Annals of Coloproctology

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Original Article

Colorectal cancer

Evaluation of the utility of a nomogram for predicting lymph node metastasis in T1 colorectal cancer in shared decision-making in clinical practice: a survey-based study: Hyeon Seung Kim, Kyung Su Han, Min Wan Lee, Dae Kyung Sohn, Chang Won Hong, Dong Woon Lee, Kiho You, Sung Chan Park, Byung Chang Kim, Bun Kim, Jae Hwan Oh; Ann Coloproctol. 2025;41(4):303-309. Published online August 25, 2025; DOI: https://doi.org/10.3393/ac.2025.00318.0045

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Abstract PDF: Purpose
In 2019, we reported a novel nomogram to predict lymph node metastasis (LNM) in T1 colorectal cancer. Herein, we conducted a survey-based study to evaluate the clinical utility of this nomogram in determining the need for additional surgery after endoscopic resection for high-risk T1 colorectal cancer.
Methods
A survey was conducted among 77 members of the Korean Society of Coloproctology and 25 members of the Korean Society of Gastrointestinal Endoscopy. The survey assessed decision-making regarding additional surgery after endoscopic resection for high-risk T1 colorectal cancer according to various predicted LNM rates (3%, 10%, and 27%) and tumor locations (anal verge [AV] 2, 7, and 25 cm). Additionally, participants provided feedback regarding the reliability, usefulness, and potential adoptability of the prediction model in patient counseling.
Results
Of the 2,314 surveys distributed, 102 responses were analyzed. A trend was observed in which tumors located closer to the anus and associated with a lower predicted risk of LNM were less likely to lead respondents to opt for surgery (e.g., AV 2 cm and 3% of predicted LNM risk, 21.6% opt for surgery vs. AV 25 cm and 27% of predicted LNM risk, 98.0% opt for surgery). Additionally, 94.1% of the respondents reported that the prediction model would be helpful in clinical decision-making and patient counseling.
Conclusion
Our findings suggest that the nomogram is an effective and reliable tool for guiding treatment strategies and enhancing consultations in patients with T1 colorectal cancer.

Videos

Video clip

Cranial-first approach for laparoscopic extended right hemicolectomy: Kyong-Min Kang, Heung-Kwon Oh, Hong-Min Ahn, Tae-Gyun Lee, Hye-Rim Shin, Mi-Jeong Choi, Duck-Woo Kim, Sung-Bum Kang; Ann Coloproctol. 2024;40(3):282-284. Published online June 19, 2024; DOI: https://doi.org/10.3393/ac.2023.00661.0094

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Abstract PDF Supplementary Material: Complete mesocolic excision and central vascular ligation with D3 lymphadenectomy are important surgical principles for improving oncological outcomes in colon cancer. The cranial-first approach is a colonic mobilization–first approach to radical right hemicolectomy, which has several advantages, including early feasibility assessment, safe dissection from surrounding organs, preestablished inferior margin of lymph node dissection, and revelation of the tangible anatomy of the tributaries of the gastrocolic trunk. This video demonstrates the cranial-first approach to radical right hemicolectomy in a 66-year-old man with locally advanced cecal cancer.

Tips and tricks for robotic lateral pelvic node dissection: James Chi-Yong Ngu, Nan-Zun Teo; Ann Coloproctol. 2023;39(6):531-531. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00766.0109

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Abstract PDF Supplementary Material: Lateral pelvic node dissection can be challenging. In addition to detailed anatomical knowledge of the pelvic side wall, surgeons also need to be proficient in performing fine dissection within the confines of this limited operative field. While the incorporation of robotics can facilitate the safe completion of this technically demanding procedure, this is nonetheless dependent on the way the robotic system is used. This video aims to demonstrate several tips and tricks for performing robotic lateral pelvic node dissection.

Review

Colorectal cancer

Essential anatomy for lateral lymph node dissection: Yuichiro Yokoyama, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Shigenobu Emoto, Hiroyuki Matsuzaki, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Daisuke Hojo, Soichiro Ishihara; Ann Coloproctol. 2023;39(6):457-466. Published online December 8, 2023; DOI: https://doi.org/10.3393/ac.2023.00164.0023

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259 Download
5 Web of Science
5 Citations

Abstract PDF

In Western countries, the gold-standard therapeutic strategy for rectal cancer is preoperative chemoradiotherapy (CRT) following total mesorectal excision (TME), without lateral lymph node dissection (LLND). However, preoperative CRT has recently been reported to be insufficient to control lateral lymph node recurrence in cases of enlarged lateral lymph nodes before CRT, and LLND is considered necessary in such cases. We performed a literature review on aspects of pelvic anatomy associated with rectal surgery and LLND, and then combined this information with our experience and knowledge of pelvic anatomy. In this review, drawing upon research using a 3-dimensional anatomical model and actual operative views, we aimed to clarify the essential anatomy for LLND. The LLND procedure was developed in Asian countries and can now be safely performed in terms of functional preservation. Nonetheless, the longer operative time, hemorrhage, and higher complication rates with TME accompanied by LLND than with TME alone indicate that LLND is still a challenging procedure. Laparoscopic or robotic LLND has been shown to be useful and is widely performed; however, without a sufficient understanding of anatomical landmarks, misrecognition of vessels and nerves often occurs. To perform safe and accurate LLND, understanding the landmarks of LLND is essential.

Citations

Citations to this article as recorded by

da Vinci robotic-assisted micro-space dissection and autonomic nerve network preservation technique in the total mesorectal excision procedure for rectal cancer: a single-center, retrospective, observational, real-world study
Fanghai Han, Yequan Xie, Guangyu Zhong, Jintao Zeng, Yang Chen, Jianan Tan, Shengning Zhou
Journal of Robotic Surgery.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
Deep learning-based vessel and nerve recognition model for lateral lymph node dissection: a retrospective feasibility study
Shoma Sasaki, Daichi Kitaguchi, Tomohiro Noda, Hiroki Matsuzaki, Hiro Hasegawa, Nobuyoshi Takeshita, Masaaki Ito
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
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
Annals of Coloproctology.2024; 40(4): 363. CrossRef
Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision
Daichi Kitaguchi, Masaaki Ito
Annals of Coloproctology.2024; 40(4): 375. CrossRef

Original Articles

Minimally invasive surgery

A comparative study of the pathological outcomes of robot-assisted versus open surgery for rectal cancer: René Reyes, Csaba Kindler, Kenneth Smedh, Catarina Tiselius; Ann Coloproctol. 2024;40(2):154-160. Published online December 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00332.0047

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2 Web of Science
3 Citations

Abstract PDF

Purpose
The use of robot-assisted surgery for rectal cancer is increasing, but the pathological outcomes have not been fully clarified. We compared the surgical and pathological outcomes between robot-assisted and open surgery in specimens from patients operated on for rectal cancer.
Methods
All patients who underwent resection for rectal cancer from 2016 to 2018 were included (n=137). Specimens were divided into 3 sections to analyze the pathology of the lymph nodes.
Results
The total specimen lengths were shorter in the robot-assisted group than in the open surgery group (mean±standard deviation: 29.1±8.6 cm vs. 33.8±9.9 cm, P=0.004) because of a shorter proximal resection margin (21.7±8.7 cm vs. 26.4±10.6 cm, P=0.006). The number of recruited lymph nodes (35.8±21.8 vs. 39.6±16.5, P=0.604) and arterial vessel length (8.84±2.6 cm vs. 8.78±2.4 cm, P=0.891) did not differ significantly between the 2 surgical approaches. Lymph node metastases were found in 33 of 137 samples (24.1%), but the numbers did not differ significantly between the procedures. Among these 33 cases, metastatic lymph nodes were located in the mesorectum (75.8%), in the sigmoid colon mesentery (33.3%), and at the arterial ligation site of the inferior mesenteric artery (12.1%). The circumferential resection margin and the proportion of complete mesorectal fascia were comparable between the groups.
Conclusion
There were no significant differences between the 2 surgical approaches regarding arterial vessel length, recruitment of lymph node metastases, and resection margins.

Citations

Citations to this article as recorded by

Robotic Surgery for Rectal Cancer Treatment: Clinical Outcomes and Quality of Life. Comparison of Surgical Methods
Raminta Akelaitytė, Justas Žilinskas
Lietuvos chirurgija.2025; 24(3): 184. CrossRef
Can robotic surgery lead the way in the treatment of rectal cancer?
Jeonghee Han
Annals of Coloproctology.2024; 40(2): 87. CrossRef
Comparative analysis of short-term outcomes and oncological results between robotic-assisted and laparoscopic surgery for rectal cancer by multiple surgeon implementation: a propensity score-matched analysis
E. Barzola, L. Cornejo, N. Gómez, A. Pigem, D. Julià, N. Ortega, O. Delisau, K. A. Bobb, R. Farrés, P. Planellas
Journal of Robotic Surgery.2023; 17(6): 3013. CrossRef

Colorecal cancer

Prognostic significance of lymph node yield on oncologic outcomes according to tumor response after preoperative chemoradiotherapy in rectal cancer patients: Hyo Seon Ryu, In Ja Park, Bo Kyung Ahn, Min Young Park, Min Sung Kim, Young Il Kim, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2023;39(5):410-420. Published online April 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00143.0020

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130 Download
6 Web of Science
5 Citations

Graphical Abstract Abstract PDF

Purpose
This study aimed to evaluate the predictive value of lymph node yield (LNY) for survival outcomes according to tumor response after preoperative chemoradiotherapy (PCRT) in patients with rectal cancer.
Methods
This study was a retrospective study conducted in a tertiary center. A total of 1,240 patients with clinical stage II or III rectal cancer who underwent curative resection after PCRT between 2007 and 2016 were included. Patients were categorized into the good response group (tumor regression grade [TRG], 0–1) or poor response group (TRG, 2–3). Propensity score matching was performed for age, sex, and pathologic stage between LNY of ≥12 and LNY of <12 within tumor response group. The primary outcome was 5-year disease-free survival (DFS) and overall survival (OS).
Results
LNY and positive lymph nodes were inversely correlated with TRG. In good responders, 5-year DFS and 5-year OS of patients with LNY of <12 were better than those with LNY of ≥12, but there was no statistical significance. In poor responders, the LNY of <12 group had worse survival outcomes than the LNY of ≥12 group, but there was also no statistical significance. LNY of ≥12 was not associated with DFS and OS in multivariate analysis.
Conclusion
LNY of <12 showed contrasting outcomes between the good and poor responders in 5-year DFS and OS. LNY of 12 may not imply adequate oncologic surgery or proper staging in rectal cancer patients treated by PCRT. Furthermore, a decrease in LNY should be comprehended differently according to tumor response.

Citations

Citations to this article as recorded by

Breaking Myths: Comparable Outcomes in Lymph Node Analysis Across Surgical Methods
Salvatore Pezzino, Tonia Luca, Mariacarla Castorina, Giulia Fuccio Sanzà, Gaetano Magro, Stefano Puleo, Ornella Coco, Sergio Castorina
Cancers.2025; 17(8): 1312. CrossRef
A predictive nomogram for assessing the likelihood of retrieving 12 lymph nodes after rectal cancer surgery: a single-center study
Jian Ma, Runyang Hao, Shuai Jiao, Qingmin Chen, Baohong Yang, Xu Guan, Jiale Li, Xinxuan Zhao, Yu Huo, Qingxia Xu, Haiyi Liu, Wen Su, Xishan Wang
Frontiers in Oncology.2025;[Epub] CrossRef
Effects of Adjuvant Chemotherapy on Oncologic Outcomes in Patients With Stage ⅡA Rectal Cancer Above the Peritoneal Reflection Who Did Not Undergo Preoperative Chemoradiotherapy
Hyo Seon Ryu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Yong Sang Hong, Tae Won Kim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(4): 392. CrossRef
Artificial Intelligence-Driven Volumetric Analysis of Muscle Mass as a Predictor of Tumor Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer
Minsung Kim, Sang Min Lee, Il Tae Son, Jaewoong Kang, Gyoung Tae Noh, Bo Young Oh
Journal of Clinical Medicine.2024; 13(23): 7018. CrossRef
Multidisciplinary Treatment Strategy for Early Colon Cancer: A Review-An English Version
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 203. CrossRef

Case Report

Rare disease & stoma

A small, low-grade rectal neuroendocrine tumor with lateral pelvic lymph node metastasis: a case report: Seonhui Shin, Young-In Maeng, Seyun Jung, Chun-Seok Yang; Ann Coloproctol. 2022;38(4):327-331. Published online March 7, 2022; DOI: https://doi.org/10.3393/ac.2021.00899.0128

7,079 View
185 Download
7 Web of Science
8 Citations

Abstract PDF

Rectal neuroendocrine tumors (NETs) are typically small lesions that are confined to the submucosa and have favorable behavior at the time of diagnosis. Local endoscopic or surgical resection is recommended because lymph node metastasis is very rare. In this report, we present the case of a 36-year-old male presenting with an incidentally found rectal mass during screening colonoscopy. Pathologic examination of the primary tumor revealed a 9-mm grade 1 NET with submucosal invasion and no significant aggressive factors except for central ulceration. However, radiologic studies revealed a suspected 2.6-cm mesorectal lymph node metastasis and multiple left internal iliac lymph node metastases. We performed laparoscopic intersphincteric resection with left lateral pelvic lymph node dissection. The final pathologic report revealed a metastatic lymph node with low grade, low mitotic count, and low Ki-67 index. We describe an overview of lymph node metastasis of rectal NETs focusing on lateral pelvic lymph node metastasis.

Citations

Citations to this article as recorded by

Risk factors for and prognostic impact of lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: a single-center retrospective analysis of 214 cases with radical resection
Tsubasa Sakurai, Y. Hiyoshi, N. Daitoku, S. Matsui, T. Mukai, T. Nagasaki, T. Yamaguchi, T. Akiyoshi, H. Kawachi, Y. Fukunaga
Surgery Today.2025; 55(2): 144. CrossRef
Construction and evaluation of the prediction model for advanced disease in well-differentiated colorectal neuroendocrine neoplasms less than 2 cm in diameter
Hongda Yin, Yanan Chen, Wei Zhao, Fuqiang Zhao, Zhijun Huang, Aimin Yue, Zhijie Wang
Heliyon.2025; 11(1): e41197. CrossRef
Primary small rectal neuroendocrine tumor with pelvic lateral lymph nodes metastasis: A case report and review of literature
Lihong Li, Ziyue Chen, Dajian Zhu, Qianbao Lv, Tianpeng Zhang, Jinsong Lai
International Journal of Surgery Case Reports.2025; 127: 110963. CrossRef
Risk factors for lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: a systematic review and meta-analysis
Ziyue Chen, Dajian Zhu
Frontiers in Oncology.2025;[Epub] CrossRef
Endoscopic treatment of rectal neuroendocrine tumors: a consecutive analysis of multi-institutional data
Jae Won Shin, Eun-Jung Lee, Sung Sil Park, Kyung Su Han, Chang Gyun Kim, Hee Chul Chang, Won Youn Kim, Eui Chul Jeong, Dong Hyun Choi
Annals of Coloproctology.2025; 41(3): 221. CrossRef
Successfully Resected Isolated Lateral Lymph Node Recurrence in a Patient with T1 Lower Rectal Cancer: Case Report and Literature Review
Kazuma Rifu, Koji Koinuma, Hisanaga Horie, Katsusuke Mori, Daishi Naoi, Mineyuki Tojo, Yuko Homma, Satoshi Murahashi, Atsushi Kihara, Toshiki Mimura, Joji Kitayama, Naohiro Sata
Journal of the Anus, Rectum and Colon.2024; 8(3): 259. CrossRef
Clinical application of endoscopic ultrasonography in the management of rectal neuroendocrine tumors
Soo-Young Na, Seong Jung Kim, Hyoun Woo Kang
International Journal of Gastrointestinal Intervention.2023; 12(3): 105. CrossRef
Multiple rectal neuroendocrine tumors: An analysis of 15 cases and literature review
Shu Pang, Ye Zong, Kun Zhang, Haiying Zhao, Yongjun Wang, Junxiong Wang, Chuntao Liu, Yongdong Wu, Peng Li
Frontiers in Oncology.2022;[Epub] CrossRef

Review

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

Surgical Treatment of Low-Lying Rectal Cancer: Updates: Cristopher Varela, Nam Kyu Kim; Ann Coloproctol. 2021;37(6):395-424. Published online December 22, 2021; DOI: https://doi.org/10.3393/ac.2021.00927.0132

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410 Download
52 Web of Science
56 Citations

Abstract PDF

Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

Citations

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Original Article

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

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

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Abstract PDF Supplementary Material

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

Citations

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MRI-based scoring systems for selective lateral lymph node dissection in locally advanced low rectal cancer after neoadjuvant chemoradiotherapy
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Ying-Zi Zheng, Fang-Fang Yan, Lian-Xiang Luo
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Reviews

Malignant disease,Prognosis and adjuvant therapy,Colorectal cancer,Minimally invasive surgery,Surgical technique

Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?: Gyung Mo Son, In Young Lee, Yoon Suk Lee, Bong-Hyeon Kye, Hyeon-Min Cho, Je-Ho Jang, Chang-Nam Kim, Kil Yeon Lee, Suk-Hwan Lee, Jun-Gi Kim, On behalf of The Korean Laparoscopic Colorectal Surgery Study Group; Ann Coloproctol. 2021;37(6):434-444. Published online December 8, 2021; DOI: https://doi.org/10.3393/ac.2021.00955.0136

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Abstract PDF

Colon cancer treatment is on the way to evolution over several decades. The minimally invasive surgery has improved postoperative short-term outcomes. Adjuvant chemotherapy has prolonged the survival of advanced colon cancer patients. Hohenberger proposed the noble concept of complete mesocolic excision (CME) which consists of 3 components: plane surgery, sufficient longitudinal bowel resection, and central vascular ligation (CVL). Mesocolic plane surgery shares the same surgical principle of total mesorectal excision, which is maintaining the intact mesothelial envelope. However, there remain debates about the extent of bowel resection and the level of CVL for maximizing lymph node dissection. There is no solid clinical evidence for the oncological necessity and benefit of extended radical dissection in right hemicolectomy. CME with CVL based on open surgery has been adopted in laparoscopic surgery. So, it is also necessary to look at how the CME could be transformed and successfully implanted in the laparoscopic era. Recent rapid advances in surgical technology and cancer biology are preparing for fundamental changes in cancer surgery. In this study, we reviewed the history, oncological necessity, and compatibility of CME for the right hemicolectomy in the laparoscopic era and outline the new perspectives on the evolution of cancer surgery.

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G. Anania, M. Chiozza, A. Campagnaro, F. Bagolini, G. Resta, D. Azzolina, G. Silecchia, R. Cirocchi, A. Agrusa, D. Cuccurullo, M. Guerrieri, V. Adamo, M. Ammendola, P. Angelini, M. Annecchiarico, G. Aprea, F. Autori, G. Baldazzi, A. Balla, G. Baronio, G.
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Christoph Holmer
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Gyung Mo Son
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Gyung Mo Son, Tae Un Kim, Dong-Hoon Shin, Joo-Young Na, In Young Lee, Shin Hoo Park
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Journal of the Korean Medical Association.2022; 65(9): 558. CrossRef
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In Ja Park
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Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
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Malignant disease, Rectal cancer,Colorectal cancer

Extended lymphadenectomy in locally advanced rectal cancers: a systematic review: Balaji Mahendran, Supriya Balasubramanya, Simone Sebastiani, Sebastian Smolarek; Ann Coloproctol. 2022;38(1):3-12. Published online November 17, 2021; DOI: https://doi.org/10.3393/ac.2021.00703.0100

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7 Citations

Abstract PDF

Purpose
The surgical treatment of advanced low rectal cancer remains controversial. Extended lymphadenectomy (EL) is the preferred option in the East, especially in Japan, while neoadjuvant radiotherapy is the treatment of choice in the West. This review was undertaken to review available evidence supporting each of the therapies.
Methods
All studies looking at EL were included in this review. A comprehensive search was conducted as per PRISMA guidelines. Primary outcome was defined as 5-year overall survival, with secondary outcomes including 3-year overall survival, 3- and 5-year disease-free survival, length of operation, and number of complications.
Results
Thirty-one studies met the inclusion criteria. There was no significant publication bias. There was statistically significant difference in 5-year survival for patient who underwent EL (odds ratio, 1.34; 95 confidence interval, 0.09–0.5; P=0.006). There were no differences noted in secondary outcomes except for length of the operations.
Conclusion
There is evidence supporting EL in rectal cancer; however, it is difficult to interpret and not easily transferable to a Western population. Further research is necessary on this important topic.

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Kui Sun, Junwei Wang, Bingyan Wang, Ying Wang, Siyi Lu, Zhihan Jiang, Wei Fu, Xin Zhou
European Radiology.2025;[Epub] CrossRef
Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus R0 resection for resectable colorectal cancer with peritoneal metastases and low peritoneal cancer index scores: a collaborative observational study from Korea and Japan
Daichi Kitaguchi, Eun Jung Park, Seung Hyuk Baik, Shoma Sasaki, Yuichiro Tsukada, Masaaki Ito
International Journal of Surgery.2024; 110(1): 45. CrossRef
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Minsung Kim, Taeyong Park, Bo Young Oh, Min Jeong Kim, Bum-Joo Cho, Il Tae Son
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Paweł Mroczkowski, Łukasz Dziki, Tereza Vosikova, Ronny Otto, Anna Merecz-Sadowska, Radosław Zajdel, Karolina Zajdel, Hans Lippert, Olof Jannasch
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Original Articles

Preoperative endoscopic tattoo marking improves lymph node retrieval in laparoscopic rectal resection: a retrospective cohort study: Kouki Imaoka, Takuya Yano, Masanori Yoshimitsu, Sotaro Fukuhara, Ko Oshita, Kanyu Nakano, Masaki Kunihiro, Hitoshi Idani, Masazumi Okajima; Ann Coloproctol. 2023;39(2):115-122. Published online September 16, 2021; DOI: https://doi.org/10.3393/ac.2021.00458.0065

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Graphical Abstract Abstract PDF

Purpose
Harvesting at least 12 lymph nodes (LNs) is recommended for adequate tumor staging in colon surgery. Although preoperative endoscopic tattooing has been used for primary localization of tumors, its impact on LN retrieval in colorectal surgery remains controversial. We aimed to investigate the relationship between preoperative tattooing and LN retrieval after laparoscopic rectal resection.
Methods
We reviewed the records of 92 patients with rectal cancer who underwent laparoscopic resection from January 1, 2018 to December 31, 2019. Patients were categorized into 2 groups according to whether preoperative endoscopic tattooing was performed. The rate of adequate LN retrieval (≥12) was compared.
Results
The tattooed and non-tattooed groups comprised 49 and 43 patients, respectively. In the tattooed and non-tattooed groups, the rates of adequate LN retrieval were 75.5% and 55.8%, respectively (P=0.046). Univariate analysis revealed that female sex, tattooing, LN metastasis status, pathological pathological stage (p-stage), and LN dissection were predictive factors for adequate LN retrieval. In the multivariate analysis, female sex (odds ratio [OR], 3.34; 95% confidence interval [CI], 1.15–9.73; P=0.027), tattooing (OR, 2.87; 95% CI, 1.03–7.94; P=0.043), and p-stage (OR, 3.34; 95% CI, 1.04–10.75; P=0.043) were independent predictive factors for adequate LN retrieval after surgery.
Conclusion
This study revealed that preoperative endoscopic tattooing was statistically significantly associated with adequate LN retrieval in patients with rectal cancer who underwent laparoscopic rectal resection. Preoperative endoscopic tattooing should be considered to improve disease assessment and avoid stage migration.

Citations

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To what extent does endoscopic tattooing marking boost lymph node retrieval?
Won Beom Jung
Annals of Coloproctology.2023; 39(2): 95. CrossRef
The effect of preoperative endoscopic tattooing on lymph node retrieval in colorectal cancer: a systematic review and meta-analysis
Mohamad Nawras, Karan Chawla, Armelle DeRiso, Christina Dubchuk, Azizullah Beran, Muhammad Aziz, Stephanie M. Pannell
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study
Gyung Mo Son, Mi Sook Yun, In Young Lee, Sun Bin Im, Kyung Hee Kim, Su Bum Park, Tae Un Kim, Dong-Hoon Shin, Armaan M. Nazir, Gi Won Ha
Cancers.2023; 15(20): 4927. CrossRef
Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis
Qianqian Liu, Min Huang, Jing Yang, Mengyuan Jiang, Ziru Zhao, Haitong Zhao, Tingting He, Yuping Bai, Rui Zhang, Min Zhang
BMJ Open.2023; 13(12): e072244. CrossRef

Influence of colonic mesenteric area on the number of lymph node retrieval for colon cancer: a prospective cohort study: Nadir Adnan Hacım, Ahmet Akbaş, Yigit Ulgen, Talar Vartanoglu Aktokmakyan, Serhat Meric, Merve Tokocin, Onder Karabay, Yuksel Altinel; Ann Coloproctol. 2023;39(1):77-84. Published online September 16, 2021; DOI: https://doi.org/10.3393/ac.2021.00444.0063

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6 Citations

Abstract PDF

Purpose
The minimum harvested 12 lymph nodes (LNs) is regarded as the limit for accurate staging of nodal status in colorectal cancer patients. Besides the association of the lengths of resected intestinal segments and vascular pedicles, the mesocolic mesenteric area’s impact on LN count has not been studied. We aimed to evaluate the associations between metric variables, including the mesocolic mesentery area on the nodal harvest.
Methods
All consecutive patients who underwent elective colectomy with a curative intention for colon adenocarcinoma were prospectively included. The metric variables included the lengths of resected intestinal segments, vascular pedicle, and colonic mesenteric area. The variables influencing the LN count and the correlation between the total LN count and the specimens’ relevant metric measurements were analyzed.
Results
There were 46 patients with a median age of 64 years. The median count for total LNs was 22, and the LN positivity was 59.2%. There was an inadequate LN yield (<12) in 3 patients (6.1%). No significant associations were found between the adequacy of nodal harvest and the demographic, clinical, and tumoral features (P>0.05). There were significant positive correlations between total LN number and length of vascular pedicle and mesenteric area (r=0.576, P<0.001 and r=0.566, P<0.001).
Conclusion
The length of the vascular pedicle and mesenteric area were significantly correlated with total LN counts. Although there was no significant impact on the length of resected segments, the colonic mesenteric area can be used alone as a measure for the assessment of the nodal yield in colon cancer.

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Deep learning model for predicting lymph node metastasis around rectal cancer based on rectal tumor core area and mesangial imaging features
Lili Guo, Kuang Fu, Wenjia Wang, Li Zhou, Lu Chen, Miaomiao Jiang
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Effect of Fluorescence Lymph Node Mapping on Improving Diagnostic Values of CT D3 Lymph Node Staging for Right-Sided Colon Cancer
Gyung Mo Son, Tae Un Kim, Mi Sook Yun, ChangYeop Kim, In Young Lee, Su Bum Park, Dong-Hoon Shin, Gi Won Ha
Cancers.2024; 16(20): 3496. CrossRef
Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study
Gyung Mo Son, Mi Sook Yun, In Young Lee, Sun Bin Im, Kyung Hee Kim, Su Bum Park, Tae Un Kim, Dong-Hoon Shin, Armaan M. Nazir, Gi Won Ha
Cancers.2023; 15(20): 4927. CrossRef
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Ulaş Karabay, Latif Yılmaz, Alper Aytekin, Aziz Bulut
European Journal of Therapeutics.2023; 29(4): 731. CrossRef
Multidisciplinary Treatment Strategy for Early Colon Cancer: A Review-An English Version
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 203. CrossRef
Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?
Gyung Mo Son, In Young Lee, Yoon Suk Lee, Bong-Hyeon Kye, Hyeon-Min Cho, Je-Ho Jang, Chang-Nam Kim, Kil Yeon Lee, Suk-Hwan Lee, Jun-Gi Kim
Annals of Coloproctology.2021; 37(6): 434. CrossRef

Video

Malignant disease, Rectal cancer,Minimally invasive surgery,Surgical technique

Standardized Step-by-step Technique Using Surgical Landmarks in Robotic Lateral Pelvic Lymph Node Dissection: Jung Hoon Bae, Wooree Koh, Hyun Ho Kim, Yoon Suk Lee; Ann Coloproctol. 2021;37(1):58-60. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.05

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Abstract PDF Supplementary Material

We aimed to show that a standardized step-by-step robotic approach using surgical landmarks could make lateral pelvic lymph node dissection (LPND) less complicated. We performed robot-assisted LPND consisting of 4 steps using surgical landmarks. The first step is a dissection of uretero-hypogastric fascia, which envelopes the ureter and the hypogastric nerve. The second step is a dissection of the medial side of the external iliac vein located at the lateral border of the obturator lymph nodes (LNs) group. The third step is a dissection of the vesico-hypogastric fascia, which is at the medial border of the obturator LNs group. The final step is a dissection of the internal iliac artery until the Alcock’s canal. Indocyanine green was injected just before surgery around the dentate line to identify the lateral pelvic LNs. Standardization using a robotic approach for LPND guided by surgical landmarks allows a safer and more effective surgery.

Citations

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Colorectal Disease.2025;[Epub] CrossRef
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European Radiology.2025; 35(8): 4967. CrossRef
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D. Kehagias, C. Lampropoulos, A. Bellou, I. Kehagias
Techniques in Coloproctology.2024;[Epub] CrossRef
Japanese expert consensus on the standardization of robot‐assisted pelvic lymph node dissection in urological surgery: Extent of pelvic lymph node and surgical technique
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International Journal of Urology.2024; 31(12): 1300. CrossRef
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International Journal of Urology.2023; 30(2): 190. CrossRef
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Diseases of the Colon & Rectum.2023; 66(6): 785. CrossRef
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Journal of the Korean Medical Association.2021; 64(12): 820. CrossRef

Original Article

Malignant disease,Prognosis and adjuvant therapy

Identification of Risk Factors Associated With Stage III Disease in Nonmetastatic Colon Cancer: Results From a Prospective National Cohort Study: Jakob Lykke, Ole Roikjaer, Per Jess, Jacob Rosenberg, On behalf of the Danish Colorectal Cancer Group; Ann Coloproctol. 2020;36(5):316-322. Published online February 18, 2020; DOI: https://doi.org/10.3393/ac.2019.03.03

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Abstract PDF

Purpose
This study aimed to identify possible patient- and tumor-related factors associated with risk of TNM stage III disease in nonmetastatic colon cancer.
Methods
The associations between stage III disease and age, sex, lymph node yield, pathological tumor (pT) stage, tumor subsite, type of surgery, and priority of surgery were assessed in a nationwide cohort of 13,766 patients treated with curative resection of colon cancer. Each level of age, lymph node yield, and pT stage was compared to the preceding level.
Results
Age, lymph node yield, pT stage, tumor subsite, and priority of surgery were associated with stage III disease. Odds ratios (95% confidence interval [CI]) were as follows: age < 65/65–75 years: 1.28 (95% CI, 1.15–1.43) and 65–75/ > 75 years: 1.22 (95% CI, 1.13–1.32); lymph node yield 0–5/6–11: 0.60 (95% CI, 0.50–0.72), lymph node yield 6–11/12–17: 0.84 (95% CI, 0.76–0.93), and lymph node yield 12–17/ ≥ 18: 0.97 (95% CI, 0.89–1.05); pT1/pT2: 0.74 (95% CI, 0.57–0.95), pT2/pT3: 0.35 (95% CI, 0.30–0.40), and pT3/pT4: 0.49 (95% CI, 0.47–0.54). Only tumors of the transverse colon were independently associated with lower risk of stage III disease than tumors in the sigmoid colon (sigmoid colon: 1, transverse colon: 0.84 [95% CI, 0.73–0.96]; elective surgery: 1, acute surgery: 1.43 [95% CI, 1.29–1.60]).
Conclusion
In this study, stage III disease in colon cancer was significantly associated with age, lymph node yield, pT stage, tumor subsite, and priority of surgery but was not associated with right-sided location compared with stage I and II cancers.

Citations

Citations to this article as recorded by

Association of the pathomics-collagen signature with lymph node metastasis in colorectal cancer: a retrospective multicenter study
Wei Jiang, Huaiming Wang, Xiaoyu Dong, Yandong Zhao, Chenyan Long, Dexin Chen, Botao Yan, Jiaxin Cheng, Zexi Lin, Shuangmu Zhuo, Hui Wang, Jun Yan
Journal of Translational Medicine.2024;[Epub] CrossRef
Can clinicopathologic high-risk features in T3N0 colon cancer be reliable prognostic factors?
Hyun Gu Lee, Young IL Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2023; 104(2): 109. CrossRef
Deep learning-based pathology signature could reveal lymph node status and act as a novel prognostic marker across multiple cancer types
Siteng Chen, Jinxi Xiang, Xiyue Wang, Jun Zhang, Sen Yang, Wei Yang, Junhua Zheng, Xiao Han
British Journal of Cancer.2023; 129(1): 46. CrossRef
Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study
Gyung Mo Son, Mi Sook Yun, In Young Lee, Sun Bin Im, Kyung Hee Kim, Su Bum Park, Tae Un Kim, Dong-Hoon Shin, Armaan M. Nazir, Gi Won Ha
Cancers.2023; 15(20): 4927. CrossRef
Deep learning can predict lymph node status directly from histology in colorectal cancer
Lennard Kiehl, Sara Kuntz, Julia Höhn, Tanja Jutzi, Eva Krieghoff-Henning, Jakob N. Kather, Tim Holland-Letz, Annette Kopp-Schneider, Jenny Chang-Claude, Alexander Brobeil, Christof von Kalle, Stefan Fröhling, Elizabeth Alwers, Hermann Brenner, Michael Ho
European Journal of Cancer.2021; 157: 464. CrossRef

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