Annals of Coloproctology

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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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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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Optimal extent of lymph node dissection in clinical early-stage right colon cancer: a retrospective analysis
Hyeung-min Park, Jaram Lee, Soo Young Lee, Suk Hee Heo, Yong Yeon Jeong, Hyeong Rok Kim, Chang Hyun Kim
Annals of Surgical Treatment and Research.2025; 108(1): 49. CrossRef
Effects of Microsatellite Instability on the Clinical and Pathological Characteristics of Colon Cancer and the Diagnostic Accuracy of Preoperative Abdominal CT Scans
Rıdvan Yavuz, Orhan Aras, Hüseyin Çiyiltepe, Onur İlkay Dinçer, Ahmet Şükrü Alparslan, Tebessüm Çakır
Diagnostics.2025; 15(2): 190. CrossRef
Epigenetic Regulation of Nuclear Factor Erythroid-2-Related Factor 2 in Colorectal Cancer Cells Resistant to Ionizing Radiation
Kyoung Ah Kang, Jinny Park, Mei Jing Piao, Pincha Devage Sameera Madushan Fernando, Herath Mudiyanselage Udari Lakmini Herath, Herath Mudiyanselage Maheshika Madhuwanthi Senavirathna, Jung-Hwan Kim, Suk Ju Cho, Jin Won Hyun
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The Diagnostic Value of Virtual Colonoscopy in Colonic Diseases
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2023 Korean Multidisciplinary Guidelines for Colon Cancer Management: Summary of Radiological Points
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Korean Journal of Radiology.2024; 25(9): 769. CrossRef
Effect of Fluorescence Lymph Node Mapping on Improving Diagnostic Values of CT D3 Lymph Node Staging for Right-Sided Colon Cancer
Gyung Mo Son, Tae Un Kim, Mi Sook Yun, ChangYeop Kim, In Young Lee, Su Bum Park, Dong-Hoon Shin, Gi Won Ha
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Nuclear medicine based multimodal molecular imaging facilitates precision medicine for gastrointestinal tumors
Jing Zhao, Fei Wang, Rong-Fu Wang
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Impact of Early Oral Feeding on Postoperative Outcomes after Elective Colorectal Surgery: A Systematic Review and Meta-Analysis
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Original Article

Malignant disease,Prognosis and adjuvant therapy,Colorectal cancer,Epidemiology & etiology

Characteristics and outcomes of colorectal cancer surgery by age in a tertiary center in Korea: a retrospective review: Tae-Hoon Lee, Jeong Min Choo, Jeong Sub Kim, Seon Hui Shin, Ji-Seon Kim, Se-Jin Baek, Jung-Myun Kwak, Jin Kim, Seon-Hahn Kim; Ann Coloproctol. 2022;38(3):244-252. Published online November 4, 2021; DOI: https://doi.org/10.3393/ac.2021.00619.0088

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Graphical Abstract Abstract PDF

Purpose
Colorectal cancer (CRC) occurs in all age groups, and the application of treatment may vary according to age. The study was designed to identify the characteristics of CRC by age.
Methods
A total of 4,326 patients undergoing primary resection for CRC from September 2006 to July 2019 were reviewed. Patient and tumor characteristics, operative and postoperative data, and oncologic outcome were compared
Results
Patients aged 60 to 69 years comprised the largest age group (29.7%), followed by those aged 50 to 59 and 70 to 79 (24.5% and 23.9%, respectively). Rectal cancer was common in all age groups, but right-sided colon cancer tended to be more frequent in older patients. In very elderly patients, there were significant numbers of emergency surgeries, and the frequencies of open surgery and permanent stoma were greater. In contrast, total abdominal colectomy or total proctocolectomy was performed frequently in patients in their teens and twenties. The elderly patients showed more advanced tumor stages and postoperative ileus. The incidence of adjuvant treatment was low in elderly patients, who also had shorter follow-up periods. Overall survival was reduced in older patients with stages 0 to 3 CRC (P<0.001), but disease-free survival did not differ by age (P=0.391).
Conclusion
CRC screening at an earlier age than is currently undertaken may be necessary in Korea. In addition, improved surgical and oncological outcomes can be achieved through active treatment of the growing number of elderly CRC patients.

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Effects of the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls score on postoperative clinical outcomes following colorectal cancer surgery: a retrospective study
Young Jae Kim, Sung Uk Bae, Kyeong Eui Kim, Woon Kyung Jeong, Seong Kyu Baek
European Journal of Clinical Nutrition.2025; 79(4): 358. CrossRef
Immunological changes and recovery-related factors in older patients with colon cancer: A pilot trial
Byeo Lee Lim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Yousun Ko, Kyung Won Kim, In Ja Park
Journal of Geriatric Oncology.2025; 16(3): 102200. CrossRef
Comparison of body composition changes and nutritional status after surgery between older Japanese patients with upper and lower gastrointestinal cancer
Eiko Takano, Tsukasa Aritake, Kakeru Hashimoto, Yumi Suzuki, Yuichi Kitagawa, Ken Fujishiro, Yasuji Kawabata, Shinichirou Kobayashi, Izumi Kondo
The Journal of Aging Research & Lifestyle.2025; 14: 100006. CrossRef
Oncologic outcomes of surgically treated colorectal cancer in octogenarians: a comparative study using inverse probability of treatment weighting (IPTW)
Soo Young Oh, Jung Yun Park, Kwan Mo Yang, Seong-A Jeong, Yong Jae Kwon, Yun Tae Jung, Chung Hyeun Ma, Keong Won Yun, Kwang Hyun Yoon, Jae Young Kwak, Chang Sik Yu
BMC Gastroenterology.2025;[Epub] CrossRef
Oncologic outcomes and associated factors of colon cancer patients aged 70 years and older
Byeo Lee Lim, In Ja Park, Jun-Soo Ro, Young Il Kim, Seok-Byung Lim, Chang Sik Yu
Annals of Coloproctology.2025; 41(3): 198. CrossRef
Influence of additional prophylactic oral antibiotics during mechanical bowel preparation on surgical site infection in patients receiving colorectal surgery
Hayoung Lee, Jong Lyul Lee, Ji Sung Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok‐Byung Lim
World Journal of Surgery.2024; 48(6): 1534. CrossRef
Effect of Fluorescence Lymph Node Mapping on Improving Diagnostic Values of CT D3 Lymph Node Staging for Right-Sided Colon Cancer
Gyung Mo Son, Tae Un Kim, Mi Sook Yun, ChangYeop Kim, In Young Lee, Su Bum Park, Dong-Hoon Shin, Gi Won Ha
Cancers.2024; 16(20): 3496. CrossRef
Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef
The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
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
Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
In Ja Park
The Ewha Medical Journal.2023;[Epub] CrossRef
Is the oncological impact of vascular invasion more important in right colon cancer?
Gyung Mo Son
Journal of Minimally Invasive Surgery.2022; 25(2): 49. CrossRef
Tailoring strategies for colorectal cancer screening and treatment based on age in colorectal cancer patients
Eun Jung Park
Annals of Coloproctology.2022; 38(3): 181. CrossRef
Surgical treatment for metastatic colorectal cancer
Eun Jung Park, Seung Hyuk Baik
Journal of the Korean Medical Association.2022; 65(9): 568. CrossRef
Recent Advance in the Surgical Treatment of Metastatic Colorectal Cancer-An English Version
Eun Jung Park, Seung Hyuk Baik
Journal of the Anus, Rectum and Colon.2022; 6(4): 213. CrossRef

Editorials

Malignant disease

Comprehensive Approach for Older Cancer Patients: New Challenge in an Aging Society: Do Young Lee, Jung-Myun Kwak; Ann Coloproctol. 2020;36(5):289-290. Published online October 31, 2020; DOI: https://doi.org/10.3393/ac.2020.10.25

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Socio-demographic disparities in global trends of lip and oral cavity neoplasms from 1990 to 2021
Amr Sayed Ghanem, Ágnes Tóth, Attila Csaba Nagy
Scientific Reports.2025;[Epub] CrossRef
Immune Checkpoint Inhibitors: The Unexplored Landscape of Geriatric Oncology
Khalil Choucair, Abdul Rafeh Naqash, Caroline A Nebhan, Ryan Nipp, Douglas B Johnson, Anwaar Saeed
The Oncologist.2022; 27(9): 778. CrossRef
Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison
Nicolás M. González-Senac, Jennifer Mayordomo-Cava, Angela Macías-Valle, Paula Aldama-Marín, Sara Majuelos González, María Luisa Cruz Arnés, Luis M. Jiménez-Gómez, María T. Vidán-Astiz, José Antonio Serra-Rexach
International Journal of Environmental Research and Public Health.2021; 18(11): 6072. CrossRef

Malignant disease

Acknowledging the Unsung Role of the Cancer Registry in Rare Cancers: Jung-Myun Kwak; Ann Coloproctol. 2020;36(1):1-2. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2020.02.11

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Original Articles

Clinical Outcomes of Ileostomy Closure According to Timing During Adjuvant Chemotherapy After Rectal Cancer Surgery: Yoo Jin Choi, Jung-Myun Kwak, Neul Ha, Tae Hoon Lee, Se Jin Baek, Jin Kim, Seon Hahn Kim; Ann Coloproctol. 2019;35(4):187-193. Published online August 31, 2019; DOI: https://doi.org/10.3393/ac.2018.10.18.1

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Abstract PDF

Purpose
No guidelines exist detailing when to implement a temporary ileostomy closure in the setting of adjuvant chemotherapy following sphincter-saving surgery for rectal cancer. The aim of this study was to evaluate the clinical and oncological outcomes of ileostomy closure during adjuvant chemotherapy in patients with curative resection of rectal cancer.
Methods
This retrospective study investigated 220 patients with rectal cancer undergoing sphincter-saving surgery with protective loop ileostomy from January 2007 to August 2016. Patients were divided into 2 groups: group 1 (n = 161) who underwent stoma closure during adjuvant chemotherapy and group 2 (n = 59) who underwent stoma closure after adjuvant chemotherapy.
Results
No significant differences were observed in operative time, blood loss, postoperative hospital stay, or postoperative complications in ileostomy closure between the 2 groups. No difference in overall survival (P = 0.959) or disease-free survival (P = 0.114) was observed between the 2 groups.
Conclusion
Ileostomy closure during adjuvant chemotherapy was clinically safe, and interruption of chemotherapy due to ileostomy closure did not change oncologic outcomes.

Citations

Citations to this article as recorded by

Early closure of protective ileostomy—a benefit for the patient?
Zuzana Adamová, Michaela Filová, Veronika Pechalová, Martin Chrostek, Radim Slováček
European Surgery.2025;[Epub] CrossRef
Clinical Outcomes of Ileostomy Closure during versus after Adjuvant Chemotherapy in Patients with Rectal Cancer
Fan He, Fuyu Yang, Chenglin Tang, Defei Chen, Dongqin Zhao, Junjie Xiong, Yu Zou, Guoquan Huang, Kun Qian, Masanao Nakamura
Canadian Journal of Gastroenterology and Hepatology.2024; 2024: 1. CrossRef
Prophylactic effect of retromuscular mesh placement during loop ileostomy closure on incisional hernia incidence—a multicentre randomised patient- and observer-blind trial (P.E.L.I.O.N trial)
Sven Müller, Dirk Weyhe, Florian Herrle, Philipp Horvath, Robert Bachmann, Viktor von Ehrlich-Treuenstätt, Patrick Heger, Nadir Nasir, Christina Klose, Alexander Ritz, Anja Sander, Erich Grohmann, Colette Dörr-Harim, André L. Mihaljevic
Trials.2023;[Epub] CrossRef
Impact of chemotherapy on surgical outcomes in ileostomy reversal: a propensity score matching study from a single centre
H.-H. Cheng, Y.-C. Shao, C.-Y. Lin, T.-W. Chiang, M.-C. Chen, T.-Y. Chiu, Y.-L. Huang, C.-C. Chen, C.-P. Chen, F.-F. Chiang
Techniques in Coloproctology.2023; 27(12): 1227. CrossRef
Comparison of clinical outcomes of stoma reversal during versus after chemotherapy for rectal cancer patients
Kun-Yu Tsai, Jeng-Fu You, Shu-Huan Huang, Tzong-yun Tsai, Pao-Shiu Hsieh, Cheng-Chou Lai, Wen-Sy Tsai, Hsin-Yuan Hung
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Early versus late closure of temporary ileostomy after rectal cancer surgery: a meta-analysis
Li Wang, Xinling Chen, Chen Liao, Qian Wu, Hongliang Luo, Fengming Yi, Yiping Wei, Wenxiong Zhang
Surgery Today.2021; 51(4): 463. CrossRef
Low albumin level and longer interval to closure increase the early complications after ileostomy closure
HyungJoo Baik, Ki Beom Bae
Asian Journal of Surgery.2021; 44(1): 352. CrossRef
Does the timing of protective ileostomy closure post-low anterior resection have an impact on the outcome? A retrospective study
Fozan Sauri, Ahmad Sakr, Ho Seung Kim, Mohammed Alessa, Radwan Torky, Eman Zakarneh, Seung Yoon Yang, Nam Kyu Kim
Asian Journal of Surgery.2021; 44(1): 374. CrossRef
Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis
I. Vogel, N. Reeves, P. J. Tanis, W. A. Bemelman, J. Torkington, R. Hompes, J. A. Cornish
Techniques in Coloproctology.2021; 25(7): 751. CrossRef
Clinical Outcomes of Ileostomy Closure before Adjuvant Chemotherapy after Rectal Cancer Surgery: An Observational Study from a Chinese Center
Zhen Sun, Yufeng Zhao, Lu Liu, Jichao Qin, Zhongguang Luo
Gastroenterology Research and Practice.2021; 2021: 1. CrossRef
Delayed ileostomy closure increases the odds of Clostridium difficile infection
Simon J. G. Richards, Dilshan K. Udayasiri, Ian T. Jones, Ian A. Hastie, Raaj Chandra, Jacob J. McCormick, Timothy J. Chittleborough, David J. Read, Ian P. Hayes
Colorectal Disease.2021; 23(12): 3213. CrossRef
The effect of ileostomy closure timing on low anterior resection syndrome in patient who underwent low anterior resection for rectal cancer
Hemn Hussain Kaka Ali, Qalandar Hussein Abdulkarim, Karzan Seerwan, Barham M. M .Salih, Omar H Ghalib Hawramy, Dara Ahmed Mohammed, Syamand Orhaman Ahmed
Kurdistan Journal of Applied Research.2021; : 126. CrossRef
Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients
Marcin Zeman, Marek Czarnecki, Andrzej Chmielarz, Adam Idasiak, Maciej Grajek, Agnieszka Czarniecka
World Journal of Surgical Oncology.2020;[Epub] CrossRef

Early Systemic Failure After Preoperative Chemoradiotherapy for the Treatment of Patients With Rectal Cancer: Taesun Choi, Se-Jin Baek, Jung Myun Kwak, Jin Kim, Seon-Hahn Kim; Ann Coloproctol. 2019;35(2):94-99. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2018.08.28

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Abstract PDF

Purpose
Distant metastasis can occur early after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. This study was conducted to evaluate the clinical characteristics of patients who developed early systemic failure.
Methods
The patients who underwent neoadjuvant CRT for a rectal adenocarcinoma between June 2007 and July 2015 were included in this study. Patients who developed distant metastasis within 6 months after CRT were identified. We compared short- and long-term clinicopathologic outcomes of patients in the early failure (EF) group with those of patients in the control group.
Results
Of 107 patients who underwent neoadjuvant CRT for rectal cancer, 7 developed early systemic failure. The lung was the most common metastatic site. In the EF group, preoperative carcinoembryonic antigen was higher (5 mg/mL vs. 2 mg/mL, P = 0.010), and capecitabine as a sensitizer of CRT was used more frequently (28.6% vs. 3%, P = 0.002). Of the 7 patients in the EF group, only 4 underwent a primary tumor resection (57.1%), in contrast to the 100% resection rate in the control group (P < 0.001). In terms of pathologic outcomes, ypN and TNM stages were more advanced in the EF group (P < 0.001 and P = 0.047, respectively), and numbers of positive and retrieved lymph nodes were much higher (P < 0.001 and P = 0.027, respectively).
Conclusion
Although early distant metastasis after CRT for rectal cancer is very rare, patients who developed early metastasis showed a poor nodal response with a low primary tumor resection rate and poor oncologic outcomes.

Citations

Citations to this article as recorded by

Characteristics of Patients Presented With Metastases During or After Completion of Chemoradiation Therapy for Locally Advanced Rectal Cancer: A Case Series
Radwan Torky, Mohammed Alessa, Ho Seung Kim, Ahmed Sakr, Eman Zakarneh, Fozan Sauri, Heejin Bae, Nam Kyu Kim
Annals of Coloproctology.2021; 37(3): 186. CrossRef
Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer
Ho Seung Kim, Nam Kyu Kim
Annals of Gastroenterological Surgery.2020; 4(4): 379. CrossRef

Anastomotic Sinus That Developed From Leakage After a Rectal Cancer Resection: Should We Wait for Closure of the Stoma Until the Complete Resolution of the Sinus?: Chris Tae-Young Chung, Se-Jin Baek, Jung-Myun Kwak, Jin Kim, Seon-Hahn Kim; Ann Coloproctol. 2019;35(1):30-35. Published online January 25, 2019; DOI: https://doi.org/10.3393/ac.2018.08.13

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Abstract PDF

Purpose
The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus.
Methods
The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus.
Results
Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture.
Conclusion
Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.

Citations

Citations to this article as recorded by

Management of Low-Rectal Anastomotic Sinus With Transanal Minimally Invasive Septotomy
Nirvana B. Saraswat, Scott A. Brill, William E. Wise
The American Surgeon™.2023; 89(2): 322. CrossRef
The management of asymptomatic radiological anastomotic leakage following anterior resection
Mohamed Rabie, Laura Parry, Iannish Sadien, Sandeep Kapur, Adam Stearns, Irshad Shaikh
ANZ Journal of Surgery.2022; 92(4): 801. CrossRef
Chronische Anastomoseninsuffizienz nach tiefer Rektumresektion – ein ungelöstes Problem?
Peter Kienle, Jörn Richard Magdeburg
Der Chirurg.2021; 92(7): 605. CrossRef
Response to Dioscoridi et al.
G. I. Popivanov, V. M. Mutafchiyski, R. Cirocchi, S. D. Chipeva, V. V. Vasilev, K. T. Kjossev, M. S. Tabakov
Colorectal Disease.2020; 22(7): 841. CrossRef
Anastomotic Sinus Developed From Leakage in Rectal Cancer Resection: When Can We Reverse the Defunctioning Stoma?
Chang Hyun Kim
Annals of Coloproctology.2019; 35(1): 1. CrossRef

Editorial

Can Single Incision Laparoscopic Surgery be Considered Primarily for Patients with Complicated Appendicitis?: Seon Hahn Kim, Jung Myun Kwak; J Korean Soc Coloproctol. 2010;26(6):373-374. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.373

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