Annals of Coloproctology

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Original Article

Colorectal cancer

Is restrictive transfusion sufficient in colorectal cancer surgery? A retrospective study before and during the COVID-19 pandemic in Korea: Hyeon Kyeong Kim, Ho Seung Kim, Gyoung Tae Noh, Jin Hoon Nam, Soon Sup Chung, Kwang Ho Kim, Ryung-Ah Lee; Ann Coloproctol. 2023;39(6):493-501. Published online December 28, 2023; DOI: https://doi.org/10.3393/ac.2023.00437.0062

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Graphical Abstract Abstract PDF Supplementary Material: Purpose
Blood transfusion is one of the most common procedures used to treat anemia in colorectal surgery. Despite controversy regarding the adverse effects of blood products, surgeons have maintained standards for administering blood transfusions. However, this trend was restrictive during the COVID-19 pandemic because of a shortage of blood products. In this study, we conducted an analysis to investigate whether the restriction of blood transfusions affected postoperative surgical outcomes.
Methods
Medical records of 318 patients who underwent surgery for colon and rectal cancer at Ewha Womans University Mokdong Hospital between June 2018 and March 2022 were reviewed retrospectively. The surgical outcomes between the liberal and restrictive transfusion strategies in pre– and post–COVID-19 groups were analyzed.
Results
In univariate analysis, postoperative transfusion was associated with infectious complications (odds ratio [OR], 1.705; 95% confidence interval [CI], 1.015–2.865; P=0.044). However, postoperative transfusion was not an independent risk factor for the development of infectious complications in multivariate analysis (OR, 1.305; 95% CI, 0.749–2.274; P=0.348). In subgroup analysis, there was no significant association between infectious complications and the hemoglobin threshold level for the administration of a transfusion (OR, 1.249; 95% CI, 0.928–1.682; P=0.142).
Conclusion
During colorectal surgery, the decision to perform a blood transfusion is an important step in ensuring favorable surgical outcomes. According to the results of this study, restrictive transfusion is sufficient for favorable surgical outcomes compared with liberal transfusion. Therefore, modification of guidelines is suggested to minimize unnecessary transfusion-related side effects and prevent the overuse of blood products.

Case Report

Benign bowel disease

Perioperative considerations for acute appendicitis in patients with COVID-19 infection: two case reports: In-Kyeong Kim, Seung-jin Kwag, Han-Gil Kim, Young-Tae Ju, Seung-Jun Lee, Tae-Jin Park, Sang-Ho Jeong, Eun-Jung Jung, Jin-Kwon Lee; Ann Coloproctol. 2023;39(6):521-525. Published online December 7, 2021; DOI: https://doi.org/10.3393/ac.2021.00647.0092

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Abstract PDF: We report considerations related with surgery through 2 cases of acute apendicitis with COVID-19 infection. In November and December 2020, two patients infected with COVID-19 developed acute apendicitis and underwent emergency surgery. In case 1, an 84-year-old woman was asymptomatic and diagnosed with acute apendicitis on the 20th day of infection. She was discharged after surgery without complication. In contrast, case 2 was a 69-year-old male patient with pneumonia treated with antibiotics, steroids and remdesivir. After surgery, he was hospitalized for a long duration due to persistent pneumonia and wound complications. We should perform appendectomy in well-established negative pressure operating rooms, personal protective equipment, and protocols. Since the physical examination and blood tests were limited, image examination like computed tomography scan should be considered if acute apendicitis is suspected. If the patient has pneumonia before surgery, it can get worse after surgery, and complications such as wound infections can occur.

Original Articles

Special issue, Malignant disease, Rectal cancer,Colorectal cancer,Epidemiology & etiology

Has the COVID-19 Pandemic Caused Upshifting in Colorectal Cancer Stage?: Ji Ha Lim, Woo Yong Lee, Seong Hyeon Yun, Hee Cheol Kim, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park, Jung Kyong Shin; Ann Coloproctol. 2021;37(4):253-258. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2021.00269.0038

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99 Download
22 Web of Science
22 Citations

Abstract PDF

Purpose
Coronavirus disease 2019 (COVID-19) has affected many parts of daily life and healthcare, including cancer screening and diagnosis. The purpose of this study was to determine whether there was an upshift in the colorectal cancer stage at diagnosis due to delays related to the COVID-19 outbreak.
Methods
From January to June of each year from 2017 to 2020, a total of 3,229 patients who were first diagnosed with colorectal cancer were retrospectively reviewed. Those enrolled from 2017 to 2019 were classified as the ‘pre-COVID’ group, and those enrolled in 2020 were classified as the ‘COVID’ group. The primary outcome was the rate of stage IV disease at the time of diagnosis.
Results
There was no statistically significant difference in the proportion of stage IV patients between the pre-COVID and COVID groups (P=0.19). The median preoperative carcinoembryonic antigen level in the COVID group was higher than in the pre-COVID group in all stages (all P<0.05). In stage I, II patients who underwent radical surgery, the lymphatic invasion was more presented in COVID patients (P=0.009).
Conclusion
We did not find significant stage upshifting in colorectal cancer during the COVID-19 outbreak. However, there were more initially unresectable stage IV colorectal cancer patients with a low conversion rate to resectable status, and more patients had factors related to poor prognosis. These results may become more apparent over time, so it is vital not to neglect cancer screening to not delay the diagnosis during the COVID-19 epidemic.

Citations

Citations to this article as recorded by

The impact of extended invitation intervals on stage distribution of screen‐detected and interval cancer within the Dutch colorectal cancer screening program
Maria‐Alexandra Katsara, Danica van den Berg, Manon C. W. Spaander, Adriana J. van Vuuren, Evelien Dekker, Folkert J. van Kemenade, Iris D. Nagtegaal, Monique E. van Leerdam, Iris Lansdorp‐Vogelaar, Esther Toes‐Zoutendijk
International Journal of Cancer.2025; 157(2): 298. CrossRef
The COVID-19 pandemic and clinical characteristics of colorectal cancer: a multicenter retrospective study
Yoon Dae Han, Sung Uk Bae, Woo Ram Kim, Dae Ro Lim, Chang Woo Kim
Scientific Reports.2025;[Epub] CrossRef
Impact of the COVID-19 pandemic on the diagnosis, tumor characteristics, and survival outcomes of colorectal cancer: a retrospective cohort study
Enver Yarikkaya, Merve Cin, Sena Ecin-Demezoglu, Beste Noyan-Mod, Mert Mahsuni Sevinc, Yakup Bozkaya, Nevra Dursun-Kepkep
Annals of Saudi Medicine.2025; 45(3): 169. CrossRef
The impact of COVID-19 on patients diagnosed with melanoma, breast, and colorectal cancer
Danielle Hanuschak, Mallori DePiero, Melissa DeMoraes, Shamoore Bailly, Muni Rubens, Paul Lindeman, Michael Zinner, Geoffrey Young
The American Journal of Surgery.2024; 229: 36. CrossRef
The global pandemic's second deadly hit: cancer care
Emma Bradley, Magge Deepa
The American Journal of Surgery.2024; 229: 34. CrossRef
Trends in the Stage Distribution of Colorectal Cancer During the COVID-19 Pandemic in Japan: A Nationwide Hospital-claims Data Analysis
Masato Ota, Kohei Taniguchi, Mitsuhiro Asakuma, Sang-Woong Lee, Yuri Ito
Journal of Epidemiology.2024; 34(7): 356. CrossRef
Inadvertent laparoscopic lavage of perforated colon cancer: a systematic review
Mahir Gachabayov, Agon Kajmolli, Luis Quintero, Daniel M. Felsenreich, Dorin E. Popa, Dejan Ignjatovic, Roberto Bergamaschi
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Impact of the Sars-Cov-2 outbreak on the initial clinical presentation of new solid cancer diagnoses: a systematic review and meta-analysis
Simon Marty, Guillaume Lamé, Etienne Guével, Sonia Priou, Gilles Chatellier, Christophe Tournigand, Emmanuelle Kempf
BMC Cancer.2024;[Epub] CrossRef
Measuring the impact of COVID-19 on cancer survival using an interrupted time series analysis
Pascal Lambert, Katie Galloway, Allison Feely, Oliver Bucher, Piotr Czaykowski, Pamela Hebbard, Julian O Kim, Marshall Pitz, Harminder Singh, Maclean Thiessen, Kathleen M Decker
JNCI Cancer Spectrum.2024;[Epub] CrossRef
Decreased Positive Fecal Occult Blood Tests and Delayed Medical Presentation for Colorectal Cancer during the Initial COVID-19 Pandemic Period: A Single-center Experience
Tadataka Takagi, Fumikazu Koyama, Hiroyuki Kuge, Yosuke Iwasa, Takeshi Takei, Tomomi Sadamitsu, Kosuke Fujimoto, Suzuka Harada, Takashi Tamura, Goki Ejiri, Chihiro Yoshikawa, Masayuki Sho
Journal of the Anus, Rectum and Colon.2024; 8(3): 188. CrossRef
Impact of COVID-19 Pandemic on the Clinical and Pathologic Characteristics of Colorectal Cancer: A Retrospective Multicenter Study in South Korea
Jae Hyun Kang, Il Tae Son, Sang Nam Yoon, Jin Soo Ihm, Byung Mo Kang, Jong Kim
Cancer Management and Research.2024; Volume 16: 1131. CrossRef
The COVID-19 pandemic's impact on prostate cancer screening and diagnosis in Korea
Byeong Jin Kang, Kyung Hwan Kim, Hong Koo Ha
Kosin Medical Journal.2023; 38(3): 193. CrossRef
Measuring the impact of the COVID‐19 pandemic on colorectal cancer presentation: a retrospective comparative study
Kirsten Fullard, Daniel Steffens, Michael Solomon, Joo‐Shik Shin, Cherry Koh
ANZ Journal of Surgery.2023; 93(12): 2951. CrossRef
Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
In Ja Park
The Ewha Medical Journal.2023;[Epub] CrossRef
Colorectal Surgery in the COVID-19 Era: A Systematic Review and Meta-Analysis
Nikolaos Pararas, Anastasia Pikouli, Dimitrios Papaconstantinou, Georgios Bagias, Constantinos Nastos, Andreas Pikoulis, Dionysios Dellaportas, Panagis Lykoudis, Emmanouil Pikoulis
Cancers.2022; 14(5): 1229. CrossRef
Short-Term Impact of Temporary Shutdown of a University-Affiliated Hospital on Patients With Colorectal Cancer During the Coronavirus Disease 2019 Pandemic
Youn Young Park, Jaeim Lee, Kil-yong Lee, Seong Taek Oh
Journal of Korean Medical Science.2022;[Epub] CrossRef
Surgical safety in the COVID-19 era: present and future considerations
Young Il Kim, In Ja Park
Annals of Surgical Treatment and Research.2022; 102(6): 295. CrossRef
The effect of the COVID-19 pandemic on the outcomes of surgically treated colorectal diseases: a retrospective cohort study
Gülten Çiçek Okuyan, Melih Yıldırım
Annals of Surgical Treatment and Research.2022; 103(2): 104. CrossRef
Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic
Sami Akbulut, Abdirahman Sakulen Hargura, Ibrahim Umar Garzali, Ali Aloun, Cemil Colak
World Journal of Clinical Cases.2022; 10(26): 9228. CrossRef
Epidemiology, risk factors, and prevention of colorectal cancer
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
Journal of the Korean Medical Association.2022; 65(9): 549. CrossRef
Epidemiology, Risk Factors, and Prevention of Colorectal Cancer-An English Version
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 231. CrossRef
No evidence of delay in colorectal cancer diagnosis during the COVID-19 pandemic in Gwangju and Jeonnam, Korea
Hye-Yeon Kim, Min-Gyeong Kim, Mi-Ran Kang, Jeong-Ho Yang, Min-Ho Shin, Sun-Seog Kweon
Epidemiology and Health.2022; 44: e2022092. CrossRef

Special issue, Malignant disease, Rectal cancer,Colorectal cancer,Epidemiology & etiology

Modifications to Treatment Plan of Rectal Cancer in Response to COVID-19 at the Philippine General Hospital: Sofia Isabel T. Manlubatan, Marc Paul J. Lopez, Mark Augustine S. Onglao, Hermogenes J. Monroy III; Ann Coloproctol. 2021;37(4):225-231. Published online August 6, 2021; DOI: https://doi.org/10.3393/ac.2021.00381.0054

4,510 View
85 Download
6 Web of Science
6 Citations

Abstract PDF

Purpose
The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare resources worldwide. Despite the high number of cases, cancer management should remain one of the priorities of healthcare, as any delay would potentially cause disease progression.
Methods
This was an observational study that included nonmetastatic rectal cancer patients managed at the Philippine General Hospital from March 16 to May 31, 2020, coinciding with the lockdown. The treatment received and their outcomes were investigated.
Results
Of the 52 patients included, the majority were female (57.7%), belonging to the age group of 50 to 69 years (53.8%), and residing outside the capital (59.6%). On follow-up, 23.1% had no disease progression, 17.3% had local progression, 28.8% had metastatic progression, 19.2% have died, and 11.5% were lost to follow up. The initial plan for 47.6% patients was changed. Of the 21 patients with nonmetastatic disease, 2 underwent outright resection. The remaining 19 required neoadjuvant therapy. Eight have completed their neoadjuvant treatment, 8 are undergoing treatment, 2 had their treatment interrupted, and 1 has yet to begin treatment. Among the 9 patients who completed neoadjuvant therapy, only 1 was able to undergo resection on time. The rest were delayed, with a median time of 4 months. One has repeatedly failed to arrive for her surgery due to public transport limitations. There was 1 adjuvant chemotherapy-related mortality.
Conclusion
Delays in cancer management resulted in disease progression in several patients. Alternative neoadjuvant treatment options should be considered while taking into account oncologic outcomes, acceptable toxicity, and limitation of potential COVID-19 exposure.

Citations

Citations to this article as recorded by

Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
In Ja Park
The Ewha Medical Journal.2023;[Epub] CrossRef
Short-Term Impact of Temporary Shutdown of a University-Affiliated Hospital on Patients With Colorectal Cancer During the Coronavirus Disease 2019 Pandemic
Youn Young Park, Jaeim Lee, Kil-yong Lee, Seong Taek Oh
Journal of Korean Medical Science.2022;[Epub] CrossRef
Surgical safety in the COVID-19 era: present and future considerations
Young Il Kim, In Ja Park
Annals of Surgical Treatment and Research.2022; 102(6): 295. CrossRef
The effect of the COVID-19 pandemic on the outcomes of surgically treated colorectal diseases: a retrospective cohort study
Gülten Çiçek Okuyan, Melih Yıldırım
Annals of Surgical Treatment and Research.2022; 103(2): 104. CrossRef
Epidemiology, risk factors, and prevention of colorectal cancer
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
Journal of the Korean Medical Association.2022; 65(9): 549. CrossRef
Epidemiology, Risk Factors, and Prevention of Colorectal Cancer-An English Version
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 231. CrossRef

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