Annals of Coloproctology

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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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.

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Original Articles

Colorectal cancer

Is restrictive transfusion sufficient in colorectal cancer surgery? A retrospective study before and during the COVID-19 pandemic in Korea: Hyeon Kyeong Kim, Ho Seung Kim, Gyoung Tae Noh, Jin Hoon Nam, Soon Sup Chung, Kwang Ho Kim, Ryung-Ah Lee; Ann Coloproctol. 2023;39(6):493-501. Published online December 28, 2023; DOI: https://doi.org/10.3393/ac.2023.00437.0062

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Graphical Abstract Abstract PDF Supplementary Material: Purpose
Blood transfusion is one of the most common procedures used to treat anemia in colorectal surgery. Despite controversy regarding the adverse effects of blood products, surgeons have maintained standards for administering blood transfusions. However, this trend was restrictive during the COVID-19 pandemic because of a shortage of blood products. In this study, we conducted an analysis to investigate whether the restriction of blood transfusions affected postoperative surgical outcomes.
Methods
Medical records of 318 patients who underwent surgery for colon and rectal cancer at Ewha Womans University Mokdong Hospital between June 2018 and March 2022 were reviewed retrospectively. The surgical outcomes between the liberal and restrictive transfusion strategies in pre– and post–COVID-19 groups were analyzed.
Results
In univariate analysis, postoperative transfusion was associated with infectious complications (odds ratio [OR], 1.705; 95% confidence interval [CI], 1.015–2.865; P=0.044). However, postoperative transfusion was not an independent risk factor for the development of infectious complications in multivariate analysis (OR, 1.305; 95% CI, 0.749–2.274; P=0.348). In subgroup analysis, there was no significant association between infectious complications and the hemoglobin threshold level for the administration of a transfusion (OR, 1.249; 95% CI, 0.928–1.682; P=0.142).
Conclusion
During colorectal surgery, the decision to perform a blood transfusion is an important step in ensuring favorable surgical outcomes. According to the results of this study, restrictive transfusion is sufficient for favorable surgical outcomes compared with liberal transfusion. Therefore, modification of guidelines is suggested to minimize unnecessary transfusion-related side effects and prevent the overuse of blood products.

Minimally invasive surgery

Body composition index obtained by using a bioelectrical impedance analysis device can be a predictor of prolonged operative time in patients undergoing minimally invasive colorectal surgery: Ho Seung Kim, Kwang Ho Kim, Gyoung Tae Noh, Ryung-Ah Lee, Soon Sup Chung; Ann Coloproctol. 2023;39(4):342-350. Published online June 3, 2022; DOI: https://doi.org/10.3393/ac.2022.00262.0037

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Abstract PDF

Purpose
Obesity has been known to contribute to technical difficulties in surgery. Until now, body mass index (BMI) has been used to measure obesity. However, there are reports that BMI does not always correspond to the visceral fat. Recently, bioelectrical impedance analysis (BIA) has been used for body composition analysis. This study aimed to evaluate the usefulness of the body composition index obtained using a BIA device in predicting short-term postoperative outcomes.
Methods
Data of patients who underwent elective major colorectal surgery using minimally invasive techniques were reviewed retrospectively. Body composition status was recorded using a commercial BIA device the day before surgery. The relationship between BMI, body composition index, and short-term postoperative outcomes, including operative time, was analyzed.
Results
Sixty-six patients were enrolled in this study. In the correlation analysis, positive correlation was observed between BMI and body composition index. BMI and body composition index were not associated with short-term postoperative outcomes. Percent body fat (odds ratio, 4.226; 95% confidence interval [CI], 1.064–16.780; P=0.041) was found to be a statistically significant factor of prolonged operative time in the multivariate analysis. Correlation analysis showed that body fat mass was related to prolonged operative time (correlation coefficients, 0.245; P=0.048). In the area under curve analysis, body fat mass showed a statistically significant predictive probability for prolonged operative time (body fat mass: area, 0.662; 95% CI, 0.531–0.764; P=0.024).
Conclusion
The body composition index can be used as a predictive marker for prolonged operative time. Further studies are needed to determine its usefulness.

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Pretreatment bioelectrical impedance analysis predicts chemotherapy efficacy and toxicity in metastatic colorectal cancer patients
Rikako Kato, Yuji Miyamoto, Yukiharu Hiyoshi, Yuto Maeda, Mayuko Ouchi, Katsuhiro Ogawa, Keisuke Kosumi, Kojiro Eto, Satoshi Ida, Masaaki Iwatsuki, Yoshifumi Baba, Hideo Baba
Clinical Nutrition ESPEN.2025; 66: 497. CrossRef
Simple perinephric adipose tissue measurement for prediction of failed sentinel lymph node mapping in endometrial cancer
Lina Salman, Paulina Cybulska, Ryley Fowler, Manjula Maganti, Ur Metser, Sarah E. Ferguson
International Journal of Gynecological Cancer.2025; : 101949. CrossRef
The Antibody Response to the BNT162b2 mRNA COVID-19 Booster in Healthcare Workers: Association between the IgG Antibody Titers and Anthropometric and Body Composition Parameters
Marlena Golec, Adam Konka, Martyna Fronczek, Joanna Zembala-John, Martyna Chrapiec, Karolina Wystyrk, Sławomir Kasperczyk, Zenon Brzoza, Rafał Jakub Bułdak
Vaccines.2022; 10(10): 1638. CrossRef

Optimal Time of Initiating Adjuvant Chemotherapy After Curative Surgery in Colorectal Cancer Patients: Kyu Min Kang, Kyung Sook Hong, Gyoung Tae Noh, Bo-Young Oh, Soon Sup Chung, Ryung-Ah Lee, Kwang Ho Kim; Ann Coloproctol. 2013;29(4):150-154. Published online August 29, 2013; DOI: https://doi.org/10.3393/ac.2013.29.4.150

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Abstract PDF

Purpose

Adjuvant chemotherapy is routinely recommended for locally advanced colorectal cancer (CRC). There are very few data for the optimal starting date of adjuvant chemotherapy after the surgery. This study aimed to evaluate the effectiveness of earlier adoption of adjuvant chemotherapy after curative surgery for stage III CRC.

Methods

In this study, 159 patients with stage III CRC, who had undergone a curative resection, were enrolled retrospectively. Patients were categorized into 3 groups representing different timings to initiate the chemotherapy; less than 2 weeks (group 1), 3 to 4 weeks (group 2), and more than 5 weeks (group 3). The overall survival rate (OS) and the relapse-free survival rate (RFS) were analyzed to evaluate the effectiveness of adjuvant chemotherapy.

Results

The 5-year OSs of the patients were 73.7% in group 1, 67.0% in group 2, and 55.2% in group 3. The 5-year RFSs of the patients were 48.8% in group 1, 64.7% in group 2, and 57.1% in group 3. There were no significant differences in either the OS or the RFS (P = 0.200, P = 0.405).

Conclusion

Starting chemotherapy earlier than 6 weeks after surgery does not show any significant difference. Thus, although adjuvant chemotherapy should preferably begin within 6 weeks, the starting date should not necessarily be hastened, and the patient's general condition should be taken into consideration.

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Hao Lin, Wen-Hsin Chen, Chen-Hsuan Wu, Yu-Che Ou, Yu-Jen Chen, Ying-Yi Chen, Yu-Han Lin, Hung-Chun Fu
Cancer Management and Research.2021; Volume 13: 5413. CrossRef
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Sara Kaveh, Parvin Ebrahimi, Aziz Rezapour, Masoud Mozafari, Kourosh Sayehmiri
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Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis
Fausto Petrelli, Alberto Zaniboni, Antonio Ghidini, Michele Ghidini, Luca Turati, Claudio Pizzo, Margherita Ratti, Michela Libertini, Gianluca Tomasello
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Safety and feasibility of in-hospital early chemotherapy initiation after surgery in patients with stage II–IV colon cancer
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Surgical stress response and promotion of metastasis in colorectal cancer: a complex and heterogeneous process
Corina Behrenbruch, Carolyn Shembrey, Sophie Paquet-Fifield, Christina Mølck, Hyun-Jung Cho, Michael Michael, Benjamin N. J. Thomson, Alexander G. Heriot, Frédéric Hollande
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Intensity modulated radiotherapy delivers competitive local control rate with limited acute toxicity in the adjuvant treatment of rectal cancer
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Molecular analysis of sentinel lymph node in colon carcinomas by one-step nucleic acid amplification (OSNA) reduces time to adjuvant chemotherapy interval
Alix Marhic, Jean-François Tremblay, Rachid Kaci, Thierry André, Clarisse Eveno, Marc Pocard
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Timely initiation of chemotherapy: a systematic literature review of six priority cancers – results and recommendations for clinical practice
M. Alexander, R. Blum, K. Burbury, J. Coutsouvelis, M. Dooley, O. Fazil, T. Griffiths, H. Ismail, S. Joshi, N. Love, S. Opat, P. Parente, N. Porter, E. Ross, J. Siderov, P. Thomas, S. White, S. Kirsa, D. Rischin
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Association Between Time (Initiation and Length) and Oncological Outcomes for the Patients with Colon Cancer Treated with Adjuvant Chemotherapy
In Seob Jeong, Jong Han Yoo, Sang Hyuk Seo, Min Sung An, Kwang Hee Kim, Ki Beom Bae, Chang Soo Choi, Jin Won Hwang, Ji Hyun Kim, Mi Seon Kang, Min Kyung Oh, Kwan Hee Hong
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Timing of Adjuvant Chemotherapy in Colorectal Cancer Patients
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Case Report

Extensive Bowel Ischemia with Heavy Alcohol Consumption: Report of a Case: Ji Hyoun Lee, Gyoung Tae Noh, Ryung-Ah Lee; J Korean Soc Coloproctol. 2012;28(1):61-65. Published online February 29, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.1.61

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Abstract PDF

Alcohol is well-recognized systemic toxin that causes numerous adverse effects, including psychosocial problems, fatal myocardial infarction, stroke and atherosclerosis. The intra-abdominal complications caused by acute alcohol consumption have not been defined. We report an 80-year-old man with sub-acute small bowel and colonic ischemia after heavy alcohol intake in one sitting. We performed a resection of gangrenous bowel segments. Microscopically, there were diffuse infarction, with vasoconstriction of the mesenteric vessels in the ileum and colon without any thrombotic occlusion of the intestinal vessels. The clinicians should always be assured by confirmation of a history of recent substance abuse in patients with unexplained abdominal pain, and mesenteric ischemia should be considered in the differential diagnosis of acute or chronic abdominal pain in consumers of alcohol.

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Alcohol use disorders associated with an increased risk of mesenteric ischemia: A nationwide cohort study
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