Background:Gallbladder-related pathologies may influence colorectal carcinogenesis, yet systematic evaluation of their associations with precursor lesions remains limited. This study addresses critical knowledge gaps by investigating the dual-axis relationship between cholecystectomy/gallbladder pathologies and colorectal polyp risk while elucidating geographical and biological effect modifiers. Methods:In accordance with the MOOSE/Cochrane guidelines, 27 observational studies were analysed through PROSPERO (CRD420251012876). Comprehensive meta-analysis was performed to assess the effects of cholecystectomy across polyp subtypes and gallbladder pathology (stones/polyps) associations. Heterogeneity was quantified via I² statistics, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated via the DerSimonian-Laird random effects model to account for between-study variance. Subgroup analysis stratified by geography, pathology type, and adjustment model was performed with χ² tests for subgroup differences. Sensitivity analysis and publication bias were assessed through leave-one-out methods, funnel plots and Egger's test. Results:Cholecystectomy was associated with a 39% increased risk (OR = 1.39, 95% CI: 1.21-1.59), with East Asian populations exhibiting a nearly doubled risk compared with North American populations (OR=1.95(95%CI:1.44-2.63) vs OR=1.16(95%CI:1.00-1.34). Compared with unclassified polyps, adenomas were more strongly associated (OR = 1.37, 95% CI: 1.16-1.62). Medium-sized studies (OR = 1.69, 95% CI: 1.36-2.11) and those adjusted for health factors (OR = 1.34, 95% CI: 1.12-1.61) yielded higher estimates, whereas dietary adjustment nullified significance. Gallbladder pathology (stones/polyps) conferred a 27% higher risk overall, with gallbladder polyps showing greater risk (OR = 1.30, 95% CI: 1.17-1.38) than stones (OR = 1.20, 95% CI: 1.08-1.32). Older populations (≥50 years) had stronger associations OR=1.41(95%CI:1.20-1.66) vs OR=1.20(95%CI:1.10-1.30). Adjustment for smoking, alcohol, and BMI strengthened the estimates (OR = 1.43, 95% CI: 1.22-1.68). Sensitivity analysis supported the robustness of the primary findings, particularly for cholecystectomy. Conclusions:This comprehensive analysis establishes gallbladder status as an independent risk modulator for early colorectal lesions, with cholecystectomy demonstrating the highest risk magnitude. These findings advocate personalized surveillance strategies that integrate gallbladder history, particularly high-risk demographics. The mechanistic synergies between bile acid dysmetabolism and gut microbiota dysbiosis warrant further exploration as preventive targets. Systematic review registration:https://www.crd.york.ac.uk/prospero/, identifier CRD420251012876.

Background: Radionuclide therapy (RNT) and immune checkpoint inhibitors (ICIs) show mechanistic synergy in colorectal cancer (CRC), but clinical evidence remains limited.Objective: To summarize biological rationale, translational mechanisms, and current clinical evidence supporting RNT-ICI combinations in CRC.Methods: Narrative translational review integrating preclinical studies, radionuclide therapy literature, and CRC radiotherapy-ICI clinical trials.Results: ICIs are effective mainly in MSI-H/dMMR CRC, whereas MSS/pMMR tumors remain resistant. RNT-particularly Y-90 radioembolization-may induce immunogenic cell death, cGAS-STING activation, type I interferon signaling, and stromal remodeling. A pilot clinical study of Y-90 plus dual ICIs demonstrated feasibility and safety but limited efficacy. Evidence from EBRT-ICI CRC studies supports radiation-induced immune priming but is not directly transferable to RNT.Conclusion: RNT-ICI combinations are biologically plausible but not yet clinically validated. Future progress requires biomarker-driven, dosimetry-informed, and liver-dominant trial designs.

Robot surgery is an important trend in contemporary colorectal cancer surgical treatment. The Robotic Surgery Group, Colorectal Cancer Committee of Chinese Medical Doctor Association organized experts in relevant fields across the country to update and revise the application standards of robotic colorectal cancer surgery based on the Expert consensus on robotic surgery for colorectal cancer (2015 edition) and the revised version in 2020, in accordance with the development of robotic surgery concepts, technologies, and equipment in recent years, in order to promote the application and promotion of robotic surgery.

Background: The rapid evolution of endoscopic resection techniques for colorectal polyps has created a diverse but fragmented evidence base, making it challenging to determine the technique that optimally balances efficacy and safety. Objectives: To comprehensively compare the efficacy and safety of all mainstream colorectal polypectomy techniques. Design: A systematic review and Bayesian network meta-analysis (NMA), conducted in accordance with PRISMA-NMA guidelines. Data sources and methods: Databases searched included PubMed, Web of Science, Embase, Scopus, Cochrane Library, CNKI, Wanfang Database, and SinoMed. Model convergence was assured (Brooks-Gelman-Rubin diagnostic), and consistency was evaluated via node-splitting analysis. Treatment hierarchies for primary efficacy outcomes (R0 resection, En bloc resection, complete resection) and secondary safety outcomes (bleeding, perforation) were established using surface under the cumulative ranking curve (SUCRA) probabilities. Results: 100 RCTs (24,786 patients; 34,244 polyps) comparing 13 techniques were included. Underwater endoscopic mucosal resection (U-EMR) and EMR ranked highest for R0 resection (SUCRA: U-EMR 49%, EMR 30%) and En bloc resection. For complete resection, endoscopic submucosal dissection (ESD) ranked highest (SUCRA: ESD 49%). Cold forceps polypectomy (CFP) and cold snare polypectomy with submucosal injection (CSP-SI) were consistently the least effective across efficacy outcomes. Hot snare EMR (HS-EMR) was associated with the highest risk of bleeding, while cold snare polypectomy (CSP)-based techniques were generally safer for perforation. ESD demonstrated a favorable safety profile for bleeding. The evidence certainty was generally low to moderate. Conclusion: This NMA provides a comprehensive hierarchy of polypectomy techniques. U-EMR and EMR are among the most effective for R0 and En bloc resection, while CSP-based techniques are among the safest. HS-EMR carries a higher bleeding risk. These findings provide crucial evidence to guide clinical decision-making and future guideline development, while also highlighting key evidence gaps requiring further research. Trial registration: PROSPERO (CRD420251139746).

This paper provides an overview of the development, technical features and current applications of the da Vinci surgical robots in colorectal cancer surgeries and conducts an in-depth analysis of the precision and stability of the da Vinci surgical robots in surgeries, as well as its technical advantages in reducing surgical trauma and accelerating recovery. This paper evaluates the clinical efficacy and safety of da Vinci surgical robotic-assisted surgery through a comparison of partial clinical data with traditional surgical methods, particularly focusing on the economic and social benefits. It fully demonstrates the advantages and application prospects of the da Vinci surgical robots in colorectal surgery, including intelligent precision technology, good clinical outcomes and excellent cost-effectiveness, while also discussing the current challenges and countermeasures.

The relevant mechanism of tumor-associated macrophages (TAMs) in the treatment of colorectal cancer patients with immune checkpoint inhibitors (ICIs) is discussed, and the application prospects of TAMs in reversing the treatment tolerance of ICIs are discussed to provide a reference for related studies. As a class of drugs widely used in clinical tumor immunotherapy, ICIs can act on regulatory molecules on cells that play an inhibitory role-immune checkpoints-and kill tumors in the form of an immune response by activating a variety of immune cells in the immune system. The sensitivity of patients with different types of colorectal cancer to ICI treatment varies greatly. The phenotype and function of TAMs in the colorectal cancer microenvironment are closely related to the efficacy of ICIs. ICIs can regulate the phenotypic function of TAMs, and TAMs can also affect the tolerance of colorectal cancer to ICI therapy. TAMs play an important role in ICI resistance, and making full use of this target as a therapeutic strategy is expected to improve the immunotherapy efficacy and prognosis of patients with colorectal cancer.

Despite the global increase in the adoption of robotic natural orifice specimen extraction surgery (R-NOSES), its advantages over robotic transabdominal specimen extraction surgery (R-TSES) for treating early-stage rectal cancer remain debated. There is scant nationwide, multicenter studies comparing the surgical quality and short-term outcomes between R-NOSES and R-TSES for this condition. This retrospective cohort study was conducted nationally across multiple centers to compare the surgical quality and short-term outcomes between R-NOSES and R-TSES in early-stage rectal cancer. Multicenter retrospective cohort trial. Eight experienced surgeons from 8 high-volume Chinese colorectal cancer treatment centers. The study included 1086 patients who underwent R-NOSES or R-TSES from October 2015 to November 2023 at the 8 centers. Inclusion criteria were: (1) histologically confirmed rectal adenocarcinoma; (2) robotic total mesorectal excision; (3) postoperative pathological staging of TisN0M0 or T1-2N0M0; (4) availability of complete surgical and postoperative follow-up data. Patients were matched 1:1 in the R-NOSES and R-TSES groups using the propensity score matching (PSM) technique. After PSM, 318 matched pairs with well-balanced patient characteristics were identified. The operation time for the R-NOSES group was significantly longer than that for the R-TSES group [140 min (125–170 min) vs. 140 min (120–160 min), P = 0.032]. Conversely, the times to first flatus and initial oral intake in the R-NOSES group were significantly shorter than those in the R-TSES group [48 h (41–56 h) vs. 48 h (44–62 h), P = 0.049 and 77 h (72–94 h) vs. 82 h (72–96 h), P = 0.008], respectively. Additionally, the length of postoperative hospital stay was shorter in the R-NOSES group compared with the R-TSES group [7 day (7–9 day) vs. 8 day (7–9 day), P = 0.005]. The overall postoperative complication rates were similar between the groups (10.7

ObjectiveDuring the past decade, the concept of complete mesocolic excision (CME) has been developed in an attempt to minimize recurrence for right-sided colon cancer. This study aims to compare outcomes of robotic versus laparoscopic right hemicolectomy with CME for right-sided colon cancer.MethodsWe performed a retrospective multicenter propensity score matching study. From July 2016 to July 2021, 382 consecutive patients from different Chinese surgical departments were available for inclusion out of an initial cohort of 412, who underwent robotic or laparoscopic right hemicolectomy with CME. Data of all patients were retrospectively collected and reviewed. Of these, 149 cases were performed by a robotic approach, while the other 233 cases were done by laparoscopy. Propensity score matching was applied at a ratio of 1:1 to compare perioperative, pathologic, and oncologic outcomes between the robotic and the laparoscopic groups (n = 142).ResultsBefore propensity score matching, there were no statistical differences regarding the sex, history of abdominal surgery, body mass index (BMI), American Joint Committee on Cancer (AJCC) staging system, tumor location, and center between groups (p > 0.05), while a significant difference was observed regarding age (p = 0.029). After matching, two comparable groups of 142 cases were obtained with equivalent patient characteristics (p > 0.05). Blood loss, time to oral intake, return of bowel function, length of stay, and complications were not different between groups (p > 0.05). The robotic group showed a significantly lower conversion rate (0% vs. 4.2%, p = 0.03), but a longer operative time (200.9 min vs. 182.3 min, p < 0.001) and a higher total hospital cost (85,016 RMB vs. 58,266 RMB, p < 0.001) compared with the laparoscopic group. The number of harvested lymph nodes was comparable (20.4 vs. 20.5, p = 0.861). Incidence of complications, mortality, and pathologic outcomes were similar between groups (p > 0.05). The 2-year disease-free survival rates were 84.9% and 87.1% (p = 0.679), and the overall survival rates between groups were 83.8% and 80.7% (p = 0.943).ConclusionDespite the limitations of a retrospective analysis, the outcomes of robotic right hemicolectomy with CME were comparable to the laparoscopic procedures with fewer conversions to open surgery. More clinical advantages of the robotic surgery system need to be further confirmed by well-conducted randomized clinical trials with large cohorts of patients.

Background There are many studies on the association of tea and its extracts with colorectal adenomas, but the results have varied. The study aims to investigate the effect of tea and its extracts on colorectal adenomas using meta analysis and systematic review. Methods Literature was obtained through PubMed, Cochrane Library, Embase and Chinese BioMedical Literature Service System since the establishment of the database until April 31, 2023. Search terms include adenomas, polyps, colorectal, rectal, rectum, tea, epigallocatechin, drinking and beverages. Meta-regression analysis was used to infer the source of heterogeneity. Heterogeneity was assessed using I 2 statistics and Q test. The effect measures were odds ratio (OR) and 95% confidence interval (95% CI). Stata17.0 software was used for data processing. Results The findings indicated that study design ( t = 0.78, P = 0.454), types of tea intake ( t = 1.35, P = 0.205), occurrences ( t = -0.19, P = 0.852), regions ( t = 1.13, P = 0.281) and grades of adenomas ( t = 0.06, P = 0.952) were statistical homogeneity. Tea and its extracts were negatively correlated with the risk of colorectal adenomas (OR = 0.81, 95% CI: 0.66–0.98). No publication bias was found in this study ( t = -0.22, P = 0.828) and the results are robust. Conclusion This study suggests that tea and its extracts have a certain protective effect on colorectal adenomas, which provides scientific evidence for preventive strategies for colorectal adenomas. As for the causal relationship between tea and its extracts on colorectal adenomas, further prospective studies are needed.

BackgroundDietary factors may affect the incidence of colorectal serrated polyps (SP). However, its effects on SP are unclear as epidemiological studies on this topic have showed inconsistent results. The present systematic review and meta-analysis sought to evaluate the effects of dietary factors on SPs.MethodsStudies regarding the association between dietary factors and SPs were identified by searching PubMed, Cochrane library, Embase and Chinese Biomedical Literature database from inception until 27 February 2023. Search terms include serrated, hyperplastic, adenoma, polyps, colorectal, rectal, rectum and risk. Heterogeneity was assessed using I2 statistics. The meta-analysis was conducted by using a random-effects model, and the pooled effects were expressed with odds ratios (OR) and 95% confidence intervals (95% CI). Probable sources of heterogeneity were identified through meta-regression. Subgroup analysis were based on lesion types, study designs, countries, and so on.Results28 studies were ultimately eligible after scanning, and five dietary factors including vitamin D, calcium, folate, fiber and red or processed meat were excerpted. Higher intakes of vitamin D (OR = 0.95, 95%CI:0.90–1.02), calcium (OR = 0.97, 95%CI: 0.91–1.03) and folate (OR = 0.82, 95% CI: 0.6–1.13) were not significantly associated with SP. Fiber intake (OR = 0.90, 95% CI: 0.82–0.99) was a protective factor against SPs. Red meat intake increased the risk of SPs by 30% for the highest versus lowest intakes (OR = 1.30, 95% CI: 1.13–1.51). For different lesion types, higher folate intake was associated with a decreased risk of HPs (OR = 0.59, 95%CI: 0.44–0.79), and higher vitamin D intake decreased the risk of SPs including SSA/P (OR = 0.93, 95%CI: 0.88–0.98).ConclusionsHigher dietary fiber intake plays an effective role in preventing SP, while red meat intake is associated with an increased risk of SP. This evidence provides guidance for us to prevent SP from a dietary perspective.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?, RecordID=340750.

在直肠癌特别是低位直肠癌的手术治疗中,如何处理左结肠动脉(LCA)是外科医生所面临的重要问题之一.目前对于肠系膜下动脉(IMA)的处理方式主要分为两种,即不保留LCA的高位结扎及保留LCA的低位结扎,两种方式孰优孰劣一直存在争议.越来越多的研究表明,低位结扎IMA对减少患者术后并发症、提升患者术后生存质量具有明显优势,确立了保留LCA的临床价值及意义.本文对国内外低位直肠癌根治术中保留LCA术后疗效的研究进行综述,旨在为低位直肠癌的外科治疗策略提供参考.