Objective:

To compare the safety and effectiveness of the Colovac Anastomosis Protection Device with standard diverting ostomy (DO) following low anterior resection (LAR) for rectal cancer.

Summary Background Data:

DO is standard of care (SOC) following LAR for rectal cancer but is associated with substantial morbidity. Colovac Device is designed to divert the fecal stream away from the anastomosis intraluminally.

Methods:

Three prospective multicenter Colovac trials were pooled and compared with a prospective cohort of patients undergoing LAR with DO for rectal cancer using a propensity score-weighted approach to balance baseline characteristics. The primary safety endpoint for both Colovac and SOC trials was the rate of device-related or stoma-related early major complications by POD10. Secondary endpoints included early anastomotic leak (AL) rates, fecal stream diversion effectiveness, and device migration.

Results:

Patients were included (Colovac=49, DO=54). By POD10, device- or stoma-related major complications rates were 4.1% (2/49) vs 5.6% (3/54) (P=0.167). All Colovac devices were successfully placed and retrieved with stoma avoidance achieved in 83.7% at POD10. Major complication rates were similar between groups. Rates of AL detected on POD9/10 were comparable between Colovac and control patients (28.6% vs. 20.4%, P=0.102), with total AL rate of 32.6% in Colovac versus 27.8% (P=0.342) in control at POD30. Effective fecal diversion was achieved in 91.7% of Colovac patients, with device migration in 14.3%.

Conclusions:

Colovac enabled ostomy avoidance in most patients without increasing major complications or AL, suggesting its role as a potential alternative to DO following LAR for rectal cancer.

Trial Registration:

SAFE-2019: NCT05180565; SAFE-2: NCT05010850; SAFE-2023: NCT06540807; SH-SOC23: NCT06152276.

Objective:

This retrospective cohort study aimed to determine the incidence of persistent perineal sinus (PPS) after proctectomy for Crohn disease (CD) and to identify associated risk factors.

Summary Background Data:

Proctectomy remains necessary in a subset of patients with CD, yet impaired perineal wound healing and PPS continue to represent major sources of postoperative morbidity.

Methods:

All patients undergoing proctectomy for CD between 1993 and 2023 at a tertiary referral center were included. The primary outcome was development of PPS, defined as a perineal wound remaining unhealed for ≥6 months after proctectomy. Associated risk factors were analyzed using regression analyses.

Results:

Among 139 patients, 66.20% were women, and PPS occurred in 26. Healing was 81.30% (95% CI, 74.40%–87.30%) at 6 months and 93.50% (95% CI, 88.60%–96.80%) at 12 months; median healing time was 1.80 months (IQR, 0.90–4.60).

Patients operated after 2011 (n=113, 81.30%) were significantly older, more ASA III, and active smokers, with longer disease duration, lower CRP, and higher number of advanced therapies.

PPS was associated with younger age (OR 0.79; P=0.014) and omentoplasty (OR 2.60; P=0.036). After correction for year of surgery, only older age independently predicted faster healing (OR 0.90; 95% CI, 0.83–0.97; P=0.005), while ≥3 therapy lines showed a nonsignificant protective effect (OR 0.36; 95% CI, 0.12–1.07; P=0.067).

Conclusion:

Although PPS remains frequent after proctectomy for Crohn disease, most patients ultimately achieve perineal healing. Older age at surgery is the only independent predictor of faster healing. Improved control of systemic inflammation may reduce the risk of PPS.

Background and Aims:

Auxiliary partial orthotopic liver transplantation (APOLT) for fulminant hepatic failure (FHF) allows potential withdrawal of lifelong immunosuppression (ISP) following native liver regeneration, which may be advantageous in young children with high regenerative capacity. Despite these potential benefits, APOLT has been rarely used, and long-term outcomes in children under 10 years remain unclear. This study aimed to evaluate perioperative safety, long-term outcomes, and native liver regeneration rates in children under 10 years undergoing APOLT for FHF at major centers in the UK and the USA.

Materials and Methods:

We conducted a multicenter international retrospective study using data from King’s College Hospital, Columbia University, and the University of Miami. Children under 10 years with FHF who underwent APOLT between 1996 and 2025 were included.

Results:

Forty-two patients were analyzed. Median age was 3.2 years (interquartile range, 1.69 to 5.89), and 59.5% were males. Etiologies included idiopathic (n = 19), autoimmune hepatitis (n = 8), and adenovirus (n = 7). Left lateral segment grafts were used in 83.3%. No perioperative mortality occurred within 90 days. Perioperative morbidity included hepatic artery thrombosis (7.1%), portal vein thrombosis (4.8%), biliary strictures (7.1%), and bile leaks (2.4%). Median follow-up was 11.1 years (interquartile range, 6.74 to 15.7), with a 25-year overall survival of 97.6%. Native liver regeneration was confirmed in 95.0% (38/40) with successful withdrawal from ISP. Four patients (9.5%) required retransplantation; in 2 of them, APOLT was repeated. Finally, 40 patients underwent APOLT, and 80% are off ISP and 76.2% in the intention-to-treat analysis.

Conclusion:

APOLT is a safe and effective treatment for patients under 10 years old with FHF, providing excellent long-term survival and a high rate of native liver regeneration.

Objective:

To investigate the potential of integrating muscle and fat compartments into a novel and unified score for outcome prediction in a bicentric European cohort of LT recipients.

Background:

Body composition (BC) reflects nutritional status and metabolic reserves and influences outcomes after orthotopic liver transplantation (LT). Validated tools for predicting long-term survival after LT remain scarce. Increasing evidence highlights sex-specific disparities in post-transplant outcomes.

Study Design:

A total of 695 adult patients undergoing LT at Charité–Berlin (n=412, 2010 to 2020; discovery cohort) and University Hospital Aachen (n=283, 2010 to 2018; validation cohort) were included. CT-based BC was assessed at lumbar level 3/4. Muscle mass, quality, and adipose tissue were integrated into the integrative muscle-adipose score (IMAS) and correlated with survival and postoperative morbidity.

Results:

Median follow-up was 54 (discovery) and 47 months (validation). A total of 31% of recipients were female. IMAS quartiles significantly stratified overall survival in both cohorts (P<0.01). Low IMAS was independently prognostic of overall survival in both cohorts. Sex-specific IMAS cutoffs were independently prognostic in both sexes (♂︎: HR=1.89, 95% CI: 1.37-2.70, P=0.001; ♀︎: HR=2.04, 95% CI: 1.17-3.55, P=0.012), whereas the BAR score failed to predict long-term survival in female recipients. Across sexes, low IMAS was associated with significantly lower restricted mean survival time at 5 years (♂︎ 43.2 vs. 50.16 mo, P<0.001; ♀︎ 44.2 vs. 51.71 mo, P=0.013) and a higher Comprehensive Complication Index 90 days after LT.

Conclusion:

The IMAS provides a novel, reproducible sex-sensitive framework for long-term outcome prediction after LT.

Objectives:

This national, multicenter retrospective study of 764 adult liver transplantations (LT) in Sweden (2019–2023) employed a data-driven approach to identify the out-of-hours (OOH) high-risk window and evaluate its impact on patient outcomes and health care costs.

Summary Background Data:

LT logistics often necessitate OOH surgery, but the evidence for an impact on outcomes remains conflicting, partly due to arbitrary window definitions.

Methods

Using the mathematical principle of permutations and linear regression analysis of 1-hour start-time intervals across 552 temporal windows, we identified the period with the greatest impact on the primary endpoint: the 3-month Comprehensive Complication Index (CCI). Secondary outcomes included intensive care unit length of stay, Clavien-Dindo complications, reoperations, patient and graft survival, and health care costs.

Results:

The 17:00 to 05:59 window was identified as having the greatest negative impact on CCI. After adjusting for covariates, procedures initiated during this timeframe were associated with significantly higher CCI (β=7.41, 95% CI: 4.27–10.56, P<0.01), increased Clavien-Dindo IIIb and IV complications, 1.16 days longer intensive care unit stay and a higher risk of LT-related reoperations (odds ratio: 1.61, 95% CI: 1.11–2.36). One-year graft and patient survival were comparable between groups. Health care costs were 169.629 SEK (€15,500) higher per patient operated OOH, during the 3-month follow-up.

Conclusion:

This data-driven analysis identified a high-risk OOH window beginning earlier than previously reported (17:00 vs. traditional nighttime definitions). LT starting in this interval is associated with significantly increased morbidity and health care costs. Further studies are needed to evaluate mitigating strategies to enable daytime transplantation.