The incidence of rectal cancer is on the rise globally. The advancement of minimally invasive technologies has made surgical refinement a core clinical requirement. However, the complex pelvic anatomy means that the precision of surgical procedures directly impacts tumor radical cure outcomes and patients’ postoperative quality of life. Spearheaded by the Minimally Invasive Anatomy Group of the Colorectal Cancer Professional Committee of the Chinese Medical Doctor Association, this consensus is based on anatomical principles. It interprets the anatomical theories of key structures such as the mesorectum and pelvic nerves, and clarifies the technical essentials and operational standards for minimally invasive surgeries. Targeted prevention and management strategies are provided for common postoperative complications. Additionally, the consensus looks ahead to the application prospects of new technologies including AI assistance and fluorescence imaging, offering practical references for clinicians. It aims to enhance the standardization and precision of minimally invasive anatomical surgery for rectal cancer in China, thereby better safeguarding patient prognosis.

As an innovative minimally invasive surgical technique, natural orifice specimen extraction surgery (NOSES) has been widely applied in the field of colorectal cancer with significant technological breakthroughs. Currently, amid the accelerating global aging process, the incidence of colorectal cancer among the elderly remains persistently high. Population aging poses multiple challenges to the diagnosis and treatment of colorectal cancer: elderly patients exhibit diminished physiological functions, complex comorbidities, and delayed postoperative recovery, which places higher demands on surgical tolerance and perioperative management. Meanwhile, physicians must balance the benefits of minimal invasiveness with surgical risks while ensuring oncological radicality, making traditional diagnosis and treatment models increasingly inadequate to meet the needs of this special population. These challenges serve as the intrinsic motivation for formulating this guideline. For the specific group of elderly patients, standardizing the safe application of NOSES in elderly colorectal cancer patients is of paramount importance. Based on the Guidelines for natural orifice specimen extraction surgery (NOSES) in colorectal cancer (2023 Edition) and integrated with the concept of enhanced recovery after surgery (ERAS), this guideline is formulated. It systematically elaborates on the core principles of NOSES for elderly colorectal cancer, perioperative multidisciplinary collaboration, and other key content, with a focus on critical aspects such as comprehensive preoperative assessment of elderly patients, individualized principles for indications and contraindications, optimized strategies for perioperative multidisciplinary collaboration (including organ function preservation, nutritional status improvement, anesthetic management, surgical technique optimization, ERAS pathways, etc.), and prevention and treatment of postoperative complications. By integrating evidence-based medical evidence with clinical practice experience, this guideline aims to provide standardized technical standards that balance oncological safety and minimally invasive benefits for elderly patients, thereby promoting the scientific application and high-quality development of NOSES in the elderly population.

Magnetic Resonance Imaging (MRI) plays a pivotal role in the diagnosis and management of rectal cancer. Advancements in high-resolution sequences, functional imaging, and artificial intelligence have broadened MRI’s role from morphological staging to encompassing efficacy assessments, prognostic predictions, and guiding personalized treatment strategies. This review comprehensively examines the evolving role of MRI in the primary staging of rectal cancer (including T/N staging, extramural vascular invasion, tumor deposits, and mesorectal fascia assessment), the evaluation of treatment response following neoadjuvant therapy, and the prediction of survival outcomes. It also discusses the current challenges in MRI evaluation and offers insights into future directions, aiming to inform clinical practice and research.

To investigate the clinical application of laparoscopic extralevator abdominoperineal excision(L-ELAPE) for the treatment of low rectal cancer.

The clinical data of 109 patients with low rectal cancer admitted to the 960th Hospital of the Joint Logistic Support Force of the People’s Liberation Army of China from May 2018 to May 2023 were retrospectively analyzed. Among them, sixty-nine patients who underwent L-ELAPE were assigned to the study group, and 40 patients who underwent traditional laparoscopic abdominoperineal excision(APE) were assigned to the control group. The general data before surgery, intraoperative observation indicators, postoperative recovery, long-term postoperative complications, and urogenital system scores of the two groups were compared and analyzed.

All 109 patients successfully completed their surgeries. The basic conditions of the patients in the study group and the control group, such as gender, age, distance from the tumor to the anal margin, body mass index(BMI), clinical stage, whether neoadjuvant therapy was applied, intraoperative lymph node dissection, postoperative recovery exhaust time, delayed healing of perineal incision, urinary dysfunction, severe pulmonary infection, postoperative TNM pathological stage, hospital stay and sexual dysfunction, showed no statistically significant difference (all P>0.05). The intraoperative blood loss[(136.86±52.53 mL vs. 215.40±70.21 mL), t=6.648, P=0.001]and the number of intraoperative perforations[4.34%(3/69) vs. 22.5(9/40), χ²=8.516, P=0.004], operation time(178.36±55.32 min vs. 142.47±36.53 min, t=3.663, P=0.001), positive rate of circumferential margin(CRM)[2.9%(2/69) vs. 15%(6/40), χ²=5.453, P=0.020], perineum long-term chronic pain[18.8%(13/69) vs. 2.9%(2/40), χ²=4.087, P=0.043)], chronic pain after caudal resection[28.6%(10/35) vs. 8.8%(3/34), χ²=4.398, P=0.036], local recurrence rate[4.3%(3/69) vs. 15%(6/40), χ²=3.793, P=0.050] differences exist statistical significance.

L-ELAPE surgery for advanced low rectal cancer can reduce the positive rate of CRM, intraoperative intestinal perforation and postoperative local recurrence rate. The occurrence of chronic perineal pain after surgery may be related to the resection of the coccyx during the operation. The application of biological patches for pelvic floor reconstruction is safe and feasible.Therefore, the L-ELAPE surgery is safe and effective and deserves further promotion and application.

To compare the disparities in prognosis and influencing factors between patients with familial adenomatous polyposis associated colorectal cancer (FAP-CRC) and sporadic synchronous multiple primary colorectal cancer (SSM-CRC) undergoing total colectomy with ileorectal anastomosis (TC-IRA).

The clinical and prognostic data of patients who underwent TC-IRA treatment at the Affiliated Cancer Hospital of Zhengzhou University & He’nan Cancer Hospital from January 2010 to June 2020 were retrospectively collected. Propensity score matching (PSM) was performed at a 1:2 ratio (FAP-CRC vs. SSM-CRC) to balance patient characteristics. Survival differences between two groups and across subgroups were compared using the Kaplan-Meier method with the log-rank test. Furthermore, univariate and multivariate Cox proportional hazards regression analyses were employed to identify independent risk factors affecting prognosis.

After propensity score matching, seventy-three patients with FAP-CRC and 146 patients with SSM-CRC were included in this study. The 5-years overall survival (OS) rate was significantly higher in the FAP-CRC group than in the SSM-CRC group (87.5% vs. 78.1%, χ²=4.804, P=0.028). However, no significant difference was observed in the disease-free survival (DFS) between the two groups. Subgroup analyses consistently demonstrated higher OS rate for FAP-CRC, including females, age<55 years, carcinoembryonic antigen(CEA)≤5 ng/mL, multiple tumor lesions, lymph node metastasis, absence of cancerous node, absence of lymphovascular invasion and absence of perineural invasion. Univariate and multivariate Cox regression analyses identified tumor recurrence (P<0.001) as independent risk factor for two group patients.

FAP-CRC patients who underwent TC-IRA had a better long-term survival prognosis than SSM-CRC patients, particularly in subgroups such as females, younger individuals (<55 years), those with low CEA levels (≤5 ng/mL), those with multiple tumor lesions, those with lymph node metastasis, and those without cancerous node or lymphovascular invasion or perineural invasion. Tumor recurrence were identified as independent risk factor influencing postoperative survival in FAP-CRC patients.

This study aimed to investigate the expression of stimulated by retinoic acid 6(STRA6), cytochrome P450 family 24 subfamily A member 1(CYP24A1), and neurexophilin 4(NXPH4) proteins in colorectal cancer liver metastasis and their correlations with clinicopathological characteristics, prognosis, and diagnostic significance.

A total of 80 patients with colorectal cancer initially diagnosed and undergoing surgery at the First Affiliated Hospital of Hebei North University between January 2017 and December 2019 were enrolled. Among them, thirty patients developed liver metastasis, while 50 did not. Immunohistochemistry was used to detect the expression levels of STRA6, CYP24A1, and NXPH4. The relationships between these proteins and clinicopathological parameters were analyzed. The Kaplan-Meier method was applied to evaluate the prognostic significance of these proteins in colorectal liver metastasis patients. Univariate and multivariate logistic regression analyses were conducted to identify influencing factors for liver metastasis in colorectal cancer patients. Receiver operating characteristic (ROC) curve analysis was utilized to assess the predictive value of individual and combined detection of these proteins for colorectal liver metastasis.

The expression levels of STRA6, CYP24A1, and NXPH4 were significantly higher in the liver metastasis group compared to the non-metastasis and paracancerous tissue groups (P<0.05). In colorectal liver metastasis patients, high expression of STRA6 and NXPH4 was correlated with lymph node metastasis and depth of invasion, while high expression of CYP24A1 was associated with lymph node metastasis, depth of invasion, and tumor differentiation (P<0.05). Survival analysis showed that colorectal liver metastasis patients with high expression of STRA6, CYP24A1, and NXPH4 had a lower 5-year survival rate (HR=2.690, 4.279, and 2.784, respectively; P<0.05). Liver metastasis in colorectal cancer patients was correlated with lymph node metastasis, depth of invasion, and degree of differentiation, and CEA (P<0.05). Multivariate analysis identified lymph node metastasis, CEA≥5 ng/mL, and elevated levels of STRA6, CYP24A1, and NXPH4 as independent risk factors for liver metastasis (P<0.05). ROC curve analysis demonstrated that the AUC values for predicting colorectal liver metastasis were 0.722 (95%CI: 0.602~0.843) for STRA6, 0.797 (95%CI: 0.696~0.898) for CYP24A1, and 0.696 (95%CI: 0.577~0.814) for NXPH4. The sensitivities and specificities were 46.70% and 94.00% for STRA6, 56.70% and 92.00% for CYP24A1, and 86.70% and 52.00% for NXPH4, respectively. The combined detection of these proteins achieved an AUC of 0.820 (95%CI: 0.719~0.921), with a sensitivity of 66.70% and specificity of 90.00%.

High expression of STRA6, CYP24A1, and NXPH4 indicates an increased risk of liver metastasis and poor prognosis in colorectal cancer patients. These proteins may serve as potential biomarkers for risk stratification and prognosis of colorectal cancer liver metastasis, providing references for early clinical intervention.

Accumulating evidence indicates that gut microbiota dysbiosis is closely associated with the development of colorectal cancer, providing a theoretical basis for microbiota-based interventions. Probiotics, prebiotics, and synbiotics exhibit adjunctive therapeutic potential by modulating microbial composition, improving the mucosal environment, and suppressing inflammation. Certain bacterial strains and their metabolites can directly regulate tumor progression through receptor–signaling pathways, offering a rationale for targeted modulation. In recent years, engineered bacteria, phage therapy, and strategies involving supplementation or antagonism of microbial metabolites have been rapidly advanced, showing promising safety and feasibility in early studies. Despite persistent challenges such as individual variability, limited long-term efficacy, and lack of standardization, multidimensional microbiota-based therapies guided by multi-omics and precision medicine are expected to become an important component of comprehensive colorectal cancer management.

This study aims to evaluate the clinical efficacy and safety of local injection of human umbilical cord mesenchymal stem cells (hUCMSCs) in the treatment of perianal fistulizing Crohn’s disease (pfCD).

Nineteen patients with non-active pfCD (aged 15~39 years) who received treatment at Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine between October 2022 and December 2024 were included. They underwent perianal local hUCMSCs transplantation surgery and were followed up for 6 to 12 months. The fistula closure was assessed through clinical signs and MRI imaging. The Crohn’s Disease Activity Index (CDAI), Perianal Disease Activity Index (PDAI), Visual Analog Scale (VAS) for pain, Inflammatory Bowel Disease Questionnaire (IBDQ), and Wexner score for anal incontinence were dynamically monitored. Adverse events and nutritional indicators were also recorded.

The cumulative fistula healing rates at 6 and 12 months postoperatively were 73.7% (14/19) and 90.9% (10/11), respectively, with complete fistula closure confirmed by pelvic MRI. The patients’ clinical activity index remained at an inactive level throughout the treatment period. Compared with baseline, the CDAI score showed a significant decrease by postoperative day 14, with the median score dropping to 27.5 (13.5, 40.4) (Z=−3.175, P=0.009). The PDAI index decreased to 2.0 (0.0, 2.0) by the second postoperative month (Z=−2.839, P=0.022). The median VAS score dropped to 0 from 1 to 6 months after surgery (P>0.05). The IBDQ score showed a slight, non-significant decrease on postoperative day 7 [201.0 (195.0, 212.5) (P>0.05)] and returned to baseline levels by postoperative day 14. The Wexner incontinence score demonstrated an improving trend compared with baseline, although the difference was not statistically significant (Z=−1.472, P>0.05), indicating no impairment of anal function. Furthermore, during the study period, mild and self-limiting pain was observed in 42.1% (8/19) of patients, and transient low-grade fever occurred in 10.5% (2/19), with no serious adverse events reported. Albumin levels were significantly increased at 6 months postoperatively compared with baseline (t=3.370, P=0.010).

Local injection of hUCMSCs for the treatment of pfCD offers advantages such as minimal trauma, fast recovery, light pain, and good anal function protection, demonstrating high clinical efficacy and safety.

This case report presents a patient with familial adenomatous polyposis (FAP) and low rectal cancer who underwent radical anterior resection of the rectum, total colectomy, and transverse colonic lengthening. This approach achieved complete tumor resection while avoiding a permanent colostomy and improving postoperative bowel function. The patient initially received a prophylactic loop ileostomy during the first-stage surgery, which has since been successfully reversed. During follow-up, the patient has maintained good general health, preserved bowel function, and has resumed normal daily activities.

Recurrent inflammatory granulation tissue hyperplasia at the small enterostomy is rare. Our center reported a case of a 67-year-old male who developed inflammatory granulation tissue hyperplasia at the small enterostomy 5 and 7 years after the small bowel obstruction surgery, respectively. We surgically removed the hyperplastic tissue, and postoperative pathology showed inflammatory granulation tissue hyperplasia without cancer cells. Although the probability of malignant transformation of inflammatory granulation tissue is extremely low, the risk of stoma cancer still needs to be considered. Therefore, this article summarized the treatment of the case to provide more evidence for clinical treatment.

The utilization of robotic systems for synchronous resection of rectal cancer with liver metastases and transvaginal specimen extraction remains uncommon. This report presents a 51-year-old female patient with rectal cancer and multiple liver metastases who successfully underwent conversion therapy followed by synchronous robotic resection with transvaginal specimen extraction. Both hepatic and rectal tumors were resected using shared trocar ports. The total operative time was 320 minutes, with an estimated blood loss of 50 mL. The patient recovered uneventfully without postoperative complications. This case demonstrates that robotic-assisted surgery is a safe and effective approach for synchronous resection of rectal cancer with multiple liver metastases and transvaginal specimen extraction.