Annals of Coloproctology

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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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

Reliability of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Nodal Staging of Colorectal Cancer Patients: Hee Jung Yi, Kyung Sook Hong, Nara Moon, Soon Sup Chung, Ryung-Ah Lee, Kwang Ho Kim; Ann Coloproctol. 2014;30(6):259-265. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.259

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Abstract PDF

Purpose

Lymph-node metastasis is considered as critical prognostic factor in colorectal cancer. A preoperative evaluation of lymph-node metastasis can also help to determine the range of distant lymph node dissection. However, the reliability of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of lymph-node metastasis is not fully known.

Methods

The medical records of 433 patients diagnosed with colorectal cancer were reviewed retrospectively. FDG-PET/CT and CT were performed on all patients. Lymph nodes were classified into regional and distant lymph nodes according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th edition.

Results

The patients included 231 males (53.3%) and 202 females (46.7%), with a mean age of 64.7 ± 19.0 years. For regional lymph nodes, the sensitivity of FDG-PET/CT was lower than that of CT (57.1% vs. 73.5%, P < 0.001). For distant lymph nodes, the sensitivity of FDG-PET/CT was higher than that of CT (64.7% vs. 52.9%, P = 0.012). The sensitivity of FDG-PET/CT for regional lymph nodes was higher in patients with larger primary tumors. The positivity of lymph-node metastasis for FDG-PET/CT was affected by carcinoembryonic antigen levels, tumor location, and cancer stage for regional lymph nodes and by age and cancer stage for distant lymph nodes (P < 0.05).

Conclusion

The sensitivity of FDG-PET/CT for regional lymph-node metastasis was not superior to that of CT. However, FDG-PET/CT provides helpful information for determining surgical plan especially in high risk patients group.

Citations

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Evaluation of colon cancer prognostic factors by CT and MRI: an up-to-date review
Ruggeri B. Guimarães, Eduardo O. Pacheco, Serli N. Ueda, Dario A. Tiferes, Fernanda L. Mazzucato, Aley Talans, Ulysses S. Torres, Giuseppe D’Ippolito
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Clinical evaluation of18F-fludeoxyglucose positron emission tomography/CT using point spread function reconstruction for nodal staging of colorectal cancer
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Short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision and central ligation
Ik Yong Kim, Bo Ra Kim, Eun Hee Choi, Young Wan Kim
International Journal of Surgery.2016; 27: 151. CrossRef
Preoperative Staging With Positron Emission Tomography in Patients With Colorectal Cancer
Young Wan Kim, Ik Yong Kim
Annals of Coloproctology.2014; 30(6): 247. CrossRef

Role of β₁-Integrin in Colorectal Cancer: Case-Control Study: Bo-Young Oh, Kwang Ho Kim, Soon Sup Chung, Kyoung Sook Hong, Ryung-Ah Lee; Ann Coloproctol. 2014;30(2):61-70. Published online April 25, 2014; DOI: https://doi.org/10.3393/ac.2014.30.2.61

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Abstract PDF

Purpose

In the metastatic process, interactions between circulating tumor cells (CTCs) and the extracellular matrix or surrounding cells are required. β₁-Integrin may mediate these interactions. The aim of this study was to investigate whether β₁-integrin is associated with the detection of CTCs in colorectal cancer.

Methods

We enrolled 30 patients with colorectal cancer (experimental group) and 30 patients with benign diseases (control group). Blood samples were obtained from each group, carcinoembryonic antigen (CEA) mRNA for CTCs marker and β₁-integrin mRNA levels were estimated by using reverse transcription-polymerase chain reaction, and the results were compared between the two groups. In the experimental group, preoperative results were compared with postoperative results for each marker. In addition, we analyzed the correlation between the expressions of β₁-integrin and CEA.

Results

CEA mRNA was detected more frequently in colorectal cancer patients than in control patients (P = 0.008). CEA mRNA was significantly reduced after surgery in the colorectal cancer patients (P = 0.032). β₁-Integrin mRNA was detected more in colorectal cancer patients than in the patients with benign diseases (P < 0.001). In colorectal cancer patients, expression of β₁-integrin mRNA was detected more for advanced-stage cancer than for early-stage cancer (P = 0.033) and was significantly decreased after surgery (P < 0.001). In addition, expression of β₁-integrin mRNA was significantly associated with that of CEA mRNA in colorectal cancer patients (P = 0.001).

Conclusion

In conclusion, β₁-integrin is a potential factor for forming a prognosis following surgical resection in colorectal cancer patients. β₁-Integrin may be a candidate for use as a marker for early detection of micrometastatic tumor cells and for monitoring the therapeutic response in colorectal cancer patients.

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The Expression Pattern of Adhesion G Protein-Coupled Receptor F5 Is Related to Cell Adhesion and Metastatic Pathways in Colorectal Cancer—Comprehensive Study Based on In Silico Analysis
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Epidermal growth factor-mediated Rab25 pathway regulates integrin β1 trafficking in colon cancer
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A New Size-based Platform for Circulating Tumor Cell Detection in Colorectal Cancer Patients
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Twist1-induced epithelial-mesenchymal transition according to microsatellite instability status in colon cancer cells
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Expression of L1 protein correlates with cluster of differentiation 24 and integrin β1 expression in gastrointestinal stromal tumors
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Correlation between tumor engraftment in patient-derived xenograft models and clinical outcomes in colorectal cancer patients
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Invasion and Metastasis in the Viewpoint of Cell Adhesive Molecules
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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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The optimal time of starting adjuvant chemotherapy after curative surgery in patients with colorectal cancer
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BMC Cancer.2023;[Epub] CrossRef
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Editorial

Clinical Characteristics of Ischemic Colitis According to the Localization: Kwang Ho Kim; J Korean Soc Coloproctol. 2011;27(6):275-275. Published online December 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.6.275

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Ischaemic colitis: practical challenges and evidence-based recommendations for management
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Original Articles

Clinical Applications of Radio-Frequency Ablation in Liver Metastasis of Colorectal Cancer: Ji Hun Gwak, Bo-Young Oh, Ryung Ah Lee, Soon Sup Chung, Kwang Ho Kim; J Korean Soc Coloproctol. 2011;27(4):202-210. Published online August 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.4.202

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Abstract PDF

Purpose

The aim of this study is to evaluate long-term survival and prognostic factors for radio-frequency ablation (RFA) in colorectal liver metastases.

Methods

We retrospectively reviewed 35 colorectal liver metastases patients who underwent RFA between 2004 and 2008. We analyzed survival after RFA and prognostic factors for survival.

Results

Of the 35 patients, 23 patients were male and 12 were female. Their mean age was 62.40 ± 12.52 years. Mean overall survival was 38.8 ± 4.6 months, and mean progression free survival was 19.9 ± 3.4 months. Three- and 5-year overall survival rates were 42.7 ± 0.1% and 26.0 ± 0.1%, respectively. Three- and 5-year progression-free survival rates were 19.6 ± 0.1% and 4.9 ± 0.04%, respectively. Overall survival and progression-free survival were significantly improved in male and in patients with carcinoembryonic antigen (CEA) ≤ 100 ng/mL, carbohydrate antigen (CA) 19-9 ≤ 100 ng/mL, absence of extrahepatic disease, and a unilobar hepatic lesion. In addition, progression-free survival was improved in patients with a solitary hepatic lesion. On the multivariate analysis, significant survival factors were the absence of extrahepatic disease and the presence of a unilobar hepatic lesion.

Conclusion

RFA for colorectal liver metastases is an effective treatment option in male patients and in patients with CEA or CA19-9 ≤ 100, absence of extrahepatic disease, a solitary hepatic lesion, and a unilobar hepatic lesion.

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Microwave Ablation, Radiofrequency Ablation, Irreversible Electroporation, and Stereotactic Ablative Body Radiotherapy for Intermediate Size (3–5 cm) Unresectable Colorectal Liver Metastases: a Systematic Review and Meta-analysis
Sanne Nieuwenhuizen, Madelon Dijkstra, Robbert S. Puijk, Bart Geboers, Alette H. Ruarus, Evelien A. Schouten, Karin Nielsen, Jan J. J. de Vries, Anna M. E. Bruynzeel, Hester J. Scheffer, M. Petrousjka van den Tol, Cornelis J. A. Haasbeek, Martijn R. Meije
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Optimizing Loco Regional Management of Oligometastatic Colorectal Cancer: Technical Aspects and Biomarkers, Two Sides of the Same Coin
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Combined CT-guided radiofrequency ablation with systemic chemotherapy improves the survival for nasopharyngeal carcinoma with oligometastasis in liver: Propensity score matching analysis
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JIANBIN WANG, PING LIANG, JIE YU, MING-AN YU, FANGYI LIU, ZHIGANG CHENG, XIAOLING YU
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Epidermal Growth Factor Receptor Mutations in Colorectal Cancer Patients: Bo-Young Oh, Ryung-Ah Lee, Soon-Sup Chung, Kwang Ho Kim; J Korean Soc Coloproctol. 2011;27(3):127-132. Published online June 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.3.127

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Abstract PDF

Purpose

The epidermal growth factor receptor (EGFR) plays an important role in tumorigenesis and tumor progression of colorectal cancer and leads to the activation of intracellular signaling pathways. The use of anti-EGFR-targeted therapy has increased for patients with colorectal cancer, but patients with EGFR mutations will be resistant to anti-EGFR-targeted therapy. The identification of gene mutations is critical in cancer treatment; therefore, the aim of this study is to investigate the incidences of EGFR mutations in colorectal cancer patients in Korea.

Methods

We retrospectively reviewed 58 colorectal cancer patients who underwent surgery between 2003 and 2006. We analyzed their EGFR mutations in four loci by DNA sequencing. In addition, we analyzed the correlation between the presence of EGFR mutation and patients' clinicopathologic features.

Results

Of the 58 patients, 35 patients were male and 23 were female. Their mean age was 63.28 ± 11.18 years. Two patients (3.45%) were diagnosed as stage Tis, 7 patients (12.07%) as stage I, 24 patients (41.38%) as stage II, 20 patients (34.48%) as stage III, and 5 patients (8.62%) as stage IV. As a result of mutational analysis, EGFR mutations on exon 20 were detected in 13 patients (22.41%, G→A transitions). No EGFR mutations were detected on exons 18, 19, and 21. EGFR mutation was increased in the earlier stage and in the absence of lymph node metastasis (P = 0.028).

Conclusion

The incidence of EGFR mutation in Korean colorectal cancer patients is 22.41%. In addition, EGFR mutation was significantly increased in the earlier stage and in the absence of lymph node metastasis.

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