AIM: to evaluate the outcomes of surgery for perianal fistulas using draining seton in perianal fistulizing Crohn's disease (CD). P ATIENT S AND METHODS: retrospective study included 199 patients with perianal fistulas associated with CD who underwent surgical treatment with draining latex seton placement between February 2017 and October 2024. Transrectal ultrasound (TRUS) of the rectum was performed for preoperative and postoperative imaging. The endpoints included positive response to treatment and partial improvement rate, primary treatment failure, recurrence rate, and rate of reinterventions. RESULT S: positive response to treatment, according to predefined criteria, was achieved in 121/199 (61%) patients. A second surgical stage was performed in 89/121 (74%) patients, with a median interval of 12 months (IQR: 7–18) between procedures. Recurrence occurred in 7/121 (6%) patients, with a median time to recurrence of 14 months (IQR: 11–16). In 32/199 (16%) cases, a partial improvement was noted — a decrease in the size of the collections or their number. Primary failure due to persistent undrained collections was diagnosed in 46/199 (23%) patients. In 25 (54%) of these cases, progression of perianal disease was noted postoperatively, characterized by new fistula tracts and enlargement of existing collections. Repeat drainage with seton placement was performed in 33/46 (72%) patients. In 11/46 (24%) cases, due to an aggressive disease course, an abdominoperineal resection (APR) was performed. CONCLUSION: the results largely confirm that draining seton placement is only one component of a multimodal strategy for perianal Crohn's disease (pCD). Therefore, further studies are warranted to identify and analyze factors influencing healing, recurrence, and progression rates of perianal fistulas.
OBJECTIVE: to analyze existing definitions of “textbook outcome” (TO) in colorectal cancer surgery and to justify the need for their standardization. P ATIENT S AND METHODS: a systematic review was conducted in accordance with the PRISMA guidelines. PubMed, the Cochrane Library, and eLIBRARY were searched for the period 2010-2025. Original studies evaluating TO in adult patients after surgical treatment for colorectal cancer were included. Study quality was assessed using the Newcastle-Ottawa scale. RESULT S: sixteen studies (335,575 patients) were included. The rate of achieving TO ranged from 28.5% to 77.4%. Significant heterogeneity in TO definitions was identified. The most common components were R0 resection, lymph node dissection ≥ 12, absence of major complications (Clavien-Dindo ≥ III), readmissions, and mortality (30/90 days), as well as length of hospitalization (fixed values or 75th percentile). Achieving TO was associated with improved survival (a 40-55% reduction in the risk of death). Significant factors included surgical approach, ERAS, age, comorbidities, stage, neoadjuvant therapy, insurance type, and surgical volume. CONCLUSION: TO is a valid tool for assessing the quality of surgical treatment of colorectal cancer associated with long-term survival. The lack of a unified definition limits the comparability of results. The proposed standardized definition (R0 resection, lymph node dissection ≥ 12, absence of major complications, 30-day mortality and readmissions, length of stay within the 75th percentile) can serve as the basis for international consensus.
OBJECTIVE: to develop and internally validate a prognostic model of adverse events after endoscopic removal of colorectal neoplasms. PATIENTS AND METHODS: a retrospective analysis of medical records was conducted from January 2024 to June 2025. 3753 patients were included; all available preoperative variables were assessed as potential predictors. Sequential univariable and multivariable binary logistic regression analyses were performed. Internal validation was conducted using bootstrap resampling (B = 1000) with division into training and test samples in a ratio of 7:3. RESULTS: multivariable logistic regression identified the following independent predictors of adverse events: arterial hypertension (odds ratio (OR) = 2,86; 95% confidence interval (CI): 1,71–4,79; p<0.001) and maximum neoplasm size (OR = 1,04; 95% CI: 1,03–1,05; p<0.001). Protective factors included JNET classification 2a and lower (OR = 0,07; 95% CI: 0,04–0,10; p<0.001), 0-I (p+s) (OR = 0,45; 95% CI: 0,23–0,88; p=0,019), and left-sided localization (OR = 0,23; 95% CI: 0,14–0,36; p<0.001). The variables CHD (p=0,243) and LST-NG (p=0,705) did not significantly influence the adverse outcome. The model demonstrated excellent discrimination (AUC = 0,894; 95% CI: 0,857–0,929 (overall sample) . CONCLUSION: the developed model demonstrated high discriminative performance for predicting adverse outcomes after endoscopic colorectal neoplasm removal and may serve as the basis for a patient routing algorithm between day-case and inpatient settings.
INTRODUCTION : in patients with adenomatous polyposis syndrome (APS), extracolonic manifestations are often detected. According to many researchers, desmoid tumors are the most common cause of death in patients with APS who underwent prophylactic bowel removal before polyps’ transformation into colorectal cancer. The inconsistent data in the current literature on the predisposive factors to the development of desmoid tumors in patients with APS prompted us to conduct our own research. AIM : to evaluate the frequency of desmoid tumors in patients with adenomatous polyposis syndrome and to identify independent risk factors for the development of desmoid tumors. PATIENTS AND METHODS: the single-center retrospective study included patients who underwent treatment for adenomatous polyposis syndrome and subsequent monitoring between January 2013 and January 2025. After the surgical stage of treatment, the patients were included in a long-term dynamic outpatient monitoring program. As part of this program, patients underwent annual endoscopic examinations of the upper and lower gastrointestinal tract, as well as CT scans of the chest, abdomen, and pelvis with intravenous contrast. The primary endpoint of the study was the detection of a desmoid tumor in a patient with APS. A univariate analysis followed by a logistic regression analysis was conducted to identify independent risk factors for the development of desmoid tumors in patients with APS. RESULTS : In 79 (21.4%) out of the 369 patients included in the study desmoid tumors were detected on average, 18 (6 to 60) months after surgery for APS. In 90.1% of patients with a desmoid tumor, a pathogenic variant in the APC gene was detected. Based on the ROC analysis, it was found that the localization of pathogenic variant beyond codon 876 in the APC gene is more strongly associated with the development of desmoid tumor (AUC=0.60, p=0.01). As a result of the logistic regression analysis, it was revealed that the localization of the pathogenic variant in the APC gene beyond codon 876 (OR=2.15, 95% CI: 1.20-3.83, p=0.0097) and open access during surgery (OR=2.09, 95% CI: 1.18-3.71, p=0.0119) served as independent risk factors for the development of desmoid tumors in patients with APS. CONCLUSION : the incidence of desmoid tumors detection in the studied cohort of patients with APS was 21.4%. The high risk of extraintestinal manifestations of APS confirms the need for long-term regular monitoring of patients after colorectal surgery, especially in the high-risk group – with the location of the pathogenic variant in the APC gene beyond codon 876 and/or after open surgery.
A few papers on bladder augmentation in patient with local advanced colon cancer are found in literature. «Gold» standard here is small intestinal augmentation. A clinical case of using stomach for this is presented.
