Annals of Coloproctology

Review

Colorectal cancer

Essential knowledge and technical tips for total mesorectal excision and related procedures for rectal cancer: Min Soo Cho, Hyeon Woo Bae, Nam Kyu Kim; Ann Coloproctol. 2024;40(4):384-411. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00388.0055

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Total mesorectal excision (TME) has greatly improved rectal cancer surgery outcomes by reducing local recurrence and enhancing patient survival. This review outlines essential knowledge and techniques for performing TME. TME emphasizes the complete resection of the mesorectum along embryologic planes to minimize recurrence. Key anatomical insights include understanding the rectal proper fascia, Denonvilliers fascia, rectosacral fascia, and the pelvic autonomic nerves. Technical tips cover a step-by-step approach to pelvic dissection, the Gate approach, and tailored excision of Denonvilliers fascia, focusing on preserving pelvic autonomic nerves and ensuring negative circumferential resection margins. In Korea, TME has led to significant improvements in local recurrence rates and survival with well-adopted multidisciplinary approaches. Surgical techniques of TME have been optimized and standardized over several decades in Korea, and minimally invasive surgery for TME has been rapidly and successfully adopted. The review emphasizes the need for continuous research on tumor biology and precise surgical techniques to further improve rectal cancer management. The ultimate goal of TME is to achieve curative resection and function preservation, thereby enhancing the patient’s quality of life. Accurate TME, multidisciplinary-based neoadjuvant therapy, refined sphincter-preserving techniques, and ongoing tumor research are essential for optimal treatment outcomes.

Citations

Citations to this article as recorded by

Robotic-assisted colorectal surgery in colorectal cancer management: a narrative review of clinical efficacy and multidisciplinary integration
Engeng Chen, Li Chen, Wei Zhang
Frontiers in Oncology.2025;[Epub] CrossRef
From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef
Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef

Original Article

Colorectal cancer

Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study: Ahmad Sakr, Seung Yoon Yang, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim; Ann Coloproctol. 2024;40(1):27-35. Published online February 28, 2024; DOI: https://doi.org/10.3393/ac.2022.01067.0152

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Abstract PDF

Purpose
Despite advances in neoadjuvant chemoradiotherapy and anal sphincter-preserving surgery for rectal cancer, bowel dysfunction is still unavoidable and negatively affects patients’ quality of life. In this longitudinal study, we aimed to investigate the changes in bowel function with follow-up time and the effect of neoadjuvant chemoradiotherapy on bowel function following low anterior resection for rectal cancer.
Methods
In this study, 171 patients with upper or middle rectal cancer who underwent low anterior resection between 2012 and 2018 were included. Bowel function was assessed longitudinally with Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner scores every 6 months after restoration of bowel continuity. Patients with at least 2 follow-up visits were included.
Results
Overall, 100 patients received neoadjuvant chemoradiotherapy. Urgency, soilage, and fecal incontinence were noted within 24 months in the patients treated with neoadjuvant chemoradiotherapy. After 2 years of follow-up, significant bowel dysfunction and fecal incontinence were observed in the neoadjuvant chemoradiotherapy group. Low tumor level and neoadjuvant chemoradiotherapy were associated with delayed bowel dysfunction.
Conclusion
Neoadjuvant chemoradiotherapy in combination with low tumor level was significantly associated with delayed bowel dysfunction even after 2 years of follow-up. Therefore, careful selection and discussion with patients are paramount.

Citations

Citations to this article as recorded by

Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef

Technical Notes

Benign GI diease,Surgical technique

Double-layered hand-sewn anastomosis: a valuable resource for the colorectal surgeon: Cristopher Varela, Manar Nassr, Azharuddin Razak, Nam Kyu Kim; Ann Coloproctol. 2022;38(3):271-275. Published online March 17, 2022; DOI: https://doi.org/10.3393/ac.2021.00990.0141

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Abstract PDF Supplementary Material

Hand-sewn anastomosis is an essential and fundamental skill for surgeons dealing with any gastrointestinal anastomosis. Despite the advances in minimally invasive surgery and stapling devices, there are still complex surgical circumstances when the surgeon’s surgical know-how are necessary. Therefore, a safe hand-sewn technique for bowel anastomosis is required to establish a tension-free, well-perfused, and sealed anastomosis that allows gastrointestinal continuity with no unexpected complications. We describe a step-by-step procedure for hand-sewn double-layered anastomosis that reflects these principles and is practical for small and large bowel anastomosis.

Citations

Citations to this article as recorded by

Grampeadores mecânicos versus sutura manual em Anastomoses intestinais: uma revisão sistemática
Letícia Meneses Teixeira, Yuri Fleury de Melo Prudente Guimarães, Leonardo de Oliveira Leite Coelho, Leo Ferreira Mattos De Miranda
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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
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef

Review

Malignant disease, Rectal cancer,Prognosis and adjuvant therapy,Colorectal cancer

Surgical Treatment of Low-Lying Rectal Cancer: Updates: Cristopher Varela, Nam Kyu Kim; Ann Coloproctol. 2021;37(6):395-424. Published online December 22, 2021; DOI: https://doi.org/10.3393/ac.2021.00927.0132

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46 Citations

Abstract PDF

Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

Citations

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Oncologic impact of technical difficulties during the early experience with laparoscopic surgery for colorectal cancer: long-term follow-up results of a prospective cohort study
Hong-min Ahn, Tae Gyun Lee, Hye-Rim Shin, Jeehye Lee, In Jun Yang, Jung Wook Suh, Heung-Kwon Oh, Duck-Woo Kim, Sung-Bum Kang
Current Problems in Surgery.2025; 63: 101694. CrossRef
Comparative efficacy analysis of laparoscopic-assisted transanal total mesorectal excision vs laparoscopic transanal mesorectal excision for low-lying rectal cancer
Feng Lu, Shu-Guang Tan, Juan Zuo, Hai-Hua Jiang, Jian-Hua Wang, Yu-Ping Jiang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery
Jia-Rui Liu, Jin Zhang, Xiang-Long Duan
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Clinical using of innovative biodegradable stent with extension sleeve in Ta_tme for low rectal cancer with high risk of anastomotic leakage
Rongrong Hao, Wensheng Wang, Yuanhang Ma, Jianghong Chen, Yunbo Li, Yang Yang, Dan Ma, Zhicao Zhang
Scientific Reports.2025;[Epub] CrossRef
Robotic-assisted colorectal surgery in colorectal cancer management: a narrative review of clinical efficacy and multidisciplinary integration
Engeng Chen, Li Chen, Wei Zhang
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Radiomic Features of Mesorectal Fat as Indicators of Response in Rectal Cancer Patients Undergoing Neoadjuvant Therapy
Francesca Treballi, Ginevra Danti, Sofia Boccioli, Sebastiano Paolucci, Simone Busoni, Linda Calistri, Vittorio Miele
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Elderly Rectal Cancer: An Updated Review
Chih-Kai Huang, Chi-Hsiu Shih, Yung-Shuo Kao
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Jasper Max Gebhardt, Neno Werner, Andrea Stroux, Frank Förster, Ioannis Pozios, Claudia Seifarth, Christian Schineis, Benjamin Weixler, Katharina Beyer, Johannes Christian Lauscher
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Study of surgical feasibility and outcome of laparoscopic surgery in malignant rectal tumors
Islam Abdelkhalek, Galal AbuElnagah, Tarek Elfayoumi, Ahmed shoukry Hafez, Mohamed Asal
Alexandria Journal of Medicine.2024; 60(1): 113. CrossRef
Postoperative Imaging Findings of Colorectal Surgery: A Pictorial Essay
Inkeon Yeo, Myung-Won Yoo, Seong Jin Park, Sung Kyoung Moon
Journal of the Korean Society of Radiology.2024; 85(4): 727. CrossRef
Complications Rate and Related Factors After Laparoscopic Sphincter-Preserving Total Mesorectal Excision for Low Rectal Cancer: A Single-Center Study in Vietnam
Ly Huu Phu, Ho Tat Bang, Ung Van Viet, Hoang Danh Tan, Nguyen Trung Tin
Cureus.2024;[Epub] CrossRef
Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
Youn Young Park, Nam Kyu Kim
Annals of Gastroenterological Surgery.2024; 8(5): 761. CrossRef
Personalized Decisional Algorithms for Soft Tissue Defect Reconstruction after Abdominoperineal Resection for Low-Lying Rectal Cancers
Dan Cristian Moraru, Mihaela Pertea, Stefana Luca, Valentin Bejan, Andrian Panuta, Raluca Tatar, Dan Mircea Enescu, Dragos Viorel Scripcariu, Viorel Scripcariu
Current Oncology.2024; 31(6): 3253. CrossRef
Comparative analysis of organ preservation attempt and radical surgery in clinical T2N0 mid to low rectal cancer
Hyeung-min Park, Jaram Lee, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Essential knowledge and technical tips for total mesorectal excision and related procedures for rectal cancer
Min Soo Cho, Hyeon Woo Bae, Nam Kyu Kim
Annals of Coloproctology.2024; 40(4): 384. CrossRef
The role of robotic-assisted surgery in the management of rectal cancer: a systematic review and meta-analysis
Chenxiong Zhang, Hao Tan, Han Xu, Jiaming Ding
International Journal of Surgery.2024; 110(10): 6282. CrossRef
Endoscopic submucosal dissection for superficial ultra-low rectal tumors: outcomes and predictive factors for procedure difficulty
Yinxin Wu
American Journal of Cancer Research.2024; 14(12): 5784. CrossRef
Pathologic Implications of Magnetic Resonance Imaging-detected Extramural Venous Invasion of Rectal Cancer
Hyun Gu Lee, Chan Wook Kim, Jong Keon Jang, Seong Ho Park, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Clinical Colorectal Cancer.2023; 22(1): 129. CrossRef
Customized Denonvilliers' Fascia Excision: An Advanced total Mesorectal Excision Technique for Anteriorly Located Rectal Cancer
Sung Uk Bae, Cristopher Varela, Manar Nassr, Nam Kyu Kim
Diseases of the Colon & Rectum.2023;[Epub] CrossRef
Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef
The Safe Values of Quantitative Perfusion Parameters of ICG Angiography Based on Tissue Oxygenation of Hyperspectral Imaging for Laparoscopic Colorectal Surgery: A Prospective Observational Study
Gyung Son, Armaan Nazir, Mi Yun, In Lee, Sun Im, Jae Kwak, Sang-Ho Park, Kwang-Ryul Baek, Ines Gockel
Biomedicines.2023; 11(7): 2029. CrossRef
International Society of University Colon and Rectal Surgeons survey of surgeons’ preference on rectal cancer treatment
Audrius Dulskas, Philip F. Caushaj, Domas Grigoravicius, Liu Zheng, Richard Fortunato, Joseph W. Nunoo-Mensah, Narimantas E. Samalavicius
Annals of Coloproctology.2023; 39(4): 307. CrossRef
Clinical Significance of Combining Preoperative and Postoperative Albumin-Bilirubin Score in Colorectal Cancer
Doyoun Kim, Jae-Hoon Lee, Eun-Suk Cho, Su-Jin Shin, Hye Sun Lee, Hwa-Hee Koh, Kang Young Lee, Jeonghyun Kang
Cancer Research and Treatment.2023; 55(4): 1261. CrossRef
Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach
Ji-Hyun Seo, In-Ja Park
Cancers.2023; 15(21): 5211. CrossRef
Low anterior resection syndrome: is it predictable?
Dong Hyun Kang
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Beyond the Horizon: Unveiling the Frontiers of Rectal Cancer Research and Treatment
Reda H Mithany, M Hasaan Shahid, Shenouda Abdallah, Mark Abdelmaseeh, Mina Manasseh, Farid Gerges, Andrew Wanees, Mohamed S Mohamed, Mina W Hakim, Samana Aslam, Nesma Daniel
Cureus.2023;[Epub] CrossRef
Optimal surgical techniques for curative resection of the rectal cancer
Hyeon Woo Bae, Nam Kyu Kim
Formosan Journal of Surgery.2023; 56(6): 171. 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
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Youngbae Jeon, Eun Jung Park
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How Can We Improve the Tumor Response to Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer?
Jeonghee Han
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Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
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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
Epidemiologie, Diagnostik und Therapie des Rektumkarzinoms
Maurice Vuattoux, Soleen Stocker-Ghafoor, Hatice Bunea, Christoph Kettelhack, Andreas Wicki, Frank B. Zimmermann
InFo Hämatologie + Onkologie.2022; 25(3): 44. CrossRef
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Hyo Seon Ryu, Jin Kim
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Multidisciplinary treatment strategy for early colon cancer
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Korean Medical Association.2022; 65(9): 558. CrossRef
Direction of diagnosis and treatment improvement in colorectal cancer
In Ja Park
Journal of the Korean Medical Association.2022; 65(9): 540. CrossRef
Robotic surgery for colorectal cancer
Sung Uk Bae
Journal of the Korean Medical Association.2022; 65(9): 577. CrossRef
Current Status and Future of Robotic Surgery for Colorectal Cancer-An English Version
Sung Uk Bae
Journal of the Anus, Rectum and Colon.2022; 6(4): 221. CrossRef
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Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
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Seung Mi Yeo, Gyung Mo Son
The Ewha Medical Journal.2022;[Epub] CrossRef
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Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
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Chan Wook Kim
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
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Case Reports

Malignant disease, Rectal cancer,Colorectal cancer,Complication

Neorectal Mucosal Prolapse After Intersphincteric Resection for Low-Lying Rectal Cancer: A Case Report: Mohammed Alessa, Hyeon Woo Bae, Homoud Alawfi, Ahmad Sakr, Fozan Sauri, Nam Kyu Kim; Ann Coloproctol. 2021;37(Suppl 1):S15-S17. Published online April 22, 2021; DOI: https://doi.org/10.3393/ac.2020.02.22

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7 Citations

Abstract PDF

Radical resection for low rectal cancer is the mainstay among the treatment modalities. Intersphincteric resection (ISR) is considered a relatively new but effective surgical treatment for low-lying rectal tumor. As the sphincter preserving techniques get popularized, we notice uncommon complication associated with it in the form of rectal mucosal prolapse. We presented 2 rare cases that developed neorectal mucosa prolapse after ISR a complication following low rectal cancer surgery. Although ISR is a safe and effective surgical technique for low rectal cancer, it should be considered to correct modifiable possible risk factors. Also, Delorme procedure is good option for management of neorectal mucosal prolapse.

Citations

Citations to this article as recorded by

Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
Youn Young Park, Nam Kyu Kim
Annals of Gastroenterological Surgery.2024; 8(5): 761. CrossRef
Treatment of side limb full-thickness prolapse of the side-to-end coloanal anastomosis following intersphincteric resection: a case report and review of literature
Guglielmo Niccolò Piozzi, Krunal Khobragade, Seon Hui Shin, Jeong Min Choo, Seon Hahn Kim
Annals of Coloproctology.2024; 40(Suppl 1): S38. CrossRef
Surgical Treatment for Mucosal Prolapse after Intersphincteric Resection
Rina Takahashi, Makoto Takahashi, Yuki Ii, Megumi Kawaguchi, Hirotaka Momose, Shunsuke Motegi, Ryoichi Tsukamoto, Yu Okazawa, Masaya Kawai, Kiichi Sugimoto, Yutaka Kojima, Kazuhiro Sakamoto
Nippon Daicho Komonbyo Gakkai Zasshi.2023; 76(3): 299. 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
Clinical outcome of the Gant-Miwa-Thiersch procedure for colonic mucosal prolapse after intersphincteric resection—a single-center report from Japan
Toshikatsu Nitta, Masatsugu Ishii, Jun Kataoka, Sedakatsu Senpuku, Yasuhiko Ueda, Ryo Iida, Ayumi Matsutani, Takashi Ishibashi
Annals of Medicine and Surgery.2021; 72: 103005. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Surgical Treatment of Low-Lying Rectal Cancer: Updates
Cristopher Varela, Nam Kyu Kim
Annals of Coloproctology.2021; 37(6): 395. CrossRef

Malignant disease,Rare disease & stoma

Malignant Melanoma of Anorectum: Two Case Reports: Binh Van Pham, Jae Hyun Kang, Huynh Huu Phan, Min Soo Cho, Nam Kyu Kim; Ann Coloproctol. 2021;37(1):65-70. Published online February 28, 2021; DOI: https://doi.org/10.3393/ac.2020.01.07.1

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12 Citations

Abstract PDF

Malignant melanoma of the anorectum is a rare disorder. Patients often present with local symptoms similar to benign diseases. The prognosis is very poor, and almost all patients die because of metastases. We report 2 female patients with unremarkable histories. Both of them received previous operations before visiting our center after they were diagnosed with anorectal malignant melanoma. One case underwent abdominoperineal resection and postoperative chemotherapy. The other had been treated with ultralow anterior resection followed by immunotherapy.

Citations

Citations to this article as recorded by

A Rare Entity: Primary Malignant Melanoma of the Anorectum
Jeongmin Choi, Jong Whan Kim
Journal of Digestive Cancer Research.2024; 12(1): 44. CrossRef
Anorectal Malignant Melanoma Post- Hemorrhoidectomy
Ramazan Kozan, Ozkan Akpinar, Meral Toker
Acta Médica Portuguesa.2024; 37(7-8): 556. CrossRef
Immunotherapy for anorectal melanoma: A case report
Nicholas L. Vitagliano, Muhammad B. Darwish, Roger W. Hsiung
Current Problems in Cancer: Case Reports.2024; 15: 100302. CrossRef
Amelanotic Malignant Melanoma With Atypical Divergent Neuroendocrine Differentiation: A Report of an Unusual and Rare Case of Anorectal Bleeding
Shamiliprabha MG, Anand CD, Supriya Verma, Nivethitha S, Jaison J John
Cureus.2024;[Epub] CrossRef
Anorectal melanoma: systematic review of the current literature of an aggressive type of melanoma
Giovanni Paolino, Antonio Podo Brunetti, Carolina De Rosa, Carmen Cantisani, Franco Rongioletti, Andrea Carugno, Nicola Zerbinati, Mario Valenti, Domenico Mascagni, Giulio Tosti, Santo Raffaele Mercuri, Riccardo Pampena
Melanoma Research.2024; 34(6): 487. CrossRef
A rare account of incidentally discovered anal melanoma
Nawal Khan, Dondre Irving, Lynn O’Connor
Journal of Surgical Case Reports.2024;[Epub] CrossRef
Prolapsed anorectal malignant melanoma presenting as hemorrhoids
Busara Songtanin, Kenneth Nugent, Sameer Islam
Baylor University Medical Center Proceedings.2023; 36(1): 89. CrossRef
Long recurrence-free survival of localized rectal melanoma after abdominoperineal resection in comparison to partial excision and highlighting the place of immunotherapy: A case report
Othmane Bourouail, Noureddine Njoumi, Youssef Elmahdaouy, Mohamed Fahssi, Mbarek Yaka, Abderrahmane Hejjouji, Abdelmounaim Ait Ali
JRSM Open.2023;[Epub] CrossRef
Challenges in managing anorectal melanoma, a rare malignancy
Jyotirmoy Biswas, Lakshmi Deepak Bethineedi, Arkadeep Dhali, Jamal Miah, Sukanta Ray, Gopal Krishna Dhali
International Journal of Surgery Case Reports.2023; 105: 108093. CrossRef
Organ preservation in anorectal melanoma: A tempting challenge—a case report
Mohamed Mehdi Trabelsi, Neirouz Kammoun, Marwa Inoubli, Mohamed Ali Chaouch, Haifa Ben Romdhane, Wafa Koubaa, Hichem Jerraya
SAGE Open Medical Case Reports.2023;[Epub] CrossRef
Primary anorectal amelanotic melanoma with liver, lungs and lymph nodal metastases
James R Marak, Gaurav Raj, Shivam Dwivedi, Ariba Zaidi
BMJ Case Reports.2023; 16(11): e257510. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef

Video

Malignant disease, Rectal cancer

Robotic Partial Excision of Levator-Ani Muscle for Locally Advanced Low Rectal Cancer Invading Ipsilateral Pelvic Floor: Seung Yoon Yang, Nam Kyu Kim; Ann Coloproctol. 2020;36(6):415-416. Published online December 31, 2020; DOI: https://doi.org/10.3393/ac.2020.06.29

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10 Web of Science
6 Citations

Abstract PDF Supplementary Material

Tumors at the level of the anorectal junction had required abdominoperineal resection (APR) to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle (LAM), en-bloc resection of the rectum with LAM including tumor would be possible. This video is to show the critical anatomic steps of this procedure. A video was produced from the robotic right partial excision of LAM (PELM) performed in a 57-year-old female patient with rectal cancer at 3 cm from the anal verge, invading the ipsilateral anorectal ring, who had received neoadjuvant chemoradiotherapy. The patient discharged at postoperative day 8 without complication. The pathology of the surgical specimen revealed ypT3N1bM0. The secure resection margin from the tumor was achieved. Robotic PELM is the sphincter-preserving technique that can be an alternative treatment option for low rectal cancer invading the ipsilateral LAM, which has been an indication for APR or extralevator APR.

Citations

Citations to this article as recorded by

Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
Youn Young Park, Nam Kyu Kim
Annals of Gastroenterological Surgery.2024; 8(5): 761. CrossRef
Recent advances in functional bismuth chalcogenide nanomaterials: Cancer theranostics, antibacterial and biosensing
Qian Wang, Jun Du, Ruizhuo Ouyang, Baolin Liu, Yuqing Miao, Yuhao Li
Coordination Chemistry Reviews.2023; 492: 215281. CrossRef
Robotic APR with en bloc TAH/BSO and posterior vaginectomy
M. S. Meece, L. P. Horner, S. J. Danker, A. K. Sinno, N. Paluvoi
Techniques in Coloproctology.2023; 27(12): 1381. CrossRef
Current status and role of robotic approach in patients with low-lying rectal cancer
Hyo Seon Ryu, Jin Kim
Annals of Surgical Treatment and Research.2022; 103(1): 1. CrossRef
Robot-Assisted Colorectal Surgery
Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Outcomes of robotic partial excision of the levator ani muscle for locally advanced low rectal cancer invading the ipsilateral pelvic floor at the anorectal ring level
Seung Yoon Yang, Min Soo Cho, Nam Kyu Kim
The International Journal of Medical Robotics and Computer Assisted Surgery.2021;[Epub] CrossRef

Original Article

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

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; Ann Coloproctol. 2021;37(3):186-191. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.10.1

3,534 View
99 Download
6 Web of Science
4 Citations

Abstract PDF

Purpose
Locally advanced rectal cancer (LARC) is managed by chemoradiotherapy (CRT), followed by surgery. Herein we reported patients with metastases during or after CRT.
Methods
Data of patients with LARC who received CRT from 2008 to 2017 were reviewed. Patients with metastases after CRT were included. Those with metastatic tumors at the initial diagnosis were excluded.
Results
Fourteen patients (1.3%) of 1,092 who received CRT presented with metastases. Magnetic resonance circumferential resection margin (mrCRM) and mesorectal lymph nodes (LNs) were positive in 12 patients (85.7%). Meanwhile, magnetic resonance extramural vascular invasion (mrEMVI) was positive in 10 patients (71.4%). Magnetic resonance tumor regression grade (mrTRG) 4 and mrTRG5 was detected in 5 and 1 patient respectively. Ten patients (71.4%) underwent combined surgery and 3 (21.4%) received palliative chemotherapy.
Conclusion
Patients with metastases after CRT showed a higher rate of positive mrCRM, mrEMVI, mesorectal LNs, and poor tumor response. Further studies with a large number of patients are necessary for better survival outcomes in LARC.

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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
Advances in the Treatment of Colorectal Cancer with Peritoneal Metastases: A Focus on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Youngbae Jeon, Eun Jung Park
The Ewha Medical Journal.2023;[Epub] 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
Update on Diagnosis and Treatment of Colorectal Cancer
Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef

Case Report

Benign GI diease,Benign diesease & IBD,Complication

Clostridium difficile Infection After Ileostomy Reversal: Ho Seung Kim, Jae Hyun Kang, Han-gil Kim, Young Hun Kim, Hyeonwoo Bae, Nam Kyu Kim; Ann Coloproctol. 2021;37(Suppl 1):S4-S6. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.09.24

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Clostridium difficile infection (CDI) after ileostomy reversal is rare, with few reports available in the available literature describing this condition. The diagnosis of CDI after ileostomy reversal is challenging because symptoms such as diarrhea observed in these patients can occur frequently after surgery. However, CDI can be fatal, so early diagnosis and prompt treatment are important. We discuss 2 patients with positive C. difficile toxin assay results on stool cultures performed after ileostomy reversal. Clinical progression differed between these patients: one patient who presented with severe CDI and shock was successfully treated following a prolonged intensive care unit stay for the management of vital signs and underwent hemodialysis, while another patient showed symptoms of mild colitis but we could not confirm whether diarrhea was associated with CDI or with the usual postoperative state. To our knowledge, these represent 2 of just a few cases reported in the literature describing CDI after ileostomy reversal.

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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
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef

Original Articles

Malignant disease

Long-term Oncologic Outcome and Its Relevant Factors in Anal Cancer in Korea: A Nationwide Data Analysis: Hyuk Hur, Kyu-Won Jung, Byung-Woo Kim, Chang-Mo Oh, Young-Joo Won, Jae Hwan Oh, Nam Kyu Kim; Ann Coloproctol. 2020;36(1):35-40. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2019.07.17

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Abstract PDF Supplementary Material

Purpose
Anal cancer is a rare disease in Korea, and thus survival analyses are limited by small sample sizes. This study used the Korea Central Cancer Registry (KCCR) for a survival analysis and for assessing characteristics of anal cancer in a large sample of Koreans.
Methods
From the KCCR, data on 3,615 patients who were diagnosed and treated for anal cancer from 1993 to 2015 were retrieved. Clinicopathologic variables including age, sex, histological type, and Surveillance Epidemiology and End Results (SEER) stage were reviewed, and a survival analysis was performed according to these variables.
Results
The 5-year relative survival rate improved from 39.7% in 1993–1995 to 66.5% in 2011–2015. Squamous cell carcinoma was the most common and showed the highest survival rate. Males and older patients (≥40 years and ≥70 years) showed poor prognoses.
Conclusion
The survival rate for anal cancer in Korea has improved steadily over time. The characteristics related to survival were the histological type, sex, and age. These statistics will be fundamental for future Korean anal cancer research.

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Risk of Anorectal Cancer Associated with Benign Anal Inflammatory Diseases: A Retrospective Matched Cohort Study
Wonjeong Chae, Seung Yeon Kang, Sung-In Jang, Yoon Dae Han
International Journal of Environmental Research and Public Health.2022; 19(12): 7467. CrossRef
Immune Checkpoint Blockade in Lower Gastrointestinal Cancers: A Systematic Review
K. C. Wilson, M. P. Flood, D. Oh, N. Calvin, M. Michael, R. G. Ramsay, A. G. Heriot
Annals of Surgical Oncology.2021; 28(12): 7463. CrossRef
Acknowledging the Unsung Role of the Cancer Registry in Rare Cancers
Jung-Myun Kwak
Annals of Coloproctology.2020; 36(1): 1. CrossRef

Impact of Adjuvant Chemotherapy Completion on Oncologic Outcomes in ypTNMstage 2 Rectal Cancer Patients: Youn Young Park, Kang Young Lee, Nam Kyu Kim, Sat Byol Lee, Ga Ram Kim, Byung Soh Min, Seong-Taek Oh; Ann Coloproctol. 2019;35(6):335-341. Published online December 31, 2019; DOI: https://doi.org/10.3393/ac.2019.03.10

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Abstract PDF

Purpose
Adjuvant chemotherapy (aCT) in rectal cancer patients who have undergone curative resection after neoadjuvant chemoradiation (nCRT) is controversial. We aimed to investigate the benefits of using aCT and the clinical impact of completing aCT in ypstage 2 rectal cancer patients.
Methods
We retrospectively reviewed clinicopathological data from patients who had undergone radical resection after nCRT between January 2006 and December 2012. In total, 152 patients with ypT3/4N0M0 rectal cancer were included. Of these patients, 139 initiated aCT, while 13 did not receive aCT (no-aCT). Among those who received aCT, 132 patients completed their planned cycles (aCT-completion) whereas 7 did not (aCT-incompletion). All patients received longcourse chemoradiation; a 5-fluorouracil-based regimen was used for nCRT in most patients. The prognostic factors affecting disease-free survival (DFS) and overall survival (OS) were analyzed.
Results
The median follow-up duration was 41 months. Demographic data did not differ significantly among the 3 groups. In multivariate analysis, open surgery, a tumor size >2 cm, retrieval of <12 lymph nodes, circumferential resection margin (CRM) positivity and aCT incompletion were independent prognostic factors for poor DFS. Old age (≥60 years), open surgery, CRM positivity, aCT incompletion, and lack of aCT initiation compared to aCT completion were independent prognostic factors for poor OS.
Conclusion
In ypstage 2 rectal cancer patients, aCT after nCRT and total mesorectal excision affected both DFS and OS; however, only patients who completed planned aCT exhibited survival benefits. Therefore, improving patients’ compliance with the completion of aCT is desirable.

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Adjuvant chemotherapy in locally advanced rectal cancer after neo-adjuvant concurrent chemoradiotherapy and surgery: A retrospective study in Vietnamese patients
Thang Tran, Huy Van Nguyen, Hoa Thi Nguyen, Hung Van Nguyen
Annals of Medicine & Surgery.2023; 85(9): 4234. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef

Short-term Outcomes After Upfront Chemotherapy Followed by Curative Surgery in Metastatic Colon Cancer: A Comparison With Upfront Surgery Patients: Myung Hyun Han, Youn Young Park, Shiva Pratap, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim; Ann Coloproctol. 2019;35(6):327-334. Published online December 31, 2019; DOI: https://doi.org/10.3393/ac.2019.03.04.1

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Abstract PDF

Purpose
Upfront systemic chemotherapy with target agents has been recommended for patients with stage IV colon cancer. Some with partial response are considered for curative resection. There is high risk of developing postoperative complications following upfront systemic chemotherapy. We aimed to evaluate short-term perioperative outcomes of curative surgery after upfront chemotherapy in comparison with upfront surgery in patients with metastatic colon cancer.
Methods
Between January 2010 and October 2015, 146 patients (80 in the surgery first group, 66 in the upfront chemotherapy group) who underwent surgical resection before or after systemic chemotherapy for metastatic colon cancer were included in the present study. All decisions for treatment were made through a multidisciplinary team. Postoperative clinical outcomes and complications were analyzed to compare the groups.
Results
There was no difference between the 2 groups in terms of postoperative clinical outcomes. Overall complication rates were not different between the groups (surgery first group: 46.3% vs. upfront chemotherapy group: 60.6%; P = 0.084). When classified according to the Clavien-Dindo method, there was no difference between the 2 groups in terms of major complications (grade 3 or more) (surgery first group: 18.9% vs. upfront chemotherapy group: 27.5%; P = 0.374).
Conclusion
There was no significant increase in major postoperative complications in metastatic colon cancer patients who received upfront chemotherapy followed by curative surgery. Careful patient selection and treatment planning are important.

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Impact of preoperative chemotherapy on perioperative morbidity in combined resection of colon cancer and liver metastases
Joy Z. Done, Angelos Papanikolaou, Miloslawa Stem, Shannon N. Radomski, Sophia Y. Chen, Chady Atallah, Jonathan E. Efron, Bashar Safar
Journal of Gastrointestinal Surgery.2023; 27(11): 2380. CrossRef
Treatment for Peritoneal Metastasis of Patients With Colorectal Cancer
Young Jin Kim, Chang Hyun Kim
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Single-center Experience of 24 Cases of Tailgut Cyst: Ahmad Sakr, Ho Seung Kim, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim; Ann Coloproctol. 2019;35(5):268-274. Published online October 31, 2019; DOI: https://doi.org/10.3393/ac.2018.12.18

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Abstract PDF

Purpose
Tailgut cysts are rare congenital or developmental lesions that arise from vestiges of the embryological hindgut. They are usually present in the presacral space. We report our single-center experience with managing tailgut cysts.
Methods
We conducted a retrospective analysis of 24 patients with tailgut cyst treated surgically at the Colorectal Surgery Department of Severance Hospital, Yonsei University, Seoul, South Korea, between 2007–2018.
Results
This study included 24 patients (18 females) with a median age of 51.5 years (range, 21–68 years). Ten cases were symptomatic and 14 were asymptomatic. Cysts were retrorectal in 21 patients. Cysts were below the coccyx level in 16 patients, opposite the coccyx in 6, and above the coccyx in 2. Cysts were supralevator in 5 patients, had a supra- and infralevator extension in 18 patients, and were infralevator in 1. Ten patients were managed using an anterior laparoscopic approach, 11 using a posterior approach, and 3 using a combined approach. Mean cyst size was 5.5 ± 2.7 cm. Postoperative complications were Clavien-Dindo (CD) classification grade II in 9 patients (37.5%) and CD grade III in 1 (4.2%). The posterior approach group showed the highest rate of complications (P = 0.021). Patients managed using a combined approach showed a larger cyst size (P < 0.001), longer operation times (P < 0.001), and a greater likelihood of tumor level above the coccyx (P = 0.002) compared to other approaches. The tumors of 2 male patients were malignant: 1 was a neuroendocrine tumor treated with radiotherapy, while the other was a closely followed adenocarcinoma. Median follow-up was 12 months (range, 1–66 months) with no recurrence.
Conclusion
Tailgut cysts are uncommon but can cause perineal or pelvic pain. Complete surgical excision via an appropriate approach according to tumor size, location, and correlation with adjacent pelvic floor muscles is the key treatment.

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Characteristics and Survival of Korean Patients With Colorectal Cancer Based on Data From the Korea Central Cancer Registry Data: Hyuk Hur, Chang-Mo Oh, Young-Joo Won, Jae Hwan Oh, Nam Kyu Kim; Ann Coloproctol. 2018;34(4):212-221. Published online August 31, 2018; DOI: https://doi.org/10.3393/ac.2018.08.02.1

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Abstract PDF

Purpose
The incidence of colorectal cancer (CRC) in Korea has increased remarkably during the past few decades. The present study investigated the characteristics and survival of patients with CRC in Korea as a function of time, tumor distribution, stage, sex, and age.
Methods
We retrieved clinical data on 326,712 CRC patients diagnosed between 1996 and 2015 from the Korea Central Cancer Registry. The incidence and the 5-year relative survival rates were compared across time period, tumor distribution, stage, sex, and age group.
Results
The percentage of patients with colon cancer increased from 49.5% in 1996–2000 to 66.4% in 2011–2015 while the percentage of patients with rectal cancer decreased from 50.5% to 33.6%. The 5-year relative survival rates for all CRCs improved from 58.7% in 1996–2000 to 75.0% in 2011–2015. For 1996–2000, survival rates were highest for patients with left-sided colon cancers, followed by those with right-sided, transverse, rectal, rectosigmoid cancers. For 2011–2015, the survival rates for patients with left-sided cancers were highest, followed by those with rectosigmoid, rectal, transverse, and right-sided colon cancers. Patients with local and regional, but not distant, SEER (Surveillance, Epidemiology, and End Results) stage tumors experienced significantly increased survival rates for 2006–2010 and 2011–2015. The proportion of CRC patients by age decreased in the order ≥70, 60–69, 50–59, 40–49, ≤39 years whereas survival rates decreased in the order 50–59, 60–69, 40–49, ≤39, ≥70 years.
Conclusion
Korean CRC has some distinct characteristics and survival patterns in terms of tumor distribution, stage, sex, and age. With time, survival outcomes have improved for both local and regional, but not distant, stage tumors.

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Seung Min Hong, Ahreum Kim, Changhoon Kim, Seunghye Jang, Dong Uk Kim, Dong Hoon Baek, Seung Hun Lee, Yu Hyeon Yi, Heeseung Park, Jonghyun Lee, Tae In Kim, Hyun Joo Lee
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Review

Essential Anatomy of the Anorectum for Colorectal Surgeons Focused on the Gross Anatomy and Histologic Findings: Jong Min Lee, Nam Kyu Kim; Ann Coloproctol. 2018;34(2):59-71. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.12.15

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Abstract PDF

The anorectum is a region with a very complex structure, and surgery for benign or malignant disease of the anorectum is impossible without accurate anatomical knowledge. The conjoined longitudinal muscle consists of smooth muscle from the longitudinal muscle of the rectum and the striate muscle from the levator ani and helps maintain continence; the rectourethralis muscle is connected directly to the conjoined longitudinal muscle at the top of the external anal sphincter. Preserving the rectourethralis muscle without damage to the carvernous nerve or veins passing through it when the abdominoperineal resection is implemented is important. The mesorectal fascia is a multi-layered membrane that surrounds the mesorectum. Because the autonomic nerves also pass between the mesorectal fascia and the parietal fascia, a sharp pelvic dissection must be made along the anatomic fascial plane. With the development of pelvic structure anatomy, we can understand better how we can remove the tumor and the surrounding metastatic lymph nodes without damaging the neural structure. However, because the anorectal anatomy is not yet fully understood, we hope that additional studies of anatomy will enable anorectal surgery to be performed based on complete anatomical knowledge.

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