International Journal Of Colorectal Disease[JOURNAL]
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200 papers
Machine learning prediction of increased healthcare utilization in colectomy for inflammatory bowel disease.
Salgado-Garza G, Ballato E, Araradian C … +3 more , Walsh M, Fang SH, Tsikitis VL
Int J Colorectal Dis · 2026 Jul · PMID 42402529 · Publisher ↗
PURPOSE: Healthcare spending for patients with inflammatory bowel disease (IBD) has steadily increased over the past few decades. While some of the increase is due to the rise in the use of biologics, surgery and postope...
PURPOSE: Healthcare spending for patients with inflammatory bowel disease (IBD) has steadily increased over the past few decades. While some of the increase is due to the rise in the use of biologics, surgery and postoperative care contribute significantly to healthcare spending. We aimed to analyze the preoperative factors associated with increased healthcare resource utilization (HRU) by developing and internally validating machine learning prediction models for increased HRU. METHODS: We analyzed the ACS-NSQIP database from 2018 to 2022 to identify preoperative factors that could predict increased HRU in patients undergoing non-emergent colectomy for Crohn's disease or ulcerative colitis. Increased HRU was defined as a composite of either (a) discharge destination other than home, (b) readmission within 30 days of surgery, or (c) prolonged length of stay. A total of six machine learning algorithms were utilized to find the best-performing model determined by area under the curve. Models were internally validated with an 80:20 training and testing split. RESULTS: A total of 7535 patients were analyzed. The overall rate of increased HRU was 33%. The best-performing model was the random forest, achieving an AUC of 0.75, an accuracy of 0.73, and an F1 of 0.82. The most important preoperative variables for model accuracy were albumin, hematocrit, and creatinine. CONCLUSION: Machine learning may assist in identifying IBD patients at risk for increased healthcare resource utilization. Here, we propose a predictive model in the preoperative setting that may allow targeted perioperative planning to optimize outcomes and resource use.
The effects of socioeconomic deprivation on colorectal cancer outcomes; a retrospective regional cohort study.
Cullinane C, Coyne R, McNamara E … +8 more , Mahony AO, Korpanty G, Bassiouni ME, Condon E, Peirce C, O'Donnell P, Coffey C, Fleming C
Int J Colorectal Dis · 2026 Jul · PMID 42397454 · Publisher ↗
BACKGROUND: Although colorectal cancer (CRC) survival and outcomes are improving worldwide, there is emerging recognition of the impact of social deprivation on disparities in CRC outcomes. The reasons for the disparitie...
BACKGROUND: Although colorectal cancer (CRC) survival and outcomes are improving worldwide, there is emerging recognition of the impact of social deprivation on disparities in CRC outcomes. The reasons for the disparities in incidence and mortality amongst different socioeconomic groups are complex and not fully understood. The aim of this study was to explore the impact of socioeconomic deprivation on CRC presentation, treatment course and outcomes. METHODS: A retrospective cohort study of patients with CRC at University Hospital Limerick was performed. A mixed-effects logistic regression analysis approach was utilised to determine the association between socioeconomic deprivation and various CRC outcomes. Data was analysed using IBM SPSS V29.0.2.0 (20). RESULTS: Six hundred thirty-one patients were eligible for inclusion. Twenty were more likely to present with metastatic disease (OR 1.87, 95% CI 1.002-3.497, p = 0.049) or present as an emergency (OR 3.47, CI 2.283-5.274) than non-socioeconomically deprived groups. Of the 466 patients that were treated with curative intent, persons with a lower social deprivation score were more likely to require a stoma (OR 0.25, CI 0.152-0.439) and develop disease recurrence (OR 2.60, CI 1.491-4.467). CONCLUSION: Those living in more deprived areas face barriers to accessing timely healthcare and are more likely to present as an emergency or with metastatic CRC. These findings could help inform more effective targeting of public health interventions for CRC.
Learning curves in Versius-assisted colorectal surgery: a risk-adjusted CUSUM analysis from a single center.
Sachańbiński T, Miodoński M, Kropieniewicz J
Int J Colorectal Dis · 2026 Jul · PMID 42397453 · Publisher ↗
PURPOSE: To evaluate procedure- and operator-specific learning curves in Versius-assisted colorectal cancer surgery using risk-adjusted cumulative sum (RA-CUSUM) analysis in a real-world single-center setting. METHODS: T...
PURPOSE: To evaluate procedure- and operator-specific learning curves in Versius-assisted colorectal cancer surgery using risk-adjusted cumulative sum (RA-CUSUM) analysis in a real-world single-center setting. METHODS: This retrospective study included consecutive adult patients with histologically confirmed colorectal cancer who underwent elective robotic surgery using the Versius system between December 2022 and August 2025. Right hemicolectomy (RHC), sigmoid resection (SR), and anterior rectal resection (AR) were analyzed. Learning curves were assessed using RA-CUSUM analysis of skin-to-skin operative time, adjusted for patient- and procedure-specific variables. Separate models were constructed for each procedure and operator. RESULTS: A total of 156 procedures were included: 79 AR, 51 RHC, and 26 SR. Median operative time was 215 min (IQR 185-255). Conversion to open surgery was low (3.2%), and major postoperative complications were infrequent. RA-CUSUM analysis demonstrated distinct procedure- and operator-specific learning patterns. RHC and SR reached earlier stabilization, whereas AR required a higher case volume to achieve consistent operative time reduction, with more prolonged variability in the learning phase. Oncological quality indicators were within accepted standards. CONCLUSION: Learning curves in Versius-assisted colorectal surgery are procedure- and operator-dependent. RA-CUSUM provides a structured method for monitoring trends in operative performance and may support structured training pathways and quality monitoring during implementation of robotic surgery programs.
Long-term disease-free survival in young-onset rectal cancer patients surgically treated with curative intent: a retrospective cohort study.
Johnsen OF, Riis RN, Meltzer S … +2 more , Ree AH, Augestad KM
Int J Colorectal Dis · 2026 Jul · PMID 42397449 · Publisher ↗
PURPOSE: Although colorectal cancer incidence is declining among individuals aged over 50 years, possibly due to screening, young-onset rectal cancer (YORC) in those under 50 years of age is increasing. YORC is often dia...
PURPOSE: Although colorectal cancer incidence is declining among individuals aged over 50 years, possibly due to screening, young-onset rectal cancer (YORC) in those under 50 years of age is increasing. YORC is often diagnosed at advanced stages, leading to worse outcomes and higher mortality. This study compared short- and long-term clinical, surgical, and pathological outcomes, including survival, between patients with YORC (< 50 years) and older age groups. METHOD: A retrospective single-center study of patients undergoing curative-intent resection for rectal cancer at a Norwegian university hospital from 2014 to 2024. We divided the cohort into three age groups: < 50 (YORC), 50-75, and > 75. Clinical and pathological parameters, surgical complications, and overall and disease-free survival (DFS) were compared using parametric and nonparametric analyses, Kaplan-Meier methods, and Cox proportional hazard regression. RESULTS: 642 patients underwent curative-intent surgery for rectal cancer: YORC: n = 53 (8%); 50-75: n = 435 (68%); and > 75: n = 154 (24%). The mean age for YORC was 44 years (range 26-49). The median follow-up was 52.4 months, with an interquartile range (IQR) of 27.9-85.6 months. The oldest age group had worse DFS during follow-up (p < 0.0001, log-rank test); YORC 7 events (13.5%); 50-75 67 events (16.1%); and > 75 66 (44.9%). DFS was comparable between the YORC and the 50-75 group (p = 0.6, log-rank test). Cox models showed poorer DFS in patients aged > 75 (hazard ratio 3.04, p = 0.009) and in those with higher American Society of Anesthesiologists scores or higher pathological stages. CONCLUSION: The YORC group had DFS outcomes comparable to those of patients aged 50-75 following curative-intent surgery. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: While the incidence of YORC has increased over the past decades, few studies have analyzed survival beyond five years. This study compares YORC patients who were followed for a median of more than five years with groups of older patients with shorter follow-up (56.0 months for those aged 50-75 years, and 39.7 for those aged > 75). The outcomes for YORC patients, including disease-free survival, were comparable to those aged 50-75.
Single-center experience with robotic colorectal surgery for benign indications.
Gunabalasingam S, George K, de Silva C … +9 more , Chang STW, Cheung FY, Butnari V, Phakanant Chaichanavichkij, Kaul S, Hanson M, Boulton R, Huang J, Rajendran N
Int J Colorectal Dis · 2026 Jul · PMID 42390601 · Publisher ↗
PURPOSE: Robotic colorectal surgery is established for malignant indications, but evidence supporting its use in benign disease remains limited. We describe perioperative outcomes of 403 consecutive robotic colorectal re...
PURPOSE: Robotic colorectal surgery is established for malignant indications, but evidence supporting its use in benign disease remains limited. We describe perioperative outcomes of 403 consecutive robotic colorectal resections across all indications at a single UK NHS center, with primary focus on safety across benign indications. METHODS: Retrospective analysis of a prospectively maintained database (February 2020-November 2025). Cases were stratified by indication: malignant or highly suspected malignancy (n = 332, 82.4%) and benign (n = 71, 17.6%). Benign cases were subclassified into diverticular disease (n = 39), ulcerative colitis (n = 14), Crohn's disease (n = 13), and other (n = 5). Primary outcomes were operative time, length of stay, and Clavien-Dindo complication grade. RESULTS: Benign patients were younger (median 53 vs. 68 years; p < 0.001) with higher rates of prior abdominal surgery (33.8% vs 19.6%; p = 0.012). Across all 403 cases, median operative time was 240 min (IQR 199-302), median LOS 5 days (IQR 4-8), and CD Grade III-IV rate 9.2%. Despite equivalent operative times (p = 0.84), benign cases converted more frequently (15.5% vs 6.9%; p = 0.031), independently predicted by age (OR 1.04; p = 0.013), and cancer indication (OR 0.31; p = 0.012). Within the benign cohort, IBD patients were younger than those with diverticular disease (p < 0.001). Procedure type and stoma rates differed significantly by subgroup (both p < 0.001), yet complication rates, operative time, and LOS were equivalent. CONCLUSION: Robotic colorectal surgery is safe and reproducible across malignant and benign indications within specialised colorectal robotic centers. Complication profiles matched published benchmarks. Benign cases had a higher conversion rate, but this was driven by prior surgical burden and operative complexity, not platform limitation, and it did not increase morbidity. These data constitute the largest single-center UK evidence base for robotic colorectal surgery across all indications and support the expansion of robotic commissioning into benign practice.
Diagnostic yield of the one-year surveillance colonoscopy after curative colorectal cancer resection.
Cross J, Johnson G, Singh H … +3 more , Shariff F, Hyun E, Helewa R
Int J Colorectal Dis · 2026 Jun · PMID 42360498 · Publisher ↗
PURPOSE: Guidelines recommend routine colonoscopy 1 year after curative colorectal cancer resection, despite limited evidence supporting its diagnostic yield. This study evaluated the real-world outcomes of 1-year survei...
PURPOSE: Guidelines recommend routine colonoscopy 1 year after curative colorectal cancer resection, despite limited evidence supporting its diagnostic yield. This study evaluated the real-world outcomes of 1-year surveillance colonoscopy following colorectal cancer resection. METHODS: This is a retrospective observational study using pathology, clinic, and endoscopy data patients who underwent segmental oncologic resection for primary colon or rectal. Adenocarcinoma between January 2007 and June 2020 in Winnipeg, Manitoba. Patients were excluded if they had a total proctocolectomy, if no follow-up colonoscopy data were available, or if the date of the first surveillance scope was < 6 months or > 24 months from surgery. Colonoscopy findings were categorized as adenocarcinoma, advanced adenoma, simple adenoma or normal. RESULTS: A total of 454 patients met the inclusion criteria. The 1-year surveillance colonoscopy detected 2 (0.44%) adenocarcinomas, 3 (0.66%) advanced adenomas, and 87 (19.2%) simple adenomas. The majority (n = 362, 79.7%) had normal colonoscopy results. Preoperative bowel preparation quality was not reported for either recurrent adenocarcinoma. Neither of the recurrent adenocarcinomas was associated with elevated carcinoembryonic antigen (CEA), abnormal imaging, or known hereditary cancer syndromes. CONCLUSIONS: Our data demonstrate a low observed rate of clinically significant findings at 1-year surveillance colonoscopy following colorectal cancer resection. Incomplete documentation of index colonoscopy quality limited assessment of whether surveillance findings represented true metachronous lesions or lesions missed at the preoperative examination. Given the low event rate and observational study design, these findings should be interpreted as descriptive real-world data regarding postoperative surveillance outcomes.
Malignancy as a rising contributor to mortality in patients with inflammatory bowel disease: a population-based epidemiological study.
Ibrahim AAA, Shaaban Abdelgalil M, El-Farargy SH … +7 more , Shaheen RS, Darwish MY, Abdelrazek A, Metwally S, Nassef MA, Attia KS, Abd-ElGawad M
Int J Colorectal Dis · 2026 Jun · PMID 42360479 · Full text
BACKGROUND: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is associated with increased malignancy risk. This study assessed national trends in malignancy-related mortality...
BACKGROUND: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is associated with increased malignancy risk. This study assessed national trends in malignancy-related mortality among United States IBD patients from 1999 to 2020 using representative data. METHODS: A retrospective, population-based analysis was conducted using the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database. Deaths among individuals with IBD were identified using ICD-10 codes K50 and K51, while malignancy-related deaths were captured using codes C00-C97. Crude and Age-adjusted mortality rates (AMRs) were calculated and stratified by sex, ethnicity, region, state, and age group. Linear regression models evaluated trends and forecast malignancy-related mortality through 2030. RESULTS: Between 1999 and 2020, 9,531 malignancy-related deaths occurred among IBD patients. Malignancy-related deaths rose significantly, increasing by 108.3% (p = 0.010, R = 0.439). Higher AMRs were observed among males (p = 0.009), White individuals (p = 0.019), Midwest residents (p = 0.015), and patients aged ≥ 65. The largest relative increases were among females (55.2%), White individuals (55.1%), West residents (75.2%), and those aged 65-74 years (72.6%). Lung and colon cancers were the leading causes of malignancy-related deaths. Projections suggest continued rises in malignancy-related AMRs, particularly among CD patients, while UC patients remain relatively stable. CONCLUSION: Malignancy is an increasingly important contributor to mortality among US IBD patients, particularly older adults, males, Midwest residents and White individuals. These findings highlight the need for enhanced cancer surveillance, equitable healthcare access, and integrated long-term management of IBD populations.
Emergency left side colectomy and primary anastomosis with or without diverting stoma: a comparative study.
Ceresoli M, Podda M, Ferro CAP … +5 more , Cioffi SPB, Biloslavo A, Cozza V, Coccolini F, study collaborative group
Int J Colorectal Dis · 2026 Jun · PMID 42348009 · Publisher ↗
BACKGROUND: Left-sided colonic perforation is a common surgical emergency. While Hartmann's procedure has traditionally been the standard treatment, growing evidence supports primary anastomosis as a safe and effective a...
BACKGROUND: Left-sided colonic perforation is a common surgical emergency. While Hartmann's procedure has traditionally been the standard treatment, growing evidence supports primary anastomosis as a safe and effective alternative. The benefit of adding a diverting ileostomy in this scenario remains uncertain. This study aimed to evaluate the clinical impact of a diverting stoma after emergency left-sided colectomy with primary anastomosis. METHODS: This was a retrospective multicentre cohort study. All consecutive adult patients undergoing emergency left-sided colectomy with primary anastomosis between 2019 and 2023 were included. Patients were divided into two groups according to the use of a diverting stoma (DS) or no stoma (NS). The primary outcome was 30-day mortality. Secondary outcomes included postoperative morbidity, anastomotic leak, reoperation, readmission, and 1-year stoma-free survival. RESULTS: A total of 211 patients were included, of whom 75 (35.2%) received a diverting stoma. While baseline demographic characteristics and comorbidities were similar between the two cohorts, patients in the DS group presented with significantly higher rates of generalized peritonitis. Thirty-day mortality did not differ (DS 2.2% vs NS 1.3%, p = 0.656). Anastomotic leak occurred in 4.0% of DS and 8.8% of NS patients (p = 0.192). Reoperations were fewer in the DS group (4.0% vs 12.5%, p = 0.044). Readmission rates were higher among patients with diversion (16.2% vs 2.3%, p < 0.001). One-year stoma-free survival favored the NS group (96.7% vs 83.1%, p = 0.003). CONCLUSIONS: Diverting stoma after emergency left-sided colectomy with primary anastomosis does not influence mortality or overall morbidity but was associated with reduced reoperations related to anastomotic leaks. Diversion is associated with higher readmission rates and delayed stoma reversal, highlighting the importance of individualized, evidence-based decision-making in emergency colorectal surgery.
The 'other' colonic polyposis syndromes-evolving insights and guidance for endoscopists.
Liesegang A, Wu A, Heriot A … +1 more , Guerra G
Int J Colorectal Dis · 2026 Jun · PMID 42348001 · Publisher ↗
PURPOSE: Polyposis syndromes contribute to a significant proportion of colorectal cancer (CRC) diagnoses. While Lynch syndrome (LS) and familial adenomatous polyposis (FAP) are well characterised, a growing number of rar...
PURPOSE: Polyposis syndromes contribute to a significant proportion of colorectal cancer (CRC) diagnoses. While Lynch syndrome (LS) and familial adenomatous polyposis (FAP) are well characterised, a growing number of rarer polyposis syndromes are increasingly recognised in clinical practice. These conditions often present with overlapping phenotypes and variable penetrance, posing diagnostic and management challenges for the practising clinician. The evidence base remains limited, with current guidance largely derived from small cohort studies and expert opinion. This narrative review summarises the current literature on the genetic basis, clinical manifestations, and endoscopic features of the rarer colorectal polyposis syndromes, excluding LS and FAP. METHODS: A comprehensive literature search was conducted using PubMed and Ovid databases. Selected articles were evaluated for relevance and quality, and key findings were synthesised narratively to provide an overview of current knowledge and emerging trends relating to the rarer polyposis syndromes. RESULTS: This review consolidates international recommendations for surveillance and management, with a focus on practical guidance for the endoscopist. Advances in next-generation sequencing and multigene panel testing have reshaped our understanding of polyposis genetics, leading to the identification of several novel autosomal dominant and recessive syndromes. Despite these discoveries, surveillance protocols remain heterogeneous, and gaps persist in defining cancer risk, optimal timing of intervention, and the role of chemoprevention. Greater awareness of these syndromes among clinicians is essential for timely diagnosis and personalised management. CONCLUSION: Collaborative registries, prospective data, and consensus-driven guidelines are urgently required to standardise care and improve outcomes for patients with rare polyposis syndromes.
Prognostic value of D3 lymph node dissection and nutritional status in colorectal cancer patients aged 80 years and older.
Ishiyama Y, Hirano Y, Akuta S … +7 more , Minagawa Y, Nakanishi A, Nishi Y, Hayashi H, Fujii T, Sugita H, Hiranuma C
Int J Colorectal Dis · 2026 Jun · PMID 42347976 · Publisher ↗
PURPOSE: To evaluate the impact of D3 lymph node dissection and nutritional status on outcomes in patients aged ≥80 years with colorectal cancer. METHODS: We retrospectively analyzed patients aged ≥80 years who underwent...
PURPOSE: To evaluate the impact of D3 lymph node dissection and nutritional status on outcomes in patients aged ≥80 years with colorectal cancer. METHODS: We retrospectively analyzed patients aged ≥80 years who underwent curative resection for stage I-III colorectal cancer between April 2007 and February 2020. Patients were divided into D3 and non-D3 lymph node dissection groups. Propensity score matching was performed to reduce baseline differences. Short- and long-term outcomes, including overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS), were compared. Multivariate Cox regression analyses were used to identify independent prognostic factors, with particular attention to the prognostic nutritional index (PNI). Competing-risk analysis for cancer-specific death was also conducted. RESULTS: After propensity score matching, 272 patients (136 per group) were analyzed. The D3 group showed significantly better OS (5-year: 73.5% vs. 60.0%, P = 0.0039) and DFS (5-year: 69.5% vs. 56.1%, P = 0.0099) than the non-D3 group. CSS was not significantly different on Kaplan-Meier analysis; however, competing-risk analysis demonstrated a significantly lower cumulative incidence of cancer-specific death in the D3 group (5-year: 23.0% vs. 29.6%, P = 0.024). Multivariate analysis identified D3 dissection and PNI ≥ 45 as independent favorable prognostic factors for OS, DFS, and CSS. CONCLUSIONS: In patients aged ≥80 years with colorectal cancer, D3 lymph node dissection improved OS and DFS without increasing perioperative morbidity. Preoperative PNI was a strong predictor of long-term prognosis and may aid surgical decision-making in elderly patients.
Development and internal validation of a nomogram to predict colorectal cancer risk in patients with diverticulitis.
Usman M, Correa E, Chung WY … +4 more , Farazi SN, Baronos K, Samarakoon L, Kadri SR
Int J Colorectal Dis · 2026 Jun · PMID 42337066 · Publisher ↗
AIM: Diverticulitis, considered a benign condition, has emerging evidence linking it to colorectal cancer (CRC). Current guidelines lack standardised risk stratification tools to guide post-diverticulitis surveillance. T...
AIM: Diverticulitis, considered a benign condition, has emerging evidence linking it to colorectal cancer (CRC). Current guidelines lack standardised risk stratification tools to guide post-diverticulitis surveillance. This study aims to create and validate a nomogram to predict CRC risk in patients with diverticulitis. METHOD: This retrospective cohort study included 1546 patients diagnosed with diverticulitis at a UK tertiary hospital between January 2021 and December 2023. Patients aged ≥ 18 years who underwent endoscopic assessment following a diverticulitis episode were included. A logistic regression model with L2 regularisation and balanced class weights (C = 0.1) was developed to predict a binary outcome: high CRC risk (histologically confirmed cancer) versus low/moderate risk (no cancer), designed to guide referral for flexible sigmoidoscopy (FS). RESULTS: The mean age of the cohort was 69.2 years, with near-equal sex distribution. CRC was identified in 42 patients (2.7%). Significant predictors of high CRC risk included older age, male sex, and CT-detected colonic wall thickening, whereas abdominal pain, PR bleeding, and diverticulosis were associated with lower risk. The model achieved a cross-validated mean AUC of 0.736 (95% CI 0.661-0.811) and full-sample AUC of 0.784. At the Youden-optimal threshold (0.523), sensitivity was 72.1% and specificity 73.8%. CONCLUSION: We developed and internally validated a nomogram to predict CRC risk in patients with diverticulitis, using a binary classification to guide FS referral. The tool demonstrated robust discriminative ability and could reduce unnecessary colonoscopies while prioritising high-risk patients for timely evaluation. Unlike existing CRC risk models targeting asymptomatic individuals, our nomogram is tailored to diverticulitis patients. External validation in multi-centre cohorts is required before adoption into routine clinical practice.
Diversion proctitis during staged restorative proctocolectomy with ileal pouch anal anastomosis is not associated with subsequent cuffitis.
Dharia I, Plietz M, Hahn S … +5 more , Khaitov S, Sylla P, Greenstein A, Dubinsky MC, Kayal M
Int J Colorectal Dis · 2026 Jun · PMID 42334607 · Publisher ↗
AIM: The aim of this study was to assess the impact of diversion proctitis (DP) between the first and second surgical stage on pouch outcomes in patients with ulcerative colitis (UC) who underwent three-stage restorative...
AIM: The aim of this study was to assess the impact of diversion proctitis (DP) between the first and second surgical stage on pouch outcomes in patients with ulcerative colitis (UC) who underwent three-stage restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA). METHODS: We conducted a retrospective chart review of patients with UC who underwent three stage RPC with IPAA followed by at least one pouchoscopy at Mount Sinai Hospital between 1/2008 and 12/2020. DP was defined as the presence of mucosal atrophy and lymphoid hyperplasia on proctectomy specimen as noted by the reporting pathologist. The primary outcome was cuffitis defined as ulceration of the cuff as reported during pouchoscopy. Continuous and categorical variables were analyzed with t-tests and chi-squared tests, respectively. RESULTS: Of the 281 patients included in this study, 68 (24.2%) were found to have DP. Age, sex, race, ethnicity, anastomosis type, and disease duration were not significant risk factors for DP development. More patients with vs without DP had evidence of severe disease pre-colectomy with admission for acute severe ulcerative colitis, steroids, and infliximab, though this did not reach statistical significance. A significantly greater proportion of patients with vs without DP required rectal therapy between the first and second surgical stages (32.4% vs 19.2%, p = 0.02). There was no significant difference in the development of cuffitis among patients with vs without DP (19.1% vs 14.1%, p = 0.32). CONCLUSION: The occurrence of DP between the first and second surgical stage of RPC with IPAA is significantly associated with the need for rectal therapy; however, is not associated with subsequent cuffitis.
Correction to: 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 Jun · PMID 42334471 · Full text
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Rethinking surgical strategy for margin-positive only T1 colorectal cancer: a multicenter retrospective cohort study.
Park JH, Kim CH, Pyo DH … +5 more , Park JK, Lim CD, Kim JH, Kye BH, Jin Kim H
Int J Colorectal Dis · 2026 Jun · PMID 42322413 · Publisher ↗
PURPOSE: Endoscopic resection is frequently performed for early T1 colorectal cancer (CRC), with additional surgery indicated when histopathological risk factors are present, such as a positive vertical margin, submucosa...
PURPOSE: Endoscopic resection is frequently performed for early T1 colorectal cancer (CRC), with additional surgery indicated when histopathological risk factors are present, such as a positive vertical margin, submucosal invasion depth greater than 1000 µm, lymphatic or vascular invasion, poorly differentiated adenocarcinoma, signet-ring cell carcinoma, mucinous carcinoma, or grade 2/3 tumor budding at the deepest invasive site. In patients undergoing radical resection for T1 CRC, the incidence of lymph node metastases(LNM) has been reported to be approximately 10%. The purpose of this study is to identify factors influencing the decision for radical resection in patients with pathologically confirmed T1 CRC following endoscopic resection and to evaluate lymph node metastasis rates according to each risk factor, with a focus on determining whether radical resection might be safely avoided in carefully selected low-risk cases. METHODS: The study was designed as a retrospective multicenter comparative cohort study conducted at three tertiary referral centers in Korea. The study population consisted of patients with pathological T1 colorectal cancer who underwent radical resection following endoscopic resection between April 2019 and December 2024. The main outcome measure was the incidence of lymph node metastasis according to pathological risk factors, with a particular focus on patients with margin-positive lesions without any other risk factors. Univariate analyses were performed, and exact binomial confidence intervals were calculated for the margin-positive subgroups. RESULTS: Among 250 patients who underwent radical surgery after endoscopic resection, 25 (10.0%) had lymph node metastasis. Lymphovascular invasion and KRAS mutation were significantly associated with lymph node metastasis. Twenty-two patients with margin positivity without any other risk factors had no LNM (0/22; 95% exact binomial confidence interval, 0-15.4%). Half (11/22) of these patients had no residual tumors on surgical specimens, whereas the remainder showed only submucosal residual tumors without nodal involvement. CONCLUSION: Among patients who underwent radical resection after endoscopic resection for T1 CRC, margin positivity without other recorded high-risk features was not associated with LNM in this cohort. However, given the small sample size and wide confidence interval, these findings should be considered hypothesis-generating and require further validation [1].
Sinusoidal injury and portal hypertension after hepatectomy for colorectal liver metastases: predictors, risk stratification, and clinical outcomes.
Hernández-Yagüe X, López-Ben S, Aula-Olivar A … +9 more , Carbajal-Ochoa W, Martínez-Sancho J, Albiol-Quer MT, Osca-Gelis G, Ortíz MR, Falgueras-Verdaguer L, Buxó M, Meléndez-Muñoz C, Figueras I Felip J
Int J Colorectal Dis · 2026 Jun · PMID 42301506 · Publisher ↗
INTRODUCTION: Sinusoidal obstruction syndrome (SOS) and early portal hypertension (ePHT) represent significant hepatic vascular complications following preoperative chemotherapy and liver resection for colorectal liver m...
INTRODUCTION: Sinusoidal obstruction syndrome (SOS) and early portal hypertension (ePHT) represent significant hepatic vascular complications following preoperative chemotherapy and liver resection for colorectal liver metastases (CRLM). This study aimed to identify predictors of SOS and ePHT and to develop a risk model for preoperative stratification. METHODS: A retrospective analysis was conducted in 108 patients undergoing hepatectomy for CRLM after ≥ 4 cycles of neoadjuvant chemotherapy combined with anti-EGFR or anti-VEGF therapy. SOS severity was graded histologically, and ePHT was defined by thrombocytopenia, splenomegaly, varices, or ascites within 3 months postoperatively. Logistic regression models identified predictors of moderate-to-severe SOS (G2-3) and ePHT. Predictive performance was assessed using receiver operating characteristic (ROC) analysis. RESULTS: Moderate-to-severe SOS occurred in 24.07% of patients and ePHT in 21.3%. Independent predictors of SOS were anti-VEGF therapy (protective, OR = 0.214; 95% CI 0.075-0.610; p = 0.004) and preoperative portal vein embolization (PVE) or ligation (risk factor, OR = 2.819; 95% CI 1.019-7.796; p = 0.046). The SOS predictive model showed good discrimination (AUC = 0.75). For ePHT, major hepatectomy (OR = 7.78; 95% CI 2.32-25.99; p < 0.001) and the calculated probability to SOS G2-3 (OR = 40.82; 95% CI 2.60-640.53; p = 0.008) were independent predictors (AUC = 0.80; specificity = 84.3%). Neither SOS nor ePHT significantly affected 90-day mortality (8.3%) or overall survival (p > 0.05). CONCLUSIONS: Major hepatectomy and chemotherapy-induced sinusoidal injury are key determinants of ePHT after CRLM resection. Anti-VEGF therapy exerts a protective endothelial effect, while PVE increases risk. Despite their incidence, neither SOS nor ePHT compromised survival, suggesting reversibility with optimized perioperative management.
Evaluation of the prognostic impact of intraoperative cytology results according to tumor sidedness in stage II/III resectable colorectal cancer.
Usui A, Kobayashi H, Kotake K … +20 more , Maeda K, Shuto T, Kawasaki M, Komori K, Ozawa H, Kosugi C, Ohue M, Funahashi K, Takemasa I, Ishida H, Kazama S, Shimada Y, Motohashi H, Kinugasa Y, Kanemitsu Y, Ochiai H, Ishihara S, Itabashi M, Sugihara K, Ueno H
Int J Colorectal Dis · 2026 Jun · PMID 42298064 · Publisher ↗
AIM: To investigate whether colorectal cancer (CRC) sidedness is associated with intraoperative lavage cytology results, tumor recurrence, and prognosis. METHOD: Using data from a multicenter prospective observational st...
AIM: To investigate whether colorectal cancer (CRC) sidedness is associated with intraoperative lavage cytology results, tumor recurrence, and prognosis. METHOD: Using data from a multicenter prospective observational study conducted by the Japanese Society for Cancer of the Colon and Rectum (JSCCR), we retrospectively analyzed prognosis and recurrence patterns in pathological stage II/III right-sided and left-sided CRC, stratified by positive versus negative lavage cytology results. RESULTS: A total of 1500 patients met the inclusion criteria and were enrolled. Of these, 534 had right-sided CRC and 966 had left-sided CRC. Fifty-nine patients (3.9%) had positive lavage cytology. Among patients with recurrence, pT4, positive lavage cytology, and right-sided tumor location were independently associated with peritoneal recurrence. Among cytology-negative patients, the 5-year relapse-free survival (RFS) rate was significantly higher in right-sided than in left-sided CRC (79.6% vs. 73.4%, p = 0.01), whereas the 5-year overall survival (OS) rate did not differ significantly (89.2% vs. 87.7%, p = 0.52). Among cytology-positive patients, no statistically significant differences in RFS or OS were observed between tumor locations. However, among cytology-positive patients who developed recurrence, post-recurrence survival was significantly worse in right-sided CRC than in left-sided CRC (p = 0.04). CONCLUSION: Among cytology-negative patients, left-sided CRC was associated with poorer RFS than right-sided CRC, although OS did not differ. Right-sided tumor location and positive lavage cytology were independently associated with peritoneal recurrence among patients who developed recurrence. Among cytology-positive patients, right-sided CRC was associated with poorer post-recurrence survival.
Appendiceal abscess: pathologic definitions and a diagnostic framework-SIRC/SICUT consensus.
Cirocchi R, Brachini G, Alemanno G … +55 more , Allegritti M, Al-Sabe L, Anania G, Arkoudis NA, Assenza M, Aurello P, Barberini F, Bellezza G, Bellini MI, Biloslavo A, Boselli C, Brucchi F, Bruzzone P, Cassini D, Cheruiyot I, Cirillo B, Coccolini F, Corona M, Covarelli P, Cozza V, Crocetti D, Davies J, Desai G, Dixit S, Spizzirri A, Napolitano V, Giuliani D, Giordano A, Akingboye A, Gong W, Guarino S, Helmy AHI, Lauricella S, Lauro A, Mascianà G, Matteucci M, Panarese A, Podda M, Popivanov G, Prosperi P, Ramírez-Giraldo C, Tartaglia D, Tesei J, Tomassini L, Vaccari S, Yagnik VD, Xiang X, Zago M, Nigri G, Fiori E, Rizzuto A, Sapienza P, Mingoli A, D'Andrea V, Pesce A
Int J Colorectal Dis · 2026 Jun · PMID 42295413 · Publisher ↗
BACKGROUND: Appendiceal abscesses are a heterogeneous manifestation of acute appendicitis, with diverse pathological substrates and imaging phenotypes. The lack of standardized definitions hampers cross-study comparabili...
BACKGROUND: Appendiceal abscesses are a heterogeneous manifestation of acute appendicitis, with diverse pathological substrates and imaging phenotypes. The lack of standardized definitions hampers cross-study comparability and consistent diagnostic pathways. METHODS: The Italian Society of Surgical Research (SIRC) and the Italian Society of Emergency Surgery and Trauma (SICUT) conducted a four-round modified Delphi, culminating in an in-person consensus conference (Rome, November 6, 2025). A multidisciplinary panel refined the statements on pathological definitions, classifications, and imaging correlates. RESULTS: Consensus was reached on 22 statements. Part 1 reports seven statements that delineate the spectrum from uncomplicated to complicated appendicitis (phlegmonous, gangrenous, and perforated) and distinguishes appendiceal abscesses from appendiceal masses. An imaging framework centered on CT descriptors was used to support consistent radiology-pathology correlations. CONCLUSIONS: These statements provide a unified taxonomy and diagnostic framework for appendiceal abscesses and related entities, improving interdisciplinary communication, and enabling cross-study comparability.
Risk factors for rebleeding in acute lower gastrointestinal bleeding: a systematic review and meta-analysis.
Lu Z, Zong D, Yang Z … +1 more , Yue B
Int J Colorectal Dis · 2026 Jun · PMID 42287444 · Publisher ↗
OBJECTIVE: To investigate the potential risk factors for rebleeding following acute lower gastrointestinal bleeding (ALGIB). METHODS: A comprehensive literature review was performed utilizing the PubMed, Embase, Web of S...
OBJECTIVE: To investigate the potential risk factors for rebleeding following acute lower gastrointestinal bleeding (ALGIB). METHODS: A comprehensive literature review was performed utilizing the PubMed, Embase, Web of Science, and Cochrane Library databases, encompassing articles published up to May 10, 2024. Two researchers independently performed literature screening, data extraction, and risk of bias assessment to ensure methodological rigor and minimize potential biases. The meta-analysis was performed using R (version 4.3.2) and Stata 17.0 software. RESULTS: A total of 2799 studies were retrieved, of which 29 were ultimately included in the analysis, comprising 23 case-control studies and 6 cohort studies, involving 14,069 patients with ALGIB, of whom 1930 experienced rebleeding. The pooled results of multivariable meta-analysis indicated that age ≥ 70 years, blood transfusion requirements, shock at presentation, hypertension, comorbid chronic kidney disease (CKD), hyperlipidemia, NSAIDs use, active bleeding on colonoscopy, colonic diverticular bleeding, and non-aspirin antiplatelet treatment are risk factors for rebleeding after ALGIB. In addition, the results of univariable analysis also showed that steroids, aspirin, and anticoagulant drug use are associated factors for rebleeding. CONCLUSION: Based on available evidence, several factors, including age ≥ 70 years, blood transfusion requirements, shock at presentation, hypertension, CKD, hyperlipidemia, NSAIDs use, active bleeding on colonoscopy, colonic diverticular bleeding, and non-aspirin antiplatelet treatment, may be associated with an increased risk of rebleeding after ALGIB. Early identification of these risk factors and implementation of individualized interventions may help improve patient outcomes.
Utilization of indocyanine green fluorescence angiography in redo IPAA surgery.
Gulmez M, Hinduja P, Ajredini M … +8 more , Esen E, Grieco MJ, Aydinli HH, Schwartzberg D, Erkan A, da Luz Moreira A, Monson J, Remzi FH
Int J Colorectal Dis · 2026 Jun · PMID 42287337 · Publisher ↗
BACKGROUND: Redo/revisional ileal pouch-anal anastomosis (IPAA) surgery is technically challenging and more likely to require mesenteric lengthening maneuvers, largely due to mesenteric reach issues, which may affect the...
BACKGROUND: Redo/revisional ileal pouch-anal anastomosis (IPAA) surgery is technically challenging and more likely to require mesenteric lengthening maneuvers, largely due to mesenteric reach issues, which may affect the perfusion of the critical sites in the pouch. Indocyanine green fluorescence angiography (ICG-FA) offers real-time assessment of tissue perfusion and may reduce the risk of complications, such as anastomotic leak. We aimed to evaluate the impact of intraoperative ICG-FA on surgical outcomes in patients undergoing redo/revisional IPAA surgery. METHODS: This is a retrospective case-control study with 1:1 propensity score matching based on data from a high-volume quaternary inflammatory bowel disease center. Patients who underwent redo/revisional IPAA surgery between September 2016 and December 2023 were included. The primary objective was to evaluate the direct impact of ICG-FA on intraoperative decision-making, measured by the rate of change in surgical plan. Secondary objectives included an exploratory comparison of short- and long-term outcomes, such as anastomotic leak and major complications. RESULTS: A total of 46 patients were included, with 23 patients in each of the ICG and non-ICG groups. ICG-FA led to intraoperative changes in surgical management in 2 patients (8.7%), including one pouch augmentation with resection of the tip of the J pouch and one pouch excision. The 30-day major complication rate was lower in the ICG group (11.1%) compared to non-ICG (18.2%), though not statistically significant (p = 1.00). No significant difference was found in long-term complication rates after adjusting for a marked disparity in follow-up duration between the groups. No adverse reactions related to ICG-FA were observed. CONCLUSIONS: ICG-FA is a safe and feasible adjunct during redo/revisional IPAA surgery. Its use may guide intraoperative decision-making, leading to timely revisions.
Postoperative anastomotic leakage after colon cancer surgery may reduce long-term survival.
Müller S, Koeller P, Hendricks A … +4 more , Seggewiss-Bernhardt R, Flemming S, Germer CT, Lock JF
Int J Colorectal Dis · 2026 Jun · PMID 42283878 · Full text
BACKGROUND: Anastomotic leakage (AL) remains a major cause of postoperative morbidity and mortality after colon cancer surgery and has been discussed potentially impairing long-term survival. However, most available data...
BACKGROUND: Anastomotic leakage (AL) remains a major cause of postoperative morbidity and mortality after colon cancer surgery and has been discussed potentially impairing long-term survival. However, most available data originate from rectal cancer or mixed cohorts including colon and rectal cancer. Therefore, we investigated the association between AL and overall survival (OS) focusing only on colon cancer. METHODS: We identified all patients who underwent surgery for colon cancer at the University Hospital of Wuerzburg between 1 January 2019 and 31 December 2021 via the institutional tumor registry (Onkostar). Rectal cancer patients were not included in the present study. Clinical, surgical, pathologic, and follow-up data (last follow-up June 30, 2025) were extracted and complemented by hospital information systems. OS was defined as time from diagnosis to death or last contact. Multivariable Cox proportional hazards regression-with candidate variables including age, UICC stage, R-status, emergency presentation, diabetes, and immune status-was conducted using stepwise forward selection (entry p < 0.05, exit p > 0.10). Hazard ratios (HRs) with 95% confidence intervals (CIs) were reported and Kaplan-Meier curves plotted to visualize group differences. RESULTS: The cohort comprised 166 patients; 15 (9%) developed AL. The overall mean survival was 59.6 months (95% CI 55.6-63.7). Baseline tumor localization, UICC stage, and R0 resection rates (98%) were similar between patients with and without AL. Rectal anastomoses exhibited a trend toward higher leak rates than non-rectal ones; other surgical and tumor-related parameters were comparable. In multivariable Cox regression analysis, AL was independently associated with decreased OS (HR 2.97; 95% CI 1.11-7.93; p = 0.030). After adjusting for age, UICC stage, R-status, emergency presentation, diabetes, and immune status, Kaplan-Meier curves confirmed shorter survival in patients experiencing AL. CONCLUSION: AL is an independent factor negatively influencing OS of colon cancer. These findings highlight the value of perioperative strategies reducing AL incidence.
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