Annals of Coloproctology

Volume 40(2); April 2024

Editorial

Can robotic surgery lead the way in the treatment of rectal cancer?: Jeonghee Han; Ann Coloproctol. 2024;40(2):87-88. Published online April 5, 2024; DOI: https://doi.org/10.3393/ac.2024.00234.0033

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Guideline

Colorectal cancer

Colon cancer: the 2023 Korean clinical practice guidelines for diagnosis and treatment: Hyo Seon Ryu, Hyun Jung Kim, Woong Bae Ji, Byung Chang Kim, Ji Hun Kim, Sung Kyung Moon, Sung Il Kang, Han Deok Kwak, Eun Sun Kim, Chang Hyun Kim, Tae Hyung Kim, Gyoung Tae Noh, Byung-Soo Park, Hyeung-Min Park, Jeong Mo Bae, Jung Hoon Bae, Ni Eun Seo, Chang Hoon Song, Mi Sun Ahn, Jae Seon Eo, Young Chul Yoon, Joon-Kee Yoon, Kyung Ha Lee, Kyung Hee Lee, Kil-Yong Lee, Myung Su Lee, Sung Hak Lee, Jong Min Lee, Ji Eun Lee, Han Hee Lee, Myong Hoon Ihn, Je-Ho Jang, Sun Kyung Jeon, Kum Ju Chae, Jin-Ho Choi, Dae Hee Pyo, Gi Won Ha, Kyung Su Han, Young Ki Hong, Chang Won Hong, Jung-Myun Kwak, Korean Colon Cancer Multidisciplinary Committee; Ann Coloproctol. 2024;40(2):89-113. Published online April 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00059.0008

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Abstract PDF Supplementary Material

Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.

Citations

Citations to this article as recorded by

2023 Korean Multidisciplinary Guidelines for Colon Cancer Management: Summary of Radiological Points
Nieun Seo, Hyo Seon Ryu, Myungsu Lee, Sun Kyung Jeon, Kum Ju Chae, Joon-Kee Yoon, Kyung Su Han, Ji Eun Lee, Jae Seon Eo, Young Chul Yoon, Sung Kyung Moon, Hyun Jung Kim, Jung-Myun Kwak
Korean Journal of Radiology.2024; 25(9): 769. CrossRef

Original Articles

Colorectal cancer

Estimation of risk posed by malignant polyps amongst colorectal surgeons in Australia and New Zealand: Andrew P. Zammit, Ian Brown, John D. Hooper, David A. Clark, Andrew D. Riddell; Ann Coloproctol. 2024;40(2):114-120. Published online March 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00178.0025

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Abstract PDF Supplementary Material: Purpose
The estimation of the risk posed by malignant polyps for residual or lymphatic disease plays a central role. This study investigated colorectal surgeons’ assessment of these risks associated with malignant polyps.
Methods
A cross-sectional questionnaire was electronically administered to colorectal surgeons in Australia and New Zealand in October 2022. The questionnaire contained 17 questions on demographics, when surgeons consider colorectal resection appropriate, and the risk assessment for 5 hypothetical malignant polyps.
Results
The mean risk of residual or lymphatic disease that would prompt surgeons to recommend colonic resection was 5%. However, this increased to a mean risk of 10% if the malignant polyp was located in the rectum, and the only resection option was abdominoperineal resection with end-colostomy. There was high concordance between the estimated risk of residual or lymphatic disease by colorectal surgeons and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines for the 5 hypothetical malignant polyps, with the ACPGBI estimated risk lying within the 95% confidence interval for 4 of the 5 malignant polyps. Nonetheless, 96.6% of surgeons felt that an online risk calculator would improve clinical practice.
Conclusion
Colorectal surgeons in Australia and New Zealand accurately estimated the risk posed by malignant polyps. An online risk calculator may assist in better conveying risk to patients.

Colorectal cancer

Comparing the efficacy of combined versus single immune cell adaptive therapy targeting colorectal cancer: Denis Nchang Che, NaHye Lee, Hyo-Jung Lee, Yea-Won Kim, Solongo Battulga, Ha Na Lee, Won-Kook Ham, Hyunah Lee, Mi Young Lee, Dawoon Kim, Haengji Kang, Subin Yun, Jinju Park, Daeyoun David Won, Jong Kyun Lee; Ann Coloproctol. 2024;40(2):121-135. Published online April 22, 2024; DOI: https://doi.org/10.3393/ac.2023.00402.0057

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Abstract PDF Supplementary Material: Purpose
Colorectal cancer (CRC) is the most frequent cancer with limited therapeutic achievements. Recently, adoptive cellular immunotherapy has been developed as an antitumor therapy. However, its efficacy has not been tested in CRC. This study investigated the ability of an immune cell cocktail of dendritic cells (DCs), T cells, and natural killer (NK) cells to overcome immunological hurdles and improve the therapeutic efficacy of cell therapy for CRC.
Methods
CRC lysate-pulsed monocyte-derived DCs (Mo-DCs), CRC antigen-specifically expanded T cells (CTL), and in vitro-expanded NK cells were cultured from patient peripheral blood mononuclear cells (PBMC). The ability of the combined immune cells to kill autologous tumor cells was investigated by co-culturing the combined immune cells with patient-derived tumor cells.
Results
The Mo-DCs produced expressed T cell co-stimulating molecules like CD80, CD86, human leukocyte antigen (HLA)-DR and HLA-ABC, at high levels and were capable of activating naive T cells. The expanded T cells were predominantly CD8 T cells with high levels of CD8 effector memory cells and low levels of regulatory T cells. The NK cells expressed high levels of activating receptors and were capable of killing other cancer cell lines (K562 and HT29). The immune cell cocktail demonstrated a higher ability to kill autologous tumor cells than single types. An in vivo preclinical study confirmed the safety of the combined immune cell adaptive therapy showing no therapy-related death or general toxicity symptoms.
Conclusion
The results suggested that combined immune cell adaptive therapy could overcome the limited efficacy of cell immunotherapy.

Benign bowel disease

Risk factors of incisional hernia at the umbilical specimen extraction site in patients with laparoscopic colorectal cancer surgery: Masatsugu Hiraki, Toshiya Tanaka, Shinya Azama, Eiji Sadashima, Hirofumi Sato, Shuusuke Miyake, Kenji Kitahara; Ann Coloproctol. 2024;40(2):136-144. Published online June 21, 2022; DOI: https://doi.org/10.3393/ac.2022.00213.0030

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Graphical Abstract Abstract PDF

Purpose
Incisional hernia (IH) is a frequent complication following laparoscopic colorectal surgery. The present study investigated the risk factors for IH after laparoscopic surgery for colorectal cancer.
Methods
A retrospective study was conducted on 202 patients who underwent laparoscopic surgery for colorectal cancer. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with IH.
Results
The overall incidence of IH was 25.7% (52 of 202). The univariate analysis showed that female sex (P=0.004), a high body mass index (P<0.001), noncurrent smoking habit (P=0.043), low level of hemoglobin (P=0.035), high subcutaneous fat area (P<0.001), high visceral fat area (P=0.006), low skeletal muscle area (P=0.001), long distance between the inner edges of the rectus abdominis muscle (P=0.001), long protrusion of the peritoneum at the umbilical site (P<0.001), and lymph node metastasis (P=0.007) were significantly more frequent in the group with IH than in the group without it. The multivariate logistic regression analysis revealed an older age (10-year increments: odds ratio [OR], 1.576; 95% confidence interval [CI], 1.027–2.419; P=0.037), lymph node metastasis (OR, 2.384; 95% CI, 1.132–5.018; P=0.022) and lengthy protrusion of the peritoneum at the umbilical site (10-mm increments: OR, 5.555; 95% CI, 3.058–10.091; P<0.001) were independent risk factors for IH.
Conclusion
Our findings suggest that older age, lymph node metastasis, and lengthy protrusion of the peritoneum at the umbilical site are risk factors for IH after laparoscopic surgery for colorectal cancer. An assessment using these factors before the operation and the implementation of countermeasures might help prevent IH.

Citations

Citations to this article as recorded by

Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study
I. Omar, A. Townsend, O. Hadfield, T. Zaimis, M. Ismaiel, J. Wilson, C. Magee
Hernia.2024;[Epub] CrossRef
The first case of robotic‐assisted transabdominal retrorectus repair for incisional hernia in Japan
Gen Shimada, Taketo Matsubara, Mariko Sanbonmatsu, Rumi Nakabayashi, Yosuke Miyachi, Takashi Taketa, Akihiro Suzuki, Tadao Yokoi, Toshimi Kaido
Asian Journal of Endoscopic Surgery.2023; 16(2): 305. CrossRef
Mid-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution
Heita Ozawa, Naoyuki Toyota, Junichi Sakamoto, Hiroki Nakanishi, Ryo Nakanishi, Shin Fujita
Surgery Today.2023; 53(8): 992. CrossRef
Impact of non-muscle cutting periumbilical transverse incision on the risk of incisional hernia as compared to midline incision during laparoscopic colon cancer surgery: a study protocol for a multi-centre randomised controlled trial
Soo Yeun Park, Gi Won Ha, Soo Young Lee, Chang Hyun Kim, Gyung Mo Son
Trials.2023;[Epub] CrossRef

Colorectal cancer

Public effect of the 2022 Colorectal Cancer Awareness Campaign delivered through a metaverse platform: Tae-Gyun Lee, Gil-Hyeon Song, Hong-min Ahn, Heung-Kwon Oh, Moonkyoung Byun, Eon Chul Han, Sohyun Kim, Chang Woo Kim, Hye Jin Kim, Samin Hong, Kee-Ho Song, Chan Wook Kim, Yong Beom Cho, on behalf of the Public Relations Committee of the Korean Society of Coloproctology (KSCP); Ann Coloproctol. 2024;40(2):145-153. Published online April 28, 2023; DOI: https://doi.org/10.3393/ac.2023.00122.0017

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Graphical Abstract Abstract PDF

Purpose
The Korean Society of Coloproctology has been conducting Colorectal Cancer Awareness Campaign, also known as the Gold Ribbon Campaign, every September since 2007. The 2022 campaign was held through a metaverse platform targeting the younger age group under the slogan of raising awareness of early-onset colorectal cancer (CRC). This study aimed to analyze the impact of the 2022 campaign on a metaverse platform.
Methods
Anonymized survey data were collected from participants in the metaverse campaign from September 1 to 15, 2022. The satisfaction score of the participants was evaluated by sex, age group, and previous campaign participation status.
Results
During the campaign, 2,770 people visited the metaverse. Among them, 455 people participated in the survey (response rate, 16.4%). Approximately 95% of the participants reported being satisfied with the information provided by the campaign, understood the necessity of undergoing screening for and prevention of early-onset CRC, and were familiar with the structure of the metaverse. The satisfaction score for campaign information tended to decrease as the participants’ age increased. When the participants’ overall level of satisfaction with the metaverse platform was assessed, teenagers scored particularly lower than the other age groups. The satisfaction scores for CRC information provided in the metaverse, as well as the scores for recognizing the seriousness and necessity of screening for early-onset CRC, indicated a high positive tendency (P<0.001).
Conclusion
Most of the 2022 Gold Ribbon Campaign participants were satisfied with the metaverse platform. Medical society should pay attention to increasing participation in and satisfaction with future public campaigns.

Citations

Citations to this article as recorded by

#CRCandMe: results of a pre-post quasi-experimental study of a mass media campaign to increase early-onset colorectal cancer awareness in Utah and Wisconsin
Ami E Sedani
American Journal of Cancer Research.2024; 14(8): 3873. CrossRef

Minimally invasive surgery

A comparative study of the pathological outcomes of robot-assisted versus open surgery for rectal cancer: René Reyes, Csaba Kindler, Kenneth Smedh, Catarina Tiselius; Ann Coloproctol. 2024;40(2):154-160. Published online December 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00332.0047

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Abstract PDF

Purpose
The use of robot-assisted surgery for rectal cancer is increasing, but the pathological outcomes have not been fully clarified. We compared the surgical and pathological outcomes between robot-assisted and open surgery in specimens from patients operated on for rectal cancer.
Methods
All patients who underwent resection for rectal cancer from 2016 to 2018 were included (n=137). Specimens were divided into 3 sections to analyze the pathology of the lymph nodes.
Results
The total specimen lengths were shorter in the robot-assisted group than in the open surgery group (mean±standard deviation: 29.1±8.6 cm vs. 33.8±9.9 cm, P=0.004) because of a shorter proximal resection margin (21.7±8.7 cm vs. 26.4±10.6 cm, P=0.006). The number of recruited lymph nodes (35.8±21.8 vs. 39.6±16.5, P=0.604) and arterial vessel length (8.84±2.6 cm vs. 8.78±2.4 cm, P=0.891) did not differ significantly between the 2 surgical approaches. Lymph node metastases were found in 33 of 137 samples (24.1%), but the numbers did not differ significantly between the procedures. Among these 33 cases, metastatic lymph nodes were located in the mesorectum (75.8%), in the sigmoid colon mesentery (33.3%), and at the arterial ligation site of the inferior mesenteric artery (12.1%). The circumferential resection margin and the proportion of complete mesorectal fascia were comparable between the groups.
Conclusion
There were no significant differences between the 2 surgical approaches regarding arterial vessel length, recruitment of lymph node metastases, and resection margins.

Citations

Citations to this article as recorded by

Can robotic surgery lead the way in the treatment of rectal cancer?
Jeonghee Han
Annals of Coloproctology.2024; 40(2): 87. CrossRef
Comparative analysis of short-term outcomes and oncological results between robotic-assisted and laparoscopic surgery for rectal cancer by multiple surgeon implementation: a propensity score-matched analysis
E. Barzola, L. Cornejo, N. Gómez, A. Pigem, D. Julià, N. Ortega, O. Delisau, K. A. Bobb, R. Farrés, P. Planellas
Journal of Robotic Surgery.2023; 17(6): 3013. CrossRef

Colorectal cancer

Evaluating prognostic significance of preoperative C-reactive protein to albumin ratio in older patients with pathological stage II or III colorectal cancer: Koji Numata, Yukari Ono, Mihwa Ju, Shizune Onuma, Ayano Tanaka, Taichi Kawabe, Sho Sawazaki, Akio Higuchi, Kazuki Yamanaka, Shinsuke Hatori, Hiroyuki Saeki, Hiroshi Matsukawa, Yasushi Rino, Kazuyuki Tani; Ann Coloproctol. 2024;40(2):161-168. Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00367.0052

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Abstract PDF

Purpose
This study was performed to evaluate the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in older patients with colorectal cancer (CRC) undergoing curative resection.
Methods
We retrospectively analyzed 244 older patients (aged 75 years or higher) with pathological stage II or III CRC who underwent curative surgery between 2008 and 2016. The optimal value of CAR was calculated and its correlation with the clinicopathological factors and prognosis was examined.
Results
The optimal cutoff value of the CAR was 0.085. High preoperative CAR was significantly associated with high carcinoembryonic antigen levels (P=0.001), larger tumor size (P<0.001), and pT factor (P=0.001). On multivariate analysis, high CAR was independent prognostic factor for relapse-free survival (P=0.042) and overall survival (P=0.001).
Conclusion
Preoperative elevated CAR could be considered as an adverse predictor of both relapse-free survival and overall survival in older patients with CRC undergoing curative surgery.

Citations

Citations to this article as recorded by

C-Reactive Protein/Albumin Ratio Is an Independent Risk Factor for Recurrence and Survival Following Curative Resection of Stage I–III Colorectal Cancer in Older Patients
Tomoaki Bekki, Manabu Shimomura, Minoru Hattori, Saki Sato, Atsuhiro Watanabe, Sho Ishikawa, Kouki Imaoka, Kosuke Ono, Keiso Matsubara, Tetsuya Mochizuki, Shintaro Akabane, Takuya Yano, Hideki Ohdan
Annals of Surgical Oncology.2024; 31(7): 4812. CrossRef
Towards a Gradual Optimization of Oncologic Prognostic Factors in the Era of the Frail Patient: The Potential Role of Preoperative Inflammation and Nutritional Status
Giuseppe Zimmitti
Annals of Surgical Oncology.2024; 31(8): 4853. CrossRef
Prognostic role of C-reactive protein to albumin ratio in cancer patients treated with immune checkpoint inhibitors: a meta-analysis
Menglu Dai, Wei Wu
Frontiers in Oncology.2023;[Epub] CrossRef
The association of blood biomarkers with treatment response and adverse health outcomes in older patients with solid tumors: A systematic review
Yara van Holstein, P. Janne E. van den Berkmortel, Stella Trompet, Diana van Heemst, Frederiek van den Bos, Marieke Roemeling-van Rhijn, Nienke A. de Glas, Marian Beekman, P. Eline Slagboom, Johanneke E.A. Portielje, Simon P. Mooijaart, Barbara C. van Mun
Journal of Geriatric Oncology.2023; 14(7): 101567. CrossRef
Prognostic prediction of colorectal cancer using the C-reactive protein to albumin ratio: the importance of inflammatory biomarkers and their association with long-term outcomes
Chul Seung Lee
Annals of Coloproctology.2023; 39(4): 287. CrossRef

Anorectal benign disease

Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study: In Seob Jeong, Sung Hwan Hwang, Hye Mi Yu, Hyeonseok Jeong; Ann Coloproctol. 2024;40(2):169-175. Published online February 6, 2023; DOI: https://doi.org/10.3393/ac.2022.00486.0069

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Abstract PDF

Purpose
Surgeons can treat debilitating conditions of uncontrollable complex anorectal fistulas with sepsis, even after repeated fistula surgeries, for curative intention. Adipose-derived stem cells have shown good outcomes for refractory Crohn fistula. Unfortunately, cell therapy has some limitations, including high costs. We have therefore attempted immediate cell-assisted lipotransfer (CAL) in treating refractory complex anal fistulas and observed its outcomes.
Methods
In a retrospective study, CAL, using a mixture of freshly extracted autologous stromal vascular fraction (SVF) and fat tissues, was used to treat 22 patients of refractory complex anal fistula from March 2018 to May 2021. Preoperative and postoperative assessments were performed with direct visual inspection, digital palpation, and endoanal ultrasonography. A fistula was considered completely healed if (1) the patient had no symptoms of discharge or inflammation; (2) there were no visible secondary openings of fistula tract inside and outside of the anorectal unit and even in the perineum; and (3) there was no primary opening in the anus. The endpoint of complete remission was wound healing without signs of inflammation 3 months after CAL treatment.
Results
In a total of 22 patients who received CAL treatment, 19 patients showed complete remission, 1 patient showed partial improvement, and 2 patients showed no improvement. One of the 2 patients without improvement at primary endpoint showed complete remission 9 months after CAL. There were no significant adverse effects of the procedure.
Conclusion
We found that the immediately-collected CAL procedure for refractory complex anal fistula showed good outcomes without adverse side effects. It can be strongly recommended as an alternative surgical option for the treatment of complex anal fistula that is uncontrollable even after repeated surgical procedures. However, considering the unpredictable characteristics of SVF, long-term follow-up is necessary.

Citations

Citations to this article as recorded by

Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef

Anorectal benign disease

The importance of compression time in stapled hemorrhoidopexy: is patience a virtue?: Byung Eun Yoo, Wook Ho Kang, Yong Teak Ko, Young Chan Lee, Cheong Ho Lim; Ann Coloproctol. 2024;40(2):176-181. Published online December 20, 2022; DOI: https://doi.org/10.3393/ac.2022.00556.0079

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Abstract PDF: Purpose
The aim of this study was to evaluate whether longer compression time before firing the stapler reduced the postoperative complications related to staple line formation in stapled hemorrhoidopexy.
Methods
This retrospective case-control study was conducted at a colorectal-anal specialty hospital. Consecutive patients with grades III and IV hemorrhoids who underwent stapled hemorrhoidopexy between January 2016 and November 2019 were included. According to the compression time, patients were assigned to the long compression time group (2 minutes) or the typical compression time group (30 seconds). The primary outcome measure was incidence of staple line complications such as dehiscence, bleeding, and stenosis.
Results
A total of 348 patients treated with stapled hemorrhoidopexy were evaluated. Seventy-three and 275 patients were included in the long compression time group and the typical compression time group, respectively. No significant differences were observed in patient characteristics between the groups. However, additional procedures were performed more frequently in the typical compression time group (78.1% vs. 92.0%, P=0.001). Bleeding occurred more frequently in the typical compression time group (1.4% vs. 8.4%, P=0.030). The rates of dehiscence and stenosis were not significantly different between the groups. Fecal urgency developed more frequently in the typical compression time group (0% vs. 5.1%, P=0.040). In logistic regression analysis, typical compression time (30 seconds) was the only risk factor for bleeding (odds ratio, 8.496; P=0.040).
Conclusion
Longer compression time was associated with a decreased incidence of postoperative bleeding after stapled hemorrhoidopexy.

Technical Note

Technical tips

Introduction of extraperitoneal tunneling method: a way to secure the drain tube in the pelvic cavity after proctectomy: Sung Il Kang, Sohyun Kim, Jae Hwang Kim; Ann Coloproctol. 2024;40(2):182-185. Published online March 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00073.0010

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Abstract PDF: The effectiveness of closed drainage tube insertion after low anterior resection has been controversial. We believe that drain tube displacement, which occurs up to 35% in real clinical practice, reduces the effectiveness of the drain tube. We report in this video a simple way to secure the drain tube in the pelvic cavity after low anterior resection and introduce a case that used the drain fixation method and treated anastomotic leakage without interventional procedure.

Video

Video clip

Robotic total colectomy and ileorectal anastomosis: Jonathan Yu Jin Chua, Nan Zun Teo, James Chi-Yong Ngu; Ann Coloproctol. 2024;40(2):186-187. Published online April 22, 2024; DOI: https://doi.org/10.3393/ac.2024.00066.0009

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Abstract PDF Supplementary Material: The benefits of minimally invasive approaches in colorectal surgery have been well demonstrated. However, some hesitancy remains with regards to the utilization of the robotic platform for total colectomies, mostly due to the perceived need for multiple re-dockings in multiquadrant surgery. This video aims to demonstrate how the robotic platform can be efficiently utilized in multiquadrant surgery without the need for multiple re-dockings, as well as some tips on how to overcome the potential challenges that may be encountered during this procedure.

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