Neoadjuvant radiochemotherapy is the standard treatment for locally advanced rectal cancer. In recent years，the exploration of treatment modalities such as total neoadjuvant therapy（TNT）and neoadjuvant immunotherapy has led to the continuous improvement of the efficacy of neoadjuvant therapy，but treatment-related nausea and vomiting are still common，which not only affects the quality of life，but also reduces the adherence to the treatment，especially in the case of a long course of treatment such as the total neoadjuvant therapy，which may lead to delayed or interrupted treatment and seriously affects the effectiveness of the treatment. At present，there is a lack of specialized guidelines for the prevention，diagnosis，and treatment of nausea and vomiting associated with neoadjuvant therapy for rectal cancer. For this reason，the Chinese Anti-cancer Association Colorectal Tumor Integrated Rehabilitation Committee and Beijing Cancer Prevention ＆ Treatment Society have organized experts to consolidate the relevant research progress in recent years，follow the evidence of domestic and international evidence-based medical science，refer to the existing guidelines and experts' consensus，and combine with the clinical practice. The guideline aims to provide professional guidance and suggestions for the prevention and treatment of nausea and vomiting side effects associated with neoadjuvant therapy for rectal cancer，to improve the prognosis and quality of life of patients and therapeutic effect.

Objective

The purpose of this study is to explore the feasibility and safety of the omental fusion line-guided splenic flexure mobilization（SFM） technique based on fascia anatomy in radical surgery for left-sided colon cancer.

Methods

Using the method of observational study，our study retrospectively collected the clinical data of 112 patients who underwent laparoscopic radical resection for left-sided colon cancer at the Department of Gastrointestinal Surgery of Guangdong Province Hospital of Traditional Chinese Medicine from January 2018 to December 2023. The data included some basic information，preoperative examinations，surgical videos，and general postoperative conditions. The study observed indicators including laparoscopic operating time，intraoperative blood loss，splenic flexure mobilization time，splenic flexure blood loss，postoperative complications，and postoperative hospital stay.

Results

All patients successfully completed the surgery without conversion to open laparotomy. No complications related to splenic，pancreatic，or gastric omental vascular injuries occurred. Among them，the key outcomes included a median laparoscopic operating time of 42.0（36.0，46.8） minutes，a median splenic flexure mobilization time of 14.0 （12.0，16.0） minutes，a median intraoperative blood loss of 50 （20.0，50.0） mL，and median splenic flexure blood loss was 3.0 （1.1，7.0） mL. The median postoperative hospital stay was 6.0 （5.0，7.0） days，with no postoperative complications such as bleeding，pancreatic fistula，or intestinal fistula.

Conclusion

The omental fusion line-guided splenic flexure mobilization technique is safe and feasible to be applied in laparoscopic radical surgery for left-sided colon cancer，which can effectively addressing the technical challenges of splenic flexure mobilization of the colon，and can be further promoted and applied.

Objective

To investigate the factors influencing tumor regression grade （TRG）and long-term prognosis in patients with locally advanced rectal cancer （LARC） following neoadjuvant chemoradiotherapy （nCRT），with the aim of identifying patients who can benefit from nCRT and finding accurate prognostic indicators.

Methods

A retrospective analysis was conducted on the clinical data of 136 LARC patients who received nCRT followed by surgery at the Cancer Hospital，Chinese Academy of Medical Sciences from September 2014 to July 2021. Univariate and multivariate logistic regression analyses were performed to evaluate the factors affecting TRG，and Kaplan-Meier survival curves and Cox proportional hazards regression models were used to analyze factors influencing overall survival （OS）.

Results

Univariate analysis revealed that mesorectal fascia （MRF） and extramural vascular invasion（EMVI） were significant factors affecting TRG （MRF: χ²=13.072，P＜0.001； EMVI: χ²=8.397，P=0.004）.Multivariate logistic regression analysis indicated that MRF （OR=3.277，95%CI: 1.190～9.606，P=0.024）significantly influenced TRG. Univariate Cox regression analysis showed that MRF （HR=4.555，95%CI:1.249～16.620，P=0.022） and CA19-9 （HR=10.057，95%CI: 2.983～33.909，P＜0.001） significantly influenced OS. Multivariate Cox regression analysis further confirmed that MRF （HR=5.755，95%CI: 1.549～21.376，P=0.009） and CA19-9 （HR=13.331，95%CI: 3.802～46.700，P＜0.001） were independent predictors of OS.

Conclusion

MRF and CA19-9 are important factors influencing tumor regression and prognosis in LARC patients after nCRT. Clinical focus should be on MRF and CA19-9 positive patients to optimize individualized treatment strategies，thereby improving treatment outcomes and patient survival.

Objective

To compare the short-term clinical efficacy observation of laparoscopic surgery or open surgery after placement of self-expandable metal stent in patients with obstructive leftsided colorectal cancer.

Methods

Clinical case data of patients with obstructive left-sided colorectal cancer who attended the Department of Anorectology of Gansu Provincial People's Hospital from June 2016 to June 2024 were retrospectively analyzed. Patients who were successfully stented and underwent radical surgery were included，and according to the different surgical methods，they were divided into the laparoscopic surgery group and the open surgery group to compare the short-term clinical efficacy between the two groups.

Results

A total of 64 patients were included，thirty-five in the laparoscopic surgery group and 29 in the open surgery group. There was no statistically significant difference between the two groups in terms of gender，age，BMI，tumor size，T stage，TNM stage，ASA grade and whether neoadjuvant therapy was performed（P＞0.05）. Compared with the intraoperative and postoperative conditions of patients in the two groups，the laparoscopic surgery group showed no significant differences in intraoperative bleeding （t=-3.004，P=0.008），postoperative time to exhaustion （t=-2.333，P=0.031），postoperative time to feeding （t=-2.240，P=0.038），postoperative hospitalization time （t=-2.418，P=0.030），time to first postoperative chemotherapy （t=-3.430，P=0.003），and stage I resection anastomosis （χ²=5.823，P=0.016） were better than those in the open surgery group，and the differences were all statistically significant； there was no statistically significant difference between laparoscopic surgery group and the open surgery group in terms of operation time，number of lymph nodes discharged，and death at 30 days （P＞0.05）. The incidence of early postoperative complications （wound infection，anastomotic leakage，intra-abdominal abscess，pneumonia，and other complications） was lower in the laparoscopic surgery group than in the open surgery group，and the overall difference was statistically significant （χ²=4.932，P＜0.026）.

Conclusion

For patients with obstructive left-sided colorectal cancer，self-expanding metal stent placement combined with laparoscopic surgery improves the intraoperative and postoperative conditions of the patients and reduces the rate of early complications，so its short-term therapeutic efficacy is better than that of open surgery.

Objective

This study aims to identify miRNAs associated with overall survival （OS）in colorectal cancer patients using The Cancer Genome Atlas （TCGA） database，develop a miRNA-based nomogram prognostic model，and assess the model's predictive capability.

Methods

miRNA sequencing data and clinical information of colorectal cancer patients were downloaded and integrated from the TCGA database. The data were randomly divided into a training cohort and a validation cohort in a 3:1 ratio.Univariate Cox regression，LASSO regression，and multivariate Cox regression analyses were employed to identify a set of miRNAs related to colorectal cancer prognosis and to establish a prognostic risk score for colorectal cancer. A nomogram model was then constructed by combining the risk score with clinical indicators. The predictive performance of the model was evaluated using receiver operating characteristic （ROC）curves，concordance index （C-index），calibration curves，and decision curve analysis （DCA）.

Results

A total of 498 CRC patients were included in the study. Differential analysis identified 291 miRNAs. The risk score was calculated as follows: Risk Score=（0.05634381×miR-548u expression）+（0.03900542×miR-4665-5p expression）- （0.10097599×miR-887-3p expression）. A nomogram prognostic model was constructed incorporating the risk score，age，and TNM stage. In the validation cohort，the AUC values of the nomogram prognostic model，risk score，and TNM stage were 0.752，0.720，and 0.673，respectively. The C-index of the nomogram prognostic model in the training and validation cohorts were 0.743 and 0.761，respectively. The calibration curve demonstrated good agreement between the nomogram's predicted and actual 5-year OS.DCA showed that the nomogram prognostic model offered greater clinical benefit compared to the TNM staging system.

Conclusion

The nomogram prognostic model demonstrates strong predictive ability and may aid in clinical decision-making and prognosis assessment for colorectal cancer patients.

Objective

In order to explore the risk factors of lymph node metastasis of stage T1 colorectal cancer and establish a random forest model to predict lymph node metastasis of stage T1 colorectal cancer patients.

Methods

We collected the clinical data of 280 patients with stage T1 colorectal cancer who underwent radical surgery in the Sixth Affiliated Hospital of Sun Yat-sen University from August 2010 to June 2020，and established a random forest model to predict lymph node metastasis of stage T1 colorectal cancer patients by R software.

Results

The incidence of lymph node metastasis in T1 stage colorectal cancer was 11.07% （31/280）. The importance ranking of risk factors following the random forest model for lymph node metastasis in stage T1 colorectal cancer was as follows: age，vascular or neural invasion，tumor location，differentiation degree，gender，tumor size，and Ki67 level. The area under the curve （AUC） of our random forest model for lymph node metastasis in stage T1 colorectal cancer was 0.811，with an optimal threshold of 0.072，specificity of 0.703 and sensitivity of 0.778.

Conclusion

The random forest model is helpful for clinicians to quickly analyze the risk of lymph node metastasis in stage T1 colorectal cancer and make appropriate treatment plans.

Objective

To investigate the surgical effect of laparoscopic pelvic floor repair combined with procedure for prolapse and hemorrhoids （PPH） vs. PPH only in the treatment of internal rectal prolapse （IRP）.

Methods

Clinical data of 122 patients with internal rectal prolapse admitted to the Department of Gastrointestinal Surgery from January 2019 to October 2021 were collected and divided into two groups according to different surgical methods. Among them，sixty-two patients underwent laparoscopic pelvic floor repair combined with PPH as the group A and 60 patients underwent PPH as group B. The Wexner Constipation Scale （WCS），the Wexner Incontinence Scale （WIS），the Degree of Internal Rectal Prolapse （DIRP），and the Gastrointestinal Quality of Life Index （GIQLI） were utilized for the assessment of two patient groups pre-surgery，and at 6-month and 2-year intervals post-surgery. Furthermore，postoperative complications and recurrences at 6 months and 2 years were documented.

Results

No significant variations were observed between the two groups in terms of gender，age，BMI，and preoperative measurements on the WCS，WIS，DIRP，and GIQLI scales （all P＞0.05）. The WCS，WIS，DIRP and GIQLI of the two groups at 6 months and 2 years after surgery were statistically significant （all P＜0.05）. Six months and two years followed the surgery，the observation group showed significantly improved WCS，WIS，DIRP，and GIQLI scores compared to the control group （F=24.445，26.455，58.896，101.355，90.579，115.87，22.893，68.252； all P＜0.001）. No significant differences were observed in Grade I and I～III postoperative complications between the two groups （χ²=0.003，P＞0.05），and the recurrence rate in the observation group was lower than that in the control group at 2 years after operation （χ²=4.481，P＜0.05）.

Conclusion

Laparoscopic pelvic floor repair combined with PPH is effective in the treatment of internal rectal prolapse with low recurrence rate.

Objective

Exploring the effect of staged fumigation and washing on the generation of granulation tissue on the wound of patients after anal fistula surgery.

Methods

120 patients who underwent anal fistula surgery at the Colorectal Department of Chengdu University Affiliated Hospital from January 2022 to November 2023 were selected. Among them，sixty patients were treated with potassium permanganate solution fumigation （control group） and 60 patients were treated with staged formula fumigation （observation group）. The clinical data of the two groups of patients were matched 1:1 using propensity score matching method to adjust the balance. Compare the clinical efficacy，wound healing rate，wound pain，edema，secretion scores，granulation tissue generation，and immune and inflammatory related indicators of granulation tissue between two groups of patients. Using Generalized Estimation Equation Modeling （GEE） to analyze the degree and influencing factors of granulation tissue generation in two groups of wounds.

Results

The total effective rates of clinical treatment in the two groups of patients were 100.00% （54/54） in the observation group and 87.04% （47/54） in the control group，respectively. The total effective rate of clinical treatment in the observation group was significantly higher than that in the control group （χ²=7.485，P=0.006）. After a comparative study，the wound healing rates of the two groups at 7，14，21，and 28 days after surgery showed a significant increase. There was no significant difference in the wound healing rate between the observation group and the control group at 7 days after surgery （t=0.140，P=0.889）. The healing rates at 14 days after surgery （t=2.432，P=0.017），21 days after surgery （t=3.210，P=0.002），and 28 days after surgery （t=4.632，P＜0.001） were significantly higher than those in the control group. On postoperative days 3，7，and 14，the wound pain，wound margin edema，and secretion scores in both groups were significantly reduced compared to postoperative day 1，and the degree of reduction in the observation group was significantly better than that in the control group （P＜0.05）. At the same time，the granulation tissue growth scores of both groups significantly increased on postoperative days 3，7，and 14，with the observation group showing a significantly greater increase than the control group （P＜0.05）. The expression levels of immune related markers CD86 in granulation tissue of two groups of wounds at 3，7，and 14 days after surgery were significantly reduced compared to 1 day after surgery （P＜0.05），while the expression levels of CD206 and CD31 increased（P＜0.05）. The expression level of inflammation related indicators IL-1β was significantly reduced （P＜0.05）compared to postoperative day 1，while the expression levels of VEGF and vWF increased （P＜0.05）. The improvement in the observation group was better than that in the control group （P＜0.05）. As observed by GEE，the increase in CD206，CD31，VEGF，and vWF levels and the decrease in CD86 and IL-1β levels in the postoperative wound tissue of the observation group were superior to those of the control group （P＜0.05）.CD86，CD206，CD31，VEGF，vWF，IL-1β and treatment methods significantly affected the generation of granulation tissue in patients' wounds （P＜0.05）.

Conclusion

Staged application of formula fumigation and washing has significant therapeutic effects on postoperative anal fistula wounds，promoting wound healing，improving patient symptoms，and also improving the expression levels of CD86，CD206，CD31，IL-1β，VEGF，and vWF in granulation tissue. It is safe and reliable.

Functional constipation is a common clinical condition，with long-term sufferers frequently exhibiting tendencies toward anxiety and depression. Medication targeting anxiety and depression may exacerbate constipation，creating a vicious cycle of comorbidity. Therefore，effectively managing the coexistence of functional constipation and anxiety-depression is a crucial clinical challenge.Understanding the interaction mechanisms of such comorbidities and selecting appropriate psychosocial assessment questionnaires are key to treatment. This article explores the interaction mechanisms of functional constipation with anxiety and depression from the perspectives of the nervous system，abnormal brain-gut peptide secretion，gut microbiota，drug effects，and intestinal immune mechanisms. It also reviews related psychosocial assessment questionnaires，aiming to analyze the factors contributing to these conditions and to emphasize the importance of psychological assessment in treating constipation，providing a reference for the diagnosis and treatment of comorbid functional constipation and anxietydepression.

Sacral nerve stimulation （SNS） refers to a physical therapy method that stimulates specific sacral nerves through short frequency pulses of electrical current. At present，SNS can be used clinically to treat various intestinal diseases and fecal incontinence caused by colorectal surgery，but its mechanism of action is not fully understood. This article provides an overview of the mechanism of action of SNS in the current treatment of fecal incontinence，providing new ideas for clinical treatment.

Objective

To explore the difference and indication between various surgical treatment methods for rectovaginal fistula （RVF） that occurs after rectal tumor surgery.

Methods

Retrospectively collected clinical data of patients who developed RVF following rectal tumor surgery and were hospitalized for treatment in Peking Union Medical College Hospital from January 2014 to June 2022. The treatment plans，the outcomes of RVF healing were recorded.

Results

A total of 37 patients were included in the study，with an average age of （58 ± 13） years. Among them，twenty-eight had malignant tumors and 9 had benign tumors. Patients underwent 1，2，or 3 times of surgical treatments for RVF in 18 （48.6%），10 （27.0%），and 3 （8.1%） cases，respectively. Surgical methods included diversion surgery，transanal RVF repair，transanal combined with endoscopic RVF repair，transanal sphincteric RVF repair （Mason procedure），laparoscopic anterior rectal resection RVF repair （Dixon/Hartmann procedure），transvaginal repair，endoscopic RVF repair，and pelvic drainage surgery. Ultimately，seven patients’ （18.9%） RVF were cured and got stoma reversed，with a median reversal time of 37 months from the rectal surgery and 29 months from RVF discovery. Among the successfully reversed patients，five patients had benign tumors and 2 patients had malignant tumors，with a significant difference in reversal success rates between benign and malignant tumors （P=0.005）.

Conclusion

RVF following rectal tumor surgery causing lots of patients undergo multiple surgeries and are still unable to have their stomas reversed. Some patients face the risk of recurrent RVF even after stoma reversal. The success rate of treating complex RVF after malignant rectal tumor surgery is lower than that of benign tumors. The choice of RVF repair method should be based on the location，size，and complexity of the fistula. For fistulas located higher up，an abdominal approach is preferred. For cases where abdominal surgery is difficult or the fistula is located lower，transanal or perineal approach or a combined multi-approach repair is recommended. For patients with high-risk factors for RVF，prevention should be emphasized during the initial surgery.

Perianal endometriosis is a special type of endometriosis，and its pathogenesis is currently unclear. It is most commonly found in the pelvic cavity，and reports related to the perianal region are relatively rare.This disease is often accompanied by a history of childbirth or gynecological surgery，and the typical symptom is perianal periodic pain closely related to menstruation. Surgery is currently the main treatment method.

Chronic radiation enteritis （CRE） is characterized by intestinal wall fibrosis and obliterative endarteritis，with approximately one-third of CRE cases requiring surgical intervention. The ideal surgical strategy involves resection of radiation-damaged intestinal segments followed by primary digestive tract reconstruction. Leveraging the high-definition imaging and flexible operation capabilities of the Da Vinci robotic surgical system，combined with our center's extensive experience in definitive surgery for CRE，we have pioneered the application of robotic-assisted definitive surgery for CRE. This study explores key aspects such as trocar placement，surgical approach，adhesion release strategies，and digestive tract reconstruction，resulting in the development of a feasible and effective surgical protocol.