Annals of Coloproctology

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Original Article

Colorectal cancer

Impact of the timing of additional surgery after noncurative endoscopic resection of early colorectal cancer on perioperative and oncological outcomes: a single-center retrospective cohort study: Shuhua Zhuo, Yijuan Liu, Kaiyan Wei, Jiantao Zheng, Lin Zhang; Ann Coloproctol. 2026;42(3):345-354. Published online June 26, 2026; DOI: https://doi.org/10.3393/ac.2025.01319.0188

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Abstract PDF Supplementary Material: Purpose
For early colorectal cancer (CRC) following noncurative endoscopic resection, additional curative surgery is the standard of care, but the optimal timing remains unclear. This study investigated the effect of the interval between procedures on surgical complexity, complications, and oncological outcomes.
Methods
This retrospective study included 112 patients with early CRC who underwent additional laparoscopic surgery after noncurative endoscopic resection between August 2019 and August 2024. Clinical and pathological data were collected, with primary endpoints focused on surgical difficulty (operative duration and intraoperative blood loss). Statistical analyses were performed using multivariate analysis of variance, logistic regression, and receiver operating characteristic curve analysis.
Results
The interval between procedures was not significantly associated with surgical difficulty or lymph node metastasis (P>0.05). Multivariate analysis did not identify an optimal timing point for surgery. However, a longer waiting time was independently associated with an increased risk of residual tumor (odds ratio, 1.09; 95% confidence interval, 1.03–1.16; P=0.004). Furthermore, lymphovascular invasion and elevated preoperative carcinoembryonic antigen levels were identified as independent predictors of lymph node metastasis. A higher preoperative lymphocyte ratio was associated with an increased risk of postoperative intra-abdominal infection (r=0.243, P=0.010).
Conclusion
In the era of laparoscopic surgery, the timing of additional surgery does not appear to be the primary determinant of surgical difficulty in CRC. Clinical decision-making should prioritize high-risk pathological features, such as lymphovascular invasion, rather than rigid adherence to a predetermined waiting period. Strategically delaying surgery may facilitate the selection of patients without residual disease, thereby helping to avoid unnecessary procedures.

Case Report

A Case of Endoscopic Resection of a Colonic Semipedunculated Leiomyoma: Seung Hwa Lee, Gun Yoong Huh, Yoo Seock Cheong; J Korean Soc Coloproctol. 2011;27(4):215-219. Published online August 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.4.215

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12 Citations

Abstract PDF

During colonoscopic examination, epithelial lesions, such as adenomatous polyps, are frequently encountered, unlike subepithelial lesions, such as leiomyomas, which are uncommon. A colonic leiomyoma is a rare tumor, originating either from the mucularis mucosa or from the proper muscle, and accounts for only 3% of all gastrointestinal leiomyomas. Colonic leiomyomas are usually benign and asymptomatic. However, they can sometimes cause symptoms, ie, abdominal pain, intestinal obstruction, hemorrhage, and perforation. The traditional management option for a colonic leiomyoma is surgical resection. Recently, with the development of endoscopy devices and techniques, the endoscopic resection has been considered as an alternative treatment option. We experienced a patient with a leiomyoma that was diagnosed during colonoscopy. The leiomyoma was resected endoscopically without complication. We report this case with a review of the literature.

Citations

Citations to this article as recorded by

Rectal Leiomyoma on Routine Colonoscopy: Narrative Review and an Australian Case Report
Joshua Sungho Hong, Radha Nair
World Journal of Colorectal Surgery.2026; 15(1): 18. CrossRef
Ascending Colon Leiomyoma: A Case Report of a Uncommon Case
Abdulwahed A. Alotay
Journal of Pharmacy and Bioallied Sciences.2024; 16(Suppl 3): S3002. CrossRef
Descending Colon Leiomyoma: A Case Report and Literature Review
Norah I Alabdulaaly , Bader D Alanazi , Khalid A Albassam , Nada N Binkhashlan , Saad T Alqahtani , Nahla S Arab, Fatima A Badahdah , Saeed S Albalawi
Cureus.2024;[Epub] CrossRef
An Unusual Diagnosis of Rectosigmoid Leiomyoma in an Adult: A Rare Case Report
Karam Karam, Houssein Chebbo, Sarah Saleh, Sarah Jalloul, Johny Salem, Karim Al Halabi, Elias Fiani
Clinical Medicine Insights: Case Reports.2024;[Epub] CrossRef
Spontaneous Perforation of Maternal Small Bowel Leiomyoma during the Third Trimester of Pregnancy
In Hye Kim, Hyeon Jin Kim, So Hee Kim, Eun Hee Yu, Sul Lee, Seung Chul Kim
Perinatology.2023; 34(1): 41. CrossRef
Colonic Leiomyoma: A Case Report of an Uncommon Endoscopic Finding
Cristina Silva, José Mendes, Amélia Gaspar, Filipe Leal, Rui Almeida
Cureus.2023;[Epub] CrossRef
Leiomyoma in the Transverse Colon With Resection
James R Pellegrini, Jose R Russe, Rezwan Munshi, Rebecca Smoller, Nausheer Khan
Cureus.2021;[Epub] CrossRef
Colon Leiomyoma Diagnosed and Treated with Endoscopy
Ha Young Oh
The Korean Journal of Medicine.2020; 95(5): 336. CrossRef
A case of surgical complete transanal resection of rectal gastrointestinal stromal tumor diagnosed by endoscopic ultrasonography and endoscopic ultrasonography-guided fine needle aspiration
Koichi SOGA, Kenji ITANI
Choonpa Igaku.2019; 46(1): 71. CrossRef
Rectal Leiomyoma, a Rare Entity
Tagore Sunkara, Eric Omar Then, Andrea Culliford, Vinaya Gaduputi
Clinics and Practice.2018; 8(2): 1053. CrossRef
Incidental Subepithelial Sigmoid Colon Lesion
Mohamed Naem, Peter P. Stanich, Samer El-Dika
Clinical Gastroenterology and Hepatology.2015; 13(1): A32. CrossRef
Colonoscopy procedural skills and training for new beginners
Seung-Hwa Lee
World Journal of Gastroenterology.2014; 20(45): 16984. CrossRef

Original Article

Value and Interpretation of Resection Margin after a Colonoscopic Polypectomy for Malignant Polyps: Eun Jung Jang, Dae Dong Kim, Chang Ho Cho; J Korean Soc Coloproctol. 2011;27(4):194-201. Published online August 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.4.194

5,543 View
22 Download
5 Citations

Abstract PDF

Purpose

This study was designed to compare the clinicopathologic findings of an endoscopic polypectomy for malignant polyps with subsequent surgery and to evaluate the appropriateness of the pathologic finding criterion of the resection margin as an indicator for surgery in cases of malignant colorectal polyps.

Methods

We examined the clinicopathologic characteristics, complications and prognoses among the patients who underwent a colonoscopic polypectomy in both our hospitals and at other hospitals from April 2003 and April 2010. These patients were divided into two groups, the group (non-operation group) that only underwent a polypectomy (n = 37) and the group (operation group) that underwent a polypectomy with subsequent surgery (n = 33).

Results

There were no differences between two groups in the ratios of the number of men to the number of women, the ages or the comorbidities. In terms of endoscopic findings, we found no differences between the two groups in the locations of the polyps, the sizes of the polyps, or the presence of stalks. However, ulceration of polyps was higher in the non-operation group (51.5% vs. 21.6%; P = 0.009), as was the case with submucosal invasion (75.8% vs. 16.2%; P < 0.005). When an endoscopic polypectomy was performed, incomplete resection margins and specimens with margins involved occurred more frequently in the operation group (93.9% vs. 51.4%; P < 0.005), but no residual tumor was detected in 31 of 33 (93.9%) patients in that group. One pathologist reviewed the specimens of 54 patients (operation group, 19; non-operation group, 36). Six of the 19 polyps (31.6%) in the operation group and fifteen of the 36 polyps (41.7%) in the non-operation group had a margin without cancer cells.

Conclusion

We may accept the criterion of a safe margin, including a coagulation zone. A multidisciplinary approach has to be developed by surgeons, endoscopists and pathologists based on a discussion of the risk factors for the patient before making a decision on the treatment treatment.

Citations

Citations to this article as recorded by

Additional colectomy after endoscopic excision of malignant polyps: is it always necessary?
Mariana Marques, Mariana Peyroteo, Luís Lencastre, André Vale Guimarães, Maria João Madeira-Cardoso, Paula Ferreira Pinto, José Carlos Pereira, Flávio Videira, Joaquim Abreu de Sousa
Surgical Oncology.2026; 65: 102361. CrossRef
Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
Goran Mohammed Raouf Abdulqader
Open Medicine.2024;[Epub] CrossRef
Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience
Olga Mandic, Igor Jovanovic, Mirjana Cvetkovic, Jasmina Maksimovic, Tijana Radonjic, Maja Popovic, Novica Nikolic, Marija Brankovic
Medicina.2022; 58(10): 1440. CrossRef
Near-infrared photoimmunotherapy is effective treatment for colorectal cancer in orthotopic nude-mouse models
Hannah M. Hollandsworth, Siamak Amirfakhri, Filemoni Filemoni, Justin Molnar, Robert M. Hoffman, Paul Yazaki, Michael Bouvet, Irina V. Lebedeva
PLOS ONE.2020; 15(6): e0234643. CrossRef
Surgical treatment of malignant colon polyps
Nuno Telo Preto Ramos, André Gonçalves, Pedro Correia da Silva, José Barbosa
Journal of Coloproctology.2018; 38(04): 260. CrossRef

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