The integration of laparoscopy and endoscopy has led to the emergence of colonoscopy-assisted natural orifice specimen extraction surgery (CA-NOSES) as a significant development in minimally invasive procedures. Natural orifice specimen extraction surgery (NOSES) is increasingly favored by surgeons for its benefits such as reduced trauma, faster recovery, better aesthetics, and lower psychological impact on patients. However, the Guidelines for Natural Orifice Specimen Extraction Surgery for Colorectal Tumors (2023 Edition) do not recommend transvaginal NOSES for unmarried women, women without prior childbirth, or married women who intend to conceive in the future. In male patients with early-stage tumors of the ascending colon, transverse colon, or descending colon, the implementation of natural orifice specimen extraction remains technically challenging because of current limitations in specimen extraction techniques and anatomical constraints. Consequently, its clinical application is still subject to certain limitations. CA-NOSES, incorporating endoscopy for specimen retrieval, broadens the scope of NOSES within defined criteria but demands skilled surgical teams and applies to specific cases. Concerns persist regarding aseptic practices, tumor spread, and infection risks during specimen extraction, necessitating robust research to verify surgical and oncological outcomes.

To evaluate the long-term effectiveness of sphincter-preserving seton surgery combined with Adalimumab (ADA) in pediatric patients with perianal fistulizing Crohn’s disease (PFCD), and to explore predictive factors affecting efficacy.

A retrospective analysis was conducted on the clinical data of pediatric patients who met the inclusion and exclusion criteria between January 1, 2021 and December 31, 2024, to healing rate of anal fistula and the clinical remission rate. Binary logistic regression analysis was used to identify factors affecting fistula healing, and a receiver operating characteristic (ROC) curve was plotted for predictive indicators.

Seventy-one patients were included. The median follow-up time was 115 (100, 127) weeks. At the follow-up endpoint, 32/71 (45.1%) patients achieved healing of anal fistulas, and 39.4% (28/71) achieved fistula healing under MRI, and 39/71 (54.9%) patients achieved clinical remission. Univariate logistic regression results indicated that Body Mass Index (BMI) (OR: 0.851, 95%CI: 0.725~0.999, P=0.049) was a protective factor associated with fistula healing, while PCDAI (OR: 1.347, 95%CI: 1.168~1.554, P＜0.001), SES-CD (OR: 3.460, 95%CI: 1.839~6.509, P＜0.001) and fistula complexity (OR: 21.562, 95%CI: 4.499~103.346, P＜0.001) were risk factors for poor fistula healing. Multivariate logistic regression showed that PCDAI was an independent risk factor affecting fistula healing in pediatric patients with PFCD (OR: 1.309, 95%CI: 1.087~1.576, P=0.005). The ROC curve constructed based on PCDAI demonstrated good predictive performance (AUC=0.907, 95%CI: 0.832~0.981, sensitivity 0.769, specificity 0.969, positive predictive value 0.968, negative predictive value 0.775, Youden index 0.738).

Sphincter-preserving seton surgery combined with Adalimumab is effective for treating PFCD. Baseline PCDAI has high accuracy in predicting perianal fistula healing outcomes in pediatric PFCD, which can assist clinical decision-making.

To investigate the expression of mismatch repair (MMR) proteins in early-onset colorectal cancer (EO-CRC) and its correlation with clinicopathological parameters and prognosis.

A retrospective analysis was conducted on the clinical data of 441 patients with colorectal cancer who underwent surgery at the Gastrointestinal Center of Northern Jiangsu People’s Hospital from January 2017 to September 2019. The patients were divided into the EO-CRC group (age＜50 years, 63 cases) and the late-onset colorectal cancer (LO-CRC) group (age≥50 years, 378 cases). The expression of MMR proteins was detected by immunohistochemistry (IHC) and classified as deficient (dMMR) or proficient (pMMR). The association between MMR protein expression and clinicopathological features was analyzed using the chi-square test and rank sum test. The relationship between MMR status and prognosis in EO-CRC patients was analyzed using the Kaplan-Meier method combined with the Log-rank test.

The incidence of dMMR was 16.8% (74/441) among the 441 patients. Among them, the proportion of dMMR in the EO-CRC group was 26.98% (17/63), and that in the LO-CRC group was 15.08% (57/378). The difference was statistically significant (χ²=4.896, P=0.027). The low differentiation rate (20.63%, χ²=7.519, P=0.023), the increase rate of CA19-9 (15.87%, χ²=5.982, P=0.014), and the nerve invasion rate (22.22%, χ²=6.024, P=0.014) in the EO-CRC group were significantly higher than those in the LO-CRC group. The difference was statistically significant. Subgroup analysis of EO-CRC showed that the proportion of right hemicolon masses in the dMMR group (58.82%, χ²=8.324, P=0.015) and the proportion of T₁+T₂ stage (64.71%, χ²=4.328, P=0.038) were significantly higher than those in the pMMR group. The vascular invasion rate in the dMMR group (11.76%, χ²=3.982, P=0.046) was significantly lower than that in the pMMR group, and the difference was statistically significant. The follow-up survival data showed that the overall survival rate of the EO-CRC group and the dMMR group was higher than that of the pMMR group (Log-rank χ²=4.513, P=0.034).

The incidence of dMMR in EO-CRC is higher than that in LO-CRC, and it is associated with right-sided colon occurrence, earlier tumor stage, lower rate of vascular invasion, and better overall survival rate. MMR status is not only an important biological marker for EO-CRC but also a significant indicator for prognosis assessment.

To systematically evaluate the efficacy and safety differences between immune combination regimens and single-agent chemotherapy/single-agent targeted therapy in the third-line treatment of metastatic colorectal cancer (mCRC), providing an evidence-based basis for the selection of later-line strategies.

This systematic review was conducted according to the PRISMA 2020 statement and a predefined PICO framework. PubMed, Embase, Cochrane Library, Web of Science, Scopus, CNKI, Wanfang, VIP and SinoMed were searched from inception to December 31, 2025. Randomized trials, prospective studies and controlled cohort studies comparing immune combination regimens (group T) with single-agent chemotherapy/targeted therapy or stratifiable conventional later-line control regimens (group C) were included. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and adverse events were extracted. RevMan 5.4 was used for Meta-analysis. Dichotomous outcomes were pooled as risk ratios (RR) with 95%CI. Heterogeneity was assessed using Cochran’s Q test and I² statistics, and sensitivity analyses and publication-bias assessments were performed.

The included studies were published between 2021 and 2025, with the combination mode primarily consisting of anti-angiogenic small molecules (regorafenib, fruquintinib, apatinib, etc.) combined with PD-1 inhibitors. ORR (582 cases in Group T and 543 cases in Group C) showed that the combined regimen significantly improved the objective response rate [OR=3.55, 95%CI: 2.38~5.29, P＜0.001]. DCR (504 cases in Group T and 465 cases in Group C) also significantly increased [OR=2.20, 95% CI: 1.49~3.26, P=0.001]. PFS (850 cases in Group T and 1 022 cases in Group C) demonstrated a statistical advantage for the combined regimen [OR=1.35, 95% CI: 1.08~1.68, P=0.008]. OS (836 cases in Group T and 1 008 cases in Group C) also significantly improved [OR=2.08, 95% CI: 1.44~2.99, P=0.001]. In terms of safety (770 cases in Group T and 941 cases in Group C), there was no statistically significant difference in the overall incidence of adverse reactions [OR=1.18, 95% CI: 0.94~1.47, P=0.150]. The heterogeneity for each outcome was low (I²≈0%).

The efficacy of immunotherapy combined regimen in the treatment of mCRC patients as a third-line therapy is superior to that of monotherapy chemotherapy/targeted therapy, significantly improving ORR and DCR, prolonging PFS and OS, and maintaining comparable safety. This provides a reference for clinical later-line treatment.

To systematically evaluate the association between peripheral blood neutrophil-to-lymphocyte ratio (NLR) and long-term all-cause mortality in colorectal cancer survivors using data from the National Health and Nutrition Examination Survey (NHANES), providing evidence for clinical prognosis assessment.

This study utilized data from the NHANES spanning 1999 to 2018. A total of 267 adult participants diagnosed with colorectal cancer were included. NLR was calculated based on peripheral blood cell counts. Survival data were obtained by linking to the national death index (NDI), with follow-up extending through December 31, 2019. The primary endpoint was defined as all-cause mortality. Multiple covariates, including age, sex, race, education level, poverty income ratio (PIR), body mass index (BMI), diabetes, and hypertension, were adjusted to evaluate the association between NLR and the prognosis of colorectal cancer patients.

When NLR was analyzed as a continuous variable, in the unadjusted crude model, each 1-unit increase in NLR was associated with a 31% increase in all-cause mortality risk (HR=1.31, 95%CI: 1.15~1.49, P＜0.001). After adjusting for age, sex, and race (Model 1), the HR was 1.27 (95%CI: 1.13~1.43, P＜0.001). After further adjustment for education level and PIR (Model 2), the HR was 1.30 (95%CI: 1.14~1.48, P＜0.001). In the fully adjusted model (Model 3) including BMI, hypertension, and diabetes, the HR was 1.30 (95%CI: 1.40~1.48, P＜0.001).

Elevated NLR is independently associated with an increased risk of all-cause mortality in colorectal cancer survivors. As a simple and low-cost inflammatory marker, NLR may aid in identifying high-risk patients and guiding long-term health management and surveillance strategies for colorectal cancer survivors.

To explore the application value of deep learning (DL)-based segmentation and classification models using MRI for preoperative TN staging of rectal cancer.

A retrospective analysis was conducted on clinical, pathological, and pre-treatment MRI data from patients with postoperatively pathologically confirmed rectal cancer at the First Affiliated Hospital of Naval Medical University between January 2019 and December 2023. Patients were chronologically divided into training and testing cohorts. High-resolution rectal T₂-weighted imaging (T₂WI) for all enrolled subjects was first reconstructed and optimized using Deep Learning Reconstruction (DLR) technology. On the DLR-reconstructed T₂WI images, the lesion region of interest was manually delineated slice-by-slice using two methods: minimal target delineation (Method 1) and maximal target delineation (Method 2). DL segmentation models were constructed and compared. Subsequently, a DL classification model for preoperative TN staging of rectal cancer was built based on the optimal segmentation method and comprehensively evaluated.

This study included 326 patients, with 143 patients from 2019~2020 as the training set and 183 patients from 2021~2023 as the testing set. The test set showed that the DL segmentation model of Method 2 achieved median DSC, HD95, and ASD of 0.796, 7.730 mm, and 1.420 mm, respectively, which were superior to Method 1 (0.708, 10.931 mm, and 2.388 mm), with higher DSC (P＜0.001) and smaller ASD (P=0.013). The DL classification model was constructed using the segmentation results of Method 2. In the T-staging task, 177 test cases showed that the model achieved an AUC (95%CI) of 0.957 (0.932~0.975), significantly higher than subjective evaluation at 0.811 (0.733~0.882). The diagnostic specificity, sensitivity and accuracy of the model were 91.5%, 95.3% and 93.8%, respectively. In the N-staging task, 182 test cases showed an AUC (95%CI) of 0.837 (0.768~0.897), significantly better than subjective evaluation at 0.625 (0.558~0.803), with diagnostic specificity, sensitivity and accuracy of 98.6%, 63.9% and 91.8%, respectively. DeLong tests showed P＜0.001 for both, and the model demonstrated good calibration and higher clinical net benefit.

DLR-optimized MRI images combined with the DL segmentation model using maximal target delineation can accurately extract quantitative information and significantly improve the diagnostic efficacy of preoperative TN staging of rectal cancer.

To investigate the differences in electrogastroenterogram parameters among patients with different subtypes of functional constipation (FC), analyze their correlation with clinical features, and evaluate their diagnostic efficacy for subtypes of functional constipation.

A total of 104 patients with functional constipation admitted to the Third People’s Hospital of Chengdu from June 2023 to July 2024 were selected. According to the colonic transit test, there were 21 cases of slow-transit constipation (STC), forty-five cases of defecation disorder constipation (DD), and 38 cases of normal-transit constipation (NTC), no mixed type constipation patients diagnosed. Differences in gastrointestinal electromyography parameters and clinical pathological features among FC patients with different subtypes were compared; the correlation between gastrointestinal electromyography parameters and clinical pathological features was analyzed; multivariate Logistic regression analysis was used to identify factors influencing disease subtypes and gastrointestinal electromyography parameters; receiver operating characteristic (ROC) curves were drawn to evaluate the predictive value of gastrointestinal electromyography parameters for FC disease subtypes.

There are statistically significant differences among the three groups in the proportion of patients with different FC subtypes in terms of hard stools (χ²=6.309, P=0.043), straining during defecation (χ²=7.036, P=0.030), sensation of incomplete evacuation (χ²=6.378, P=0.041), and the need for manual assistance (χ²=16.788, P＜0.001) during defecation. Analysis of electrogastrography parameters showed that the average preprandial amplitude differed significantly among the three groups (F=33.354, P＜0.001), with the slow-transit constipation (STC) group being the lowest, the defecation disorder (DD) group the highest, and the normal-transit constipation (NTC) group in between. The postprandial/preprandial power ratio in the DD group was significantly higher than that in the STC group (t=2.259, P=0.027). Regarding intestinal electrogastrography parameters, the STC group showed the lowest preprandial amplitude, the highest percentage of rhythm disturbances, and the lowest postprandial increase; the DD group had the highest pre- and postprandial amplitudes and the highest postprandial power ratio, significantly higher than those in the STC group (t=3.806, P＜0.001; t=6.619, P＜0.001; t=7.796, P＜0.001). Analysis of the correlation between symptoms and parameters shows that hard stools are negatively correlated with preprandial intestinal electrical amplitude and frequency (r=−0.468, P=0.002; r=−0.518, P=0.009), while straining during defecation and the sensation of incomplete evacuation are positively correlated with the average preprandial gastric amplitude (r=0.614, P=0.015; r=0.394, P=0.013). Manual assistance for defecation is significantly positively correlated with the average postprandial intestinal amplitude and the postprandial/preprandial intestinal power ratio (r=0.691, P＜0.001; r=0.542, P＜0.001), and negatively correlated with the percentage of preprandial intestinal dysrthythmia (r=−0.453, P=0.023). For STC, the preprandial gastric average amplitude, postprandial/preprandial gastric power ratio, preprandial intestinal average amplitude, postprandial intestinal average amplitude, and postprandial/preprandial intestinal power ratio are independent protective factors, while preprandial intestinal dysrhythmia and postprandial intestinal dysrhythmia are independent risk factors; for DD, the preprandial gastric average amplitude, preprandial intestinal average amplitude, increased postprandial intestinal average amplitude, and postprandial/preprandial intestinal power ratio are independent risk factors; for NTC, the percentage of preprandial intestinal dysrhythmia and postprandial intestinal dysrhythmia are independent protective factors (all P＜0.05). ROC analysis further confirmed that the combined use of parameters such as pre-meal average amplitude, postprandial rhythm disturbance, and postprandial power ratio could significantly improve the prediction efficiency of STC, DD and NTC isotypes (the combined prediction AUC was 0.989, 0.934 and 0.947, respectively), and its effect was better than that of a single parameter.

Gastrointestinal electromyography parameters are correlated with the clinical characteristics of FC, and combining gastrointestinal electromyography parameters can effectively distinguish various subtypes, providing an important basis for non-invasive objective classification and precise diagnosis and treatment.

To observe the relationship between defecography grading and clinical symptom in patients with internal rectal prolapse (IRP), and to explore the clinical significance of anorectal manometry (ARM) and three-dimensional transperineal ultrasound (3D-TPU) in the comprehensive diagnostic evaluation of IRP.

A total of 246 patients with IRP who were admitted to the Department of Gastro-Colorectal and Anal Surgery, Daping Hospital, Army Medical University, from November 2023 to February 2025 and met the inclusion and exclusion criteria were prospectively enrolled. The collected data included the patients’ demographic characteristics, clinical symptom scores, constipation-related clinical scores, ARM and 3D-TPU parameters. After grouping patients with IRP according to defecography grading, the clinical manifestation characteristics of each group and the data of ARM and 3D-TPU were analyzed.

A total of 246 IRP patients were enrolled in this study, including 213 females (86.59%) and 33 males (13.41%), with an average age of (53.12±11.76) years. A total of 246 patients completed defecography and ARM examinations, while 70 patients underwent 3D-TPU examination. The higher the defecography grading, the more severe the clinical symptoms in patients. Among patients with defecography grades Ⅰ~Ⅱ, those with concurrent dyssynergic defecation and increased bladder neck mobility had a significantly higher obstructive defecation syndrome (ODS) score than those without either of these abnormalities.

The higher the defecography grading in patients with IRP, the more severe their clinical symptoms; patients with low-grade but significant symptoms require multidimensional assessment to identify the underlying cause. ARM and 3D-TPU can provide complementary information for IRP patients from functional and morphological aspects, offering a more reliable objective basis for comprehensive clinical assessment and individualized treatment.

Colorectal cancer is the second leading cause of cancer-related death worldwide, and its occurrence and development are complicated by the dynamic regulation of autophagy: autophagy is a highly conserved self-degradation process that degrades cytoplasmic components through the lysosomal pathway. Therefore, in the occurrence and development of colorectal cancer, autophagy substantially affects the responsiveness of cancer cells to conventional therapies (chemotherapy, radiotherapy, immunotherapy) by regulating DNA damage repair, cell death pathway, cell proliferation and other key processes. Therefore, targeting autophagy pathway is likely to become a more powerful strategy to overcome drug resistance in colorectal cancer. More importantly, existing evidence suggests that autophagy plays a tumor suppressor role in the early stage of colorectal cancer, and then switches to a pro-tumor role during disease progression and drug-induced stress. Based on this, this paper systematically and rigorously summarizes the potential and advantages of autophagy inhibitors combined with conventional therapy in the treatment of colorectal cancer, and leads to its clinical application prospects, thereby providing a new perspective for optimizing the treatment of colorectal cancer.

Colorectal cancer is a malignant tumor with high incidence and mortality worldwide. Chemotherapy serves as the core treatment for adjuvant therapy after surgery and advanced-stage patients; however, its application is often limited by drug resistance and dose-limiting toxicities (such as diarrhea, neurotoxicity, mucositis, etc.). In recent years, the gut microbiota, recognized as the “second genome” of the human body, has been confirmed to have a close bidirectional interaction with chemotherapeutic drugs: on the one hand, chemotherapeutic drugs can reshape the structure of the gut microbiota; on the other hand, the microbiota and their metabolites can significantly affect the efficacy and toxicity of chemotherapeutic drugs. This review aims to systematically elaborate on the core mechanisms underlying the bidirectional interaction between chemotherapy and gut microbiota, and focuses on exploring precise intervention strategies targeting the microbiota to reverse drug resistance and alleviate adverse effects. It holds great significance for achieving clinical translation and formulating personalized treatment plans.

Colorectal cancer remains one of the most common malignancies in China and continues to impose a heavy disease burden. Because early screening is still insufficient in some populations, a proportion of patients are already at an advanced stage at diagnosis, and further improving prognosis remains difficult. Liquid biopsy uses blood or other body fluid samples to detect tumor-related information, mainly through biomarkers such as circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and tumor-educated platelets (TEPs). At the current stage, liquid biopsy should be viewed more as a useful supplement to colonoscopy rather than as a replacement. Clinically, liquid biopsy may find applications in screening triage, postoperative monitoring of minimal residual disease, and recurrence risk assessment. Among the circulating biomarkers, ctDNA is supported by more robust evidence and is closer to clinical translation, particularly in minimal residual disease detection and adjuvant treatment decision-making. CTCs can offer cellular-level information on tumour morphology and function, but their clinical use remains constrained by low abundance, pronounced heterogeneity, and a lack of assay standardisation. Tumour-educated platelets are readily accessible and carry abundant RNA-related information; however, their clinical value still awaits confirmation in larger, well-designed studies. Future efforts should prioritise improving the sensitivity of early detection, establishing standardised testing workflows, reducing costs, and conducting prospective investigations, so that the role of liquid biopsy can be more clearly delineated across different clinical scenarios.

The advancement of laparoscopic minimally invasive techniques has driven the surgical treatment of colorectal cancer toward greater minimal invasiveness. As the “ultimate minimally invasive procedure”, natural orifice specimen extraction surgery (NOSES) has emerged as a crucial development direction in colorectal surgery due to its advantages including mild postoperative pain, fewer incision complications, rapid recovery of gastrointestinal function, and excellent cosmetic outcomes. Caudal approach laparoscopic radical resection of right colon cancer conforms to oncological radical principles, shortens the surgical learning curve, ensures surgical safety, and offers unique advantages over other approaches in terms of the completeness of lymph node dissection and perioperative patient recovery. Based on the Chinese Expert Consensus on the Definition and Nomenclature of Mesentery, Fasciae and Planes in the Colon and Rectum (2023 Edition) and relevant clinical research evidence, this article reports the application of caudal tunnel three-dimensional through-and-through technique and reciprocating vascular skeletonization technique in the performance of radical resection of right colon cancer with transvaginal specimen extraction and no auxiliary abdominal incision (NOSES ⅧA procedure) in municipal hospitals. It also discusses the surgical techniques, clinical safety and application value of this procedure, providing a reference for municipal hospitals to perform NOSES for right colon cancer.