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Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Ann Coloproctol. 2024;40(6):525-526.   Published online December 3, 2024
DOI: https://doi.org/10.3393/ac.2024.00815.0116
  • 701 View
  • 85 Download
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Original Articles
Malignant disease, Functional outcomes,Colorectal cancer
The Relationship Between High-Output Stomas, Postoperative Ileus, and Readmission After Rectal Cancer Surgery With Diverting Ileostomy
Naa Lee, Soo Young Lee, Chang Hyun Kim, Han Deok Kwak, Jae Kyun Ju, Hyeong Rok Kim
Ann Coloproctol. 2021;37(1):44-50.   Published online September 18, 2020
DOI: https://doi.org/10.3393/ac.2020.08.03
  • 3,848 View
  • 166 Download
  • 9 Web of Science
  • 8 Citations
AbstractAbstract PDF
Purpose
This study aimed to evaluate the relationship between high-output stomas (HOSs), postoperative ileus (POI), and readmission after rectal cancer surgery with diverting ileostomy.
Methods
We included 302 patients with rectal cancer who underwent restorative resection with diverting ileostomy between January 2011 and December 2015. HOSs were defined as stomas with ≥ 2,000 mL/day output. We analyzed predictive factors for readmission of these patients.
Results
Forty-eight patients (15.9%) had HOSs during the hospital stay, and 41 patients (13.6%) experienced POI. HOSs were strongly associated with POI (45.8% vs. 7.5%, P < 0.001). The all-cause readmission rate was 16.9%, with 19 (6.3%) and 20 (6.6%) experiencing ileus and acute kidney injury, respectively. HOSs (27.1% vs. 15.0%, P = 0.040) and POI (34.1% vs. 14.2%, P = 0.002) were associated with all-cause readmission, and POI was associated with readmission with ileus (17.1% vs. 4.6%, P = 0.007). POI was an independent risk factor for all-cause readmission (adjusted odds ratio [OR], 2.640; 95% confidence interval [CI], 1.162 to 6.001; P = 0.020) and readmission with ileus (adjusted OR = 3.869; 95% CI 1.387 to 10.792; P = 0.010).
Conclusion
POI was associated with readmission, particularly for subsequent ileus, in patients with diverting ileostomy. We should make efforts to reduce POI, such as strong control of HOSs, to prevent readmission.

Citations

Citations to this article as recorded by  
  • High output stoma after surgery for rectal cancer - a risk factor for low anterior resection syndrome?
    Xuena Zhang, Qingyu Meng, Jianna Du, Zhongtao Tian, Yinju Li, Bin Yu, Wenbo Niu
    BMC Gastroenterology.2025;[Epub]     CrossRef
  • Maximizing Readmission Reduction in Colon Cancer Patients
    Mario Schootman, Chenghui Li, Jun Ying, Sonia T. Orcutt, Jonathan Laryea
    Journal of Surgical Research.2024; 295: 587.     CrossRef
  • Analysis of decision-making factors for defunctioning ileostomy after rectal cancer surgery and their impact on perioperative recovery: a retrospective study of 1082 patients
    Xiaojiang Yi, Huaguo Yang, Hongming Li, Xiaochuang Feng, Weilin Liao, Jiaxin Lin, Zhifeng Chen, Dechang Diao, Manzhao Ouyang
    Surgical Endoscopy.2024; 38(11): 6782.     CrossRef
  • Effect of intracorporeal anastomosis on postoperative ileus after laparoscopic right colectomy
    Sangwoo Kim, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek, Young-Gil Son
    Annals of Surgical Treatment and Research.2023; 104(3): 156.     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
  • Overall readmissions and readmissions related to dehydration after creation of an ileostomy: a systematic review and meta-analysis
    I. Vogel, M. Shinkwin, S. L. van der Storm, J. Torkington, J. A.Cornish, P. J. Tanis, R. Hompes, W. A. Bemelman
    Techniques in Coloproctology.2022; 26(5): 333.     CrossRef
  • Postoperative paralytic ileus following debulking surgery in ovarian cancer patients
    Eva K. Egger, Freya Merker, Damian J. Ralser, Milka Marinova, Tim O. Vilz, Hanno Matthaei, Tobias Hilbert, Alexander Mustea
    Frontiers in Surgery.2022;[Epub]     CrossRef
  • Obstructive and secretory complications of diverting ileostomy
    Shingo Tsujinaka, Hideyuki Suzuki, Tomoya Miura, Yoshihiro Sato, Chikashi Shibata
    World Journal of Gastroenterology.2022; 28(47): 6732.     CrossRef
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
  • 4,011 View
  • 106 Download
  • 4 Web of Science
  • 4 Citations
AbstractAbstract PDF
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

Citations to this article as recorded by  
  • 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
  • 4,763 View
  • 114 Download
  • 14 Web of Science
  • 14 Citations
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • 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
    Journal of Surgical Oncology.2021; 123(1): 299.     CrossRef
  • 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
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
  • 7,492 View
  • 97 Download
  • 5 Web of Science
  • 4 Citations
AbstractAbstract PDFSupplementary 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.

Citations

Citations to this article as recorded by  
  • Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review
    Bo-Ya Chiu, Shu-Hung Chuang, Shih-Chang Chuang, Kung-Kai Kuo
    World Journal of Clinical Cases.2023; 11(9): 1939.     CrossRef
  • Laparoscopic radical resection for situs inversus totalis with colonic splenic flexure carcinoma: A case report
    Zi-Ling Zheng, Shou-Ru Zhang, Hao Sun, Mao-Cai Tang, Jing-Kun Shang
    World Journal of Clinical Cases.2022; 10(16): 5435.     CrossRef
  • MicroRNA-129-3p Inhibits Colorectal Cancer Proliferation
    Lei Kang, Dongmei Guo, Yanhai Dong, Xiaowei Chen, Chao Yuan
    Journal of Biomaterials and Tissue Engineering.2022; 12(12): 2413.     CrossRef
  • Technique for Improving the Adoption of Minimally Invasive Surgery in Challenging Cases
    Giorgio Bogani, Francesco Raspagliesi
    Journal of Investigative Surgery.2021; 34(3): 334.     CrossRef
Original Article
Knowledge of and Practice Patterns for Hereditary Colorectal Cancer Syndromes in Korean Surgical Residents
Jangho Park, Soo Young Lee, Duck-Woo Kim, Sung-Bum Kang, Seung-Yong Jeong, Kyu Joo Park
Ann Coloproctol. 2013;29(5):186-191.   Published online October 31, 2013
DOI: https://doi.org/10.3393/ac.2013.29.5.186
  • 4,330 View
  • 36 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

Obtaining a detailed family history through detailed pedigree is essential in recognizing hereditary colorectal cancer (CRC) syndromes. This study was performed to assess the current knowledge and practice patterns of surgery residents regarding familial risk of CRC.

Methods

A questionnaire survey was performed to evaluate the knowledge and the level of recognition for analyses of family histories and hereditary CRC syndromes in 62 residents of the Department of Surgery, Seoul National University Hospital. The questionnaire consisted of 22 questions regarding practice patterns for, knowledge of, and resident education about hereditary CRC syndromes.

Results

Two-thirds of the residents answered that family history should be investigated at the first interview, but only 37% of them actually obtained pedigree detailed family history at the very beginning in actual clinical practice. Three-quarters of the residents answered that the quality of family history they obtained was poor. Most of them could diagnose hereditary nonpolyposis colorectal cancer and recommend an appropriate colonoscopy surveillance schedule; however, only 19% knew that cancer surveillance guidelines differed according to the family history. Most of our residents lacked knowledge of cancer genetics, such as causative genes, and diagnostic methods, including microsatellite instability test, and indicated a desire and need for more education regarding hereditary cancer and genetic testing during residency.

Conclusion

This study demonstrated that surgical residents' knowledge of hereditary cancer was not sufficient and that the quality of the family histories obtained in current practice has to be improved. More information regarding hereditary cancer should be considered in education programs for surgery residents.

Citations

Citations to this article as recorded by  
  • Efficacy, functional outcome and post‑operative complications of total abdominal colectomy with ileorectal anastomosis vs. segmental colectomy in hereditary non‑polyposis colorectal cancer
    Jie Sun, Mingjie Dong, Xiaoping Xiao
    Experimental and Therapeutic Medicine.2018;[Epub]     CrossRef
  • Clinicopathological Features and Type of Surgery for Lynch Syndrome: Changes during the Past Two Decades
    Il Tae Son, Duck-Woo Kim, Seung-Yong Jeong, Young-Kyoung Shin, Myong Hoon Ihn, Heung-Kwon Oh, Sung-Bum Kang, Kyu Joo Park, Jae Hwan Oh, Ja-Lok Ku, Jae-Gahb Park
    Cancer Research and Treatment.2016; 48(2): 605.     CrossRef
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