AI-powered 3D pathology protocol enhances enteric nervous system visualization and quantification for clinical diagnostics.

Accurate diagnosis and understanding of gastrointestinal (GI) diseases such as ulcerative colitis and Hirschsprung's disease remain challenging due to the limitations of traditional two-dimensional (2D) histopathology in capturing the intricate three-dimensional (3D) architecture and dynamic microenvironment of GI tissues. This study explores the potential of integrating 3D imaging techniques with artificial intelligence (AI)-based analysis to improve histological evaluation and diagnostic accuracy. Using advanced imaging and computational tools, we identified critical structural and functional details of the enteric nervous system and associated tissues that are often missed by 2D approaches.

[Seoul Consensus on Clinical Practice Guidelines for Functional Constipation].

Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation.

Leveraging automated machine learning to predict colon cancer prognosis from clinical features and risk groups: a retrospective cohort study.

Background: Predicting colon cancer recurrence is crucial for determining the need for adjuvant therapy after curative resection. However, clinical decisions often rely on limited features, even when a large amount of data is available.

Methods: We assessed the clinical utility of automated machine learning (AutoML) models to predict the prognosis of colon cancer patients from a tertiary hospital using clinical features, pathologic characteristics, and blood markers.

Impact of sleep disturbances due to low anterior resection syndrome on the quality of life of patients with rectal cancer.

Purpose: We aimed to analyze the effects of nighttime symptoms on quality of life of patients with low anterior resection syndrome (LARS) and determine the correlation between nighttime symptoms and insomnia.

Methods: A single-center observational study was conducted on patients with rectal adenocarcinoma who underwent sphincter-preserving surgery at Seoul National University Hospital between 2019 and 2023. Eligible patients were surveyed during routine outpatient follow-up.

Safety and efficacy of flexible articulated instrument (ArtiSential) in laparoscopic surgery for rectal cancer.

Background: Laparoscopic surgery for rectal cancer remains challenging because of limited joint motion during dissection in the deep and narrow pelvis. Handheld multiarticulated instruments have been developed to address these limitations. This study aimed to assess the safety and efficacy of a flexible articulated instrument, the ArtiSential (Livsmed Co, Korea), at reducing the duration of laparoscopic rectal cancer surgery.

Longitudinal quality of life assessment after laparoscopic colorectal cancer surgery using the Gastrointestinal Quality of Life Index questionnaire: A multicentre prospective study.

Aim: The aim of this study was to validate the Gastrointestinal Quality of Life Index (GIQLI) and assess its effectiveness in measuring changes in postoperative quality of life (QOL) after laparoscopic colorectal cancer surgery, including factors affecting early QOL impairment.

Method: This multicentre prospective study enrolled patients who underwent laparoscopic colorectal cancer surgery between November 2021 and February 2023. Participants completed the GIQLI and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Colorectal Cancer (EORTC QLQ-CR29) questionnaires preoperatively and at 1 and 3 weeks, 6 months and 1 year postoperatively.

Ulcerative colitis-associated colorectal neoplasm is increasing as a surgical indication in the biologics era: a retrospective observational study of 20 years of experience in a single tertiary center.

Purpose: We aimed to identify changes in surgical indications in patients with ulcerative colitis (UC) in the biologics era in a single tertiary center.

Methods: In this retrospective observational study, 108 patients with UC who underwent abdominal surgery for UC at Seoul National University Hospital from 2000 to 2021 were included. We compared the total number of patients undergoing UC before and after the introduction of biologic therapy.

Comparison of warm sitz bath and electronic bidet with a lower-force water flow for postoperative management after hemorrhoidectomy (BIDLOW).

Aim: Electronic bidets can be a substitute for sitz baths, but no study has examined the use of electronic bidets to manage anal problems.

Methods: A randomized, controlled, single-blind, multicenter, parallel group trial was performed. Patients who underwent hemorrhoidectomy were randomly assigned (1:1) to use the electronic bidet or warm sitz baths for 7 days after hemorrhoidectomy.

Single-Dose Versus Multiple-Dose Prophylactic Antibiotics in Minimally Invasive Colorectal Surgery: A Propensity Score Matched Analysis.

Background: Recent guidelines about preventing surgical site infections (SSIs) recommend against the administration of prophylactic antibiotics after surgery. However, many colorectal surgeons still prefer prolonged use of prophylactic antibiotics. While minimally invasive surgery (MIS) has become the standard for colorectal cancer surgery, there were few studies about proper dose of prophylactic antibiotics in minimally invasive colorectal surgery.

Integrated responses of the SIP syncytium generate a major motility pattern in the colon.

The peristaltic reflex has been a central concept in gastrointestinal motility; however, evidence was published recently suggesting that post-stimulus responses that follow inhibitory neural responses provide the main propulsive force in colonic motility. This new concept was based on experiments on proximal colon where enteric inhibitory neural inputs are mainly nitrergic. However, the nature of inhibitory neural inputs changes from proximal to distal colon where purinergic inhibitory regulation dominates.

Tumor Deposits as an Adverse Prognostic Indicator in Stage III Colon Cancer: A Multicenter Database Study.

Objective: We explored the oncological impact of tumor deposits (TDs) on colon cancer and proposed optimal modifications to the current staging system.

Background: In the existing American Joint Committee on Cancer colon cancer staging system, TDs are incorporated into the N category as N1c. When lymph node metastases (LNMs) are present, their number is considered to determine nodal stages, such as N1a/b or N2a/b, regardless of TDs.

Are sporadic colorectal cancers in young patients distinct from those in elderly patients?

Aim: The aim of this study was to compare the clinicopathological and oncological characteristics of sporadic colorectal cancer (CRC) between young and elderly patients without any genetic mutations that cause hereditary CRC.

Method: In this cross-sectional, retrospective study conducted at three tertiary referral hospitals, we enrolled 1599 patients with CRC who underwent surgery between January 2010 and December 2017, including 157 young patients (age ≤ 40 years; yCRC) and 1442 elderly patients (age ≥ 70 years; eCRC). The clinicopathological and oncological outcomes were compared between the two groups.

Glycemic traits and colorectal cancer survival in a cohort of South Korean patients: A Mendelian randomization analysis.

Background: Clinical diabetic traits have been reported to be associated with increased colorectal cancer (CRC) risk in observational studies. Using the Mendelian randomization (MR) analysis method, we examined the causal association between glycemic traits, such as fasting glucose (FG), fasting insulin (FI), and glycosylated hemoglobin A1c (HbA1c), and survival in a cohort of CRC patients.

Methods: We conducted a two-sample MR analysis among a cohort of patients with locally advanced CRC at Seoul National University Hospital.

Risk Factor Analysis of Lymph Node Metastasis for Rectal Neuroendocrine Tumors: Who Needs a Radical Resection in Rectal Neuroendocrine Tumors Sized 1-2 cm?

Background: Rectal neuroendocrine tumors (NETs) have malignant potential, and lymph node (LN) or distant metastases can occur; however, treatment of NETs 1-2 cm in size is controversial.

Objective: This study aimed to identify predictive factors for LN metastasis and prognostic factors for recurrence of rectal NETs, especially tumors 1‒2 cm in size.

Methods: Between October 2004 and November 2020, 453 patients underwent endoscopic or surgical treatment for rectal NETs in Seoul National University Hospital.

Three-dimensional body composition parameters using automatic volumetric segmentation allow accurate prediction of colorectal cancer outcomes.

Background: Parameters obtained from two-dimensional (2D) cross-sectional images have been used to determine body composition. However, data from three-dimensional (3D) volumetric body images reflect real body composition more accurately and may be better predictors of patient outcomes in cancer. This study aimed to assess the 3D parameters and determine the best predictive factors for patient prognosis.

Cystic lymphangioma causing intussusception of the right colon: a case report and review of current literature.

Among intraabdominal lymphangiomas, colonic lymphangiomas are rare. These cystic tumors are generally asymptomatic and incidentally found but may present with bleeding or obstructive symptoms. Intussusception by such tumors is scarcely reported, with only nine previously reported cases listed in Pubmed.

Real-world survival after colorectal surgery for malignancy in Korean patients with chronic kidney disease: an analysis of Korean healthcare big data, 2002-2019.

Purpose: Globally, chronic kidney disease (CKD) is common and has been associated with an increased risk of colorectal cancer (CRC). There is a dearth of literature on the real-world morbidity and mortality associated with CKD comorbid with CRC. This study was performed to evaluate real-world survival outcomes of colorectal malignancy in Korean CKD patients.

A 3 mm Port Reduces Postoperative Pain After Laparoscopic Colon Cancer Surgery: A Case-control Matched Study.

Background: Recently, smaller-size trocars and instruments have been developed for laparoscopic colon cancer surgery; however, their effectiveness and safety have not been elucidated. This study aimed to investigate whether 3 mm trocars and instruments have benefits compared with conventional trocars and instruments.

Patients And Methods: Patients with colon cancer who underwent laparoscopic anterior resection or right hemicolectomy were included.

Epigenetic insights into colorectal cancer: comprehensive genome-wide DNA methylation profiling of 294 patients in Korea.

DNA methylation regulates gene expression and contributes to tumorigenesis in the early stages of cancer. In colorectal cancer (CRC), CpG island methylator phenotype (CIMP) is recognized as a distinct subset that is associated with specific molecular and clinical features. In this study, we investigated the genomewide DNA methylation patterns among patients with CRC.

Total neoadjuvant therapy with short-course radiotherapy Versus long-course neoadjuvant chemoradiotherapy in Locally Advanced Rectal cancer, Korean trial (TV-LARK trial): study protocol of a multicentre randomized controlled trial.

Background: For locally advanced rectal cancer (LARC), total neoadjuvant therapy (TNT) may enhance tumour response, reduce recurrence, and improve patient compliance compared to upfront surgery. Recent studies have shown that chemoradiotherapy (CRT) followed by consolidation chemotherapy leads to higher rate of pathologic complete response (pCR) than induction chemotherapy followed by CRT. However, an optimal TNT regimen that maximise the pCR rate and minimise toxicity has not been established.

2022 Seoul Consensus on Clinical Practice Guidelines for Functional Constipation.

Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation.

Personalised circulating tumour DNA assay with large-scale mutation coverage for sensitive minimal residual disease detection in colorectal cancer.

Background: Postoperative minimal residual disease (MRD) detection using circulating-tumour DNA (ctDNA) requires a highly sensitive analysis platform. We have developed a tumour-informed, hybrid-capture ctDNA sequencing MRD assay.

Methods: Personalised target-capture panels for ctDNA detection were designed using individual variants identified in tumour whole-exome sequencing of each patient.

Gut microbiome associated with low anterior resection syndrome after rectal cancer surgery.

This study aimed to assess the likely association of gut microbiome with low anterior resection syndrome (LARS) symptoms. Postoperative stool samples from patients with minor or major LARS after sphincter-preserving surgery (SPS) for rectal cancer were collected and analyzed using 16S ribosomal RNA sequencing method. The symptom patterns of LARS were classified into two groups (PC1LARS, PC2LARS) using principal component analysis.

Mutational evolution after chemotherapy-progression in metastatic colorectal cancer revealed by circulating tumor DNA analysis.

Emerging new mutations after treatment can provide clues to acquired resistant mechanisms. Circulating tumor DNA (ctDNA) sequencing has enabled noninvasive repeated tumor mutational profiling. We aimed to investigate newly emerging mutations in ctDNA after disease progression in metastatic colorectal cancer (mCRC).