérez A, Schena CA, Pellino G … +3 more , Martínez-López E, Azzolina D, de'Angelis N
Int J Colorectal Dis · 2025 Dec · PMID 41329358 · Full text
PURPOSE: The role of mesenteric excision in Crohn's Disease (CD) remains uncertain. We aimed to evaluate the impact of extended vs. limited mesenteric excisions on intra- and postoperative outcomes in patients undergoing...
PURPOSE: The role of mesenteric excision in Crohn's Disease (CD) remains uncertain. We aimed to evaluate the impact of extended vs. limited mesenteric excisions on intra- and postoperative outcomes in patients undergoing primary ileocolic resection for CD. METHODS: A systematic search was conducted in PubMed, EMBASE, Web of Science, ClinicalTrials.gov, and ISRCTN up to February 2025. Randomized controlled trials (RCTs), non-RCTs, and retrospective studies comparing extended and limited mesenteric excision in primary ileocolic resections for CD were included. The primary outcome was endoscopic CD recurrence (Rutgeerts score ≥ i2). Secondary outcomes included severe endoscopic recurrence (≥ i2b or ≥ i3), surgical recurrence, anastomotic leaks, operative time, conversion to open surgery, severe postoperative complications, and length of hospital stay. RESULTS: Over the 2588 records initially screened, 4 studies were included, involving a total of 632 patients. Pooled analysis showed no significant difference in endoscopic recurrence rates between extended and limited resections (48.2% vs. 54.1%; RR: 0.91; 95% CI: 0.70-1.18; p = 0.46; I = 57%). Additionally, there were no significant differences in the risk of anastomotic leak (3.8% vs. 2.6%; RR: 1.35; 95% CI: 0.14-12.88; p = 0.80; I = 52%) or any other analyzed outcomes. CONCLUSION: Extended mesenteric excision does not appear to significantly reduce endoscopic recurrence compared with limited excision in primary ileocolic resections for CD. Until further high-quality evidence is available, surgical teams should adhere to their established practice and refrain from implementing extended resections outside well-designed prospective studies. REGISTRATION: PROSPERO (CRD42025644791).
Perianal fistulas: a new management approach using mesenchymal stem cells as a human, biological and autologous tool-a single-centre observational study.
Testa A, Passantino D, Garbarino C … +4 more , Verdi A, Cozza T, Mascagni D, Eberspacher C
Int J Colorectal Dis · 2025 Dec · PMID 41329341 · Full text
PURPOSE: The surgical treatment of perianal fistulas is challenging, especially in complex cases. Many surgical options may cause impairment of the anal sphincter with subsequent incontinence or may be less effective wit...
PURPOSE: The surgical treatment of perianal fistulas is challenging, especially in complex cases. Many surgical options may cause impairment of the anal sphincter with subsequent incontinence or may be less effective with a high number of relapses or the persistence of the pathology. New techniques, such as the use of mesenchymal stem cells, are becoming increasingly important because of their effectiveness and lower risk of complications. METHODS: In this single-centre prospective observational study, patients with complex perianal fistulas were treated via the infiltration of mesenchymal stem cells that had been purified using the Lipogems® system. RESULTS: This study included 63 patients with complex perianal fistulas who were treated with mesenchymal stem cells extracted from adipose tissue. Successful clinical healing was observed in 43 (68.25%) patients. Eleven (17.4%) patients presented recurrence after treatment, and 9 (14.3%) had persistent incomplete healing. Minor postoperative complications were observed in six (9.5%) patients, which were related to adipose tissue harvesting in three patients. In the majority of patients, postoperative pain was mild or not present. CONCLUSIONS: Mesenchymal stem cells offer an innovative therapeutic tool for treating perianal fistulas. This study confirms their safety and efficacy in treating complex perianal fistulas. Nevertheless, more extensive patient follow-up is necessary, as demonstrated by the most recent literature on related techniques.
The surgical management of perforated diverticulitis Hinchey III: a systematic review and meta-analysis.
Ib MT, Holbek OT, Tøttrup A
Int J Colorectal Dis · 2025 Nov · PMID 41261215 · Full text
UNLABELLED: The purpose of the present study was to perform a systematic review and meta-analysis of the available literature on the surgical management of Hinchey III diverticulitis comparing laparoscopic lavage with su...
UNLABELLED: The purpose of the present study was to perform a systematic review and meta-analysis of the available literature on the surgical management of Hinchey III diverticulitis comparing laparoscopic lavage with surgical resection. METHODS: A PubMed and EMBASE search using well-defined mesh terms was used. All identified papers were screened for possible inclusion in the study by initial review of abstracts. Only randomized trials were included in the meta-analysis. RESULTS: The search resulted in 23 studies available for closer investigation. We managed to identify 3 separate randomized trials comparing the outcome after laparoscopic lavage and sigmoid resection for Hinchey III diverticulitis. Early and late results of these trials have been reported in 7 scientific papers constituting the basis of the present systematic review and meta-analysis. For the different endpoints, pooled data from between 292 and 380 patients randomized to either sigmoid resection or laparoscopic lavage was available for analysis. Ninety-day mortality was similar between the groups (OR = 0.69 (0.32-1.49)), but the risk of severe complications and of recurrent diverticulitis was lower among patients randomized to sigmoid resection (OR = 0.61 (0.38-0.98) and OR = 0.15 (0.05-0.44), respectively). The risk of having a stoma after 1 year was higher among patients randomized to resection (OR = 2.97 (1.30-6.81)). No significant differences were identified regarding the need for reoperation. Subsequent analysis of data from two of the randomized trials showed that smoking and use of immunosuppressant medications were associated with a poorer outcome after laparoscopic lavage. CONCLUSIONS: Laparoscopic lavage has certain advantages when compared to resection for Hinchey III diverticulitis, but should be used with caution in smokers and patients taking immunosuppressants. After lavage, recurrent diverticulitis (often uncomplicated) is likely to occur. Resection with primary anastomosis is a good option in stable and fit patients when surgical expertise is available, but for a number of patients, resection with formation of a stoma seems to be the safest option.
Colorectal adenocarcinoma in children and adolescents: the management of advanced disease.
Guanà R, Soto Torselli AS, De Leo F … +8 more , Marino B, Perin S, Morgani G, Allaix ME, Piglione M, Di Martino V, Falco EC, Gennari F
Int J Colorectal Dis · 2025 Nov · PMID 41258467 · Full text
INTRODUCTION: Colorectal carcinoma (CC) is a rare disease in the pediatric population, with an annual incidence of 1 in 10 million adolescents, and it accounts for approximately 1% of pediatric solid neoplasms. It is the...
INTRODUCTION: Colorectal carcinoma (CC) is a rare disease in the pediatric population, with an annual incidence of 1 in 10 million adolescents, and it accounts for approximately 1% of pediatric solid neoplasms. It is the most common primary gastrointestinal malignancy in children with the vast majority of CCs being adenocarcinoma (CA). Unfortunately, the proportion of poorly differentiated, mucinous type, signet-ring cell containing carcinomas is higher in younger patients than in adults. Moreover, due to the low awareness of the disease, diagnosis is usually delayed until advanced stages, resulting in an extremely poor prognosis. Surgery is the only curative modality for localized CAs, whereas adjuvant chemotherapy is the standard of care for patients with stage III cancer to eradicate micro-metastases. PATIENTS AND METHODS: In the last 10 years, we treated 3 patients diagnosed with CA: a 14-year-old female, a 15-year-old male, and a 15-year-old female. All patients presented to our Emergency Department with nonspecific symptoms of abdominal pain and vomiting. RESULTS: All patients were subjected to laparoscopic tumor resection to relief intestinal obstruction. In the male patient, laparoscopy was converted to laparotomy to safely assess the anatomy because of strong peritoneal adhesions. No stomas were created, in order to improve quality of life. Oxaliplatin and 5-fluorouracil-based regimens were among the most commonly used chemotherapy combinations. The 15-year-old female and the 15-year-old male died 1 year after the surgical resection, while the 14-year-old female is still on follow-up. CONCLUSIONS: CAs behave aggressively in children; they not only show a poorer response to chemotherapy, but are also associated with extensive intramural spread and peritoneal carcinomatosis. Lack of awareness and timely intervention remain the main challenges for early diagnosis and improved prognosis of CA.
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