Anal fistula frequently develops following surgical drainage of a first cryptoglandular perianal abscess. The role of postoperative antibiotics in preventing fistula formation remains uncertain. PERIQxA is a multicentre, randomised, double-blind, placebo-controlled trial evaluating postoperative amoxicillin–clavulanate compared with placebo after surgical drainage of a first cryptoglandular perianal abscess. This report presents early clinical outcomes from the ongoing trial. Adults without systemic infection or immunosuppression were randomised 1:1 to receive oral amoxicillin–clavulanate (875/125 mg) or placebo every 8 h for 7 days. The primary outcome was anal fistula formation at 6 months. Between March 2022 and May 2025, 65 participants were randomised. One participant withdrew consent and was excluded from all analyses. Fifty-seven participants (28 antibiotic, 29 placebo) were included in the primary analysis. At 6 months, anal fistula developed in 21.4
Enhanced Recovery After Surgery (ERAS) pathways and combined mechanical and oral antibiotic bowel preparation (MBP + OAB) have improved outcomes in colorectal surgery by reducing infectious complications and anastomotic leakage. However, their impact on anastomotic bleeding (AB) remains unclear. We conducted a prospective observational study including consecutive patients undergoing elective colorectal resection with primary anastomosis between 2012 and 2025 at a tertiary center. A modified ERAS pathway incorporating systematic MBP + OAB was progressively implemented. Predictors of AB were identified using Elastic Net penalized regression and multivariable logistic regression. Temporal trends were assessed using interrupted time series and change point analyses. A total of 1547 patients were included. Following implementation of the modified ERAS pathway, anastomotic leakage decreased (10.7
Intersphincteric prosthetic implants have emerged as a minimally invasive treatment option for faecal incontinence (FI), positioned between conservative therapies and more invasive surgical or neuromodulatory interventions. However, evidence supporting their effectiveness remains fragmented and largely nonrandomised. A PRISMA-compliant systematic review with exploratory quantitative synthesis was conducted. MEDLINE and Embase were searched from inception to August 2025, with an updated search in January 2026 for nonrandomised studies evaluating intersphincteric prosthetic implants (GateKeeper® or SphinKeeper®) in adults with FI. The primary outcome was the proportion of patients achieving a clinically meaningful response, defined as a ≥ 50
The inferior mesenteric artery (IMA) is a crucial artery that supplies the colon and rectum. As colorectal cancer is most commonly localized in the descending and sigmoid colon, as well as in the rectum, detailed knowledge of the anatomy of the IMA is of utmost importance for oncological surgeons performing hemicolectomies. An extensive search of major databases was performed up to April 2026 for studies detailing the morphometry, anatomy, and variations of the IMA. The study strictly adhered to the PRISMA guidelines. Out of 143,884 initial records, 66 original studies met the inclusion criteria. A random effects model was applied in the statistical analyses, and heterogeneity was evaluated using Chi-squared and I-squared statistics. The IMA most often originated at the L3 vertebral level (60.35
Oral antibiotic bowel prophylaxis (OAP) is used to reduce infectious complications in colorectal surgery, but its effects on perioperative gut microbiota composition remain unclear. This systematic review evaluated the impact of OAP on intestinal microbiota composition in adults undergoing colorectal surgery. A systematic search of PubMed, Cochrane Library, and Google Scholar was conducted up to November 18th, 2025, following PRISMA guidelines. Studies were eligible if they included adult colorectal surgery patients receiving OAP and reported microbiota composition using 16S rRNA sequencing and/or qPCR. Primary outcomes were changes in microbial diversity and taxonomic composition. Secondary outcomes were surgical site infection (SSI) and anastomotic leakage (AL). Eleven studies involving over 1500 microbiota samples met inclusion criteria. OAP regimens varied widely in agents, duration, and combination with mechanical bowel preparation (MBP) or probiotics. Across studies, OAP consistently reduced microbial diversity and altered taxonomic composition, some shifts, such as increased Enterococcus or decreased Bacteroides, persisted postoperatively. Only a minority of studies assessed microbiota recovery beyond the early postoperative phase. Clinical outcomes such as SSI and anastomotic leakage were inconsistently reported, with limited direct correlations to microbiota data. OAP substantially alters perioperative gut microbiota composition in colorectal surgery patients. Heterogeneity in sampling, analysis, and clinical correlation limits definitive conclusions. Standardized study designs are needed to clarify the relationship between OAP and microbiota composition changes.
The New Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire (CCF-CaQL) was developed to assess postoperative quality of life (QoL) in patients with colorectal cancer (CRC). Since its introduction, it has been validated in several countries. This study aimed to evaluate the reliability and validity of the Modified Chinese version of the CCF-CaQL and its applicability in the Chinese population. Data analyses were performed using R (version 4.3.3). Questionnaire reliability was assessed using Cronbach’s alpha and composite reliability, with additional reliability evaluated using Spearman’s correlation coefficient and the split-half method. Construct validity was examined using confirmatory factor analysis (CFA), with convergent validity assessed based on factor loadings and discriminant validity evaluated using the heterotrait–monotrait (HTMT) ratio. A total of 215 patients undergoing colorectal cancer surgery were included in this study. The revised questionnaire demonstrated high internal consistency, with a Cronbach’s alpha coefficient of 0.882 and composite reliability (CR) values exceeding 0.70 for all factors. Confirmatory factor analysis showed acceptable convergent validity, with all factors yielding average variance extracted (AVE) values greater than 0.40 and CR values ranging from 0.769 to 0.890. The HTMT coefficients indicated adequate discriminant validity, with most values below the recommended threshold of 0.85 and only one slightly above (0.887). All factors were significantly correlated with the total questionnaire score, with correlation coefficients ranging from 0.508 to 0.855. Furthermore, the questionnaire showed strong correlations with the Chinese versions of the EORTC QLQ-C30 and QLQ-CR29. The modified Chinese version of the CCF-CaQL exhibited strong psychometric properties, confirming its validity and reliability as a disease-specific tool for evaluating quality of life in colorectal cancer patients. This study is the first to translate and validate the CCF-CaQL in Chinese, filling a gap in validated tools for assessing postoperative quality of life in patients with colorectal cancer. The availability of this instrument enables reliable clinical and research applications in Chinese-speaking populations.
Transanal irrigation (TAI) is used in a range of functional digestive disorders; however, its clinical implementation remains notably heterogeneous. The absence of clear operational definitions for discontinuation, refusal, and adherence hampers the interpretation of outcomes and comparison across centres. The aim of this study was to reach a national consensus on these concepts through a structured Delphi process. A national Delphi study was conducted following the RAND/UCLA methodology over two consecutive rounds. The questionnaire included 46 items distributed across four thematic sections and two exploratory parts. RAND/UCLA criteria were applied to determine appropriateness and degree of consensus, and items without consensus were reconsidered in the second round. A total of 111 professionals with experience in TAI were invited to participate; 100 completed the first round and 91 the second. Of the 46 items, 24 (52.17
Surgical treatment remains an essential component in the management of inflammatory bowel disease (IBD) despite advances in medical therapy. Although minimally invasive surgery is preferred, technical challenges related to chronic inflammation and altered anatomy may limit laparoscopic approaches. Robotic surgery has been increasingly adopted, but its role in IBD surgery remains to be clearly defined. To synthesize the available evidence on the feasibility, safety, and perioperative outcomes of robotic surgery in patients with IBD. A systematic review was conducted according to PRISMA guidelines. Studies were identified through an electronic search of the PubMed database for reports evaluating outcomes of robotic surgery in IBD. Eligible studies included case series, comparative studies, and systematic reviews published in English. Primary outcomes were conversion to open surgery and postoperative complications; secondary outcomes included operative time, length of stay (LOS), reoperation, readmission, and anastomotic leak. Thirty-four studies were included. Robotic surgery was consistently associated with longer operative time. However, postoperative morbidity, major complications, anastomotic leak, reoperation, and mortality rates were comparable between techniques. Robotic approaches demonstrated lower and favorable conversion rates, particularly in complex inflammatory phenotypes or pelvic procedures. Length of stay and estimated blood loss were similar or numerically lower in several robotic cohorts. Robotic surgery is a safe and feasible minimally invasive approach for IBD patients, with perioperative outcomes comparable to conventional surgery. Its potential advantages may be most relevant in complex or technically demanding cases, although high-quality prospective studies are needed to better define its role.
Vascular endothelial growth factor inhibitors (VEGFIs) are essential for the treatment of metastatic colorectal cancer (mCRC). Given the ineffectiveness of epidermal growth factor receptor inhibitors in managing RAS-mutant mCRC, long-term VEGFI therapy is often required; however, it is associated with an increased risk of proteinuria. As the use of VEGFI in later-line mCRC treatment has become more prevalent, proteinuria has emerged as a critical dose-limiting toxicity. However, its effect on the treatment outcomes remains unclear. This study examined the incidence of proteinuria during extended VEGFI use and its effect on overall survival (OS) in RAS-mutant mCRC. This single-center retrospective study analyzed patients with RAS-mutant stage IV mCRC treated with first-line VEGFIs at Gifu University Hospital. Proteinuria incidence was estimated using the Kaplan–Meier method. OS from a 12-month landmark was compared according to the occurrence of dipstick proteinuria 2+ or greater within the first year using Cox regression. Among 185 patients, the Kaplan–Meier cumulative incidence of dipstick proteinuria 2+ or greater was 11
Chronic constipation comprises heterogeneous clinical entities, including slow-transit constipation (STC) and functional defecation disorders such as obstructed defecation syndrome (ODS). Although neuroenteric mechanisms are implicated, reproducible histomorphological correlates remain incompletely defined, partly due to methodological heterogeneity and lack of standardized quantification. The study characterizes the myenteric plexus morphology and neuroimmune cell distribution across clinically defined subgroups of functional bowel disorders using a standardized digital pathology approach. Retrospective observational cohort study at a tertiary colorectal referral center. A total of 100 patients after bowel surgery were included: ODS (n = 17), STC (n = 24), combined ODS + STC (n = 28), and a control cohort without clinically evident bowel motility disorders (n = 31). Digital morphometric assessment of ganglionic density and morphology, neuronal content (immunohistochemistry against MAP2, HuC/D), and the distribution of CD3-positive T-lymphocytes within and around myenteric ganglia were performed. Ganglionic density differed significantly between groups (p = 0.002), with increased density in ODS, whereas STC values were comparable to controls. Neuronal content per ganglion was preserved across all groups as demonstrated by MAP2 and HuC/D analyses. In contrast, the presence of CD3-positive lymphocytes was reduced in all constipation groups, most pronounced in STC, affecting both the intra- and periganglionic compartments. Functional bowel motility and defecation disorders appear to show distinct neuroarchitectural and neuroimmune patterns. Increased ganglionic density in ODS contrasts with preserved neuronal content and reduced presence of T-lymphocytes, particularly in STC. These findings represent associations rather than proven disease mechanisms, derived from comparison with a surgical rather than a healthy control cohort. Standardized digital morphometry nonetheless provides a reproducible framework for phenotypic characterization of chronic constipation and may support future studies linking enteric structure to function. Clinicaltrials.gov (NCT05016700; 09/12/2020).
To systematically classify and describe transabdominal surgical techniques designed to eliminate or neutralize staple-line intersection during low anterior resection (LAR), and to summarize their reported clinical outcomes. A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420261368367). Major databases were searched for studies describing transabdominal techniques aimed at eliminating or neutralizing staple-line intersection in colorectal anastomosis during LAR. Both modified double-stapling techniques (mDST) and abdominal single-stapled techniques (aSST) were included. Outcomes of interest included anastomotic leak (AL), use of protective stoma, and perioperative variables. Reported outcomes were descriptively summarized, and exploratory aggregated analyses were performed when appropriate. Seventeen studies (998 patients) were included. Ten studies (529 patients) evaluated mDST (suture-based: n = 192; invagination-based: n = 337), while seven studies (469 patients) assessed aSST. Reported AL rates remained low across both mDST subgroups (3.1
To evaluate the feasibility of short-term prehabilitation and its impact on quality of life in patients with colorectal cancer through a systematic review and a feasibility study. The systematic review was conducted in accordance with the PRISMA guidelines. PubMed, PubPsych, CINAHL, EMBASE, Web of Science and EBSCOhost were searched for studies evaluating quality of life in colorectal cancer patients undergoing prehabilitation. We conducted a prospective non-randomised interventional feasibility study, with a 2-week post-surgery follow-up, enrolling patients diagnosed with colon cancer. The systematic review included six studies from 517 unique records for final analysis. Among six studies, evidence for quality-of-life benefits of prehabilitation was conflicting but predominantly favourable, with generally low-to-moderate study quality and substantial heterogeneity. In the feasibility study, 110 patients were eligible for inclusion; 70 (64
Accurate prediction of lymph node (LN) metastasis is essential for determining completion radical surgery following local excision (LE) in rectal cancer treated with neoadjuvant chemoradiotherapy (CRT). This study aimed to identify predictors of LN metastasis and develop a nomogram to support post-excision decision-making in rectal cancer patients after CRT. We retrospectively reviewed 215 patients with pathological stage ypT0–2 rectal cancer who underwent radical surgery following CRT. Pre- and post-CRT magnetic resonance imaging findings and clinicopathological factors were analysed to identify predictors of LN metastasis. A predictive nomogram was subsequently constructed and evaluated using receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC). Factors associated with LN metastasis included pre-CRT mrN stage (mrN0 7.3
Despite recent advances in multimodal treatment strategies, radical tumor resection remains a cornerstone in the management of patients with rectal cancer. However, a substantial proportion of patients develop postoperative functional impairment known as low anterior resection syndrome (LARS). Emerging evidence suggests that robotic-assisted surgery may offer superior functional outcomes compared to other approaches. Therefore, this study aimed to compare the incidence and severity of LARS after robotic and open surgery using a patient-reported outcome measure (PROM). This retrospective, single-center cohort study included patients with primary adenocarcinoma of the sigmoid colon or rectum who underwent open or robotic oncological resection between 2014 and 2024. Eligible participants completed a standardized, validated questionnaire to assess their individual LARS score. The LARS scores were subsequently correlated with selected clinicopathological characteristics. LARS questionnaires were analyzed in 184 patients. The incidence of major LARS was comparable between open and robotic surgery (39.1
Accurate preoperative staging of rectal cancer (RC) is essential for treatment planning. MRI is the standard for local assessment but has limitations in evaluating nodal involvement and tumor deposits. Hybrid PET/MR combines morphological and metabolic imaging and may improve staging accuracy. This study assessed PET/MR performance in RC and regional lymph nodes staging compared with histopathology. Sixteen patients with biopsy-proven rectal cancer underwent PET/MR with ^18F-FDG. Tumor size, T stage, nodal status, and tumor deposits were evaluated using multiparametric MR sequences (T1, T2, diffusion-weighted, contrast-enhanced) combined with PET. Imaging findings were compared to histopathological results. Diagnostic performance metrics, including accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated with corresponding 95
The optimal management of the mesenteric defect after minimally invasive right hemicolectomy remains controversial, particularly in the setting of complete mesocolic excision (CME), where a large mesenteric defect is created. This study was aimed at evaluating whether mesenteric defect closure after CME reduces postoperative complications and whether the closure itself introduces additional risks. A single-center retrospective study was conducted using a prospectively maintained database of patients with stage II–III right colon cancer who underwent minimally invasive right hemicolectomy with CME between May 2022 and July 2025. Patients were divided into two groups according to whether the mesenteric defect was closed or left open. Demographic, operative, and postoperative outcomes were analyzed, including postoperative ileus (POI), internal herniation, small bowel obstruction, operative time, and length of hospital stay. A total of 87 patients were included: 46 underwent mesenteric defect closure, and 41 did not. Baseline characteristics were comparable between groups. Postoperative gastrointestinal bleeding occurred in eight patients (9
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. 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. 642 patients underwent curative-intent surgery for rectal cancer: YORC: n = 53 (8
