Objectives: Colorectal cancer (CRC) with synchronous peritoneal metastasis is considered to have a worse prognosis. Although macroscopic complete resection is associated with a favorable prognosis, the prognostic determinants in this population remain poorly characterized. Therefore, it is crucial to identify prognostic factors following macroscopic complete resection to determine optimal care strategies that improve patient outcomes and to predict prognosis. Methods: In a multi-institute cohort study, we prospectively assessed clinicopathological factors that affect prognosis in 36 patients with CRC and synchronous peritoneal metastasis who underwent macroscopic complete resection. Results: 26 of 36 patients (72%) developed recurrence during follow-up, with a median of 34 months. Peritoneum was the most common site of recurrence. In survival analysis, patients with low preoperative serum CA19-9 levels had a favorable overall survival compared with those with high preoperative serum CA19-9 levels (HR: 0.42, 95% CI: 0.15-1.21, P=0.044). Also, patients with right-sided CRC had more favorable overall survival than those with left-sided CRC (HR: 0.44, 95% CI: 0.18-1.06, P=0.047). Furthermore, right-sided CRC with low preoperative serum CA19-9 levels was associated with significantly better overall survival than those with high preoperative serum CA19-9 levels or left-sided CRC (HR: 0.17, 95% CI: 0.07-0.41, P<0.001). Conclusions: In this prospective multi-institutional cohort of CRC patients with synchronous peritoneal metastasis undergoing macroscopic complete resection, recurrence was frequent, predominantly involving the peritoneum. Integrating tumor biology (sidedness) and serum biomarkers (CA19-9) may enhance prognostic stratification and guide individualized management strategies in this high-risk population.
Objectives: False positive detection (FPD) is a clinically relevant challenge that must be solved to ensure the safe and effective integration of artificial intelligence (AI) into colonoscopy. This study aimed to develop a novel AI system for quantifying FPD and to compare FPD rates between two commercially available AI platforms. Methods: From October 2022 to May 2025, a total of 436,637 images were collected from 78 patient colonoscopy videos: 38 videos (340,121 images) using CAD EYE (Fujifilm, Tokyo, Japan) and 40 videos (96,516 images) using EndoBRAIN (Olympus, Tokyo, Japan). Using these images, YOLOv8 convolutional neural networks were applied to construct original AI model for FPD analysis: ARBS-YOLOv8 (with active learning). The performance of the model was validated using the CAD EYE and EndoBRAIN clinical videos. Results: For CAD EYE validation, ARBS-YOLOv8 achieved an accuracy, sensitivity, specificity, precision, and F1 score of 99.22%, 99.51%, 99.97%, 99.96%, and 99.90%, respectively. For EndoBRAIN validation, the ARBS-YOLOv8 results were 99.97%, 99.84%, 99.97%, 99.97%, and 99.90%, respectively. The false-positive and false-negative rates of FPD detection were only 0.04% and 0.03% for CAD EYE and 0.03% and 0.03% for EndoBRAIN. In 13 collected clinical videos (7 CAD EYE, 6 EndoBRAIN), ARBS-YOLOv8 identified total FPD rates of 8.08% for CAD EYE and 2.47% for EndoBRAIN, showing a significant difference (p<0.001). Conclusion: We developed the first AI system capable of objectively measuring FPD during colonoscopy under two commercially available AI platforms. The model validated performance differences between CAD EYE and EndoBRAIN, providing a basis for FPD reduction and safe AI endoscopy.
Objectives:Surgical resection (SR) is recommended for pT1 colorectal cancer (CRC) with high-risk histological features for lymph node metastasis. However, endoscopic resection (ER) alone without additional SR is sometimes chosen for elderly patients due to surgical tolerance. Comparative studies on outcomes and prognosis between ER and SR remain limited. Methods:This retrospective study evaluated the outcomes of ER alone or SR in elderly patients (≥80 years) with high-risk pT1 CRC between 2008 and 2021. Results:A total of 59 patients were included, with 23 in the ER group and 36 in the SR group (additional SR after ER: 21, initial SR: 15). In the ER/SR groups, median age was 83 years, and the male ratio was 52%/64%, respectively. Median of Prognostic Nutritional Index (PNI) was 46.9/51.0. Median lesion size was 20 mm in both groups. Pathological findings showed pT1b in 96%/92%, lymphovascular invasion in 35%/33%, and budding grade ≥2 in 22%/28%. Treatment-related complications occurred in 7%/8% in each procedure, with one surgery-related death. Over a median follow-up of 57/63 months, no recurrences or disease-specific deaths were observed. The 5-year survival rates were 90%/81%, with no significant difference in overall survival (P = 0.12). PNI <43.4 was identified as a prognostic risk factor, and in the ER group, patients with low PNI showed significantly worse survival. Conclusion:There was no significant difference between the outcomes of ER alone and SR among elderly patients with high-risk pT1 CRC. PNI can be a valuable predictor of prognosis in the ER group.
Objectives: This study aimed to histologically identify and validate a consistent perivascular membranous structure encasing the superior mesenteric vessels and to evaluate its intraoperative visibility as an objective landmark for standardizing robotic central (D3) lymphadenectomy with central vascular ligation in right-sided colon cancer (RSCC). Methods: This translational anatomic study comprised (i) cadaveric histology of the superior mesenteric artery and vein (n = 5), (ii) validation using surgical resection specimens from RSCC (n = 5), and (iii) retrospective review of non-edited intraoperative videos from 78 consecutive robotic D3 procedures. Two skill-qualified surgeons, who were blinded to pathological outcomes, independently graded visibility and assessed associations with body mass index (BMI) and surgeon experience. Results: Histology consistently showed a collagenous and elastic membranous layer encasing the superior mesenteric vessels and separating them from mesenteric lymphofatty tissue; this is termed the thin membranous connective tissue (TMCT). Of 78 cases, TMCT has clear visibility in 69 (88%) and poor visibility in 9 (12%), with no association with BMI (p = 0.55) or surgeon experience (p = 0.32). No central vascular injuries occurred. Estimated blood loss and lymph node yield did not significantly differ between cases with clear versus poor TMCT identification. Conclusions: TMCT, a histologically defined perivascular layer that is usually identifiable during robotic surgery, provides an objective boundary to delineate the optimal central dissection plane around the superior mesenteric vessels and supports safer, more reproducible robotic D3 lymphadenectomy for RSCC.
Objectives:Severe anal stenosis, particularly Whitehead deformity, presents a significant reconstructive challenge. This study reports the clinical outcomes of a modified subcutaneous pedicle advancement flap anoplasty emphasizing pivot point medialization, developed in collaboration with plastic surgeons. Methods:We retrospectively analyzed data from 52 consecutive patients (aged 32-97 years; median, 67) treated between April 2021 and June 2025. The etiologies included postsurgical cicatricial stenosis (65.4%) and chronic anal fissure (34.6%). The technique involves establishing the pivot point-defined in this study as the biomechanical anchoring point at the deep subcutaneous fat layer-allowing tension-free advancement of the flap medially without rotation while preserving blood flow through the subcutaneous pedicle. Forty-nine patients completed the 6-month follow-up. Bougie examination at 6 months was performed without anesthesia during outpatient visits. Results:Surgical success, defined as bougie passage of ≥22 mm (#9), was achieved in 48 of 49 patients (98.0%), with a median operative time of 24 min (range, 14-35 min). No flap necrosis occurred (0%). Complications included wound dehiscence in nine patients (17.3%), which healed conservatively within a median of 4 weeks, and rectal prolapse in one patient (1.9%). One patient (2.0%) showed insufficient dilation at 6 months and required reoperation at 12 months. No fecal incontinence was observed. Patient satisfaction at 3 months was high (very satisfied 63.5%, satisfied 21.2%, unchanged 15.4%, dissatisfied 0%). Conclusion:This technique, utilizing pivot point medialization and straight advancement without rotation, may offer a safe and effective option for severe anal stenosis.
Background:Organ-preserving strategies are increasingly used in rectal cancer for those achieving a pathological complete response (pCR) following chemoradiotherapy (CRT). In locally advanced rectal cancer (LARC), CRT may not significantly impact local recurrence or overall survival when an R0 resection is feasible. Accurate pretreatment prediction of pCR is critical to assist patients in deciding on CRT when it may not be oncologically required. The initial phase of the ongoing INTERCEPTOR study evaluated whether machine learning (ML) models using pretreatment clinical variables could improve pCR prediction beyond the baseline probability of 15-20%. Methods:Patients with LARC who received CRT followed by total mesorectal excision between 2004 and 2018 at a tertiary referral center were analyzed. Eligible patients received ≥25 fractions of CRT (50.0-50.4 Gy with concomitant capecitabine) and surgery ≥6 weeks after CRT. Extreme gradient boosting (XGBoost) models were trained with 5-fold cross-validation. Model performance was assessed using AUROC, sensitivity, and specificity. Feature importance was assessed with Shapley additive explanations (SHAP) and XGBoost feature importance. Results:Among 238 included patients, 30 (12.6%) achieved pCR. The number of radiologically positive lymph nodes was the strongest single predictor, but with limited discriminative power (AUROC 0.65 ± 0.04, sensitivity 0.83 ± 0.15 and specificity 0.45 ± 0.1). Combining positive node count with additional clinical variables led to a modest improvement in performance. SHAP analysis confirmed positive lymph node count was the most influential predictor. Conclusion:Pretreatment clinical variables alone provide poor-to-fair accuracy for predicting pCR after CRT in LARC.
Objectives:Although the Japan NBI Expert Team (JNET) classification for colorectal lesions is clinically useful, standardization remains challenging owing to endoscopist variabilities. Therefore, we developed a computer-aided diagnosis (CADx) system to support JNET diagnoses, potentially facilitating a "Resect and Discard" strategy. The CADx system's diagnostic performance and its potential to support the "Resect and Discard" strategy were compared with those of endoscopists of varying experience. Methods:Forty-three patients (60 lesions) who underwent CADx system colonoscopies at Hiroshima University Hospital between September 2022 and July 2024 were evaluated. Endoscopists were grouped by experience: beginners (100-500 cases, n=4), intermediates (1,000-2,000 cases, n=5), and experts (>2,000 cases, n=3). In Study 1, JNET classification concordance between the CADx system and beginner/intermediate endoscopists was compared, using expert diagnosis as the gold standard. Study 2 included 38 <10 mm lesions, with histopathology as the gold standard. Lesions excluding advanced neoplasia were classified as "Resect and Discard". The CADx system and endoscopists were evaluated for identifying JNET Type 1 and 2A lesions as non-advanced neoplasia. Results:In Study 1, CADx-expert concordance was 83.3% (Kappa=0.75)-significantly higher than beginners (66.7%) and outperforming intermediates (78.0%). In Study 2, the CADx system's accuracy was 92.1%-significantly higher than beginners (70.4%) and outperforming intermediates (82.6%) and experts (78.9%). The CADx system's advanced neoplasia negative predictive value was 100%. Conclusions:The CADx system showed high concordance with expert diagnoses. For lesions <10 mm, its high advanced neoplasia diagnostic accuracy indicates its potential utility in supporting the "Resect and Discard" strategy.
Background:Several studies have reported the potential effectiveness of indocyanine green fluorescence angiography (ICG-FA) for preventing anastomotic leakage (AL) in rectal cancer surgery; however, its clinical benefit remains uncertain. The purpose of this study was to investigate the effectiveness of ICG-FA in rectal cancer surgery in Japan using real-world data. Methods:We retrieved data from the Diagnosis Procedure Combination database in Japan for rectal cancer surgeries between April 2018 and March 2022. A total of 68,022 cases were registered, and 55,299 eligible patients were analyzed. Using a two-level structure of nested individuals from 1,057 hospitals, we applied multilevel logistic regression. Results:A total of 40,013 laparoscopic (72.4%), 7,464 robotic (13.5%), and 7,822 open (14.1%) operations were performed. The rate of AL was 4.3% in the ICG-FA group and 5.1% in the non-ICG-FA group. After adjustment for patient- and hospital-level factors, ICG-FA was associated with a lower risk of AL (OR 0.87, 95% CI 0.76-1.00, p = 0.043); however, after additional adjustment for fiscal year, the association was no longer statistically significant (OR 0.91, 95% CI 0.79-1.04, p = 0.167). Conclusions:ICG-FA may be associated with a lower risk of AL after rectal cancer surgery in real-world settings, although the benefit was not statistically significant after additional adjustment for fiscal year.
Comprehensive genomic profiling (CGP) using circulating tumor DNA (ctDNA) has recently become available in Japan, but its clinical utility in daily practice remains unclear. We retrospectively evaluated 19 patients with metastatic colorectal cancer (mCRC) who underwent plasma-based CGP (Guardant360 CDx) between November 2023 and May 2025. ctDNA was detected in 18 of 19 patients (95%) with previously treated mCRC. The median turnaround time from blood collection to result was 11 days (range: 7-15). The median number of gene alterations was 5 (range: 1-29), and pathogenic/likely pathogenic alterations were identified in 15 patients (79%). ctDNA was preferentially selected over tissue CGP in patients with small tumor burden, lack of contemporary tumor sample, or double cancer (considering spatial and temporal heterogeneity). Three patients initially identified with RAS mutant tumors by tissue were subsequently identified as RAS wild-type by plasma CGP. Those were treated with anti-epidermal growth factor receptor (EGFR) therapy, resulting in partial response or stable disease. These observations suggest that plasma-based CGP may provide additional molecular information that could be clinically informative in mCRC in a real-world setting. Although the findings should be interpreted as exploratory, re-evaluation of molecular profiles using ctDNA enabled the exploratory identification of NeoRAS wild-type patients, who could potentially benefit from anti-EGFR therapy.
Background:The prognostic and predictive value of the lymph node ratio (LNR; metastatic/harvested nodes) in stage III colon cancer (CC) remains unclear, particularly in combination with molecular profiles such as RAS, BRAF, and microsatellite instability (MSI) status. Methods:We retrospectively analyzed stage III CC patients who underwent curative resection with D3 lymph node dissection (2013-2023). Optimal LNR cutoffs were determined using maximally selected rank statistics. Cox models assessed the prognostic impact of LNR adjusted for clinicopathological and molecular factors. The effect of adjuvant chemotherapy (ACT) on recurrence-free (RFS) and overall survival (OS) was evaluated by LNR subgroup. Results:Among 361 patients, optimal LNR cutoffs for RFS and OS were 0.16 and 0.21, respectively. Based on the cutoffs of 0.2, the RFS and OS were longer in patients with low LNR than those with high LNR. Multivariate analysis identified RAS and BRAF mutation, venous invasion, LNR and ACT as independent factors for RFS, while RAS mutation, lymphatic invasion, ACT and LNR were significant for OS. In patients with low LNR (≤0.2), ACT improved RFS (HR 0.57 (95% CI 0.33-0.99)) and OS (HR 0.48 (95% CI 0.28-0.85)) and similar tendency was observed in those with high LNR (>0.2) (RFS: HR 0.56 (95% CI: 0.29-1.09), OS: HR 0.51 (95%CI 0.23-1.13)). Conclusion:After adjustment for multiple biomarkers, LNR remained an independent predictor of OS in stage III CC. ACT was associated with improved survival regardless of LNR, with a consistent trend observed even in patients with high LNR.
Objective: To retrospectively evaluate the clinical features, perioperative findings, and long-term outcomes of patients who underwent bowel resection for intestinal endometriosis, and to clarify diagnostic and therapeutic challenges with the goal of supporting optimal surgical strategies that minimize recurrence while preserving function. Methods: Twenty-one patients who underwent bowel resection for intestinal endometriosis from 2002 to 2022 were evaluated regarding clinicopathological findings and short and long-term outcomes. Results: The median age was 38 years. All patients had gastrointestinal symptoms. Colonoscopy confirmed endometriosis histologically in only 1 patient (7.1%). Lesions were identified in the sigmoid colon to the upper rectum in 17 patients, some of which were accompanied by obliteration of the pouch of Douglas. Low anterior resection was performed in 15 of these patients, and temporary stomas were created in 4 patients. Gynecologic procedures were performed in 9 patients. Histopathology showed invasion into the submucosal and muscular layers. Early complications (Clavien-Dindo 2) occurred in 2 patients (anastomotic leak and ileus), while late complications included anastomotic stenosis, bowel stricture, and rectovaginal fistula (1 patient each). Only one recurrence (4.8%) was observed during a median follow-up of 2,088 days. Spontaneous pregnancy was achieved in 2 patients. Conclusions: This study highlights the clinical significance of bowel resection for intestinal endometriosis, suggesting the importance of comprehensive evaluation to improve diagnostic accuracy, the utility of collaboration with gynecology, and the potential for recurrence reduction and functional preservation through appropriate resection margins. These findings may contribute to the development of future treatment strategies for this condition.
The number of patients with inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), continues to increase in many countries and regions. With recent rapid advances in medical therapies targeting intestinal inflammation, the number of patients with long-term disease duration is also increasing. It is well-recognized that longstanding IBD carries an increased risk of developing gastrointestinal (GI) neoplasia, particularly colorectal cancer. However, compared to sporadic GI tumors, IBD-associated GI tumors are relatively rare, and even among specialists in GI diseases, opportunities to encounter such cases remain limited. In light of this situation, the Japanese Society for Cancer of the Colon and Rectum (JSCCR), in collaboration with the Japanese Inflammatory Bowel Disease Research Group (funded by the Japan Sciences Research Grant for Research on Intractable Diseases affiliated with the Ministry of Health, Labour, and Welfare) launched the Guideline Development Committee for IBD-associated Gastrointestinal Tumors in 2021, with the aim of establishing clinical practice guidelines to support the diagnosis and management of these tumors. The committee-comprising experts in gastroenterology, surgery, pathology, guideline development, and literature review-conducted extensive discussions and successfully published the first Japanese edition of the guidelines in July 2024. We believe that the current edition provides the best possible guidance based on presently available knowledge. Furthermore, the guideline development process highlighted several key issues to be addressed in future research and clinical practice. We are pleased to present here the English version of the JSCCR Guidelines 2024 for the Clinical Practice of IBD-associated Intestinal Neoplasia.
Objectives:This study investigated the incidence of colostomy, aiming to identify its risk factors following chemoradiotherapy (CRT) for squamous cell carcinoma of the anus (SCCA) in a large Asian cohort, and to clarify the prognostic significance of a complete response (CR). While CRT is the standard of care for SCCA, the risk of colostomy remains a major concern due to its potential impact on a patient's quality of life. Prior studies focused mainly on Western populations, and data from Asian cohorts are limited. Methods:We conducted a retrospective multicenter study of 246 patients with SCCA who underwent CRT at 47 Japanese Society for Cancer of the Colon and Rectum (JSCCR)-affiliated institutions-the largest Asian cohort analyzed to date. Colostomy incidence, colostomy-free survival (CFS), and associated risk factors were assessed. Results:Consistent with earlier Western reports, the 5-year cumulative colostomy incidence was 20.4% and the CFS rate was 65.9%. Multivariable analysis identified tumor size >50 mm (HR 9.619, P=0.0026) and male sex (HR 5.170, P<0.0001) as independent predictors of colostomy. Failure to achieve CR was strongly associated with higher colostomy risk (HR 3.732, P<0.0001), and local recurrence after CR further increased this risk (HR 16.302, P<0.0001). Conclusions:In this largest Asian cohort to date of patients with SCCA treated with CRT, tumor size, male sex, and abscence of CR emerged as key predictors of colostomy. Early identification of high-risk patients and achieving CR are essential for improving anal preservation and guiding individualized treatment strategies.
While venous anomalies of the right colon are relatively common, arterial variations are rare. We report a case of cecal cancer with a unique vascular anomaly. A 65-year-old man presented with fatigue and melena. Colonoscopy revealed a cecal tumor, and biopsy confirmed moderately differentiated adenocarcinoma. Contrast-enhanced CT and three-dimensional CT angiography (3D-CTA) demonstrated a rare arterial anomaly in which the ileocolic artery (ICA) and middle colic artery (MCA) arose from a common trunk branching ventral to the superior mesenteric vein (SMV). The ICA coursed parallel to the ileocolic vein (ICV), while the MCA ran cranially along the ventral aspect of the SMV. Robot-assisted right hemicolectomy with D3 lymphadenectomy was performed. The ICA was divided distal to its bifurcation from the common trunk. The MCA was meticulously isolated during lymphadenectomy and traced cranially to its bifurcation, where the right branch was divided while preserving the left branch. Final pathology revealed T3 N1b (2/51) M0, Stage IIIB, with negative margins. This case highlights the value of preoperative 3D-CTA in detecting rare vascular anomalies and tailoring surgical strategies, and underscores how robot-assisted surgery, combined with precise preoperative imaging, facilitates optimal management in anatomically complex colorectal cases.
Objectives: Colorectal cancer is the most common malignant disease in Japan. This study aimed to publish data on colorectal cancer cases registered in 2024, focusing on patients who received initial treatment in 2016. Methods: Participating facilities of the Japanese Society for Cancer of the Colon and Rectum (JSCCR) registered cases treated in 2016 according to the 8th edition of the Japanese Classification of Colorectal Carcinoma. Data submitted to the National Registration Committee in 2024 were analyzed. Results: A total of 12,825 cases were analyzed. Of these, 1,091 patients underwent endoscopic treatment, 756 underwent additional surgical resection after endoscopic treatment, and 10,806 underwent surgical treatment. Notably, among patients treated endoscopically, the proportion of endoscopic submucosal dissection (ESD) cases increased from 10.1% in 2010 to 25.5% in 2016. Conclusions: This report describes the characteristics, treatment methods, and outcomes of colorectal cancer patients receiving initial treatment in 2016 at JSCCR-affiliated facilities. Notably, the proportion of cases with ESD among all endoscopic procedures increased by more than twofold between 2010 and 2016. These data are expected to be useful for patients to better understand their disease and for healthcare professionals when explaining colorectal cancer and its treatments to patients.
Detection of rat sarcoma virus (RAS) and B rapidly accelerated fibrosarcoma (BRAF) mutations is critical for selecting an appropriate treatment for metastatic colorectal cancer (mCRC). Although RAS and BRAF V600E mutations are traditionally mutually exclusive, they occasionally co-occur. The concurrent occurrence of RAS and BRAF V600E mutations is rare, with an incidence of < 0.001-0.05% in CRC. Treatment outcomes for cases involving concurrent occurrence of these mutations remain unclear, with reported cases exhibiting a poor prognosis of approximately 1 year. Moreover, reports on the long-term survival of patients with unresectable mCRC with concurrent mutations are lacking. The present study reports a rare case of long-term survival of over 39 months in a patient with mCRC harboring both RAS and BRAF V600E mutations, where chemotherapy alone was effective without surgical resection of the primary or metastatic lesions.
Objectives: This study evaluates the short-term safety and technical feasibility of robot-assisted low anterior resection (RALAR) for rectal cancer in obese patients (BMI 25 kg/m2) compared to non-obese patients. Methods: A retrospective cohort study was conducted on patients undergoing RALAR for rectal cancer at Okayama University Hospital (September 2020-January 2025). Patients were divided into obese (BMI 25 kg/m2) and non-obese (BMI < 25 kg/m2) groups. Patient characteristics, surgical data, and postoperative outcomes were analyzed. Statistical analysis was performed using appropriate tests (Student's t-test, Mann-Whitney U test) with a significance level of p < 0.05. Results: The study included 27 obese and 49 non-obese patients. The obese group had a significantly higher median BMI (28.1 vs. 21.6 kg/m2, p < 0.01) and a higher proportion of patients with ASA classification 2 (81.5% vs. 57.1%, p = 0.03). There were no significant differences in operative time, console time, estimated blood loss, or conversion rate to open surgery. Postoperative complication rates were similar between groups (p=0.13). The incidence of severe complications (Clavien-Dindo grade III or higher) and anastomotic leakage were also not significantly different. Postoperative length of stay was comparable. Conclusions: RALAR for obese rectal cancer patients is feasible, despite trends toward increased technical difficulty (more staple firings, longer operative times, higher blood loss, complications). No conversions occurred, and hospital stays were comparable.
Objectives: The fecal immunochemical test (FIT) is widely used for colorectal cancer (CRC) screening, owing to its high diagnostic accuracy. Antithrombotic medications, particularly direct-acting oral anticoagulants (DOACs), can influence FIT performance; however, the evidence concerning this phenomenon remains inconsistent in the literature. This study evaluated the impact of DOACs on the positive predictive value (PPV) of FIT for diagnosing advanced neoplasia (AN). Methods: This retrospective study, conducted at Mie University Hospital, analyzed 818 patients who underwent colonoscopy procedures following positive FIT results between 2015 and 2024. A propensity score-matched analysis was used to compare PPVs for AN, advanced adenoma, invasive cancer, and all adenomas in the patients who did and did not use DOAC. A logistic regression model was used to conduct a sensitivity analysis evaluating the associations between DOAC use and FIT performance. Results: AN was diagnosed in 4.0% of the DOAC users and 16.8% of the non-users. Our propensity score-matched analysis confirmed that the PPV for AN in the DOAC-user group was significantly lower than that in the non-user group (odds ratio 0.20, 95% confidence interval 0.05-0.92, p = 0.038). Sensitivity analyses supported these findings, indicating reduced FIT performance among the DOAC users (odds ratio 0.25, 95% confidence interval 0.08-0.83, p = 0.024). Conclusions: DOAC use significantly reduced the PPV of FIT for diagnosing AN. This finding suggests that current guidelines should consider alternative strategies, such as adjunctive diagnostic tools, to improve accuracy and reduce unnecessary colonoscopies in patients using DOACs.
There is ongoing debate on the respective merits of extracorporeal and intracorporeal anastomoses in patients undergoing minimally invasive surgery for right-sided colon cancer. Herein, we report the benefits of intracorporeal anastomosis for right-sided colon cancer using an umbilical assistant port. The final decision to perform an intracorporeal or extracorporeal anastomosis was made intraoperatively. Robotic ports were established; the Da Vinci Xi robotic system was used with the specified instrument configuration. The benefits of intracorporeal anastomosis for right-sided colon cancer using an umbilical assistant port include reduced stress for the surgical team and improved adaptability. Although techniques differ, standardizing practices tailored to each team's strengths is vital for advancing robotic-assisted surgery. This method minimizes lower abdominal incisions, thereby reducing the risk of wound infection and incidence of postoperative hernia. Comprehensive evidence of robotic-assisted colon surgery remains limited, underscoring the need for ongoing evaluation and refinement of techniques.
In 2024, the second edition of the Japan Society of Coloproctology (JSCP) Practice Guidelines for Fecal Incontinence was published in Japan, followed by the release of this English version. This marks the first major revision in 7 years since the publication of the first edition. The second edition was completed over a span of 3 years, and its overview and key features are summarized below. This guideline begins with a clinical flowchart outlining the general diagnostic and therapeutic approach. A notable update is the inclusion of insertable anal and vaginal continence devices, which are now considered a form of conservative therapy under clinical research frameworks. In Chapter I-B (Epidemiology), the prevalence of anal incontinence was newly reported: among a Japanese population with an average age of 35 years, 15.5% of men and 42.7% of women were affected. In Chapter II (Diagnosis), the utility of a bowel diary for patient assessment is discussed for the first time. The guideline also provides a detailed description of the evaluation method for digital rectal examination. Additionally, a new section was added addressing incontinence-associated dermatitis (IAD), including its risks and methods of assessment. In Chapter III (Diagnostic Testing), the guideline expands upon previously established diagnostic tests by newly including detailed descriptions of ultrasound techniques-specifically, endoanal ultrasound, transperineal ultrasound, and transvaginal ultrasound. Chapter IV (Treatment) outlines conservative treatment strategies, including dietary guidance, bowel habit instruction, and care for fecal incontinence. Pharmacologic therapies are presented with itemized explanations by drug type. Pelvic floor muscle training, biofeedback therapy, and transanal irrigation are classified under “specialized conservative therapies” and discussed in detail. For surgical treatment, a new Clinical Question (CQ) addresses postpartum fecal incontinence. It recommends early referral to a specialized center when a sphincter injury is present to be repaired, whereas observation for one year may be appropriate when no injury is identified. Another new CQ discusses the mode of delivery in subsequent pregnancies following obstetric anal sphincter injuries (OASIS), emphasizing the need to evaluate fecal incontinence severity, anal sphincter function, and its integrity before making clinical decisions. Stoma creation is described in detail as one of the surgical treatment options, including its implications for improved postoperative quality of life. For the first time, regenerative therapy for the anal sphincter is introduced as a novel surgical option, reporting promising long-term outcomes from trials involving the transplantation of autologous cultured myoblasts into the external anal sphincter. Finally, Chapter V addresses special clinical scenarios in detail, including fecal incontinence associated with neurological and spinal disorders, dementia, frailty, and bedridden elderly patients.
