Artificial intelligence (AI) technologies are rapidly being applied across all segments of colorectal cancer management, including cancer screening, endoscopic diagnosis and treatment, imaging and pathological analysis, therapeutic decision‐making, intraoperative assistance, and follow‐up management. Nevertheless, substantial disparities exist among various AI systems in terms of task definition, data sources, validation methodologies, performance metrics, safety thresholds, and real‐world clinical practicability. There is an urgent need to establish a dedicated evaluation framework tailored to clinical scenarios specific to colorectal cancer. To address this demand, the Colorectal Surgery Group of the Chinese Society of Surgery (Chinese Medical Association), the Colorectal Cancer Committee of China Anti‐Cancer Association, and the Colorectal Surgeon Expert Group of the Surgeon Branch (Chinese Medical Doctor Association) jointly assembled a working group composed of specialists covering colorectal surgery, digestive endoscopy, medical imaging, pathology, medical oncology, radiation oncology, artificial intelligence, medical statistics, medical informatization, medical ethics, and regulations. Through systematic literature retrieval, collation of existing clinical guidelines and regulatory documents, expert letter consultations, and panel discussions, the working group formulated 13 recommendations graded by levels of evidence and strength of recommendation, and developed the Expert Consensus on Evaluation Standards for Artificial Intelligence Applications in Colorectal Cancer (2026 Edition). This consensus establishes a tiered evaluation framework centered on seven core dimensions: algorithmic performance, clinical safety, clinical efficacy, user experience, model interpretability, ethical compliance, and continuous supervision. It further clarifies targeted evaluation requirements for key AI application scenarios, including AI‐assisted lesion detection during endoscopy, AI‐aided diagnosis via imaging and pathological slides, generative AI and clinical decision support, intraoperative AI assistance, and real‐world surveillance of AI systems. The consensus underscores that AI systems shall only serve as auxiliary clinical tools and must not replace clinicians to independently render diagnostic, therapeutic or surgical decisions. Prior to clinical deployment, all AI systems for colorectal cancer shall undergo rigorous validation commensurate with their risk classification, implement disease‐specific safety red lines, mandate mandatory clinician review, and enforce full‐lifecycle supervision throughout clinical use.

Colorectal cancer is one of the common malignant tumors in the world, among which mucinous adenocarcinoma of the large intestine is a unique pathological subtype, accounting for 10%~20% of all colorectal cancer cases. It is characterized by extracellular mucin components accounting for no less than 50% of the tumor volume. This disease has a higher incidence in women and young people, and is often diagnosed at an advanced stage with a high rate of peritoneal metastasis and lymph node infiltration, leading to a poor overall prognosis. Compared with adenocarcinoma, mucinous adenocarcinoma has significant differences in molecular characteristics, which may be related to resistance to adjuvant therapy and poor prognosis, but the pathogenesis has not been clear. Tissue biopsy is the gold standard for diagnosis, while CT, MRI and other imaging modalities also have diagnostic advantages. At present, there is a lack of special clinical guidelines for mucinous adenocarcinoma, and the treatment strategy mostly refers to the scheme of adenocarcinoma, and its efficacy and prognosis are controversial. This article reviews the research progress of mucinous adenocarcinoma in epidemiology, molecular background, diagnosis, treatment, prognosis and the latest research directions, in order to provide references for subsequent basic and clinical research.

Pelvic exenteration (PE) is one of the radical surgical options for treating locally advanced or recurrent pelvic malignancies. However, due to its high degree of invasiveness, elevated complication rates, and significant perioperative mortality, clinical decision-making and patient selection present substantial challenges. Traditional studies have primarily focused on outcomes from the physician’s perspective, such as R0 resection rates and survival, while often overlooking patients’ long-term quality of life and decision-making experiences. In recent years, the concept of enhanced recovery after surgery (ERAS) has been gradually introduced into PE. Current evidence suggests that while the application of ERAS in PE is associated with reduced hospital stays and a lower incidence of severe complications, the simple adoption of standard colorectal or gynecological ERAS protocols in the PE population may lead to increased complications such as intestinal paralysis, urinary leakage, and pelvic abscesses. Metrics including patient-reported outcomes (PROMs) and quality of life (QoL), indicate that some patients, even after achieving R0 resection and long-term survival, still express hesitation or regret regarding their decision to undergo PE. This review, based on an analysis of the anatomical and demographic characteristics of PE as well as perioperative challenges, systematically summarizes the current status and main findings of ERAS application in PE, synthesizes evidence on long-term survival and quality of life following PE, highlights the discrepancies in outcome evaluation between physician-centered and patient-centered perspectives, and proposes a risk-stratified, PROMs-based PE-specific ERAS pathway alongside multidisciplinary, patient-centered management recommendations. The aim is to provide a reference framework for clinical practice and future research.

To describe the 2024 national estimates of colorectal cancer incidence and mortality and their rankings among all cancers in China, and to compare them descriptively with the 2022 estimates overall and by sex and urban-rural residence.

A descriptive secondary analysis of publicly available aggregate data was conducted using national model-based estimates released by the National Cancer Center. The main indicators included numbers of new cases and deaths, crude incidence and mortality rates, age-standardized incidence and mortality rates using the 2000 Chinese standard population (age-standardized incidence rates by Chinese population & age-standardized mortality rates by Chinese population), and those using the Segi world standard population (age-standardized incidence rates by world population & age-standardized mortality rates by world population). Absolute and relative differences were calculated using the published 2022 point estimates as the reference; no hypothesis testing was performed.

In 2024, the estimated numbers of new colorectal cancer cases and deaths were 561 800 and 255 700, respectively, which were numerically higher than the 2022 point estimates by 44 700 (8.64%) and 15 700 (6.54%). Crude incidence and mortality rates were higher by 3.35 per 100 000 (9.15%) and 1.20 per 100 000 (7.06%), respectively. Age-standardized incidence rates by Chinese population & age-standardized incidence rates by world population were higher by 0.59 per 100 000 (2.91%) and 0.55 per 100 000 (2.74%), whereas age-standardized mortality rates by Chinese population was lower by 0.01 per 100 000 (−0.12%) and age-standardized mortality rates by World population was unchanged. The overall incidence rank changed from second to third, while the mortality rank changed from fourth to third. Numerical differences for most indicators were greater in men than in women. In 2024, rural areas had higher crude rates, whereas urban areas had higher Chinese- and world-standardized rates.

The 2024 point estimates of case counts, deaths, and crude rates were higher than the corresponding 2022 estimates, whereas differences in age-standardized rates were small. Evaluation of colorectal cancer control should jointly consider absolute burden, crude rates, age-standardized rates, and rankings among all cancers. Risk-factor control should be strengthened, together with continuity across screening, diagnosis, treatment, and follow-up.

This study leveraged long-term data on colorectal cancer incidence and mortality from 1994 to 2023 to quantify the effects of age, period, and birth cohort on both disease risk measures. It further estimated the temporal trajectories of disability-adjusted life years (DALYs) and mortality attributable to major risk factors, with the aim of identifying priority intervention nodes for current prevention and control strategies.

Data on colorectal cancer incidence and mortality in China from 1994 to 2023 were extracted from the Global Burden of Disease Study 2023 (GBD 2023) database. Case counts, death counts, crude rates, and age-standardized rates were compiled. For trend analysis, Joinpoint regression models were applied to estimate the annual percent change (APC) and average annual percent change (AAPC) to evaluate temporal dynamics in age-standardized rates. Additionally, age-period-cohort models were fitted to estimate the respective effects of age, period, and birth cohort on incidence and mortality risks. On this basis, changes in attributable mortality and DALYs due to major risk factors were quantified.

From 1994 to 2023, both the number of new cases and deaths from colorectal cancer in China showed an increasing trend. New cases rose from 213 800 to 611 400, and deaths increased from 149 100 to 257 500. Joinpoint regression results showed that the age-standardized incidence rate was on the rise (AAPC=0.75%, 95%CI: 0.44%~0.93%, P＜0.05), while the age-standardized mortality rate was declining (AAPC=−1.24%, 95%CI: −1.58%~−1.06%, P＜0.05). The age-period-cohort model indicated that both incidence and mortality risk increased with age. The period effect for incidence showed relatively small overall changes, while the period effect for mortality continued to decline. There were gender differences in the cohort effect on incidence, whereas the cohort effect on mortality generally showed a downward trend. Attributional burden results revealed that dietary factors and high fasting blood glucose remained important modifiable risk factors. The burden related to high BMI and excessive processed meat intake increased compared to 1994, and men consistently had higher attributional burdens related to behavioral and metabolic risks than women.

From 1994 to 2023, both the number of colorectal cancer cases and deaths in China have shown an upward trend. The age-standardized incidence rate has been rising, while the age-standardized mortality rate has been declining. The risk of getting sick and dying increases with age, so men and middle-aged to older adults should be prioritized for interventions. Improving diet, managing weight, and addressing metabolic issues can help ease the growing burden of colorectal cancer.

To develop a multivariable model incorporating lipid profiles and endoscopic features of colorectal adenomatous polyps, and to validate its performance in predicting polyp recurrence risk and estimating polyp growth rate based on the surveillance interval.

A retrospective observational study was conducted, enrolling adult patients who had undergone adenomatous polypectomy and at least one follow-up colonoscopy at the Second Affiliated Hospital of Nanjing University of Chinese Medicine. Baseline and follow-up endoscopic data (polyp number, cumulative volume, maximum diameter, and surveillance interval) from the rectum and ascending colon were collected. Patients from the endoscopy center (n=795) and the colorectal surgery center (n=476) were assigned to the test group and validation group, respectively. Univariate and multivariate logistic regression were used to screen for independent predictors of recurrence and to construct a nomogram model. The discriminatory performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC). Multiple linear regression, robust regression, and log-transformation models were employed to analyze the impact of various factors on the number, cumulative volume, and maximum diameter of polyps detected during follow-up.

A total of 1 271 patients were included (1 005 in the recurrence group and 266 in the non-recurrence group). Multivariate logistic regression showed that elevated total cholesterol (OR=2.51, 95% CI: 1.53~4.11), prolonged surveillance interval (OR=1.08, 95%CI: 1.04~1.12), and higher baseline polyp count (OR=1.15, 95%CI: 1.06~1.25) were independent risk factors for polyp recurrence, while decreased high-density lipoprotein cholesterol (OR=0.51, 95%CI: 0.27~0.95) was a protective factor. The nomogram model constructed based on these factors achieved AUCs of 0.736 and 0.710 in the training and validation sets, respectively. Multiple linear regression analysis further confirmed that the surveillance interval was a stable factor for predicting the number (β=0.13, P＜0.001), cumulative volume (β=2.94, P＜0.001), and maximum diameter (β=0.23, P＜0.001) of polyps at follow-up. The model predicted a median time of 25.08 months for the maximum polyp diameter to reach 10.0 mm. Subgroup analysis showed that the recurrence rates in the rectal group and the ascending colon group were 80.60% and 77.39%, respectively, with no statistically significant difference (P = 0.182). Polyp location was not identified as an independent predictor of recurrence (OR = 0.82, 95% CI: 0.61~1.08, P = 0.160).

The multivariable model prediction model, integrating lipid parameters with endoscopic features, has the potential to serve as an adjunctive tool for post-polypectomy recurrence risk assessment, providing a preliminary quantitative reference for individualizing surveillance intervals.

To compare the short-term clinical efficacy of robotic single-incision plus one-port total colectomy (TC) versus multi-port laparoscopic total colectomy in the treatment of slow transit constipation (STC).

A retrospective study with frequency matching was conducted. The clinical data of 50 patients diagnosed with STC who underwent surgical treatment in the First Affiliated Hospital of Soochow University from June 2021 to November 2025 were collected. According to the surgical method, the patients were divided into the robot-assisted single-incision plus one-port group (25 cases) and the laparoscopic multi-port group (25 cases). Baseline data and perioperative indicators were compared between the two groups, including operative duration, intraoperative blood loss, pain score, time to first ambulation, first oral feeding and first defecation, and length of hospital stay. Short-term postoperative follow-up indicators covered the Wexner Constipation Score (WCS), complete spontaneous bowel movements (CSBM), Gastrointestinal Quality of Life Index (GIQLI), Bristol Stool Form Scale (BSFS), and incision cosmetic satisfaction score.

There were no statistically significant differences between the two groups in baseline characteristics, including sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) classification (P＞0.05); however, age differed to some extent between the groups (t=−2.025, P=0.048). All operations were completed successfully without conversion to open laparotomy or severe intraoperative complications. Compared with the multi-port laparoscopic group, the robotic-assisted single-incision plus one-port group required longer operative duration [(293.52±60.57) min vs.(235.56±56.31) min, t=3.504, P＜0.001]. However, the time to first defecation [(25.00±5.00) h vs.(28.92±6.94) h, t=−2.423, P=0.020], time to first ambulation [(42.52±12.43) h vs. (51.92±13.07) h, t=−2.606, P=0.012] and length of hospital stay [(9.08±1.91) d vs. (11.84±2.98) d, t=−3.895, P＜0.001] were shorter in the laparoscopic multi-port group. No statistically significant intergroup differences were observed in intraoperative blood loss, pain scores, WCS, CSBM and GIQLI scores at the 3-month postoperative follow-up, as well as overall postoperative complications (P＞0.05). The incision cosmetic satisfaction score showed a statistically significant difference between the two groups (Z=−3.830, P＜0.001).

Compared with laparoscopic multi-port group, robot-assisted single-incision plus one-port group for STC is equally safe and feasible, and has more advantages in postoperative rapid recovery and incision cosmesis, which can be used as one of the preferred options for individualized minimally invasive treatment of patients with STC.

Lymph node metastasis in rectal cancer, which is regulated by the tumor immune microenvironment (TIME), is closely correlated with patient prognosis. Nevertheless, the current accuracy in evaluating lymph node metastasis in rectal cancer patients is still less than satisfactory and needs further enhancement. This review clarifies the main mechanisms by which the immune microenvironment regulates lymph node metastasis in rectal cancer and summarizes the current state of research on imaging-based assessment of immune microenvironment heterogeneity, with a focus on MRI. The objective is to enhance the precision of preoperative diagnosis of lymph node metastasis, improve patient prognosis, and provide novel perspectives for individualized diagnosis and treatment.

Regulatory T cells (Tregs) are key immune components that mediate immunosuppression in the colorectal cancer tumor microenvironment (TME), facilitating tumor immune evasion and promoting tumor progression through various mechanisms. This article reviews the biological characteristics and intrinsic heterogeneity of Treg cells, as well as the mechanisms by which they mediate immunosuppression, including the secretion of inhibitory cytokines, nutrient competition, metabolic interference, and the formation of specific spatial niches. Furthermore, it summarizes the evolution and shift of Treg-targeted therapeutic strategies from simple depletion toward precise regulation, offering new directions for immunotherapy in colorectal cancer.

Necrotizing fasciitis (NF) is a rare, life-threatening acute critical illness in colorectal and anal surgery, characterized by insidious onset, rapid progression, extensive tissue destruction and high mortality. The infection can spread rapidly along fascial planes, involving the perianal region, perineum, pelvic floor, and even the retroperitoneal space. Traditional management has mainly focused on infection control and surgical debridement during the acute phase, while insufficient attention has been paid to functional preservation, staged reconstruction, and long-term rehabilitation in the later course of treatment. The concept of whole-course management emphasizes the establishment of a comprehensive care system spanning prevention, screening, diagnosis, treatment and rehabilitation. Through multidisciplinary collaboration and individualized decision-making, it integrates early recognition and differential diagnosis, imaging-based stratified assessment, thorough debridement and targeted antimicrobial therapy in the acute phase, staged wound management, functional reconstruction and long-term rehabilitation follow-up, thereby reducing gaps in care and optimizing overall prognosis. This review discusses the clinical application of the whole-course management concept for NF in colorectal and anal surgery, and its significance in improving treatment success rate and patients’ long-term quality of life.

A 59-year-old man with a body mass index of 25.2 kg/m² was diagnosed with adenocarcinoma of the descending colon near the splenic flexure and a rectal tumor 5 cm from the anal verge. Totally laparoscopic left hemicolectomy with transrectal natural orifice specimen extraction surgery (NOSES) was performed together with transanal local excision of the rectal lesion. The inferior mesenteric vein was preserved, and the specimen was removed through an approximately 3 cm upper rectal incision using a double-bag technique. Operative time was 140 min and blood loss was 20 mL. Pathology showed moderately differentiated adenocarcinoma of the left colon (pT₃N_1b; 3/14 lymph nodes positive; perineural invasion present; no definite lymphovascular invasion), with an additional tubulovillous adenoma containing focal intramucosal carcinoma in the same specimen. The rectal lesion was a 0-Ip tubulovillous adenoma with focal moderately differentiated adenocarcinoma invading the head of the submucosa (pT₁), with negative margins and no lymphovascular or perineural invasion. The patient was discharged on postoperative day 6 without complications. This case suggests that an integrated transrectal NOSES and transanal local excision strategy may be technically feasible in carefully selected patients with synchronous left-sided colon and rectal cancer.

A case of severe immune-related colitis complicated by spontaneous transanal passage of necrotic intestinal mucosa following immune checkpoint inhibitor therapy is reported. The patient was diagnosed with stage IV thymic squamous cell carcinoma and was treated with albumin-bound paclitaxel and carboplatin in combination with tislelizumab. At 5.5 weeks after the last cycle of combined chemotherapy and immunotherapy, colonoscopy revealed scattered mucosal congestion, erosions, and superficial ulcers throughout the colorectum. Subsequently, an approximately 20-cm-long segment of dark-red necrotic intestinal mucosa was discharged through the anus. Histopathological examination of intestinal mucosal biopsy specimens supported the diagnosis of immune-related enterocolitis, which was classified as grade 3 according to the Common Terminology Criteria for Adverse Events. Conservative treatment, including bowel rest, nutritional support, mucosal protection, and symptomatic management, resulted in no significant clinical improvement. Following multidisciplinary consultation involving the departments of gastroenterology, colorectal surgery, and oncology, the necrotic intestinal tissue was surgically removed. The patient recovered uneventfully after the procedure. Histopathological examination of the resected tissue demonstrated ischemic necrosis of the intestinal mucosa accompanied by a severe inflammatory response. This case highlights the complexity and diversity of the clinical manifestations, diagnosis, and management of immune checkpoint inhibitor–related colitis. For patients receiving immune checkpoint inhibitors who develop hematochezia or diarrhea, early assessment and grading of colitis, repeated clinical evaluation, and prompt multidisciplinary consultation are recommended. When necrotic tissue is identified or conservative treatment is ineffective, timely surgical intervention should be considered to prevent serious adverse outcomes.

This article presents the clinical data and surgical experience of a patient who successfully underwent laparoscopic radical resection for rectal cancer with natural orifice specimen extraction surgery (NOSES) Type IV in a primary hospital. During the initial implementation of this technique in primary healthcare settings, patients with early-stage tumors, moderate tumor size, and non-obese mesentery are preferentially selected to reduce technical difficulty and facilitate a smooth learning curve. The procedure strictly adhered to oncological principles, including total mesorectal excision (TME) and lymph node dissection. Using the standard five-port laparoscopic approach routinely available in primary hospitals, intracorporeal digestive tract reconstruction was completed through close collaboration of a dedicated surgical team, and the resected specimen was successfully extracted transrectally via the natural orifice. The patient recovered uneventfully, with minimal postoperative pain, rapid gastrointestinal functional recovery, a shortened hospital stay, and only several small trocar incisions remaining on the abdominal wall, demonstrating the advantages of minimal invasiveness and superior cosmetic outcomes. We believe that, with appropriate patient selection and standardized operative protocols, laparoscopic NOSES Type IV can be safely and feasibly performed in primary hospitals. This technique not only ensures satisfactory oncological radicality but also maximizes the benefits of ultra-minimally invasive surgery and enhanced recovery, making it a valuable procedure for wider adoption in primary healthcare settings.

This article reports a case of small bowel resection and anastomosis performed via the transrectal NOTES approach using the Shurui® snake-like robotic system in a 30 kg healthy pig. After transrectal establishment of access to the peritoneal cavity, the robotic system was deployed to complete mesenteric vessel dissection, clipping, and transection, followed by bowel resection and hand-sewn full-thickness anastomosis. The specimen was retrieved transanally, and the rectal incision was closed per anally. The total operative time was 175 minutes, including 35 minutes for establishing the transrectal access and 140 minutes for robotic operation. Intraoperative blood loss was less than 10 mL, and no conversion to other approaches or intraoperative complications occurred. The animal was euthanized immediately after surgery. The findings demonstrate that the snake-like robotic system enables small bowel resection and anastomosis via the transrectal NOTES approach, with preliminary technical feasibility at the procedural execution level. However, clinical feasibility aspects such as anastomotic healing and infection control require further validation through survival studies.