PurposeWe aimed to determine whether intra-anal cryotherapy reduces postoperative pain in patients undergoing hemorrhoidectomy.MethodsThis randomized controlled trial was conducted from January 2023 to August 2024. Patients with symptomatic grade III hemorrhoids were randomized 1:1 to receive either 1 minute of intra-anal cryotherapy or standard postoperative care. Because cryotherapy was applied before reversal of general anesthesia, patients were blinded to treatment allocation. The primary outcome was pain at rest on postoperative day (POD) 1. Secondary outcomes included pain after defecation, time to return to work or non-work activities, 30-day complications, and compliance with analgesia. Pain was measured using the visual analog scale.ResultsA total of 50 patients were randomized (25 per group). All 50 were included in the analysis. Baseline clinicodemographic characteristics were comparable between groups. The primary outcome, POD 1 pain at rest, did not demonstrate superiority of cryotherapy compared with standard care (median, 3.0 vs. 4.0, P=0.062). However, the POD 1 pain score after defecation was significantly lower with cryotherapy than without (3.0 vs. 4.0, P=0.046). On POD 2, median pain scores at rest and after defecation were both significantly lower in the cryotherapy cohort (at rest: 2.0 vs. 4.0, P=0.043; after defecation: 2.0 vs. 5.0, P=0.001).ConclusionIntra-anal cryotherapy significantly reduces pain after defecation in the early postoperative period following surgery for grade III hemorrhoids. Its therapeutic efficacy, ease of application, and safety support consideration for routine use.Trial registrationClinicalTrials.gov identifier: NCT06005727

PurposeAnastomotic leakage (AL) is a serious postoperative complication after colorectal cancer surgery, and accurate preoperative prediction remains challenging. This study aimed to develop and validate a magnetic resonance imaging (MRI)–based radiomics nomogram for the preoperative prediction of AL.MethodsA total of 146 patients with colorectal cancer, including 11 with AL, were retrospectively enrolled and randomly divided into training and validation cohorts at a 7:3 ratio. Clinical variables and preoperative MRI-based radiomic features were analyzed. A clinical model was constructed using logistic regression. Radiomic features were selected using the least absolute shrinkage and selection operator method to develop a radiomics model, from which a radiomic score was calculated. A combined radiomics nomogram integrating the radiomic score and significant clinical factors was subsequently established. Model performance was evaluated using receiver operating characteristic curve analysis in both cohorts.ResultsThe clinical model achieved an area under the curve (AUC) of 0.766 in the training cohort and 0.583 in the validation cohort. The radiomics model demonstrated improved discrimination, with AUCs of 0.822 and 0.800, respectively. The combined radiomics nomogram showed the best predictive performance, yielding AUCs of 0.869 in the training cohort and 0.858 in the validation cohort.ConclusionThe proposed MRI-based radiomics nomogram demonstrates good predictive performance for postoperative anastomotic leakage and may serve as a useful tool for preoperative risk stratification in patients with colorectal cancer.

PurposeUnderstanding the muscular structure of the anal canal is crucial for the diagnosis and treatment of anorectal diseases. Treitz muscle is a vital yet poorly understood component. It supports the anal venous plexus and contributes to anal cushion formation. However, its anatomical details remain unclear, and various theories suggest different origins for its muscle bundles, which affects our understanding of the pathophysiology of hemorrhoids. In this study, we sought to clarify the origin and localization of Treitz muscle to provide an anatomical foundation for understanding anal function.MethodsIn this descriptive cadaveric study of 11 cadavers, we performed macroscopic examinations and immunohistological analyses on tissues from the anterior, lateral, and posterior walls of the anal canal. The origin and localization of Treitz muscle were qualitatively evaluated.ResultsTreitz muscle is a smooth muscle formed by a directional change in the muscle bundles of the internal anal sphincter, running longitudinally along its surface. A shift in the direction of muscle bundles originating from the internal anal sphincter, giving rise to Treitz muscle, was frequently observed in the anterolateral wall of the anal canal.ConclusionIn summary, Treitz muscle, a smooth muscle extending from the internal anal sphincter, is considered part of the muscularis propria. Its directional shift was localized to the anterolateral wall, indicating that Treitz muscle is not uniformly distributed around the anal canal. This site-specific localization may influence the risk of hemorrhoids or cancer invasion depending on its anatomical position.

PurposeThis study aimed to identify predictors of lateral lymph node metastasis (LLNM) and assess prognostic factors in patients with locally advanced low rectal cancer (LALRC), with the goal of informing optimal treatment strategies for LALRC.MethodsWe retrospectively analyzed clinicopathological data from patients with LALRC who underwent lateral lymph node dissection without preoperative treatment between 2014 and 2023. The radiological criterion for LLNM was a short-axis diameter of ≥6 mm on magnetic resonance imaging (MRI).ResultsOf 163 patients, 27 (16.6%) had pathological LLNM (pLLNM). Among 130 patients preoperatively classified as LLNM-negative, 5 (3.8%) were found to have pLLNM. Univariate and multivariate analyses showed that meeting the radiological LLNM criterion independently predicted pLLNM (odds ratio, 53.000; P<0.001). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this criterion were 90.2%, 81.5%, 91.9%, 66.7%, and 96.2%, respectively. In multivariate analyses, pLLNM was an independent risk factor for 3‑year relapse‑free survival. MRI‑detected extramural vascular invasion (mrEMVI) was independently associated with 3‑year relapse‑free survival, local recurrence‑free survival, and distant recurrence‑free survival.ConclusionThese radiological criteria may help clinicians develop personalized treatment plans for patients with LALRC. The high negative predictive value and specificity of LLNM assessment can assist in avoiding overtreatment in appropriate patients. Further evaluation is needed to define optimal management for mrEMVI‑positive cases.

PurposeTo evaluate long-term outcomes and identify prognostic factors for stoma construction following loose seton placement in patients with Crohn disease (CD)-associated perianal fistulas.MethodsThis single-center, retrospective study included 136 patients who underwent initial loose seton placement for CD-associated perianal fistulas between 1999 and 2021, with at least 3 years of follow-up. Patient demographics, anorectal findings, and perioperative pharmacotherapy were assessed. Prognosis was defined as the cumulative incidence of stoma formation. Independent risk factors were identified using multivariate logistic regression. The association between postoperative molecular-targeted therapy and stoma-free survival was further analyzed in patients with severe anal ulceration and rectal stricture (high-risk features). Kaplan-Meier curves and log-rank tests were used for comparisons.ResultsDuring follow-up, 42 patients required stoma construction. Severe anal ulceration (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.04–5.38; P=0.039), rectal stricture (OR, 2.84; 95% CI, 1.09–7.37; P=0.032), and absence of postoperative molecular-targeted therapy (OR, 0.36; 95% CI, 0.15–0.84; P=0.018) were independent risk factors. In patients with severe anal ulceration, the cumulative stoma construction rate was significantly lower with postoperative molecular-targeted therapy (P=0.018). No significant difference was observed in patients with rectal strictures (P=0.058).ConclusionSevere anal ulceration, rectal stricture, and absence of postoperative molecular-targeted therapy were independently associated with stoma construction. Postoperative molecular-targeted therapy improved stoma-free survival in patients with severe anal ulceration. Individualized treatment strategies, including early pharmacological intervention, may improve long-term outcomes and preserve anorectal function. Tailoring treatment according to lesion characteristics may reduce stoma formation and enhance quality of life in CD-associated perianal disease.

PurposeReal-world evidence comparing surgical techniques for symptomatic hemorrhoidal disease (HD) remains limited, despite the availability of multiple approaches. This study aimed to evaluate short-term, interim outcomes from a prospective, nationwide cohort study that compared the effectiveness of different operative techniques based on patient-reported outcome measures (PROMs) in patients with symptomatic HD.MethodsA prospective, nationwide cohort study was conducted at 20 tertiary care centers across Turkiye between July 2022 and July 2024. Adult patients aged 18 years or older with symptomatic HD (grades I–IV) who underwent surgery during this period were included. The choice of procedure was determined by the operating surgeon, and patients were categorized into excisional, fixative, and ablative groups according to the surgical approach used. The primary outcomes were changes in the Hemorrhoidal Disease Symptom Score, Short Health ScaleHD, visual analog scale for pain, and patient satisfaction, assessed from the preoperative period to postoperative day 7 and postoperative week 6.ResultsThe study included a total of 315 patients after excluding those who did not fulfil the inclusion criteria. Among them, 239 (75.9%) were male, with a mean age of 43.7±11.7 years. The distribution of patients across surgical groups was 207 (65.7%) in the excisional group, 30 (9.5%) in the fixative group, and 78 (24.8%) in the ablative group. All groups demonstrated significant improvements in PROM scores from preoperative to postoperative assessments. However, no statistically significant differences were observed between groups at any time point for PROM scores or for changes in PROM scores across consecutive evaluations (P≥0.05 for all comparisons). Urinary retention occurred more frequently, and hospital stays were longer in the fixative group (P=0.006 and P<0.001, respectively). The excisional group had a greater need for narcotic use and longer duration of use (P=0.003 and P<0.001, respectively).ConclusionThis real-world cohort study shows that all 3 surgical approaches are effective for HD, providing comparable short-term symptomatic relief and patient satisfaction. These techniques appear equally valid treatment options, and the choice of procedure may best be individualized based on patient-specific characteristics and surgeon preference.Trial registrationClinicalTrials.gov identifier: NCT05429060

PurposeTraditionally, fasting from midnight has been a standard practice in elective surgery for reduce the risk of aspiration. However, Enhanced Recovery After Surgery (ERAS) programs recommend clear fluid intake until 2 hours before anesthesia. This study aimed to evaluate the safety and patient satisfaction of preoperative carbohydrate drink intake until 2 hours before colorectal cancer surgery.MethodsSixty patients who underwent colorectal cancer surgery between April 2021 and February 2023 at Keimyung University Dongsan Medical Center were enrolled. This study included 30 patients who fasted from midnight (nothing by mouth [NPO] group) and 30 patients who consumed a high concentration of complex carbohydrate fluids (New Care NO-NPO) until 2 hours before surgery (No-NPO group). Patient satisfaction was assessed using a visual analog scale. Perioperative and postoperative outcomes were compared.ResultsBasic characteristics of patients were similar for the 2 groups. The No-NPO group had a significantly higher patient satisfaction score than the NPO group (3.7 vs. 2.2, P=0.040). Scores of operative difficulty, operation time, blood loss, postoperative recovery parameters, and postoperative complication rates were similar for the 2 groups. Pathological outcomes were also comparable. No mortality occurred in either group.ConclusionHigh-concentration carbohydrate fluid intake until 2 hours before induction of anesthesia could improve patient satisfaction without increasing postoperative complications, demonstrating its safety and feasibility in colorectal cancer surgery.Trial registrationCRIS (cris.nih.go.kr) identifier: KCT0011323.

PurposeLow anterior resection syndrome (LARS) is common and devastating complication for patients with rectal cancer who have undergone sphincter-sparing surgery. Prunes are a fiber-rich fruit being effective in treating chronic constipation. The aim of this study was to investigate the effect of prune consumption on the incidence of LARS.MethodsA prospective, double-arm, parallel, nonblinded, randomized controlled trial was conducted from September 2019 to March 2021 at a single tertiary center for patients who underwent low anterior resection. Patients randomized to the prune group consumed prune daily for 2 weeks after surgery, while those in the no-prune group did not. The primary outcome was the incidence of major LARS at 3 weeks after surgery.ResultsA total of 130 patients were randomized and 118 completed the study (81 men, 37 women), including 55 patients (46.6%) in the prune group and 63 patients (53.4%) in the no-prune group. LARS was confirmed in 15 patients (27.3%) in the prune group and 47 patients (74.6%) in the no-prune group (P<0.001). The incidence of major LARS was also significantly lower in the prune group (18.2% vs. 61.9%, P<0.001). Multivariable analysis showed that the level of anastomosis and prune consumption were significantly associated with the incidence of LARS. The prune group had higher emotional scores and lower symptom scores for constipation, sleep disturbance, and loss of appetite in the quality-of-life questionnaire.ConclusionPrune consumption significantly reduced the incidence of LARS and improved quality of life after low anterior resection.Trial registrationCRIS identifier: KCT0006085 (registered on September 1, 2019).