Annals of Coloproctology

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Original Article

Colorectal cancer

Effects of clinical information on the treatment decisions for good responders to neoadjuvant chemoradiotherapy among rectal cancer patients: Eon Bin Kim, In Ja Park, Hwa Jung Kim, Jong Keon Jang, Seong Ho Park, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu; Ann Coloproctol. 2025;41(5):473-482. Published online July 10, 2025; DOI: https://doi.org/10.3393/ac.2024.00276.0039

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Abstract PDF Supplementary Material: Purpose
The decision for treatment after neoadjuvant chemoradiotherapy (nCRT) in rectal cancer is intricately linked to tumor response and clinical parameters. This study was designed to elucidate determinants influencing treatment decisions for good responders to nCRT, while concurrently evaluating the ramifications of modifications in magnetic resonance imaging (MRI) tumor response evaluation protocols.
Methods
A survey was constructed with 5 cases of good responder after nCRT based on the magnetic resonance–based tumor regression grade (mrTRG) criteria. A total of 35 colorectal surgeons in Korea participated in the survey via email, and they were introduced to 2 discrete MRI-based tumor response evaluation methodologies: the conventional mrTRG and an emergent complete response (CR)/non-CR classification system. Surgeons were directed to select between total mesorectal excision, local excision, or a watch and wait strategy.
Results
Treatment decisions varied significantly (P<0.01), as gradually more clinical information was provided with mrTRG. The paradigm shift from mrTRG to CR/non-CR evaluation criterion instigated the highest alteration in decision (P<0.01). Even comparing with other sets of information, decision change with different tumor response assessment (i.e., mrTRG vs. CR/non-CR) was statistically significant (P<0.01). Three particular cases consistently displayed a declining predilection for total mesorectal excision, favoring a more pronounced inclination towards watch and wait strategy or local excision. Nonetheless, the magnitude of these decisional shifts oscillated depending on the specific endoscopic imagery present.
Conclusion
Our current findings underscore the significant role of tumor response assessment methods in shaping treatment decisions for rectal cancer patients who respond well to nCRT. This highlights the need for clear and accurate tools to interpret MRI results.

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

Citations to this article as recorded by

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

Colorectal cancer

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

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Abstract PDF

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

Citations

Citations to this article as recorded by

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

Efficacy of preoperative chemoradiotherapy in patients with cT2N0 distal rectal cancer: Min Young Park, Chang Sik Yu, Tae Won Kim, Jong Hoon Kim, Jin-hong Park, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2023;39(3):250-259. Published online April 4, 2022; DOI: https://doi.org/10.3393/ac.2022.00066.0009

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
This study was designed to determine the feasibility of preoperative chemoradiotherapy (PCRT) in patients with clinical T2N0 distal rectal cancer.
Methods
Patients who underwent surgery for clinical T2N0 distal rectal cancer between January 2008 and December 2016 were included. Patients were divided into PCRT and non-PCRT groups. Non-PCRT patients underwent radical resection or local excision (LE) according to the surgeon’s decision, and PCRT patients underwent surgery according to the response to PCRT. Patients received 50.0 to 50.4 gray of preoperative radiotherapy with concurrent chemotherapy.
Results
Of 127 patients enrolled, 46 underwent PCRT and 81 did not. The mean distance of lesions from the anal verge was lower in the PCRT group (P=0.004). The most frequent operation was transanal excision and ultralow anterior resection in the PCRT and non-PCRT groups, respectively. Of the 46 patients who underwent PCRT, 21 (45.7%) achieved pathologic complete response, including 15 of the 24 (62.5%) who underwent LE. Rectal sparing rate was significantly higher in the PCRT group (11.1% vs. 52.2%, P<0.001). There were no significant differences in 3- and 5-year overall survival and recurrence-free survival regardless of PCRT or surgical procedures.
Conclusion
PCRT in clinical T2N0 distal rectal cancer patients increased the rectal sparing rate via LE and showed acceptable oncologic outcomes. PCRT may be a feasible therapeutic option to avoid abdominoperineal resection in clinical T2N0 distal rectal cancer.

Citations

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Lymph node metastasis following chemoradiotherapy in advanced rectal cancer: ypT2-focused analyses of total mesorectal excision specimens
A. N. Singhi, T.-G. Lee, H.-M. Ahn, H.-R. Shin, M. J. Choi, M. H. Jo, H.-K. Oh, D.-W. Kim, S.-B. Kang
Techniques in Coloproctology.2025;[Epub] CrossRef
Performance reporting design in artificial intelligence studies using image-based TNM staging and prognostic parameters in rectal cancer: a systematic review
Minsung Kim, Taeyong Park, Bo Young Oh, Min Jeong Kim, Bum-Joo Cho, Il Tae Son
Annals of Coloproctology.2024; 40(1): 13. 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
Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef
Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef

An investigation into tumor regression grade as a parameter for locally advanced rectal cancer and 5-year overall survival rate: Supparerk Laohawiriyakamol, Wongsakorn Chaochankit, Worawit Wanichsuwan, Kanet Kanjanapradit, Teeranan Laohawiriyakamol; Ann Coloproctol. 2023;39(1):59-70. Published online March 18, 2022; DOI: https://doi.org/10.3393/ac.2021.01011.0144

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Abstract PDF

Purpose
The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiation (nCRT) followed by surgery. Several parameters are associated with patient survival in LARC. One of these parameters is tumor regression grade (TRG); however, the significance of TRG remains controversial. In this study, we aimed to examine the correlations of TRG with 5-year overall (OS) and relapse-free survival (RFS) and identify other factors that influence the survival rates in LARC after nCRT followed by surgery.
Methods
This retrospective study included 104 patients diagnosed with LARC who underwent nCRT followed by surgery at Songklanagarind Hospital from January 2010 to December 2015. All patients received fluoropyrimidine-based chemotherapy at a total dose of 45.0 to 50.4 Gy in 25 daily fractions. Tumor response was evaluated using the 5-tier Mandard TRG classification. TRG was categorized into good (TRG 1–2) and poor (TRG 3–5) responses.
Results
TRG (classified by either the 5-tier classification system or the 2-group classification system) was not correlated with 5-year OS or RFS. The 5-year OS rates were 80.0%, 54.5%, 80.8%, and 67.4% in patients with TRG 1, 2, 3, and 4, respectively (P=0.22). Poorly differentiated rectal cancer and systemic metastasis were associated with poor 5-year OS. Intraoperative tumor perforation, poor differentiation, and perineural invasion were correlated with inferior 5-year RFS.
Conclusion
TRG was probably not associated with either 5-year OS or RFS; however, poor differentiation and systemic metastasis were strongly associated with poor 5-year OS.

Citations

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Is Mandard tumor regression grade scoring sufficient for locally advanced rectal cancer?
Buket Şahin Çelik, Aslı Geçgel, Erdem Göker
Medical Science and Discovery.2025; 12(1): 1. CrossRef
Risk score model for predicting local control and survival in patients with rectal cancer treated with neoadjuvant chemoradiotherapy
Tuba Kurt Catal, Günay Can, İsmai̇l Demi̇rel, Sefi̇ka Ergen, Di̇dem Öksüz
Oncology Letters.2025; 29(5): 1. CrossRef
Evaluation of pre-treatment F-18 FDG PET/CT according to Mandard classification in locally advanced rectal cancer patients undergoing neoadjuvant chemoradiotherapy
Feray Aras, Murtaza Parvizi, Olcay Ak Nalbant, Volkan Ozkol, Engin Kut
BMC Cancer.2025;[Epub] CrossRef
Performance reporting design in artificial intelligence studies using image-based TNM staging and prognostic parameters in rectal cancer: a systematic review
Minsung Kim, Taeyong Park, Bo Young Oh, Min Jeong Kim, Bum-Joo Cho, Il Tae Son
Annals of Coloproctology.2024; 40(1): 13. CrossRef
Risk-factors for locally advanced rectal cancer relapse after neoadjuvant chemoradiotherapy: A single center experience
Dragana Stupar, Saša Jungić, Zdenka Gojković, Jelena Berendika, Živojin Janičić
Medicine.2023; 102(44): e35519. CrossRef

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

Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review: Min Chul Kim, Jae Hwan Oh; Ann Coloproctol. 2021;37(6):382-394. Published online December 22, 2021; DOI: https://doi.org/10.3393/ac.2021.00913.0130

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Abstract PDF Supplementary Material

Purpose
We aimed to evaluate the surgicopathological outcomes of lateral pelvic lymph node dissection (LPLD) and long-term oncological outcomes of selective LPLD after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer and compare them to those of total mesorectal excision (TME) alone based on pretreatment magnetic resonance imaging (MRI).
Methods
We compared the TME-alone group (2001–2009, n=102) with the TME with LPLD group (2011–2016, n=69), both groups having lateral lymph nodes (LLNs) of ≥5 mm in short axis diameter. The surgicopathological outcomes were analyzed retrospectively. Oncological outcomes were analyzed using the Kaplan-Meier method.
Results
The rates of overall postoperative 30-day morbidity (42.0% vs. 26.5%, P=0.095) and urinary retention (13.7% vs. 10.1%, P=0.484) were not significantly different between the LPLD and TME-alone groups, respectively. Pathologically proven LLN metastasis was identified in 24 (34.8%) LPLD cases after nCRT. The LPLD group showed a lower 5-year local recurrence (LR) rate (27.9% vs. 4.6%, P<0.001) and better recurrence-free survival (RFS) (59.6% vs. 78.2%, P=0.008) than those of the TME-alone group, while the 5-year overall survival was not significantly different between the 2 groups (76.2% vs. 86.5%, P=0.094).
Conclusion
This study suggests that LPLD is a safe and feasible procedure. The oncological outcomes suggest that selective LPLD improves LR and RFS in patients with clinically suspicious LLNs on pretreatment MRI. Considering that lateral nodal disease is not common, a multicenter large-scale study is necessary.

Citations

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MRI-based scoring systems for selective lateral lymph node dissection in locally advanced low rectal cancer after neoadjuvant chemoradiotherapy
Min Jeong Cho, Kyunghwa Han, Hye Jung Shin, Woong Sub Koom, Kang Young Lee, Joo Hee Kim, Joon Seok Lim
European Radiology.2025; 35(8): 4967. CrossRef
Feasibility and limitations of combined treatment for lateral pelvic lymph node metastases in rectal cancer
Ying-Zi Zheng, Fang-Fang Yan, Lian-Xiang Luo
World Journal of Clinical Oncology.2024; 15(5): 591. CrossRef
Totally Extraperitoneal Approach for Recurrent Lateral Pelvic Lymph Nodes After Rectal Cancer Surgery
Tae-Gyun Lee, Hong-Min Ahn, Hye-Rim Shin, Mi Jeong Choi, Min Hyeong Jo, Heung-Kwon Oh, Duck-Woo Kim, Sung-Bum Kang
Diseases of the Colon & Rectum.2024; 67(6): e360. CrossRef
Identification of lateral pelvic nodes without metastasis in patients with rectal cancer treated with preoperative chemoradiotherapy or chemotherapy based on magnetic resonance imaging
Nobuaki Hoshino, Yudai Fukui, Kohei Ueno, Koya Hida, Kazutaka Obama, Kazuhiro Sakamoto, Hirotoshi Kobayashi, Michio Itabashi, Soichiro Ishihara, Kazushige Kawai, Yoichi Ajioka
Annals of Gastroenterological Surgery.2024; 8(5): 732. CrossRef
Survival analysis in rectal cancer patients after lateral lymph node dissection: Exploring the necessity of nCRT for suspected lateral lymph node metastasis
Jiafei Liu, Peishi Jiang, Zhichun Zhang, Hongjie Yang, Yuanda Zhou, Peng Li, Qingsheng Zeng, Xipeng Zhang, Yi Sun
Current Problems in Surgery.2024; 61(8): 101525. CrossRef
Clinical outcomes of neoadjuvant chemoradiotherapy followed by total mesorectal excision in locally advanced rectal cancer with mesorectal fascia involvement
Jeong Ha Lee, Nalee Kim, Jeong Il Yu, Gyu Sang Yoo, Hee Chul Park, Woo-Yong Lee, Seong Hyeon Yun, Hee Cheol Kim, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park, Jung Kyong Shin, Joon Oh Park, Seung Tae Kim, Young Suk Park, Jeeyun Lee, Won Ki Kang
Radiation Oncology Journal.2024; 42(2): 130. CrossRef
Literature research on the low rectal cancer complicated with lateral pelvic lymph node metastasis
Miao He, Jing Fan
Asian Journal of Surgery.2024; 47(10): 4575. CrossRef
Innovációk a colorectalis sebészetben
Balázs Bánky, András Fülöp, Viktória Bencze, Lóránd Lakatos, Petra Rozman, Attila Szijártó
Orvosi Hetilap.2024; 165(2): 43. CrossRef
Meta-analysis of the efficacy and safety of robot-assisted comparative laparoscopic surgery in lateral lymph node dissection for rectal cancer
Hao Shi, Xianhao Yi, Xin Yan, Wenjie Wu, Hui Ouyang, Chengke Ou, Xiangheng Chen
Surgical Endoscopy.2024; 38(10): 5584. CrossRef
The Role of Lateral Pelvic Lymph Node Dissection in Middle and Lower Rectal Cancer (Stage II or III): A Literature Review
Alexandra-Eleftheria Menni, Georgios Tzikos, Patroklos Goulas, Stylianos Apostolidis
Cureus.2024;[Epub] CrossRef
Lateral pelvic lymph node positivity (LPLNP) score: predictive clinic-radiological model of lateral pelvic lymph node involvement in rectal cancer patients
Petr Tsarkov, Vladimir Balaban, Harutyun Babajanyan, Abe Fingerhut, Inna Tulina, Mingze He
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Short-term outcomes of 47 selective laparoscopic lymph node dissection for rectal cancer: A retrospective study
Xiajuan Xue, Shuijie Lin, Qunzhang Zeng, Yincong Guo
Medicine.2024; 103(43): e39684. CrossRef
Fluorescence-guided colorectal surgery: applications, clinical results, and protocols
Jin-Min Jung, In Ja Park, Eun Jung Park, Gyung Mo Son
Annals of Surgical Treatment and Research.2023; 105(5): 252. CrossRef
Development of a Diagnostic Artificial Intelligence Tool for Lateral Lymph Node Metastasis in Advanced Rectal Cancer
Kosuke Ozaki, Yusuke Kurose, Kazushige Kawai, Hirotoshi Kobayashi, Michio Itabashi, Yojiro Hashiguchi, Takuya Miura, Akio Shiomi, Tatsuya Harada, Yoichi Ajioka
Diseases of the Colon & Rectum.2023; 66(12): e1246. CrossRef
Advances in the Treatment of Colorectal Cancer with Peritoneal Metastases: A Focus on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Youngbae Jeon, Eun Jung Park
The Ewha Medical Journal.2023;[Epub] CrossRef
Clinical Implication of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy
In Ja Park
The Ewha Medical Journal.2022; 45(1): 3. CrossRef
Current status and role of robotic approach in patients with low-lying rectal cancer
Hyo Seon Ryu, Jin Kim
Annals of Surgical Treatment and Research.2022; 103(1): 1. CrossRef
Multidisciplinary treatment strategy for early colon cancer
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Korean Medical Association.2022; 65(9): 558. CrossRef
Robotic surgery for colorectal cancer
Sung Uk Bae
Journal of the Korean Medical Association.2022; 65(9): 577. CrossRef
Multidisciplinary Treatment Strategy for Early Colon Cancer: A Review-An English Version
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 203. 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
It Is a Pleasure to Announce the Issue Titled “Master Class 2021” in Annals of Coloproctology
In Ja Park
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Case Reports

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

Late Recurrence in a Rectal Cancer Patient Who Underwent Preoperative Chemoradiotherapy Followed by Local Excision: A Case Report: Jin Soo Han, Seok-Byung Lim, Jin-hong Park, Yong Sang Hong; Ann Coloproctol. 2021;37(Suppl 1):S24-S27. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2020.00073.0010

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Abstract PDF

Some patients who have undergone preoperative chemoradiotherapy (CRT) following surgery have been diagnosed with late recurrence more than 5 years after treatment, raising questions about the possible benefit extending surveillance beyond the recommended 5 years. In 2011, a 71-year-old male patient was diagnosed with T3N+ low-lying rectal cancer located 3 cm from the anal verge before undergoing long-course preoperative CRT. After CRT, the patient was reexamined and diagnosed with ycT1–2N0 lesion, so local excision (LE) was performed. The patient underwent intensive surveillance for up to 5 years, and no evidence of recurrence was found. At 74 months after surgery, the patient was hospitalized for a hematochezia, and local recurrence at the excision site and peritoneal seeding nodules were identified. Considering the late recurrence in this patient, it might be necessary to long-term follow-up beyond 5 years in patients with preoperative CRT followed by LE.

Citations

Citations to this article as recorded by

Effects of clinical information on the treatment decisions for good responders to neoadjuvant chemoradiotherapy among rectal cancer patients
Eon Bin Kim, In Ja Park, Hwa Jung Kim, Jong Keon Jang, Seong Ho Park, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu
Annals of Coloproctology.2025; 41(5): 473. CrossRef
Coccygodynia in a Long-Term Cancer Survivor Diagnosed with Metastatic Cancer: A Case Report
Jung Hyun Park, Seong Jin Park, Dulee Kim, Jae Hoo Park, So Young Kwon
Medicina.2024; 60(8): 1365. CrossRef

Benign GI diease,Rare disease & stoma,Complication

Acute Ileal Perforation Caused by Radiation Enteritis After Restoration: Jong Beom Kim, Jong Lyul Lee, Seong Ho Park, Jihun Kim, Jin Cheon Kim; Ann Coloproctol. 2021;37(Suppl 1):S51-S54. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.07.30

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Abstract PDF

Few radiation-induced bowel perforations have been reported to date. Furthermore, perforation after ileal restoration in asymptomatic patients is rare. We report the case of a 61-year-old man who was administered preoperative chemoradiotherapy for advanced rectal cancer. The patient underwent ultra-low anterior resection with ileal diversion, followed by ileal restoration. Perforation was detected 9 days after restoration, and he underwent a right hemicolectomy. The histologic evaluation indicated ileal perforation caused by acute radiation enteritis.

Citations

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MR Imaging of Anal Cancer
Josip Nincevic, Gaiane M. Rauch, Jennifer S. Golia Pernicka
Radiologic Clinics of North America.2025; 63(3): 435. CrossRef
Pathological classification of chronic radiation-induced intestinal injury and its clinical implications
Yi-Ting Wang, Ya-Xi Zhu, Rui-Yan Huang, Yan Huang, Xiang-Bo Wan, Xiao-Yan Huang, Qing-Hua Zhong, Qi-Yuan Qin, Yun-Long Wang, Teng-Hui Ma, Xin-Juan Fan
Gastroenterology Report.2025;[Epub] CrossRef
Potential applications of drug delivery technologies against radiation enteritis
Dongdong Liu, Meng Wei, Wenrui Yan, Hua Xie, Yingbao Sun, Bochuan Yuan, Yiguang Jin
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Analysis of the incidence and influencing factors of sarcopenia in elderly patients with radiation enteritis
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Original Article

Malignant disease, Rectal cancer,Prognosis and adjuvant therapy

Beware of Early Relapse in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy: Seul Gi Oh, In Ja Park, Ji-hyun Seo, Young Il Kim, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2020;36(6):382-389. Published online June 17, 2020; DOI: https://doi.org/10.3393/ac.2020.06.11

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Abstract PDF

Purpose
Recurrence patterns in rectal cancer patients treated with preoperative chemoradiotherapy (PCRT) are needed to evaluate for establishing tailored surveillance protocol.
Methods
This study included 2,215 patients with locally-advanced mid and low rectal cancer treated with radical resection between January 2005 and December 2012. Recurrence was evaluated according to receipt of PCRT; PCRT group (n = 1,258) and no-PCRT group (n = 957). Early recurrence occurred within 1 year of surgery and late recurrence after 3 years. The median follow-up duration was 65.7 ± 29 months.
Results
The overall recurrence rate was similar between the PCRT and no-PCRT group (25.8% vs. 24.9%, P = 0.622). The most common initial recurrence site was the lungs in both groups (50.6% vs. 49.6%, P = 0.864), followed by the liver, which was more common in the no-PCRT group (22.5% vs. 33.6%, P = 0.004). Most of the recurrence occurred within 3 years after surgery in both groups (85.3% vs. 85.8%, P = 0.862). Early recurrence was more common in the PCRT group than in the no-PCRT group (43.1% vs. 32.4%, P = 0.020). Recurrence within the first 6 months after surgery was significantly higher in the PCRT group than in the no-PCRT group (18.8% vs. 7.6%, P = 0.003). Lung (n = 27, 44.3%) and liver (n = 22, 36.1%) were the frequent the first relapsed site within 6 months after surgery in PCRT group.
Conclusion
Early recurrence within the first 1 year after surgery was more common in patients treated with PCRT. This difference would be considered for surveillance protocols and need to be evaluated in further studies.

Citations

Citations to this article as recorded by

Efficacies of radiotherapy in rectal cancer patients treated with total mesorectal excision or other types of surgery: an updated meta-analysis
Wenshu Wang, Runyuan Zhao, Xi Liang, Manjun Liu, Haiyan Bai, Jianli Ge, Binxi Yao, Zheng Zhi, Jianming He
Oncology Reviews.2025;[Epub] CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Update on Diagnosis and Treatment of Colorectal Cancer
Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
The watch-and-wait strategy versus radical resection for rectal cancer patients with a good response (≤ycT2) after neoadjuvant chemoradiotherapy
Chungyeop Lee, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Annals of Surgical Treatment and Research.2022; 103(6): 350. CrossRef
Optimal Postoperative Surveillance Strategies for Colorectal Cancer: A Retrospective Observational Study
Min-Young Park, In-Ja Park, Hyo-Seon Ryu, Jay Jung, Min-Sung Kim, Seok-Byung Lim, Chang-Sik Yu, Jin-Cheon Kim
Cancers.2021; 13(14): 3502. CrossRef
Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(19): 4823. CrossRef
Shifting Treatment Strategies to Prevent Early Relapse of Locally Advanced Rectal Cancer After Preoperative Chemoradiotherapy
Eun Jung Park
Annals of Coloproctology.2020; 36(6): 357. CrossRef

Current Practice in Asia-Pacific Region

Malignant disease, Rectal cancer

Current Status of “Watch-and-Wait” Rectal Cancer Treatment in Asia-Pacific Countries: Jung Wook Huh, Kotaro Maeda, Zheng Liu, Xishan Wang, April Camilla Roslani, Woo Yong Lee; Ann Coloproctol. 2020;36(2):70-77. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2020.01.19

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Abstract PDF

Purpose
Current acceptance of the watch-and-wait (W&W) approach by surgeons in Asia-Pacific countries is unknown. An international survey was performed to determine status of the W&W approach on behalf of the Asia-Pacific Federation of Coloproctology (APFCP).
Methods
Surgeons in the APFCP completed an Institutional Review Board-approved anonymous e-survey and/or printed letters (for China) containing 19 questions regarding nonsurgical close observation in patients who achieved clinical complete response (cCR) to neoadjuvant chemoradiotherapy (nCRT).
Results
Of the 417 responses, 80.8% (n = 337) supported the W&W approach and 65.5% (n = 273) treated patients who achieved cCR after nCRT. Importantly, 78% of participants (n = 326) preferred a selective W&W approach in patients with old age and medical comorbidities who achieved cCR. In regard to restaging methods after nCRT, the majority of respondents based their decision to use W&W on a combination of magnetic resonance imaging results (94.5%, n = 394) with other test results. For interval between nCRT completion and tumor response assessment, most participants used 8 weeks (n = 154, 36.9%), followed by 6 weeks (n = 127, 30.5%) and 4 weeks (n = 102, 24.5%). In response to the question of how often responders followed-up after W&W, the predominant period was every 3 months (209 participants, 50.1%) followed by every 2 months (75 participants, 18.0%). If local regrowth was found during follow-up, most participants (79.9%, n = 333) recommended radical surgery as an initial management.
Conclusion
The W&W approach is supported by 80% of Asia-Pacific surgeons and is practiced at 65%, although heterogeneous hospital or society protocols are also observed. These results inform oncologists of future clinical study participation.

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Effects of clinical information on the treatment decisions for good responders to neoadjuvant chemoradiotherapy among rectal cancer patients
Eon Bin Kim, In Ja Park, Hwa Jung Kim, Jong Keon Jang, Seong Ho Park, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu
Annals of Coloproctology.2025; 41(5): 473. CrossRef
Patient and multidisciplinary team perspectives on watch and wait in rectal cancer
Helen Mohan, Mohammed Rabie, Ciaran Walsh, Deena Harji, Paul Sutton, Ian Geh, Ian Jackson, Emma Helbren, Martyn Evans, John T. Jenkins
Colorectal Disease.2023; 25(7): 1489. CrossRef
Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef
International Society of University Colon and Rectal Surgeons survey of surgeons’ preference on rectal cancer treatment
Audrius Dulskas, Philip F. Caushaj, Domas Grigoravicius, Liu Zheng, Richard Fortunato, Joseph W. Nunoo-Mensah, Narimantas E. Samalavicius
Annals of Coloproctology.2023; 39(4): 307. CrossRef
Clinical Implication of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy
In Ja Park
The Ewha Medical Journal.2022; 45(1): 3. CrossRef
Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Surgical treatment for metastatic colorectal cancer
Eun Jung Park, Seung Hyuk Baik
Journal of the Korean Medical Association.2022; 65(9): 568. CrossRef
Correlation between T stage and lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy
Seijong Kim, Jung Wook Huh, Woo Yong Lee, Seong Hyeon Yun, Hee Cheol Kim, Yong Beom Cho, Yoonah Park, Jung Kyong Shin
Therapeutic Advances in Medical Oncology.2022;[Epub] CrossRef
Recent Advance in the Surgical Treatment of Metastatic Colorectal Cancer-An English Version
Eun Jung Park, Seung Hyuk Baik
Journal of the Anus, Rectum and Colon.2022; 6(4): 213. CrossRef
Update on Diagnosis and Treatment of Colorectal Cancer
Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
The watch-and-wait strategy versus radical resection for rectal cancer patients with a good response (≤ycT2) after neoadjuvant chemoradiotherapy
Chungyeop Lee, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Annals of Surgical Treatment and Research.2022; 103(6): 350. CrossRef
Contemporary snapshot of tumor regression grade (TRG) distribution in locally advanced rectal cancer: a cross sectional multicentric experience
Paola Germani, Francesca Di Candido, Daniel Léonard, Dajana Cuicchi, Ugo Elmore, Marco Ettore Allaix, Vittoria Pia Barbieri, Laura D’Allens, Seraina Faes, Marika Milani, Damiano Caputo, Carmen Martinez, Jan Grosek, Valerio Caracino, Niki Christou, Sapho X
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Current Colorectal Cancer Reports.2021; 17(2): 23. CrossRef
Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
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Original Articles

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

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Abstract PDF

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

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The Benefits of Adjuvant Chemotherapy for ypT3-4N0M0 Rectal Cancer Following Neoadjuvant Chemoradiation and Surgery
Chih-Hsien Chang, Hung-Hsin Lin, Shih-Ching Chang, Jeng-Kai Jiang, Huann-Sheng Wang, Yuan-Tzu Lan
Clinical Medicine Insights: Oncology.2025;[Epub] CrossRef
Adjuvant chemotherapy in locally advanced rectal cancer after neo-adjuvant concurrent chemoradiotherapy and surgery: A retrospective study in Vietnamese patients
Thang Tran, Huy Van Nguyen, Hoa Thi Nguyen, Hung Van Nguyen
Annals of Medicine & Surgery.2023; 85(9): 4234. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef

Sensitivity of Various Evaluating Modalities for Predicting a Pathologic Complete Response After Preoperative Chemoradiation Therapy for Locally Advanced Rectal Cancer: Sungwoo Jung, Anuj Parajuli, Chang Sik Yu, Seong Ho Park, Jong Seok Lee, Ah Young Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2019;35(5):275-281. Published online October 31, 2019; DOI: https://doi.org/10.3393/ac.2019.01.07

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Abstract PDF

Purpose
We investigated the sensitivity of various evaluating modalities in predicting a pathologic complete response (pCR) after preoperative chemoradiation therapy (PCRT) for locally advanced rectal cancer (LARC).
Methods
From a population of 2,247 LARC patients who underwent PCRT followed by surgery at Asan Medical Center, Seoul, Korea from January 2007 to June 2016, we retrospectively analyzed 313 patients (14.1%) who showed a pCR after surgery. Transrectal ultrasound (TRUS), high-resolution magnetic resonance imaging (MRI), abdominopelvic computed tomography (AP-CT), and endoscopy were performed within 2 weeks prior to surgery.
Results
Of the 313 patients analyzed, 256 (81.8%) had a pCR after radical surgery and 57 (18.2%) showed total regression after local excision. Preoperative TRUS, MRI, and AP-CT were performed in 283, 305, and 139 patients, respectively. Among these 3 groups, a prediction of a pCR of the primary tumor was made in 41 (14.5%), 51 (16.7%), and 27 patients (19.4%), respectively, before surgery. A prediction of a clinical N0 stage was made in 204 patients (88.3%) using TRUS, 130 (52.2%) using MRI, and 78 (65.5%) using AP-CT. Of the 211 patients who underwent endoscopy, 87 (41.2%) had a mention of clinical CR in their records. A prediction of a pathologic CR was made for 124 patients (39.6%) through at least one diagnostic modality.
Conclusion
The various evaluation methods for predicting a pCR after PCRT show a predictive sensitivity of 0.15–0.41 for primary tumors and 0.52–0.88 for lymph nodes. Endoscopy is a relatively superior modality for predicting the pCR of the primary tumor of LARC patients.

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Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(19): 4823. CrossRef
Predicting Neoadjuvant Chemoradiotherapy Response in Locally Advanced Rectal Cancer Using Tumor-Infiltrating Lymphocytes Density
Yao Xu, Xiaoying Lou, Yanting Liang, Shenyan Zhang, Shangqing Yang, Qicong Chen, Zeyan Xu, Minning Zhao, Zhenhui Li, Ke Zhao, Zaiyi Liu
Journal of Inflammation Research.2021; Volume 14: 5891. CrossRef
A Nine-Gene Signature for Predicting the Response to Preoperative Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer
In Ja Park, Yun Suk Yu, Bilal Mustafa, Jin Young Park, Yong Bae Seo, Gun-Do Kim, Jinpyo Kim, Chang Min Kim, Hyun Deok Noh, Seung-Mo Hong, Yeon Wook Kim, Mi-Ju Kim, Adnan Ahmad Ansari, Luigi Buonaguro, Sung-Min Ahn, Chang-Sik Yu
Cancers.2020; 12(4): 800. CrossRef

Combination Assessment of Clinical Complete Response of Patients With Rectal Cancer Following Chemoradiotherapy With Endoscopy and Magnetic Resonance Imaging: Hye Mi Ko, Yo Han Choi, Jeong Eun Lee, Kyung Ha Lee, Ji Yeon Kim, Jin Soo Kim; Ann Coloproctol. 2019;35(4):202-208. Published online August 31, 2019; DOI: https://doi.org/10.3393/ac.2018.10.15

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Abstract PDF

Purpose
The response to neoadjuvant chemoradiotherapy (CRT) for rectal cancer can be assessed using digital rectal examination, endoscopy and magnetic resonance imaging (MRI). Precise assessment of clinical complete response (CR) after CRT is essential when deciding between optimizing surgery or organ-preserving treatment. The objectives of this study were to correlate the CR finding in endoscopy and MRI with pathologic CR and to determine the appropriate approach for combining endoscopy and MRI to predict the pathologic CR in patients with rectal cancer after neoadjuvant CRT.
Methods
This retrospective cohort study included 102 patients with rectal cancer who underwent endoscopy and MRI at 2–4 weeks after CRT. We assigned a confidence level (1–4) for the endoscopic and MRI assessments. Accuracy, sensitivity, and specificity were analyzed based on the endoscopy, MRI, and combination method findings. Diagnostic modalities were compared using the likelihood ratios.
Results
Of 102 patients, 17 (16.7%) had a CR. The accuracy, sensitivity, and specificity for the prediction CR of endoscopy with biopsy were 85.3%, 52.9%, and 91.8%, while those of MRI were 91.2%, 70.6%, and 95.3%, and those of combined endoscopy and MRI were 89.2%, 52.9%, and 96.5%, respectively. No significant differences were noted in the sensitivity and specificity of any each modality. The prediction rate for CR of the combination method was 92.6% after the posttest probability test.
Conclusion
Our study demonstrated that combining the interpretation of endoscopy with biopsy and MRI could provide a good prediction rate for CR in patients with rectal cancer after CRT.

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Implementation of Organ Preservation for Locally Advanced Rectal Cancer in Canada: A National Survey of Clinical Practice
Megan Delisle, Victoria Ivankovic, Doris Goubran, Eliane Yvonne Paglicauan, Mariam Alsobaei, Nicole Alcasid, Mary Farnand, Kristopher Dennis
Current Oncology.2025; 32(6): 341. CrossRef
Validierung künstlicher Intelligenz für die Klassifizierung von Mastdarmkrebs während endoskopischer Chirurgie
Felix Aigner, David Duller, Christoph Skias, Gabriele Moitzi, Martin Mitteregger
coloproctology.2025; 47(5): 340. CrossRef
Endoscopic assessment of rectal cancer response after neoadjuvant chemoradiotherapy: A narrative literature review
Fotios Seretis, Antonia Panagaki, Paraskevas Gkolfakis, Georgios Tziatzios, Konstantina Paraskeva
World Journal of Clinical Oncology.2025;[Epub] CrossRef
Assessing Endoscopic Response in Locally Advanced Rectal Cancer Treated with Total Neoadjuvant Therapy: Development and Validation of a Highly Accurate Convolutional Neural Network
Hannah Williams, Hannah M. Thompson, Christina Lee, Aneesh Rangnekar, Jorge T. Gomez, Maria Widmar, Iris H. Wei, Emmanouil P. Pappou, Garrett M. Nash, Martin R. Weiser, Philip B. Paty, J. Joshua Smith, Harini Veeraraghavan, Julio Garcia-Aguilar
Annals of Surgical Oncology.2024; 31(10): 6443. CrossRef
Transanal endoscopic microsurgery after radiation or chemoradiation therapy for rectal cancer — peculiarities and results
A А. Nevolskikh, A. R. Brodskiy, V. A. Avdeenko, T. P. Pochuev, Yu. Yu. Mihaleva, T. P. Berezovskaya, R. F. Zibirov, S. A. Myalina, I. A. Orehov, L. O. Petrov, S. A. Ivanov, A. D. Kaprin
Koloproktologia.2024; 23(1): 82. CrossRef
Nonoperative management of rectal cancer
Hannah Williams, Christina Lee, Julio Garcia-Aguilar
Frontiers in Oncology.2024;[Epub] CrossRef
Diagnostic performance of MRI and endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy: a systematic review of the literature
Nicolai Egholt Munk, Peter Bondeven, Bodil Ginnerup Pedersen
Acta Radiologica.2023; 64(1): 20. CrossRef
Correlation of Tumor Response Between Flexible Sigmoidoscopy and Magnetic Resonance Imaging in Patients Undergoing Neoadjuvant Therapy for Locally Advanced Rectal Cancer: A Retrospective Review
Maria A. Rojas, Jose Cataneo, Marianne Gagnon-Konamna, Daniel J. Borsuk, Angela J. Jarzabek, Slawomir J. Marecik, John J. Park, Kunal Kochar
The American Surgeon™.2023; 89(6): 2595. CrossRef
Endoscopy and MRI for restaging early rectal cancer after neoadjuvant treatment
Rutger C. H. Stijns, Jeroen Leijtens, Eelco de Graaf, Simon P. Bach, Geerard Beets, Andre J. A. Bremers, Regina G. H. Beets‐Tan, Johannes H. W. de Wilt
Colorectal Disease.2023; 25(2): 211. CrossRef
Deep learning of endoscopic features for the assessment of neoadjuvant therapy response in locally advanced rectal cancer
Anqi Wang, Jieli Zhou, Gang Wang, Beibei Zhang, Hongyi Xin, Haiyang Zhou
Asian Journal of Surgery.2023; 46(9): 3568. CrossRef
MRI Evaluation of Complete and Near-Complete Response after Neoadjuvant Therapy in Patients with Locally Advanced Rectal Cancer
Anca-Raluca Popita, Cosmin Lisencu, Adriana Rusu, Cristian Popita, Calin Cainap, Alexandru Irimie, Liliana Resiga, Alina Munteanu, Zsolt Fekete, Radu Badea
Diagnostics.2022; 12(4): 921. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Early conformational changes at tumour bed and long term response after neoadjuvant therapy in locally-advanced rectal cancer
Inês Santiago, Maria-João Barata, Nuno Figueiredo, Oriol Parés, Celso Matos
European Journal of Radiology.2021; 140: 109742. CrossRef
Improvement in the Assessment of Response to Preoperative Chemoradiotherapy for Rectal Cancer Using Magnetic Resonance Imaging and a Multigene Biomarker
Eunhae Cho, Sung Woo Jung, In Ja Park, Jong Keon Jang, Seong Ho Park, Seung-Mo Hong, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(14): 3480. CrossRef
High-Resolution T2-Weighted MRI to Evaluate Rectal Cancer: Why Variations Matter
Kirsten L Gormly
Korean Journal of Radiology.2021; 22(9): 1475. CrossRef
Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(19): 4823. CrossRef
MRI T2-weighted sequences-based texture analysis (TA) as a predictor of response to neoadjuvant chemo-radiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC)
Filippo Crimì, Giulia Capelli, Gaya Spolverato, Quoc Riccardo Bao, Anna Florio, Sebastiano Milite Rossi, Diego Cecchin, Laura Albertoni, Cristina Campi, Salvatore Pucciarelli, Roberto Stramare
La radiologia medica.2020; 125(12): 1216. CrossRef
MRI Assessment of Complete Response to Preoperative Chemoradiation Therapy for Rectal Cancer: 2020 Guide for Practice from the Korean Society of Abdominal Radiology
Seong Ho Park, Seung Hyun Cho, Sang Hyun Choi, Jong Keon Jang, Min Ju Kim, Seung Ho Kim, Joon Seok Lim, Sung Kyoung Moon, Ji Hoon Park, Nieun Seo
Korean Journal of Radiology.2020; 21(7): 812. CrossRef
Watch and wait approach in rectal cancer: Current controversies and future directions
Fernando López-Campos, Margarita Martín-Martín, Roberto Fornell-Pérez, Juan Carlos García-Pérez, Javier Die-Trill, Raquel Fuentes-Mateos, Sergio López-Durán, José Domínguez-Rullán, Reyes Ferreiro, Alejandro Riquelme-Oliveira, Asunción Hervás-Morón, Felipe
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Oncologic Outcomes of Postoperative Chemoradiotherapy Versus Chemotherapy Alone in Stage II and III Upper Rectal Cancer: Ji Eun Yoon, Soo Young Lee, Han Duk Kwak, Seung Seop Yeom, Chang Hyun Kim, Jae Kyun Joo, Hyeong Rok Kim, Young Jin Kim; Ann Coloproctol. 2019;35(3):137-143. Published online June 30, 2019; DOI: https://doi.org/10.3393/ac.2018.09.28

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Abstract PDF

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

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Minyi He, Wuteng Cao, Qiulan He, Fujin Ye, Pinzhu Huang, Taixuan Wan, Huashan Liu, Xiaobin Zheng, Shuangling Luo, Liang Kang, Mian Chen, Liang Huang
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Zhiwei Ma, Jumei Zhou, Ke Liu, Sisi Chen, Qinghui Wu, Lin Peng, Wei Zhao, Suyu Zhu
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Which Definition of Upper Rectal Cancer Is Optimal in Selecting Stage II or III Rectal Cancer Patients to Avoid Postoperative Adjuvant Radiation?
Xian Hua Gao, Bai Zhi Zhai, Juan Li, Jean Luc Tshibangu Kabemba, Hai Feng Gong, Chen Guang Bai, Ming Lu Liu, Shao Ting Zhang, Fu Shen, Lian Jie Liu, Wei Zhang
Frontiers in Oncology.2021;[Epub] CrossRef
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Journal of Zhejiang University-SCIENCE B.2020; 21(7): 549. CrossRef

Oncologic Outcomes in Patients Who Undergo Neoadjuvant Chemoradiotherapy and Total Mesorectal Excision for Locally Advanced Rectal Cancer: A 14-Year Experience in a Single Institution: Min Jung Kim, Seung-Yong Jeong, Ji Won Park, Seung-Bum Ryoo, Sang Sik Cho, Ki Young Lee, Kyu Joo Park; Ann Coloproctol. 2019;35(2):83-93. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2019.04.22.1

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Abstract PDF

Purpose
This study evaluated the oncologic outcomes of locally advanced rectal cancer patients who underwent preoperative neoadjuvant chemoradiotherapy (CRT) followed by surgery and determined the prognostic significance of pathologic complete response (pCR).
Methods
Between January 2002 and December 2015, 580 patients with rectal cancer who underwent surgery after neoadjuvant CRT were identified. Survival according to tumor response to CRT and pathologic stage was analyzed using the Kaplan-Meier method, and the Cox proportional hazard model was used to identify factors associated with survival outcomes.
Results
A total of 111 patients (23.7%) achieved pCR while the other 469 patients showed residual disease. Patients with pCR had a lower pretreatment carcinoembryonic antigen level and earlier cT classification than those with residual disease. With a median follow-up of 78 months, disease-free survival (DFS) and overall survival (OS) were significantly better in the pCR group than in the residual disease group. The 5-year DFS and 5-year OS for patients with ypStage 0, I, II, or III were 92.5%, 85.1%, 72.2%, 54.3% (P < 0.001) and 94.5%, 91.0%, 83.1%, 69.3%, respectively (P < 0.001). Pathologic AJCC stage after CRT was the most statistically significant independent predictor of OS (HR, 6.97 [95% confidence interval, 3.16–15.39] for stage III vs. stage 0) and DFS (HR, 7.30 [95% confidence interval, 3.63–14.67] for stage III vs. stage 0).
Conclusion
Rectal cancer patients who achieved pCR showed improved survival compared to those with residual disease after preoperative CRT. Moreover, pCR was an independent indicator of OS and DFS, and pathologic AJCC stage was correlated with survival after preoperative CRT.

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Analysis of clinical and pathological prognostic factors of survival in rectal adenocarcinoma treated with preoperative radiochemotherapy
Sarhan Sydney Saad, Nora Forones, Gaspar Lopes Filho, Jaques Waisberg, Elesiario Caetano Júnior, Ricardo Artigiani-Neto, Delcio Matos
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Tae-Gyun Lee, Duck-Woo Kim, Hong-min Ahn, Hye-Rim Shin, Mi Jeong Choi, Min Hyeong Jo, Heung-Kwon Oh, Sung-Bum Kang
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Iulian M Slavu, Octavian Munteanu, Florin Filipoiu, Raluca Tulin, Anca Monica Macovei Oprescu , Ileana Dima, Iulian A Dogaru, Adrian Tulin
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Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
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Youngki Hong, Amandeep Ghuman, Keat Seong Poh, Dimitri Krizzuk, Arun Nagarajan, Sudha Amarnath, Juan J. Nogueras, Steven D. Wexner, Giovanna DaSilva
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From Total Mesorectal Excision to Organ Preservation for the Treatment of Rectal Cancer
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Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy: Chang Hyun Kim, Seung-Seop Yeom, Hand-Duk Kwak, Soo Young Lee, Jae Kyun Ju, Young Jin Kim, Hyeong Rok Kim; Ann Coloproctol. 2019;35(2):72-82. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2019.04.22

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Abstract PDF

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

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A Review of Neoadjuvant Therapy and the Watch-and-Wait Protocol in Rectal Cancer: Current Evidence and Future Directions
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Oncologic Outcomes Associated With MRI-detected Extramural Venous Invasion (mrEMVI) in Rectal Cancer
François Rouleau Fournier, Mohammad Ali K. Motamedi, Carl J. Brown, Terry Phang, Manoj J. Raval, Cameron J. Hague, Ahmer A. Karimuddin
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Watch and wait strategies for rectal cancer: A systematic review
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Are oncological long-term outcomes equal after laproscopic completed and converted laparoscopic converted rectal resection for cancer?
M. Finochi, B. Menahem, G. Lebreton, J. Lubrano, Y. Eid, A. Alves
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Reconsideration of the Safety of Laparoscopic Rectal Surgery for Cancer
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Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery: Byong Ho Jeon, Ui Sup Shin, Sun Mi Moon, Jung Il Choi, Mi-Sook Kim, Kie Hwan Kim, Se-Jin Sung; Ann Coloproctol. 2019;35(2):100-106. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2018.10.01

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Abstract PDF

Purpose
In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT).
Methods
Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors.
Results
The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145–0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061–4.985).
Conclusion
Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed.

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Circulating Markers of Systemic Inflammation, Measured After Completion of Neoadjuvant Therapy, Associated With Response in Locally Advanced Rectal Cancer
Ross K. McMahon, Sean M. O’Cathail, Colin W. Steele, Harikrishnan S. Nair, Jonathan J. Platt, Donald C. McMillan, Paul G. Horgan, Campbell S. Roxburgh
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Response Prediction to Neoadjuvant Chemoradiotherapy in Rectal Cancer Based on Systemic Inflammatory Markers (NLR, PLR, and LMR)
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Giuseppe Portale, Patrizia Bartolotta, Danila Azzolina, Dario Gregori, Valentino Fiscon
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NEUTROPHIL-LYMPHOCYTE RATIO (NLR) AND LYMPHOPENIAAS PROGNOSTIC FACTORS OF OVERALL SURVIVAL IN LOCALADVANCED RECTAL CANCER
Ocanto A, Morera R, Rodríguez I, Cantero R
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Yu-Ming Huang, Hsi-Hsien Hsu, Chien-Kuo Liu, Ching-Kuo Yang, Po-Li Tsai, Tzu-Yin Tang, Shih-Ming Hsu, Yu-Jen Chen
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Hytham K.S. Hamid, George N. Davis, Mario Trejo-Avila, Patrick O. Igwe, Andrés Garcia-Marín
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Early Systemic Failure After Preoperative Chemoradiotherapy for the Treatment of Patients With Rectal Cancer: Taesun Choi, Se-Jin Baek, Jung Myun Kwak, Jin Kim, Seon-Hahn Kim; Ann Coloproctol. 2019;35(2):94-99. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2018.08.28

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Abstract PDF

Purpose
Distant metastasis can occur early after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. This study was conducted to evaluate the clinical characteristics of patients who developed early systemic failure.
Methods
The patients who underwent neoadjuvant CRT for a rectal adenocarcinoma between June 2007 and July 2015 were included in this study. Patients who developed distant metastasis within 6 months after CRT were identified. We compared short- and long-term clinicopathologic outcomes of patients in the early failure (EF) group with those of patients in the control group.
Results
Of 107 patients who underwent neoadjuvant CRT for rectal cancer, 7 developed early systemic failure. The lung was the most common metastatic site. In the EF group, preoperative carcinoembryonic antigen was higher (5 mg/mL vs. 2 mg/mL, P = 0.010), and capecitabine as a sensitizer of CRT was used more frequently (28.6% vs. 3%, P = 0.002). Of the 7 patients in the EF group, only 4 underwent a primary tumor resection (57.1%), in contrast to the 100% resection rate in the control group (P < 0.001). In terms of pathologic outcomes, ypN and TNM stages were more advanced in the EF group (P < 0.001 and P = 0.047, respectively), and numbers of positive and retrieved lymph nodes were much higher (P < 0.001 and P = 0.027, respectively).
Conclusion
Although early distant metastasis after CRT for rectal cancer is very rare, patients who developed early metastasis showed a poor nodal response with a low primary tumor resection rate and poor oncologic outcomes.

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Characteristics of Patients Presented With Metastases During or After Completion of Chemoradiation Therapy for Locally Advanced Rectal Cancer: A Case Series
Radwan Torky, Mohammed Alessa, Ho Seung Kim, Ahmed Sakr, Eman Zakarneh, Fozan Sauri, Heejin Bae, Nam Kyu Kim
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Review

Lateral Lymph Node Dissection With the Focus on Indications, Functional Outcomes, and Minimally Invasive Surgery: Min Jung Kim, Jae Hwan Oh; Ann Coloproctol. 2018;34(5):229-233. Published online October 31, 2018; DOI: https://doi.org/10.3393/ac.2018.10.26

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Abstract PDF

The lateral lymph node dissection (LLND) is still a subject of great debate as to the appropriate treatment for patients with mid to low advanced rectal cancer. The guidelines of the Japanese Society for Cancer of the Colon and Rectum recommend a LLND for patients with T3/4 rectal cancer below the peritoneal reflection. However, in most Western countries, a routine LLND is not recommended unless a node or nodes are clinically suspicious for metastasis. Even after preoperative chemoradiotherapy (CRT), an 8% to 12% lateral pelvic recurrence was noted. The size of the lateral lymph node and responsiveness to preoperative CRT should be the main factors for selecting appropriate patients to undergo a LLND. In addition, from the recent literature, a laparoscopic LLND is safe and oncologically feasible and might have some advantages in short-term outcomes.

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Significant improvement after training in the assessment of lateral compartments and short-axis measurements of lateral lymph nodes in rectal cancer
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Katsuji Tokuhara, Hidehiko Hishikawa, Terufumi Yoshida, Yosuke Ueyama, Kazuhiko Yoshioka, Mitsugu Sekimoto
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Ryun Kyong Ha, Boram Park, Sung Chan Park, Hee Jin Chang, Jae Hwan Oh
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Brendan Zhen Yang Law, Zeneera Yusuf, Yu En Ng, Emad H. Aly
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Original Articles

Impact of Adjuvant Therapy Type on Survival in Stage II/III Rectal Cancer Without Preoperative Chemoradiation: A Korean Multicenter Retrospective Study: Byung Mo Kang, Jeong-Heum Baek, Sun Jin Park, Seong Kyu Baek, Ki-Jae Park, Hong-Jo Choi, Byung-Noe Bae, Sun Keun Choi, Kap Tae Kim, Jin-Su Kim, Suk-Hwan Lee; Ann Coloproctol. 2018;34(3):144-151. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.09.26.1

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Abstract PDF

Purpose
This study compared the oncologic impact of postoperative chemotherapy and chemoradiotherapy on patients with rectal cancer without preoperative chemoradiation.
Methods
This retrospective study analyzed 713 patients with a mean follow-up of 58 months who had undergone radical resection for stage II/III rectal cancer without preoperative treatment in nine hospitals from January 2004 to December 2009. The study population was categorized a chemotherapy group (CG, n = 460) and a chemoradiotherapy group (CRG, n = 253). Five-year overall survival (OS) and disease-free survival (DFS) were analyzed, and independent factors predicting survival were identified.
Results
The patients in the CRG were significantly younger (P < 0.001) and had greater incidences of low rectal cancer (P < 0.001) and stage III disease (P < 0.001). Five-year OS (P = 0.024) and DFS (P = 0.012) were significantly higher in the CG for stage II disease; however, they were not significantly different for stage III disease. In the multivariate analysis, independent predictive factors were male sex, low rectal cancer and stage III disease for OS and male sex, abdominoperineal resection, stage III disease and tumor-positive circumferential margin for DFS. However, adjuvant therapy type did not independently affect OS (hazard ratio [HR], 1.243; 95% confidence interval [CI], 0.794–1.945; P = 0.341) and DFS (HR, 1.091; 95% CI, 0.810–1.470; P = 0.566).
Conclusion
Adjuvant therapy type did not affect survival of stage II/III rectal cancer patients without neoadjuvant chemoradiotherapy. These results suggest that adjuvant therapy can be chosen based on the patient’s condition and the policies of the surgeons and hospital facilities.

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Wenshu Wang, Runyuan Zhao, Xi Liang, Manjun Liu, Haiyan Bai, Jianli Ge, Binxi Yao, Zheng Zhi, Jianming He
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Ilknur ALSAN CETIN, Sıtkı Utku AKAY
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Selection of Adjuvant Treatment Without Neoadjuvant Chemoradiotherapy for Patients With Rectal Cancer: Room for Further Investigation
In Ja Park
Annals of Coloproctology.2018; 34(3): 109. CrossRef

Difference in Tumor Area as a Predictor of a Pathological Complete Response for Patients With Locally Advanced Rectal Cancer: Ji Hyeong Song, Yo-Han Park, Sang Hyuk Seo, Anbok Lee, Kwang Hee Kim, Min Sung An, Ki Beom Bae, Kwan Hee Hong, Jin Won Hwang, Ji Hyun Kim, Hyun Seok Jung, Ki Jung Ahn; Ann Coloproctol. 2017;33(6):219-226. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.219

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Abstract PDF

Purpose

This study was conducted to discover the clinical factors that can predict pathologically complete remission (pCR) after neoadjuvant chemoradiotherapy (CRT), so that those factors may help in deciding on a treatment program for patients with locally advanced rectal cancer.

Methods

A total of 137 patients with locally advanced rectal cancer were retrospectively enrolled in this study, and data were collected retrospectively. The patients had undergone a total mesorectal excision after neoadjuvant CRT. Histologic response was categorized as pCR vs. non-pCR. The tumor area was defined as (tumor length) × (maximum tumor depth). The difference in tumor area was defined as pre-CRT tumor area – post-CRT tumor area. Univariate and multivariate logistic regression analyses were conducted to find the factors affecting pCR. A P-value < 0.05 was considered significant.

Results

Twenty-three patients (16.8%) achieved pCR. On the univariate analysis, endoscopic tumor circumferential rate <50%, low pre-CRT T & N stage, low post-CRT T & N stage, small pretreatment tumor area, and large difference in tumor area before and after neoadjuvant CRT were predictive factors of pCR. A multivariate analysis found that only the difference in tumor area before and after neoadjuvant CRT was an independent predictor of pCR (P < 0.001).

Conclusion

The difference in tumor area, as determined using radiologic tools, before and after neoadjuvant CRT may be important predictor of pCR. This clinical factor may help surgeons to determine which patients who received neoadjuvant CRT for locally advanced rectal cancer should undergo surgery.

Citations

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Particular aspects of treating rectal cancer: The watch and wait approach
Diana Andreea Draghici, Alexandru Rares Stoian, Vlad Andrei Porojan, Oana Ilona David, Ştefan Bedereag, Anda Natalia Ciuhu, Andrei Haidar, Dragoş Crețoiu, Carmen Elena Condrat, Valentin Titus Grigorean
Journal of Cancer Research and Therapeutics.2023; 19(2): 461. CrossRef
Predicting stage ypT0–1N0 for nonradical management in patients with middle or low rectal cancer who undergo neoadjuvant chemoradiotherapy: a retrospective cohort study
Jeehye Lee, In Jun Yang, Jung Wook Suh, Hong-min Ahn, Heung-Kwon Oh, Duck-Woo Kim, Young-Hoon Kim, Kyoung Ho Lee, Sung-Bum Kang
Annals of Surgical Treatment and Research.2022; 103(1): 32. CrossRef
Radiotherapy after local excision of rectal cancer may offer reduced local recurrence rates
H. J. S. Jones, S. Goodbrand, R. Hompes, N. Mortensen, C. Cunningham
Colorectal Disease.2019; 21(4): 451. CrossRef
‘Watch and wait’ in rectal cancer: summary of the current evidence
Jason On, Emad H Aly
International Journal of Colorectal Disease.2018; 33(9): 1159. CrossRef

Transanal Minimally-Invasive Surgery for Treating Patients With Regressed Rectal Cancer After Preoperative Chemoradiotherapy: Byoung Chul Lee, Seonok Oh, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2017;33(2):52-56. Published online April 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.2.52

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Abstract PDF

Purpose

Although the standard treatment for patients with locally advanced rectal cancer managed by preoperative chemoradiotherapy (CRT) is a radical resection, local excisions are used in highly-selective cases. Recently, transanal minimally-invasive surgery (TAMIS) has emerged as a feasible technique for local excision of midrectal lesions. We assess the feasibility of using TAMIS to treat patients with locally advanced rectal cancer who showed good response to CRT.

Methods

From October 2010 to June 2013, 35 consecutive patients with rectal cancer managed by using preoperative CRT underwent TAMIS. After a single-incision laparoscopic surgery port had been introduced into the anal canal, a full-thickness local excision with conventional laparoscopic instruments was performed. We retrospectively reviewed a prospectively collected database of these cases.

Results

Of the 35 patients analyzed, 18 showed pathologic complete responses and 17 had residual lesions (2 ypTis, 4 ypT1, 9 ypT2, and 2 ypT3); 34 (97.1%) showed clear deep, lateral margins. The median distance of lesions from the anal verge was 5 cm. All procedures were completed laparoscopically, and the median operating time was 84 minutes. No intraoperative events or morbidities were seen in any of the patients, except one with wound dehiscence, who was treated conservatively. The median postoperative hospital stay and follow-up period were 4 days and 36 months, respectively. During the study period, no patients died, but 5 (14.3%) experienced recurrence, including one recurrence at the TAMIS site.

Conclusion

TAMIS seems to be a feasible, safe modality for treating patients with locally advanced rectal cancer who show good response to preoperative CRT.

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Nurhilal Kızıltoprak, Jack Aaron, Camila Diez, Sam Atallah
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Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
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Transanal Minimally Invasive Surgery: A Promising Alternative for Certain Advanced Rectal Cancer Patients
Hernan A. Sanchez-Trejo, Daniel Hakakian, Terrence Curran, Luca Antonioli, Balazs Csoka, Zoltan H. Nemeth
Journal of Investigative Surgery.2019; 32(4): 377. CrossRef
Transanal minimally invasive surgery as a treatment option for a completely occluded anastomosis after low anterior resection: A new approach to severe anastomotic stenosis
Jun Woo Bong, Seok‐Byung Lim
Asian Journal of Endoscopic Surgery.2019; 12(2): 175. CrossRef
A systematic review and meta-analysis of pT2 rectal cancer spread and recurrence pattern: Implications for target design in radiation therapy for organ preservation
Joanna Socha, Lucyna Pietrzak, Anna Zawadzka, Anna Paciorkiewicz, Anna Krupa, Krzysztof Bujko
Radiotherapy and Oncology.2019; 133: 20. CrossRef
Transanal Minimally Invasive Surgery After Chemoradiotherapy: Widening Scope of Indications for Local Excision
Min Jung Kim, Jae Hwan Oh
Annals of Coloproctology.2017; 33(2): 43. CrossRef

Review

Overview of Radiation Therapy for Treating Rectal Cancer: Bong-Hyeon Kye, Hyeon-Min Cho; Ann Coloproctol. 2014;30(4):165-174. Published online August 26, 2014; DOI: https://doi.org/10.3393/ac.2014.30.4.165

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Abstract PDF

A major outcome of importance for rectal cancer is local control. Parallel to improvements in surgical technique, adjuvant therapy regimens have been tested in clinical trials in an effort to reduce the local recurrence rate. Nowadays, the local recurrence rate has been reduced because of both good surgical techniques and the addition of radiotherapy. Based on recent reports in the literature, preoperative chemoradiotherapy is now considered the standard of care for patients with stages II and III rectal cancer. Also, short-course radiotherapy appears to provide effective local control and the same overall survival as more long-course chemoradiotherapy schedules and, therefore, may be an appropriate choice in some situations. Capecitabine is an acceptable alternative to infusion fluorouracil in those patients who are able to manage the responsibilities inherent in self-administered, oral chemotherapy. However, concurrent administration of oxaliplatin and radiotherapy is not recommended at this time. Radiation therapy has long been considered an important adjunct in the treatment of rectal cancer. Although no prospective data exist for several issues, we hope that in the near future, patients with rectal cancer can be treated by using the best combination of surgery, radiation therapy, and chemotherapy in near future.

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Original Articles

A Phase II Study of Additional Four-Week Chemotherapy With Capecitabine During the Resting Periods After Six-Week Neoadjuvant Chemoradiotherapy in Patients With Locally Advanced Rectal Cancer: Kyung Ha Lee, Min Sang Song, Jun Boem Park, Jin Soo Kim, Dae Young Kang, Ji Yeon Kim; Ann Coloproctol. 2013;29(5):192-197. Published online October 31, 2013; DOI: https://doi.org/10.3393/ac.2013.29.5.192

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Abstract PDF

Purpose

The aim of this study is to evaluate the efficacy and the safety of additional 4-week chemotherapy with capecitabine during the resting periods after a 6-week neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer.

Methods

Radiotherapy was delivered to the whole pelvis at a total dose of 50.4 Gy for 6 weeks. Oral capecitabine was administered at a dose of 825 mg/m² twice daily for 10 weeks. Surgery was performed 2-4 weeks following the completion of chemotherapy.

Results

Between January 2010 and September 2011, 44 patients were enrolled. Forty-three patients underwent surgery, and 41 patients completed the scheduled treatment. Pathologic complete remission (pCR) was noted in 9 patients (20.9%). T down-staging and N down-staging were observed in 32 patients (74.4%) and 33 patients (76.7%), respectively. Grade 3 to 5 toxicity was noted in 5 patients (11.4%). The pCR rate was similar with the pCR rates obtained after conventional NCRT at our institute and at other institutes.

Conclusion

This study showed that additional 4-week chemotherapy with capecitabine during the resting periods after 6-week NCRT was safe, but it was no more effective than conventional NCRT.

Citations

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Locally Advanced Rectal Cancer: What We Learned in the Last Two Decades and the Future Perspectives
Vivek Srivastava, Aakansha Giri Goswami, Somprakas Basu, Vijay Kumar Shukla
Journal of Gastrointestinal Cancer.2023; 54(1): 188. CrossRef
The Effect of Continuing Chemotherapy after Chemoradiotherapy during the Time to Surgery on Tumor Response and Survival for Local Advanced Rectal Cancer
Atike Gökçen Demiray, Arzu Yaren, Uğur Sungurtekin, Papatya Bahar Baltalarlı, Neşe Demirkan, Duygu Herek, Burcu Yapar Taşköylü, Gamze Gököz Doğu, Serkan Değirmencioğlu, Utku Özgen, Halil Sağınç, Umut Çakıroğlu, Nail Özhan, Canan Karan, Burçin Çakan Demire
Journal of Oncology.2022; 2022: 1. CrossRef
Phase 2 Neoadjuvant Treatment Intensification Trials in Rectal Cancer: A Systematic Review
Mark T.W. Teo, Lucy McParland, Ane L. Appelt, David Sebag-Montefiore
International Journal of Radiation Oncology*Biology*Physics.2018; 100(1): 146. CrossRef
Efficacy and Safety of Low-Dose-Rate Endorectal Brachytherapy as a Boost to Neoadjuvant Chemoradiation in the Treatment of Locally Advanced Distal Rectal Cancer: A Phase-II Clinical Trial
Shapour Omidvari, Shadi Zohourinia, Mansour Ansari, Leila Ghahramani, Mohammad Zare-Bandamiri, Ahmad Mosalaei, Niloofar Ahmadloo, Saeedeh Pourahmad, Hamid Nasrolahi, Sayed Hasan Hamedi, Mohammad Mohammadianpanah
Annals of Coloproctology.2015; 31(4): 123. CrossRef
Additional Chemotherapy During Resting Periods After Preoperative Chemoradiotherapy in Patients With Rectal Cancer
Ok Suk Bae
Annals of Coloproctology.2013; 29(5): 178. CrossRef

Clinical Significance of Serial Serum Carcinoembryonic Antigen Values for Treating Rectal Cancer with Preoperative Chemoradiotherapy: Young Jae Ryu, Chang Hyun Kim, Hun Jin Kim, Hyo Kang, Sang Woo Lim, Jung Wook Huh, Jae Kyun Ju, Young Jin Kim, Hyeong Rok Kim; J Korean Soc Coloproctol. 2012;28(4):205-212. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.205

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Abstract PDF

Purpose

Preoperative chemoradiotherapy is now widely accepted to treat rectal cancer; however, the prognosis for rectal cancer patients during and after chemoradiotherapy must be determined. The aim of this study was to evaluate the serial serum carcinoembryonic antigen (s-CEA) samples in patients with rectal cancer who underwent radical surgery after concurrent chemoradiotherapy (CRT).

Methods

This study evaluated 236 patients with rectal cancer who received preoperative CRT followed by curative surgery between June 2005 and June 2010. We measured the patient's s-CEA levels pre-CRT, post-CRT and post-surgery. Patients were classified into four groups according to their s-CEA concentrations (group 1, high, high, high; group 2, high, high, normal; group 3, high, normal, normal; group 4, normal, normal, normal). We analyzed the clinicopathologic factors and the outcomes among these groups.

Results

Of the 236 patients, 12 were in group 1, 31 were in group 2, 67 were in group 3, and 126 were in group 4. The 3-year disease-free survival rate in group 1 was poorer than those in group 3 (P = 0.007) and group 4 (P < 0.001). In a univariate analysis, type of surgery, clinical N stage, pathologic T or N stage, lymphovascular invasion, perineural invasion, and CEA group were prognostic factors. A multivariate analysis revealed that type of surgery, pathologic T stage, and lymphovascular invasion were independent prognostic factors; however, no statistical significance was associated with the CEA group.

Conclusion

High pre-CRT, post-CRT, and post-surgery s-CEA levels in patients with rectal cancer were associated with high rates of systemic recurrence and poor survival. Therefore, patients with sustained high s-CEA levels during CRT require careful monitoring after surgery.

Citations

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Accessing new prognostic significance of preoperative carcinoembryonic antigen in colorectal cancer receiving tumor resection: More than positive and negative
Zerong Cai, Jian Xiao, Xiaosheng He, Jia Ke, Yifeng Zou, Yufeng Chen, Xianrui Wu, Xiaoling Li, Lei Wang, Jianping Wang, Ping Lan, Xiaojian Wu
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Prognosis Can Be Predicted More Accurately Using Pre- and Postchemoradiotherapy Carcinoembryonic Antigen Levels Compared to Only Prechemoradiotherapy Carcinoembryonic Antigen Level in Locally Advanced Rectal Cancer Patients Who Received Neoadjuvant Chemor
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YANTAO CAI, ZHENYANG LI, XIAODONG GU, YANTIAN FANG, JIANBIN XIANG, ZONGYOU CHEN
Oncology Letters.2014; 7(1): 10. CrossRef
Factors predicting long-term survival in colorectal cancer patients with a normal preoperative serum level of carcinoembryonic antigen
Jung Wook Huh, Chang Hyun Kim, Sang Woo Lim, Hyeong Rok Kim, Young Jin Kim
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Review

An Update on Preoperative Radiotherapy for Locally Advanced Rectal Cancer: Seung-Gu Yeo, Dae Yong Kim; J Korean Soc Coloproctol. 2012;28(4):179-187. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.179

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Abstract PDF

Even in patients undergoing an optimal surgical technique (e.g., total mesorectal excision), radiotherapy provides a significant benefit in the local control of rectal cancer. Compared with postoperative treatment, chemoradiotherapy given preoperatively has been shown to decrease local recurrence rates and toxicity. Additionally, preoperative chemoradiotherapy permits the early identification of tumor responses to this cytotoxic treatment by surgical pathology. Pathological parameters reflecting the tumor response to chemoradiotherapy have been shown to be surrogate markers for long-term clinical outcomes. Post-chemoradiotherapy downstaging from cStage II-III to ypStage 0-I indicates a favorable prognosis, with no difference between ypStage 0 and ypStage I. Research is ongoing to develop useful tools (clinical, molecular, and radiological) for clinical determination of the pathologic chemoradiotherapeutic response before surgery, and possibly even before preoperative treatment. In the future, risk-adapted strategies, including intensification of preoperative therapy, conservative surgery, or the selective administration of postoperative chemotherapy, will be realized for locally-advanced rectal cancer patients based on their response to preoperative chemoradiotherapy.

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Seven low-mass ions in pretreatment serum as potential predictive markers of the chemoradiotherapy response of rectal cancer
Kangsan Roh, Seung-Gu Yeo, Byong Chul Yoo, Kyung-Hee Kim, Sun Young Kim, Min-Jeong Kim
Anti-Cancer Drugs.2016; 27(8): 787. CrossRef
Preoperative chemoradiotherapy followed by transanal local excision for T3 distal rectal cancer: A case report
SEUNG-GU YEO
Experimental and Therapeutic Medicine.2016; 11(4): 1465. CrossRef
Clinical Outcomes of Local Excision Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer
Nam Kwon Lee, Dae Yong Kim, Sun Young Kim, Jae Hwan Oh, Won Park, Doo Ho Choi, Taek-Keun Nam, Kyung-Ja Lee
Cancer Research and Treatment.2014; 46(2): 158. CrossRef
Identification of Hypoxanthine and Phosphoenolpyruvic Acid as Serum Markers of Chemoradiotherapy Response in Locally Advanced Rectal Cancer
Kun Kim, Seung-Gu Yeo, Byong Chul Yoo
Cancer Research and Treatment.1970; 47(1): 78. CrossRef

Original Articles

Clinical Significance of Tumor Regression Grade in Rectal Cancer with Preoperative Chemoradiotherapy: Young Joo Park, Byung Ryul Oh, Sang Woo Lim, Jung Wook Huh, Jae Kyun Joo, Young Jin Kim, Hyeong Rok Kim; J Korean Soc Coloproctol. 2010;26(4):279-286. Published online August 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.4.279

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Abstract PDF

Purpose

Neoadjuvant chemoradiotherapy applied to the locally advanced rectal cancer reduces local recurrence and improves survival. We assessed tumor regression grade (TRG) and its influence on survival in rectal cancer patients treated with chemoradiotherapy followed by surgical resection.

Methods

We studied 108 patients that were seen at our hospital between August 2004 and December 2008. Patients received preoperative chemoradiotherapy consisting of 5-fluorouracil and leucovorin by continous infusion during the first and fifth week, delivered with concurrent pelvic radiation of 50.4 Gy, followed by radical surgery at 6-8 weeks. The TRG was determined by the amount of fibrosis in the tumor embedding area and was divided into 5 grades based on the relative amount of fibrosis. We analyzed all preoperative clinicopathologic factors, postoperative pathologic stages, TRG and prognosis, retrospectively.

Results

Downstaging of rectal cancer through neoadjuvant chemoradiotherapy occurred in 64 (59%) patients. The numbers of total regressions (TRG4), good regressions (TRG3), moderate regressions (TRG2), minor regressions (TRG1), and no regression (TRG0) were 19 (18%), 65 (60%), 17 (16%), 6 (5%), and 1 (1%) respectively. The TRG was inversely correlated with perineural invasion and lymphovascular invasion (P = 0.008, P = 0.032). The local recurrence rate declined as the tumor regression grade increased (P = 0.032). The 19 patients with TRG4 had a better three-year disease free survival than the 89 patients with TRG0-3 (P = 0.034). The 16 patients with pathologic complete remission (pCR) had a better three-year disease free survival than the 92 patients with non-pCR (P = 0.025).

Conclusion

Higher TRG after preoperative chemoradiotherapy for rectal cancer closely correlates with better survival and low local recurrence. The TRG is considered to be a significant prognostic factor.

Citations

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An investigation into tumor regression grade as a parameter for locally advanced rectal cancer and 5-year overall survival rate
Supparerk Laohawiriyakamol, Wongsakorn Chaochankit, Worawit Wanichsuwan, Kanet Kanjanapradit, Teeranan Laohawiriyakamol
Annals of Coloproctology.2023; 39(1): 59. CrossRef
Rezultate preliminare ale markerilor ca predictori ai răspunsului tisular la radiochimioterapie în cancerul rectal
Sânziana Ionescu, Petre Radu, Octavia Luciana Madge, Victor Strâmbu
Oncolog-Hematolog.ro.2022; 1(58): 8. CrossRef
Clinical Implication of Perineural and Lymphovascular Invasion in Rectal Cancer Patients Who Underwent Surgery After Preoperative Chemoradiotherapy
Young Il Kim, Chan Wook Kim, Jong Hoon Kim, Jihun Kim, Jun-Soo Ro, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Diseases of the Colon & Rectum.2022; 65(11): 1325. CrossRef
Downstaging in Advanced Rectal Cancers: A Propensity-Matched Comparison Between Short-Course Radiotherapy Followed by Chemotherapy and Long-Course Chemoradiotherapy
Praveen S. Kammar, Niharika R. Garach, Sivasanker Masillamany, Ashwin de’Souza, Vikas Ostwal, Avanish P. Saklani
Diseases of the Colon & Rectum.2022; 65(10): 1215. CrossRef
Overexpression of MLPH in Rectal Cancer Patients Correlates with a Poorer Response to Preoperative Chemoradiotherapy and Reduced Patient Survival
Wan-Shan Li, Chih-I Chen, Hsin-Pao Chen, Kuang-Wen Liu, Chia-Jen Tsai, Ching-Chieh Yang
Diagnostics.2021; 11(11): 2132. CrossRef
How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement
Iris D. Nagtegaal, Rob Glynne-Jones
Cancer Treatment Reviews.2020; 84: 101964. CrossRef
Neoadjuvant chemoradiotherapy might provide survival benefit in patients with stage IIIb/IIIc locally advanced rectal cancer: A retrospective single‐institution study with propensity score‐matched comparative analysis
Xi‐yu Sun, Song‐hua Cai, Lai Xu, Dan Luo, Hui‐zhong Qiu, Bin Wu, Guo‐le Lin, Jun‐yang Lu, Guan‐nan Zhang, Yi Xiao
Asia-Pacific Journal of Clinical Oncology.2020; 16(3): 142. CrossRef
Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta‐analysis
J. C. Kong, G. R. Guerra, S. K. Warrier, A. Craig Lynch, M. Michael, S. Y. Ngan, W. Phillips, G. Ramsay, A. G. Heriot
Colorectal Disease.2018; 20(7): 574. CrossRef
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United European Gastroenterology Journal.2018;[Epub] CrossRef
Prognostic significance of tumour regression grade after neoadjuvant chemoradiotherapy for a cohort of patients with locally advanced rectal cancer: an 8‐year retrospective single‐institutional study
L. Xu, S. Cai, T. Xiao, Y. Chen, H. Qiu, B. Wu, G. Lin, X. Sun, J. Lu, W. Zhou, Y. Xiao
Colorectal Disease.2017;[Epub] CrossRef
Magnetic resonance tumor regression grade (MR-TRG) to assess pathological complete response following neoadjuvant radiochemotherapy in locally advanced rectal cancer
Marco Rengo, Simona Picchia, Simona Marzi, Davide Bellini, Damiano Caruso, Mauro Caterino, Maria Ciolina, Domenico De Santis, Daniela Musio, Vincenzo Tombolini, Andrea Laghi
Oncotarget.2017; 8(70): 114746. CrossRef
Oncologic impact of pathologic response on clinical outcome after preoperative chemoradiotherapy in locally advanced rectal cancer
Wook Hyeon Yoon, Hun Jin Kim, Chang Hyun Kim, Jae Kyoon Joo, Young Jin Kim, Hyeong Rok Kim
Annals of Surgical Treatment and Research.2015; 88(1): 15. CrossRef
Low Lymph Node Retrieval After Preoperative Chemoradiation for Rectal Cancer is Associated with Improved Prognosis in Patients with a Good Tumor Response
Hun Jin Kim, Jeong Seon Jo, Soo Young Lee, Chang Hyun Kim, Young Jin Kim, Hyeong Rok Kim
Annals of Surgical Oncology.2015; 22(6): 2075. CrossRef
Clinical Prediction of Pathological Complete Response After Preoperative Chemoradiotherapy for Rectal Cancer
Jung Wook Huh, Hyeong Rok Kim, Young Jin Kim
Diseases of the Colon & Rectum.2013; 56(6): 698. CrossRef
Prognostic Significance of Partial Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer
Yen-Chien Lee, Chung-Cheng Hsieh, Jen-Pin Chuang
Diseases of the Colon & Rectum.2013; 56(9): 1093. CrossRef
Prognostic Role of p53 Messenger Ribonucleic Acid Expression in Patients after Curative Resection for Stage I to III Colorectal Cancer: Association with Colon Cancer Stem Cell Markers
Jung Wook Huh, Hyeong Rok Kim, Young Jin Kim
Journal of the American College of Surgeons.2013; 216(6): 1063. CrossRef
A phase II study of neoadjuvant chemoradiotherapy with oxaliplatin and capecitabine for rectal cancer
Lin Zhao, Chunmei Bai, Yajuan Shao, Mei Guan, Ning Jia, Yi Xiao, Huizhong Qiu, Fuquan Zhang, Ti Yang, Guangxi Zhong, Shuchang Chen
Cancer Letters.2011; 310(2): 134. CrossRef
Oncologic outcomes of pathologic stage I lower rectal cancer with or without preoperative chemoradiotherapy: Are they comparable?
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Surgery.2011; 150(5): 980. CrossRef

Pretreatment Serum CEA as a Prognostic Factor for Rectal Cancer Treated with Preoperative Chemoradiotherapy.: Kim, Kyu Hyung , Oh, Jae Hwan , Choi, Hyo Seong , Park, Ji Won , Park, Seong Chan , Kim, Dae Yong , Chang, Hee Jin , Baek, Ji Yeon , Kim, Sun Young; J Korean Soc Coloproctol. 2010;26(1):39-44.; DOI: https://doi.org/10.3393/jksc.2010.26.1.39

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PURPOSE
Preoperative serum carcinoembryonic antigen (s-CEA) is well known to be a prognostic factor in patients with colorectal cancer. However, the prognostic effect of s-CEA in patients with rectal cancer treated with preoperative chemoradiotherapy (CRT) has not been well studied. The aim of this study is to evaluate the prognostic value of pretreatment s-CEA for rectal cancer treated with preoperative CRT.
METHODS
This study analyzed the data of 436 patients who received preoperative CRT and underwent curative surgery for locally advanced rectal cancer from January 2002 to July 2007. Patients were categorized into two groups according to pretreatment CEA levels: < or =10 and >10 ng/mL. The disease-free survivals between the two groups were compared.
RESULTS
The three-year disease-free survival rates of the CEA < or =10 ng/mL group and the CEA >10 ng/mL group were 80.4% and 67.3%, respectively (P=0.002). Multivariate analysis revealed the following independent risk factor for recurrence: pretreatment CEA >10 ng/mL (hazard ratio [HR] 1.616; 95% confidence interval [CI], 1.007 to 2.594; P=0.047), positive lymph node status (HR, 2.580; 95% CI, 1.625 to 4.094; P<0.001), and positive circumferential resection margin (HR, 1.889; 95% CI, 1.035 to 3.446; P=0.038).
CONCLUSION
Pretreatment s-CEA (cutoff value 10 ng/mL) may be a prognostic factor for disease-free survival in rectal cancer patients treated with preoperative CRT and surgery.

Citations

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Factors predicting oncologic outcomes in patients with fewer than 12 lymph nodes retrieved after curative resection for colon cancer
Jung Wook Huh, Chang Hyun Kim, Hyeong Rok Kim, Young Jin Kim
Journal of Surgical Oncology.2012; 105(2): 125. CrossRef
Factors Influencing Oncological Outcomes in Patients Who Develop Pulmonary Metastases After Curative Resection of Colorectal Cancer
Chang Hyun Kim, Jung Wook Huh, Hun Jin Kim, Sang Woo Lim, Sang Yun Song, Hyeong Rok Kim, Kook Joo Na, Young Jin Kim
Diseases of the Colon & Rectum.2012; 55(4): 459. CrossRef

Pathologic Complete Remission after Preoperative Chemoradiation for Rectal Cancer: Analysis of Clinicopathologic Characteristics and Oncologic Outcome.: Kim, Dae Dong , Yu, Chang Sik , Shin, Ui Sup , Yoon, Sang Nam , Kim, Jin Cheon; J Korean Soc Coloproctol. 2008;24(6):473-478.; DOI: https://doi.org/10.3393/jksc.2008.24.6.473

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Abstract PDF

PURPOSE
To assess the clinico-pathologic characteristics associated with pathologic complete remission (pCR) after preoperative chemoradiotherapy (PCRT) for rectal cancer and evaluate predictive factors for pCR and prognostic impact of pCR.
METHODS
We analyzed 325 patients who underwent PCRT and surgical resection between September 1999 and September 2006. We have treated 319 patients with PCRT for locally advanced rectal cancer and 6 patients for sphincter-saving procedure. Chemotherapy consisted of either of bolus 5-FU (325 mg/m2/d) or capecitabine (1,650 mg/m2/d) for the duration of radiation and after surgery. Radiation therapy was delivered and surgery was performed 4~6 weeks following the completion of PCRT. We compared pCR patients with non-pCR patients according to the clinico-pathologic characteristics and followed up with a median of 32 (range, 12~91) months.
RESULTS
The pCR (n=41, 12.6%) and non-pCR (n=284) groups were comparable in age, sex, location of the tumor, chemotherapy regimen, pre-CRT CEA level except pre-CRT clinical stage (12.2% vs. 0.4% in stage I, P= 0.047). There was no significant difference in genetic characteristics between groups. There was no specific predictive factors for pCR except pre-CRT T category (pCR in T2 (5/8, 62.5%) vs. T3 (33/283, 11.7%) or T4 (3/33, 9.1%), P=0.001). The 3-year disease free survival (DFS) was 100% and 83.6% in the pCR and non-pCR group respectively (P=0.012). There were 5 local and 34 systemic recurrences only in non-pCR group.
CONCLUSIONS
Rectal cancer patients with pCR after PCRT have an excellent prognosis and are unlikely to fail locally or systemically because of the effect of stage. However there was no specific predictive factor for pCR except preoperative T category.

Citations

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Monitoring of Residual Pesticides in Grape Seed Oil being Sold in Gyeonggi Province
Mi-Hui Son, Jae-Kwan Kim, You-Jin Lee, Ji-Eun Kim, Eun-Jin Baek, Byeong-Tae Kim, Myoung-Ki Park, Bo-yeon Kwon
Journal of Food Hygiene and Safety.2024; 39(2): 128. CrossRef

Pathological Analysis of Tumor Response after Preoperative Chemoradiation Therapy for Advanced Rectal Cancer.: Lee, Seok Young , Choi, Yoon Jung , Kang, Jung Gu , Chung, Eun Ji , Kim, Yong Tai; J Korean Soc Coloproctol. 2007;23(6):511-517.; DOI: https://doi.org/10.3393/jksc.2007.23.6.511

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Abstract PDF

PURPOSE
We investigated the association of survivin expression with the prognosis in advanced rectal cancer with preoperative chemoradiotherapy for pathological analysis.
METHODS
We examined 16 patients with rectal cancer who were preoperatively staged as T3 or T4. The enrolled patients were given 5-FU, 425 mg/m2/day, and leucovorin, 20 mg/m2/day, intravenously for 3 days during weeks 1 and 5 of pelvic radiotherapy. Surgical resection was performed 4~6 weeks after completion of the schedule. Tumor response was divided into CR (complete remission), PR (partial remission), and NR (non remission). Immunohistochemical staining of paraffin sections using monoclonal antibodies for survivin, bcl-2, and p53 was performed on pretreatment biopsy and surgically resected tissue by using the standard avidin-biotin-peroxidase technique.
RESULTS
No CR was achieved. PR was achieved in 10 patients (62.5%), and NR in 6 patients (37.5%). After preoperative treatment, survivin expression tended to be decreased in tumor cells (62.5% to 31.3%) and slightly increased in adjacent normal mucosa a (12.5% to 25%). After preoperative treatment, survivin expression was correlated with lymph-node metastasis in the statistical analysis. We failed to find any other significant relationship between survivin expression and any parameters, except lymph node metastasis and apoptotic index.
CONCLUSIONS
Survivin expression before preoperative treatment was not related to the prognosis in rectal cancer patients, but survivin expression after preoperative treatment was related to lymph node metastasis of advanced rectal cancer. Further studies, including large numbers of rectal cancer cases with a sufficient follow-up period, are needed in order to establish survivin as a prognostic target in rectal cancer.

Citations

Citations to this article as recorded by

Clinicopathologic significance of survivin expression in colorectal adenocarcinoma
Woong Na, Se Min Jang, Young Jin Jun, Young Soo Song, Ki‐Seok Jang, Kang Hong Lee, Kyeong Geun Lee, Hong Xiu Han, Seung Sam Paik
Basic and Applied Pathology.2009; 2(3): 94. CrossRef

Long-term Result for Rectal Cancer in Cases of a Curative Resection after Preoperative Chemoradiotherapy.: Lee, Dong Hyun , Jung, Sang Hun , Kim, Jae Hwang , Shim, Min Chul; J Korean Soc Coloproctol. 2007;23(6):503-510.; DOI: https://doi.org/10.3393/jksc.2007.23.6.503

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Abstract PDF

PURPOSE
Preoperative chemoradiation is the recommended standard therapy for locally advanced rectal cancer and is associated with sphincter preservation and improved survival. Our study was performed to determine the surgical outcomes and the prognostic factors for rectal cancer with preoperative chemoradiotherapy (PCRT) followed by a relative curative resection.
METHODS
We retrospectively reviewed the cases of 251 advanced rectal cancer patients who underwent a PCRT, between Jan 1995 and Dec 2002. All patients a received 25 days RTX (total dose: 4,500~5,040 cGy) and intravenous 5-FU (425 mg/m2/ day) plus leucovorin (20 mg/day) for 24 hrs. Surgery was performed about 4~6 weeks after completion of RTX. The median follow up was 79 months (range 1-142).
RESULTS
All patients were comfortable with PCRT. Postoperative mortality was 1.1%. After PCRT, 92.2% of the patients and, especially, 82.2% of the low rectal cancer patients had sphincter preserving surgery. Complete remission of the tumor was stenin 15.1% of the cases, but was not significantly associated with recurrence. The overall recurrence and the local recurrence rates were 15.1% and 4.4%, respectively. Cell differentiation, circumferential margin, and lymphovascular invasion were independent risk factors for local recurrence in the multivariate analysis. Prognostic factors for overall and disease-free survival were cell differentiation, circumferential margin, lymphovascular invasion, and lymph node metastasis in the multivariate analysis. The 5-year disease-free survival rates for stages I, II, and III, and for no-residual tumor were 96.1%, 83.4%, 69.0%, and 89.1%, respectively (P<0.05).
CONCLUSIONS
Advanced rectal cancer treated using preoperative chemoradiation resulted in excellent sphincter preservation. Our long-term follow-up results showed good local control and improved survival for rectal cancer.

Citations

Citations to this article as recorded by

Long-term Outcomes of Laparoscopic Surgery for Colorectal Cancer
Jeong-Eun Lee, Yong-Geul Joh, Sang-hwa Yoo, Geu-Young Jeong, Sung-Han Kim, Choon-Sik Chung, Dong-Gun Lee, Seon Hahn Kim
Journal of the Korean Society of Coloproctology.2011; 27(2): 64. CrossRef

Distant Metastasis Identified Immediately after Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer.: Park, In Ja , Kim, Hee Cheol , Yu, Chang Sik , Choi, Pyung Hwa , Jung, Sang Hoon , Hong, Dong Hyun , Kim, Dae Dong , Ryu, Min Hee , Chang, Heung Moon , Kim, Jong Hoon , Kim, Jin Cheon; J Korean Soc Coloproctol. 2007;23(5):327-332.; DOI: https://doi.org/10.3393/jksc.2007.23.5.327

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Abstract PDF: PURPOSE
This study was designed to analyze the clinical characteristics of patients with immediate distant metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer and to help select patients for preoperative chemoradiotherapy.
METHODS
Two hundred eight patients, who underwent preoperative chemoradiotherapy for locally advanced rectal cancer, were included. Patients were excluded from the study if they had tumor types other than an adenocarcinoma, prior chemotherapy, radiotherapy, or hereditary nonpolyposis colorectal cancer. The clinicopathological characteristics of patients with distant metastasis immediately after preoperative chemoradioterapy were compared with those of patients without distant metastasis.
RESULTS
Distant metastases immediately after preoperative chemoradiotherapy were identified in 15 patients (7.2%). The liver was the most common site of metastasis (8/15), followed by peritoneal seeding (4), the lung (2), bone (1), and the aortocaval lymph node (1). Age, sex, chemotherapy regimen used, and primary tumor response for patients with distant metastases were similar to those for patients without distant metastasis. In patients with immediate distant metastasis, pre-chemoradiotherapy CEA was significantly higher (11.1 vs. 7.4 ng/ml; P= 0.003).
CONCLUSIONS
Immediate distant metastasis after preoperative chemoradiotherapy is associated with pre-chemoradiotherapy CEA level. A careful work-up is necessary when pre-chemoradiotherapy CEA is higher than the normal range.

Preoperative Chemoradiation Therapy in the Management of Locally Advanced Rectal Cancer.: Kim, Ik Yong , Shin, Dae Geun , Park, Kyung Ran , Sung, Seong Hoon , Chu, Young Keun , Kim, Dae Sung; J Korean Soc Coloproctol. 2005;21(1):19-26.

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Abstract PDF: PURPOSE
Surgery is the standard care in the treatment of rectal cancer. However, after surgery alone, local recurrence and distant metastasis remain high for locally advanced rectal cancer. Preoperative chemoradiation therapy (pre-CRT) has been thought to be effective for increasing resectability and decreasing the rate of local recurrence for locally advanced rectal cancer. This study was designed to assess the efficacy of preoperative concurrent chemoradiation therapy in the management of locally advanced rectal cancer.
METHODS
Between July 1999 and December 2003, 29 patients had locally advanced rectal cancer (uT3/ T4, uN1 by endorectal ultrasonography) or were ineligible to undergo sphincter-preserving surgery. All patients were treated with pre-CRT, followed by surgery in 25 patients. Patients were treated with radiation therapy with a total dose of 45~50.4 Gy to the surgical bed and pelvic lymph- node area for 5.5 weeks. We analyzed the degree of toxicity and the therapeutic resopnse from CRT, the type of surgery, including sphincter-saving procedures, and the mid- term outcome.
RESULTS
Of the 29 patients who received pre-CRT, a radical resection was possible in 25 patients. A low anterior resection and an ultra-low anterior resection- coloanal anastomosis were performed in 13 (52%) and 7 (28%) cases, respectively. Sphincter-preserving surgery was performed in 80% of the patients. The postoperative pathological response rates of CRT were 25% complete remission, 45% partial remission, 30% no response. Postoperative complications and toxicity from CRT were acceptable. The duration of median follow-up was 24 months (9~62 months). Recurrence was seen in 6 cases. Distant recurrence alone was seen in 5 patients (19.2%) and distant and local recurrences were seen in only one patient (4%). The 3-year overall survival rate was 72.4%, and 3-year disease-free survival rate was 59.5%.
CONCLUSION
Our data suggested that preoperative concurrent CRT therapy for locally advanced rectal cancer is safe and tolerable. These data showed a high local control rate and a high 3-year survival rate. Preoperative CRT was an effective modality for sphincter preservation in selected patients who would have required an abdominoperineal resection. Additional studies with larger numbers of patients and long-term follow up are warranted to confirm our results. In addition, more effective chemotherapeutic regimens are needed to decrease distant metastasis.

The Effects and Surgical Morbidity of Preoperative Combined Chemoradiotherapy for Locally Advanced Rectal Cancer.: Chung, Ji Eun , Kim, Kap Tae , Chung, Eul Sam; J Korean Soc Coloproctol. 2001;17(6):324-331.

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Abstract PDF: PURPOSE
The aim of this study is to evaluate the effectiveness and surgical morbidity of preoperative chemoradiotherapy for locally advanced rectal cancer.
METHODS
Between December 1997 and March 2000, 36 patients with locally advanced rectal cancer (clinical stage II or III) were treated with preoperative chemoradiation: bolus i.v. leucovorin, 20 mg/m2, plus 24-h continuous infusion i.v. 5-Fluorouracil, 425 mg/m2, Days 1-5, 29-33 and concurrent radiotherapy 4,500 cGy over 5 weeks. Surgery was performed 4-8 weeks after completion of the chemoradiotherapy.
RESULTS
Grade 3-4 toxicity during chemoradiotherapy was low: hematological toxicities 2.8%, gastro-intestinal toxicities 5.5% and skin toxicities 8.3%. Complete response rate was 16.7% and partial response rate was 47.2%, the rate of downstaging for tumor was 65.5%. The overall rate of resectability was 94.1%. In 13 of 22 (59.1%) patients planned APR, the sphincter was preserved. The overall rate of surgical morbidity was 23.5%, but there was no postoperative mortality. One patient needed a reoperation because a complication may be associated with preoperative chemoradiotherapy.
CONCLUSIONS
Preoperative chemoradiotherapy for locally advanced rectal cancer seems to afford some potential advantages: patients are able to tolerate higher chemotherapy doses with low toxicities; tumor downstaging and resectability rates are high; sphincter preservation is feasible; But perioperative morbidity has generally tolerable complications. And so we recommend the preoperative chemoradiotherapy may be one of the best treatments for locally advanced rectal cancer.

Preoperative Concurrent Chemoradiotherapy in Locally Advanced Rectal Cancer.: Kim, Nam Kyu , Sohn, Seung Kok , Min, Jin Sik , Sung, Jin Sil , Noh, Jae Kyung; J Korean Soc Coloproctol. 2000;16(2):93-98.

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Abstract PDF: PURPOSE
Preoperative concurrent chemoradiation for locally advanced rectal cancer can reduce tumor volume and can eliminate viable tumor cells at surgical margin (lateral or posterior margin). It also achieve a rate of high resectability, and negative margin and also have been known to be a safe treatment modality even though its fatal complication was reported as 4%. The aim of this study is to analyze its efficacy and complications after concurrent chemoradiation treatment for advanced rectal cancer.
METHODS
We recruited a total thirty three patients with locally advanced rectal cancer, which were staged preoperatively as T3 or T4 and multiple enlarged lymph nodes by Transrectal Ultrasonography or pelvic Magnetic Resonance Image between march 1996 and June, 1998. 5 Fluorouracil 450 mg/m2 and leucovorin 30 mg infused intravenously during the first and fifth weeks of radiation therapy (4500~5040 cGy). Surgical resection was performed after four or six weeks after completing radiation therapy. To follow up tumor response, digital rectal examination and transrectal ultrasonography were done every two weeks.
RESULTS
Tumor level was distal (N=16, 48.4%), middle (N=9, 27.2%) and upper (N=8, 24.4%). mean age was fifty two years old. Overall resectability was 91%. Types of operations were abdominoperineal resection (N=10, 30.3%), Low anterior resection (N=8, 24.2), Hartmann (N=8, 24.2%), Posterior exenteration (N=2. 6.1%), Total pelvic exenteration (N=2, 6.1%), colostomy only (N=3, 9.1%). Tumor response was Complete remission (N=3,10%), Partial response (N=17, 57%), Non-response (N=10, 33%), progressive disease (N=3). Pathological status was No residual tumor (N=3, 10%), T2N1 (N=5, 16.6%), T3N0 (N=6, 20%), T4N0 (N=4, 13.3%), T2N1 (N=1, 3.3%), T3N1 (N=11, 36.6%). Downstaging status was as follows: from T3 to T0 (N=2), to T2 (N=3) and From T4 to T0 (N=1), to T2 (N=3), to T3 (N=3). Postoperative morbidity was noted in 2 patients (1 case of anastomotic leakage, 1 case of wound infection).
CONCLUSIONS
Preoperative concurrent chemoradiation therapy for locally advanced rectal cancer can be performed safely and show high tumor response and resectability.

Effects of Preoperative Chemoradiotherapy on the Healing of Colonic Anastomosis with the Lapse of Operation Time in the Rat.: Yun, Sung Su , Kim, Dong Sik , Kim, Chun Jik , Kim, Sang Woon , Kim, Jae Whang , Suh, Bo Yang , shim, Min Chul , Kwun, Kaing Bo , Sung, Un Ki; J Korean Soc Coloproctol. 1999;15(1):21-30.

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Abstract PDF: PURPOSE
Preoperative chemoradiotherapy has become an important adjunct in the management of rectal cancer. But both systemic toxicity of chemotherapy and local effect of radiation interfere wound healing of intestinal anastomosis and ultimately may lead to anastomotic leak and septic complications. The purpose of this study is to determine the optimal time interval between preoperative chemoradiotherapy and anastmotic construction, and it was evaluated by security of anastomotic construction.
METHODS
One hundred and twenty male Sprague Dawley rats weighing approximately 250 g were randomly divided into 4 groups (Control group; n=40, Group 1; n=20, Group 2; n=20, Group 3; n=40). The control group (n=20) underwent anastomotic construction at 1 week after general anesthesia without preoperative chemoradiotherapy. The experimental animals (group 1, 2, 3) received preoperative chemoradiotherapy with 5 daily dose (20 mg/kg) of 5-fluorouracil and single dose of 1500 cGy radiation at the rectosigmoid junction under general anesthesia on the day after last dose of chemotherapy. And group 1~3 subsequently underwent a laparotomy to make anastomotic construction at 1 week (Group 1), 2 weeks (Group 2), and 3 weeks (Group 3; n=20) after completion of chemoradiotherapy. The security of anastomotic construction was determined by bursting pressure, tissue hydroxyproline content, gross and microscopic findings of anastomotic area at the 5th and 10th postoperative day after anastomotic construction. To evaluate systemic toxicity after che-moradiotherapy, serial body weight and alteration of CBC were measured in the control group (n=20) and Group 3 (n=20) without anastomotic construction.
RESULTS
At the 5th postoperative day, Mean bursting pressures of the all treated groups were lower than that of the control group (Control group; 88 23 mmHg, Group 1; 49 22 mmHg, Group 2; 56 17 mmHg, Group 3; 78 23 mmHg). The difference was not significant in the group 3 compared with the control group. Body weight decreased in the all treated animals. The mean body weight was lowest on the day 8 after completion of chemoradiotherapy and then it gradually increased. WBC and platelet counts also decreased in the all treated animals. WBC count was lowest on the day 1 and platelet count was lowest on the day 3 after completion of chemoradiotherapy. Mean hydroxyproline contents at the anastomotic sites in the all treated groups were higher than that of the control group, especially in the group 2 and 3. Similar histologic changes were observed in both group 3 and control group.
CONCLUSION
The results suggest that the optimal time interval for safe intestinal anastomosis after preoperative chemoradiotherapy is 3 weeks or later.

33 Cases of Anal Cancer.: Ahn, Byung Kwon , Park, Yong Rae , Baek, Sung Uhn; J Korean Soc Coloproctol. 1998;14(4):743-750.

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Abstract PDF: PURPOSE
Malignant disease of the anus is rare. Abdominoperineal resection was formerly considered to be the treatment of choice. But, in recent, less ablative and more effective combined therapeutic modalities have been developed.
METHODS
we analyzed 33 patients who were diagnosed and treated as anal cancers at the Department of Surgery, Gospel Hospital, Kosin Medical Collage, from July 1, 1988 to Nov. 30, 1997.
RESULTS
The ratio of male to female was 1.4:1 and mean age was 56.7 years old. Twenty-two (84.8%) of these cancers were located in the anal canal and 5 (15.2%) in the anal margin. Three main histologic types of the anal cancers were identified: squamous cell carcinoma was the most common lesion, accounted for 17 cases (51.1%), adenocarcinoma accounted for 8 cases (24.2%), malignant melanoma accounted for 8 cases (24.2%). The overall 3-year survival rate and 5-year survival rate of anal cancer were 54.1%, 41.7%. Eleven patients with squamous cell carcinoma were treated curatively: 6 patients were treated with chemoradiotherapy, 3 patients with abdominoperineal resection, one patient with chemoradiotherapy and abdominoperineal resection, one patient with local excision.
CONCLUSION
In survival rate, there were no significant differences between chemoradiotherapy group and surgical treatment group. In squamous cell carcinomas, chemoradiotherapy had anal sparing benefit without loss of survival. On univariate analysis, T, N, type of treatment, histologic type had no statistical significances on survival. On multivariate analysis, location of lesion and distant metastasis had statistical significances.

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