Annals of Coloproctology

Original Articles

Oncologic Outcomes of Postoperative Chemoradiotherapy Versus Chemotherapy Alone in Stage II and III Upper Rectal Cancer: Ji Eun Yoon, Soo Young Lee, Han Duk Kwak, Seung Seop Yeom, Chang Hyun Kim, Jae Kyun Joo, Hyeong Rok Kim, Young Jin Kim; Ann Coloproctol. 2019;35(3):137-143. Published online June 30, 2019; DOI: https://doi.org/10.3393/ac.2018.09.28

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Purpose
The aim of this study was to assess oncological outcomes of postoperative radiotherapy plus chemotherapy (CRT) versus chemotherapy alone (CTx) in stage II or III upper rectal cancer patients who underwent curative surgery.
Methods
We retrospectively reviewed 263 consecutive patients with pathologic stage II or III upper rectal cancer who underwent primary curative resection with postoperative CRT or CTx from January 2008 to December 2014 at Chonnam National University Hwasun Hospital. Multivariate and propensity score matching analyses were used to reduce selection bias.
Results
Median follow-up was 48.1 months for the entire cohort and 53.5 months for the matched cohort. In subgroup analysis of the propensity score matched cohort, the 3-year local recurrence-free survival was 94.1% (95% confidence interval [CI], 87.8%–100%) in the CRT group and 90.1% (95% CI, 82.8%–97.9%) in the CTx group (P = 0.370). No significant difference in disease-free survival was observed according to treatment type. On multivariate analysis, circumferential resection margin involvement (hazard ratio [HR], 2.386; 95% CI, 1.190–7.599; P = 0.032), N stage (HR, 6.262; 95% CI, 1.843–21.278, P = 0.003), and T stage (HR, 5.896, 95% CI, 1.298–6.780, P = 0.021) were identified as independent risk factors for local recurrence of tumors of the upper rectum.
Conclusion
Omission of radiotherapy in an adjuvant treatment setting may not jeopardize oncologic outcomes in stages II and III upper rectal cancer.

Citations

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Is radiotherapy necessary for upper rectal cancer underwent curative resection? A retrospective study of 363 patients
Zhiwei Ma, Jumei Zhou, Ke Liu, Sisi Chen, Qinghui Wu, Lin Peng, Wei Zhao, Suyu Zhu
Radiation Oncology.2024;[Epub] CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplement
Sean J. Langenfeld, Bradley R. Davis, Jon D. Vogel, Jennifer S. Davids, Larissa K.F. Temple, Kyle G. Cologne, Samantha Hendren, Steven Hunt, Julio Garcia Aguilar, Daniel L. Feingold, Amy L. Lightner, Ian M. Paquette
Diseases of the Colon & Rectum.2023;[Epub] CrossRef
Which Definition of Upper Rectal Cancer Is Optimal in Selecting Stage II or III Rectal Cancer Patients to Avoid Postoperative Adjuvant Radiation?
Xian Hua Gao, Bai Zhi Zhai, Juan Li, Jean Luc Tshibangu Kabemba, Hai Feng Gong, Chen Guang Bai, Ming Lu Liu, Shao Ting Zhang, Fu Shen, Lian Jie Liu, Wei Zhang
Frontiers in Oncology.2021;[Epub] CrossRef
Role of adjuvant (chemo)radiotherapy for resected extrahepatic cholangiocarcinoma: a meta-analysis
Xin-qi Shi, Jing-yu Zhang, Hua Tian, Ling-na Tang, Ai-lin Li
Journal of Zhejiang University-SCIENCE B.2020; 21(7): 549. CrossRef

Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy: Chang Hyun Kim, Seung-Seop Yeom, Hand-Duk Kwak, Soo Young Lee, Jae Kyun Ju, Young Jin Kim, Hyeong Rok Kim; Ann Coloproctol. 2019;35(2):72-82. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2019.04.22

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Abstract PDF

Purpose
Treatment after failure of circumferential resection margin (CRM) conversion after preoperative chemoradiotherapy (pCRT) for locally advanced rectal cancer (LARC) has not been evaluated well. We conducted a single‐center, retrospective analysis to fill this information gap.
Methods
From 2008 to 2016, we included 112 patients who had predictive CRM involvement on baseline magnetic resonance imaging (MRI) and who underwent surgery following pCRT for LARC. Baseline and posttreatment radiologic and clinical factors were analyzed.
Results
Of 493 patients with LARC, 112 had CRM involvement by baseline MRI (mrCRM). In 40 patients (35.7%), mrCRM involvement was converted as negative posttreatment CRM (ymrCRM−). Multivariate analysis showed the risk factors for persistent CRM involvement (ymrCRM+) after pCRT were extramural venous invasion (mrEMVI+) (P = 0.030) and lower tumor location (P = 0.007). In addition, persistent CRM involvement after pCRT was an independent risk factor for predicting pathologic CRM involvement. The Cox proportional hazard model showed baseline positive mrEMVI remained significant for disease-free survival (DFS) (P < 0.001). On posttreatment MRI, abdominoperineal resection (P = 0.031), intersphincteric resection (P = 0.006), and persistent CRM involvement (P = 0.001) remained significant for local recurrence-free survival. With regard to DFS, persistent CRM involvement (P = 0.048) and positive EMVI on posttreatment MRI (ymrEMVI) (P = 0.014) were significant. In the patient subgroup with persistent CRM involvement, 5-year DFS in patients with mrEMVI and ymrEMVI was 29.8% and 21.2%, respectively.
Conclusion
Patients who fail to convert to negative CRM have extremely poor oncologic outcomes. Lower tumor height and negative mrEMVI status were good responders to ymrCRM conversion. Our results suggest that these patients require a more intensive treatment modality.

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Post‐diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta‐analysis
Nerea Becerra‐Tomás, Georgios Markozannes, Margarita Cariolou, Katia Balducci, Rita Vieira, Sonia Kiss, Dagfinn Aune, Darren C. Greenwood, Laure Dossus, Ellen Copson, Andrew G. Renehan, Martijn Bours, Wendy Demark‐Wahnefried, Melissa M. Hudson, Anne M. Ma
International Journal of Cancer.2024; 155(3): 400. CrossRef
A Review of Neoadjuvant Therapy and the Watch-and-Wait Protocol in Rectal Cancer: Current Evidence and Future Directions
Iulian M Slavu, Octavian Munteanu, Florin Filipoiu, Raluca Tulin, Anca Monica Macovei Oprescu , Ileana Dima, Iulian A Dogaru, Adrian Tulin
Cureus.2024;[Epub] CrossRef
A Predictive Model to Evaluate Pathologic Complete Response in Rectal Adenocarcinoma
Shuiwang Qing, Lei Gu, Tingting Du, Xiaolan Yin, Ke-jia Zhang, Huo-jun Zhang
Technology in Cancer Research & Treatment.2023;[Epub] CrossRef
Oncologic Outcomes Associated With MRI-detected Extramural Venous Invasion (mrEMVI) in Rectal Cancer
François Rouleau Fournier, Mohammad Ali K. Motamedi, Carl J. Brown, Terry Phang, Manoj J. Raval, Cameron J. Hague, Ahmer A. Karimuddin
Annals of Surgery.2022; 275(2): 303. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Are oncological long-term outcomes equal after laproscopic completed and converted laparoscopic converted rectal resection for cancer?
M. Finochi, B. Menahem, G. Lebreton, J. Lubrano, Y. Eid, A. Alves
Techniques in Coloproctology.2021; 25(1): 91. CrossRef
Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?
Philippe Rouanet, Michel Rivoire, Sophie Gourgou, Bernard Lelong, Eric Rullier, Merhdad Jafari, Laurent Mineur, Marc Pocard, Jean Luc Faucheron, François Dravet, Denis Pezet, Jean Michel Fabre, Laurent Bresler, Jacques Balosso, Christophe Taoum, Claire Le
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The prognostic value of MRI-detected extramural vascular invasion (mrEMVI) for rectal cancer patients treated with neoadjuvant therapy: a meta-analysis
Silin Chen, Ning Li, Yuan Tang, Jinming Shi, Ying Zhao, Huiying Ma, Shulian Wang, Ye-xiong Li, Jing Jin
European Radiology.2021; 31(12): 8827. CrossRef
Predictors of Positive Circumferential Resection Margin in Rectal Cancer: A Current Audit of the National Cancer Database
Hillary L. Simon, Thais Reif de Paula, Magda M. Profeta da Luz, Ravi P. Kiran, Deborah S. Keller
Diseases of the Colon & Rectum.2021; 64(9): 1096. CrossRef
MRI-detected extramural venous invasion of rectal cancer: Multimodality performance and implications at baseline imaging and after neoadjuvant therapy
Akitoshi Inoue, Shannon P. Sheedy, Jay P. Heiken, Payam Mohammadinejad, Rondell P. Graham, Hee Eun Lee, Scott R. Kelley, Stephanie L. Hansel, David H. Bruining, Jeff L. Fidler, Joel G. Fletcher
Insights into Imaging.2021;[Epub] 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
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
Reconsideration of the Safety of Laparoscopic Rectal Surgery for Cancer
Gyung Mo Son, Bong-Hyeon Kye, Min Ki Kim, Jun-Gi Kim
Annals of Coloproctology.2019; 35(5): 229. CrossRef

Variation in the Height of Rectal Cancers According to the Diagnostic Modalities: Seung-Seop Yeom, In Ja Park, Dong-Hoon Yang, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seok-Byung Lim, Sung Ho Park, Hwa Jung Kim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2019;35(1):24-29. Published online February 28, 2019; DOI: https://doi.org/10.3393/ac.2018.07.31

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Abstract PDF

Purpose
Although the height of a rectal tumor above the anal verge (tumor height) partly determines the treatment strategy, no practical standard exists for reporting this. We aimed to demonstrate the differences in tumor height according to the diagnostic modality used for its measurement.
Methods
We identified 100 patients with rectal cancers located within 15 cm of the anal verge who had recorded tumor heights measured by using magnetic resonance imaging (MRI), colonoscopy, and digital rectal examination (DRE). Tumor height measured by using MRI was compared with those measured by using DRE and colonoscopy to assess reporting inconsistencies. Factors associated with differences in tumor height among the modalities were also evaluated.
Results
The mean tumor heights were 77.8 ± 3.3, 52.9 ± 2.3, and 68.9 ± 3.1 mm when measured by using MRI, DRE, and colonoscopy, respectively (P < 0.001). Agreement among the 3 modalities in terms of tumor sublocation within the rectum was found in only 39% of the patients. In the univariate and the multivariate analyses, clinical stage showed a possible association with concordance among modalities, but age, sex, and luminal location of the tumor were not associated with differences among modalities.
Conclusion
The heights of rectal cancer differed according to the diagnostic modality. Tumor height has implications for rectal cancer’s surgical planning and for interpreting comparative studies. Hence, a consensus is needed for measuring and reporting tumor height.

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The efficacy of open transanal drainage tube against anastomotic leakage in left-sided colorectal cancer surgery: a propensity score matching study
Gen Tsujio, Tatsunari Fukuoka, Atsushi Sugimoto, Ken Yonemitsu, Yuki Seki, Hiroaki Kasashima, Yuichiro Miki, Mami Yoshii, Tatsuro Tamura, Masatsune Shibutani, Takahiro Toyokawa, Shigeru Lee, Kiyoshi Maeda
BMC Surgery.2025;[Epub] CrossRef
Defining the tumor location in rectal cancer – Practice variations and impact on treatment decision making
Elisabeth P. Goedegebuure, Francesco M. Arico, Max J. Lahaye, Monique Maas, Geerard L. Beets, Femke P. Peters, Monique E. van Leerdam, Regina G.H. Beets-Tan, Doenja M.J. Lambregts
European Journal of Surgical Oncology.2025; 51(6): 109700. CrossRef
Effects of Adjuvant Chemotherapy on Oncologic Outcomes in Patients With Stage ⅡA Rectal Cancer Above the Peritoneal Reflection Who Did Not Undergo Preoperative Chemoradiotherapy
Hyo Seon Ryu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Yong Sang Hong, Tae Won Kim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(4): 392. CrossRef
Interrater Agreement of Height Assessment by Rigid Proctoscopy/Rectoscopy for Rectal Carcinoma
Matthias Kraemer, Sarkhan Nabiyev, Silvia Kraemer, Stephanie Schipmann
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Chinese national clinical practice guidelines on prevention, diagnosis and treatment of early colorectal cancer
Jingnan Li, Hongwei Yao, Yun Lu, Shutian Zhang, Zhongtao Zhang
Chinese Medical Journal.2024; 137(17): 2017. CrossRef
Review of definition and treatment of upper rectal cancer
Elias Karam, Fabien Fredon, Yassine Eid, Olivier Muller, Marie Besson, Nicolas Michot, Urs Giger-Pabst, Arnaud Alves, Mehdi Ouaissi
Surgical Oncology.2024; 57: 102145. CrossRef
Comparison of flexible endoscopy and magnetic resonance imaging in determining the tumor height in rectal cancer
Mohammed H. Basendowah, Mohammed A. Ezzat, Aseel H. Khayyat, Eyad Saleh A. Alamri, Turki A. Madani, Anas H. Alzahrani, Rana Y. Bokhary, Arwa O. Badeeb, Hussam A. Hijazi
Cancer Reports.2023;[Epub] CrossRef
Measuring Rectal Cancer Tumor Height: Concordance Between Clinical Examination and MRI
Shannon M. Navarro, Shuai Chen, Linda M. Farkas
Diseases of the Colon & Rectum.2022; 65(4): 497. CrossRef
How do they measure up: Assessing the height of rectal cancer with digital rectal exam, endoscopy, and MRI,,
Jordan Wlodarczyk, Kshitij Gaur, Nicholas Serniak, Kevin Mertz, Jason Muri, Sarah Koller, Sang W. Lee, Kyle G. Cologne
Surgery in Practice and Science.2022; 10: 100096. CrossRef
Measurement of rectal tumor height from the anal verge on MRI: a comparison of internal versus external anal sphincter
David D. B. Bates, James L. Fuqua, Junting Zheng, Marinela Capanu, Jennifer S. Golia Pernicka, Sidra Javed-Tayyab, Viktoriya Paroder, Iva Petkovska, Marc J. Gollub
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Video

Reduced-Port Laparoscopic Surgery for Patients With Proximal Transverse Colon Cancer With Situs Inversus Totalis: A Case Report: Seung-Seop Yeom, Kyung Hwan Kim, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim, Young Jin Kim; Ann Coloproctol. 2018;34(6):322-325. Published online December 31, 2018; DOI: https://doi.org/10.3393/ac.2018.05.29.1

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Abstract PDF Supplementary Material

Situs inversus is a rare hereditary disorder in which various anomalies have been reported with internal rotation abnormalities. This case involved an 85-year-old woman who had been diagnosed with transverse colon cancer and who underwent reduced-port laparoscopic surgery. All intra-abdominal organs were reversed left to right and right to left. The aberrant midcolic artery was identified during surgery. The total surgery time was 170 minutes, and the patient lost 20 mL of blood. The patient was discharged on the 8th postoperative day without complications.

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Original Article

Trephine Transverse Colostomy Is Effective for Patients Who Have Previously Undergone Rectal Surgery: Seung-Seop Yeom, Chan Wook Kim, Sung Woo Jung, Se Heon Oh, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2018;34(2):72-77. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.09.29

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Abstract PDF

Purpose
Colostomy creation is an essential procedure for colorectal surgeons, but the preferred method of colostomy varies by surgeon. We compared the outcomes of trephine colostomy creation with open those for the (laparotomy) and laparoscopic methods and evaluated appropriate indications for a trephine colostomy and the advantages of the technique.
Methods
We retrospectively evaluated 263 patients who had undergone colostomy creation by trephine, open and laparoscopic approaches between April 2006 and March 2016. We compared the clinical features and the operative and postoperative outcomes according to the approach used for stoma creation.
Results
One hundred sixty-three patients (62%) underwent colostomy surgery for obstructive causes and 100 (38%) for fistulous problems. The mean operative time was significantly shorter with the trephine approach (trephine, 46.0 ± 1.9 minutes; open, 78.7 ± 3.9 minutes; laparoscopic, 63.5 ± 5.0 minutes; P < 0.001), as was the time to flatus (1.8 ± 0.1 days, 2.1 ± 0.1 days, 2.2 ± 0.3 days, P = 0.025). Postoperative complications (<30 days) were not different among the 3 approaches (trephine, 4.3%; open, 1.2%; laparoscopic, 0%; P = 0.828). In patients who underwent rectal surgery, a trephine colostomy was feasible for a diversion colostomy (P < 0.001).
Conclusion
The trephine colostomy is safe and can be implemented quickly in various situations, and compared to other colostomy procedures, the patient’s recovery is faster. Previous laparotomy history was not a contraindication for a trephine colostomy, and a trephine transverse colostomy is feasible for patients who have undergone previous rectal surgery.

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Non-operative management of gallstone sigmoid ileus in a patient with a prostatic cancer
Ahmed M AlMuhsin, Abdulaziz Bazuhair, Omar AlKhlaiwy, Rami O Abu Hajar, Thabit Alotaibi
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Comparison of blowhole colostomy and loop ostomy for palliation of acute malignant colonic obstruction
Yongjun Park, Dong Uk Choi, Hyung Ook Kim, Yong Bog Kim, Chungki Min, Jung Tack Son, Sung Ryol Lee, Kyung Uk Jung, Hungdai Kim
Annals of Coloproctology.2022; 38(4): 319. CrossRef
Minimally invasive colostomy with endoscopy as a novel technique for creation of a trephine stoma
Teppei Kamada, Hironori Ohdaira, Junji Takahashi, Wataru Kai, Keigo Nakashima, Yuichi Nakaseko, Norihiko Suzuki, Masashi Yoshida, Yutaka Suzuki
Scientific Reports.2021;[Epub] CrossRef

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