BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burde...BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burden are limited.Electroacupuncture has been proposed as a potential adjunctive therapy,but its psychological benefits remain inadequately studied.AIM To investigate the therapeutic effect of electroacupuncture on emotional recovery and gastrointestinal function in patients with moderate to severe LARS,and to explore its potential advantages in psychologically vulnerable subgroups.METHODS We conducted a retrospective,controlled study involving 100 patients with moderate to severe LARS(LARS score≥21)treated at two tertiary hospitals in China between January 2022 and December 2024.Patients received either standard postoperative care alone(n=50)or in combination with a standardized 4-week electroacupuncture protocol(n=50).Psychological and functional outcomes were assessed using validated instruments including Hospital Anxiety and Depression Scale(HADS),Body Image Scale(BIS),General Self-Efficacy Scale,Perceived Social Support Scale(PSSS),LARS score,and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at four time points.The primary endpoint was emotional remission,defined as a≥3-point reduction in HADS-Anxiety subscale(HADS-A).Analyses included repeated-measures comparisons,Kaplan-Meier survival curves,Cox regression models,and subgroup-interaction testing.RESULTS At baseline,demographic,surgical,and psychosocial characteristics were comparable among groups.By week 4,patients receiving electroacupuncture demonstrated significantly greater reductions in anxiety(HADS-A:4.8±2.6 vs 7.3±3.0;P<0.001),depression,and body-image disturbance(BIS:8.7±3.6 vs 11.9±4.2;P<0.001),alongside enhanced coping capacity(Brief Coping Orientation to Problems Experienced),perceived social support(PSSS),and bowel function(LARS score).Emotional remission-defined as a≥3-point HADS-A reduction-was achieved more rapidly in the electroacupuncture group,as confirmed by Kaplan-Meier analysis(log-rank P<0.001;odds ratio=4.7).Multivariate Cox regression identified higher baseline LARS and BIS scores as independent predictors of delayed emotional recovery.Subgroup analyses revealed significantly amplified treatment benefits in patients with high baseline anxiety(HADS-A≥8),elevated body-image disturbance(BIS≥12),or low perceived social support(PSSS<60),with consistent interaction effects(P for interaction<0.05 across subgroups).CONCLUSION Electroacupuncture may accelerate emotional recovery and improve functional and psychosocial outcomes in patients with LARS.Its integration into postoperative care may offer particular benefits for psychologically vulnerable subgroups.展开更多
BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT e...BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT enhances resect-ability,improves treatment compliance,increases the rate of pathological comp-lete response,and reduces the risk of systemic recurrence.However,concerns have been raised that the prolonged interval to surgery associated with TNT,particularly in regimens such as the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol,may exacerbate fibrosis,leading to more technically challenging resections and poorer surgical outcomes.RAPIDO vs LCCRT.METHODS A single-center,retrospective cohort study was conducted of patients with LARC treated with TNT-RAPIDO or standard LCCRT followed by surgical resection between 2014 and 2024.A total of 99 patients with LARC were analyzed,inclu-ding 29 treated with TNT-RAPIDO and 70 treated with standard LCCRT.Demo-graphics,clinicopathological characteristics and early post-operative outcomes were compared between both groups.RESULTS Both groups were comparable in terms of demographics and clinicopathological characteristics.The median interval from initiation of neoadjuvant therapy to Core Tip:Rectal cancer and preoperative induction therapy followed by dedicated operation has emerged as a total neoadjuvant therapy strategy with improved oncological and functional outcomes.The impact of total neoadjuvant therapy on operative difficulty and short-term surgical outcomes,compared with long-course chemoradiotherapy,remains an area of ongoing debate.This cohort study of 99 patients demonstrated that the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol does not increase surgical difficulty or compromise early surgical outcomes compared with long-course chemoradiotherapy.It may also confer a shorter total stoma duration and a lower permanent stoma rate.randomized controlled trials in the future are warranted to more accurately assess the differences between TNT-RAPIDO and LCCRT in relation to oncological outcomes.展开更多
BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the cor...BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.展开更多
BACKGROUND The peritumoral region possesses attributes that promote cancer growth and progression.However,the potential prognostic biomarkers in this region remain relatively underexplored in radiomics.AIM To investig...BACKGROUND The peritumoral region possesses attributes that promote cancer growth and progression.However,the potential prognostic biomarkers in this region remain relatively underexplored in radiomics.AIM To investigate the prognostic value and importance of peritumoral radiomics in locally advanced rectal cancer(LARC).METHODS This retrospective study included 409 patients with biopsy-confirmed LARC treated with neoadjuvant chemoradiotherapy and surgically.Patients were divided into training(n=273)and validation(n=136)sets.Based on intratumoral and peritumoral radiomic features extracted from pretreatment axial high-resolution small-field-of-view T2-weighted images,multivariate Cox models for progression-free survival(PFS)prediction were developed with or without clinicoradiological features and evaluated with Harrell’s concordance index(C-index),calibration curve,and decision curve analyses.Risk stratification,Kaplan-Meier analysis,and permutation feature importance analysis were performed.RESULTS The comprehensive integrated clinical-radiological-omics model(ModelICRO)integrating seven peritumoral,three intratumoral,and four clinicoradiological features achieved the highest C-indices(0.836 and 0.801 in the training and validation sets,respectively).This model showed robust calibration and better clinical net benefits,effectively distinguished high-risk from low-risk patients(PFS:97.2%vs 67.6%and 95.4%vs 64.8%in the training and validation sets,respectively;both P<0.001).Three most influential predictors in the comprehensive ModelICRO were,in order,a peritumoral,an intratumoral,and a clinicoradiological feature.Notably,the peritumoral model outperformed the intratumoral model(C-index:0.754 vs 0.670;P=0.015);peritumoral features significantly enhanced the performance of models based on clinicoradiological or intratumoral features or their combinations.CONCLUSION Peritumoral radiomics holds greater prognostic value than intratumoral radiomics for predicting PFS in LARC.The comprehensive model may serve as a reliable tool for better stratification and management postoperatively.展开更多
BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic...BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.展开更多
BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually be...BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.展开更多
BACKGROUND The liver,as the main target organ for hematogenous metastasis of colorectal cancer,early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients.Herein,this study...BACKGROUND The liver,as the main target organ for hematogenous metastasis of colorectal cancer,early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients.Herein,this study aims to investigate the application value of a combined machine learning(ML)based model based on the multiparameter magnetic resonance imaging for prediction of rectal metachronous liver metastasis(MLM).AIM To investigate the efficacy of radiomics based on multiparametric magnetic resonance imaging images of preoperative first diagnosed rectal cancer in predicting MLM from rectal cancer.METHODS We retrospectively analyzed 301 patients with rectal cancer confirmed by surgical pathology at Jingzhou Central Hospital from January 2017 to December 2023.All participants were randomly assigned to the training or validation queue in a 7:3 ratio.We first apply generalized linear regression model(GLRM)and random forest model(RFM)algorithm to construct an MLM prediction model in the training queue,and evaluate the discriminative power of the MLM prediction model using area under curve(AUC)and decision curve analysis(DCA).Then,the robustness and generalizability of the MLM prediction model were evaluated based on the internal validation set between the validation queue groups.RESULTS Among the 301 patients included in the study,16.28%were ultimately diagnosed with MLM through pathological examination.Multivariate analysis showed that carcinoembryonic antigen,and magnetic resonance imaging radiomics were independent predictors of MLM.Then,the GLRM prediction model was developed with a comprehensive nomogram to achieve satisfactory differentiation.The prediction performance of GLRM in the training and validation queue was 0.765[95%confidence interval(CI):0.710-0.820]and 0.767(95%CI:0.712-0.822),respectively.Compared with GLRM,RFM achieved superior performance with AUC of 0.919(95%CI:0.868-0.970)and 0.901(95%CI:0.850-0.952)in the training and validation queue,respectively.The DCA indicated that the predictive ability and net profit of clinical RFM were improved.CONCLUSION By combining multiparameter magnetic resonance imaging with the effectiveness and robustness of ML-based predictive models,the proposed clinical RFM can serve as an insight tool for preoperative assessment of MLM risk stratification and provide important information for individual diagnosis and treatment of rectal cancer patients.展开更多
BACKGROUND Colorectal cancer(CRC)ranks high among the most common types of malignant tumors.The primary cause of cancer-related mortality is metastasis,with lung metastases accounting for 32.9%of all cases of metastat...BACKGROUND Colorectal cancer(CRC)ranks high among the most common types of malignant tumors.The primary cause of cancer-related mortality is metastasis,with lung metastases accounting for 32.9%of all cases of metastatic CRC(MCRC).However,cases of MCRC in the lungs,which present concurrently with primary peripheral lung adenocarcinoma,are exceptionally rare.CASE SUMMARY This report describes the case of a 52-year-old female patient who,following a colonoscopy,was diagnosed with moderately differentiated adenocarcinoma based on rectal mucosal biopsy findings.A preoperative chest computed tomography scan revealed a ground-glass nodule in the right lung and a small nodule(approximately 0.6 cm in diameter)in the extramural basal segment of the left lower lobe,which suggested multiple lung metastases from rectal cancer.Subsequent treatment and follow-up led to a diagnosis of rectal cancer with left lung metastasis and peripheral adenocarcinoma of the lower lobe of the right lung.CONCLUSION This case report describes the therapeutic journey of a patient with lung metastasis from rectal cancer in addition to primary peripheral adenocarcinoma,thus underscoring the critical roles of multidisciplinary collaboration,personalized treatment strategies,and comprehensive patient rehabilitation guidance.展开更多
A recent study by Long et al used a predictive model to explore the efficacy of radiomics based on multiparametric magnetic resonance imaging in predicting metachronous liver metastasis(MLM)in newly diagnosed rectal c...A recent study by Long et al used a predictive model to explore the efficacy of radiomics based on multiparametric magnetic resonance imaging in predicting metachronous liver metastasis(MLM)in newly diagnosed rectal cancer(RC)patients.The machine learning algorithms,particularly the random forest model(RFM),appeared well-matched to the complex nature of radiomics data.The predictive capabilities of the RFM,as evidenced by the area under the curve of 0.919 in the training cohort and 0.901 in the validation cohort,highlighted its potential clinical utility.However,we highlighted several methodological limi-tations,including excluding genomic markers,potential biases from the retro-spective design,limited generalizability due to a single-center study,and variability in image interpretation.We propose further investigation into inte-grating multi-omic data,conducting larger multicenter studies,and utilizing advanced imaging techniques.Additionally,we highlighted the importance of interdisciplinary collaboration to improve predictive model development and advocate for cost-effectiveness analyses to facilitate clinical integration.Overall,this predictive model may improve the early detection and management of MLM in RC patients,with promising avenues for future exploration.Ongoing research in this domain can potentially improve clinical outcomes and the quality of care for RC patients.展开更多
BACKGROUND Rectal cancer has increased in incidence,and surgery remains the cornerstone of multimodal treatment.Pelvic anatomy,particularly a narrow pelvis,poses challenges in rectal cancer surgery,potentially affecti...BACKGROUND Rectal cancer has increased in incidence,and surgery remains the cornerstone of multimodal treatment.Pelvic anatomy,particularly a narrow pelvis,poses challenges in rectal cancer surgery,potentially affecting oncological outcomes and postoperative complications.AIM To investigate the relationship between radiologically assessed pelvic anatomy and surgical outcomes as well as the impact on local recurrence following rectal cancer surgery.METHODS We retrospectively analyzed 107 patients with rectal adenocarcinoma treated with elective rectal surgery between January 1,2017,and September 1,2022.Pelvimetric measurements were performed using computed tomography(CT)-based two-dimensional methods(n=77)by assessing the pelvic inlet area in mm^(2),and magnetic resonance imaging(MRI)-based three-dimensional techniques(n=52)using the pelvic cavity index(PCI).Patient demographic,clinical,radiological,surgical,and pathological characteristics were collected and analyzed in relation to their pelvimetric data.RESULTS When patients were categorized based on CT measurements into narrow and normal/wide pelvis groups,a significant association was observed with male sex,and a lower BMI was more common in the narrow pelvis group(P=0.002 for both).A significant association was found between a narrow pelvic structure,indicated by low PCI,and increased surgical morbidity(P=0.049).Advanced age(P=0.003)and male sex(P=0.020)were significantly correlated with higher surgical morbidity.Logistic regression analysis identified four parameters that were significantly correlated with local recurrence:older age,early perioperative readmission,longer operation time,and a lower number of dissected lymph nodes(P<0.05).However,there were no significant differences between the narrow and normal/wide pelvis groups in terms of the operation time,estimated blood loss,or overall local recurrence rate(P>0.05).CONCLUSION MRI-based pelvimetry may be valuable in predicting surgical difficulty and morbidity in rectal cancer surgery,as indicated by the PCI.The observed correlation between low PCI and increased surgical morbidity suggests the potential importance of a preoperative MRI-based pelvimetric evaluation.In contrast,CT-based pelvimetry did not show significant differences in predicting surgical outcomes or cancer recurrence,indicating that the utility of pelvimetry alone may be limited in these respects.展开更多
Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and p...Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.展开更多
BACKGROUND According to the Global Cancer Statistics Report,the incidence of colorectal cancer ranks third and the mortality rate ranks second worldwide among malignant tumors.AIM To explore the effects of Nursing Out...BACKGROUND According to the Global Cancer Statistics Report,the incidence of colorectal cancer ranks third and the mortality rate ranks second worldwide among malignant tumors.AIM To explore the effects of Nursing Outcomes Classification(NOC)-based multidimensional nursing on self-efficacy and symptom relief in patients with low anterior resection syndrome(LARS)following sphincter-preserving surgery.METHODS This observational study enrolled 120 patients with LARS after sphincterpreserving surgery for low rectal cancer admitted to our hospital between January 2022 and December 2024.The patients were randomly divided into a control group(n=60)that received routine nursing intervention or an observation group(n=60)that received multidimensional nursing intervention.Before and after the intervention,the Chinese version of the Self-Management Efficacy Scale for Cancer Patients(SUPPH),the LARS scoring scale,and the European Organization for Research and Treatment of Cancer Quality of Life Core Scale(EORTC QLQC30)were used to evaluate the self-efficacy,symptom relief,and quality of life of the two patient groups,and the nursing satisfaction was compared between the groups.RESULTS After the intervention,both groups showed increased scores for each item on the SUPPH and EORTC QLQ-C30 scales compared with those before the intervention,whereas the LARS score showed a decreasing trend.Compared with the control group,the scores for each item of the SUPPH and EORTC QLQ-C30 scales in the observation group were significantly higher after the intervention,while the LARS score was significantly lower(all P<0.05).Nursing satisfaction was significantly higher in the observation group than in the control group(83.33%vs 95.00%,P<0.05).CONCLUSION Multidimensional NOC-based nursing improves self-efficacy,symptoms,quality of life,and satisfaction in patients with LARS.However,further research is needed to assess its long-term and comparative effectiveness.展开更多
BACKGROUND With advances in sequencing techniques,microbiota dysbiosis and pathogenic microbes that accelerate colorectal cancer progression have been identified and widely reported.However,few studies have focused on...BACKGROUND With advances in sequencing techniques,microbiota dysbiosis and pathogenic microbes that accelerate colorectal cancer progression have been identified and widely reported.However,few studies have focused on the microbiota taxa of rectal mucus in rectal cancer(RC)patients.Here,we analyzed the composition and characteristics of the rectal mucosa microbiota of RC patients from Wenzhou city,China,and compared the results with those of healthy controls.AIM To explore the changes in the characteristics of the rectal mucosal flora associated with RC,and identify biomarkers of microbe taxa for RC.METHODS Rectal mucosa samples from a Chinese cohort of 72 recently diagnosed RC patients and 71 healthy controls were obtained.A validation cohort,which included 22 RC patients and 60 healthy controls,was also established.Changes in the rectal mucosal flora were observed by cultivation,16S ribosomal DNA gene sequencing analysis and quantitative polymerase chain reaction analysis.RESULTS The 16S ribosomal DNA results demonstrated that RC patients presented increased bacterial community richness and alpha diversity as well as an altered rectal mucosal microbiota,with depletion of Proteobacteria and Thermi and enrichment of Bacteroidetes and Fusobacteria in cancerous mucosal tissues(CM)and enrichment of Firmicutes and Cyanobacteria in adjacent noncancerous mucosal tissues(AM).The culture results showed that the mean loads of Escherichia coli,Bifidobacterium,Enterococcus,and Lactobacillus were significantly reduced in RC patients.The ratios of Prevotella to Ruminococcus[areas under the receiver operating curve:0.795 in AM vs normal control mucosa(NM),0.77 in CM vs NM]and of Prevotella stercorea to Propionibacterium acnes(areas under the receiver operating curve:0.808 in AM vs NM,0.843 in CM vs NM)exhibited excellent abilities to differentiate between healthy controls and RC patients.CONCLUSION RC patients have an altered rectal mucosal microbiota,and the ratio of Prevotella to Ruminococcus or the ratio of Prevotella stercorea to Propionibacterium acnes may serve as a marker for RC diagnosis.展开更多
BACKGROUND An efficient index holds the potential to predict rectal cancer prognosis.AIM To investigate the impact of neutrophil-to-lymphocyte ratio(NLR),platelet-tolymphocyte ratio(PLR),and monocyte-to-lymphocyte rat...BACKGROUND An efficient index holds the potential to predict rectal cancer prognosis.AIM To investigate the impact of neutrophil-to-lymphocyte ratio(NLR),platelet-tolymphocyte ratio(PLR),and monocyte-to-lymphocyte ratio(MLR)on rectal cancer prognosis.METHODS This retrospective study involved 180 patients with rectal cancer from the Changzhi People’s Hospital of Shanxi Province.A 2-mL blood sample was collected at 24 h preoperatively and 72 h postoperatively to measure neutrophils,lymphocytes,platelets,and monocytes using an automatic blood analyzer.Preoperative and postoperative NLR,PLR,and MLR were compared.Patients were followed up for 12 months and categorized into good and poor prognosis groups.A receiver operating characteristic curve was constructed to analyze their predictive values.RESULTS The NLR,PLR,and MLR values were significantly lower post-surgery(P<0.05).A total of 152 and 28 patients were categorized in the good and poor prognosis groups,respectively.Patients with poor prognoses exhibited slightly higher postoperative NLR,PLR,and MLR values than those with good prognoses(P<0.05).Receiver operating characteristic analysis showed that the area under the curve for NLR,PLR,and MLR was 0.828 with a sensitivity and specificity of 89.29%and 90.79%,respectively.These values were higher than individual NLR(area under the curve:0.660,sensitivity:67.86%,specificity:54.61%),PLR(0.668,75.00%,55.30%),and MLR(0.635,60.71%,48.03%),all showing statistically significant differences(P<0.05),effectively predicting patient outcomes.CONCLUSION The findings of this study indicated that NLR,PLR,and MLR values of patients with rectal cancer can be used to effectively predict the outcome of patients.展开更多
Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly ma...Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly machine learning and deep learning,offer promising avenues for predicting and preventing AL.These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition,body composition,and radiological features.AI-based models have demonstrated superior predictive power compared to traditional statistical methods,potentially guiding clinical decisionmaking and improving patient outcomes.Additionally,AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes,minimizing the risk of intraoperative complications and reducing the likelihood of AL development.展开更多
BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisit...BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisited rectal anatomy,advances in surgical techniques and neoadjuvant therapies have enabled the possibility of sphincter-preserving procedures,however,it is uniformly not applicable.Selecting appropriate candidates for sphincter preservation is crucial,as an illadvised approach may compromise oncological outcome or lead to poor functional outcomes.Currently there is no consensus-which clinical,anatomical,or molecular factors most accurately predict the feasibility of sphincter-preserving surgery(SPS)in this subset of patients.By identifying these predictors,the study seeks to support improved patient selection,enhance surgical planning,and ultimately contribute to better functional and oncological outcomes in patients with low rectal cancer.AIM To identify predictive factors that determine the feasibility of SPS in patients with low rectal cancer.METHODS A comprehensive literature search was conducted using PubMed/MEDLINE databases.The search focused on various factors influencing the feasibility of SPS in low rectal cancer.These included patient-related factors,anatomical considerations,findings from different imaging modalities,advancements in diagnostic tools and techniques,and the role of neoadjuvant chemoradiotherapy.The relevance of each factor in predicting the potential for sphincter preservation was critically analyzed and presented based on the current evidence RESULTS Multiple studies have identified a range of predictive factors influencing the feasibility of SPS in low rectal cancer.Patient-related factors include age,sex,preoperative continence status,comorbidities,and body mass index.Anatomical considerations,such as tumor distance from the anal verge,involvement of the external anal sphincter,and levator ani muscles,also play a critical role.Additionally,a favourable response to neoadjuvant chemoradiotherapy has been associated with improved suitability for sphincter preservation.Several biomarkers,such as inflammatory markers like interleukins and C-reactive protein,as well as tumor markers like carcinoembryonic antigen,are important.Molecular markers,including BRAF and KRAS mutations and microsatellite instability status,have been linked to prognosis and may further guide decision-making regarding sphincter-preserving approaches.Artificial intelligence(AI)can further add in to select an ideal patient for sphincter preservation.CONCLUSION SPS is feasible in low rectal cancer and depends on patient factors,tumor anatomy and biology,preoperative treatment response,and biomarkers.In addition,tools and technology including AI can further help in selecting an ideal patient for long term optimal outcome.展开更多
We provide an editorial of recent findings on early recurrence(ER)in rectal cancer(RC),focusing on the study on ER of resectable RC by Tsai et al.The study established an 8-month recurrence-free survival cut-off for d...We provide an editorial of recent findings on early recurrence(ER)in rectal cancer(RC),focusing on the study on ER of resectable RC by Tsai et al.The study established an 8-month recurrence-free survival cut-off for differentiating ER from late recurrence,with implications for postrecurrence survival and overall survival.This offers not only a valuable timeframe for enhancing surveillance strategies in patients at higher risk,especially those who have undergone neoadjuvant chemoradiotherapy(CRT),but also raises questions about its applicability across different populations.Furthermore,the article suggests that while CRT is very effective in reducing locoregional recurrence,this treatment alone may not fully address the overall risk of ER.The authors advocate for personalized risk assessment and intensive surveillance during the postoperative period to improve outcomes,particularly in the first year.Future research should focus on larger,multicenter studies and incorporate advanced diagnostic techniques with genetic and molecular biomarkers to enhance prediction and management of ER.The ultimate goal is to refine treatment and surveillance strategies to improve survival and quality of life for patients with RC.展开更多
BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate...BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate of AL,their preventive effects are controversial.AIM To determine the efficacy of reinforcing sutures in preventing AL in rectal cancer.METHODS A systematic search of major medical databases was conducted to identify studies up to June 2024.Intraoperative and postoperative outcomes were assessed;the primary outcome assessed was the incidence of AL.Pooled odds ratios(ORs)and mean differences(MDs)with a 95%confidence interval(CI)were calculated using fixed-effect or random-effect models under heterogeneity.RESULTS This meta-analysis incorporated 20 studies involving 3726 patients.Pooled results demonstrated a statistically significant reduction AL incidence in the reinforced suture group(OR:0.26,95%CI:0.19-0.35,P<0.001)than the unreinforced suture group.The reinforced suture group also exhibited a shorter hospital stay(MD:-1.17,95%CI:-1.78 to-0.57,P<0.001),earlier anal exhaust(MD:-0.13,95%CI:-0.22 to-0.05,P=0.002),longer operative time(MD:15.25,95%CI:10.71-19.80,P<0.001),lower infection rate(OR:0.54,95%CI:0.29-1.00,P=0.05)and lower reoperation rate(OR:0.19,95%CI:0.08-0.45,P<0.001).CONCLUSION The results substantiate the clinical value of anastomotic reinforcement sutures in reducing AL incidence postrectal cancer surgery.Nevertheless,these conclusions warrant verification through additional high-quality randomized controlled trials.展开更多
Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including o...Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including only 15%-20%of patients achieving pathological complete response,underscores the urgent need for accurate predictive tools.This review explored current and emerging biomarkers to enhance neoadjuvant chemoradiotherapy response prediction and inform clinical practice.展开更多
BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete cli...BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment,which often translates to pathologic complete response(pCR)as assessed on surgical specimens after curative intent surgery.Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.AIM To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.METHODS An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.RESULTS Fifteen studies were identified through literature review.The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia.Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies.In most studies,the diagnostic accuracy for predicting pCR exceeded 0.8.The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.CONCLUSION Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.展开更多
文摘BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burden are limited.Electroacupuncture has been proposed as a potential adjunctive therapy,but its psychological benefits remain inadequately studied.AIM To investigate the therapeutic effect of electroacupuncture on emotional recovery and gastrointestinal function in patients with moderate to severe LARS,and to explore its potential advantages in psychologically vulnerable subgroups.METHODS We conducted a retrospective,controlled study involving 100 patients with moderate to severe LARS(LARS score≥21)treated at two tertiary hospitals in China between January 2022 and December 2024.Patients received either standard postoperative care alone(n=50)or in combination with a standardized 4-week electroacupuncture protocol(n=50).Psychological and functional outcomes were assessed using validated instruments including Hospital Anxiety and Depression Scale(HADS),Body Image Scale(BIS),General Self-Efficacy Scale,Perceived Social Support Scale(PSSS),LARS score,and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at four time points.The primary endpoint was emotional remission,defined as a≥3-point reduction in HADS-Anxiety subscale(HADS-A).Analyses included repeated-measures comparisons,Kaplan-Meier survival curves,Cox regression models,and subgroup-interaction testing.RESULTS At baseline,demographic,surgical,and psychosocial characteristics were comparable among groups.By week 4,patients receiving electroacupuncture demonstrated significantly greater reductions in anxiety(HADS-A:4.8±2.6 vs 7.3±3.0;P<0.001),depression,and body-image disturbance(BIS:8.7±3.6 vs 11.9±4.2;P<0.001),alongside enhanced coping capacity(Brief Coping Orientation to Problems Experienced),perceived social support(PSSS),and bowel function(LARS score).Emotional remission-defined as a≥3-point HADS-A reduction-was achieved more rapidly in the electroacupuncture group,as confirmed by Kaplan-Meier analysis(log-rank P<0.001;odds ratio=4.7).Multivariate Cox regression identified higher baseline LARS and BIS scores as independent predictors of delayed emotional recovery.Subgroup analyses revealed significantly amplified treatment benefits in patients with high baseline anxiety(HADS-A≥8),elevated body-image disturbance(BIS≥12),or low perceived social support(PSSS<60),with consistent interaction effects(P for interaction<0.05 across subgroups).CONCLUSION Electroacupuncture may accelerate emotional recovery and improve functional and psychosocial outcomes in patients with LARS.Its integration into postoperative care may offer particular benefits for psychologically vulnerable subgroups.
文摘BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT enhances resect-ability,improves treatment compliance,increases the rate of pathological comp-lete response,and reduces the risk of systemic recurrence.However,concerns have been raised that the prolonged interval to surgery associated with TNT,particularly in regimens such as the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol,may exacerbate fibrosis,leading to more technically challenging resections and poorer surgical outcomes.RAPIDO vs LCCRT.METHODS A single-center,retrospective cohort study was conducted of patients with LARC treated with TNT-RAPIDO or standard LCCRT followed by surgical resection between 2014 and 2024.A total of 99 patients with LARC were analyzed,inclu-ding 29 treated with TNT-RAPIDO and 70 treated with standard LCCRT.Demo-graphics,clinicopathological characteristics and early post-operative outcomes were compared between both groups.RESULTS Both groups were comparable in terms of demographics and clinicopathological characteristics.The median interval from initiation of neoadjuvant therapy to Core Tip:Rectal cancer and preoperative induction therapy followed by dedicated operation has emerged as a total neoadjuvant therapy strategy with improved oncological and functional outcomes.The impact of total neoadjuvant therapy on operative difficulty and short-term surgical outcomes,compared with long-course chemoradiotherapy,remains an area of ongoing debate.This cohort study of 99 patients demonstrated that the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol does not increase surgical difficulty or compromise early surgical outcomes compared with long-course chemoradiotherapy.It may also confer a shorter total stoma duration and a lower permanent stoma rate.randomized controlled trials in the future are warranted to more accurately assess the differences between TNT-RAPIDO and LCCRT in relation to oncological outcomes.
文摘BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.
文摘BACKGROUND The peritumoral region possesses attributes that promote cancer growth and progression.However,the potential prognostic biomarkers in this region remain relatively underexplored in radiomics.AIM To investigate the prognostic value and importance of peritumoral radiomics in locally advanced rectal cancer(LARC).METHODS This retrospective study included 409 patients with biopsy-confirmed LARC treated with neoadjuvant chemoradiotherapy and surgically.Patients were divided into training(n=273)and validation(n=136)sets.Based on intratumoral and peritumoral radiomic features extracted from pretreatment axial high-resolution small-field-of-view T2-weighted images,multivariate Cox models for progression-free survival(PFS)prediction were developed with or without clinicoradiological features and evaluated with Harrell’s concordance index(C-index),calibration curve,and decision curve analyses.Risk stratification,Kaplan-Meier analysis,and permutation feature importance analysis were performed.RESULTS The comprehensive integrated clinical-radiological-omics model(ModelICRO)integrating seven peritumoral,three intratumoral,and four clinicoradiological features achieved the highest C-indices(0.836 and 0.801 in the training and validation sets,respectively).This model showed robust calibration and better clinical net benefits,effectively distinguished high-risk from low-risk patients(PFS:97.2%vs 67.6%and 95.4%vs 64.8%in the training and validation sets,respectively;both P<0.001).Three most influential predictors in the comprehensive ModelICRO were,in order,a peritumoral,an intratumoral,and a clinicoradiological feature.Notably,the peritumoral model outperformed the intratumoral model(C-index:0.754 vs 0.670;P=0.015);peritumoral features significantly enhanced the performance of models based on clinicoradiological or intratumoral features or their combinations.CONCLUSION Peritumoral radiomics holds greater prognostic value than intratumoral radiomics for predicting PFS in LARC.The comprehensive model may serve as a reliable tool for better stratification and management postoperatively.
基金Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2022D01C297.
文摘BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.
基金Supported by Health Research Project of Hunan Provincial Health Commission,No.D202315018915.
文摘BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.
文摘BACKGROUND The liver,as the main target organ for hematogenous metastasis of colorectal cancer,early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients.Herein,this study aims to investigate the application value of a combined machine learning(ML)based model based on the multiparameter magnetic resonance imaging for prediction of rectal metachronous liver metastasis(MLM).AIM To investigate the efficacy of radiomics based on multiparametric magnetic resonance imaging images of preoperative first diagnosed rectal cancer in predicting MLM from rectal cancer.METHODS We retrospectively analyzed 301 patients with rectal cancer confirmed by surgical pathology at Jingzhou Central Hospital from January 2017 to December 2023.All participants were randomly assigned to the training or validation queue in a 7:3 ratio.We first apply generalized linear regression model(GLRM)and random forest model(RFM)algorithm to construct an MLM prediction model in the training queue,and evaluate the discriminative power of the MLM prediction model using area under curve(AUC)and decision curve analysis(DCA).Then,the robustness and generalizability of the MLM prediction model were evaluated based on the internal validation set between the validation queue groups.RESULTS Among the 301 patients included in the study,16.28%were ultimately diagnosed with MLM through pathological examination.Multivariate analysis showed that carcinoembryonic antigen,and magnetic resonance imaging radiomics were independent predictors of MLM.Then,the GLRM prediction model was developed with a comprehensive nomogram to achieve satisfactory differentiation.The prediction performance of GLRM in the training and validation queue was 0.765[95%confidence interval(CI):0.710-0.820]and 0.767(95%CI:0.712-0.822),respectively.Compared with GLRM,RFM achieved superior performance with AUC of 0.919(95%CI:0.868-0.970)and 0.901(95%CI:0.850-0.952)in the training and validation queue,respectively.The DCA indicated that the predictive ability and net profit of clinical RFM were improved.CONCLUSION By combining multiparameter magnetic resonance imaging with the effectiveness and robustness of ML-based predictive models,the proposed clinical RFM can serve as an insight tool for preoperative assessment of MLM risk stratification and provide important information for individual diagnosis and treatment of rectal cancer patients.
文摘BACKGROUND Colorectal cancer(CRC)ranks high among the most common types of malignant tumors.The primary cause of cancer-related mortality is metastasis,with lung metastases accounting for 32.9%of all cases of metastatic CRC(MCRC).However,cases of MCRC in the lungs,which present concurrently with primary peripheral lung adenocarcinoma,are exceptionally rare.CASE SUMMARY This report describes the case of a 52-year-old female patient who,following a colonoscopy,was diagnosed with moderately differentiated adenocarcinoma based on rectal mucosal biopsy findings.A preoperative chest computed tomography scan revealed a ground-glass nodule in the right lung and a small nodule(approximately 0.6 cm in diameter)in the extramural basal segment of the left lower lobe,which suggested multiple lung metastases from rectal cancer.Subsequent treatment and follow-up led to a diagnosis of rectal cancer with left lung metastasis and peripheral adenocarcinoma of the lower lobe of the right lung.CONCLUSION This case report describes the therapeutic journey of a patient with lung metastasis from rectal cancer in addition to primary peripheral adenocarcinoma,thus underscoring the critical roles of multidisciplinary collaboration,personalized treatment strategies,and comprehensive patient rehabilitation guidance.
文摘A recent study by Long et al used a predictive model to explore the efficacy of radiomics based on multiparametric magnetic resonance imaging in predicting metachronous liver metastasis(MLM)in newly diagnosed rectal cancer(RC)patients.The machine learning algorithms,particularly the random forest model(RFM),appeared well-matched to the complex nature of radiomics data.The predictive capabilities of the RFM,as evidenced by the area under the curve of 0.919 in the training cohort and 0.901 in the validation cohort,highlighted its potential clinical utility.However,we highlighted several methodological limi-tations,including excluding genomic markers,potential biases from the retro-spective design,limited generalizability due to a single-center study,and variability in image interpretation.We propose further investigation into inte-grating multi-omic data,conducting larger multicenter studies,and utilizing advanced imaging techniques.Additionally,we highlighted the importance of interdisciplinary collaboration to improve predictive model development and advocate for cost-effectiveness analyses to facilitate clinical integration.Overall,this predictive model may improve the early detection and management of MLM in RC patients,with promising avenues for future exploration.Ongoing research in this domain can potentially improve clinical outcomes and the quality of care for RC patients.
文摘BACKGROUND Rectal cancer has increased in incidence,and surgery remains the cornerstone of multimodal treatment.Pelvic anatomy,particularly a narrow pelvis,poses challenges in rectal cancer surgery,potentially affecting oncological outcomes and postoperative complications.AIM To investigate the relationship between radiologically assessed pelvic anatomy and surgical outcomes as well as the impact on local recurrence following rectal cancer surgery.METHODS We retrospectively analyzed 107 patients with rectal adenocarcinoma treated with elective rectal surgery between January 1,2017,and September 1,2022.Pelvimetric measurements were performed using computed tomography(CT)-based two-dimensional methods(n=77)by assessing the pelvic inlet area in mm^(2),and magnetic resonance imaging(MRI)-based three-dimensional techniques(n=52)using the pelvic cavity index(PCI).Patient demographic,clinical,radiological,surgical,and pathological characteristics were collected and analyzed in relation to their pelvimetric data.RESULTS When patients were categorized based on CT measurements into narrow and normal/wide pelvis groups,a significant association was observed with male sex,and a lower BMI was more common in the narrow pelvis group(P=0.002 for both).A significant association was found between a narrow pelvic structure,indicated by low PCI,and increased surgical morbidity(P=0.049).Advanced age(P=0.003)and male sex(P=0.020)were significantly correlated with higher surgical morbidity.Logistic regression analysis identified four parameters that were significantly correlated with local recurrence:older age,early perioperative readmission,longer operation time,and a lower number of dissected lymph nodes(P<0.05).However,there were no significant differences between the narrow and normal/wide pelvis groups in terms of the operation time,estimated blood loss,or overall local recurrence rate(P>0.05).CONCLUSION MRI-based pelvimetry may be valuable in predicting surgical difficulty and morbidity in rectal cancer surgery,as indicated by the PCI.The observed correlation between low PCI and increased surgical morbidity suggests the potential importance of a preoperative MRI-based pelvimetric evaluation.In contrast,CT-based pelvimetry did not show significant differences in predicting surgical outcomes or cancer recurrence,indicating that the utility of pelvimetry alone may be limited in these respects.
基金Supported by the Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.
文摘BACKGROUND According to the Global Cancer Statistics Report,the incidence of colorectal cancer ranks third and the mortality rate ranks second worldwide among malignant tumors.AIM To explore the effects of Nursing Outcomes Classification(NOC)-based multidimensional nursing on self-efficacy and symptom relief in patients with low anterior resection syndrome(LARS)following sphincter-preserving surgery.METHODS This observational study enrolled 120 patients with LARS after sphincterpreserving surgery for low rectal cancer admitted to our hospital between January 2022 and December 2024.The patients were randomly divided into a control group(n=60)that received routine nursing intervention or an observation group(n=60)that received multidimensional nursing intervention.Before and after the intervention,the Chinese version of the Self-Management Efficacy Scale for Cancer Patients(SUPPH),the LARS scoring scale,and the European Organization for Research and Treatment of Cancer Quality of Life Core Scale(EORTC QLQC30)were used to evaluate the self-efficacy,symptom relief,and quality of life of the two patient groups,and the nursing satisfaction was compared between the groups.RESULTS After the intervention,both groups showed increased scores for each item on the SUPPH and EORTC QLQ-C30 scales compared with those before the intervention,whereas the LARS score showed a decreasing trend.Compared with the control group,the scores for each item of the SUPPH and EORTC QLQ-C30 scales in the observation group were significantly higher after the intervention,while the LARS score was significantly lower(all P<0.05).Nursing satisfaction was significantly higher in the observation group than in the control group(83.33%vs 95.00%,P<0.05).CONCLUSION Multidimensional NOC-based nursing improves self-efficacy,symptoms,quality of life,and satisfaction in patients with LARS.However,further research is needed to assess its long-term and comparative effectiveness.
基金Supported by the Medical and Health Research Project of Zhejiang Province,No.2023KY998.
文摘BACKGROUND With advances in sequencing techniques,microbiota dysbiosis and pathogenic microbes that accelerate colorectal cancer progression have been identified and widely reported.However,few studies have focused on the microbiota taxa of rectal mucus in rectal cancer(RC)patients.Here,we analyzed the composition and characteristics of the rectal mucosa microbiota of RC patients from Wenzhou city,China,and compared the results with those of healthy controls.AIM To explore the changes in the characteristics of the rectal mucosal flora associated with RC,and identify biomarkers of microbe taxa for RC.METHODS Rectal mucosa samples from a Chinese cohort of 72 recently diagnosed RC patients and 71 healthy controls were obtained.A validation cohort,which included 22 RC patients and 60 healthy controls,was also established.Changes in the rectal mucosal flora were observed by cultivation,16S ribosomal DNA gene sequencing analysis and quantitative polymerase chain reaction analysis.RESULTS The 16S ribosomal DNA results demonstrated that RC patients presented increased bacterial community richness and alpha diversity as well as an altered rectal mucosal microbiota,with depletion of Proteobacteria and Thermi and enrichment of Bacteroidetes and Fusobacteria in cancerous mucosal tissues(CM)and enrichment of Firmicutes and Cyanobacteria in adjacent noncancerous mucosal tissues(AM).The culture results showed that the mean loads of Escherichia coli,Bifidobacterium,Enterococcus,and Lactobacillus were significantly reduced in RC patients.The ratios of Prevotella to Ruminococcus[areas under the receiver operating curve:0.795 in AM vs normal control mucosa(NM),0.77 in CM vs NM]and of Prevotella stercorea to Propionibacterium acnes(areas under the receiver operating curve:0.808 in AM vs NM,0.843 in CM vs NM)exhibited excellent abilities to differentiate between healthy controls and RC patients.CONCLUSION RC patients have an altered rectal mucosal microbiota,and the ratio of Prevotella to Ruminococcus or the ratio of Prevotella stercorea to Propionibacterium acnes may serve as a marker for RC diagnosis.
文摘BACKGROUND An efficient index holds the potential to predict rectal cancer prognosis.AIM To investigate the impact of neutrophil-to-lymphocyte ratio(NLR),platelet-tolymphocyte ratio(PLR),and monocyte-to-lymphocyte ratio(MLR)on rectal cancer prognosis.METHODS This retrospective study involved 180 patients with rectal cancer from the Changzhi People’s Hospital of Shanxi Province.A 2-mL blood sample was collected at 24 h preoperatively and 72 h postoperatively to measure neutrophils,lymphocytes,platelets,and monocytes using an automatic blood analyzer.Preoperative and postoperative NLR,PLR,and MLR were compared.Patients were followed up for 12 months and categorized into good and poor prognosis groups.A receiver operating characteristic curve was constructed to analyze their predictive values.RESULTS The NLR,PLR,and MLR values were significantly lower post-surgery(P<0.05).A total of 152 and 28 patients were categorized in the good and poor prognosis groups,respectively.Patients with poor prognoses exhibited slightly higher postoperative NLR,PLR,and MLR values than those with good prognoses(P<0.05).Receiver operating characteristic analysis showed that the area under the curve for NLR,PLR,and MLR was 0.828 with a sensitivity and specificity of 89.29%and 90.79%,respectively.These values were higher than individual NLR(area under the curve:0.660,sensitivity:67.86%,specificity:54.61%),PLR(0.668,75.00%,55.30%),and MLR(0.635,60.71%,48.03%),all showing statistically significant differences(P<0.05),effectively predicting patient outcomes.CONCLUSION The findings of this study indicated that NLR,PLR,and MLR values of patients with rectal cancer can be used to effectively predict the outcome of patients.
文摘Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly machine learning and deep learning,offer promising avenues for predicting and preventing AL.These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition,body composition,and radiological features.AI-based models have demonstrated superior predictive power compared to traditional statistical methods,potentially guiding clinical decisionmaking and improving patient outcomes.Additionally,AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes,minimizing the risk of intraoperative complications and reducing the likelihood of AL development.
文摘BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisited rectal anatomy,advances in surgical techniques and neoadjuvant therapies have enabled the possibility of sphincter-preserving procedures,however,it is uniformly not applicable.Selecting appropriate candidates for sphincter preservation is crucial,as an illadvised approach may compromise oncological outcome or lead to poor functional outcomes.Currently there is no consensus-which clinical,anatomical,or molecular factors most accurately predict the feasibility of sphincter-preserving surgery(SPS)in this subset of patients.By identifying these predictors,the study seeks to support improved patient selection,enhance surgical planning,and ultimately contribute to better functional and oncological outcomes in patients with low rectal cancer.AIM To identify predictive factors that determine the feasibility of SPS in patients with low rectal cancer.METHODS A comprehensive literature search was conducted using PubMed/MEDLINE databases.The search focused on various factors influencing the feasibility of SPS in low rectal cancer.These included patient-related factors,anatomical considerations,findings from different imaging modalities,advancements in diagnostic tools and techniques,and the role of neoadjuvant chemoradiotherapy.The relevance of each factor in predicting the potential for sphincter preservation was critically analyzed and presented based on the current evidence RESULTS Multiple studies have identified a range of predictive factors influencing the feasibility of SPS in low rectal cancer.Patient-related factors include age,sex,preoperative continence status,comorbidities,and body mass index.Anatomical considerations,such as tumor distance from the anal verge,involvement of the external anal sphincter,and levator ani muscles,also play a critical role.Additionally,a favourable response to neoadjuvant chemoradiotherapy has been associated with improved suitability for sphincter preservation.Several biomarkers,such as inflammatory markers like interleukins and C-reactive protein,as well as tumor markers like carcinoembryonic antigen,are important.Molecular markers,including BRAF and KRAS mutations and microsatellite instability status,have been linked to prognosis and may further guide decision-making regarding sphincter-preserving approaches.Artificial intelligence(AI)can further add in to select an ideal patient for sphincter preservation.CONCLUSION SPS is feasible in low rectal cancer and depends on patient factors,tumor anatomy and biology,preoperative treatment response,and biomarkers.In addition,tools and technology including AI can further help in selecting an ideal patient for long term optimal outcome.
文摘We provide an editorial of recent findings on early recurrence(ER)in rectal cancer(RC),focusing on the study on ER of resectable RC by Tsai et al.The study established an 8-month recurrence-free survival cut-off for differentiating ER from late recurrence,with implications for postrecurrence survival and overall survival.This offers not only a valuable timeframe for enhancing surveillance strategies in patients at higher risk,especially those who have undergone neoadjuvant chemoradiotherapy(CRT),but also raises questions about its applicability across different populations.Furthermore,the article suggests that while CRT is very effective in reducing locoregional recurrence,this treatment alone may not fully address the overall risk of ER.The authors advocate for personalized risk assessment and intensive surveillance during the postoperative period to improve outcomes,particularly in the first year.Future research should focus on larger,multicenter studies and incorporate advanced diagnostic techniques with genetic and molecular biomarkers to enhance prediction and management of ER.The ultimate goal is to refine treatment and surveillance strategies to improve survival and quality of life for patients with RC.
文摘BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate of AL,their preventive effects are controversial.AIM To determine the efficacy of reinforcing sutures in preventing AL in rectal cancer.METHODS A systematic search of major medical databases was conducted to identify studies up to June 2024.Intraoperative and postoperative outcomes were assessed;the primary outcome assessed was the incidence of AL.Pooled odds ratios(ORs)and mean differences(MDs)with a 95%confidence interval(CI)were calculated using fixed-effect or random-effect models under heterogeneity.RESULTS This meta-analysis incorporated 20 studies involving 3726 patients.Pooled results demonstrated a statistically significant reduction AL incidence in the reinforced suture group(OR:0.26,95%CI:0.19-0.35,P<0.001)than the unreinforced suture group.The reinforced suture group also exhibited a shorter hospital stay(MD:-1.17,95%CI:-1.78 to-0.57,P<0.001),earlier anal exhaust(MD:-0.13,95%CI:-0.22 to-0.05,P=0.002),longer operative time(MD:15.25,95%CI:10.71-19.80,P<0.001),lower infection rate(OR:0.54,95%CI:0.29-1.00,P=0.05)and lower reoperation rate(OR:0.19,95%CI:0.08-0.45,P<0.001).CONCLUSION The results substantiate the clinical value of anastomotic reinforcement sutures in reducing AL incidence postrectal cancer surgery.Nevertheless,these conclusions warrant verification through additional high-quality randomized controlled trials.
文摘Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including only 15%-20%of patients achieving pathological complete response,underscores the urgent need for accurate predictive tools.This review explored current and emerging biomarkers to enhance neoadjuvant chemoradiotherapy response prediction and inform clinical practice.
文摘BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment,which often translates to pathologic complete response(pCR)as assessed on surgical specimens after curative intent surgery.Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.AIM To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.METHODS An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.RESULTS Fifteen studies were identified through literature review.The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia.Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies.In most studies,the diagnostic accuracy for predicting pCR exceeded 0.8.The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.CONCLUSION Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.
