Annals of Coloproctology

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Original Article

Colorectal cancer

Is clinical complete response as accurate as pathological complete response in patients with mid-low locally advanced rectal cancer?: Niyaz Shadmanov, Vusal Aliyev, Guglielmo Niccolò Piozzi, Barıs Bakır, Suha Goksel, Oktar Asoglu; Ann Coloproctol. 2025;41(1):57-67. Published online February 28, 2025; DOI: https://doi.org/10.3393/ac.2024.00339.0048

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Purpose
The standard treatment for locally advanced rectal cancer involves neoadjuvant chemoradiation followed by total mesorectal excision surgery. A subset of patients achieves pathologic complete response (pCR), representing the optimal treatment outcome. This study compares the long-term oncological outcomes of patients who achieved pCR with those who attained clinical complete response (cCR) after total neoadjuvant therapy, managed using a watch-and-wait approach.
Methods
This study retrospectively evaluated patients with mid-low locally advanced rectal cancer who underwent neoadjuvant treatment from January 1, 2005, to May 1, 2023. The pCR and cCR groups were compared based on demographic, clinical, histopathological, and long-term survival outcomes.
Results
The median follow-up times were 54 months (range, 7–83 months) for the cCR group (n=73), 96 months (range, 7–215 months) for the pCR group (n=63), and 72 months (range, 4–212 months) for the pathological incomplete clinical response (pICR) group (n=627). In the cCR group, 15 patients (20.5%) experienced local regrowth, and 5 (6.8%) developed distant metastasis (DM). The pCR group had no cases of local recurrence, but 3 patients (4.8%) developed DM. Among the pICR patients, 58 (9.2%) experienced local recurrence, and 92 (14.6%) had DM. Five-year disease-free survival rates were 90.0% for cCR, 92.0% for pCR, and 69.5% for pICR (P=0.022). Five-year overall survival rates were 93.1% for cCR, 92.0% for pCR, and 78.1% for pICR. There were no significant differences in outcomes between the cCR and pCR groups (P=0.810); however, the pICR group exhibited poorer outcomes (P=0.002).
Conclusion
This study shows no significant long-term oncological differences between patients who exhibited cCR and those who experienced pCR.

Citations

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Total neoadjuvant therapy in rectal cancer: The FOREST protocol, a patient‐centered approach that clusters two cohorts with different outcomes
Hector Guadalajara, Jose Luis Domínguez‐Tristancho, Raquel Fuentes Mateo, Miguel Leon‐Arellano, Raquel Sanz‐Baro, Eleonora Geraldi, Ana Isabel Hormigo‐Sanchez, Víctor Manuel Castellano Megías, Marta Pérez Cobos, Patricia Mellado Miras, Begoña Lopez‐Botet
International Journal of Cancer.2025;[Epub] CrossRef
The Shifting and Evolving Neoadjuvant Treatments and Surgical Platforms on Oncological Outcomes and Sphincter Preservation in Distal Rectal Cancer: A 23-Year Retrospective Experience
Niyaz Shadmanov, Vusal Aliyev, Barıs Bakır, Suha Goksel, Oktar Asoglu
Journal of Gastrointestinal Cancer.2025;[Epub] CrossRef

Review

Colorectal cancer

The role of lateral pelvic lymph node dissection in advanced rectal cancer: a review of current evidence and outcomes: Gyu-Seog Choi, Hye Jin Kim; Ann Coloproctol. 2024;40(4):363-374. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00521.0074

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9 Web of Science
12 Citations

Abstract PDF

Metastatic lateral pelvic lymph nodes (LPNs) in rectal cancer significantly impact the prognosis and treatment strategies. Western practices emphasize neoadjuvant chemoradiotherapy (CRT), whereas Eastern approaches often rely on LPN dissection (LPND). This review examines the evolving role of LPND in the context of modern treatments, including total neoadjuvant therapy (TNT), and the impact of CRT on the management of clinically suspicious LPNs. We comprehensively reviewed the key literature comparing the outcomes of LPND versus preoperative CRT for rectal cancer, focusing on recent advancements and ongoing debates. Key studies, including the JCOG0212 trial and recent multicenter trials, were analyzed to assess the efficacy of LPND, particularly in conjunction with preoperative CRT or TNT. Current evidence indicates that LPND can reduce local recurrence rates compared to total mesorectal excision alone in patients not receiving radiation therapy. However, the benefit of LPND in the context of neoadjuvant CRT is influenced by the size and pretreatment characteristics of LPNs. While CRT can effectively control smaller metastatic LPNs, larger or clinically suspicious LPNs may require LPND for optimal outcomes. Advances in surgical techniques, such as robotic-assisted LPND, offer potential benefits but also present challenges and complications. The role of TNT in controlling metastatic LPNs and improving patient outcomes is emerging but remains underexplored. The decision to perform LPND should be individualized based on patient-specific factors, including LPN size, response to neoadjuvant treatment, and surgeon expertise. Future research should focus on optimizing treatment protocols and further evaluating the role of TNT in managing metastatic LPNs.

Citations

Citations to this article as recorded by

Who is a candidate at the initial presentation? Prediction of positive lateral lymph node and survival after dissection
Y. Lee
Techniques in Coloproctology.2025;[Epub] CrossRef
The oncologic benefits of lateral lymph node dissection after neoadjuvant therapy – local control or survival?
T. Sammour
Techniques in Coloproctology.2025;[Epub] CrossRef
Laparoscopic Versus Robotic Lateral Pelvic Lymph Node Dissection in Locally‐Advanced Rectal Cancer: A Cohort Study Comparing Perioperative Morbidity and Short‐Term Oncological Outcomes
Joseph Mathew, Yogesh Kisan Bansod, Nishant Yadav, Janesh Murugan, Kovvuru Bhaskar Reddy, Mufaddal Kazi, Ashwin DeSouza, Avanish Saklani
Cancer Reports.2025;[Epub] CrossRef
Robotic-assisted colorectal surgery in colorectal cancer management: a narrative review of clinical efficacy and multidisciplinary integration
Engeng Chen, Li Chen, Wei Zhang
Frontiers in Oncology.2025;[Epub] CrossRef
Cirugía por cáncer de recto más allá del mesorrecto: indicaciones, preparación límites y resultados
Blas Flor-Lorente, Mario Javier de Miguel Valencia
Cirugía Española.2025; 103(9): 800202. CrossRef
Surgery for rectal cancer beyond the mesorectum: Indications, preparation, limits, and results
Blas Flor-Lorente, Mario J. de Miguel-Valencia
Cirugía Española (English Edition).2025; 103(9): 800202. CrossRef
Cancer-associated fibroblasts enhance colorectal cancer lymphatic metastasis via CLEC11A/LGR5-mediated WNT pathway activation
Chuhan Zhang, Teng Pan, Yuyuan Zhang, Yushuai Wu, Anning Zuo, Shutong Liu, Yuhao Ba, Benyu Liu, Shuaixi Yang, Yukang Chen, Hui Xu, Peng Luo, Quan Cheng, Siyuan Weng, Long Liu, Xing Zhou, Jingyuan Ning, Xinwei Han, Jinhai Deng, Zaoqu Liu
Journal of Clinical Investigation.2025;[Epub] CrossRef
Robotic lateral pelvic lymphadenectomy for rectal cancer—A video vignette
D. Castrodá, M. Paniagua, L. Pérez Corbal, L. Otalora, R. Oubiña, A. Parajó
Colorectal Disease.2025;[Epub] CrossRef
Learning curve for lateral lymph node dissection in rectal cancer – a systematic review of literature
D. Kehagias, L. Baldari, E. Cassinotti, L. Boni, C. Lampropoulos, I. Kehagias
Techniques in Coloproctology.2025;[Epub] CrossRef
Pelvic Neuroanatomy in Colorectal Surgery: Advances in Nerve Preservation for Optimized Functional Outcomes
Asim M. Almughamsi, Yasir Hassan Elhassan
Surgeries.2025; 6(4): 94. CrossRef
Targeting lateral pelvic lymph nodes in rectal cancer: response to neoadjuvant therapy and artificial intelligence driven clinical decision support
Ruiqing Liu, Yun Lu, Luca Stocchi
Intelligent Medicine.2025;[Epub] CrossRef
From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef

Original Articles

Minimally invasive surgery

Preoperative localization of potentially invisible colonic lesions on the laparoscopic operation field: using autologous blood tattooing: Ji Yeon Mun, Hyunjoon An, Ri Na Yoo, Hyeon-Min Cho, Bong-Hyeon Kye; Ann Coloproctol. 2024;40(3):225-233. Published online June 19, 2024; DOI: https://doi.org/10.3393/ac.2023.00059.0008

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1 Citations

Graphical Abstract Abstract PDF

Purpose
Preoperative colonoscopic (POC) localization is recommended for patients scheduled for elective laparoscopic colectomy for early colon cancer. Among the various localization method, POC tattooing localization has been widely used. Several dyes have been used for tattooing, but dye has disadvantages, including foreign body reactions. For this reason, we have used autologous blood tattooing for POC localization. This study aimed to evaluate the safety and efficacy of the autologous blood tattooing method.
Methods
This study included patients who required POC localization of the colonic neoplasm among the patients who were scheduled for elective colon resection. The indication for localization was early colon cancer (clinically T1 or T2) or colonic neoplasms that could not be resected endoscopically. POC autologous blood tattooing was performed after saline injection, and 2 hemoclips were applied.
Results
A total of 45 patients who underwent autologous blood tattooing and laparoscopic colectomy were included in this study. All POC localization sites were visible in the laparoscopic view. POC localization sites showed almost perfect agreement with intraoperative surgical findings. There were no complications like bowel perforation, peritonitis, hemoperitoneum, and mesenteric hematoma.
Conclusion
Autologous blood is a safe and effective agent for localizing materials that can replace previous dyes. However, a large prospective case-control study is required for the routine application of this procedure in early colon cancer or colonic neoplasms.

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

Translational/basic research

Exfoliate cancer cell analysis in rectal cancer surgery: comparison of laparoscopic and transanal total mesorectal excision, a pilot study: Kiho You, Jung-Ah Hwang, Dae Kyung Sohn, Dong Woon Lee, Sung Sil Park, Kyung Su Han, Chang Won Hong, Bun Kim, Byung Chang Kim, Sung Chan Park, Jae Hwan Oh; Ann Coloproctol. 2023;39(6):502-512. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00479.0068

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Graphical Abstract Abstract PDF Supplementary Material: Purpose
Minimally invasive surgery (MIS) is currently the standard treatment for rectal cancer. However, its limitations include complications and incomplete total mesorectal resection (TME) due to anatomical features and technical difficulties. Transanal TME (TaTME) has been practiced since 2010 to improve this, but there is a risk of local recurrence and intra-abdominal contamination. We aimed to analyze samples obtained through lavage to compare laparoscopic TME (LapTME) and TaTME.
Methods
From June 2020 to January 2021, 20 patients with rectal cancer undergoing MIS were consecutively and prospectively recruited. Samples were collected at the start of surgery, immediately after TME, and after irrigation. The samples were analyzed for carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20) through a quantitative real-time polymerase chain reaction. The primary outcome was to compare the detected amounts of CEA and CK20 immediately after TME between the surgical methods.
Results
Among the 20 patients, 13 underwent LapTME and 7 underwent TaTME. Tumor location was lower in TaTME (7.3 cm vs. 4.6 cm, P=0.012), and negative mesorectal fascia (MRF) was more in LapTME (76.9% vs. 28.6%, P=0.044). CEA and CK20 levels were high in 3 patients (42.9%) only in TaTME. There was 1 case of T4 with incomplete purse-string suture and 1 case of positive MRF with dissection failure. All patients were followed up for an average of 32.5 months without local recurrence.
Conclusion
CEA and CK20 levels were high only in TaTME and were related to tumor factors or intraoperative events. However, whether the detection amount is clinically related to local recurrence remains unclear.

Colorectal cancer

Recurrence following transanal total mesorectal excision for rectal cancer: a monocentric retrospective series of technically difficult cases: Jonathan Frigault, Geneviève Morin, Sébastien Drolet, Philippe Bouchard, Alexandre Bouchard, Thanh-Quan Philips Ngo, François Letarte; Ann Coloproctol. 2023;39(4):332-341. Published online November 14, 2022; DOI: https://doi.org/10.3393/ac.2022.00178.0025

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Abstract PDF: Purpose
Transanal total mesorectal excision (TaTME) has been proposed to overcome surgical difficulties encountered during rectal resection, especially for patients having high body mass index or low rectal cancer. The aim of this study was to evaluate oncologic outcomes following TaTME.
Methods
This retrospective study included all consecutive patients with rectal cancer who had a TaTME from 2013 to 2019. The main outcome was the incidence of locoregional recurrence by the end of the follow-up period.
Results
Among a total of 81 patients, 96.3% were male, and their mean age was 63±9 years. The mean body mass index was 30.3±5.7 kg/m2, and the median distance from tumor to anal verge was 5.0 cm (interquartile range [IQR], 4.0–6.0 cm). Most patients had a low anterior resection performed (n=80, 98.8%) with a diverting ileostomy (n=64, 79.0%). Distal and circumferential resection margins were positive in 2.5% and 6.2% of patients, respectively. Total mesorectal excision was complete or near complete in 95.1% of patients. A successful resection was achieved in 72 patients (88.9%). After a median follow-up of 27.5 months (IQR, 16.7–48.1 months), 4 patients (4.9%) experienced locoregional recurrence. Anastomotic leaks were observed in 21 patients (25.9%). At the end of the follow-up, 69 patients (85.2%) were stoma-free.
Conclusion
TaTME was associated with acceptable oncological outcomes, including low locoregional recurrence rates in selected patients with low rectal cancer. Although associated with a high incidence of postoperative morbidities, the use of TaTME enabled a high rate of successful sphincter-saving procedures in selected patients who posed a technical challenge.

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

Citations to this article as recorded by

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

Malignant disease, Rectal cancer,Prognosis

Initial local excision for clinical T1 rectal cancer showed comparable overall survival despite high local recurrence rate: a propensity-matched analysis: Jong Hee Hyun, Mohamed K. Alhanafy, Hyoung-Chul Park, Su Min Park, Sung-Chan Park, Dae Kyung Sohn, Duck-Woo Kim, Sung-Bum Kang, Seung-Yong Jeong, Kyu Joo Park, Jae Hwan Oh, on behalf of the Seoul Colorectal Research Group (SECOG); Ann Coloproctol. 2022;38(2):166-175. Published online October 6, 2021; DOI: https://doi.org/10.3393/ac.2021.00479.0068

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10 Citations

Abstract PDF

Purpose
Local excision (LE) is an alternative initial treatment for clinical T1 rectal cancer, and has avoided potential morbidity. This study aimed to evaluate the clinical outcomes of LE compared with total mesorectal excision (TME) for clinical T1 rectal cancer.
Methods
Between January 2000 and December 2011, we retrospectively reviewed from multicenter data in patients with clinically suspected T1 rectal cancer treated with either LE or TME. Of 1,071 patients, 106 were treated with LE and 965 were treated with TME. The data were analyzed using propensity score matching, with each group comprising 91 patients.
Results
After propensity score matching, the median follow-up time was 60.8 months (range, 0.6–150.6 months). After adjustment for the necessary variables, patients who underwent LE showed a significantly higher local recurrence rate than did those who underwent TME; however, there were no differences in disease-free survival and overall survival. In the multivariate analysis, age (hazard ratio [HR], 9.620; 95% confidence interval [CI], 3.415–27.098; P<0.001) and angiolymphatic invasion (HR, 3.63; 95% confidence interval, 1.33–9.89; P=0.012) were independently associated with overall survival. However, LE was neither associated with overall survival nor disease-free survival.
Conclusion
LE for clinical T1 rectal cancer yielded a higher local recurrence rate than did TME. Nevertheless, LE provided comparable overall survival rate and can be proposed as an optional treatment in terms of organ-preserving strategies.

Citations

Citations to this article as recorded by

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
Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
Survival prognostic in different age groups of patients undergoing local versus radical excision for rectal cancer: a study based on the SEER database
Jinghui Li, Liang Wen, Yongli Ma, Guosheng Zhang, Ping Wang, Chengzhi Huang, Xueqing Yao
Updates in Surgery.2024; 76(3): 975. 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
Surgical Techniques for Transanal Local Excision for Early Rectal Cancer
Gyoung Tae Noh
The Ewha Medical Journal.2023;[Epub] CrossRef
How Can We Improve the Tumor Response to Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer?
Jeonghee Han
The Ewha Medical Journal.2023;[Epub] 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
The risk-benefit trade-off in local excision of early rectal cancer
Chang Hyun Kim
Annals of Coloproctology.2022; 38(2): 95. CrossRef
Applications of propensity score matching: a case series of articles published in Annals of Coloproctology
Hwa Jung Kim
Annals of Coloproctology.2022; 38(6): 398. CrossRef

Case Report

Malignant disease,Rare disease & stoma

Malignant Melanoma of Anorectum: Two Case Reports: Binh Van Pham, Jae Hyun Kang, Huynh Huu Phan, Min Soo Cho, Nam Kyu Kim; Ann Coloproctol. 2021;37(1):65-70. Published online February 28, 2021; DOI: https://doi.org/10.3393/ac.2020.01.07.1

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14 Citations

Abstract PDF

Malignant melanoma of the anorectum is a rare disorder. Patients often present with local symptoms similar to benign diseases. The prognosis is very poor, and almost all patients die because of metastases. We report 2 female patients with unremarkable histories. Both of them received previous operations before visiting our center after they were diagnosed with anorectal malignant melanoma. One case underwent abdominoperineal resection and postoperative chemotherapy. The other had been treated with ultralow anterior resection followed by immunotherapy.

Citations

Citations to this article as recorded by

Case Report: Surgical management and prognostic factors in primary anorectal melanoma: a retrospective analysis of nine cases
Xiangxiang Ren, Xiaoshi Jin, Tianhao Xie, Litao Liu, Qiang Wang, Xingli Sun, Meng Zhang
Frontiers in Medicine.2025;[Epub] CrossRef
Malignant melanoma of the anal canal: a case report
Shubu Parajuli, Shruti Sah, Narendra Pandit
Journal of Surgical Case Reports.2025;[Epub] CrossRef
A Rare Entity: Primary Malignant Melanoma of the Anorectum
Jeongmin Choi, Jong Whan Kim
Journal of Digestive Cancer Research.2024; 12(1): 44. CrossRef
Anorectal Malignant Melanoma Post- Hemorrhoidectomy
Ramazan Kozan, Ozkan Akpinar, Meral Toker
Acta Médica Portuguesa.2024; 37(7-8): 556. CrossRef
Immunotherapy for anorectal melanoma: A case report
Nicholas L. Vitagliano, Muhammad B. Darwish, Roger W. Hsiung
Current Problems in Cancer: Case Reports.2024; 15: 100302. CrossRef
Amelanotic Malignant Melanoma With Atypical Divergent Neuroendocrine Differentiation: A Report of an Unusual and Rare Case of Anorectal Bleeding
Shamiliprabha MG, Anand CD, Supriya Verma, Nivethitha S, Jaison J John
Cureus.2024;[Epub] CrossRef
Anorectal melanoma: systematic review of the current literature of an aggressive type of melanoma
Giovanni Paolino, Antonio Podo Brunetti, Carolina De Rosa, Carmen Cantisani, Franco Rongioletti, Andrea Carugno, Nicola Zerbinati, Mario Valenti, Domenico Mascagni, Giulio Tosti, Santo Raffaele Mercuri, Riccardo Pampena
Melanoma Research.2024; 34(6): 487. CrossRef
A rare account of incidentally discovered anal melanoma
Nawal Khan, Dondre Irving, Lynn O’Connor
Journal of Surgical Case Reports.2024;[Epub] CrossRef
Prolapsed anorectal malignant melanoma presenting as hemorrhoids
Busara Songtanin, Kenneth Nugent, Sameer Islam
Baylor University Medical Center Proceedings.2023; 36(1): 89. CrossRef
Long recurrence-free survival of localized rectal melanoma after abdominoperineal resection in comparison to partial excision and highlighting the place of immunotherapy: A case report
Othmane Bourouail, Noureddine Njoumi, Youssef Elmahdaouy, Mohamed Fahssi, Mbarek Yaka, Abderrahmane Hejjouji, Abdelmounaim Ait Ali
JRSM Open.2023;[Epub] CrossRef
Challenges in managing anorectal melanoma, a rare malignancy
Jyotirmoy Biswas, Lakshmi Deepak Bethineedi, Arkadeep Dhali, Jamal Miah, Sukanta Ray, Gopal Krishna Dhali
International Journal of Surgery Case Reports.2023; 105: 108093. CrossRef
Organ preservation in anorectal melanoma: A tempting challenge—a case report
Mohamed Mehdi Trabelsi, Neirouz Kammoun, Marwa Inoubli, Mohamed Ali Chaouch, Haifa Ben Romdhane, Wafa Koubaa, Hichem Jerraya
SAGE Open Medical Case Reports.2023;[Epub] CrossRef
Primary anorectal amelanotic melanoma with liver, lungs and lymph nodal metastases
James R Marak, Gaurav Raj, Shivam Dwivedi, Ariba Zaidi
BMJ Case Reports.2023; 16(11): e257510. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef

Original Articles

Malignant disease, Rectal cancer,Prognosis and adjuvant therapy,Colorectal cancer,Epidemiology & etiology

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; Ann Coloproctol. 2021;37(3):186-191. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.10.1

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6 Web of Science
4 Citations

Abstract PDF

Purpose
Locally advanced rectal cancer (LARC) is managed by chemoradiotherapy (CRT), followed by surgery. Herein we reported patients with metastases during or after CRT.
Methods
Data of patients with LARC who received CRT from 2008 to 2017 were reviewed. Patients with metastases after CRT were included. Those with metastatic tumors at the initial diagnosis were excluded.
Results
Fourteen patients (1.3%) of 1,092 who received CRT presented with metastases. Magnetic resonance circumferential resection margin (mrCRM) and mesorectal lymph nodes (LNs) were positive in 12 patients (85.7%). Meanwhile, magnetic resonance extramural vascular invasion (mrEMVI) was positive in 10 patients (71.4%). Magnetic resonance tumor regression grade (mrTRG) 4 and mrTRG5 was detected in 5 and 1 patient respectively. Ten patients (71.4%) underwent combined surgery and 3 (21.4%) received palliative chemotherapy.
Conclusion
Patients with metastases after CRT showed a higher rate of positive mrCRM, mrEMVI, mesorectal LNs, and poor tumor response. Further studies with a large number of patients are necessary for better survival outcomes in LARC.

Citations

Citations to this article as recorded by

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
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
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

Benign proctology

Prospective Comparative Analysis of the Incidence of Vasovagal Reaction and the Effect of Rectal Submucosal Lidocaine Injection in Stapled Hemorrhoidopexy: A Randomized Controlled Trial: Kyung Jin Cho, Do Yeon Hwang, Hyun Joo Lee, Ki Hoon Hyun, Tae Jung Kim, Duk Hoon Park; Ann Coloproctol. 2020;36(5):344-348. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2020.02.12

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2 Web of Science
4 Citations

Abstract PDF

Purpose
This study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention.
Methods
One hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention).
Results
Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374).
Conclusion
Patients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.

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Reducing Pain, Spasm, and Vasovagal Syndrome in Transradial Cardiac Angiography: The Role of Lidocaine Cream and Injectable Lidocaine
Behrang Bahreini, Saeed Alipour Parsa, Vahid Eslami, Mohammad Khani, Abdolhamid Bagheri
International Journal of Cardiovascular Practice.2024;[Epub] CrossRef
PROSPECT guideline for haemorrhoid surgery
Alexis Bikfalvi, Charlotte Faes, Stephan M. Freys, Girish P. Joshi, Marc Van de Velde, Eric Albrecht
European Journal of Anaesthesiology Intensive Care.2023; 2(3): e0023. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
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The Effort to Reduce Vasovagal Reaction and Abdominal Pain During Stapled Hemorrhoidopexy
Hyeonseok Jeong
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Preoperative Tattooing Using Indocyanine Green in Laparoscopic Colorectal Surgery: Sang Jae Lee, Dae Kyung Sohn, Kyung Su Han, Byung Chang Kim, Chang Won Hong, Sung Chan Park, Min Jung Kim, Byung Kwan Park, Jae Hwan Oh; Ann Coloproctol. 2018;34(4):206-211. Published online July 26, 2018; DOI: https://doi.org/10.3393/ac.2017.09.25

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Abstract PDF

Purpose
The aim of the present study was to evaluate the usefulness of indocyanine green (ICG) as a preoperative marking dye for laparoscopic colorectal surgery.
Methods
Between March 2013 and March 2015, 174 patients underwent preoperative colonoscopic tattooing using 1.0 to 1.5 mL of ICG and saline solution before laparoscopic colorectal surgery. Patients’ medical records and operation videos were retrospectively assessed to evaluate the visibility, duration, and adverse effects of tattooing.
Results
The mean age of the patients was 65 years (range, 34–82 years), and 63.2% of the patients were male. The median interval between tattooing and operation was 1.0 day (range, 0–14 days). Tattoos placed within 2 days of surgery were visualized intraoperatively more frequently than those placed at an earlier date (95% vs. 40%, respectively, P < 0.001). For tattoos placed within 2 days before surgery, the visualization rates by tattoo site were 98.6% (134 of 136) from the ascending colon to the sigmoid colon. The visualization rates at the rectosigmoid colon and rectum were 84% (21 of 25) and 81.3% (13 of 16), respectively (P < 0.001). No complications related to preoperative ICG tattooing occurred.
Conclusion
Endoscopic ICG tattooing is more useful for the preoperative localization of colonic lesions than it is for rectal lesions and should be performed within 2 days before laparoscopic surgery.

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Clinical Etiology of Hypermetabolic Pelvic Lesions in Postoperative Positron Emission Tomography/Computed Tomography for Patients With Rectal and Sigmoid Cancer: Yun Hee Kang, Eunji Han, Geon Park; Ann Coloproctol. 2018;34(2):78-82. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.09.21

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Abstract PDF

Purpose
The purpose of this study was to present various clinical etiologies of hypermetabolic pelvic lesions on postoperative positron emission tomography/computed tomography (PET/CT) images for patients with rectal and sigmoid cancer.
Methods
Postoperative PET/CT images for patients with rectal and sigmoid cancer were retrospectively reviewed to identify hypermetabolic pelvic lesions. Positive findings were detected in 70 PET/CT images from 45 patients; 2 patients who were lost to follow-up were excluded. All PET findings were analyzed in comparison with contrast-enhanced CT.
Results
A total of 43 patients were classified into 2 groups: patients with a malignancy including local recurrence (n = 30) and patients with other benign lesions (n = 13). Malignant lesions such as a local recurrent tumor, peritoneal carcinomatosis, and incidental uterine malignancy, as well as various benign lesions such as an anastomotic sinus, fistula, abscess, reactive lymph node, and normal ovary, were observed.
Conclusion
PET/CT performed during postoperative surveillance of rectal and sigmoid colon cancer showed increased fluorodeoxyglucose uptake not only in local recurrence, but also in benign pelvic etiologies. Therefore, physicians need to be cautious about the broad clinical spectrum of hypermetabolic pelvic lesions when interpreting images.

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Case Report

Intramural Recurrence Without Mucosal Lesions After an Endoscopic Mucosal Resection for Early Colorectal Cancer: Min Sung Kim, Nam Kyu Kim, Ji Hye Park; Ann Coloproctol. 2013;29(3):126-129. Published online June 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.3.126

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Abstract PDF

Advances in endoscopic instruments and techniques have enabled increased detection and removal of early colorectal cancer (ECC), which is defined as a tumor whose invasion is limited to the mucosa or submucosa. Some cases can be treated by endoscopic mucosal resection (EMR). However, local recurrence frequently occurs after an EMR for ECC. The recurrence pattern is usually intramural recurrence with a mucosal lesion at the EMR's site. We report the cases of two patients with intramural recurrence without mucosal lesions after an EMR for ECC. These cases indicate that a local recurrence after an EMR for ECC can appear as an intramural recurrence without mucosal lesions at a previous EMR site or another site, although this presentation is very unusual.

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Reviews

Pelvic Exenteration: Surgical Approaches: Jin Kim; J Korean Soc Coloproctol. 2012;28(6):286-293. Published online December 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.6.286

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Abstract PDF

Although the incidence of local recurrence after curative resection of rectal cancer has decreased due to the understanding of the anatomy of pelvic structures and the adoption of total mesorectal excision, local recurrence in the pelvis still remains a significant and troublesome complication. While surgery for recurrent rectal cancer may offer a chance for a cure, conservative management, including radiation and chemotherapy, remain widely accepted courses of treatment. Recent improvement in imaging modalities, perioperative care, and surgical techniques, including bone resection and wound coverage, have allowed for reductions in operative mortality, though postoperative morbidity still remains high. In this review, the techniques, including surgical approaches, employed for management of locally recurrent rectal cancer are highlighted.

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Update and Debate Issues in Surgical Treatment of Middle and Low Rectal Cancer: Nam Kyu Kim, Min Sung Kim, Sami F. AL-Asari; J Korean Soc Coloproctol. 2012;28(5):230-240. Published online October 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.5.230

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Abstract PDF

Based on a review of the literature, this paper provides an update on surgical treatment of middle and low rectal cancer and discusses issues of debate surrounding that treatment. The main goal of the surgical treatment of rectal cancer is radical resection of the tumor and surrounding lymphatic tissue. Local excision of early rectal cancer can be another treatment option, in which the patient can avoid possible complications related to radical surgery. Neoadjuvant chemoradiation therapy (CRT) has been recommended for patients with cT3-4N0 or any T N+ rectal cancer because CRT shows better local control and less toxicity than adjuvant CRT. However, recent clinical trials showed promising results for local excision after neoadjuvant CRT in selected patients with low rectal cancer. In addition, the "wait and see" concept is another modality that has been reported for the management of tumors that show complete clinical remission after neoadjuvant CRT. Although radical surgery for middle and low rectal cancer is the cornerstone therapy, an ultralow anterior resection with or without intersphincteric resection (ISR) has become an alternative standard surgical method for selected patients. Many studies have reported on the oncological safety of the ISR, but few of them have addressed the issue the functional outcome. Furthermore, an abdominoperineal resection (APR) has problems with high rates of tumor perforations and positive circumferential resection margins, and those factors have contributed to its having a high rate of local recurrence and a poor survival rate for rectal cancer compared with sphincter-saving procedures. Recently, great efforts have been made to reduce these problems, and the total levator excision or the extended APR concept has emerged. Surgical management for low rectal cancer should aim to radically excise the tumor and to preserve as much of the sphincter function as possible by using multidisciplinary approaches. However, further prospective clinical trials are needed for tailored treatment of rectal cancer patients.

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Original Articles

Clinical Characteristics of Ischemic Colitis According to Location: Ho Jin Chang, Chul Woon Chung, Kwang Hyun Ko, Jong Woo Kim; J Korean Soc Coloproctol. 2011;27(6):282-286. Published online December 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.6.282

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Abstract PDF

Purpose

The aim of this study was to analyze various clinical characteristics of ischemic colitis according to its location.

Methods

The medical records of 92 cases of gastrointestinal ischemic colitis (IC) diagnosed at Bundang CHA Hospital from 1995 to 2008 were reviewed and analyzed retrospectively. The patients were diagnosed by using colonoscopic biopsies or laparotomy findings. The patients were divided into two groups, right and left, according to the main involvement area of the IC at the embryologic boundary line of the distal transverse colon, and the two groups were compared as to clinical characteristics and co-morbid diseases.

Results

Left IC was present in 59 patients (64.1%) and right IC in 33 patients (35.9%). No differences between the two groups in terms of clinical characteristics, cardiovascular disease and diabetes mellitus were observed. However, in 16 cases with renal failure, 10 patient had right IC and 6 patients had left IC, and this difference had statistical significance (P = 0.014). Among the 16, the 11 patients requiring hemodialysis included 8 with right IC (24.2%) and 3 with left IC (5.1%; P = 0.009). Among the 19 cases of severe IC requiring surgical treatment or involving mortality, irrespective of surgery, 11 patients showed right IC and 8 patients showed left IC (P = 0.024).

Conclusion

Right-side ischemic colitis was significantly associated with renal failure and disease severity, so patients with right-side colon ischemia should be more carefully observed and managed.

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Analysis of the Prognostic Effectiveness of a Multivisceral Resection for Locally Advanced Colorectal Cancer: Sejin Park, Yun Sik Lee; J Korean Soc Coloproctol. 2011;27(1):21-26. Published online February 28, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.1.21

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Abstract PDF

Purpose

The aim of this study was to evaluate the prognostic effectiveness of multivisceral resections of organs involved by locally advanced colorectal cancer.

Methods

A retrospective study was performed to analyze the data collected for 266 patients who underwent a curative resection for pT3-pT4 colorectal cancer without distant metastasis from January 2000 to December 2007. Of these 266 patients, 54 patients had macroscopically direct invasion of adjacent organs and underwent a multivisceral resection. We evaluated the short-term and the long-term outcomes of a multiviceral resection relative to that of standard surgery.

Results

The most common location for the primary lesion was the rectum, followed by the right colon and the sigmoid colon. Among the combined resected organs, common organs were the small bowel, ovary, and bladder. In the multivisceral resection group, tumor infiltration was confirmed histologically in 44.4% of the cases while in the remaining patients, a peritumorous adhesion had mimicked tumor invasion. Postoperative complications occurred in 17.5% of the patients who underwent standard surgery vs. 35.2% of those who underwent a multivisceral resection (P < 0.0001). But the survival rate of patients after a multivisceral resection was similar to that of patients after standard surgery (5-year survival rates: 61% vs. 58%; P = 0.36).

Conclusion

For locally advanced colorectal cancer, multivisceral resection was associated with higher postoperative morbidity, but the long-term survival after a curative resection is similar to that after a standard resection. Thus, a multivisceral resection can be recommended for most patients of locally advanced colorectal cancer.

Citations

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Multivisceral Resections in GI Oncology: Where to Draw the Line?
Supreet Kumar, Sonam Gupta, Vivek Tandon, Deepak Govil
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Nikki C.M. van Ham, Sofie Glazemakers, Mirjam van der Ende-van Loon, Grard A.P. Nieuwenhuijzen, Harm J.T. Rutten, Jip L. Tolenaar, Anne Jacobs, Jacobus W.A. Burger, Stijn H.J. Ketelaers, Johanne G. Bloemen
European Journal of Surgical Oncology.2024; 50(6): 108259. CrossRef
A Novel Clinical Nomogram for Predicting Overall Survival in Patients with Emergency Surgery for Colorectal Cancer
Georgiana Bianca Constantin, Dorel Firescu, Raul Mihailov, Iulian Constantin, Ioana Anca Ștefanopol, Daniel Andrei Iordan, Bogdan Ioan Ștefănescu, Rodica Bîrlă, Eugenia Panaitescu
Journal of Personalized Medicine.2023; 13(4): 575. CrossRef
Multivisceral resection of advanced colon and rectal cancer: a prospective multicenter observational study with propensity score analysis of the morbidity, mortality, and survival
Michael Arndt, Hans Lippert, Roland S. Croner, Frank Meyer, Ronny Otto, Karsten Ridwelski
Innovative Surgical Sciences.2023; 8(2): 61. CrossRef
Extended Total Mesorectal Excision (e-TME) for Locally Advanced Rectal Cancer
Narendra Pandit, Kunal Bikram Deo, Sujan Gautam, Tek Narayan Yadav, Awaj Kafle, Sudhir Kumar Singh, Laligen Awale
Journal of Gastrointestinal Cancer.2022; 53(2): 253. CrossRef
Predictors of undergoing multivisceral resection, margin status and survival in Dutch patients with locally advanced colorectal cancer
L.C.F. de Nes, J.A.G. van der Heijden, M.G. Verstegen, L. Drager, P.J. Tanis, R.H.A. Verhoeven, J.H.W. de Wilt
European Journal of Surgical Oncology.2022; 48(5): 1144. CrossRef
Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks
Karin A.T.G.M. Wasmann, Charlotte E.L. Klaver, Jarmila D.W. van der Bilt, Iris D. Nagtegaal, Albert M. Wolthuis, Hjalmar C. van Santvoort, Bert Ramshorst, André D’Hoore, Johannes H.W. de Wilt, Pieter J. Tanis
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Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer
Chun-Ming Huang, Ching-Wen Huang, Cheng-Jen Ma, Hsiang-Lin Tsai, Wei-Chih Su, Tsung-Kun Chang, Ming-Yii Huang, Jaw Yuan Wang
World Journal of Gastrointestinal Oncology.2020; 12(12): 1428. CrossRef
Hospital volume and outcome in rectal cancer patients; results of a population-based study in the Netherlands
J.A.W. Hagemans, W.J. Alberda, M. Verstegen, J.H.W. de Wilt, C. Verhoef, M.A. Elferink, J.W.A. Burger
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Significance of multivisceral resections in oncologic surgery: A systematic review of the literature
Giorgi Nadiradze, Can Yurttas, Alfred Königsrainer, Philipp Horvath
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Neo-adjuvant chemoradiotherapy and multivisceral resection to optimize R0 resection of locally recurrent adherent colon cancer
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Trans-Sacral Local Resection as a Posterior Approach.: Lee, Bong Hwa , Park, Hyoung Chul , Lee, Hae Wan , An, Chang Nam , Um, Taeik , Lim, Young A , Kim, Byoung Sup , Chang, Mi Young , Kim, Soo Hyoung , Cho, Sung Wook; J Korean Soc Coloproctol. 2010;26(3):197-203.; DOI: https://doi.org/10.3393/jksc.2010.26.3.197

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Abstract PDF

PURPOSE
Surgical removal for a mass in the pre-sacral space or mid rectum through a posterior approach is not frequent. We would like to present the technique of trans-sacral local resection as a posterior approach. We analyzed the follow up of patients who underwent surgery using the proposed technique.
METHODS
A total of 21 patients who had undergone a trans-sacral local resection with lower sacrectomy between January 1997 and December 2006 were enrolled in this study. The diagnoses were large epidermal cyst, gastrointestinal stromal tumor, high grade adenoma, and early cancers in the mid rectum. We analyzed the surgical complications and disease recurrences. The mean follow up for tumors of the rectum was 53+/-35 mo.
RESULTS
Epidural anesthesia was appropriate for all whole procedures. Among the 21 cases, there was one case of a rectocutaneous fistula as a postoperative complication (4.9%). In one case among the submucosal cancers, there was a systemic metastasis at 24 mo without local recurrence.
CONCLUSION
In our experience, a trans-sacral resection with a lower sacrectomy is a good option and provides a wide and direct surgical exposure for the removal of a pre-sacral or a mid-rectal mass. Good bowel preparation is mandatory.

Citations

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How to Treat Retrorectal Cysts or Tumors in Adult
Bong Hwa Lee, Hyoung Chul Park, Byung Seup Kim
Journal of the Korean Society of Coloproctology.2011; 27(6): 276. CrossRef

Abdominoperineal Resection in the Treatment of Locally-advanced Low Rectal Cancer: Is Preoperative Chemoradiation Advantageous?.: Kim, Jeong Yeon , Kim, Jin Soo , Kim, Young Wan , Hur, Hyuk , Min, Byung Soh , Kim, Nam Kyu; J Korean Soc Coloproctol. 2010;26(2):129-136.; DOI: https://doi.org/10.3393/jksc.2010.26.2.129

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Abstract PDF: PURPOSE
An abdominoperineal resection (APR) has a poor prognosis. However, limited studies about the prognostic factors in APR and the role of preoperative chemoradiotherapy (CRT) have been performed even though in rectal cancer, the application of preoperative CRT provides better local control compared to postoperative CRT. The aim of this study was to identify the prognostic factors and the impact of preoperative CRT in patients who undergo an APR.
METHODS
A retrospective analysis was conducted with a total of 133 patients who underwent an APR, cT3, cT4, or cN(+) patients, for rectal cancer between January 1995 and October 2004. Fifty-one patients treated with preoperative CRT (Group 1) were compared with 82 APR patients treated with postoperative CRT (Group 2). Oncologic outcomes were compared between the two groups, and the clinicopathologic factors affecting the treatment outcomes were evaluated.
RESULTS
The median follow-up period was 61.2 mo (range 6 to 194 mo). Circumferential margin (CRM) involvement was significantly associated with local recurrence (LR) and with disease-free survival in APR patients (P<0.001, P=0.011). The 5-yr LR rate was significantly lower in Group 1 than in Group 2 (P=0.013) in the univariate analysis, but no difference was noted in multivariate analysis (P=0.315). In Group 1, CRM involvement, tumor size, and lymph node metastasis were significantly lower than they were in Group 2 (P=0.043, P=0.003, P<0.001).
CONCLUSION
For achieving adequate oncologic outcomes in APR patients, an adequate CRM should be acquired with an optimal operation. In addition, preoperative CRT would be helpful for high-risk APR patients with a threatening CRM margin, providing the benefit of tumor downstaging.

Feasibility of York-Mason Operation for Selective Advanced Rectal Cancer.: Jeong, Woon Kyung , Baek, Seong Kyu , Bae, Ok Suk; J Korean Soc Coloproctol. 2009;25(3):178-185.; DOI: https://doi.org/10.3393/jksc.2009.25.3.178

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Abstract PDF

PURPOSE
The York-Mason operation has been used as local therapy for benign rectal tumors not easily excised with a conventional transanal excision and for T1 rectal cancers having a low risk of lymph-node metastasis. This study evaluated whether a York-Mason operation could be an alternative therapy for selected patients with T2 or T3 rectal cancers.
METHODS
From February 2004 to March 2008, 11 patients with T2 or T3 rectal cancer, who refused rectal excision due to fear of abdominal surgery itself and perioperative side effects or unwillingness to have a permanent stoma, underwent a York-Mason operation. The data on the patients were analyzed retrospectively.
RESULTS
The distance from the anal verge to the tumor was 5 cm (median, 2-8 cm), and the tumor size was 3 cm (median, 1.5-4 cm). Histological examination revealed a pathological tumor (pT) stage 2 in eight patients, stage pT3 in one patient, and stage pTx in two patients. The distance from the resection margin to the tumor was 0.3 cm (median, 0.1-0.5 cm). Six patients (55%) had incomplete tumor excision. Radiotherapy was performed in one patient preoperatively and in eight postoperatively. Postoperative morbidity occurred in four patients (36%). During a median of 38.2 months, two patients (18%) developed local recurrence and liver metastasis. Postoperative mortality, which was not related to the procedure, occurred in one patient (9%).
CONCLUSION
The York-Mason operation could be considered as an alternative therapy for selected T2 or T3 rectal cancer patients who refuse rectal excision.

Citations

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Trans-Sacral Local Resection as a Posterior Approach
Bong Hwa Lee, Hyoung-Chul Park, Hae Wan Lee, Chang Nam An, Taeik Um, Young A Lim, Byoung Sup Kim, Mi Young Chang, Soo Hyoung Kim, Sung Wook Cho
Journal of the Korean Society of Coloproctology.2010; 26(3): 197. CrossRef

Concomitant Adjacent Organ Resection in Locally Advanced Colon Cancer.: Cho, Sung Wook , Lee, Ryung Ah , Chung, Soon Sup , Kim, Kwang Ho; J Korean Soc Coloproctol. 2009;25(2):94-99.; DOI: https://doi.org/10.3393/jksc.2009.25.2.94

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Abstract PDF

PURPOSE
In locally advanced adherent colon cancer surgery, a mutivisceral resection is known to reduce local recurrence and improve survival. Practically, the benefit of using this procedure may outweigh the risk of associated morbidity, but the procedure may not be performed uniformly. We reviewed the results of multivisceral resections for locally advanced colon cancer. METHODS: From 2003 January to 2008 January, 476 colon cancer patients underwent surgery for locally advanced colon cancer in our hospital. Out of the 476 patients, 36 patients with pT3-pT4 who underwent any kind of adjacent organ resection other than a resection of the colon were reviewed retrospectively. RESULTS: Out of the 36 patients, 22 were male and 14 were female, and the mean age was 63.44+/-13.26 yr. The sigmoid colon was the most common location for the primary lesion, followed by the ascending colon, the transverse colon, and the cecum. Invaded organs were the abdominal or pelvic wall in 5 patients, the visceral organs in 26 patients, the retroperitoneum in 2 patients. All patients received an en-bloc resection of the invaded organs. Ten patients were stage II, 14 patients were stage III, and 12 patients were stage IV. Fifteen patients were disease free at the end of this study, local recurrence had occurred in 1 patient, 6 patients had an intraabdominal recurrence, and 2 patients had developed a distant metastasis. The overall complication rate was 28%. The 5-yr survival rate of each stage according to the surgical approach did not show any meaningful difference. CONCLUSION: A multivisceral en-bloc resection has been recommended for locally advanced adherent colon cancer patients. To improve the outcome, we suggest progressive surgical treatment in such patients.

Citations

Citations to this article as recorded by

Analysis of the Prognostic Effectiveness of a Multivisceral Resection for Locally Advanced Colorectal Cancer
Sejin Park, Yun Sik Lee
Journal of the Korean Society of Coloproctology.2011; 27(1): 21. CrossRef

Case Report

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

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

Original Articles

Is a Short Distal Resection Margin of Less than One Centimeter in a Sphincter-saving Resection for Rectal Cancer Oncologically Safe?.: Cho, Min Jeong , Yu, Chang Sik , Park, In Ja , Jeong, Sang Hoon , Chae, Pheung Ha , Hong, Dong Heun , Kim, Dea Dong , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2007;23(6):454-459.; DOI: https://doi.org/10.3393/jksc.2007.23.6.454

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Abstract PDF: PURPOSE
Sphincter preservation is one of the main goals in the treatment of rectal cancer. The aim of this study was to evaluate the oncologic safety of a sphincter-saving resection with a distal resection margin of less than 1 cm.
METHODS
Two hundred forty-eight patients who underwent a sphincter-saving resection between June 1989 and December 2002 and who had a confirmed distal resection margin of less than 1 cm on pathologic examination were included. All patients were evaluated for local and systemic recurrences.
RESULTS
The median follow-up period was 45 (6~144) months. The mean length of distal resection margin was 0.79+/-0.26 cm. Lower rectalcancer was most common (56.5%). Forty patients (16.1%) experienced recurrence. The local recurrence rate was 3.6%, systemic recurrence rate was 11.7%, and the combined local and systemic recurrence rate was 0.4%. In systemic recurrence, the liver was the most common site, followed by the lung. Among stage II & III groups, patients who underwent adjuvant chemoradiotherapy experienced significantly lower local recurrence compared to patients in the chemotherapy-only or the no-adjuvant group (2.6%, 12.9%, 8.7%, P=0.05). The length of distal resection margin, the total mesorectal excision, the location of tumor, sex, histology, and stage were not associated with local recurrence.
CONCLUSIONS
A distal resection margin of less than 1 cm in a sphincter-saving resection showed acceptableoncologic outcomes. Adjuvant chemoradiotherapy were beneficial to reduce local recurrence in the stage II and the stage III groups.

Local Control of Local Excision for T1/T2 Rectal Cancer .: Park, Ki Jae , Choi, Hong Jo , Roh, Young Hoon , Shin, Jong Sok , Lee, Hyung Sik; J Korean Soc Coloproctol. 2007;23(2):87-92.; DOI: https://doi.org/10.3393/jksc.2007.23.2.87

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Abstract PDF

PURPOSE
The aim of this study was to review the outcome of local control after the local excision for T1/T2 rectal cancers and, thus, to assess its effectiveness as an alternative to a more radical resection.
METHODS
This retrospective study analyzed 23 patients with T1/T2 rectal cancer treated by local excision (LE), and their results were compared with the results for 22 patients with rectal cancer of the same stage treated by a radical resection (RR). All patients with pT2 lesions in the LE group received postoperative adjuvant chemoradiation. The outcomes were defined as 5-year local-recurrence-free survival (LRFS). The median follow-up was 72 (range, 40~92) months.
RESULTS
Recurrence occurred in 4 patients (pT1, 1; pT2, 3) in the LE group and in 3 patients (all pT2) in the the RR group. One patient with vascular invasion (T2N1M0) in the RR group showed multiple liver metastases at 23 months postoperatively. The difference in 5-year LRFS was not statistically significant between the two groups. In the LE group, the 5-year LRFS for pT2 lesions was significantly less favorable than that for pT1 lesions (40% vs. 94%; P= 0.005). The 5-year LRFS for pT2 in the RR group was more favorable than that in the LE group, although the difference was not statistically significant (76.9% vs. 40%, P=0.138). CONSLUSIONS: Local excision provides a favorable local control for pT1 rectal cancers. A more radical resection, however, remains an effective surgical option for pT2 lesions because local excision, even combined with adjuvant chemoradiation, showed substantial local recurrences.

Citations

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Recurrences after Local Excision for Early Rectal Adenocarcinoma
Jung Wook Huh, Yoon Ah Park, Kang Young Lee, Seong Ah Kim, Seung-Kook Sohn
Yonsei Medical Journal.2009; 50(5): 704. CrossRef

Clinical Analysis of the Hemorrhoidectomy with Pure Local Anesthesia.: Oh, Chang Seok , Lee, Yong Jik , Ko, Soo Jong , Lee, Young Taek; J Korean Soc Coloproctol. 2007;23(1):22-27.; DOI: https://doi.org/10.3393/jksc.2007.23.1.22

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Abstract PDF: PURPOSE
We hoped to evaluate the possibility of substitution of the local anesthesia for the spinal anesthesia in hemorrhoidectomy.
METHODS
We did Milligan-Morgan hemorrhoidectomy under local anesthesia for the sixty- eight patients from January 1998 to December 2005. These patients were compared with seventy-nine patients of spinal anesthesia, sampled with similar gender, age, a surgeon, retrospectively. We used a mixture of 0.5% lidocaine and 1:200,000 epinephrine into perianal skin and intersphincteric space.
RESULTS
The male-to-female ratio was 1:1 in local anesthesia group and 1:0.84 in spinal anesthesia group. The mean age was 50 and 46 respectively. The number of excised pile was 3.9 and 3.8 respectively. The frequency of the analgegics injected within first 24 hours was 1.79 and 2.70 respectively (P=0.001). The frequency of the urinary catheterization was 0.07 and 0.69 respectively (P < 0.001). The first bowel movement after surgery was 1.2 days and 1.6 days respectively. The hospital stay was 6.4 days and 8.1 days respectively (P=0.06). CONCLUISIONS: Local anesthesia is simple, safe and effective in the hemorrhoidectomy.

Hemorrhoidectomy Under Local Anesthesia after Pentothal Induction versus Spinal Anesthesia: a Concurrent Nonrandomized Prospective Study.: Kang, Choong Hoon , Lee, Sang Woo , Shin, Hyeon Keun , Jeong, Seung Kyu , Choi, Jai Pyo , Yang, Hyung Kyu; J Korean Soc Coloproctol. 2006;22(1):1-7.

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Abstract PDF: PURPOSE
The aim of this study was to evaluate the effectiveness of local anesthesia compared to spinal anesthesia and the usefulness of pentothal induction before infiltration of a local anesthetic agent.
METHODS
A concurrent non-randomized prospective study was conducted on 52 patients who underwent a hemorrhoidectomy. For the spinal anesthesia (SA) group (n=29), 0.5% heavy bupivacaine (Marcaine(R)), 5 mg (1 ml), was used, and for the local anesthesia (LA) group (n=23), pentothal, 3.3 mg/kg, was administrated intravenously prior to infiltration of a mixture of local anesthetics (2% lidocaine, 14 ml, with 0.5% bupivacaine, 7 ml).
RESULTS
There were no differences between the two groups in terms of operating time, postoperative pain, headache, urinary difficulty, nausea or vomiting, pain-free interval after operation, analgesic requirements, and patient's or surgeon's satisfaction. Postoperative ambulation was earlier in the LA group than in the SA group.
CONCLUSIONS
Local anesthesia after pentothal induction can be used effectively for a hemorrhoidectomy and may be a safe alternative to spinal anesthesia.

Decision of Salvage Treatment after Transanal Endoscopic Microsurgery: Clinical Experience on 36 Cases of Rectal Cancer.: Shin, Suk Hee , Han, Sang Ah , Park, Chi Min , Yun, Seong Hyeon , Lee, Woo Yong , Choi, Dong Wook , Chun, Hokyung; J Korean Soc Coloproctol. 2005;21(6):406-412.

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Abstract PDF: PURPOSE
Local excision, including transanal endoscopic microsurgery (TEM), has become an alternative to the classic radical operation for early rectal cancer. However, radical resection for rectal cancer is necessary for advanced tumor, poor differentiation, a narrow resection margin, and positive lymphovascular invasion. This study presents the factors related to recurrence in patients who required secondary radical surgery after TEM, but did not undergo the operation.
METHODS
From November 1994 to December 2004, 167 patients underwent TEM for rectal cancer. Thirty-six of those patients were included in this study. Inclusion criteria were poor differentiation, a mucinous carcinoma, invasion to a proper muscle layer, lymphovascular invasion, and a positive resection margin.
RESULTS
Twelve of the 36 patients underwent a secondary radical operation, but 24 of them did not due to poor general condition or refusal. One of 12 patients (8.3%) who underwent a secondary radical operation had a systemic recurrence. Five of 24 patients (20.8%) who did not receive surgery had recurrences; 3 of 5 were local recurrence, and the others were distant metastases. Among the 24 patients who did not undergo a secondary radical operation, there were no recurrences in 2 cases of poor differentiation or mucinous carcinoma and in 2 cases of positive resection margin. There were 2 cases of recurrences in the 7 patients (25.0%) who had lymphovascular invasion, 1 case in the 1 patient (100%) who had a T3 lesion, 3 cases in the 17 patients (12.5%) who had T2 lesions.
CONCLUSIONS
In high-risk patients, TEM followed by radical surgery is most beneficial in preventing local recurrence. A radical operation is strongly recommended especially if pathologic results after TEM shows T3 lesions or lymphovascular invasion.

Analysis of Clinicopathological Factors Affecting Local Recurrence of Colorectal Cancer after Curative Resection.: Park, Chan Ho , Lee, Ho Kil , Yun, Min Young , Choi, Sun Keun , Hur, Yun Suk , Lee, Kun Young , Kim, Sei Joong , Cho, Young Up , Ahn, Seung Ick , Hong, Kee Chun , Shin, Suk Hwan , Kim, Kyung Rae , Woo, Ze Hong; J Korean Soc Coloproctol. 2005;21(5):320-324.

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Abstract PDF: PURPOSE
Local recurrence after curative resection of colorectal cancer has an important influence on both survival and quality of life. The ability to predict local recurrence after a curative resection of colorectal cancer may be useful for an intensive follow-up program and for a decision on adjuvant radiation or chemotherapy. The aim of this study was to analyze the factors affecting the incidence of local recurrence after a curative resection of colorectal cancer.
METHODS
A retrospective review of 390 patients who had a curative resection for a primary colorectal cancer by a single surgeon at the Department of Surgery, Inha University Hospital, between June 1996 and July 2002 was done. The medical records of patients diagnosed with a local recurrence were reviewed. Local recurrence was defined as any recurrence within the field of resection, regardless of the presence or absence of distant metastasis, that was diagnosed by using colonoscopy with biopsy and/or radiologic imaging.
RESULTS
Local recurrences were detected in 40 patients (10.3%). The gender distribution of patients with local recurrence was 24 males and 16 females with a mean age of 59.8 years. The median time to local recurrence was 15 months. The most common site of local recurrence was the anastomosis site, followed by a regional lymph node, the pelvicoperineal area, and the presacral area. Local recurrence was related to the depth of the primary tumor (P=0.027), lymphatics or vascular invasion (P=0.003), perineural invasion (P= 0.000), nodal status (P=0.000), and distant metastasis (P= 0.002). However, there was no statistically significant relation between local recurrence and primary tumor location (P=0.053), primary tumor size (P=0.982), tumor differentiation (0.256), and preoperative CEA level (P=0.481).
CONCLUSIONS
The depth of the primary tumor, lymphatics or vascular invasion, and perineural invasion were significant clinicopathologic factors of local recurrence, but tumor location, tumor size, tumor differentiation, and preoperative serum CEA level were not.

Pelvic Exenteration as the Treatment for Recurrent or Locally Advanced Rectal Cancer.: Song, Seong Kyu , Park, Yong Keun , Suh, Kwang Wook; J Korean Soc Coloproctol. 2005;21(5):314-319.

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Abstract PDF: PURPOSE
The purpose of this study is to evaluate the value of pelvic exenteration (PE) for recurrent or locally advanced rectal cancer.
METHODS
This retrospective study analyzed 20 patients who underwent PE for rectal cancer from June 1994 to October 2003 in Ajou University Hospital. The surgical severity, the postoperative complications, and the survival rate were analyed based on the medical records.
RESULTS
The mean operation time was 221.5+/-93.0 minutes, the mean blood loss 750.5+/-223.3 cc, and the mean transfusion amount RBC 6.5+/-4.3 units. Operative mortality was 5% (1/20). A bleeding-associated complication was noted in one patient who underwent a reoperation for hemostasis. Other minor complications were small bowel obstruction (n=3), abdominal wound infection (n=5), vesicocutaneous fistula (n=2), delayed healing of the perineal wound (n=10). The overall 5-year survival rate was 52.6% (10 of 19 patients, excluding the operative mortality case).
CONCLUSIONS
Our study showed acceptable surgical severity and postoperative complications and a favorable 5-year survival rate (> or =50%) for pelvic exenteration as a treatment for recurrent or locally advanced rectal cancer. With strictly selected patients, PE may be one of the treatment options for recurrent or locally advanced rectal cancer.

Transanal Endoscopic Microsurgery after Preoperative Concurrent Chemoradiation Therapy in Selected Distal Rectal Cancer Patients.: Park, Chi Min , Jung, Keuk Won , Han, Sang Ah , Yun, Seong Hyeon , Lee, Woo Yong , Chun, HoKyung; J Korean Soc Coloproctol. 2005;21(5):293-299.

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Abstract PDF: PURPOSE
Preoperative concurrent chemoradiation (CCRT) therapy may allow higher rates of tumor resectability and sphincter-saving procedures. Transanal endoscopic microsurgery (TEM) has become increasingly common in the management of selected patients with early rectal cancer. The aim of this study is to evaluate the clinical outcomes of selected patients with distal rectal cancer treated with TEM after CCRT.
METHODS
Between June 2000 and August 2004, 7 patients with clinically T2 or T3 rectal cancer underwent TEM after CCRT. Pretreatment and preoperative clinical stages were estimated by using endorectal ultrasound or computed tomography and digital rectal exam. CCRT was performed with radiation therapy of 4,500 cGy/25 fractions over 5 weeks with 5-FU based chemosensitization. TEM was performed 4~7 weeks following the completion of therapy.
RESULTS
The mean age was 54.9 (35~70) years and the median follow-up period was 23.0 (5~57) months. The lesions were located between 2 to 6 cm above the anal verge (median 3.0 cm). Pre- treatment T staging was estimated as T3 in 1 case and T2 in 6 cases, and post-treatment T staging was estimated as complete remission (CR) in 2 cases, T1 in 3 cases, and T2 in 2 patients. Pathologic evaluation revealed tumor downstaging in 6 patients, including 3 patients (42.9%) with CR. In all cases, there was no tumor on the resection margin. There have been no recurrences during the follow-up period.
CONCLUSIONS
TEM after CCRT therapy appears to be an effective alternative treatment to radical resection for highly selected patients with T2 and T3 distal rectal cancer.

The Effect of Preoperative Concurrent Chemoradiation in Locally Advanced Rectal Cancer.: Cho, Hyeon Min , Kim, Jun Gi , Jung, Hun , Heo, Youn Jung , Won, Yong Sung , Chun, Kyung Hwa , Chin, Hyung Min , Park, Woo Bae , Chun, Chung Soo; J Korean Soc Coloproctol. 2005;21(2):89-99.

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Abstract PDF: PURPOSE
Tumor downstaging from preoperative chemoradiation has been associated with an increased probability of a sphincter-saving procedure and with improved local control and survival rate. We observed the effect and the prognostic value of pathologic tumor downstaging, including complete pathologic response to preoperative concurrent chemoradiation, resectability, sphincter-saving rate, disease- free survival, and overall survival in locally advanced rectal cancer patients.
METHODS
From January 2000 to December 2003, we recruited a total 78 patients with computed tomography stages II and III rectal cancer which was treated by using preoperative concurrent chemoradiation; all patients had a radical resection with total mesorectal excision. Surgical resection was performed 6 to 8 weeks after completing the radiation therapy. The average follow up was 25.40+/-13.64 months.
RESULTS
The number of patients according to CT stage before preoperative chemoradiation was 39 (II) and 39 (III). Tumor downstaging occurred in 51 (65.4%) patients, including 11 (14.1%) patients who had a complete pathologic response. Tumor size, radiation dose, and clinical stage were associated with tumor downstaging in the univariate analysis. None of the clinical or pathologic variables was associated with a complete pathologic response. The overall resectibality was 100%. The number of sphincter-saving procedures were 61 (78.2%). Recurrence occurred in 17 (21.8%) patients: local recurrence in 4 (5.1%) and distant metastasis in 13 (16.7%). None of the patients with a complete pathologic response recurred. Recurrences were 3 (17.6%)/7 (22.6%)/7 (36.8%) for pathologic stages I/II/III. Recurrence was more common among younger patients (P <0.05). Patients in the complete pathologic response group had more favorable disease-free survival compared with other group (yp stage I, II, III) (P=0.026).
CONCLUSION
Preoperative concurrent chemoradiation for locally advanced rectal cancer seems to afford some potential advantages: high tumor response, resectability, and feasible sphincter preservation, and even a complete pathologic response. A complete pathologic response to preoperative chemoradiation is associated with an improved disease-free survival.

Local Pelvic Recurrence after Curative Resection of the Rectal Cancer: Classification and Prognosis.: Park, Jea Kun , Kim, Nam Kyu , Baik, Seung Hyuk , Lee, Kang Young , Sohn, Seung Kook , Cho, Chang Hwan; J Korean Soc Coloproctol. 2005;21(2):82-88.

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Abstract PDF: PURPOSE
The management of local recurrence after curative surgery of the rectal cancer remains difficult clinical problems to surgeons. This study was performed to analyze the outcomes of patients with local pelvic recurrence according to its recurrence type.
METHODS
A total 109 patients with local recurrence were evaluated. Among the 109 patients 62 were local recurrence alone and 47 were both local and systemic recurrence. The recurrence type was classified as Central, Anterior, Posterior, Lateral and Perineal recurrence according to the relation of the tumor location and either intra pelvic organ and/or fixed pelvic structure.
RESULTS
Only 26 (23.9%) of the 109 patients had curative resection and the remaining 83 (76.1%) patients had palliative exploration or nonsurgical procedure. The resectability according to the recurrence type showed that the Central and Anterior type was higher than other type of recurrences (P=0.001). When the primary operation was Abdominoperineal Resection (APR) the resectability was poorer than Low Anterior Resection (LAR) (P=0.0001). When comparing the patients with local recurrence alone, the 5 year survival rate was significantly higher patients treated by curative resection than palliative or non-resection group (P=0.002). Mean follow up period was 44.2+/-30.0 months and mean recurrence time between primary operation and recurrence was 26.0+/-22.7 months.
CONCLUSIONS
Resection for central type of the recurrent is potentially curative, however treatment failure was common when the recurrence invaded fixed pelvic structure. Our data suggest that local pelvic recurrence should be treated with radical resection as can as possible.

Local Resection for Treatment of Early Colorectal Cancer.: Lee, Eun Joung , Chung, Soonsup , Lee, Ryung Ah , Lee, Suk Hwan , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 2004;20(6):399-404.

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Abstract PDF: PURPOSE
Early colorectal cancer is defined as invasive tumor, limited to the mucosa or submucosa. The incidence of early colorectal cancer detection has been increased due to well designed screening technology and development of colonoscopy. The novel treatment of early colorectal cancer is still not settled despite of this advancement. We performed retrospective study about outcomes of colorectal cancer after radical resection or local resection.
METHODS
Sixty two patients, diagnosed as early colorectal cancers by pathology, were selected for this case study. The hospital records were reviewed retrospectively and the following was found: Twenty four patients received local resection such as colonoscopic polypectomy or local resection of colon. Remaining thirty-eight patients received radical resection. The clinicopathologic features of two groups were analyzed statically and survival rate was compared.
RESULTS
The clinical features were similar between two groups including sex, age, stage, tumor size and differentiation. The median follow-up duration was 47.3 months (range: 2~152 months). Survival rate was not different according to resection type. Recurrent cases were one patient from each group. They were all submucosal tumors.
CONCLUSIONS
The local resection is safe treatment modality for early colorectal cancer. However, case selection for local resection should be cautious because submucosal cases have more recurrent potential. Longterm follow-up will be needed to achieve safety of early colorectal cancer.

Efficacy of Stump Irrigation in Removing Tumor Cells During Low Anterior Resection Using the Double Stapling Technique.: Park, Sang Jun , Kim, Hee Cheol , Yu, Yuen Sik , Yu, Jang Hak , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2004;20(1):52-56.

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Abstract PDF: BACKGROUND
In low rectal cancer, creating a permanent stoma can be avoided by applying a low anterior resection using the double stapling technique. However, the problem of local recurrence is still a major pattern of tumor recurrence in rectal cancer. We aimed to verify the clinicopathologic variables related to exfoliation of tumor cells and searched for an efficient method to remove the tumor cells from the rectal stump during a low anterior resection.
METHODS
Forty-four patients who underwent a low anterior resection using the double stapling technique were enrolled prospectively. For patient, we irrigated each rectal stump twice with 500 cc of normal saline through the anus. Two specimens from each irrigation were obtained and examined for any malignant tumor cells. Cases in which no tumor cells were found from the two specimens were defined as Group I, cases in which tumor cells were found in only the first specimen were defined as Group II, and cases in which tumor cells were found in both the first and the second specimens were defined as Group III. Clinicopathologic variables were analyzed with regard to the presence of exfoliated tumor cells in irrigated saline.
RESULTS
There were sixteen (36%), fourteen (32%), and fourteen cases (32%) in Groups I, II, and III, respectively, according to the examination results. Age classification (P=0.05) and metastatic lymph nodes (P=0.013) were associated with the presence of tumor cells in irrigated saline (I vs. II, II).
CONCLUSIONS
Stump irrigation during a low anterior resection using the double stapling technique is recommended as an easy and simple method to remove exfoliated tumor cells from anastomosis sites, although further study is necessary to elucidate the association between exfoliated tumor cells and local recurrence.

Surgical Treatment of Recurrent Colorectal Cancer.: Koo, Gwang Mo , Park, Sang Su , Yoon, Jin , Kim, Il Myoung , Yu, Byoung Uk , Yang, Dae Hyun , Cho, Ik Hang; J Korean Soc Coloproctol. 2003;19(5):314-321.

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Abstract PDF: PURPOSE
Recurrent colorectal cancers have important and difficult diagnostic and treatment problems. The purpose of this study is to evaluate the rationale and the efficacy of surgical re-treatment for patients with recurrence following curative surgery for colorectal cancer.
METHODS
From January 1991 to December 2002, we experienced 60 (20.9%) patients with recurred colorectal cancer among 287 patients who had curative operations in our hospital. These 60 patients were divided into three groups. Patients in group 1 had curative-intent resections, patients in group 2 had palliative resections, and patients in group 3 had conservertive treatment. The groups consisted of 17 (28.3%), 10 (16.7%) and 33 (55.0%) patients, respectively. We analyzed retrospectively those groups for any recurrence pattern and for survival.
RESULTS
Of the 60 patients with recurrent colorectal cancer, in 20 (33.3%) patients the cancer recurred in the colon, and in 40 (66.7%) it recurred in the rectum. Local recurrence was seen in 9 (15.0%) patients, liver metastasis in 25 (41.7%), and pulmonary metastasis in 13 (21.7%). The 1- and 3-, and 5-year survival rates were 86.5%, 31.7%, and 15.9%, respectively, for group 1, 33.3%, 0%, and 0% for group 2, and 28.9%, 4.4%, and 4.4% for group 3. The median survival period was 31 months for group 1, 8 months for group 2, and 7 months for group 3.
CONCLUSIONS
Although evaluation was difficult owing to the small number of patients with recurrent colorectal cancer, a significant difference in survival rates was observed between the treatment groups. On the basis of these results, we think that curative-intent aggressive surgery for recurrent colorectal cancer in appropriately selected cases can clearly prolong survival when compared with palliative resections and conservative treatment.

Local Excision for Rectal Cancer.: NamGung, Hwan , Yu, Chang Sik , Kim, Hee Cheol , Cho, Young Kyu , Ryu, Jang Hak , Cho, Moon Kyung , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(5):305-310.

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Abstract PDF: PURPOSE
Local excision of early rectal cancers with favorable histologic features can provide comparable survival rate to radical surgery with minimal morbidity and mortality, showing excellent functional results. But, still worried about high local recurrence rate and poor survival rates for local excision. This study was performed to investigate complications and evaluate oncological out comes after local excision for rectal cancers.
METHODS
We evaluated 80 cases underwent local excision among 1681 patients with rectal cancer between January 1989 and December 2000. The mean age was 58+/-11 years and median follow up period was 24 (range: 1-82) months. Type of surgery for early rectal cancer were transanal excision in 51 cases (63.8%), transsphincteric approach in 12 cases (15%) and endoscopic submucosal resection alone in 17 cases (21.2%).
RESULTS
The distance from the anal verge was 5.9+/-2.6 cm and the mean tumor size was 2.5+/-2.0 cm. Pathological depth of invasion revealed 52 Tis, 21 T1, 6 T2, and 1 T3 tumors. Cellular differentiation was well-differentiated tumor in 73% and moderately-differentiated in 27%. On histologic examination, 65% of them comprised underlying adenoma component. Leakage from the closure site was observed in two cases of transsphincteric approach. One case required abdominoperineal resection and the other was managed by temporary colostomy. Adjuvant chemoradiation was performed in 10 cases: one Tis with positive resection margin, 6 deep T1, and 3 T2 tumors. Five tumors was salvaged by immediate surgery: one T1 with positive resection margin, 3 T2 with positive resection margin, and 1 T3. During the follow up period, one local recurrence was developed after 25 months of surgery and salvaged by low anterior resection.
CONCLUSION
Local excision for rectal cancer can be performed safely in strictly selected patients and meticulous surgical technique according to tumor location is mandatory to reduce postoperative complications.

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.

Ambulatory Hemorrhoidectomy under Local Anesthesia.: Kim, Jae Han , Kim, Byung Cheol , Jang, Jeong Hwan , Kim, Cheong Yong; J Korean Soc Coloproctol. 2001;17(5):213-219.

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Abstract PDF: PURPOSE
Hemorrhoidectomy can be associated with severe pain in the immediate postoperative period. The aim of this study was to evaluate the advantages and feasibility of hemorrhoidectomy under local anesthesia (pudendal nerve block).
METHODS
From september 1998 to August 2000 we performed 77 hemorrhoidectomy with local anesthesia in our Colorectal unit under the ambulatory surgery regimen. 0.5% lidocaine and 0.25% bupivacaine mixed by 1:1 ratio were used for pudendal nerve block and local anesthesia.
RESULTS
Using pudendal nerve block, ambulatory hemorrhoidectomy with or without band ligation were done in 77 patients. Male to female ratio was 46:31, mean age was 35.2 years. 3 major piles plus 1 minor pile were present in 40 patients (51.9%). We injected mixed lidocaine and bupivacaine solution through external sphincter and puborectalis muscle. All patients were successfully operated without conversion to general anesthesia or even intravenous anesthetic injection. Postoperative pain of them were compared the patients who were operated hemorrhoidectomy under general (spinal or caudal) anesthesia during the same time. The pain were assessed using verbal rating pain scale at 24 hours, 48 hours and 72 hours (1-10, where 1 presented no pain and 10 represented the worst pain imaginable) by phone call examination. Mean pain scores for pudendal anesthesia group at 24, 48, 72 hours were 5.32, 3.07 and 2.21, respectively, compared with other anesthesia group with 6.47, 4.52 and 3.24. These differences were statistically significant (P value<0.05). Post operative pain was successfully controlled with home care and oral medications.
CONCLUSIONS
Under local anesthesia with pudendal nerve block, ambulatory hemorrhoidectomy were able to decrease pain and urinary retension in comparison to spinal or caudal anesthesia group. Ambulatory hemorrhoidectomy is useful, low cost and feasible.

Case Report

A Case of Granular Cell Tumor in the Perianal Region.: Hwang, Do Yeon , Song, Seok Kyu , Lee, Jong Ho , Kim, Hyun Shig , Lee, Jong Kyun , Lee, Jung Dal , Kim, Kwang Yun; J Korean Soc Coloproctol. 2001;17(2):108-111.

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Abstract PDF: Since granular cell tumor was first described by Abrikossoff in 1926, it has been known as a rare disease. The histogenesis of this tumor is still controversial, but the origin is thought to be from a Schwann cell. About one third of the tumors occur in the tongue, and uncommonly in the perianal region. We report a case of granular cell tumor that developed in the perianal region. The tumor grew slowly for 5 years and was removed by a local excision. This tumor showed positive staining with neuron-specific enolase (NSE).

Original Articles

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

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

Local Excision of Rectal Carcinoma.: Shin, Dong Gyeu , Shim, Kang Sup , Kim, Kwang Ho; J Korean Soc Coloproctol. 1999;15(1):73-81.

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Abstract PDF: PURPOSE
Curative local excision of the rectal cancer had been advocated by many surgeons over the standard abdominoperineal resection (APR) for lower rectal cancer due to its low complication rate and improved quality of life. The aim of this study was to evaluate the result of the local excision for rectal cancer.
METHOD
We prospectively analyzed 31 rectal cancer patients (including 2 patients of carcinoid tumor) who were suitable indication for local excision between Oct. 1993 and Dec. 1998 at Mokdong Hospital.
RESULTS
The age of the patients ranged from 39 to 81 years (>60 years: 77.8%) while sex ratio was 1:5 (M:F). Of 31 patients, 29 patients were located below 4 cm from anal verge. Other two were in between 7 cm and 10 cm from the anal verge. The tumor size ranged from 0.7 cm to 5 cm, most commonly within 3 cm. Invasion depth by tumor were as follows: 12 patients in mucosa; 7 patients in submucosa; 4 patients in inner muscle layer; 6 patients in outer muscle layer; and 2 patients in whole layer. Ten patients had well-differentiated tumors and 17 patients had moderately differentiated tumors, while one patient had mucinous histologic type. Seventy percent of patients with muscular layer invasion received adjuvant radiation therapy. Six patients received oral chemotherapeutic agent and 4 received immunopotentiator. During the follow-up period (mean: 18.4 months, range: 1~54 months), no local recurrence was found in the patients who were operated under curative intent.
CONCLUSION
We concluded that this method can be favorabe choice for the treatment of early rectal cancer without lymph node involvement if strict indication of the local excision for rectal cancer could be applied.

Results of Transanal Local Excision for Rectal Cancer.: Park, Kyu Joo , Park, Jae Gahb; J Korean Soc Coloproctol. 1997;13(1):51-62.

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Abstract PDF: Local excision for rectal cancer can yield comparable results to traditional radical operations in selected group of patients. We have retrospectively analyzed 32 cases of rectal cancer patients treated by transanal local excision for curative intent at the Department of Surgery, Seoul National University Hospital between 1990 to 1996. These 32 cases represent 4.1% of total rectal cancer patients treated during the same period. Mean age of the patients were 57.0+/-11.8 years. Median tumor size was 2 cm(mean : 2.4+/-1.1 cm), and the median distance from the anal verge to the lower margin of the tumors was 5 cm(mean : 5.1+/-1.7 cm). Deepest layer invaded by cancer was as follows: mucosa, 31.3%; submucosa, 56.3%; muscularis propria, 9.4%; subserosa, 3.1%. Sixty-nine percent of the patients had well differentiated tumors and 31% had moderately differentiated tumors, while none of the cancers were poorly differentiated. No patient received any adjuvant therapy. After a median follow-up of 21 (range: 1~83) months, no local recurrence occurred in any of the patients. Our results indicate that transanal local excision can be performed with favorable outcome in selected group of rectal cancer patients.

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