Annals of Coloproctology

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ERAS

Predicting venous thromboembolism and determining appropriate prophylaxis in elderly patients undergoing colorectal cancer surgery with Enhanced Recovery After Surgery (ERAS) using the adjusted Caprini score: Young Sun Choi, Hyung Jin Cho, Chul Seung Lee, Dong Geun Lee, Choon Sik Chung, Gwan Cheol Lee, Dong Woo Kang, Jeong Sub Kim, Tae Gyu Kim; Ann Coloproctol. 2025;41(4):279-286. Published online August 26, 2025; DOI: https://doi.org/10.3393/ac.2024.00857.0122

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Abstract PDF Supplementary Material: Purpose
Age and postoperative complications are known risk factors for venous thromboembolism (VTE). Minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocol has been implemented to reduce these risks. The purpose of this study was to assess the short- and long-term effects of a VTE prophylaxis program using the Caprini score in elderly patients undergoing minimally invasive colorectal cancer surgery with the ERAS protocol.
Methods
This retrospective cross-sectional study included 1,043 colorectal cancer patients requiring surgery from January 2017 to December 2019, divided into a control group (≤75 years) and an elderly group (>75 years), with 827 and 216 patients, respectively. The primary outcome was the incidence of VTE; secondary outcome was the incidence of postoperative complications, particularly bleeding.
Results
The incidence of VTE was 1.5% in the control group and 3.7% in the elderly group (P=0.061). Five patients (0.5%) experienced symptomatic VTE, and the Caprini score for all VTE patients was ≤8 points; thus, only mechanical prophylaxis was used. In the multivariable logistic regression, the Caprini score (P=0.024) and cancer stage (P=0.004) were selected. The odds ratios (95% confidence interval) of the Caprini score and TNM staging were 1.758 (1.078–2.867) and 6.152 (2.045–26.510), respectively.
Conclusion
When the ERAS protocol was used for patients with colorectal cancer as perioperative care, the VTE risk was lower than that estimated by the Caprini score. Given that age is a recognized risk factor for major bleeding, criteria for the use of anticoagulation to prevent VTE, particularly in elderly patients, should be carefully evaluated, considering both the bleeding risks and the potential benefits of pharmacologic prophylaxis. Trial registration: Clinical Research Information Service (CRIS; cris.nih.go.kr) identifier: KCT0007804

Anorectal benign disease

A comparative study on efficacy and safety of modified partial stapled hemorrhoidopexy versus conventional hemorrhoidectomy: a prospective randomized controlled trial: Tae Gyu Kim, Chul Seung Lee, Dong Geun Lee, Choon Sik Chung, Seung Han Kim, Sang Hwa Yu, Jeong Eun Lee, Gwan Cheol Lee, Dong Woo Kang, Jeong Sub Kim, Gyu Young Jeong; Ann Coloproctol. 2025;41(2):145-153. Published online April 28, 2025; DOI: https://doi.org/10.3393/ac.2024.00535.0076

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Abstract PDF Supplementary Material: Purpose
The long-term outcomes and efficacy of partial stapled hemorrhoidopexy (PSH) compared with those of conventional hemorrhoidectomy (CH) are not fully understood. This study aimed to introduce a modified PSH (mPSH) and compare its clinical efficacy and safety with those of CH.
Methods
A prospective randomized controlled trial was conducted. This study was performed at a single hospital and involved 6 colorectal surgeons. In total, 110 patients were enrolled between July 2019 and September 2020. Patients were randomly assigned to undergo either mPSH group (n=55) or CH group (n=55). The primary outcome was to compare postoperative average pain and postoperative peak pain using visual analog scale score between the 2 groups.
Results
The required duration of analgesia was shorter in the mPSH group than in the CH group, although the difference was not statistically significant (P=0.096). However, the laxative requirement duration (P<0.010), return to work (P<0.010), satisfaction score (P<0.010), and Vaizey score (P=0.014) were significantly better in the mPSH group. The average and peak postoperative pain scores were significantly lower in the mPSH group during the 15 days after surgery (P<0.001). The overall complication rate in both groups was 9.1%, with no significant difference between the groups (P=0.867).
Conclusion
The mPSH group demonstrated better improvement in symptoms, lower pain scores, and greater patient early satisfaction after surgery than the CH group. Therefore, this surgical technique appears to be a safe and effective alternative for CH.

Comparison of Long-term Clinical Outcomes according to the Change in the Rectocele Depth between Transanal and Transvaginal Repairs for a Symptomatic Rectocele: Choon Sik Chung, Sang Hwa Yu, Jeong Eun Lee, Dong Keun Lee; J Korean Soc Coloproctol. 2012;28(3):140-144. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.140

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13 Citations

Abstract PDF

Purpose

This study was aimed to compare the results of a transanal repair with those of a transvaginal levatorplasty and to determine the long-term clinical outcomes according to the change in the depth of the rectocele after the procedure.

Methods

Of 50 women who underwent a rectocele repair from March 2005 to February 2007, 26 women (group A) received a transanal repair, and 24 (group B) received a transvaginal repair with or without levatorplasty. At 12 months after the procedures, 45 (group A/B, 22/23 women) among the 50 women completed physiologic studies, including anal manometry and defecography, and clinical-outcome measurements. The variations of the clinical outcomes with changes in the depth of the rectocele were also evaluated in 42 women (group A/B, 20/22) at the median follow-up of 50 months.

Results

On the defecographic findings, the postoperative depth of the rectocele decreased significantly in both groups (group A vs. B, 1.91 ± 0.20 vs. 2.25 ± 0.46, P = 0.040). At 12 months after surgery, 17 women in each group (group A/B, 77/75%) reported improvement of their symptoms. However, only 11 and 13 women (group A/B, 55/59%) of groups A and B, respectively, maintained their improvement at the median follow-up of 50 months. Better results were reported in patients with a greater change in the depth of their rectocele (≥4 cm) after the procedure (P = 0.001)

Conclusion

In both procedures, clinical outcomes might become progressively worse as the length of the follow-up is increased.

Citations

Citations to this article as recorded by

Outcomes of laparoscopic ventral mesh rectopexy versus trans-vaginal repair in management of anterior rectocele, a randomized controlled trial
A. Sanad, A. Sakr, H. Elfeki, W. Omar, W. Thabet, E. Fouda, E. Abdallah, S. A. Elbaz
Techniques in Coloproctology.2025;[Epub] CrossRef
Tratamiento quirúrgico de los prolapsos genitales por vía vaginal
T. Thubert, M. Degez, C. Cardaillac, R. De Tayrac, M. Cosson
EMC - Urología.2024; 56(4): 1. CrossRef
Traitement chirurgical des prolapsus génitaux par voie vaginale
T. Thubert, M. Degez, C. Cardaillac, R. De Tayrac, M. Cosson
EMC - Techniques Chirurgicales - Urologie.2024; 41(3): 1. CrossRef
Laparoscopic or transanal repair of rectocele? Comparison of a reduction in rectocele size
Akira Tsunoda, Tomoko Takahashi, Satoshi Matsuda, Hiroshi Kusanagi
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Prise en charge chirurgicale de la rectocele – mise au point
M. Aubert, D. Mege, R. Le Huu Nho, G. Meurette, I. Sielezneff
Journal de Chirurgie Viscérale.2021; 158(2): 157. CrossRef
Surgical management of the rectocele – An update
M. Aubert, D. Mege, R. Le Huu Nho, G. Meurette, I. Sielezneff
Journal of Visceral Surgery.2021; 158(2): 145. CrossRef
ACG Clinical Guidelines: Management of Benign Anorectal Disorders
Arnold Wald, Adil E. Bharucha, Berkeley Limketkai, Allison Malcolm, Jose M. Remes-Troche, William E. Whitehead, Massarat Zutshi
American Journal of Gastroenterology.2021; 116(10): 1987. CrossRef
Early and late effects of the sequential transfixed stich technique for the treatment of the symptomatic rectocele without rectal mucosa prolapse
Fabio Gaj, Ivano Biviano, Antonello Trecca, Quirino Lai, Jacopo Andreuccetti
Minerva Chirurgica.2020;[Epub] CrossRef
Absence of a rectocele may be correlated with reduced internal anal sphincter function in patients with rectal intussusception and fecal incontinence
Akira Tsunoda, Tomoko Takahashi, Hiroshi Kusanagi
International Journal of Colorectal Disease.2019; 34(10): 1681. CrossRef
Trattamento chirurgico del rettocele
G. Meurette, A. Vénara, P.-A. Lehur
EMC - Tecniche Chirurgiche Addominale.2018; 24(1): 1. CrossRef
Tratamiento quirúrgico de los rectoceles
G. Meurette, A. Vénara, P.-A. Lehur
EMC - Técnicas Quirúrgicas - Aparato Digestivo.2018; 34(1): 1. CrossRef
Surgery for constipation: systematic review and practice recommendations
U. Grossi, E. J. Horrocks, J. Mason, C. H. Knowles, A. B. Williams
Colorectal Disease.2017; 19(S3): 73. CrossRef
Traitement chirurgical des rectocèles
G. Meurette, A. Vénara, P.-A. Lehur
EMC - Techniques chirurgicales - Appareil digestif.2017; 34(4): 1. CrossRef

Long-term Outcomes of Laparoscopic Surgery for Colorectal Cancer: Jeong-Eun Lee, Yong-Geul Joh, Sang-hwa Yoo, Geu-Young Jeong, Sung-Han Kim, Choon-Sik Chung, Dong-Gun Lee, Seon Hahn Kim; J Korean Soc Coloproctol. 2011;27(2):64-70. Published online April 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.2.64

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13 Citations

Abstract PDF

Purpose

The long-term results of a laparoscopic resection for colorectal cancer have been reported in several studies, but reports on the results of laparoscopic surgery for rectal cancer are limited. We investigated the long-term outcomes, including the five-year overall survival, disease-free survival and recurrence rate, after a laparoscopic resection for colorectal cancer.

Methods

Using prospectively collected data on 303 patients with colorectal cancer who underwent a laparoscopic resection between January 2001, and December 2003, we analyzed sex, age, stage, complications, hospital stay, mean operation time and blood loss. The overall survival rate, disease-free survival rate and recurrence rate were investigated for 271 patients who could be followed for more than three years.

Results

Tumor-node-metastasis (TNM) stage I cancer was present in 55 patients (18.1%), stage II in 116 patients (38.3%), stage III in 110 patients (36.3%), and stage IV in 22 patients (7.3%). The mean operative time was 200 minutes (range, 100 to 535 minutes), and the mean blood loss was 97 mL (range, 20 to 1,200 mL). The mean hospital stay was 11 days and the mean follow-up period was 54 months. The mean numbers of resected lymph nodes were 26 and 21 in the colon and the rectum, respectively, and the mean distal margins were 10 and 3 cm. The overall morbidity rate was 26.1%. The local recurrence rates were 2.2% and 4.4% in the colon and the rectum, respectively, and the distant recurrence rates were 7.8% and 22.5%. The five-year overall survival rates were 86.1% in the colon (stage I, 100%; stage II, 97.6%; stage III, 77.5%; stage IV, 16.7%) and 68.8% in the rectum (stage I, 90.2%; stage II, 84.0%; stage III, 57.6; stage IV, 13.3%). The five-year disease-free survival rates were 89.8% in the colon (stage I, 100%; stage II, 97.7%; stage III, 74.2%) and 74.5% in the rectum (stage I, 90.0%; stage II, 83.9%; stage III, 59.2%).

Conclusion

Laparoscopic surgery for colorectal cancer is a good alternative method to open surgery with tolerable oncologic long-term results.

Citations

Citations to this article as recorded by

The Determinants of Long-Term Outcomes After Colorectal Cancer Surgery: A Literature Review
Olorungbami K Anifalaje, Charles Ojo, Oluwaseyi T Balogun, Fikayo A Ayodele, Abeeb Azeez, Shirley Gabriels
Cureus.2024;[Epub] CrossRef
Advantages of 3d laparoscopic surgery for colorectal cancers
Thanh Xuân Nguyễn
Vietnam Journal of Endolaparoscopic Surgey.2024;[Epub] CrossRef
Laparoscopic tme with sphincter preservation for rectal cancer: Five-year results
Hữu Thịnh Nguyễn
Vietnam Journal of Endolaparoscopic Surgey.2020;[Epub] CrossRef
Functional and clinical outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 255 patients
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European Surgery.2015; 47(2): 75. CrossRef
Comparison of the clinical outcomes of laparoscopic-assisted versus open surgery for colorectal cancer
KAI CHEN, ZHUQING ZHANG, YUNFEI ZUO, SHUANGYI REN
Oncology Letters.2014; 7(4): 1213. CrossRef
Comparison of Compliance of Adjuvant Chemotherapy Between Laparoscopic and Open Surgery in Patients With Colon Cancer
Kan Ho Chun, Byung Noe Bae, Hoon An, Hyeonseok Jeong, Hyunjin Cho, Geumhee Gwak, Keun Ho Yang, Ki Hwan Kim, Hong Ju Kim, Young Duk Kim
Annals of Coloproctology.2014; 30(6): 274. CrossRef
Results of laparoscopic colorectal surgery from a national training center
Rudra Krishna Maitra, Austin G. Acheson, Chris Gornall, John H. Scholefield, Julian P. Williams, Charles A. Maxwell-Armstrong
Asian Journal of Surgery.2014; 37(1): 1. CrossRef
Laparoscopic-Assisted Versus Open Surgery for Colorectal Cancer: Short- and Long-Term Outcomes Comparison
Antonio Biondi, Giuseppe Grosso, Antonio Mistretta, Stefano Marventano, Chiara Toscano, Salvatore Gruttadauria, Francesco Basile
Journal of Laparoendoscopic & Advanced Surgical Techniques.2013; 23(1): 1. CrossRef
Long-term Outcomes After Resection for Submucosal Invasive Colorectal Cancers
Hiroaki Ikematsu, Yusuke Yoda, Takahisa Matsuda, Yuichiro Yamaguchi, Kinichi Hotta, Nozomu Kobayashi, Takahiro Fujii, Yasuhiro Oono, Taku Sakamoto, Takeshi Nakajima, Madoka Takao, Tomoaki Shinohara, Yoshitaka Murakami, Takahiro Fujimori, Kazuhiro Kaneko,
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Palliative resection of the primary tumour in patients with Stage IV colorectal cancer: systematic review and meta‐analysis of the early outcome after laparoscopic and open colectomy
T. X. Yang, B. Billah, D. L. Morris, T. C. Chua
Colorectal Disease.2013;[Epub] CrossRef
Major postoperative complications and survival for colon cancer elderly patients
Giuseppe Grosso, Antonio Biondi, Stefano Marventano, Antonio Mistretta, Giorgio Calabrese, Francesco Basile
BMC Surgery.2012;[Epub] CrossRef
A rectumtumorok sebészete
Péter Metzger
Magyar Sebészet.2012; 65(3): 129. CrossRef
Oncologic Outcomes of a Laparoscopic Right Hemicolectomy for Colon Cancer: Results of a 3-Year Follow-up
Jung Hoon Cho, Dae Ro Lim, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Kang Young Lee, Nam Kyu Kim
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