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Colorectal Disease: Novel Treatment Approaches and Outcomes

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 14025

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Special Issue Editors

Prof. Dr. Donato F. Altomare

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Guest Editor

Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
Interests: colorectal cancer; screening; hemorrhoids; fecal incontinence

Prof. Dr. Antonino Spinelli

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Guest Editor

Division Colon and Rectal Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano Milan, Italy
Interests: colorectal cancer; Inflammatory bowel diseases; laparoscopy

Special Issue Information

Dear Colleagues,

It is our pleasure to invite you to contribute to a Special Issue of the Journal of Clinical Medicine entitled “Colorectal Disease: Novel Treatment Approaches and Outcomes”.

The treatment of colorectal diseases has undergone substantial progress thanks to the development of new technologies and new diagnostic–therapeutic pathways able to minimize medical and surgical stress, improving the outcome, even in long-term results. However, the advantages and disadvantages of new technologies in the field of colorectal diseases are still debated, and several ongoing trials have recently been published.

Considering the wide range of diseases involving the colon and the rectum, including haemorrhoids, functional disorder, inflammatory diseases, and colorectal cancer, the type and way to approach the diagnosis and treatment of these conditions is still a matter of debate.

This Special Issue aims to serve as an overview of the currently available knowledge and recent findings regarding novel treatment approaches and outcomes in colorectal diseases.

Prof. Dr. Donato F. Altomare
Prof. Dr. Antonino Spinelli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cancer stem cell vaccine
microbiota
biomarkers
screening
colorectal cancer
inflammatory bowel disease
sacral nerve modulation
rectal prolapse
robotic colorectal surgery
3D modeling
hemorrhoids
TaTME
NOSE
endoluminal surgery
anastomotic leak

Published Papers (6 papers)

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Editorial

Jump to: Research

2 pages, 158 KiB

Open AccessEditorial

Cutting-Edge Research Trends in Colorectal Disease

by Jacopo Crippa, Donato F. Altomare and Antonino Spinelli

J. Clin. Med. 2022, 11(4), 1036; https://doi.org/10.3390/jcm11041036 - 16 Feb 2022

Cited by 1 | Viewed by 1417

Abstract

The scientific effort in improving colorectal disease treatment and outcomes has allowed for a continuous shift of burdens that were previously thought to be unassailable [...] Full article

(This article belongs to the Special Issue Colorectal Disease: Novel Treatment Approaches and Outcomes)

Research

Jump to: Editorial

12 pages, 2013 KiB

Open AccessArticle

Effect of Biofeedback Therapy during Temporary Stoma Period in Rectal Cancer Patients: A Prospective Randomized Trial

by Hyeon-Min Cho, Hyungjin Kim, RiNa Yoo, Gun Kim and Bong-Hyeon Kye

J. Clin. Med. 2021, 10(21), 5172; https://doi.org/10.3390/jcm10215172 - 04 Nov 2021

Cited by 7 | Viewed by 1701

Abstract

Background: This prospective randomized controlled study was designed to evaluate the effect of biofeedback therapy (BFT) during temporary stoma period to prevent defecation dysfunction after sphincter-preserving surgery (SPS). Methods: Following SPS with temporary stoma, patients were divided according to whether (BFT group) or not (Control group) they received BFT. BFT was performed once or twice a week during the temporary stoma period. Kegel exercise were advised to all the patients. Subjective defecation symptoms were evaluated according to Cleveland Clinic Incontinence Score (CCIS) as primary outcome at 12 months postoperatively. Manometric data of five time-points were also analyzed. Results: Twenty-one patients in the BFT group and 23 patients in the control group received anorectal physiologic testing. The incidence of CCIS of more than 9 points, which is the primary end point in this study, was not statistically different between BFT group and control group (p = 1.000). The liquid stool incontinence in the BFT group showed a better tendency (p = 0.06) at 12 months post-SPS. Time-dependent serial changes in maximal sensory threshold (Max RST) was significantly different between the BFT and control groups (p = 0.048). Also, the change of mean resting pressure (MRP) tended to be more stable in the BFT group (p = 0.074). Conclusions: The BFT in the period of temporary stoma may be related to liquid stool incontinence at 12 months post-SPS and lead to stable MRP and better Max RST. Therefore, BFT during temporary stoma might be helpful for preventing and minimizing defecation dysfunction in high risk patients after SPS, NCT01661829). Full article

(This article belongs to the Special Issue Colorectal Disease: Novel Treatment Approaches and Outcomes)

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12 pages, 2267 KiB

Open AccessArticle

Optimal Sequence and Second-Line Systemic Treatment of Patients with RAS Wild-Type Metastatic Colorectal Cancer: A Meta-Analysis

by Chih-Chien Wu, Chao-Wen Hsu, Meng-Che Hsieh, Jui-Ho Wang, Min-Chi Chang, Ching-Shiang Yang and Yi-Chia Su

J. Clin. Med. 2021, 10(21), 5166; https://doi.org/10.3390/jcm10215166 - 04 Nov 2021

Cited by 3 | Viewed by 1916

Abstract

Although several sequential therapy options are available for treating patients with RAS wild-type (WT) metastatic colorectal cancer (mCRC), the optimal sequence of these therapies is not well established. A systematic review and meta-analysis of 13 randomized controlled trials and 4 observational studies were performed, resulting from a search of the Cochrane Library, PubMed, and Embase databases. Overall survival (OS) did not differ significantly in patients with RAS-WT failure who were administered a second-line regimen of changed chemotherapy (CT) plus anti-epidermal growth factor receptor (EGFR) versus only changed CT, changed CT plus bevacizumab versus changed CT plus anti-EGFR, or changed CT versus maintaining CT plus anti-EGFR after first-line therapy with CT, plus bevacizumab. However, OS was significantly different with a second-line regimen that included changed CT plus bevacizumab, versus only changing CT. Analysis of first-line therapy with CT plus anti-EGFR for treatment of RAS-WT mCRC indicated that second-line therapy of changed CT plus an anti-EGFR agent resulted in better outcomes than changing CT without targeted agents. The pooled data study demonstrated that the optimal choice of second-line treatment for improved OS was an altered CT regimen with retention of bevacizumab after first-line bevacizumab failure. The best sequence for first-to-second-line therapy of patients with RAS-WT mCRC was cetuximab-based therapy, followed by a bevacizumab-based regimen. Full article

(This article belongs to the Special Issue Colorectal Disease: Novel Treatment Approaches and Outcomes)

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9 pages, 1603 KiB

Open AccessArticle

Sphinkeeper Procedure for Treating Severe Faecal Incontinence—A Prospective Cohort Study

by Christopher Dawoud, Leonhard Bender, Kerstin Melanie Widmann, Felix Harpain and Stefan Riss

J. Clin. Med. 2021, 10(21), 4965; https://doi.org/10.3390/jcm10214965 - 26 Oct 2021

Cited by 4 | Viewed by 1556

Abstract

(1) Background: The Sphinkeeper implantation for faecal incontinence (FI) is a novel surgical procedure with limited data on its clinical efficacy. Therefore, we aimed to assess the functional outcome following Sphinkeeper surgery in patients with refractory FI. (2) Methods: Between 2018 and 2020, eleven consecutive patients (9 female) with FI met the inclusion criteria and were enrolled for surgery. Functional outcome and quality of life were evaluated by standard questionnaires pre- and post-surgery. Migration of protheses was demonstrated by 3D endoanal ultrasound. The median follow-up time was eight months (range 3–18 months). (3) Results: The median age was 75 years (range 46–89 years) with a median BMI of 27.4 (range 21.2–30.1). The median number of implanted prostheses per intervention was nine (range 9–10). We found no intraoperative or early postoperative complications. After two months, two prostheses in one patient had to be removed due to pain at the perianal skin site. The median St. Mark’s incontinence score decreased significantly from 22 to 13 points (p = 0.008). The SF-12 showed a significant improvement (35.9 versus 46.3) after surgery (p = 0.028). A migration of at least one prosthesis was observed in ten patients (91%). Six (60%) prostheses were found at the same level in another ten patients. (4) Conclusion: Sphinkeeper implantation is a promising surgical technique for patients with severe FI. The complication rate is low, and short-term functional improvement can be achieved even in severe forms of FI. Migration of implants commonly occurs. Full article

(This article belongs to the Special Issue Colorectal Disease: Novel Treatment Approaches and Outcomes)

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10 pages, 1840 KiB

Open AccessArticle

by Jonas Jurt, Martin Hübner, Daniel Clerc, Pauline Curchod, Mohamed A. Abd El Aziz, Dieter Hahnloser, Laurence Senn, Nicolas Demartines and Fabian Grass

J. Clin. Med. 2021, 10(19), 4524; https://doi.org/10.3390/jcm10194524 - 29 Sep 2021

Cited by 6 | Viewed by 3307

Abstract

Aim: The aim of this study was to assess the implementation of an intraoperative standardized surgical site infection (SSI) prevention bundle. Methods: The multimodal, evidence-based care bundle included nine intraoperative items (antibiotic type, timing, and re-dosing; disinfection; induction temperature control > 36.5°; glove change; intra-cavity lavage; wound protection; and closure strategy). The bundle was applied to all consecutive patients undergoing colonic resections. The primary outcome, SSI, was independently assessed by the National Infection Surveillance Committee for up to 30 postoperative days. A historical, institutional pre-implementation control group (2012–2017) with an identical methodology was used for comparison. Findings: In total, 1516 patients were included, of which 1256 (82.8%) were in the control group and 260 (17.2%) were in the post-implementation group. After 2:1 propensity score matching, the groups were similar for all items (p > 0.05). Overall compliance with the care bundle was 77% (IQR 77–88). The lowest compliance rates were observed for temperature control (53% overall), intra-cavity lavage (64% overall), and wound protection and closure (68% and 63% in the SSI group, respectively). Surgical site infections were reported in 58 patients (22.2%) vs. 21.4% in the control group (p = 0.79). Infection rates were comparable throughout the Centers for Disease Control and Prevention (CDC) categories: superficial, 12 patients (4.5%) vs. 4.2%, p = 0.82; deep incisional, 10 patients (3.7%) vs. 5.1%, p = 0.34; organ space, 36 (14%) vs. 12.4%, p = 0.48. After propensity score matching, rates remained comparable throughout all comparisons (all p > 0.05). Conclusions: The implementation of an intraoperative standardized care bundle had no impact on SSI rates. This may be explained by insufficient compliance with the individual measures. Full article

(This article belongs to the Special Issue Colorectal Disease: Novel Treatment Approaches and Outcomes)

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11 pages, 864 KiB

Open AccessArticle

Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection

by Takuya Okugawa, Tadayuki Oshima, Keisuke Nakai, Hirotsugu Eda, Akio Tamura, Ken Hara, Tomohiro Ogawa, Tomoaki Kono, Takashi Kondo, Katsuyuki Tozawa, Masashi Fukushima, Toshihiko Tomita, Hirokazu Fukui, Jiro Watari and Hiroto Miwa

J. Clin. Med. 2021, 10(5), 928; https://doi.org/10.3390/jcm10050928 - 01 Mar 2021

Cited by 3 | Viewed by 2991

Abstract

Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6–2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding (DPPB). Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection. Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of DPPB. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of historical control patients and patients after instruction were compared. Results: A total of 3318 polyps in 1002 patients were evaluated. The control group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. DPPB occurred in 1.1% of polyps in control, and 0.4% in after-instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for DPPB even after instruction. Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy. Full article

(This article belongs to the Special Issue Colorectal Disease: Novel Treatment Approaches and Outcomes)

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