Annals of Coloproctology

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Original Articles

Effects of prune consumption on the incidence of low anterior resection syndrome: a randomized controlled trial: Dae Hee Pyo, Jung Kyong Shin, Jung Wook Huh, Hee Cheol Kim, Seong Hyeon Yun, Woo Yong Lee, Yoonah Park, Yong Beom Cho; Received April 24, 2025 Accepted July 16, 2025 Published online December 12, 2025; DOI: https://doi.org/10.3393/ac.2025.00514.0073 [Epub ahead of print]

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Abstract PDF: Purpose
Low anterior resection syndrome (LARS) is common and devastating complication for patients with rectal cancer who have undergone sphincter-sparing surgery. Prunes are a fiber-rich fruit being effective in treating chronic constipation. The aim of this study was to investigate the effect of prune consumption on the incidence of LARS.
Methods
A prospective, double-arm, parallel, nonblinded, randomized controlled trial was conducted from September 2019 to March 2021 at a single tertiary center for patients who underwent low anterior resection. Patients randomized to the prune group consumed prune daily for 2 weeks after surgery, while those in the no-prune group did not. The primary outcome was the incidence of major LARS at 3 weeks after surgery.
Results
A total of 130 patients were randomized and 118 completed the study (81 men, 37 women), including 55 patients (46.6%) in the prune group and 63 patients (53.4%) in the no-prune group. LARS was confirmed in 15 patients (27.3%) in the prune group and 47 patients (74.6%) in the no-prune group (P<0.001). The incidence of major LARS was also significantly lower in the prune group (18.2% vs. 61.9%, P<0.001). Multivariable analysis showed that the level of anastomosis and prune consumption were significantly associated with the incidence of LARS. The prune group had higher emotional scores and lower symptom scores for constipation, sleep disturbance, and loss of appetite in the quality-of-life questionnaire.
Conclusion
Prune consumption significantly reduced the incidence of LARS and improved quality of life after low anterior resection. Trial registration: CRIS identifier: KCT0006085 (registered on September 1, 2019).

Minimally invasive surgery

Comparative perioperative outcomes of articulated versus conventional straight devices in laparoscopic low anterior resection: a propensity score–matched analysis: Hayoung Lee, Yong Sik Yoon, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim; Ann Coloproctol. 2025;41(5):434-442. Published online October 16, 2025; DOI: https://doi.org/10.3393/ac.2025.00227.0032

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Abstract PDF Supplementary Material: Purpose
Laparoscopic low anterior resection for rectal cancer is technically challenging due to the precision required for mesorectal excision. Articulated instruments were developed to improve precision and oncological safety over conventional instruments. This study compares their perioperative outcomes.
Methods
A retrospective cohort study of 432 patients with colorectal cancer who underwent low anterior resection between August 2022 and February 2024 applied propensity score matching to minimize selection bias. Primary endpoints were circumferential resection margin (CRM), distal resection margin (DRM), and harvested lymph nodes count. Secondary outcomes included postoperative complications.
Results
Following propensity score matching, 84 matched pairs were analyzed. Most patients achieved CRM negativity (>1 mm), with CRM ≥10 mm in 67.9% of the articulated group and 59.5% of the conventional group (P=0.613). Median (interquartile range, IQR) lymph nodes harvests were comparable (20 [14–26] vs. 18 [14–22], P=0.147). The articulated group had a significantly longer DRM (30.0 mm [IQR, 18.0–40.0 mm] vs. 24.0 mm [IQR, 12.0–34.2 mm], P=0.008) and the median operation time (111.0 minutes [IQR, 95.8–125.2 minutes] vs. 99.5 minutes [IQR, 72.0–119.8 minutes], P=0.009). Estimated blood loss, open conversion rates, and postoperative complications, including leakage (7.1% vs. 8.3%, P>0.999) and surgical site infections, (15.5% vs. 9.5%, P=0.383), showed no significant differences.
Conclusion
Articulated laparoscopic instruments demonstrated comparable safety and feasibility to conventional instruments but offered no significant clinical or oncological benefits beyond a longer DRM. Larger studies are needed to evaluate their value in laparoscopic rectal surgery.

Complications

Prevalence and clinical significance of evacuation disorders in patients with low anterior resection syndrome: Yuko Homma, Toshiki Mimura, Koji Koinuma, Hisanaga Horie, Naohiro Sata; Ann Coloproctol. 2025;41(4):271-278. Published online August 25, 2025; DOI: https://doi.org/10.3393/ac.2024.00934.0133

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Abstract PDF: Purpose
Low anterior resection syndrome (LARS) manifests with evacuation disorder symptoms and continence problems. However, no prior study has focused on evacuation disorders in patients with LARS. This study investigated the prevalence of evacuation disorders and their association with the LARS score.
Methods
This study included patients with defecation per anus at the time of the survey, which was conducted between November 2020 and April 2021. These patients had undergone anus-preserving surgery for rectal tumors between 2014 and 2019 at a tertiary university hospital. The severity of evacuation disorders and LARS was evaluated using the Constipation Scoring System and the LARS score, respectively. The primary endpoint was the prevalence of evacuation disorders, defined as evacuation difficulty, feeling of incomplete evacuation, and abnormally long time on the toilet. The secondary endpoints were the associations between these symptoms and the LARS score.
Results
Of 332 eligible patients, 238 (71.7%) completed the questionnaire. The overall prevalence of evacuation disorders was 48.3%. The rates of feeling incomplete evacuation, evacuation difficulty, and prolonged time on the toilet were 45.6%, 15.5%, and 8.4%, respectively. Patients with minor or major LARS had a significantly higher prevalence of evacuation disorders than those with no LARS, particularly regarding feeling incomplete evacuation.
Conclusion
Evacuation disorders were present in 48.3% of patients following anus-preserving surgery. Greater severity of LARS was associated with a higher prevalence of evacuation disorders, especially a feeling of incomplete evacuation. Patients should be informed about the potential for both evacuation disorders and continence-related symptoms following anus-preserving surgery.

ERAS

Early urinary catheter removal in patients undergoing rectal cancer surgery: a randomized controlled trial on silodosin versus no pharmacological treatment on urinary function in the early postoperative period: Žilvinas Gricius, Justas Kuliavas, Eugenijus Stratilatovas, Bronius Buckus, Audrius Dulskas; Ann Coloproctol. 2025;41(3):239-245. Published online June 20, 2025; DOI: https://doi.org/10.3393/ac.2024.00703.0100

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Abstract PDF

Purpose
This study aimed to evaluate the efficacy of the α1 adrenergic receptor antagonist silodosin in preventing lower urinary tract symptoms after rectal cancer surgery.
Methods
We conducted a 2-arm, double-blind, single-center randomized controlled trial. The study included 150 patients with rectal cancer who underwent radical surgery between 2019 and 2022. On the first postoperative day, the urinary catheter was removed for all patients. Of these, 100 patients were administered silodosin, while 50 patients (control group) receive placebo (glucose tablet). Urinary dysfunction (urinary retention, infection, dysuria) and other complications were monitored.
Results
Among the 150 patients, 84 (56.0%) were male and 66 (44.0%) were female. Surgical procedures included abdominoperineal resection in 33 patients, partial mesorectal excision in 45, and total mesorectal excision in 72. A laparoscopic approach was used in 69 patients, while the remaining 81 underwent open surgery. Urinary tract symptoms developed in 10 patients (6.7%): 7 (7.0%) in the silodosin group and 3 (6.0%) in the control group (P=0.92). In the silodosin group, there was 1 case (1.0%) of urinary retention, 3 cases (3.0%) of urinary tract infection, and 3 cases (3.0%) of dysuria. In the control group, there was 1 case (2.0%) each of urinary retention, urinary tract infection, and dysuria (all P=0.92).
Conclusion
Early urinary catheter removal on the first postoperative day was safe in both groups. The use of the oral α-antagonist silodosin did not provide additional benefits in preventing lower urinary tract symptoms in patients undergoing rectal cancer surgery. Trial registration: ClinicalTrials.gov identifier: NCT03607370

Citations

Citations to this article as recorded by

Less is more: simplifying patient-centered cancer care
In Ja Park
Annals of Coloproctology.2025; 41(3): 173. CrossRef

Review

Colorectal cancer

Beyond survival: a comprehensive review of quality of life in rectal cancer patients: Won Beom Jung; Ann Coloproctol. 2024;40(6):527-537. Published online December 20, 2024; DOI: https://doi.org/10.3393/ac.2024.00745.0106

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Abstract PDF

Rectal cancer is one of the most common carcinomas and a leading cause of cancer-related mortality. Although significant advancements have been made in the treatment of rectal cancer, the deterioration of quality of life (QoL) remains a challenging issue. Various tools have been developed to assess QoL, including the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale, the QLQ-C30 and QLQ-CR29 by the European Organization for Research and Treatment of Cancer (EORTC), and the 36-Item Short Form Health Survey (SF-36). Factors such as the lower location of the tumor, radiation therapy, chemoradiotherapy, and chemotherapy are associated with a decline in QoL. Furthermore, anastomotic leakage following rectal cancer resection is an important risk factor affecting QoL. With the development of novel treatment approaches, including neoadjuvant therapies such as chemoradiotherapy and total neoadjuvant therapy, the rate of clinical complete remission has increased, leading to the emergence of organ-preserving strategies. Both local excision and the “watch-and-wait” approach following neoadjuvant therapy improved functional outcomes and QoL. Efforts to improve QoL after rectal cancer surgery are ongoing in surgical techniques for rectal cancer. Since QoL is determined by a complex interplay of factors, including the patient's physical condition, surgical techniques, and psychological and social elements, a comprehensive approach is necessary to understand and enhance it. This review aims to describe the methods for measuring QoL in rectal cancer patients after surgery, the key risk factors involved, and various strategies and efforts to improve QoL outcomes.

Citations

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Meeting report on the 8th Asian Science Editors’ Conference and Workshop 2024
Eun Jung Park
Science Editing.2025; 12(1): 66. CrossRef
Editorial: Organ preservation for rectal cancer patients
Ionut Negoi, John R. T. Monson, Leonardo Bustamante-Lopez, Zoe Garoufalia, Vito D'Andrea, Sameh Hany Emile
Frontiers in Surgery.2025;[Epub] CrossRef
Sphincter-preserving surgical techniques in low rectal cancer management: A systematic review of contemporary evidence
Song Wang, A-Jian Li, Hui-Hong Jiang, Yin Lin, Hai-Bo Ding
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Non-operative management of locally advanced rectal cancer with an emphasis on outcomes and quality of life: a narrative review
In Ja Park
Ewha Medical Journal.2025; 48(3): e40. CrossRef
Strategies to reduce intestinal toxicity in neoadjuvant management of locally advanced rectal cancer
Hoda Mahdavi, Sahar Dashti, Shima Jafari
Discover Oncology.2025;[Epub] CrossRef

Original Articles

Anorectal benign disease

Long-term outcomes of sacral neuromodulation for low anterior resection syndrome after rectal cancer surgery: Mario J. de Miguel Valencia, Gabriel Marin, Ana Acevedo, Ana Hernando, Alfonso Álvarez, Fabiola Oteiza, Mario J. de Miguel Velasco; Ann Coloproctol. 2024;40(3):234-244. Published online June 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00542.0077

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Abstract PDF

Purpose
This study assessed the long-term outcomes and quality of life in patients who underwent sacral neuromodulation (SNM) due to low anterior resection syndrome (LARS).
Methods
This single-center retrospective study, conducted from 2005 to 2021, included 30 patients (21 men; median age, 70 years) who had undergone total mesorectal excision with stoma closure and had no recurrence at inclusion. All patients were diagnosed with LARS refractory to conservative treatment. We evaluated clinical and quality-of-life outcomes after SNM through a stool diary, Wexner score, LARS score, the Fecal Incontinence Quality of Life (FIQL) questionnaire, and EuroQol-5D (EQ-5D) questionnaire.
Results
Peripheral nerve stimulation was successful in all but one patient. Of the 29 patients who underwent percutaneous nerve evaluation, 17 (58.62%) responded well to SNM and received permanent implants. The median follow-up period was 48 months (range, 18–153 months). The number of days per week with fecal incontinence episodes decreased from a median of 7 (range, 2–7) to 0.38 (range, 0–1). The median number of bowel movements recorded in patient diaries fell from 5 (range, 4–12) to 2 (range, 1–6). The median Wexner score decreased from 18 (range, 13–20) to 6 (range, 0–16), while the LARS score declined from 38.5 (range, 37–42) to 19 (range, 4–28). The FIQL and EQ-5D questionnaires demonstrated enhanced quality of life.
Conclusion
SNM may benefit patients diagnosed with LARS following rectal cancer surgery when conservative options have failed, and the treatment outcomes may possess long-term sustainability.

Citations

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Low Anterior Resection Syndrome (LARS): A Contemporary Surgical Review of Incidence, Pathophysiology, Risk Stratification and Functional Outcomes
Supreet Kumar, Vivek Tandon, Deepak Govil
Apollo Medicine.2025;[Epub] CrossRef

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

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Funktionelle Folgen von Radiotherapie, Chemotherapie und Operation bei der Behandlung des Rektumkarzinoms
Philipp Rhode, Matthias Mehdorn, Undine Gabriele Lange, Sebastian Murad Rabe, Johannes Quart, Robert Nowotny, Patrick Sven Plum, Stefan Niebisch, Sigmar Stelzner
Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie.2025; 150(04): 353. 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
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef

Colorectal cancer

Validation of the Vietnamese version of the low anterior resection syndrome score questionnaire: Tuong-Anh Mai-Phan, Vu Quang Pham; Ann Coloproctol. 2024;40(6):588-593. Published online November 25, 2022; DOI: https://doi.org/10.3393/ac.2022.00514.0073

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Abstract PDF Supplementary Material

Purpose
The aim of this study was to validate the low anterior resection syndrome (LARS) score questionnaire in the Vietnamese language among Vietnamese patients who underwent sphincter-preserving surgery for rectal cancer.
Methods
The LARS score questionnaire was translated from English into Vietnamese and then back-translated as recommended internationally. From January 2018 to December 2020, 93 patients who underwent sphincter-preserving surgery completed the Vietnamese version of the LARS score questionnaire together with an anchored question assessing the influence of bowel function on quality of life. To validate test-retest reliability, patients were requested to answer the LARS score questionnaire twice.
Results
Ninety-three patients completed the LARS score questionnaire, of whom 89 responded twice. The patients who responded twice were included in the analysis of test-retest reliability. Fifty-eight patients had a “major” LARS score. The LARS score was able to discriminate between patients who were obese and those who were not (P<0.001) and between the LAR and AR procedures (P<0.001). Age and sex were not associated with higher LARS scores (P=0.975). There was a perfect fit between the quality of life category question and the LARS score in 56.2% of cases, and a moderate fit was found in 42.7% of cases, showing reasonable convergent validity. The test-retest reliability of 89 patients showed a high intraclass correlation coefficient.
Conclusion
The Vietnamese version of the LARS score questionnaire is a valid tool for measuring LARS.

Citations

Citations to this article as recorded by

Major Low Anterior Resection Syndrome (LARS) and Quality of Life in Patients With Low Rectal Cancer: A Preoperative Survey Using LARS Score and European Organisation for Research and Treatment of Cancer’s 30-Item Core Quality of Life Questionnaire
Ly Huu Phu, Ho Tat Bang, Nguyen Viet Binh, Hoang Danh Tan, Ung Van Viet, Nguyen Trung Tin
Cureus.2023;[Epub] CrossRef

Anorectal physioloy

Risk factors associated with low anterior resection syndrome: a cross-sectional study: See Liang Lim, Wan Zainira Wan Zain, Zalina Zahari, Andee Dzulkarnaen Zakaria, Mohd Nizam Md Hashim, Michael Pak-Kai Wong, Zaidi Zakaria, Rosnelifaizur Ramely, Ahmad Shanwani Mohamed Sidek; Ann Coloproctol. 2023;39(5):427-434. Published online June 3, 2022; DOI: https://doi.org/10.3393/ac.2022.00227.0032

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10 Web of Science
8 Citations

Graphical Abstract Abstract PDF Supplementary Material

Purpose
Oncological outcomes following rectal cancer surgery have improved significantly over recent decades with lower recurrences and longer overall survival. However, many of the patients experienced low anterior resection syndrome (LARS). This study identified the prevalence and risk factors associated with the development of LARS.
Methods
This cross-sectional study involved patients who were diagnosed with rectal cancer and had undergone sphincter-preserving low anterior resection from January 2011 to December 2020. Upon clinic follow-up, patients were asked to complete an interviewed based questionnaire (LARS score) designed to assess bowel dysfunction after rectal cancer surgery.
Results
Out of 76 patients, 25 patients (32.9%) had major LARS, 10 patients (13.2%) had minor LARS, and 41 patients (53.9%) had no LARS. The height of tumor from anal verge showed an association with the development of major LARS (P=0.039). Those patients with less than 8 cm tumor from anal verge had an increased risk of LARS by 3 times compared to those with 8 cm and above (adjusted odds ratio, 3.11; 95% confidence interval, 1.06–9.13).
Conclusion
Results from our study show that low tumor height was a significant risk factor that has a negative impact on bowel function after surgery. The high prevalence of LARS emphasizes the need for study regarding risk factors and the importance of understanding the pathophysiology of LARS, in order for us to improve patient bowel function and quality of life after rectal cancer surgery.

Citations

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Score assessment and treatment in patients presenting with low anterior resection syndrome after sphincter-sparing rectal cancer surgery
R. Sguinzi, J. Fiechter, L. Bafumi, B. Gremaud, B. Geng, P. Janiak, L. Bühler, B. Egger
International Journal of Colorectal Disease.2025;[Epub] CrossRef
A randomized controlled trial of a digital lifestyle intervention involving postoperative patients with colorectal cancer
Young Il Kim, In Ja Park, Jun-Soo Ro, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Yura Lee, Yae Won Tak, Seockhoon Chung, Kyung Won Kim, Yousun Ko, Sung-Cheol Yun, Min-Woo Jo, Jong Won Lee
npj Digital Medicine.2025;[Epub] CrossRef
Impact of low anterior resection syndrome after rectal surgery on sleep quality
Akira Toyoshima, Toshihiro Nishizawa, Osamu Toyoshima, Ryuji Akai, Manabu Kaneko, Shin Sasaki
Surgery Today.2025; 55(12): 1868. CrossRef
Evaluation of the utility of a nomogram for predicting lymph node metastasis in T1 colorectal cancer in shared decision-making in clinical practice: a survey-based study
Hyeon Seung Kim, Kyung Su Han, Min Wan Lee, Dae Kyung Sohn, Chang Won Hong, Dong Woon Lee, Kiho You, Sung Chan Park, Byung Chang Kim, Bun Kim, Jae Hwan Oh
Annals of Coloproctology.2025; 41(4): 303. 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
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef
Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef
Low anterior resection syndrome: is it predictable?
Dong Hyun Kang
Annals of Coloproctology.2023; 39(5): 373. CrossRef

Anorectal physioloy

Validation of low anterior resection syndrome score in Brazil with Portuguese: Kelly C.L.R. Buzatti, Andy Petroianu, Søren Laurberg, Rodrigo G. Silva, Beatriz D.S. Rodrigues, Peter Christensen, Antonio Lacerda-Filho, Therese Juul; Ann Coloproctol. 2023;39(5):402-409. Published online May 13, 2022; DOI: https://doi.org/10.3393/ac.2022.00136.0019

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Abstract PDF

Purpose
This study was performed to investigate the convergent validity, discriminative validity, and reliability of the Brazilian version of the low anterior resection syndrome (LARS) score in a population with low educational and socioeconomic levels.
Methods
The LARS score was translated into the Portuguese language by forward- and back-translation procedures. In total, 127 patients from a public hospital in Brazil completed the questionnaires. The convergent validity was tested by comparing the LARS score with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core Module 30 (QLQ-C30) and with patients’ self-reported quality of life. For the discriminative validity, we tested the ability of the score to differentiate among subgroups of patients regarding neoadjuvant radiotherapy, type of surgery, and tumor distance from the anal verge. The test-retest reliability was investigated in a subgroup of 36 patients who responded to the survey twice in 2 weeks.
Results
The LARS score demonstrated a strong correlation with 5 of 6 items from the EORTC QLQ-C30 (P<0.05) and good concordance with patients’ self-reported quality of life (95.3%), confirming the convergent validity. The score was able to discriminate between subgroups of patients with different clinical characteristics related to LARS (P<0.001). The agreement between the test and retest showed that 86.1% of the patients remained in the same LARS category, and there was no significant difference between the LARS score numerical values (P=0.80), indicating good reliability overall.
Conclusion
The Brazilian version of the LARS score is a valid and reliable instrument to assess postoperative bowel function in a population with low educational and socioeconomic levels.

Citations

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Effects of low anterior resection syndrome after colorectal cancer resections on health-related quality of life: a systematic review and meta-analysis
S. Shojaei-Zarghani, K. Gorgi, A. Bananzadeh, A. R. Safarpour, S. V. Hosseini
Techniques in Coloproctology.2025;[Epub] CrossRef
Validation of the Vietnamese version of the low anterior resection syndrome score questionnaire
Tuong-Anh Mai-Phan, Vu Quang Pham
Annals of Coloproctology.2024; 40(6): 588. 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

Malignant disease, Rectal cancer, Functional outcomes,Colorectal cancer

The Effect of Anastomotic Leakage on the Incidence and Severity of Low Anterior Resection Syndrome in Patients Undergoing Proctectomy: A Propensity Score Matching Analysis: Sungjin Kim, Sung Il Kang, So Hyun Kim, Jae-Hwang Kim; Ann Coloproctol. 2021;37(5):281-290. Published online June 7, 2021; DOI: https://doi.org/10.3393/ac.2021.03.15

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23 Citations

Abstract PDF

Purpose
Proctectomy for the treatment of rectal cancer results in inevitable changes to bowel habits. Symptoms such as fecal incontinence, constipation, and tenesmus are collectively referred to as low anterior resection syndrome (LARS). Among the several risk factors that cause LARS, anastomotic leakage (AL) is a strong risk factor for permanent stoma formation. Therefore, the purpose of this study was to investigate the relationship between the severity of LARS and AL in patients with rectal cancer based on the LARS score and the Memorial Sloan Kettering Cancer Center (MSKCC) defecation symptom questionnaires.
Methods
We retrospectively analyzed patients who underwent low anterior resection for rectal cancer since January 2010. Patients who completed the questionnaire were classified into the AL group and control group based on medical and imaging records. Major LARS and MSKCC scores were analyzed as primary endpoints.
Results
Among the 179 patients included in this study, 37 were classified into the AL group. After propensity score matching, there were significant differences in the ratio of major LARS and MSKCC scores of the control group and AL group (ratio of major LARS: 11.1% and 37.8%, P<0.001; MSKCC score: 67.29±10.4 and 56.49±7.2, respectively, P<0.001). Univariate and multivariate analyses revealed that AL was an independent factor for major LARS occurrence and MSKCC score.
Conclusion
This study showed that AL was a significant factor in the occurrence of major LARS and defecation symptoms after proctectomy.

Citations

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Justin Dourado, Sameh Hany Emile, Anjelli Wignakumar, Brett Weiss, Nir Horesh, Victoria DeTrolio, Rachel Gefen, Zoe Garoufalia, Peter Rogers, Victor Strassmann, Steven D. Wexner
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Sameh Hany Emile, Roberta Lynn Oslin, Anjelli Wignakumar, Nir Horesh, Zoe Garoufalia, Steven D. Wexner, Marylise Boutros
Colorectal Disease.2025;[Epub] CrossRef
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Jun Yong Han, Min Jung Kim, Sang Hui Moon, Young Jin Kim, Hyun Tae Lim, Jesung Park, Jae Hyun Park, Hyo Jun Kim, Ji Won Park, Seung-Bum Ryoo, Kyu Joo Park, Seung-Yong Jeong
Familial Cancer.2025;[Epub] CrossRef
The effect of robotic surgery on low anterior resection syndrome in patients with lower rectal cancer: a propensity score-matched analysis
Lei Zhang, Chenhao Hu, Jiamian Zhao, Chenxi Wu, Zhe Zhang, Ruizhe Li, Ruihan Liu, Junjun She, Feiyu Shi
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Balázs Bánky, András Fülöp, Viktória Bencze, Lóránd Lakatos, Petra Rozman, Attila Szijártó
Orvosi Hetilap.2024; 165(2): 43. CrossRef
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Gyung Mo Son
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The Diagnosis and Evolution of Patients with LARS Syndrome: A Five-Year Retrospective Study from a Single Surgery Unit
Cosmin Vasile Obleagă, Sergiu Marian Cazacu, Tiberiu Ștefăniță Țenea Cojan, Cecil Sorin Mirea, Dan Nicolae Florescu, Cristian Constantin, Mircea-Sebastian Șerbănescu, Mirela Marinela Florescu, Liliana Streba, Dragoș Marian Popescu, Ionică Daniel Vîlcea, M
Cancers.2024; 16(24): 4175. CrossRef
Low anterior resection syndrome after radical surgical treatment of rectal cancer: interim results of a multicenter interuniversity clinical trial
A. A. Zakharenko, M. A. Belyaev, A. A. Trushin, A. A. Svechkova, I. A. Paltyshev, A. Kh. Khamid, O. A. Ten, T. V. Kupenskaya, M. V. Zavgorodnyaya, I. A. Filatova, F. Ya. Dzhafarzadeh, K. I. Vladimirova, N. M. Guseinova, L. A. Khamid, Ya. O. Baskova, Z. U.
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Angelina Di Re, Salam Tooza, Jason Diab, Charbel Karam, Mina Sarofim, Kevin Ooi, Catherine Turner, Daniel Kozman, David Blomberg, Matthew Morgan
Annals of Coloproctology.2023; 39(5): 395. CrossRef
The status of low anterior resection syndrome: data from a single-center in China
Jing Su, Qianhui Liu, Dagui Zhou, Xiaofeng Yang, Guiru Jia, Lijun Huang, Xiao Tang, Jiafeng Fang
BMC Surgery.2023;[Epub] CrossRef
Low anterior resection syndrome: is it predictable?
Dong Hyun Kang
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Kelly C.L.R. Buzatti, Andy Petroianu, Søren Laurberg, Rodrigo G. Silva, Beatriz D.S. Rodrigues, Peter Christensen, Antonio Lacerda-Filho, Therese Juul
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Jeonghee Han
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Gyoung Tae Noh
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Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef
Early vs. standard reversal ileostomy: a systematic review and meta-analysis
N. J. O’Sullivan, H. C. Temperley, T. S. Nugent, E. Z. Low, D. O. Kavanagh, J. O. Larkin, B. J. Mehigan, P. H. McCormick, M. E. Kelly
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Mingfang Yan, Zhenmeng Lin, Zhiying Wu, Huizhe Zheng, Meiqin Shi
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Seung Mi Yeo, Gyung Mo Son
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Case Report

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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14 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.

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Xiangxiang Ren, Xiaoshi Jin, Tianhao Xie, Litao Liu, Qiang Wang, Xingli Sun, Meng Zhang
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Ramazan Kozan, Ozkan Akpinar, Meral Toker
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Original Articles

Malignant disease, Rectal cancer, Functional outcomes

Validation of Korean Version of Low Anterior Resection Syndrome Score Questionnaire: Chang Woo Kim, Woon Kyung Jeong, Gyung Mo Son, Ik Yong Kim, Ji Won Park, Seung-Yong Jeong, Kyu Joo Park, Suk-Hwan Lee; Ann Coloproctol. 2020;36(2):83-87. Published online February 11, 2020; DOI: https://doi.org/10.3393/ac.2019.08.01

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221 Download
22 Web of Science
18 Citations

Abstract PDF

Purpose
Patients who undergo radical surgery for rectal cancer often experience low anterior resection syndrome (LARS). Symptoms of this syndrome include frequent bowel movements, gas incontinence, fecal incontinence, fragmentation, and urgency. The aim of this study was to investigate the convergent validity, discriminative validity, and reliability of the Korean version of the LARS score questionnaire.
Methods
The English LARS score questionnaire was translated into Korean using the forward-and-back translation method. A total of 146 patients who underwent radical surgery for rectal cancer answered the Korean version of the LARS score questionnaire including an anchor question assessing the impact of bowel function. Participants answered the questionnaire once more after 2 weeks.
Results
The Korean LARS score questionnaire showed high convergent validity in terms of high correlation between the LARS score and quality of life (perfect fit 55.5% vs. moderate fit 37.6% vs. no fit 6.8%, respectively; P < 0.001). The LARS score also showed good discriminative validity between groups of patients differing by sex (29 for males vs. 25 for females; P = 0.014), tumor level (29 for ≤8 cm vs. 24 for >8 cm; P = 0.021), and radiotherapy (32 for yes vs. 24 for no; P = 0.001). The LARS score also demonstrated high reliability at test-retest with no difference between scores at the first and second tests (intraclass correlation coefficient: Q1 = 0.932; Q2 = 0.909, Q3 = 0.944, Q4 = 0.931, and Q5 = 0.942; P < 0.001, respectively).
Conclusion
The Korean version of the LARS score questionnaire has proven to be a valid and reliable tool for measuring LARS in Korean patients with rectal cancer.

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Impact of sleep disturbances due to low anterior resection syndrome on the quality of life of patients with rectal cancer
Do Kyoon Moon, Seung-Bum Ryoo, Mi Suk Kim, Jae Hyun Park, Jesung Park, Jong Sung Ahn, Hyo Jun Kim, Minjung Kim, Ji Won Park, Seung-Yong Jeong, Kyu Joo Park
The American Journal of Surgery.2025; 246: 116399. CrossRef
Validation of the Vietnamese version of the low anterior resection syndrome score questionnaire
Tuong-Anh Mai-Phan, Vu Quang Pham
Annals of Coloproctology.2024; 40(6): 588. CrossRef
Bowel dysfunction and lower urinary tract symptoms on quality of life after sphincter-preserving surgery for rectal cancer: A cross-sectional study
Hyekyung Kim, Hyedan Kim, Ok-Hee Cho
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Inah Kim, Ji Young Lim, Sun Woo Kim, Dong Wook Shin, Hee Cheol Kim, Yoon Ah Park, Yoon Suk Lee, Jung-Myun Kwak, Seok Ho Kang, Ji Youl Lee, Ji Hye Hwang
BMC Cancer.2023;[Epub] CrossRef
Low anterior resection syndrome
Seung‐Bum Ryoo
Annals of Gastroenterological Surgery.2023; 7(5): 719. CrossRef
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Min Jung Kim, Dae Won Lee, Hyun-Cheol Kang, Ji Won Park, Seung-Bum Ryoo, Sae-Won Han, Kyung Su Kim, Eui Kyu Chie, Jae Hwan Oh, Woon Kyung Jeong, Byoung Hyuck Kim, Eun Mi Nam, Seung-Yong Jeong
BMC Cancer.2023;[Epub] CrossRef
Validation of low anterior resection syndrome score in Brazil with Portuguese
Kelly C.L.R. Buzatti, Andy Petroianu, Søren Laurberg, Rodrigo G. Silva, Beatriz D.S. Rodrigues, Peter Christensen, Antonio Lacerda-Filho, Therese Juul
Annals of Coloproctology.2023; 39(5): 402. CrossRef
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Min Kyu Kang, Soo Yeun Park, Jun Seok Park, Hye Jin Kim, Jong Gwang Kim, Byung Woog Kang, Jin Ho Baek, Seung Hyun Cho, An Na Seo, Duck-Woo Kim, Jin Kim, Se Jin Baek, Ji Hoon Kim, Ji Yeon Kim, Gi Won Ha, Eun Jung Park, In Ja Park, Chang Hyun Kim, Hyun Kang
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In Ja Park
The Ewha Medical Journal.2022; 45(1): 3. CrossRef
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Seung Mi Yeo, Gyung Mo Son
The Ewha Medical Journal.2022;[Epub] CrossRef
Analgesic effect of structured anal skin care for perianal dermatitis after low anterior resection in the rectal cancer patients: prospective, single-center, open-label, therapeutic confirmatory, randomized clinical trial
Gyung Mo Son, In Young Lee, Mi Sook Yun, Jung-Hea Youn, Hong Min An, Kyung Hee Kim, Seung Mi Yeo, Bokyung Ku, Myeong Suk Kwon, Kun Hyung Kim
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Min Jung Kim, Ji Won Park, Mi Ae Lee, Han-Ki Lim, Yoon-Hye Kwon, Seung-Bum Ryoo, Kyu Joo Park, Seung-Yong Jeong
Scientific Reports.2021;[Epub] CrossRef
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S -B Ryoo, J W Park, D W Lee, M A Lee, Y -H Kwon, M J Kim, S H Moon, S -Y Jeong, K J Park
British Journal of Surgery.2021; 108(6): 644. CrossRef
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Rui Sun, Ziyi Dai, Yin Zhang, Junyang Lu, Yuelun Zhang, Yi Xiao
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Sungjin Kim, Sung Il Kang, So Hyun Kim, Jae-Hwang Kim
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Eun Jung Park, Seung Hyuk Baik
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Benign GI diease,Benign diesease & IBD,Complication,Surgical technique

Triple-Staple Technique Effectively Reduces Operating Time for Rectal Anastomosis: Marie Shella De Robles, Christopher John Young; Ann Coloproctol. 2021;37(1):16-20. Published online February 5, 2020; DOI: https://doi.org/10.3393/ac.2019.06.30

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166 Download
10 Web of Science
10 Citations

Abstract PDF

Purpose
Stapled anastomotic techniques to the distal rectum have gained widespread acceptance due to their procedural advantages. Various modifications in the stapling techniques have evolved since their inception. The triple-staple technique utilizing stapled closure of both the proximal colon and distal rectal stump provides a rapid and secure colorectal anastomosis. The aims of this study were to determine the safety and efficacy of the triple-staple technique and to compare the clinical outcomes with a historical control group for which the conventional double-staple technique had been performed.
Methods
One hundred consecutive patients operated on by a single surgeon were included in the study; 50 patients who underwent a double-staple (DSA) procedure and 50 patients undergoing triple-staple anastomosis (TSA).
Results
The most common indication for surgery in both groups was rectal cancer followed by diverticular disease and distal sigmoid cancer. There was no significant difference in number of patients requiring loop ileostomy formation in the groups (TSA, 56.0% vs. DSA, 68.0%; P = 0.621). The mean operating time for the TSA group was significantly shorter compared to that of the DSA group (TSA, 242.8 minutes vs. DSA, 306.1 minutes; P = 0.001). There was no significant difference in complication rate (TSA, 40% vs. DSA, 50%; P = 0.315) or length of hospital stay between the two groups (TSA, 11.3 days vs. DSA, 13.0 days; P = 0.246). Postoperative complications included anastomotic leak, prolonged ileus, bleeding, wound infection, and pelvic collection.
Conclusion
The triple-staple technique is a safe alternative to double-staple anastomosis after anterior resection and effectively shortens operating time.

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Abdus Salam Raju, Seyed Mohammad Javad Taghavi, Andrew James Gilmore
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Song Wang, A-Jian Li, Hui-Hong Jiang, Yin Lin, Hai-Bo Ding
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Chungyeop Lee, In Ja Park
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Tyler McKechnie, Victoria Shi, Elena Huang, Bright Huo, Aristithes Doumouras, Nalin Amin, Cagla Eskicioglu, Dennis Hong
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Alexander A. Gaidarski III, Marco Ferrara
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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
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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
Effort to Improve Rectal Anastomosis: the Triple-Stapled Technique for Rectal Anastomosis
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Anastomotic Sinus That Developed From Leakage After a Rectal Cancer Resection: Should We Wait for Closure of the Stoma Until the Complete Resolution of the Sinus?: Chris Tae-Young Chung, Se-Jin Baek, Jung-Myun Kwak, Jin Kim, Seon-Hahn Kim; Ann Coloproctol. 2019;35(1):30-35. Published online January 25, 2019; DOI: https://doi.org/10.3393/ac.2018.08.13

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5 Citations

Abstract PDF

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

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Nirvana B. Saraswat, Scott A. Brill, William E. Wise
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Mohamed Rabie, Laura Parry, Iannish Sadien, Sandeep Kapur, Adam Stearns, Irshad Shaikh
ANZ Journal of Surgery.2022; 92(4): 801. CrossRef
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Response to Dioscoridi et al.
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Colorectal Disease.2020; 22(7): 841. CrossRef
Anastomotic Sinus Developed From Leakage in Rectal Cancer Resection: When Can We Reverse the Defunctioning Stoma?
Chang Hyun Kim
Annals of Coloproctology.2019; 35(1): 1. CrossRef

Case Report

Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome: Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul; Ann Coloproctol. 2017;33(4):146-149. Published online August 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.4.146

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5 Citations

Abstract PDF

We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.

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Effect of low anterior resection syndrome on quality of life in colorectal cancer patients: A retrospective observational study
Dong-Ai Jin, Fang-Ping Gu, Tao-Li Meng, Xuan-Xuan Zhang
World Journal of Gastrointestinal Surgery.2023; 15(10): 2123. CrossRef
Functional anorectal studies in patients with low anterior resection syndrome
Ssu‐Chi Chen, Kaori Futaba, Wing Wa Leung, Cherry Wong, Tony Mak, Simon Ng, Hans Gregersen
Neurogastroenterology & Motility.2022;[Epub] CrossRef
Variation in rectoanal inhibitory reflex after laparoscopic intersphincteric resection for ultralow rectal cancer
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European Journal of Oncology Nursing.2021; 55: 102059. CrossRef

Original Articles

Usefulness of Anorectal Manometry for Diagnosing Continence Problems After a Low Anterior Resection: Audrius Dulskas, Narimantas E. Samalavicius; Ann Coloproctol. 2016;32(3):101-104. Published online June 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.3.101

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19 Citations

Abstract PDF

Purpose

For several decades, the low anterior resection (LAR) with total mesorectal excision (TME) has been the gold standard for treating patients with rectal cancer. Up to 90% of patients undergoing sphincter-preserving surgery will have changes in bowel habits, so-called 'anterior resection syndrome.' This study examined patients' continence after a LAR for the treatment of rectal cancer.

Methods

This prospective study was performed between September 2014 and August 2015 at the National Cancer Institute and included 30 patients who underwent anorectal manometry preoperatively and at 3 and 4 months after a LAR, but 10 were excluded from further evaluation for various reasons. Wexner score was recorded preoperatively and 4 months after LAR (1 month after ileostomy repair).

Results

Postoperatively, 70% of patients complained of some degree of soiling (incontinence to liquid stool), and 30% experienced urgent defecation. Four months after surgery, these symptoms had somewhat abated. The anal resting pressure and the maximum squeezing pressure did not change significantly. Rectal capacity and compliance were reduced in all patients. The majority of patients demonstrated manometric anorectal changes and clinical anorectal function disorders during the first 4 months after surgery. The Wexner scores and the manometric findings showed no correlation.

Conclusion

Many patients undergoing a LAR with TME for the treatment of rectal cancer experience some degree of incontinence postoperatively. Anorectal manometry may be used as an additional tool for evaluating problems with continence after a LAR. No correlation between the Wexner score and the manometric findings was observed.

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Ana López-Sánchez, Antonio Morandeira-Rivas, Carlos Moreno-Sanz, Francisco Javier Cortina-Oliva, Marina Manzanera-Díaz, Jhonny David Gonzales-Aguilar
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Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study
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Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function
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Preoperative incremental maximum squeeze pressure as a predictor of fecal incontinence after very low anterior resection for low rectal cancer
Masatoshi Kochi, Hiroyuki Egi, Tomohiro Adachi, Yuji Takakura, Shoichiro Mukai, Kazuhiro Taguchi, Ikki Nakashima, Yusuke Sumi, Shintaro Akabane, Koki Sato, Hisaaki Yoshinaka, Minoru Hattori, Hideki Ohdan
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Manometric assessment of anorectal function after transanal total mesorectal excision
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Chris George Cura Pales, Sanghyun An, Jan Paolo Cruz, Kwangmin Kim, Youngwan Kim
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World Journal of Surgery.2018; 42(10): 3415. CrossRef

Feasibility of Hand-Assisted Laparoscopic Surgery as Compared to Open Surgery for Sigmoid Colon Cancer: A Case-Controlled Study: Sang Eun Nam, Eun-Joo Jung, Chun-Geun Ryu, Jin Hee Paik, Dae-Yong Hwang; Ann Coloproctol. 2013;29(1):17-21. Published online February 28, 2013; DOI: https://doi.org/10.3393/ac.2013.29.1.17

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Abstract PDF

Purpose

The aim of this study was to evaluate short-term clinical outcomes by comparing hand-assisted laparoscopic surgery (HALS) with open surgery for sigmoid colon cancer.

Methods

Twenty-six patients who underwent a hand-assisted laparoscopic anterior resection (HAL-AR group) and 52 patients who underwent a conventional open anterior resection during the same period were enrolled (open group) in this study with a case-controlled design.

Results

Pathologic parameters were similar between the two groups. The incidences of immediate postoperative leukocytosis were 38.5% in the HAL-AR group and 69.2% in the open group (P = 0.009). There were no significant differences between the two groups as to leukocyte count, hemoglobin, and hematocrits (P = 0.758, P = 0.383, and P = 0.285, respectively). Of the postoperative recovery indicators, first flatus, sips of water and soft diet started on postoperative days 3, 5, 7 in the HALS group and on days 4, 5, 6 in the open group showed statistical significance (P = 0.021, P = 0.259, and P = 0.174, respectively). Administration of additional pain killers was needed for 1.2 days in the HAL-AR group and 2.4 days in the open group (P = 0.002). No significant differences in the durations of hospital stay and the rates of postoperative complications were noted, and no postoperative mortality was encountered in either group.

Conclusion

The patients with sigmoid colon cancer who underwent a HAL-AR had a lower incidence of postoperative leukocytosis, less administration of pain killers, and faster first flatus than those who underwent open surgery. Clinical outcomes for patients' recovery and pathology status were similar between the two groups. Therefore, a HAL-AR for sigmoid colon cancer is feasible and has the same benefit as minimally invasive surgery.

Citations

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Hand-assisted laparoscopic surgery versus conventional open surgery in intraoperative and postoperative outcomes for colorectal cancer
Xubing Zhang, Qingbin Wu, Chaoyang Gu, Tao Hu, Liang Bi, Ziqiang Wang
Medicine.2017; 96(33): e7794. CrossRef
Hand-Assisted Laparoscopic Surgery: A Versatile Tool for Colorectal Surgeons
Ju Yong Cheong, Christopher J. Young
Annals of Coloproctology.2017; 33(4): 125. CrossRef
Hand-assisted laparoscopic vs open colectomy: an assessment from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted cohort
Cigdem Benlice, Meagan Costedio, Luca Stocchi, Maher A. Abbas, Emre Gorgun
The American Journal of Surgery.2016; 212(5): 808. CrossRef
Learning curve for hand-assisted laparoscopic D2 radical gastrectomy
Jia-Qing Gong
World Journal of Gastroenterology.2015; 21(5): 1606. CrossRef
Hand-assisted laparoscopic versus laparoscopy-assisted D2 radical gastrectomy: a prospective study
JiaQing Gong, YongKuan Cao, YunMing Li, GuoHu Zhang, PeiHong Wang, GuoDe Luo
Surgical Endoscopy.2014; 28(10): 2998. CrossRef

Case Report

Efficacy of Imatinib Mesylate Neoadjuvant Treatment for a Locally Advanced Rectal Gastrointestinal Stromal Tumor: Kyu Jong Yoon, Nam Kyu Kim, Kang Young Lee, Byung Soh Min, Hyuk Hur, Jeonghyun Kang, Sarah Lee; J Korean Soc Coloproctol. 2011;27(3):147-152. Published online June 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.3.147

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Abstract PDF

Surgery is the standard treatment for a primary gastrointestinal stromal tumor (GIST); however, surgical resection is often not curative, particularly for large GISTs. In the past decade, with imatinib mesylate (IM), management strategies for GISTs have evolved significantly, and now IM is the standard care for patients with locally advanced, recurrent or metastatic GISTs. Adjuvant therapy with imatinib was recently approved for use, and preoperative imatinib is an emerging treatment option for patients who require cytoreductive therapy. IM neoadjuvant therapy for primary GISTs has been reported, but there is no consensus on the dose of the drug, the duration of treatment and the optimal time of surgery. These are critical because drug resistance or tumor progression can develop with a prolonged treatment. This report describes two cases of large rectal malignant GISTs, for which a abdominoperineal resection was initially anticipated. The two patients received IM preoperative treatment; we followed-up with CT or magnetic resonance imaging to access the response. After 9 months of treatment, a multi-disciplinary consensus that maximal benefit from imatinib had been achieved was reached. We determined the best time for surgical intervention and successfully performed sphincter-preserving surgery before resistance to imatinib or tumor progression occurred. We believe that a multidisciplinary team approach, considerating the optimal duration of therapy and the timing of surgery, is required to optimize treatment outcome.

Citations

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Safety, effectiveness and the optimal duration of preoperative imatinib in locally advanced gastric gastrointestinal stromal tumors: A retrospective cohort study
Xiangfei Sun, Xiaohan Lin, Qiang Zhang, Chao Li, Ping Shu, Xiaodong Gao, Kuntang Shen
Cancer Medicine.2024;[Epub] CrossRef
Clinicopathological and Immunohistochemical Characterization of Gastrointestinal Stromal Tumour at Four Tertiary Health Centers in Nigeria Using CD117, DOG1, and Human Epidermal Growth Factor Receptor-2 Biomarkers
Mumini Wemimo Rasheed, Afolayan Enoch Abiodun, Uchechukwu Brian Eziagu, Najeem Adedamola Idowu, Abdullahi Kabiru, Taiwo Adeyemi Adegboye, Waheed Akanni Oluogun, Adekunle Adebayo Ayoade
Annals of African Medicine.2023; 22(4): 501. CrossRef
Open transanal resection of low rectal stromal tumor following neoadjuvant therapy of imatinib mesylate: Report of 11 cases and review of literature
Qiang Sun, Ning Su, Xinxing Li, Zhiqian Hu, Weijun Wang
Asia-Pacific Journal of Clinical Oncology.2020; 16(3): 123. CrossRef
Using endoscopy to minimize the extent of resection in the management of giant GISTs of the stomach
Hishaam Ismael, Yury Ragoza, Steven Cox
International Journal of Surgery Case Reports.2017; 36: 26. CrossRef
Combined Therapy of Gastrointestinal Stromal Tumors
Piotr Rutkowski, Daphne Hompes
Surgical Oncology Clinics of North America.2016; 25(4): 735. CrossRef
Indications for surgery in advanced/metastatic GIST
Samuel J. Ford, Alessandro Gronchi
European Journal of Cancer.2016; 63: 154. CrossRef
Surgical treatment of gastrointestinal stromal tumour of the rectum in the era of imatinib
M J Wilkinson, J E F Fitzgerald, D C Strauss, A J Hayes, J M Thomas, C Messiou, C Fisher, C Benson, P P Tekkis, I Judson
British Journal of Surgery.2015; 102(8): 965. CrossRef
Intolerance to Imatinib in Gastrointestinal Stromal Tumors: A Case Report and a Review of Literature
Yousra Akasbi, Samia Arifi, Sami Aziz Brahmi, Fatima Zahra El Mrabet, Nawfel Mellas, Fatima Zahra Mernisi, Omar El Mesbahi
Journal of Gastrointestinal Cancer.2014; 45(S1): 71. CrossRef
Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group
Thanh-Khoa Huynh, Pierre Meeus, Philippe Cassier, Olivier Bouché, Sophie Lardière-Deguelte, Antoine Adenis, Thierry André, Julien Mancini, Olivier Collard, Michael Montemurro, Emmanuelle Bompas, Maria Rios, Nicolas Isambert, Didier Cupissol, Jean-Yves Bla
BMC Cancer.2014;[Epub] CrossRef
Neoadjuvant Imatinib in Locally Advanced Gastrointestinal Stromal Tumors (GIST): The EORTC STBSG Experience
Piotr Rutkowski, Alessandro Gronchi, Peter Hohenberger, Sylvie Bonvalot, Patrick Schöffski, Sebastian Bauer, Elena Fumagalli, Pawel Nyckowski, Buu-Phuc Nguyen, Jan Martijn Kerst, Marco Fiore, Elzbieta Bylina, Mathias Hoiczyk, Annemieke Cats, Paolo G. Casa
Annals of Surgical Oncology.2013; 20(9): 2937. CrossRef

Original Articles

Analysis of Anastomotic Leakage after an Anterior Resection for Rectal Cancer.: Park, Hey Won , Kim, Chang Nam , Park, Jin Seok , Kang, Yoon Jung , Cho, Byung Sun , Lee, Min Koo , Choi, Young Jin , Park, Joo Seung; J Korean Soc Coloproctol. 2009;25(5):340-346.; DOI: https://doi.org/10.3393/jksc.2009.25.5.340

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Abstract PDF

PURPOSE
The aim of our study was to identify risk factors associated with anastomotic leakage (AL) after an anterior resection (high anterior resection+low anterior resection) for rectal cancer.
METHODS
Between January 1998 and December 2007, 356 patients underwent an anterior resection for rectal cancer. Early anastomotic leakage (EAL) was defined as leakage identified during hospitalization. Late anastomotic leakage (LAL) was defined as leakage identified in outpatients.
RESULTS
AL (EAL+LAL) occurred in 30 patients (8.4%, mean time: 15.4 days). Among of them, EAL occurred in 20 patients (5.6%, mean time: 5.1 days), and LAL occurred in 10 patients (2.8%, mean time: 36.0 days). In the univariate analysis, the size of the tumor, the tumor level from the anal verge, and the level of anastomosis were significantly associated with AL. In EAL, the size of the tumor, the tumor level from the anal verge, the level of anastomosis, the operation type, and the value of serum albumin on day 3 after the operation were risk factors. In LAL, the tumor level from the anal verge and the level of anastomosis were risk factors. In the multivariate analysis, tumor size >7 cm (AL: P<0.001, EAL: P<0.001) and tumor level from the anal verge < or =8 cm (AL: P=0.014, EAL: P=0.001) were independent risk factors.
CONCLUSION
AL and EAL after an anterior resection for rectal cancer were related to the size of the tumor and the level of the tumor from the anal verge.

Citations

Citations to this article as recorded by

Distribution of Lymph Node Metastases Is an Independent Predictor of Survival for Sigmoid Colon and Rectal Cancer
Jung Wook Huh, Young Jin Kim, Hyeong Rok Kim
Annals of Surgery.2012; 255(1): 70. CrossRef

The Impacts of Obesity on a Laparoscopic Low Anterior Resection.: Woo, Jin Hee , Park, Ki Jae , Choi, Hong Jo; J Korean Soc Coloproctol. 2009;25(5):306-311.; DOI: https://doi.org/10.3393/jksc.2009.25.5.306

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Abstract PDF

PURPOSE
Obese patients are generally believed to be at increased risk for surgery compared to those who are not obese. It was the purpose of this study to compare the short-term outcomes of a laparoscopic low anterior resection (LAR) in obese and non-obese patients.
METHODS
We retrospectively reviewed 79 patients who had undergone a laparoscopic LAR for rectal cancer between September 2002 and January 2008. The degree of obesity was based on the Body Mass Index (BMI, kg/m2). We divided the 79 patients into two groups: the high BMI (BMI> or =25) and the low BMI (BMI <25) groups. The parameters analyzed included age, gender, American Society of Anesthesiologists classification score, operative time, estimated blood loss, conversion rate, postoperative complications, hospital stay, and oncologic characteristics. Statistics included the t-test and Fisher's exact test. Statistical significance was assessed at the 5% level (P<0.05 being statistically significant).
RESULTS
There were no significant differences between the low BMI (n=55) and the high BMI (n=24) groups in age and gender. The high BMI group had significantly more conversion to an open procedure (20.8% vs. 3.6%, P=0.0244). The high BMI group and the low BMI group had no differences in blood loss, complications, hospital stay, and oncologic characteristics, but the high BMI group had a longer operative time (244.2 min vs. 212.0 min, P=0.0035).
CONCLUSION
A laparoscopic LAR in obese patients had a higher conversion rate and a longer operative time, but there were no differences in postoperative complications and oncologic characteristics. A further study based on many experiences is needed to clarify the influence of the surgeon's experience on the operative time and the conversion rate, and long-term follow-up is necessary to evaluate the oncologic safety of a laparoscopic LAR in obese patients.

Citations

Citations to this article as recorded by

Laparoscopic colorectal cancer resections in the obese: a systematic review
Alastair Fung, Nora Trabulsi, Martin Morris, Richard Garfinkle, Abdulaziz Saleem, Steven D. Wexner, Carol-Ann Vasilevsky, Marylise Boutros
Surgical Endoscopy.2017; 31(5): 2072. CrossRef

Case Report

Re-anastomosis above a Preceding Anastomosis Made by a Low Anterior Resection.: Shin, Milljae , Yun, Haeran , Lee, Wonseok , Yun, Seonghyeon , Lee, Wooyong , Chun, Ho Kyung; J Korean Soc Coloproctol. 2008;24(4):287-291.; DOI: https://doi.org/10.3393/jksc.2008.24.4.287

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Abstract PDF: Periodic colonoscopic checkup is needed for patients suffering from colorectal cancer, based on the property that a colorectal neoplasm often recurs synchronously or metachronously. Surgical management appropriate to the occasion should be taken in recurrent colorectal cancer. Particularly, recurring colorectal cancer closely above the prior anastomosis for a low anterior resection should be eliminated by using an abdomino-perineal resection, including the preceding anastomotic site or a new anastomotic creation. Under the latter instance, ample possibility exists for postoperative anastomotic stenosis or leakage by reason of insufficient blood supply to the segment between the earlier anastomosis and the later one. The authors report two cases of re-anastomosis for colorectal cancer just above a previous anastomosis taken by a low anterior resection for rectal cancer. In a 52-year-old male with a history of neoadjuvant concomitant chemo-radiotherapy (CCRT) and low anterior resection for rectal cancer located at 6 cm from the anal verge, a new adenocarcinoma was detected 7 cm from the previous anastomotic site and 3 cm from the anal verge. Considering anal sphincter preservation, the re-anastomosis was made at the upper part of the preceding anastomosis. The patient experienced no surgical complications, such as anastomotic stenosis or leakage and functional defecation difficulty. In another patient, a 50-year-old male with a low anterior resection and adjuvant CCRT for rectal cancer 8 cm from anal verge, a new adenocarcinoma was detected in the colon. The new adenocarcinoma was located 10 cm from the anal verge and 8 cm from the previous anastomosis. The same surgical management was applied to this case, with the same postoperative result.

Original Articles

Safety and Feasibility of Laparoscopic Low Anterior Resection in Early Learning Curve.: Kang, Jeong Hyun , Park, Yoon Ah , Baik, Seung Hyuk , Lee, Kang Young , Kim, Nam Kyu , Sohn, Seung Kook , Cho, Chang Hwan; J Korean Soc Coloproctol. 2005;21(6):396-400.

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Abstract PDF: PURPOSE
After the final report of Clinical Outcomes of Surgical Therapy (COST) study group, the application of laparoscopic surgery in colon cancer a spread widely. However, laparoscopic surgery in the rectum is still regarded as a complicated procedure to start due to technical difficulties and a steep learning curve. The aim of this study was to show the safety and technical feasibility of a laparoscopic low anterior resection at an early time on the learning curve in comparison with open low anterior resection.
METHODS
The learning curves of one colorectal surgeon in open and laparoscopic low anterior resections were retrospectively compared. The compared factors were clinicopathologic characteristics, operation time, and the factors associated with postoperative recovery, morbidity and mortality.
RESULTS
There were no significant differences in age or sex between two groups. The operation time was significantly longer in the laparoscopy group (P<0.001) In the view point of postoperative recovery, the laparoscopy group showed significant advantages in hospital stay (P<0.001), the passage of flatus (P<0.001), the number of analgesics used (P=0.03), and the removal of foley catheter (P=0.001). There were no conversions in the laparoscopy group, and the complication rate was lower in the laparoscopy group (10.7% vs. 17.6%). There was no postoperative mortality in either group.
CONCLUSIONS
Even though the operation time was significantly longer in the laparoscopy group, a laparoscopic low anterior resection appears to have some benefits in postoperative recovery and morbidity. In terms of surgical outcomes, a laparoscopic low anterior resection can be performed safely even in early times on the learning curve.

Step-by-step Management and Treatment Outcome of Bleeding Control for Anastomosis Site after Low Anterior Resection with Double Stapling Technique.: Kim, Hyuk Mun , Shin, Eung Jin , Song, Ok Pyung , Kim, Jae Joon , Jang, Yong Seok , Park, Rae Kyung , Baek, Moo Joon; J Korean Soc Coloproctol. 2005;21(6):390-395.

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Abstract PDF: PURPOSE
This study reviews our experience with a step- by-step management approach of increasing aggressiveness and evaluates the treatment outcome for intraluminal hemorrhage.
METHODS
The study group was comprised of patients who had experienced intraluminal hemorrhage after a low anterior resection with the double stapling technique from 1999 to 2003. The choice of management was selected according to our step-by-step management protocol, and the outcomes were evaluated for each step, lincluding mortality and complications.
RESULTS
Nine patients (6 males and 3 females, mean age 55 years) were identified, the mean volume of packed RBC transfusion was 2 pints, and the mean distance of the anastomotic site from the anal verge was 6 cm. The median stapler size was 31 mm. The first step was cold saline irrigation and drainage; four of 9 patients were controlled. The second step was retention enema with topical hemostatics; one of remaining 5 patients stopped bleeding. The third step was colonoscopic hypertonic saline injection around the bleeding site with direct colonoscopic electrocauterization, two of remaining 4 patients were controlled. The last step was suturing the bleeding site through the anus, the remaining 2 patients stopped bleeding. One of the 9 patients developed leakage from the anastomotic site after the last step management, three of the 9 patients had long standing ileus, and one of the 9 patients developed acute renal failure after a massive transfusion. There were no postoperative deaths.
CONCLUSIONS
It is safer and easier to control bleeding with step-by-step management system of increasing aggressiveness.

Sphincter Preserving Method for Distal Rectal Cancer: Treatment Experience of Ultra-low Anterior Resection and Hand Sewn Coloanal Anastomosis.: Baik, Seung Hyuk , Kim, Nam Kyu , Lee, Kang young , Sohn, Seung Kook , Cho, Chang Hwan; J Korean Soc Coloproctol. 2004;20(6):358-363.

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Abstract PDF: PURPOSE
As the oncologic safety of coloanal anastomosis (CAA) has been proven by many other authors, the incidence of CAA following a ultra-low anterior resection has increased. The purpose of this study is to evaluate the functional outcomes and complications for patients who underwent an ultra-low anterior resection and CAA for distal rectal cancer.
METHODS
57 patients underwent CAA following an ultra-low anterior resection between July 1997 and November 2003. 44 patients, who were followed up for more than 6 month after diverting ileostomy repair were evaluated for recurrence pattern, complications, and functional outcomes.
RESULTS
The median follow-up period was 32.0+/-22.8 (8~83) months. The mean age of the patients was 54.3+/-10.4 (23~74) years. The types of anastomosis were straight CAA (n=20) and J pouch CAA (n=37). The mean tumor size was 4.1+/-1.9 (2~8) cm, the mean distal resection margin was 1.3+/-0.9 (0.2~4) cm. Six months later, the anastomosis distance following diverting ileostomy repair was measured at 3.24+/-0.6 (2~4) cm from the anal verge. The complications were multiple fistulas (n=3), fistula with anal stenosis (n=1), local recurrence with anal stenosis (n=1), anal stenosis (n=7). Anal incontinence (Kirwan grade III) was noted in 14 patients, and bowel movements more than 6 times per day were observed in 16 patients. Overall recurrence occurred in 6 patients (13.6%). The 5-years survival rate was 84.4%, and the 5-year disease-free survival was 68.9%.
CONCLUSIONS
Although CAA in patients with rectal cancer provides excellent long-term survival, a low risk of recurrence, in tolerable function, complications, and poor functional outcomes have been observed with CAA; therefore, the choice of this method should be considered carefully.

Change of Anorectal Function after Low Anterior Resection for Rectal Cancer.: Yun, Min Young , Choi, Sun Keun , Bae, Sun Young , Hur, Yun Suk , Lee, Kun Young , Kim, Sei Joong , Ahn, Seung Ick , Hong, Kee Chun , Shin, Suk Hwan , Kim, Kyung Rae , Woo, Ze Hong; J Korean Soc Coloproctol. 2003;19(4):248-253.

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Abstract PDF: PURPOSE
The anorectal function after a low anterior resection for rectal cancer recovered progressively by 6 12 months after the operation, but the mechanisms and the recovery process are not well understood. The aim of this study was to correlate postoperative anorectal function after low anterior resection with physiologic parameters.
METHODS
Sixty-seven patients who underwent a low anterior resection for rectal cancer were studied. The control group was consisted of normal persons. Anorectal physiologic studies were conducted for 6 months postoperatively by using defecographys, anorectal manometry and electomyogram of pudendal nerve.
RESULTS
The postoperative anorectal function was gradully improved with time. Defecograms showed that the resting, squeezing, and straining anorectal angles were not significantly increased. Anorectal manometry showed that the threshold volume and the urgency volume were not significantly decreased but the maximal tolerable volume was decreased remarkably. The maximal resting pressure significantly decreased but the maximal squeezing pressure were not. The pudendal nerve electromyograms were not significantly different between the two groups. The patients were divided by based on the anastomosis level. The short anastomosis group showed more impairment in the urgency volume and the maximal resting pressure than that of the long anastomosis group.
CONCLUSION
The neorectal volume and the level of anastomosis were important for changes in the anorectal function after a low anterior resecton. Gradual improvement of symptoms resulted from a resected rectal adapted to a neorectal volum.

Laparoscopic Anterior Resection for Rectal Cancer: an Analysis of Early Experiences.: Yoon, Jin Seok , Kim, Seon Han , Lee, Dong Keun , Moon, Hong Young; J Korean Soc Coloproctol. 2002;18(1):15-21.

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Abstract PDF: PURPOSE
Regarding laparoscopic colon cancer resection, the surgical society is currently waiting for the long-term oncologic result of multi-center randomized trials with over thousands patients. For rectal cancer surgery, however, laparoscopic approach is in much debate. The aim of this study was to evaluate the feasibility and safety of laparoscopic anterior resection for rectal cancer, based on the early results of our initial experiences.
METHODS
Nineteen patients (M:F=10:9, median age 55 years) underwent laparoscopic anterior resection for rectal cancer among the 71 malignant neoplasms of the colon and rectum resected laparoscopically between October 1997 and February 2001. All clinical data were prospectively collected. During the initial period, rectosigmoid lesion was the only indication. With the development of a new roticulating stapler for distal rectal transection, the indication was extended to the lesions of the upper and middle third of the rectum. The operation parameters (operation time, blood loss), tumor parameters (stage, resection margins, and number of resected lymph nodes), and postoperative clinical course (bowel function recovery, hospital stay, and complication) were evaluated.
RESULTS
The tumors located in the rectosigmoid (n=13), upper third of the rectum (n=4), and the middle third of the rectum (n=2). Four cases were converted to an open procedure. The reasons for conversion were bladder invasion (1), tumor located too low (1), inappropriate distal resection margin (1), and tumor fixation to the sacrum (1). Median operation time was 210 minutes. Median blood loss was 400 ml. Median times to passage of flatus and oral feeding were 2 days and 3 days after surgery, respectively. Median length of the distal resection margin was 3 cm. Median number of harvested lymph nodes were 22. TNM stages were as follows; 0:I:II:III:IV=1:2:6:9:1. Two anastomotic leaks occurred in the converted patients. There were no major postoperative complications in other patients. There was no operative mortality. Median time to hospital discharge was 13 days. During a median follow-up period of 15 months, one patient developed distant metastases. There were no local/port sites recurrences.
CONCLUSIONS
Laparoscopic anterior resection is a safe alternative to conventional surgery for rectal cancer. Long- term follow-up is mandatory to evaluate the oncologic safety.

Clinical Analysis of Surgical Treatment for Mid and Lower Rectal Cancers.: Moon, Yang Joo , Kim, Byung Seok , Moon, Duk Jin , Park, Ju Sub; J Korean Soc Coloproctol. 2000;16(6):451-455.

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Abstract PDF: PURPOSE
The aim of this retrospective study was to evaluate the risk of local recurrence such as patients who were treated for Dukes stage B and C low rectal cancer by abdominoperineal resection (APR) or low anterior resection (LAR).
METHODS
From 1985 to 1995, 81 patients with low rectal cancers which were within 3~8 cm from the anal verge were treated by curative resection, 38 by APR and 43 by LAR. The present study examined clinical and tumor characteristics, type of intervention as potential predictors of local recurrence. Retrospective data were analysed by univariate Chi-square tests.
RESULTS
Local recurrence was diagnosed in 17 of 81 patients with a median follow-up period of 24 months. The local recurrence rate was 23.6% (9 of 38) after APR and 18.6% (8 of 43) after LAR. There was no difference in local recurrence between patients who had APR and LAR (P=0.58). Also we could not find any significant differences among age (< or =65 vs >65 years, P=0.53), sex (M vs F, P=0.57), sized of tumors (< or =5 vs >5 cm, P=0.32), distance from anal verge (< or =5 vs >5 cm, P=0.57), Dukes stage (B vs C, P=0.22), histological grade (well and moderate vs poorly, P=0.17), distance from distal resection margin (< or =2 vs >2 cm, P=0.35).
CONCLUSIONS
The tumor factors such as Dukes' stage were more critical for pelvic recurrences than other patient factors.

Ultralow Anterior Resection and Coloanal Anastomosis for Distal Rectal Cancer Functional and Oncologic Results.: Kim, Nam Kyu , Lim, Dae Jin , Yun, Seong Hyeon , Lee, Kang Young , Sohn, Seung Kook , Min, Jin Sik; J Korean Soc Coloproctol. 2000;16(5):334-338.

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Abstract PDF: PURPOSE
Coloanal anastomosis (CAA) following ultralow anterior resection became more popular techniques for preservation of anal sphincter in distal rectal cancer. The purpose of this study is to evaluate a functional and oncologic safety of patients who underwent ultralow anterior resection and coloanal anastomosis for distal rectal cancer.
METHODS
Forty-eight patients underwent coloanal anastomosis following ultralow anterior resection between January 1988 and January 1998. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 8 cm in length with GIA 95. All patients were followed up for fecal or gas incontinence, frequency of bowel movement and local or systemic recurrences.
RESULTS
Mean tumor distance from anal verge was 4.0 cm. Postoperative complications were transient urinary retention (N=7), anastomotic stenosis (N=3), anastomotic leakage (N=3), rectovaginal fistula (N=2), cancer positive margin (N=1; patient refuses reoperation). Overall recurrences occurred in 7/48 (14.5%). Local recurrence (N=1) and systemic recurrence (N=1) in Astler-Coller stage B2, local recurrence (N=1), systemic recurrence (N=2) and combined local and systemic recurrence (N=2) in Astler-Coller stage C2. Mean frequency of bowel movement were 6.1 per day at 3 month, 4.4 at 1 year and 3.1 at 2 years. Kirwan grade for fecal incontinence were 2.7 at 3 months, 1.8 at 1 year and 1.5 at 2 years.
CONCLUSIONS
With careful selection of patients and good operative techniques, CAA can be performed safely in distal rectal cancer. Normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation without compromising the rate of local recurrence.

A Study of Anal Manometric Finding after Low Anterior Resection of Rectal Cancer.: Min, Byung Wook , Ryu, Keun Won , Kim, Seon Han , Choi, Sang Yong , Goo, Bum Hwan , Park, Young Tae , Moon, Hong Young; J Korean Soc Coloproctol. 2000;16(5):328-333.

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Abstract PDF: PURPOSE
Low anterior resection, irrespective of anastomotic technique, may be associated with frequent bowel movement and other bowel management difficulties. The aim of this study was to access the anorectal function after low anterior resection of the rectal cancer.
METHODS
We studied 28 patients who had mid and low rectal cancer (average 8.3 cm above the anal verge) had undergone low anterior resection using stapling suture devices (average level of anastomosis was 3.8 cm above anal verge) and anal manometry was undertaken 95 times preoperatively (N=28) and 3 month (N=26), 6 months (N=22) and 12 months (N=19) postoperatively from 1992 to 1995 in Korea University Guro Hospital.
RESULTS
Maximum resting pressure was reduced after resection (from 64.7 mmHg to 42.7 mmHg, change ?22 mmHg) but gradually increased and returned to preoperative level at 12 months postoperatively. Minimum perceived volume was decreased after operation (from 40.3 ml to 25 ml change of ?15.3 ml) and this change persist at 12 months postoperatively. Rectoanal inhibitory reflex was present in all patient before surgery but disappeared in most of the patient after operation. Reflex returned to normal in 4 of 22 patients at 6 months later and in 7 of 19 patients at 12 months after operation. Maximum squeezing pressure and maximum tolerable volume were not decreased after operation.
CONCLUSIONS
Anorectal function (maximum resting pressure, minimum perceived volume and rectoanal inhibitory reflex) was reduced immediately after low anterior resection of rectal cancer. But this functional changes returning to normal at 6 months and most of the patients had good function at 12 months after operation.

Low Anterior Resection with Fixation of the Lateral Rectal Ligaments by EEA Stapler in Rectal Prolapse.: Kim, Byung Chun , Cho, Ji Woong , Kim, Hong Ki; J Korean Soc Coloproctol. 1999;15(2):121-129.

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Abstract PDF: Rectal prolapse means an abnormal descent of all layers of the rectum, with or without protrusion through the anus, and is classified into incomplete and complete rectal prolapse. Complete rectal prolapse is further divided into the first, second and third degree based on the severity. The choice of the operation for rectal prolapse is controversial. PURPOSE: The aim of this study was to evaluate the safety and effectiveness of the low anterior resection and stapled colorectal end-to-end anastomosis with fixation of the lateral rectal ligaments in rectal prolapse with redundant sigmoid colon.
METHODS
We describe our experience from January 1989 through December 1998. During this period, eight cases of complete rectal prolapse were managed at the Chunchon Sacred Heart Hospital, Hallym University. They were all men. The average age of the patients was 37 years (range, 19 to 73) and the average at onset before surgery was 19 years (range, 6 months to 33 years). At rectal examination the patients were placed in either a left supine or squatting position and were asked to strain. The duration of the follow-up assessment was ranged from one to seven years after operation. All those patients were investigated by personal interview and physical examination.
RESULTS
The most common complaint was protruding anal mass and anal bleeding. Four patients were heavy alcohol abusers. Two patients had mental retardation. Among them four patients had undergone prior anorectal procedure; two men had been treated due to hemorrhoids. The average body weight was 55 kg. The average length of the postoperative hospital stay was 16.8 days (range, 9 to 39 days). Preoperatively, there were 5 cases who had decreased anal sphincter tone. In all cases EEA stapler was used for anastomosis. The rectum was completely mobilized posteriorly and sutured to the sacrum. There was no recurrence and incontinence in all patients. The lengths of removed bowel were 15 to 20 cm (average 16.2 cm). There was no postoperative mortality, but postoperative adhesive ileus was developed in two patients, which were managed by conservative treatment.
CONCLUSIONS
In rectal prolpase, the low anterior resection of redundant sigmoid colon and stapled colorectal end-to-end anastomosis with fixation of the lateral rectal ligaments is one of the most efficient treatment.

Clinical and Physiologic Evaluation of Anorectal Function Following Low Anterior Resection.: Lee, Sang Jeon , Park, Yoon Sang; J Korean Soc Coloproctol. 1998;14(1):61-72.

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Abstract PDF: Twenty to twenty-five percent of patients are reported to experience problems with anorectal function after low anterior resection, complaining particularly urgency of defecation and minor fecal leakage, but the mechanisms underlying its cause and the recovery process are not well understood. We designed this study to elucidate the mechanism of anorectal functional problems and its recovery process after low anterior resection for rectal cancer by autonomic nerve preserving procedure. Standardized interviews and anorectal physiologic studies including balloon proctometry and manometry were performed in 32 patients preoperatively, and at 1 month, 3 months, 6 months and 1 year after the operation. Postoperatively stool frequency increased, the ability to defer defecation and discriminate stool characters were compromised, and anal incontinence scores increased, which recovered progressively by 6~12 months after the operation. Balloon proctometry showed that threshold volume, urgent volume and maximal tolerable volume decreased remarkably after the operation. The latter two parameters recovered considerably by 1 year after the operation. Rectal compliance also decreased significantly but it showed no evidence of recovery by 1 year after the operation. Anorectal manometry showed that maximum anal resting pressure decreased significantly after the operation which recovered significantly by 1 year after the operation. Maximum anal squeeze pressure showed no significant decrease after the operation. In most patients rectoanal inhibitory reflex was abolished after the operation, which recovered only in some cases by after 1 year. The group of short residual rectum(<4 cm, N=18) showed more impairment in continence and decrease in neorectal capacity and compliance than that of the long residual rectum(> or =4 cm, N=14). These results suggest impairment in fecal continence occurs due to decrease in rectal capacity, compliance, and anal canal pressure, and loss of rectoanal inhibitory reflex. Autonomic nerve preserving procedure could not prevent the decrease in resting anal pressure. Continence recovers clinically with increase in neorectal capacity, compliance and anal canal pressure but not with recovery of rectoanal inhibitory reflex. The length of the residual rectum seems to play an important role in the degree of impairment of continence and good continence can be expected when the residual rectum is more than 4 cm.

Evaluation of the Usefulness of Loop Ileostomy during Low Anterior Resection or.: Kim, Ho Young , Kim, Ik Yong , Kim, Sang Hee , Yoon, Kwang Soo; J Korean Soc Coloproctol. 1997;13(3):397-402.

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Abstract PDF: This is a retrospective clinical analysis of the usefulness of loop ileostomy for the prevention of anastomotic leakage in patients with low rectal cancer when the low anterior resection or coloanal anastomosis is performed. We reviewed 54 cases of low rectal cancer from January 1994 to May 1996 at Department of Surgery, Wonju College of Medicine, Yonsei University. In 54 cases of low rectal cancer, 28 cases were ileostomy group and 17 cases were no stoma group. There were no differences in clinical characteristics such as age and sex distribution. Most patients were classified into stage B or C by modified Astler-Coiler classification but 2 cases of stage D that simultaneous liver resection was performed were in no stoma group. Tumor locations from the anal verge were 6.8 and 10.3 cm by mean in ileostomy and no stomp group, respectively(P<0.05). Heights of anastomosis were 3.7 and 6.8 cm by mean from the anal verge in ileostomy and no stoma group, respectively(P<0.05). Double stapling technique was used for anastomosis in most patients but hand-sewn technique was also carried out in 1 case in ileostomy group. The most common postoperative minor complication was wound infection in both groups. Anastomotic leakage rate was higher in no stoma group(4 of 17, 23.5%) than that of ileostomy group (1 of 28, 3.6%) but statistical comparison could not be confirmed(P=0.00). But interestingly, such complications as stoma perforation, stoma prolapse and parastomal hernia were developed in ileostomy group and that all complications should be corrected by ileostomy repair. As forementioned above, we had concluded that ileostomy could protect anastomosis site but above mentioned complications associated with building the stoma should be also prevented by careful surgical technique.

Comparative Study of Sphincter Saving Resection and Abdominoperineal.: Yu, Chang Sik , Kim, Jin Cheon , chung, Hee Won , Lee, Han Il , Lee, Kang Hong; J Korean Soc Coloproctol. 1997;13(2):183-190.

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Abstract PDF: We compared the recurrence rate, survival and functional results of 159 low rectal cancer patients retrospectively, who had been performed 75 sphincter saving resections (SSR) and 84 abdomino-perineal resections(APR) during July 1989 to December 1994. The local recurrence rate was 9.3% in SSR and 8.3% in APR group, while systemic recurrence rate was 20.5% and 16.7%, respectively(p>0.05). Three year survival rate was 70% in SSR and 85% in APR group. Comparing with Dukes'stage, it was 69%, 89% in Dukes'B and 63%, 84% in Dukes'c stage, respectively(p>0.05). In respect to the number of metastatic lymph node,3 year survival rate was 80%,95% in Nl group(< OR =3 metastatic lymph nodes) and 61%,72% in N2 group(> OR =4 metastatic lymph nodes), respectively(p>0.05). According to the distal resection margin(DRM), it was 100% in group 1(1 cm< OR =DRM<2 cm), 63% in group 2(2 cm< OR =DRM < 3 cm) and 72% in group 3(DRM> OR = 3 cm), respectively(p>0.05). Voiding dysfunction was developed 36.0% of SSR and 28.6% of APR postoperatively. Erectile and ejaculatory dysfunction rate was 33.3%, 66.7% of SSR and 58.8%, 88.3% APR group respectively, There were no significant differences in recurrence rate, survival rate and functional results Between SSR and APR group. Conclusively, sphincter saving resection in low rectal cancer surgery did not seem to affect survival or recurrence. A good functional outcome in the SSR suggests it to be a procedure of choice, if possible.

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