Synchronous rectal and prostate adenocarcinomas are uncommon and present a real surgical challenge because the tumors share the same tight pelvic space, particularly in men, and often require combined multimodal treatment. We describe the case of a 79-year-old man who was found to have a non-stenosing distal rectal adenocarcinoma (moderately differentiated, arising from a tubulo-villous adenoma with high-grade dysplasia, staged cT3 cN1 cM0) together with a concurrent prostate adenocarcinoma (cT1c cN0 cM0, Gleason 4 + 3 = 7, PSA 7.2 ng/mL, PI-RADS 4 lesion). After standard neoadjuvant radiochemotherapy for the rectal cancer, restaging showed a good local response. In July 2024, he underwent a planned single-stage combined robot-assisted procedure: abdominoperineal rectum extirpation with total mesorectal excision and terminal descendostomy, immediately followed by radical prostatectomy with bilateral pelvic lymphadenectomy. Final pathology confirmed significant treatment response in the rectum (ypT1 pN0 (0/19) R0 with 30% vital tumor) and ypT3a pN0 R0 prostate cancer. The whole procedure took approximately 7 h with minimal blood loss. He was discharged on day 8 with a functioning descendostomy and initial signs of good recovery. This case demonstrates the feasibility of a single-stage minimally invasive approach in a carefully selected older patient with comorbidities.

Perianal fistulizing Crohn's disease affects approximately one in five patients with Crohn's disease, and many will ultimately undergo an attempt at definitive closure. The outcome of that attempt depends substantially on the complexity of the fistula and inflammatory state; medical and surgical management are sequential components of a single strategy rather than competing alternatives. This review defines adequate medical optimization before surgical management. Treatment targets span three domains: perianal sepsis, the fistula tract and the rectum. Clinical remission, the endpoint of most trials in this field, overstates the state of the tract - across biologic-treated cohorts radiologic healing is achieved in 7-25% of patients compared with clinical remission in 42-47%, but is considerably more durable. Proctitis is the most consistently reported modifiable predictor of failure across closure techniques and should be treated as a contraindication. Source control precedes escalation of immunosuppression. Anti-TNF therapy and guselkumab have the only evidence base from adequately sized fistula-specific randomized trials; and the remainder rests on exploratory subgroups. The magnetic resonance components of contemporary trial endpoints have focused on the absence of collections rather than a healed tract(s). Optimization further encompasses corticosteroid elimination, tobacco cessation, and a perioperative drug plan; we propose operational criteria for readiness across four domains.

The patient was a 70-year-old woman. Colonoscopy performed for the evaluation of hematochezia revealed a type 2 lesion involving two-thirds of the circumference of the Rb rectum, mainly on the posterior wall. The pretreatment diagnosis was cT4N2aM0, cStage Ⅲc rectal cancer, with invasion into the puborectalis muscle. Therefore, 4 courses of FOLFOXIRI plus bevacizumab therapy were administered as neoadjuvant treatment to keep the circumferential margin negative. After chemotherapy, the tumor showed marked shrinkage, and invasion into the puborectalis muscle was improved; thus, laparoscopic partial intersphincteric resection was planned. Laparoscopically, and dissection was going to between the internal and external anal sphincters as partially resected the external anal sphincter to keep the circumferential margin negative. Transanally, the internal sphincter was divided at the dentate line, and a single-layer full-thickness anastomosis was performed. Postoperative histopathological examination revealed pT2 (MP) pN0, pStage Ⅰ disease, and the therapeutic effect of chemotherapy was Grade 1b. The postoperative course was uneventful, and no recurrence has been observed. Various approaches to anus-preserving treatment using multidisciplinary therapy have been reported and achieving a balance between functional preservation and oncological control, as well as managing complications and postoperative sequelae, is considered important.

IntroductionThe incidence of early-onset colorectal cancer (EO-CRC) is steadily rising, although the cause is unclear. CRC patients often experience high symptom burden, including pain, fatigue, and distress, but symptom presentations in EO-CRC patients are poorly understood. The aim of the current study was to characterize baseline symptoms (pain, fatigue, distress) and symptom classes in a sample of symptomatic EO-CRC patients.MethodsAnalysis of cross-sectional baseline data from patients enrolled in a mHealth symptom management randomized controlled trial. Participants were 18-50 years old with a CRC diagnosis (stage I-IV) in the last 3 years and self-reported severity of ≥3/10 on at least 2 symptoms (pain, fatigue, distress). Participants completed measures assessing pain (BPI), fatigue (PROMIS), and distress (BSI). Latent class analysis was used to examine symptom classes and moderating variables [sex, cancer stage, site of disease, treatment in past 7 days, body mass index (BMI), years since diagnosis].ResultsParticipants (N=165, M age=42.2 years (SD=5.7), 53% female, 70% White, 48% Stage IV disease, M time since diagnosis=1 year), on average, endorsed mild pain (M=3.0, SD=2.1), high fatigue (M=55.9, SD=7.1), and moderate distress (M=58.2, SD=8.8). A two-class latent class model was fit. Classes were identified as: low pain, moderate fatigue, moderate distress (Class 1; 60%); moderate pain, high fatigue, high distress (Class 2, 40%). Probability profiles differed by sex and BMI, but not by cancer stage, site of disease (colon; rectum), recent active treatment, or years from diagnosis.ConclusionSymptomatic EO-CRC patients enrolled in a symptom management trial experience elevated fatigue, distress, and to a lesser extent, pain. Symptoms presented in two distinct classes characterized by overall low-moderate and moderate-high symptom burden. Sex-based and BMI differences in class membership exist; findings warrant replication. Findings support developing multi-symptom interventions tailored to the needs of EO-CRC patients.

Colorectal anastomotic leakage is commonly framed as a technical complication or a consequence of intestinal dysbiosis. Neither view fully explains how a contaminated mucosal wound restores epithelial continuity while preserving a load-bearing submucosal matrix. We define anastomotic healing as a spatially organized mucosal immune process: luminal microbes and metabolites, the epithelial wound edge, recruited immune cells, fibroblasts, collagen, and vascular support occupy distinct but interacting compartments. The most compelling available anastomosis-specific evidence supports a destructive pathway in which expressed microbial virulence, host plasminogen activation, epithelial inflammatory signaling, sustained neutrophil recruitment, and MMP9 converge on collagen loss. A complementary repair pathway is supported by human-to-mouse microbiota-transfer and metabolite-rescue experiments, but this evidence is less direct and more heterogeneous. It links commensal function and AhR-dependent IL-22 signaling to epithelial restitution, myeloid resolution, and matrix repair. NLRP3, NLRP6, and NLRC4 remain candidate threshold regulators rather than demonstrated mediators of colorectal anastomotic healing. Human macrophage atlases refine cell-state definitions, but prospective evidence linking anastomotic macrophage states or efferocytosis to leakage remains limited. We propose an evidence-weighted framework that separates human association, direct microbial-function measurements, experimental causation, and human intervention evidence. Translation will require paired spatial sampling and functional microbial assays, together with immune, matrix, mechanical, target-engagement, and ecological-safety endpoints. This framework extends beyond taxonomic dysbiosis toward testable wound-immune endotypes and mechanism-matched prevention.

Chicken enteritis severely reduces poultry productivity by impairing nutrient absorption and growth. Given the critical regulatory roles of small RNAs - particularly miR-34a-5p - in intestinal inflammation, this study investigated its specific function and underlying mechanisms in the pathogenesis of chicken intestinal inflammation. This study showed that dextran sodium sulphate (DSS)-induced enteritis in chickens led to reduced body weight, impaired intestinal structure, decreased hepatic antioxidant capacity, upregulated intestinal pro-inflammatory factor mRNA, and downregulated barrier protein mRNA. qRT-PCR analysis showed that gga-miR-34a-5p expression was significantly upregulated in the rectum of chickens with enteritis compared with controls. Target gene prediction and bioinformatics analysis revealed that the mature sequence of miR-34a-5p was highly conserved across species, and transcription factor binding sites (including NFYA, ZEB1, and NFAT5) were identified in its promoter region. Using the TargetScan and miRDB data platforms to predict target genes of miR-34a-5p, 107 target genes were identified, including NOTCH1, DLL1, PPP3R1, BCL2, SATB2, and FOXP2. We identified NOTCH1 and SATB2 as hubs for the critical pathways through protein-protein interaction (PPI) network analysis. qRT-PCR confirmed the expression levels of the predicted target genes in the control and model groups. The predicted target genes of gga-miR-34a-5p, including NOTCH1, DLL1, PPP3R1, BCL2, SATB2 and FOXP2, are involved in regulating multiple signalling pathways such as the NOTCH, WNT, and P53 pathways. In the DSS-induced intestinal inflammation model, gga-miR-34a-5p regulates the initiation and progression of intestinal inflammation and mucosal impairment by targeting both the NOTCH1 signalling pathway (via its ligand DLL1) and SATB2/FOXP2.

Anorectal manometry (ARM) provides objective physiological information on anal sphincter function, rectal or neorectal sensation, reservoir capacity, and anorectal reflexes after rectal cancer surgery. In rectal cancer surgery, ARM has been used to evaluate functional changes after sphincter-preserving procedures, reconstruction with colonic J-pouch, neoadjuvant radiotherapy, and postoperative bowel dysfunction, including low anterior resection syndrome (LARS). This review summarizes the clinical applications of ARM in rectal cancer surgery, with emphasis on historical and contemporary manometric parameters, their relationship with patient-reported outcomes, and their limitations in postoperative functional assessment. Although several studies have reported associations between manometric findings and bowel dysfunction, the clinical interpretation of ARM remains limited by heterogeneity in measurement protocols, equipment dependency, timing of assessment, and variable correlation with quality-of-life measures. Recent advances, including high-resolution manometry and standardized testing protocols, may improve the reliability and clinical utility of ARM. ARM may provide adjunctive physiological information in selected patients and research settings, but current evidence does not support its use as a stand-alone diagnostic test for LARS or as a routine treatment-decision tool.