Annals of Coloproctology

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.

Original Article

Malignant disease, Rectal cancer, Functional outcomes,Colorectal cancer

The Effect of Anastomotic Leakage on the Incidence and Severity of Low Anterior Resection Syndrome in Patients Undergoing Proctectomy: A Propensity Score Matching Analysis: Sungjin Kim, Sung Il Kang, So Hyun Kim, Jae-Hwang Kim; Ann Coloproctol. 2021;37(5):281-290. Published online June 7, 2021; DOI: https://doi.org/10.3393/ac.2021.03.15

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18 Citations

Abstract PDF

Purpose
Proctectomy for the treatment of rectal cancer results in inevitable changes to bowel habits. Symptoms such as fecal incontinence, constipation, and tenesmus are collectively referred to as low anterior resection syndrome (LARS). Among the several risk factors that cause LARS, anastomotic leakage (AL) is a strong risk factor for permanent stoma formation. Therefore, the purpose of this study was to investigate the relationship between the severity of LARS and AL in patients with rectal cancer based on the LARS score and the Memorial Sloan Kettering Cancer Center (MSKCC) defecation symptom questionnaires.
Methods
We retrospectively analyzed patients who underwent low anterior resection for rectal cancer since January 2010. Patients who completed the questionnaire were classified into the AL group and control group based on medical and imaging records. Major LARS and MSKCC scores were analyzed as primary endpoints.
Results
Among the 179 patients included in this study, 37 were classified into the AL group. After propensity score matching, there were significant differences in the ratio of major LARS and MSKCC scores of the control group and AL group (ratio of major LARS: 11.1% and 37.8%, P<0.001; MSKCC score: 67.29±10.4 and 56.49±7.2, respectively, P<0.001). Univariate and multivariate analyses revealed that AL was an independent factor for major LARS occurrence and MSKCC score.
Conclusion
This study showed that AL was a significant factor in the occurrence of major LARS and defecation symptoms after proctectomy.

Citations

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The effect of robotic surgery on low anterior resection syndrome in patients with lower rectal cancer: a propensity score-matched analysis
Lei Zhang, Chenhao Hu, Jiamian Zhao, Chenxi Wu, Zhe Zhang, Ruizhe Li, Ruihan Liu, Junjun She, Feiyu Shi
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Innovációk a colorectalis sebészetben
Balázs Bánky, András Fülöp, Viktória Bencze, Lóránd Lakatos, Petra Rozman, Attila Szijártó
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Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
Gyung Mo Son
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Outcomes following anastomotic leak from rectal resections, including bowel function and quality of life
Angelina Di Re, Salam Tooza, Jason Diab, Charbel Karam, Mina Sarofim, Kevin Ooi, Catherine Turner, Daniel Kozman, David Blomberg, Matthew Morgan
Annals of Coloproctology.2023; 39(5): 395. CrossRef
The status of low anterior resection syndrome: data from a single-center in China
Jing Su, Qianhui Liu, Dagui Zhou, Xiaofeng Yang, Guiru Jia, Lijun Huang, Xiao Tang, Jiafeng Fang
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Low anterior resection syndrome: is it predictable?
Dong Hyun Kang
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Validation of low anterior resection syndrome score in Brazil with Portuguese
Kelly C.L.R. Buzatti, Andy Petroianu, Søren Laurberg, Rodrigo G. Silva, Beatriz D.S. Rodrigues, Peter Christensen, Antonio Lacerda-Filho, Therese Juul
Annals of Coloproctology.2023; 39(5): 402. CrossRef
Fluorescence-guided colorectal surgery: applications, clinical results, and protocols
Jin-Min Jung, In Ja Park, Eun Jung Park, Gyung Mo Son
Annals of Surgical Treatment and Research.2023; 105(5): 252. CrossRef
How Can We Improve the Tumor Response to Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer?
Jeonghee Han
The Ewha Medical Journal.2023;[Epub] CrossRef
Surgical Techniques for Transanal Local Excision for Early Rectal Cancer
Gyoung Tae Noh
The Ewha Medical Journal.2023;[Epub] CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef
Early vs. standard reversal ileostomy: a systematic review and meta-analysis
N. J. O’Sullivan, H. C. Temperley, T. S. Nugent, E. Z. Low, D. O. Kavanagh, J. O. Larkin, B. J. Mehigan, P. H. McCormick, M. E. Kelly
Techniques in Coloproctology.2022; 26(11): 851. CrossRef
A predictive nomogram model for low anterior resection syndrome after rectal cancer resection
Mingfang Yan, Zhenmeng Lin, Zhiying Wu, Huizhe Zheng, Meiqin Shi
ANZ Journal of Surgery.2022; 92(12): 3224. CrossRef
Recycling of Iron Slag Waste in the Production of Ceramic Roof Tiles
M. M. Ahmed, K. A. M. El Naggar, M. F. Abadir, W. Abbas, E. M. Abdel Hamid, Ajaya Kumar Singh
Journal of Chemistry.2022; 2022: 1. CrossRef
Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
Seung Mi Yeo, Gyung Mo Son
The Ewha Medical Journal.2022;[Epub] CrossRef
The watch-and-wait strategy versus radical resection for rectal cancer patients with a good response (≤ycT2) after neoadjuvant chemoradiotherapy
Chungyeop Lee, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Annals of Surgical Treatment and Research.2022; 103(6): 350. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef

Case Report

Malignant disease

Abdominopelvic Actinomycosis Mimicking Peritoneal Carcinomatosis: A Case Report: Sungjin Kim, Sung Il Kang, Sohyun Kim, Min Hye Jang, Jae Hwang Kim; Ann Coloproctol. 2020;36(6):417-420. Published online November 13, 2019; DOI: https://doi.org/10.3393/ac.2019.11.07

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2 Citations

Abstract PDF

Actinomycosis is a rare chronic bacterial infection primarily caused by Actinomyces israelii. A 47-year-old woman presented to our clinic with a 1-week history of lower abdominal pain. Preoperative imaging studies revealed multiple peritoneal and pelvic masses suggestive of malignancy. The primary tumor could not be identified despite further endoscopic and gynecological evaluation. On exploration for tissue confirmation, excisional biopsies from multiple masses were performed because complete excision was not possible. Histopathological examination confirmed actinomycosis with multiple abscesses, and the patient was treated with antibiotics. We present a case of disseminated peritoneal actinomycosis that mimicked malignant peritoneal carcinomatosis on imaging studies.

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Carcinomatosis peritoneal, como medirla
A. Mesa Álvarez, M. da Silva Torres, A. Fernández del Valle, A. Cernuda García, E. Turienzo Santos, L. Sanz Álvarez
Radiología.2024;[Epub] CrossRef
Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease
Alin Mihai Vasilescu, Eugen Târcoveanu, Cristian Lupascu, Mihaela Blaj, Corina Lupascu Ursulescu, Costel Bradea
Life.2022; 12(3): 447. CrossRef

Original Articles

Prognostic Impact of Microsatellite Instability in Colorectal Cancer Presenting With Mucinous, Signet-Ring, and Poorly Differentiated Cells: Sang Hun Jung, So Hyun Kim, Jae Hwang Kim; Ann Coloproctol. 2016;32(2):58-65. Published online April 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.2.58

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16 Citations

Abstract PDF

Purpose

Mucinous cells (MUCs), signet-ring cells (SRCs), and poorly differentiated cells (PDCs) are uncommon histologic types and have been associated with advanced tumor stage and poor prognosis. However, MUCs, SRCs, and PDCs are commonly observed in cancers with high microsatellite instability (MSI), which have favorable outcomes compared with cancers with microsatellite stability (MSS). The purpose of this study was to evaluate the prognostic impact of high-MSI in patients with sporadic colorectal cancer presenting with MUCs, SRCs, and/or PDCs.

Methods

Between January 2006 and December 2012, 176 with proven microsatellite status who also presented with MUCs, SRCs, and PDCs were selected for this study and were divided into 2 groups, high-MSI and MSS; their outcomes were analyzed.

Results

Of the 176 patients, 56 and 120, respectively, had high-MSI and MSS cancers. High-MSI cancers had larger tumors, proximal tumor location, and a lower TNM stage. The recurrence rate was lower in the high-MSI group (13.7% vs. 35.4%, P = 0.006). Common patterns of distant metastasis for MUC, SRC, PDC cancers were peritoneal spread (46.9%) and hematogenous metastasis (46.4%). The 5-year CSS rates were 88.2% and 61.2% for patients with high-MSI and MSS cancers, respectively (P < 0.0001). In the multivariate analysis, except for stage-IV cancer, MSI status was an independent risk factor for cancer-specific survival (MSS: hazard ratio, 4.34; 95% confidence interval, 1.68-11.21).

Conclusion

In patients with colorectal cancer presenting with MUCs, SRCs, and/or PDCs, those with high-MSI cancers had better outcomes.

Citations

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Clinicopathological features and evaluation of microsatellite stability of colorectal carcinoma with cribriform comedo pattern
Tuğba Günler, Pinar Karabağli, Hicret Tiyek, Özge Keskin, Muslu K. Körez
Indian Journal of Pathology and Microbiology.2024; 67(2): 275. CrossRef
Correlation of clinical, pathologic, and genetic parameters with intratumoral immune milieu in mucinous adenocarcinoma of the colon
Azfar Neyaz, Amaya Pankaj, Andrew Crabbe, Steffen Rickelt, Lieve Leijssen, Anne Dinaux, Martin Taylor, Stuti G. Shroff, Rory Crotty, M. Lisa Zhang, Omer H. Yilmaz, Osman Yılmaz, Deepa T. Patil, Aparna R. Parikh, David T. Ting, David Berger, Vikram Deshpan
Modern Pathology.2022; 35(11): 1723. CrossRef
The Molecular Associations of Signet-Ring Cell Carcinoma in Colorectum: Meta-Analysis and System Review
Xueting Liu, Litao Huang, Menghan Liu, Zhu Wang
Medicina.2022; 58(7): 836. CrossRef
Rate of dissemination and prognosis in early and advanced stage colorectal cancer based on microsatellite instability status: systematic review and meta-analysis
James W. T. Toh, Kevin Phan, Faizur Reza, Pierre Chapuis, Kevin J. Spring
International Journal of Colorectal Disease.2021; 36(8): 1573. CrossRef
Tumour infiltrating lymphocyte status is superior to histological grade, DNA mismatch repair and BRAF mutation for prognosis of colorectal adenocarcinomas with mucinous differentiation
David S. Williams, Dmitri Mouradov, Marsali R. Newman, Elham Amini, David K. Nickless, Catherine G. Fang, Michelle Palmieri, Anuratha Sakthianandeswaren, Shan Li, Robyn L. Ward, Nicholas J. Hawkins, Iain Skinner, Ian Jones, Peter Gibbs, Oliver M. Sieber
Modern Pathology.2020; 33(7): 1420. CrossRef
Prognostic value of KRAS mutation status in colorectal cancer patients: a population-based competing risk analysis
Dongjun Dai, Yanmei Wang, Liyuan Zhu, Hongchuan Jin, Xian Wang
PeerJ.2020; 8: e9149. CrossRef
Implication of Microsatellite Instability in Chinese Cohort of Human Cancers

Meiying Cui, Pan Li, Ying Mao, Lan Zhang, Peiyi Xia, Enjie Liu, Weiwei Wang, Jianying Zhang, Guozhong Jiang, Wencai Li
Cancer Management and Research.2020; Volume 12: 10287. CrossRef
Outcomes for Metastatic Colorectal Cancer Based on Microsatellite Instability: Results from the South Australian Metastatic Colorectal Cancer Registry
Li Chia Chong, Amanda Rose Townsend, Joanne Young, Amitesh Roy, Cynthia Piantadosi, Jennifer E. Hardingham, David Roder, Christos Karapetis, Robert Padbury, Guy Maddern, James Moore, Timothy Jay Price
Targeted Oncology.2019; 14(1): 85. CrossRef
Signet ring cell colorectal cancer: genomic insights into a rare subpopulation of colorectal adenocarcinoma
Krittiya Korphaisarn, Van Morris, Jenifer S. Davis, Michael J. Overman, David R. Fogelman, Bryan K. Kee, Arvind Dasari, Kanwal P. S. Raghav, Imad Shureiqi, Metha Trupti, Robert A. Wolff, Cathy Eng, David G. Menter, Stanley Hamilton, Scott Kopetz
British Journal of Cancer.2019; 121(6): 505. CrossRef
SILAC-Based Quantification of TGFBR2-Regulated Protein Expression in Extracellular Vesicles of Microsatellite Unstable Colorectal Cancers
Fabia Fricke, Malwina Michalak, Uwe Warnken, Ingrid Hausser, Martina Schnölzer, Jürgen Kopitz, Johannes Gebert
International Journal of Molecular Sciences.2019; 20(17): 4162. CrossRef
Is microsatellite instability-high really a favorable prognostic factor for advanced colorectal cancer? A meta-analysis
Bingyan Wang, Fei Li, Xin Zhou, Yanpeng Ma, Wei Fu
World Journal of Surgical Oncology.2019;[Epub] CrossRef
Cáncer de colon en Colombia, fenotipo molecular: tamizaje para síndromes con agregación familiar
Mabel Elena Bohórquez L, Ángel Alexandro Criollo R, Luis Carvajal Carmona, María Magdalena Echeverry de Polanco
Revista de la Asociación Colombiana de Ciencias Biológicas.2019; : 87. CrossRef
Evaluation of Long-Term Outcomes of Microsatellite Instability Status in an Asian Cohort of Sporadic Colorectal Cancers
Winson Jianhong Tan, Julie Liana Hamzah, Sanchalika Acharyya, Fung Joon Foo, Kiat Hon Lim, Iain Bee Huat Tan, Choong Leong Tang, Min Hoe Chew
Journal of Gastrointestinal Cancer.2018; 49(3): 311. CrossRef
What are the Clinicopathological Features and Outcomes of Sporadic Colorectal Cancer (CRC) in an Ethiopian Cohort with focus on young-onset CRC?
Dominic Worku
Journal of Cancer Prevention & Current Research.2017;[Epub] CrossRef
Mismatch Repair Proteins and Microsatellite Instability in Colorectal Carcinoma (MLH1, MSH2, MSH6 and PMS2): Histopathological and Immunohistochemical Study
Nour El Hoda S. Ismael, Samar A. El Sheikh, Suzan M. Talaat, Eman M. Salem
Open Access Macedonian Journal of Medical Sciences.2017; 5(1): 9. CrossRef
Impact of Microsatellite Instability in Signet-Ring Cell and Mucinous Components in Patients With Colorectal Carcinoma
Ik Yong Kim
Annals of Coloproctology.2016; 32(2): 45. CrossRef

Comparative Study of Postoperative Complications in Patients With and Without an Obstruction Who Had Left-Sided Colorectal Cancer and Underwent a Single-Stage Operation After Mechanical Bowel Preparation: Sang Hun Jung, Jae Hwang Kim; Ann Coloproctol. 2014;30(6):251-258. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.251

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Abstract PDF

Purpose

The purpose of this study is to compare postoperative complications for single-stage surgery after mechanical bowel preparation in patients who experienced obstruction and those who did not.

Methods

From 2000 to 2011, 1,224 patients underwent a single-stage operation for left colorectal cancer after bowel preparation. Nonobstruction (NOB) and obstruction (OB) colorectal cancer patients were 1,053 (86.0%) and 171 (14.0%), respectively. Postoperative morbidity and mortality were compared between groups.

Results

The OB group had poor preoperative conditions (age, white blood cell, hemoglobin, albumin level, and advanced tumor stage) compared with the NOB group (P < 0.05). Mean on-table lavage time for the OB group was 17.5 minutes (range, 14-60 minutes). Mean operation time for the OB group was statistically longer than that of the NOB group (OB: 210 minutes; range, 120-480 minutes vs. NOB: 180 minutes; range, 60-420 minutes; P < 0.001). Overall morbidity was similar between groups (NOB: 19.7% vs. OB: 23.4%, P = 0.259). Major morbidity was more common in the OB group than in the NOB group, but the difference was without significance (OB: 11.7% vs. NOB: 7.6%, P = 0.070). Postoperative death occurred in 16 patients (1.3%), and death in the OB group (n = 7) was significantly higher than it was in the NOB group (n = 9) (4.1% vs. 0.9%, P = 0.001). Twelve patients had surgical complications, which were the leading cause of postoperative death: postoperative bleeding in five patients and leakage in seven patients.

Conclusion

Postoperative morbidity for a single-stage operation for obstructive left colorectal cancer is comparable to that for NOB, regardless of poor conditions of the patient.

Citations

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Clinical characteristics and risk factors of post-operative intestinal flora disorder following laparoscopic colonic surgery: A propensity-score-matching analysis
Gan-Bin Li, Chen-Tong Wang, Xiao Zhang, Xiao-Yuan Qiu, Wei-Jie Chen, Jun-Yang Lu, Lai Xu, Bin Wu, Yi Xiao, Guo-Le Lin
World Journal of Gastrointestinal Surgery.2024; 16(5): 1259. CrossRef
Laparoscopic versus open surgery for obese patients with rectal cancer: a retrospective cohort study
Hiroyuki Matsuzaki, Soichiro Ishihara, Kazushige Kawai, Koji Murono, Kensuke Otani, Koji Yasuda, Takeshi Nishikawa, Toshiaki Tanaka, Tomomichi Kiyomatsu, Keisuke Hata, Hiroaki Nozawa, Hironori Yamaguchi, Toshiaki Watanabe
Surgery Today.2017; 47(5): 627. CrossRef
Surgical Treatment of Obstructed Left-Sided Colorectal Cancer Patients
Young Jin Kim
Annals of Coloproctology.2014; 30(6): 245. CrossRef

Effectiveness of Sodium Picosulfate/Magnesium Citrate (PICO) for Colonoscopy Preparation: Ki Hwan Song, Wu Seok Suh, Jin Sik Jeong, Dong Sik Kim, Sang Woo Kim, Dong Min Kwak, Jong Seong Hwang, Hyun Jin Kim, Man Woo Park, Min Chul Shim, Ja-Il Koo, Jae Hwang Kim, Dae Ho Shon; Ann Coloproctol. 2014;30(5):222-227. Published online October 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.5.222

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8 Web of Science
6 Citations

Abstract PDF

Purpose

Bowel preparation with sodium phosphate was recently prohibited by the U.S. Food and Drug Administration. Polyethylene glycol (PEG) is safe and effective; however, it is difficult to drink. To identify an easy bowel preparation method for colonoscopy, we evaluated three different bowel preparation regimens regarding their efficacy and patient satisfaction.

Methods

In this randomized, comparative study, 892 patients who visited a secondary referral hospital for a colonoscopy between November 2012 and February 2013 were enrolled. Three regimens were evaluated: three packets of sodium picosulfate/magnesium citrate (PICO, group A), two packets of PICO with 1 L of PEG (PICO + PEG 1 L, group B), and two packets of PICO with 2 L of PEG (PICO + PEG 2 L, group C). A questionnaire survey regarding the patients' preference for the bowel preparation regimen and satisfaction was conducted before the colonoscopies. The quality of bowel cleansing was scored by the colonoscopists who used the Aronchick scoring scale and the Ottawa scale.

Results

The patients' satisfaction rate regarding the regimens were 72% in group A, 64% in group B, and 45.9% in group C. Nausea and abdominal bloating caused by the regimens were more frequent in group C than in group A or group B (P < 0.01). Group C showed the lowest preference rate compared to the other groups (P < 0.01). Group C showed better right colon cleansing efficacy than group A or group B.

Conclusion

Group A exhibited a better result than group B or group C in patient satisfaction and preference. In the cleansing quality, no difference was noted between groups A and C.

Citations

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White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial
Jeremy P Dwyer, Jonathan Y C Tan, Eldho Paul, Catherine Bunn, Dileep Mangira, Robyn Secomb, Peter R Gibson, Gregor Brown
JGH Open.2017; 1(1): 38. CrossRef
Randomized clinical trial comparing fixed-time split dosing and split dosing of oral Picosulfate regimen for bowel preparation
Jae Hyuck Jun, Koon Hee Han, Jong Kyu Park, Hyun Il Seo, Young Don Kim, Sang Jin Lee, Baek Gyu Jun, Min Sik Hwang, Yoon Kyoo Park, Myeong Jong Kim, Gab Jin Cheon
World Journal of Gastroenterology.2017; 23(32): 5986. CrossRef
Upper airway obstruction resulting from acute mucosal injury induced by direct ingestion of sodium picosulfate/magnesium citrate powder
Gyeong Bo Kim, Sung Yeon Hwang, Tae Gun Shin, Tae Rim Lee, Won Chul Cha, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong
Clinical and Experimental Emergency Medicine.2016; 3(2): 109. CrossRef
Combination could be another tool for bowel preparation?
Jae Seung Soh, Kyung-Jo Kim
World Journal of Gastroenterology.2016; 22(10): 2915. CrossRef
Phase II Randomized Controlled Trial of Combined Oral laxatives Medication for BOwel PREParation (COMBO-PREP study)
Min Jung Kim, Chang Won Hong, Byung Chang Kim, Sung Chan Park, Kyung Su Han, Jungnam Joo, Jae Hwan Oh, Dae Kyung Sohn
Medicine.2016; 95(7): e2824. CrossRef
Frustration Still Exists
Hyun Shig Kim
Annals of Coloproctology.2014; 30(5): 207. CrossRef

Intraoperative Radiotherapy for Locally Advanced Rectal Cancer: Min Kyu Kang, Myung Se Kim, Jae Hwang Kim; J Korean Soc Coloproctol. 2010;26(4):274-278. Published online August 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.4.274

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Abstract PDF

Purpose

Although intraoperative radiotherapy (IORT) is known to be a method that can reduce local recurrence in locally advanced colorectal cancer, it is not widely used. The aim of this study was to report our experience with IORT for locally advanced rectal cancer.

Methods

From 1991 to 1994, nine patients with locally advanced rectal cancer received IORT. External beam radiotherapy was given postoperatively in five patients and preoperatively in three. Seven patients received chemotherapy. IORT was done with 6-MeV or 9-MeV electrons, and 12 Gy was irradiated at the tumor bed. The median follow-up period was 84 months (range, 15 to 208 months).

Results

The median age of patients was 51 years (range, 42 to 73 years). All patients had advanced clinical T-stage (cT3/4) cancer. The overall and the disease-free survival rates were 66.7% and 66.7% at 5 years, respectively. One patient developed a local recurrence near the anastomosis site, which was out of the IORT field. Four patients died before the last follow-up; three from distant metastasis and one from secondary primary cancer. Adverse effects related to IORT did not occur.

Conclusion

Although the number of patients was small in this study, IORT is thought to be safe and effective in reducing local recurrence in locally advanced rectal cancer. However, the role of IORT should be refined in the era of preoperative radio-chemotherapy followed by total mesorectal excision.

Citations

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Laparoscopic abdominoperineal resection with intraoperative radiotherapy for locally advanced low rectal cancer
Matej Skrovina, Renata Soumarova, Miloslav Duda, Roman Bezdek, Jiri Bartos, Adam Wendrinski, Petr Andel, Javed Parvez, Martin Straka, Lukas Adamcik
Biomedical Papers.2014; 158(3): 447. CrossRef
Laparoscopic Resection with Intraoperative Radiotherapy for Local Advanced Rectal Cancer: A Preliminary Case Report
Yimei Jiang, Xiaopin Ji, Shengguang Zhao, Ren Zhao, Yening Jin
Journal of Laparoendoscopic & Advanced Surgical Techniques.2013; 23(3): 267. CrossRef
A review of the logistic role of l‐carnitine in the management of radiation toxicity and radiotherapy side effects
Haseeb Ahmad Khan, Abdullah Saleh Alhomida
Journal of Applied Toxicology.2011; 31(8): 707. CrossRef

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