Annals of Coloproctology

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Original Articles

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.

Case Report

Concurrent Large Cell Neuroendocrine Carcinoma and Adenocarcinoma of the Ascending Colon: A Case Report: Yo Na Kim, Ho Sung Park, Kyu Yun Jang, Woo Sung Moon, Dong Geun Lee, Ho Lee, Min Ro Lee, Kyung Ryoul Kim; J Korean Soc Coloproctol. 2011;27(3):157-161. Published online June 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.3.157

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9 Citations

Abstract PDF

Large cell neuroendocrine carcinomas of the colon are rare and represent only a small percentage of all colonic endocrine tumors. Here, we report a case of a colonic large cell neuroendocrine carcinomas concurrent with a colonic adenocarcinoma. A 70-year-old man presented with acute abdominal pain. A spiral computed tomography scan of the abdomen revealed eccentric wall thickening on the ascending colon. An explorative laparotomy and a right hemicolectomy were performed. Grossly, two separated masses were observed in the proximal ascending colon. One was a 7.4 × 5.1 cm ulcerative fungating lesion, and the other was a 2.8 × 1.9 cm polypoid lesion. Microscopically, the ulcerative fungating lesion showed a well-differentiated neuroendocrine morphology with necrosis and increased mitosis. Most of the tumor cells had large, vesicular nuclei with eosinophilic nucleoli, variable amounts of eosinophilic cytoplasm, and immunoreactivity for chromogranin A and synaptophysin. The polypoid lesion was a well-differentiated adenocarcinoma that had invaded the submucosa. We diagnosed these lesions as a concurrent large cell neuroendocrine carcinoma and an adenocarcinoma of the ascending colon.

Citations

Citations to this article as recorded by

Large cell neuroendocrine tumor of the gastrointestinal tract with concurrent tubular adenomas
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Gazzetta Medica Italiana Archivio per le Scienze Mediche.2021;[Epub] CrossRef
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A case of colorectal large cell neuroendocrine carcinoma accompanied by disseminated peritoneal leiomyomatosis
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Original Article

Effects of Delay in the Snap Freezing of Colorectal Cancer Tissues on the Quality of DNA and RNA: Sang Hyun Hong, Hyun Ah Baek, Kyu Yun Jang, Myoung Ja Chung, Woo Sung Moon, Myoung Jae Kang, Dong Geun Lee, Ho Sung Park; J Korean Soc Coloproctol. 2010;26(5):316-323. Published online October 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.5.316

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39 Citations

Abstract PDF

Purpose

The success of basic molecular research using biospecimens strongly depends on the quality of the specimen. In this study, we evaluated the effects of delayed freezing time on the stability of DNA and RNA in fresh frozen tissue from patients with colorectal cancer.

Methods

Tissues were frozen at 10, 30, 60, and 90 minutes after extirpation of colorectal cancer in 20 cases. Absorbance ratio of 260 to 280 nm (A₂₆₀/A₂₈₀) and agarose gel electrophoresis were evaluated. In addition, the RNA integrity number (RIN) was assayed for the analysis of the RNA integrity.

Results

Regardless of delayed freezing time, all DNA and RNA samples revealed A₂₆₀/A₂₈₀ ratios of more than 1.9, and all DNA samples showed a discrete, high-molecular-weight band on agarose gel electrophoresis. The RINs were 7.53 ± 2.04, 6.70 ± 1.88, 6.47 ± 2.58, and 4.22 ± 2.34 at 10, 30, 60, and 90 minutes, respectively. Though the concentration of RNA was not affected by delayed freezing, the RNA integrity was decreased with increasing delayed freezing time.

Conclusion

According to the RIN results, we recommend that the collection of colorectal cancer tissue should be done within 10 minutes for studies requiring RNA of high quality and within 30 minutes for usual RNA studies.

Citations

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