Neutrophil-to-lymphocyte ratio as an early predictor of anastomotic leakage after rectal cancer surgery.

Impact of Riolan arch and mesenteric vascular anatomy on tissue oxygenation in rectal cancer surgery: A prospective study on inferior mesenteric artery ligation strategies.

Circumferential resection margin (CRM) has been shown to be a strong predictor of risk of local recurrence (LR) and distant metastases (DM) in patients with rectal cancer treated with total mesorectal excision (TME). However, not all patients with a CRM of zero develop LR or DM. This study aimed to identify factors associated with disease-free survival (DFS) despite non-radical excision (CRM=0 mm). Patients surgically treated for adenocarcinoma of the rectum between 2005 and 2013 were identified through the Swedish ColoRectal Cancer Registry. Of 8,392 patients included in the study, 159 (1.8%) were found to have CRM 0 mm. The rates of LR (n=27; 17%) and DM (n=62; 39%) were high in the CRM 0 mm group; however, more than half of these patients developed neither (n=84; 52.8%). Stage II disease was associated with a higher DFS [odds ratio (OR)=2.15; 95% confidence interval (CI)=1.11-4.18] compared with stage III disease. Neoadjuvant chemotherapy was a negative prognostic factor of DFS (OR=0.47, 95% CI=0.23-0.97) independent of the stage of disease. Over half of the patients with CRM 0 mm after rectal cancer surgery did not develop LR or DM. Lower stage of disease and no neoadjuvant chemotherapy were associated with a better DFS. These findings suggest that other biological or molecular factors may influence prognosis after non-radical excision, highlighting the need for further research to improve postoperative management and follow-up.

We conducted a comparative retrospective bicentric study of rectal endometriosis treatment with high-intensity focused ultrasound (HIFU) and surgery in terms of symptoms and treatment-related morbidity at 6 months. All patients with a single symptomatic rectal nodule who had failed hormonal treatment were included in the present study. Patients' symptomatology was assessed using questionnaires: gynecologic and digestive symptoms (visual analog scale [VAS]), health status (MOSSF-36), fecal incontinence (Wexner), constipation (Knowles Eccersley Scott Symptom [KESS] score) and overall sexual health (FSFI). We also assessed the morbidity according to the Clavien-Dindo classification. A total of 120 patients, 60 in each group, received HIFU or rectal surgery. The characteristics of rectal nodules were similar in both groups. In the HIFU and surgery groups, Clavien-Dindo grades 2 and 3 complication rates were 3.3% versus 21.7% (P = 0.002) and 0% versus 10% (P = 0.01), respectively. Hospitalization duration was also significantly shorter for the HIFU group (1 vs 3 days; P < 0.001). In the HIFU group, significant improvement was observed in acute pelvic pain/dysmenorrhea (P < 0.001), dyspareunia (P < 0.001), diarrhea (P < 0.001), tenesmus/spasms (P < 0.001), pain on defecation (P < 0.001), and urinary urgency (P < 0.026). In the surgical arm, significant improvement was observed in acute pelvic pain/dysmenorrhea (P < 0.017), diarrhea (P < 0.002), tenesmus/spasms (P < 0.001), and pain on defecation (P < 0.002). In both groups, an improvement in FSFI, KESS, and Wexner scores and health status was noted at 6 months. In selected patients with only one rectal location, HIFU treatment enables a similar symptom-related and quality-of-life outcome with a significant reduction in the risk of postoperative complications.

Children's experiences of functional constipation: A qualitative reflexive thematic analysis.

Objective To investigate high-risk factors for anastomotic fistula after laparoscopic radical resection of rectal cancer and establish a prediction model. Methods This is a retrospective cohort study included a total of 306 patients diagnosed with rectal cancer who underwent laparoscopic radical resection in the Second People’s Hospital of Foshan from January 2022 to December 2024. The patients were randomly divided into a training set ( N = 214) and a validation set ( N = 92) in a 7:3 ratio. Models were constructed using univariate logistic regression analysis and multivariate logistic regression analysis based on the training set. Subsequently, the predictive capability of the model was evaluated using calibration curves, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and validation sets. Results The training set included 29 patients (13.6%) who developed anastomotic fistulas postoperatively. The study identified five predictive factors: gender ( P = 0.032, OR = 2.68, 95% CI = 1.09–6.61), tumor stage ( P = 0.008, OR = 3.66, 95% CI = 1.41–9.49), tumor location ( P = 0.046, OR = 2.53, 95% CI = 1.02–6.30), surgical duration ( P = 0.031, OR = 2.72, 95% CI = 1.10–6.76), and hypoalbuminemia ( P = 0.005, OR = 4.28, 95% CI = 1.56–11.72). The AUC of the training set is 0.776 (95% CI = 0.673–0.879). The calibration curve validation showed that the predicted and measured values were in general agreement. DCA highlighted the model’s clinical utility. Conclusion The predictive model established in this study provides a tool for clinicians to identify high-risk patients for anastomotic fistula formation following laparoscopic radical rectal cancer surgery at an early stage. This facilitates early identification, detection, intervention and prevention of high-risk anastomotic fistula patients, thereby effectively reducing the risk of anastomotic fistula formation following laparoscopic radical rectal cancer surgery.

Objective: To characterize the endoscopic severity distribution and clinical features of diversion colitis (DC) following curative resection for rectal cancer with concurrent ileostomy. Methods: This descriptive observational study enrolled patients who met the following criteria: (1) preoperative histopathological confirmation of primary rectal adenocarcinoma via colonoscopic biopsy; (2) curative rectal cancer surgery (open or laparoscopic) with simultaneous prophylactic loop ileostomy; (3) subsequent ileostomy closure; and (4) complete medical records of 1-month follow-up data after closure. Patients who underwent abdominoperineal resection or had inadequate bowel preparation precluding clear endoscopic mucosal visualization were excluded. Clinical data were retrospectively collected for 173 patients who underwent the aforementioned procedures at Peking University People's Hospital between January, 2023 and December, 2024. Primary endpoints were the overall incidence of endoscopic DC, its severity distribution (mild, moderate, severe), and specific manifestations (edema, mucosal hemorrhage, and contact bleeding). Secondary endpoints included the low anterior resection syndrome (LARS) score [range 0-42; no LARS (0-20), minor LARS (21-29), major LARS (30-42)] and bowel function-related symptoms (abdominal pain, mucous stool, rectal bleeding before and after closure, and diarrhea after closure). Results: Among the cohort, 108 patients (62.4%) were male, with a median age of 67 years (IQR 59-73). Endoscopic assessment revealed a 100% overall incidence of DC. Moderate to severe edema was present in 113 patients (65.3%), mucosal hemorrhage in 105 (60.7%), and contact bleeding in 66 (38.2%). Based on DC severity scores, cases were classified as mild in 52 (30.1%), moderate in 72 (41.6%), and severe in 49 (28.3%). Compared to the mild/moderate DC group, the severe DC group had a significantly longer median time to stoma closure [5.7 months (IQR 3.8, 7.7) vs. 4.7 months (IQR 3.7, 5.9); Z=2.335, P=0.020] and higher C-reactive protein levels (P=0.002). The severe DC group also exhibited higher incidences of pre-closure abdominal pain [20.4% (10/49) vs. 8.1% (10/124); χ²=5.234, P=0.022] and post-closure rectal bleeding [18.4% (9/49) vs. 8.1% (10/124); χ²=3.813, P = 0.049]. Furthermore, the severe DC group had a higher median LARS total score [31 (IQR 27, 38) vs. 27 (IQR 15, 34); Z=2.370, P=0.018] and a significantly greater proportion of patients with clustered defecation [59.2% (29/49) vs. 37.1% (46/124); χ²=6.977, P=0.031]. There were no statistically significant in other defecation function related symptoms between the two groups (all P>0.05). Conclusion: DC is an extremely common finding after curative rectal cancer surgery with concurrent ileostomy. Severe DC is associated with a longer interval to stoma closure, elevated inflammatory markers, and inferior postoperative bowel function.

This study aimed to characterize bowel function, anorectal physiology, and health-related quality of life (HRQoL) in rectal cancer patients following low anterior resection (LAR), comparing three groups: a control group with late stoma closure (LSC) (> 3 months), an early stoma closure group (ESC) (8-10 days), and an anastomotic leakage group (AL). This cross-sectional study evaluated anorectal function using anorectal manometry. Bowel function and HRQoL were assessed using the low anterior resection syndrome (LARS) score and the EORTC QLQ-CR29 questionnaires. Of 124 eligible participants, 42 accepted participation. ESC and AL had significantly lower median (IQR) pressures in mmHg compared to LSC: rest: LSC: 54 (50-77), ESC: 35 (20-45), AL: 28 (22.5-33), p = 0.001, p < 0.001; squeeze: LSC: 140 (95-168), ESC: 70 (46-95), AL: 71 (45-81.5), p = 0.010, p = 0.004; squeeze pressure increments: LSC: 72 (60-89), ESC: 36 (30-48) and AL: 38 (25.5-54), p = 0.003, p = 0.004. ESC showed higher but non-significant median (IQR) volumes in ml: first sensation: LSC: 30 (20-40), ESC: 40 (30-50), p = 0.153; urge: LSC: 55 (45-100), ESC: 90 (65-100) p = 0.269; max: LSC: 110 (80-180), ESC: 142 (105-179), p = 0.713. No differences in mean (95% CI) total LARS scores were detected: LSC: 26.5 (21.9-31.1), ESC: 29.5 (25.9-33.1), AL: 33.0 (28.0-38.0), p = 0.320, p = 0.051. Mean (95% CI) stool frequency was significantly higher in AL: 44.4 (32.1-56.8) compared to LSC: 29.4 (20.5-38.4), p = 0.041. No differences in HRQoL were detected between the groups (p = 0.681, p = 0.129). No differences in anorectal function and HRQoL were detected between early and late reversal of diverting loop ileostomy.

Rectal fistula is a rare complication that may occur during and after radical prostatectomy, regardless of the applied surgical technique. It accounts for about ≤ 1% of surgical complications. Patients who have undergone radical prostatectomy associated with prior pelvic radiotherapy, previous rectal surgery and transurethral re-section of the prostate have an increased risk for incidence of anorectal fistula. This review analyzes recent original studies and reviews. The studies evaluated deal with important prognosis and incidence rates, while studies related to the therapeutic resolution of the problem were excluded. The four different types of surgical techniques (ORP, RPP, LRP and RARP) to remove the prostate were also compared, in order to identify the best method associated with the fewest complications. This study aims to evaluate specific literature in order to understand which surgical technique is associated with the lowest risk of this complication, and the prognostic factors that lead to a higher risk of rectal injuries.

Achieving Quality Outcomes at reduced costs in Robotic Rectal Cancer Surgery: A Tertiary Centre's experience with 330 Robotic Rectal Cancer resections.

Low anterior resection syndrome describes chronic debilitating bowel dysfunction following rectal cancer surgery and is associated with poor quality of life. Conservative self-management strategies are the first-line treatment for low anterior resection syndrome. Qualitative analysis of text data generated by participants through an online Informational and Peer Support App, which was successfully tested through a multicenter randomized controlled trial. Forum posts were generated by study participants, peer mentors and healthcare providers. Data analyzed from the App included forum posts, chat night transcripts and video comments. Using an affinity diagram approach, 2 reviewers independently identified and organized themes from the compiled texts. To explore the lived experience of using self-management for low anterior resection syndrome among rectal cancer survivors who have actively participated on the App. In total, there were 45 participants and 2,363 App logins over 6 months. Of the 786 posts exchanged through the App, 112 (14.2%) were made by healthcare providers, and the rest by participants and peer mentors. Thematic analysis revealed 7 themes and 27 subthemes, which included: 1) diet: use and benefit of food diaries, trigger foods and probiotics, fiber supplements, and personalized dietary guide with the help of a nutritionist; 2) coping strategies: sense of humor, finding peace with acceptance of 'new normal' and managing expectations and recognition of the toll LARS can have on mental health; 3) transanal irrigation: initial reluctance to try it, learning to perform transanal irrigation from peers online, leading to significant improvement in bowel function; 4)Benefits of peer support: sharing of knowledge and sense of community found through peer support are empowering and provide hope. Small sample size, selection bias. This qualitative analysis highlighted the lived experience and unmet needs of rectal cancer survivors pursuing self-management strategies for low anterior resection syndrome. See Video Abstract.

Phase-specific impact of patient anatomy on rectal cancer surgery: robotic assistance neutralizes dissection difficulty.

The new modified four-factor functional frailty index (mFF-4) in colorectal surgery: A retrospective cohort study.

BackgroundAnastomotic leakage (AL) is a severe complication after rectal cancer surgery. This network meta-analysis (NMA) compares reinforced suturing (RS), transanal drainage tube (TDT), and no additional intervention (NRT) for AL prevention.MethodsAn NMA was conducted according to PRISMA-NMA guidelines. PubMed, Web of Science, and Embase were searched for randomized controlled trials and observational studies comparing RS, TDT, or NRT in adults undergoing anterior resection for rectal cancer, with AL as the primary outcome. Secondary outcomes included Grade C AL, stricture, bleeding, ileus, and wound infection.Results16 studies (3 RCTs, 11 RNCTs, and 2 PNCTs; n = 4562) were included. For overall AL incidence, both RS (OR 0.32, 95% CrI 0.16–0.62) and TDT (OR 0.47, 95% CrI 0.33–0.63) significantly reduced AL vs. NRT. RS ranked highest (SUCRA 0.93). Although RS had the highest SUCRA for overall AL, the RS–TDT contrast was not statistically significant(OR 1.44, 95% CrI 0.68–3.09), so ranking should not be over-interpreted as proof of superiority. For Grade C AL, RS significantly reduced risk versus both TDT (OR 5.01, 95% CrI 1.33–28.67) and NRT (OR 0.10, 95% CrI 0.02–0.32; SUCRA 0.99). No significant differences were found among interventions for anastomotic bleeding, ileus, or wound infection. TDT showed a trend toward reduced anastomotic stricture risk (SUCRA 0.73), but the effect was not statistically significant (TDT vs. NRT: OR 0.68, 95% CrI 0.19–2.27). Sensitivity analysis restricted to larger studies (≥ 100 patients/group) confirmed the robustness of primary outcomes.ConclusionsBoth RS and TDT were associated with a reduction in overall AL risk compared to NRT. Network estimates suggested that RS may be more effective than TDT in preventing the more severe Grade C AL; however, this finding is based on indirect comparisons with wide credible intervals and requires confirmation in future head-to-head trials. The choice of intervention may therefore depend on patient risk profile and clinical context.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00384-026-05085-y.

Circadian and gut-brain axis modulation is associated with neuroimmune and symptom recovery after rectal cancer surgery: An exploratory randomized controlled trial.

Creating and validating an anastomotic leakage risk prediction model after laparoscopic low anterior resection for rectal cancer.

PurposeThis study investigated the patient factors leading to ICG fluorescence angiography (ICG–FI)–guided surgical plan changes during rectal cancer surgery and evaluated the impact of these changes on anastomotic height and postoperative bowel function.MethodsIn a retrospective analysis of 302 patients undergoing laparoscopic low anterior resection, we compared 28 patients requiring perfusion-based plan changes (Change group) to 274 without changes (No-Change group). We analyzed demographics, anastomotic height, and 6-month LARS scores.ResultsThe Change group had significantly older age, higher BMI, more neoadjuvant therapy, and lower tumor height. Their final anastomoses were higher (8.0 vs. 6.0 cm, p < 0.001). This group also had better bowel function, with lower LARS scores (18 vs. 25, p = 0.007) and fewer major LARS cases (14.3% vs. 32.1%, p = 0.041). Anastomotic leakage rates were similar.ConclusionsICG–FI identifies patients with perfusion risk factors (age, obesity, neoadjuvant therapy, low tumors) who benefit from surgical plan modification. Guiding the proximal resection margin based on ICG assessment to create a higher, well-perfused anastomosis significantly improves functional outcomes, underscoring its role in personalized surgery.Trial registrationThe study was registered in the clinical trials registry with registration number NCT06270745.

BackgroundSurgical site infection (SSI), wound-related complications, and incisional hernia are common concerns following stoma reversal. These complications can significantly impair postoperative recovery and quality of life, especially in rectal cancer patients. This study compared the clinical and patient-reported outcomes of two protective stoma reversal procedures, the gunsight and conventional linear closure techniques.MethodsA retrospective propensity score matching (PSM) analysis was conducted on 194 patients who underwent stoma reversal between 2016 and 2023. Baseline characteristics, surgical outcomes, postoperative complications, and patient satisfaction were compared between the gunsight and conventional closure groups. A structured, self-designed questionnaire based on the principles of patient-reported outcome measures (PROMs) was administered at 6 months post-operatively to assess pain relief, wound healing, scar appearance, and functional recovery.ResultsAfter PSM, 97 matched pairs were analyzed. The gunsight group had significantly lower SSI rates (11.34% vs. 22.68%, p = 0.036) and reported lower postoperative pain scores on POD 1 (p < 0.001) and POD 2 (p = 0.003). No significant differences were observed in terms of operative time, hospital stay, wound dehiscence, or incidence of incisional hernia. Patient-reported satisfaction with pain relief was significantly greater in the gunsight group (p = 0.012), whereas overall satisfaction scores were comparable.ConclusionThe gunsight closure technique reduces postoperative infections and early postoperative pain without increasing complication rates. It also improves early patient-reported outcomes, making it a safe, effective, and patient-centered alternative for stoma reversal in rectal cancer surgery.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00384-025-05062-x.

Preoperative prediction of surgical difficulty in robotic-assisted total mesorectal excision for rectal cancer remains challenging. While pelvic anatomical parameters measured by MRI have been associated with surgical complexity in laparoscopy, their role in robotic surgery is not well-established. This study aimed to develop and validate a predictive model for adverse surgical outcomes by integrating machine learning and logistic regression with comprehensive preoperative MRI pelvimetry and clinical data. A retrospective multi-center study was conducted involving 1,367 patients who underwent robotic or laparoscopic radical resection for mid-to-low rectal cancer. Patients were divided into Cohort 1 (training/internal validation, n = 997) and Cohort 2 (external validation, n = 370). Eleven MRI-based pelvic parameters and baseline characteristics were analyzed. Three machine learning algorithms-Random Forest, XGBoost, and LightGBM-alongside traditional logistic regression were used for model development. Although LightGBM demonstrated the best performance among machine learning models (AUC: 0.770), logistic regression outperformed all machine learning approaches and was selected as the final model. Multivariable analysis identified six independent predictors: BMI > 25kg/m², neoadjuvant chemoradiotherapy, tumor distance from anal verge < 5cm, laparoscopic (vs. robotic) approach, interspinous distance < 9.94cm, and intertuberous diameter < 11.98cm. The logistic regression-based nomogram showed excellent discrimination, with AUCs of 0.857 (training), 0.820 (internal validation), and 0.810 (external validation). Decision curve and calibration analyses confirmed clinical utility and prediction accuracy. This study successfully developed and validated a robust prediction model integrating MRI-based pelvimetry and clinical factors to identify patients at high risk of adverse outcomes following rectal cancer surgery. The model supports the use of robotic surgery to mitigate risks in anatomically challenging cases. Prospective multicenter studies are warranted to further validate its clinical applicability.

This study compares the clinical benefits of double-tube end ileostomy versus traditional end ileostomy in patients undergoing low anterior resection for rectal cancer. A retrospective analysis was conducted on 65 patients who underwent laparoscopic radical rectal cancer surgery with preventive ileostomy between March 2022 and December 2024 at the First Affiliated Hospital of Anhui Medical University. Among these, 47 patients received traditional ileostomy, while 18 patients underwent double-tube ileostomy. The clinical characteristics and follow-up outcomes of the two groups were compared. Both groups showed no significant differences in intraoperative blood loss, postoperative bowel function recovery, or complication rates (P > 0.05). However, the double-tube ileostomy group had superior outcomes: average stoma creation time was 25.39 ± 2.85min, postoperative hospital stays averaged 8.89 ± 2.30days, and total hospitalization costs were 57,796.50 ± 5306.30 RMB, all significantly lower than in the traditional ileostomy group (P < 0.01). Complications were fewer in the double-tube group, with only one case of type A anastomotic leakage (5.56%) and no long-term complications following successful tube removal. By contrast, the traditional group had 4 cases of leakage (8.51%), and 16 patients experienced long-term complications, with only 40 (85.11%) achieving successful stoma closures. Furthermore, patients in the traditional group reported higher SCL-90 scores for somatization and sleep and eating problems (P < 0.05), indicating significant differences between the groups. Double-tube end ileostomy offers a safe and effective alternative to traditional methods, with shorter operative times, fewer secondary surgeries, and reduced physiological, psychological, and financial burdens on patients.