Annals of Coloproctology

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Original Articles

Colorectal cancer

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

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

Colorectal cancer

Predictors of lateral lymph node metastasis and prognostic factors in patients with low rectal cancer who underwent lateral lymph node dissection without preoperative treatment: Riki Ohno, Haruka Oi, Soichiro Natsume, Kazuki Kawasaki, Yuichiro Yoshioka, Nao Kakizawa, Junko Kishikawa, Toshiya Nagasaki; Ann Coloproctol. 2025;41(6):545-553. Published online December 29, 2025; DOI: https://doi.org/10.3393/ac.2025.00675.0096

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Purpose
This study aimed to identify predictors of lateral lymph node metastasis (LLNM) and assess prognostic factors in patients with locally advanced low rectal cancer (LALRC), with the goal of informing optimal treatment strategies for LALRC.
Methods
We retrospectively analyzed clinicopathological data from patients with LALRC who underwent lateral lymph node dissection without preoperative treatment between 2014 and 2023. The radiological criterion for LLNM was a short-axis diameter of ≥6 mm on magnetic resonance imaging (MRI).
Results
Of 163 patients, 27 (16.6%) had pathological LLNM (pLLNM). Among 130 patients preoperatively classified as LLNM-negative, 5 (3.8%) were found to have pLLNM. Univariate and multivariate analyses showed that meeting the radiological LLNM criterion independently predicted pLLNM (odds ratio, 53.000; P<0.001). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this criterion were 90.2%, 81.5%, 91.9%, 66.7%, and 96.2%, respectively. In multivariate analyses, pLLNM was an independent risk factor for 3‑year relapse‑free survival. MRI‑detected extramural vascular invasion (mrEMVI) was independently associated with 3‑year relapse‑free survival, local recurrence‑free survival, and distant recurrence‑free survival.
Conclusion
These radiological criteria may help clinicians develop personalized treatment plans for patients with LALRC. The high negative predictive value and specificity of LLNM assessment can assist in avoiding overtreatment in appropriate patients. Further evaluation is needed to define optimal management for mrEMVI‑positive cases.

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Clinical implications of radiologic criteria and prognostic factors for lateral lymph node metastasis in low rectal cancer
Gyung Mo Son
Annals of Coloproctology.2025; 41(6): 489. CrossRef

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.

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Pathological risk stratification after endoscopic resection of T1 colorectal cancer: a comparative analysis of international guidelines
Hyun Tae Lim, Dae Kyung Sohn
Journal of Minimally Invasive Surgery.2026; 29(1): 31. CrossRef

CRC

Impact of iron-deficiency anemia on short-term outcomes after resection of colorectal cancer liver metastasis: a US National (Nationwide) Inpatient Sample (NIS) analysis: Ko-Chao Lee, Yu-Li Su, Kuen-Lin Wu, Kung-Chuan Cheng, Ling-Chiao Song, Chien-En Tang, Hong-Hwa Chen, Kuan-Chih Chung; Ann Coloproctol. 2025;41(2):119-126. Published online April 24, 2025; DOI: https://doi.org/10.3393/ac.2024.00591.0084

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Abstract PDF Supplementary Material

Purpose
Colorectal cancer (CRC) often spreads to the liver, necessitating surgical treatment for CRC liver metastasis (CRLM). Iron-deficiency anemia is common in CRC patients and is associated with fatigue and weakness. This study investigated the effects of iron-deficiency anemia on the outcomes of surgical resection of CRLM.
Methods
This population-based, retrospective study evaluated data from adults ≥20 years old with CRLM who underwent hepatic resection. All patient data were extracted from the 2005–2018 US National (Nationwide) Inpatient Sample (NIS) database. The outcome measures were in-hospital outcomes including 30-day mortality, unfavorable discharge, and prolonged length of hospital stay (LOS), and short-term complications such as bleeding and infection. Associations between iron-deficiency anemia and outcomes were determined using logistic regression analysis.
Results
Data from 7,749 patients (representing 37,923 persons in the United States after weighting) were analyzed. Multivariable analysis revealed that iron-deficiency anemia was significantly associated with an increased risk of prolonged LOS (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 2.30–3.30), unfavorable discharge (aOR, 2.42; 95% CI, 1.83–3.19), bleeding (aOR, 5.05; 95% CI, 2.92–8.74), sepsis (aOR, 1.60; 95% CI, 1.04–2.46), pneumonia (aOR, 2.54; 95% CI, 1.72–3.74), and acute kidney injury (aOR, 1.71; 95% CI, 1.24–2.35). Subgroup analyses revealed consistent associations between iron-deficiency anemia and prolonged LOS across age, sex, and obesity status categories.
Conclusion
In patients undergoing hepatic resection for CRLM, iron-deficiency anemia is an independent risk factor for prolonged LOS, unfavorable discharge, and several critical postoperative complications. These findings underscore the need for proactive anemia management to optimize surgical outcomes.

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A commentary on “Individualized blood pressure regulation and acute kidney injury in older patients having major abdominal surgery: a pilot randomized trial”
Fu-Shan Xue, Dan-Feng Wang, Xiao-Chun Zheng
International Journal of Surgery.2025; 111(12): 9993. CrossRef

Colorectal cancer

Are the width, length, depth, and area of submucosal invasion predictive of lymph node metastasis in pT1 colorectal cancer?: Olga Maynovskaia, Evgeny Rybakov, Stanislav Chernyshov, Evgeniy Khomyakov, Sergey Achkasov; Ann Coloproctol. 2023;39(6):484-492. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00087.0012

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Abstract PDF

Purpose
Submucosa-limited (pathological T1, pT1) colorectal cancers (CRCs) pose a continuing challenge in the choice of treatment options, which range from local excision to radical surgery. The aim of this study was to evaluate the morphometric and morphologic risk factors associated with regional lymph node metastasis (LNM) in pT1 CRC.
Methods
We performed a histological review of patients who underwent oncological resection between 2016 and 2022. Tumor grade, budding, poorly differentiated clusters (PDCs), cancer gland rupture, lymphovascular invasion (LVI), and presence of deep submucosal invasion (DSI), as well as width, length, total area, and area of DSI, were evaluated as potential risk factors for LNM.
Results
A total of 264 cases of colon and rectal carcinomas with invasion into the submucosal layer (pT1) were identified. LNM was found in 46 of the 264 cases (17.4%). All morphometric parameters, as well as DSI (P=0.330), showed no significant association with LNM. High grade adenocarcinoma (P=0.050), budding (P=0.056), and PDCs (P<0.001) were associated with LNM. In the multivariate analysis, LVI presence remained the only significant independent risk factor (odds ratio, 15.7; 95% confidence interval, 8.5–94.9; P<0.001).
Conclusion
The DSI of T1 CRC, as well as other morphometric parameters of submucosal tumor spread, held no predictive value in terms of LNM. LVI was the only independent risk factor of LNM.

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The results of randomized controlled trial comparing effectiveness of transanal endoscopic microsurgery versus endoscopic submucosal dissection
Evgeny Rybakov, Stanislav Chernyshov, Aleksey Likutov, Evgeny Khomiakov, Oleg Yugai, Mikhail Alekseev, Olga Maynovskaia, Mikhail Tarasov, Sergei Achkasov
Surgical Endoscopy.2026; 40(1): 469. CrossRef
Calibrated Absolute Risk of Lymph-Node-Metastasis After Non-curative Endoscopic Resection of pT1 Colorectal Cancer
Jung Kyong Shin, Hee Cheol Kim, Woo Yong Lee, Seong Hyeon Yun, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park
Annals of Surgical Oncology.2026; 33(8): 6956. CrossRef
IMMUNOREACT 8: Immune markers of local tumor spread in patients undergoing transanal excision for clinically N0 rectal cancer
Giulia Becherucci, Cesare Ruffolo, Melania Scarpa, Federico Scognamiglio, Astghik Stepanyan, Isacco Maretto, Andromachi Kotsafti, Ottavia De Simoni, Pierluigi Pilati, Boris Franzato, Antonio Scapinello, Francesca Bergamo, Marco Massani, Tommaso Stecca, An
Surgery.2025; 178: 108902. CrossRef
Long-term outcomes and lymph node metastasis following endoscopic resection with additional surgery or primary surgery for T1 colorectal cancer
Pin-Chun Chen, Yi-Kai Kao, Po-Wen Yang, Chia-Hung Chen, Chih-I Chen
Scientific Reports.2025;[Epub] CrossRef
Management strategies for pT1 rectal cancer following local excision: Insights from a national survey by the AIRO gastrointestinal study group
Elena Galofaro, Paola De Franco, Federico Barbaro, Roberta Menghi, Silvia Pecere, Angela Romano, Silvia Di Franco, Rita Marina Niespolo, Mariantonietta Gambacorta, Giuditta Chiloiro
Journal of Radiation Research and Applied Sciences.2025; 18(4): 101955. CrossRef
Problems and prospects of using morphological risk factors for lymph node metastasis in T1 colorectal cancer (review)
O. A. Mainovskaya
Koloproktologia.2025; 24(4): 177. CrossRef

Colorectal cancer

Stratification of rate of lymph node metastasis according to risk factors and oncologic outcomes in patients who underwent radical resection for rectal neuroendocrine tumors: Myung Jae Jin, Sung Sil Park, Dong-Eun Lee, Sung Chan Park, Dong Woon Lee, Kiho You, Hee Jin Chang, Chang Won Hong, Dae Kyung Sohn, Kyung Su Han, Bun Kim, Byung Chang Kim, Jae Hwan Oh; Ann Coloproctol. 2023;39(6):467-473. Published online April 28, 2023; DOI: https://doi.org/10.3393/ac.2022.00913.0130

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Abstract PDF Supplementary Material

Purpose
Most predictive factors for lymph node metastasis in rectal neuroendocrine tumors (NETs) have been based on local and endoscopic resection. We aimed to evaluate the risk factors for lymph node metastasis in patients who underwent radical resection for rectal NETs and stratify the risk of lymph node metastasis.
Methods
Sixty-four patients who underwent radical resection for rectal NETs between January 2001 and January 2018 were included. We investigated the risk factors of lymph node metastasis using clinicopathologic data. We also performed a risk stratification for lymph node metastases using the number of previously known risk factors. For oncologic outcomes, the 5-year overall survival and recurrence-free survival were evaluated in both groups.
Results
Among the patients who underwent radical surgery, 32 (50.0%) had lymph node metastasis and 32 (50.0%) had non–lymph node metastasis. In the multivariable analysis, only the male sex was identified as a risk factor for lymph node metastasis (odds ratio, 3.695; 95% confidence interval, 1.128–12.105; P=0.031). When there were 2 or more known risk factors, the lymph node metastasis rate was significantly higher than when there were one or no risk factors (odds ratio, 3.667; 95% confidence interval, 1.023–13.143; P=0.046). There was also no statistical difference between the 2 groups in 5-year overall survival (P=0.431) and 5-year recurrence-free survival (P=0.144).
Conclusion
We found that the rate of lymph node metastasis increased significantly when the number of known risk factors is 2 or more.

Citations

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Endoscopic Resection of Rectal Neuroendocrine Tumors: Pathologic Risk Stratification and Surveillance Strategies
Ji Eun Kim
Journal of Digestive Cancer Research.2025; 13(3): 228. CrossRef
Lateral pelvic lymph nodes dissection of rectal neuroendocrine neoplasms: A prospective case-series and literature review
Yueyang Zhang, Yi Yang, Changyuan Gao, Hong Zhao, Haitao Zhou
Surgery.2024; 176(5): 1360. CrossRef

Video

Video clip

Laparoscopic right hemicolectomy with aortocaval lymphadenectomy, and pelvic peritoneum partial resection for ascending colon cancer: Hannah Kim, An Na Seo, Soo Yeun Park; Ann Coloproctol. 2023;39(3):283-286. Published online February 9, 2023; DOI: https://doi.org/10.3393/ac.2022.00780.0111

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The aim of this video is to present the procedural details of laparoscopic right hemicolectomy with aortocaval (infrarenal aortic bifurcation) lymphadenectomy, partial resection of the pelvic peritoneum (peritoneal carcinomatosis index, 3), and hyperthermic intraperitoneal chemotherapy in a patient who received neoadjuvant chemotherapy for stage IVc colorectal cancer. The total operation time was 290 minutes, and the patient was discharged on a postoperative day 13 without any complications. No postoperative complications occurred until postoperative day 60. The pathological stage of the tumor was determined to be T3N2bM1c. The pelvic peritoneal nodule was pathologically confirmed as a metastatic lesion. Among the 12 harvested aortocaval lymph nodes, 6 were metastatic lymph nodes. The minimally invasive approach was safe and feasible in this highly selected patient with colon cancer, aortocaval lymph nodes, and peritoneal metastases.

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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

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

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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

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Infiltrating Presacral Neuroendocrine Tumor: An Atypical Cause of Lower Gastrointestinal Bleeding
Laura Krause, Ross Humes
ACG Case Reports Journal.2026;[Epub] CrossRef
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;[Epub] 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

Original Articles

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

The Impact of Primary Tumor Resection on Survival in Asymptomatic Colorectal Cancer Patients With Unresectable Metastases: Ki Yoon Doah, Ui Sup Shin, Byong Ho Jeon, Sang Sik Cho, Sun Mi Moon; Ann Coloproctol. 2021;37(2):94-100. Published online April 30, 2021; DOI: https://doi.org/10.3393/ac.2020.09.15.1

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Abstract PDF

Purpose
This study was conducted to evaluate the effectiveness of primary tumor resection (PTR) in asymptomatic colorectal cancer (CRC) patients with unresectable metastases using the inverse probability of treatment weighting (IPTW) method to minimize selection bias.
Methods
We selected 146 patients diagnosed with stage IV CRC with unresectable metastasis between 2001 and 2018 from our institutional database. In a multivariate logistic regression model using the patients’ baseline covariates associated with PTR, we applied the IPTW method based on a propensity score and performed a weighted Cox proportional regression analysis to estimate survival according to PTR.
Results
Upfront PTR was performed in 98 patients, and no significant differences in baseline factors were detected. The upweighted median survival of the PTR group was 18 months and that of the non-PTR group was 15 months (P = 0.15). After applying the IPTW, the PTR was still insignificant in the univariate Cox regression (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.5–1.21). However, in the multivariate weighted Cox regression with adjustment for other covariates, the PTR showed a significantly decreased risk of cancer-related death (HR, 0.61; 95% CI, 0.40–0.94).
Conclusion
In this study, we showed that asymptomatic CRC patients with unresectable metastases could gain a survival benefit from upfront PTR by analysis with the IPTW method. However, randomized controlled trials are mandatory.

Citations

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Primary Tumor Resection in Patients With Unresectable Metastatic Colorectal Cancer: A Systematic Review and Meta‐Analysis
Junpei Takashima, Hirotoshi Kobayashi, Daisuke Fujimoto, Fumihiko Miura
Annals of Gastroenterological Surgery.2026;[Epub] CrossRef
A predictive model to identify optimal candidates for surgery among patients with metastatic colorectal cancer
Xiqiang Zhang, Zhaoyi Jing, Longchao Wu, Ze Tao, Dandan Lu
Frontiers in Oncology.2025;[Epub] CrossRef
Recurrence Rates and Postoperative Complications Following Colorectal Cancer Surgery: A 5-Year Study at a Tertiary Care Hospital in Peshawar
Tilal Ahmed Raza, Hussain Jan Abbasi, Farrukh Ozair, Hajra Imtiaz
Pakistan Journal of Health Sciences.2025; : 120. CrossRef
Primary tumor resection for asymptomatic colorectal cancer patients with synchronous unresectable metastases: a meta-analysis of randomized controlled trials and case-matched studies
Jun Huang, Jiahao Zhou, Ping Zhang, Qingbin Wu, Ziqiang Wang
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Effect of primary tumor resection on survival in patients with asymptomatic unresectable metastatic colorectal cancer: a systematic review and meta-analysis
Chengren Zhang, Cong Cao, Lili Liu, Yaochun Lv, Jingjing Li, Jiyong Lu, Shuai Wang, Binbin Du, Xiongfei Yang
Expert Review of Anticancer Therapy.2023; 23(1): 107. CrossRef
The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis
Zongyu Liang, Zhiyuan Liu, Chengzhi Huang, Xin Chen, Zhaojun Zhang, Meijuan Xiang, Weixian Hu, Junjiang Wang, Xingyu Feng, Xueqing Yao
Frontiers in Surgery.2023;[Epub] CrossRef
Primary tumor resection in colorectal cancer patients with unresectable distant metastases: a minireview
Junge Bai, Ming Yang, Zheng Liu, Sergey Efetov, Cuneyt Kayaalp, Audrius Dulskas, Darcy Shaw, Xishan Wang
Frontiers in Oncology.2023;[Epub] CrossRef
Palliative primary tumor resection in minimally symptomatic (asymptomatic) patients with colorectal cancer and synchronous unresectable metastases versus chemotherapy alone: a metaanalysis
Iu. V. Alimova, Yu. A. Shelygin, E. G. Rybakov, M. V. Alekseev
Koloproktologia.2023; 22(2): 126. CrossRef
The impact of primary tumor resection for asymptomatic colorectal cancer patients with unresectable metastases: a systematic review and meta-analysis
Shuyuan Li, Liqiang Ji, Jie Huang, Ye Wang, Peng Liu, Wei Zhang, Zheng Lou
International Journal of Colorectal Disease.2023;[Epub] CrossRef
The impact of palliative primary tumor resection on overall survival in minimally symptomatic (asymptomatic) colorectal cancer and synchronous unresectable metastases vs chemotherapy only: a comparative study of outcomes
Iu. V. Alimova, S. I. Achkasov, Yu. A. Shelygin, M. V. Alekseev, V. N. Kashnikov, M. Yu. Fedyanin, M. A. Danilov, E. G. Rybakov
Koloproktologia.2023; 22(4): 10. CrossRef
Recurrence Patterns and Risk Factors after Curative Resection for Colorectal Cancer: Insights for Postoperative Surveillance Strategies
Hyo Seon Ryu, Jin Kim, Ye Ryung Park, Eun Hae Cho, Jeong Min Choo, Ji-Seon Kim, Se-Jin Baek, Jung-Myun Kwak
Cancers.2023; 15(24): 5791. CrossRef
Palliative primary tumor resection in minimally symptomatic patients with colorectal cancer and synchronous unresectable metastases: when is it necessary? (systematic review)
Iu. V. Alimova, Yu. A. Shelygin, E. G. Rybakov
Koloproktologia.2022; 21(3): 99. CrossRef
Surgical treatment for metastatic colorectal cancer
Eun Jung Park, Seung Hyuk Baik
Journal of the Korean Medical Association.2022; 65(9): 568. 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
Molecular analyses of peritoneal metastasis from colorectal cancer
Chang Hyun Kim
Journal of the Korean Medical Association.2022; 65(9): 586. CrossRef
Molecular Analyses in Peritoneal Metastasis from Colorectal Cancer: A Review-An English Version
Chang Hyun Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 197. CrossRef
Primary Tumor Resection in Asymptomatic Colorectal Cancer Patients With Unresectable Metastases: Can It Improve Survival?
Myong Hoon Ihn
Annals of Coloproctology.2021; 37(2): 71. CrossRef
Treatment for Peritoneal Metastasis of Patients With Colorectal Cancer
Young Jin Kim, Chang Hyun Kim
Annals of Coloproctology.2021; 37(6): 425. CrossRef

Malignant disease,Prognosis and adjuvant therapy,Colorectal cancer

The Prognosis and Recurrence Pattern of Right- and Left-Sided Colon Cancer in Stage II, Stage III, and Liver Metastasis After Curative Resection: Yasuyuki Nakamura, Daisuke Hokuto, Fumikazu Koyama, Yasuko Matsuo, Takeo Nomi, Takahiro Yoshikawa, Naoki Kamitani, Tomomi Sadamitsu, Takeshi Takei, Yayoi Matsumoto, Yosuke Iwasa, Kohei Fukuoka, Shinsaku Obara, Takayuki Nakamoto, Hiroyuki Kuge, Masayuki Sho; Ann Coloproctol. 2021;37(5):326-336. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.09.14

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Abstract PDF

Purpose
Primary tumor location of colon cancer has been reported to affect the prognosis after curative resection. However, some reports suggested the impact was varied by tumor stage. This study analyzed the prognostic impact of the sidedness of colon cancer in stages II, III, and liver metastasis after curative resection using propensity-matched analysis.
Methods
Right-sided colon cancer was defined as a tumor located from cecum to splenic flexure, while any more distal colon cancer was defined as left-sided colon cancer. Patients who underwent curative resection at Nara Medical University hospital between 2000 and 2016 were analyzed.
Results
There were 110 patients with stage II, 100 patients with stage III, and 106 patients with liver metastasis. After propensity matching, 28 pairs with stage II and 32 pairs with stage III were identified. In the patients with stage II, overall survival (OS) and recurrence-free survival (RFS) were not significantly different for right- and left-sided colon cancers. In the patients with stage III, OS and RFS were significantly worse in right-sided colon cancer. In those with liver metastasis, OS of right-sided colon cancer was significantly worse than left-sided disease, while RFS was similar. Regarding metachronous liver metastasis, the difference was observed only in the patients whose primary colon cancer was stage III. In each stage, significantly higher rate of peritoneal recurrence was found in those with right-sided colon cancer.
Conclusion
Sidedness of colon cancer had a significant and varied prognostic impact in patients with stage II, III, and liver metastasis after curative resection.

Citations

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Does Tumor Sidedness Matter After Curative Surgery in Colorectal Cancer? A Retrospective Cohort Study on Recurrence Patterns and Post Recurrence Survival
Fernando Mendoza-Moreno, Manuel Díez-Alonso, Belén Matías-García, Enrique Ovejero-Merino, Héctor Aguado López, Cristina Vera-Mansilla, Lucía Diego-García, Beatriz Castro-Catalán, Alberto Vilar-Tabanera, Rubén Jiménez-Martín, Raúl Díaz-Pedrero, Miguel A. O
Clinical Colorectal Cancer.2026; 25(1): 87. CrossRef
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Molecular Analyses in Peritoneal Metastasis from Colorectal Cancer: A Review-An English Version
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Malignant disease, Rectal cancer

Clinicopathologic Analysis of Lateral Margin Measured by Whole-Mount Section in T3 Rectal Cancer: Soomin Nam, Youngki Hong, Yoon Jung Choi, Jung Gu Kang; Ann Coloproctol. 2020;36(3):172-177. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2020.01.19.1

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Purpose
Total mesorectal excision is a standard technique for rectal cancer. The whole-mount section can encompass the entire specimen, so it is a more appropriate for measuring circumferential margin than conventional section. We analyzed the clinical characteristics and prognosis based on lateral margins measured by whole-mount sections. Materials and Methods: Medical records of patients who were operated on for T3 rectal cancer from 2005 to 2015 were reviewed retrospectively. A total of 154 patients were included. The slides of the whole-mount sections were re-reviewed by a single pathologist.
Results
We divided the groups according to the length of the lateral margin (LM: 1mm, 1.5mm and 2mm). There was significantly frequent lymphovascular invasion and N state was higher when LM was short in all groups. There were more micrometastasis in group LM

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Risk factors of positive resection margin differ in pancreaticoduodenectomy and distal pancreatosplenectomy for pancreatic ductal adenocarcinoma undergoing upfront surgery
Bo Li, Shiwei Guo, Xiaoyi Yin, Chenming Ni, Suizhi Gao, Gang Li, Canrong Ni, Hui Jiang, Wan Yee Lau, Gang Jin
Asian Journal of Surgery.2023; 46(4): 1541. CrossRef
Multidisciplinary treatment strategy for early colon cancer
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Korean Medical Association.2022; 65(9): 558. CrossRef
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 Whole-Mount Section in Rectal Cancer Effective for Measuring Lateral Margin?
Jun Seong Chung, Han Deok Kwak, Jae Kyun Ju
Annals of Coloproctology.2020; 36(3): 131. CrossRef

Short-term Outcomes After Upfront Chemotherapy Followed by Curative Surgery in Metastatic Colon Cancer: A Comparison With Upfront Surgery Patients: Myung Hyun Han, Youn Young Park, Shiva Pratap, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim; Ann Coloproctol. 2019;35(6):327-334. Published online December 31, 2019; DOI: https://doi.org/10.3393/ac.2019.03.04.1

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2 Citations

Abstract PDF

Purpose
Upfront systemic chemotherapy with target agents has been recommended for patients with stage IV colon cancer. Some with partial response are considered for curative resection. There is high risk of developing postoperative complications following upfront systemic chemotherapy. We aimed to evaluate short-term perioperative outcomes of curative surgery after upfront chemotherapy in comparison with upfront surgery in patients with metastatic colon cancer.
Methods
Between January 2010 and October 2015, 146 patients (80 in the surgery first group, 66 in the upfront chemotherapy group) who underwent surgical resection before or after systemic chemotherapy for metastatic colon cancer were included in the present study. All decisions for treatment were made through a multidisciplinary team. Postoperative clinical outcomes and complications were analyzed to compare the groups.
Results
There was no difference between the 2 groups in terms of postoperative clinical outcomes. Overall complication rates were not different between the groups (surgery first group: 46.3% vs. upfront chemotherapy group: 60.6%; P = 0.084). When classified according to the Clavien-Dindo method, there was no difference between the 2 groups in terms of major complications (grade 3 or more) (surgery first group: 18.9% vs. upfront chemotherapy group: 27.5%; P = 0.374).
Conclusion
There was no significant increase in major postoperative complications in metastatic colon cancer patients who received upfront chemotherapy followed by curative surgery. Careful patient selection and treatment planning are important.

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Impact of preoperative chemotherapy on perioperative morbidity in combined resection of colon cancer and liver metastases
Joy Z. Done, Angelos Papanikolaou, Miloslawa Stem, Shannon N. Radomski, Sophia Y. Chen, Chady Atallah, Jonathan E. Efron, Bashar Safar
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Case Report

Malignant disease

Nasal Cavity Metastasis From Colorectal Cancer Represents End-Stage Disease and Should Be Palliated: Stephen Hwang, Dedrick Kok Hong Chan, Fredrik Petersson, Ker-Kan Tan; Ann Coloproctol. 2020;36(2):119-121. Published online November 13, 2019; DOI: https://doi.org/10.3393/ac.2019.03.04

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Nasal metastases from colorectal cancer is rare. The presentation of nasal metastases is often very similar to primary nasal sinus adenocarcinoma. A high index of suspicion is required, especially in patients who have had a previous history of colorectal carcinoma. Histology is ultimately required for diagnosis. We describe 2 cases of nasal metastases from colorectal carcinoma, and discuss the presentation, diagnosis and management of the case. Such metastatic disease ultimately represents end-stage malignancy, and patients should be palliated.

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Eun Jung Park, Seung Hyuk Baik
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Major driver mutations are shared between sinonasal intestinal-type adenocarcinoma and the morphologically identical colorectal adenocarcinoma
Sannia Sjöstedt, Ane Yde Schmidt, Filipe Garrett Vieira, Gro Linno Willemoe, Tina Klitmøller Agander, Caroline Olsen, Finn Cilius Nielsen, Christian von Buchwald
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Review

Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives: Hye Jin Kim, Gyu–Seog Choi; Ann Coloproctol. 2019;35(3):109-117. Published online June 30, 2019; DOI: https://doi.org/10.3393/ac.2019.06.12

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70 Citations

Abstract PDF

Lymph node metastasis is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Lymph node status based on examination of a resected specimen is a key element of the current staging system and is also a crucial factor to determine use of adjuvant chemotherapy after surgical resection. However, the current tumor-node-metastasis (TNM) staging system only incorporates the number of metastatic lymph nodes in the N category. Numerous attempts have been made to supplement this simplified N staging including lymph node ratio, distribution of metastatic lymph nodes, tumor deposits, or extracapsular invasion. In addition, several attempts have been made to identify more specific prognostic factors in resected colorectal specimens than lymph node status. In this review, we will discuss controversies in lymph node staging and factors that may influence survival beyond lymph node status.

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Jiabao Tang, Jingwen Xu, Xiaohua Li, Chun Cao
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S.V. Maliborska
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Ru-Jie Chen
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Conor Aylward, Jawed Noori, Jack Tyrrell, Niall O'sullivan, Dara O. Kavanagh, John O. Larkin, Brian J. Mehigan, Paul H. McCormick, Michael E. Kelly
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International Journal of Pediatric Otorhinolaryngology.2023; 164: 111419. CrossRef
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Junxian Long, Fengyun Cong, Yousheng Wei, Jungang Liu, Weizhong Tang
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Sameh Hany Emile, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Peige Zhou, Steven D. Wexner
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Haoran Ji, Chuang Hu, Xuhui Yang, Yuanhao Liu, Guangyu Ji, Shengfang Ge, Xiansong Wang, Mingsong Wang
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Alexander J. Pennings, Brecht A. van der Velden, Maximilian Kloft, Loes F. S. Kooreman, Jos M. P. Kleijnen, Stephanie O. Breukink, Geerard L. Beets, Heike I. Grabsch, Jarno Melenhorst
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Jun Woo Bong, Sanghee Kang, Pyoungjae Park
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Maurizio Zizzo, Maria Pia Federica Dorma, Magda Zanelli, Francesca Sanguedolce, Maria Chiara Bassi, Andrea Palicelli, Stefano Ascani, Alessandro Giunta
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Marcin Zeman, Władysław Skałba, Piotr Szymański, Grzegorz Hadasik, Dmytro Żaworonkow, Dominik A. Walczak, Agnieszka Czarniecka
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In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
An unusual case of right-sided colon cancer with isolated lateral pelvic side wall lymph node metastases
Rishaan Pawaskar, James Wei Tatt Toh
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High-resolution MRI-based radiomics analysis to predict lymph node metastasis and tumor deposits respectively in rectal cancer
Yan-song Yang, Feng Feng, Yong-juan Qiu, Gui-hua Zheng, Ya-qiong Ge, Yue-tao Wang
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Competitive Risk Analysis of Prognosis in Patients With Cecum Cancer: A Population-Based Study
Wentao Wu, Jin Yang, Daning Li, Qiao Huang, Fanfan Zhao, Xiaojie Feng, Hong Yan, Jun Lyu
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Noshad Peyravian, Stefania Nobili, Zahra Pezeshkian, Meysam Olfatifar, Afshin Moradi, Kaveh Baghaei, Fakhrosadat Anaraki, Kimia Nazari, Hamid Asadzadeh Aghdaei, Mohammad Reza Zali, Enrico Mini, Ehsan Nazemalhosseini Mojarad
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European Journal of Cancer.2021; 155: 200. CrossRef
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María Diestro, Alberto Berjón, Ignacio Zapardiel, Laura Yébenes, Irune Ruiz, Arantza Lekuona, Marta Rezola, Ibon Jaunarena, Jaime Siegrist, Margarita Sánchez-Pastor, María Cuadra, Amaia Sagasta, Isabel Guerra, Luis Lete, Fernando Roldán, Carlo Marta, Marí
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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
Pathological Features and Prognostication in Colorectal Cancer
Kabytto Chen, Geoffrey Collins, Henry Wang, James Wei Tatt Toh
Current Oncology.2021; 28(6): 5356. CrossRef
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Stanislav Filip, Veronika Vymetalkova, Jiri Petera, Ludmila Vodickova, Ondrej Kubecek, Stanislav John, Filip Cecka, Marketa Krupova, Monika Manethova, Klara Cervena, Pavel Vodicka
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Original Article

Early Systemic Failure After Preoperative Chemoradiotherapy for the Treatment of Patients With Rectal Cancer: Taesun Choi, Se-Jin Baek, Jung Myun Kwak, Jin Kim, Seon-Hahn Kim; Ann Coloproctol. 2019;35(2):94-99. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2018.08.28

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Abstract PDF

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

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Characteristics of Patients Presented With Metastases During or After Completion of Chemoradiation Therapy for Locally Advanced Rectal Cancer: A Case Series
Radwan Torky, Mohammed Alessa, Ho Seung Kim, Ahmed Sakr, Eman Zakarneh, Fozan Sauri, Heejin Bae, Nam Kyu Kim
Annals of Coloproctology.2021; 37(3): 186. CrossRef
Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer
Ho Seung Kim, Nam Kyu Kim
Annals of Gastroenterological Surgery.2020; 4(4): 379. CrossRef

Case Reports

Toxocara canis Mimicking a Metastatic Omental Mass from Sigmoid Colon Cancer: A Case Report: Han-Gil Kim, Jung-Wook Yang, Soon-Chan Hong, Young-Joon Lee, Young-Tae Ju, Chi-Young Jeong, Jin-Kwon Lee, Seung-Jin Kwag; Ann Coloproctol. 2018;34(3):160-163. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.12.20

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Abstract PDF

Toxocara canis is an important roundworm of canids and a fearsome animal parasite of humans. Human infections can lead to syndromes called visceral larva migrans (VLM), ocular larva migrans, neurotoxocariasis, and covert toxocariasis. VLM is most commonly diagnosed in children younger than 8 years of age, but adult cases are relatively frequent among those infected by ingesting the raw tissue of paratenic hosts in East Asia. This research reports the case of a 59-year-old man with sigmoid colon cancer, who visited our institution for surgery. An intraperitoneal mass was found on preoperative computed tomography, and it was thought to be a metastatic mass from sigmoid colon cancer. A postoperative histologic examination and serum test showed eosinophilic granuloma due to toxocariasis. Diagnosis of VLM is often difficult and highly suspicious in adults. Researchers suggest, although rarely, that VLM be included in the differential diagnosis as a cause of intraperitoneal tumors.

Citations

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Toxocariasis: An Overlooked Neglected Tropical Disease in Latin America
Alfonso J. Rodriguez-Morales, Ivan Camilo Jaramillo-Montoya, Jessica Marcela Hermosa-Sanchez, Juan Felipe López-Marín, Maria Camila Bernal-Chica, Nahun Alejandro Giraldo-Corrales, Omar Jair Mantilla-Moreno, Hector Andres Mosquera-Alba, Sergio Imbachi-Anac
Revista del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo.2025; 18(1): e2835. CrossRef
Current status of intestinal parasite infections in fecal samples of dogs in Korea
You-Jeong Lee, Beoul Kim, Dongmi Kwak, Min-Goo Seo
Parasites, Hosts and Diseases.2024; 62(4): 438. CrossRef
Human Toxocariasis in individuals with blood disorders and cancer patients: the first seroepidemiological study in Iran
Vahid Raissi, Nasrin Sohrabi, Fatemeh Bayat, Soudabeh Etemadi, Omid Raiesi, Pantea Jalali, Maryam Karami, Ali Abdollahi, Ziba Hoseiny, Mahdi Shayanfard, Gita Alizadeh, Mahmoud E. Gadalla, Asmaa Ibrahim
Journal of Parasitic Diseases.2021; 45(3): 643. CrossRef
Pulmonary Exacerbation of Undiagnosed Toxocariasis in Intensively-Treated High-Risk Neuroblastoma Patients
Szymon Janczar, Monika Bulas, Justyna Walenciak, Dobromila Baranska, Marek Ussowicz, Wojciech Młynarski, Beata Zalewska-Szewczyk
Children.2020; 7(10): 169. CrossRef
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Masaki Kakimoto, Masayuki Murata, Fujiko Mitsumoto-Kaseida, Eiichi Ogawa, Yuji Matsumoto, Akira Kusaga, Kazuhiro Toyoda, Takeo Hayashi, Kazuya Ura, Keishi Kanno, Norihiro Furusyo, Susumu Tazuma
Internal Medicine.2019; 58(18): 2737. CrossRef

Multiple Myeloma Mimics Bone Metastasis From a Rectal Adenocarcinoma: Im-Kyung Kim, Jeonghyun Kang, Yu Ri Kim, Tae Joo Jeon, Seung Hyuk Baik, Seung-Kook Sohn; Ann Coloproctol. 2017;33(2):70-73. Published online April 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.2.70

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Abstract PDF

A presumptive diagnosis of bone metastasis can be easily made when a patient with a history of colorectal cancer develops bone lesions that are seen on follow-up imaging. In this case report, we describe a patient whose multiple bone lesions were wrongly attributed to a recurrence of rectal cancer rather than being identified as multiple myeloma lesions. When clinicians detect new, abnormal, bony lesions in a patient with a previous history of cancer, they should consider diseases such as multiple myeloma in their differential diagnosis.

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Capecitabine/fluorouracil/oxaliplatin

Reactions Weekly.2017; 1661(1): 71. CrossRef

Original Articles

Single Center Experience With Hyperthermic Intraperitoneal Chemotherapy: Woo Ram Kim, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Kang Young Lee, Nam Kyu Kim; Ann Coloproctol. 2017;33(1):16-22. Published online February 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.1.16

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Abstract PDF

Purpose

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed for controlling peritoneal seeding metastasis in some kinds of cancers, including those of colorectal origin, but their safety and oncological benefits are subjects of debate. We present our early experience with those procedures.

Methods

Data were retrospectively collected from all patients with peritoneal carcinomatosis (PC) and pseudomyxoma peritonei (PMP) treated using CRS and HIPEC at Yonsei Cancer Center between July 2014 and July 2015. Short-term outcomes and risk factors for postoperative complications were analyzed.

Results

Twenty-three patients with PC (n = 18) and PMP (n = 5) underwent CRS and HIPEC. Median follow-up and age were 2 months and 54 years, respectively. The median peritoneal carcinomatosis index score was 15, and CC0-1 was achieved in 78.3% of all patients. The median operation time and bleeding loss were 590 minutes and 570 mL, respectively. Grade-IIIa/grade-IIIb complications occurred in 4.3% (n = 1)/26.1% (n = 6) of the patients within 30 days postoperatively, and no 30-day mortalities were reported. Factors related to postoperative complications with CRS and HIPEC were number of organ resection (P = 0.013), longer operation time (P < 0.001), and amount of blood loss (P = 0.003). All patients treated with cetuximab for recurred colorectal cancer had grade-III postoperative complication.

Conclusion

Our initial experience with CRS and HIPEC presented about 30% grade-III postoperative complications. Therefore, expert surgeons need to perform those procedures with great caution in selected patients who might benefit from it.

Citations

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Multisocietal Consensus on the Use of Cytoreductive Surgery and HIPEC for the Treatment of Diffuse Malignant Peritoneal Mesothelioma: A GRADE Approach for Evidence Evaluation and Recommendation
Shigeki Kusamura, Michela Cinquini, David Morris, Pompiliu Piso, Hedy Kindler, Andreas Brandl, Edward Levine, Olivier Glehen, Vahan Kepenekian, Olivia Sgarbura, Paul H. Sugarbaker, Dario Baratti, Guaglio Marcello, Deraco Marcello
Journal of Surgical Oncology.2025; 131(5): 810. CrossRef
Pharmacologic Effects of Oxaliplatin Instability in Chloride-Containing Carrier Fluids on the Hyperthermic Intraperitoneal Chemotherapy to Treat Colorectal Cancer In Vitro and In Vivo
Eun Jung Park, Junhyun Ahn, Sharif Md Abuzar, Kyung Su Park, Sung-Joo Hwang, Seung Hyuk Baik
Annals of Surgical Oncology.2022; 29(13): 8583. CrossRef
Treatment for Peritoneal Metastasis of Patients With Colorectal Cancer
Young Jin Kim, Chang Hyun Kim
Annals of Coloproctology.2021; 37(6): 425. CrossRef
Is Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy a Safe and Effective Procedure for Treating Patients With a Peritoneal Surface Malignancy?
Dong-Guk Park
Annals of Coloproctology.2017; 33(1): 3. CrossRef

Prognostic Factors in Terms of the Number of Metastatic Nodules in Patients With Colorectal Cancer Liver Metastases: Ki Ung Jang, Chan Wook Kim, Ki-Hun Kim, Seok-Byung Lim, Chang Sik Yu, Tae Won Kim, Pyo Nyun Kim, Jong Hoon Kim, Jin Cheon Kim; Ann Coloproctol. 2016;32(3):92-100. Published online June 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.3.92

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Abstract PDF

Purpose

The hepatic resection is the gold-standard treatment for patients with colorectal-cancer liver metastases (CLM). This study aimed to identify prognostic factors in patients with synchronous CLM who underwent a surgical curative (R0) resection with respect to the number of metastatic nodules.

Methods

Of 1,261 CLM patients treated between January 1991 and December 2010, 339 who underwent a R0 resection for synchronous CLM were included in this retrospective analysis. Patients were grouped according to the number of CLM nodules: 1–2 CLM nodules, n = 272 (group 1) and 3–8 CLM nodules, n = 67 (group 2).

Results

The 5-year progression-free survival (PFS) rate in group 1was better than that in group 2 (P = 0.020). The multivariate analysis identified lymph-node metastasis (N2), lymphovascular invasion (LVI), and three or more CLM nodules as independent poor prognostic factors for PFS in all patients and lymph-node metastasis (N2) and LVI as independent poor prognostic factors for patients in group 1. No independent prognostic factors were identified for patients in group 2. CLM treatment method and neoadjuvant chemotherapy were not associated with survival.

Conclusion

Three or more metastatic nodules, lymph-node metastasis (N2), and LVI were independent poor prognostic factors for PFS in patients with synchronous CLM who underwent a R0 resection. The latter 2 factors were also independent prognostic factors for PFS in patients with less than 3 CLM nodules; however, in patients with three or more CLM nodules, the prognosis for PFS may be related only to liver metastasis.

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Ana Margarida Abrantes, Rui Caetano-Oliveira, Bárbara Oliveiros, Maria Augusta Cipriano, José Guilherme Tralhão
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Gemma Garcia-Vicién, Artur Mezheyeuski, María Bañuls, Núria Ruiz-Roig, David G. Molleví
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Xiao-Zhan Zhang, Hong-Li Mao, Shi-Jie Zhang, Li Sun, Wen-Jing Zhang, Qing-Zhou Chen, Lei Wang, Hong-Chun Liu
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HIF-1α expression in liver metastasis but not primary colorectal cancer is associated with prognosis of patients with colorectal liver metastasis
Yuma Wada, Yuji Morine, Satoru Imura, Tetsuya Ikemoto, Yu Saito, Chie Takasu, Shinichiro Yamada, Mitsuo Shimada
World Journal of Surgical Oncology.2020;[Epub] CrossRef
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Heeji Shin, Chan Wook Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok‐Byung Lim, Chang Sik Yu, Jin Cheon Kim
ANZ Journal of Surgery.2019; 89(1-2): 61. CrossRef
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Rui Caetano Oliveira, Henrique Alexandrino, Maria Augusta Cipriano, José Guilherme Tralhão
Journal of Oncology.2019; 2019: 1. CrossRef
Which Patients with Isolated Para-aortic Lymph Node Metastasis Will Truly Benefit from Extended Lymph Node Dissection for Colon Cancer?
Sung Uk Bae, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Kang Young Lee, Nam Kyu Kim
Cancer Research and Treatment.2018; 50(3): 712. CrossRef
Resection after preoperative chemotherapy versus synchronous liver resection of colorectal cancer liver metastases
Chan W. Kim, Jong L. Lee, Yong S. Yoon, In J. Park, Seok-Byung Lim, Chang S. Yu, Tae W. Kim, Jin C. Kim
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A postoperative scoring system for post-hepatectomy early recurrence of colorectal liver metastases
Rui Mao, Jian-Jun Zhao, Xin-Yu Bi, Ye-Fan Zhang, Zhi-Yu Li, Jian-Guo Zhou, Xiao-Long Wu, Chen Xiao, Hong Zhao, Jian-Qiang Cai
Oncotarget.2017; 8(60): 102531. CrossRef
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Case Reports

Metastatic Spermatic Cord Tumor From Colorectal Cancer: Ji Geon Jang, Hye Yun Jeong, Ki Soo Kim, Mi Jung Park, Jin Sook Lee, Sang Su Kim, Ho Young Kim; Ann Coloproctol. 2015;31(5):202-204. Published online October 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.5.202

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Abstract PDF

Metastatic tumors of the spermatic cord are extremely rare, and the prognosis for patients is typically poor. In the majority of cases, the primary tumor occurs in the gastrointestinal tract. We report a case of a 62-year-old man with a metastatic spermatic cord tumor. The patient complained of groin discomfort with a tender mass in the right inguinal area. An excisional biopsy was performed, and the pathologic finding was a metastatic mucinous adenocarcinoma. We performed a systemic evaluation including colonoscopy, abdominal computed tomography, and total-body positron emission tomography, and the primary tumor was confirmed to involve the total colon, including the cecum, sigmoid colon, and rectum. The pathologic finding for rectum revealed a mucinous adenocarcinoma compatible with a metastatic spermatic cord tumor.

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Spermatic cord metastasis in patient with colorectal adenocarcinoma: A case report and review of literature
Pranjal Rai, Pradeep Kumar, Joe Joseph, Dhairya A. Lakhani
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Paratesticular metastasis from colorectal adenocarcinoma presenting as hydrocele: a rare case report and literature review
XiaoJun Huang, KeLi Xu, Yin Zhao, MinHui Chen, ZheYang Li
Frontiers in Oncology.2024;[Epub] CrossRef

Colonic Metastasis Presenting as an Intraluminal Fungating Mass 8 Years After Surgery for Ovarian Cancer: Jeong Rye Kim, Bong Man Kim, You Me Kim, Won Ae Lee, Hwan Namgung; Ann Coloproctol. 2015;31(5):198-201. Published online October 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.5.198

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Abstract PDF

We report a case of colonic metastasis from ovarian cancer presented as an intraluminal fungating mass mimicking primary colon cancer 8 years after surgery for ovarian cancer. A 70-year-old woman presented with constipation. She had undergone an extended total abdominal hysterectomy with bilateral salpingo-oophorectomy for an ovarian papillary serous cystadenocarcinoma 8 years earlier. Colonoscopy showed a large fungating mass 10 cm from the anal verge that was suspected to be colorectal cancer. A computed tomography scan showed a bulky intraluminal fungating mass in the rectosigmoid junction. After a lower anterior resection and a pathologic diagnosis, a diagnosis of a papillary serous adenocarcinoma due to metastasis from an ovarian tumor was made for this patient.

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Serous Carcinomas Initially Diagnosed on Colon Biopsies: A Case Series Highlighting the Role of p53 to Guide Management
Brianna Waller, John A. Steinharter, John M. Kennedy, Charles Ashley, Amer K. Abu Alfa, Kristen E. Muller, Bronwyn Bryant
International Journal of Surgical Pathology.2026; 34(2): 501. CrossRef
A Case Report of Bilateral Endometrioid-Type Ovarian Carcinoma with Synchronous Dual Metastasis to the Colon
W. T. N. Widanage, K. S. Nathawitharanalage, N. A. Kodithuwakku, A. A. S. Samarathunga, H. M. S. P. Rajaguru, K. P. Dissanayake, L. R. A. Wijesooriya, J. A. S. B. Jayasundara
SN Comprehensive Clinical Medicine.2024;[Epub] CrossRef
Synchronous Tumors in the Cecum and Ovary: Differentiating a Primary Colonic Tumor from Metastasis
Raksha Ramesh, Shalini Shree Krishnamurthy, Jayashree Natarajan, Ramakrishnan Ayloor Seshadri
Indian Journal of Colo-Rectal Surgery.2024; 7(3): 54. CrossRef
Metastasis of Ovarian Cancer to the Descending Colon
Kentaro Abe, Hiroyuki Anzai, Satoko Eguchi, Masako Ikemura, Aya Shinozaki-Ushiku, Takahide Shinagawa, Hirofumi Sonoda, Yuichiro Yoshioka, Yuzo Nagai, Shinya Abe, Hiroyuki Matsuzaki, Yuichiro Yokoyama, Shigenobu Emoto, Koji Murono, Kazuhito Sasaki, Hiroaki
Case Reports in Gastroenterology.2023; 17(1): 136. CrossRef
Clinicopathologic Features of Gynecologic Malignancies Presenting Clinically as Colonic Malignancies
Lanisha D Fuller, Andrew Dunn, Aaron R Huber, Monika Vyas, Raul S Gonzalez
American Journal of Clinical Pathology.2022; 157(1): 82. CrossRef
Rectorrhagia revealing colonic metastasis from an ovarian primary, an exceptional case report
Rachid Jabi, Siham Elmir, Soumia El Arabi, Achraf Merry, Mohammed Bouziane
International Journal of Surgery Case Reports.2021; 88(C): 106490. CrossRef
Metastatic colon cancer of an ovarian cancer origin mimicking primary colon cancer: A case report
Ji-Hyeon Park, Dong Hae Jung, Jeong-Heum Baek
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Original Articles

Role of Peritoneal Lavage Cytology and Prediction of Prognosis and Peritoneal Recurrence After Curative Surgery for Colorectal Cancer: Sung Joon Bae, Ui Sup Shin, Young-Jun Ki, Sang Sik Cho, Sun Mi Moon, Sun Hoo Park; Ann Coloproctol. 2014;30(6):266-273. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.266

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Abstract PDF

Purpose

In colorectal cancer, the role of detecting free malignant cells from peritoneal lavage is currently unclear. In this study, we investigated the positive rate of free malignant cells in peritoneal lavage fluid and their predictive value for prognosis and peritoneal recurrence after a curative resection.

Methods

From October 2009 to December 2011, in a prospective manner, we performed cytologic examinations of peritoneal lavage fluid obtained just after the abdominal incision from 145 patients who underwent curative surgery for colorectal cancer. We used proportional hazard regression models to analyze the predictive role of positive cytology for peritoneal recurrence and survival.

Results

Among total 145 patients, six patients (4.1%) showed positive cytology. During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence. Among them, 5 patients (3.4%) showed peritoneal carcinomatosis. In the multivariate analysis, positive cytology was an independent predictive factor for peritoneal recurrence (hazard ratio [HR], 136.5; 95% confidence interval [CI], 12.2-1,531.9; P < 0.0001) and an independent poor prognostic factor for overall survival (HR, 11.4; 95% CI, 1.8-72.0; P = 0.009) and for disease-free survival (HR, 11.1; 95% CI, 3.4-35.8; P < 0.0001).

Conclusion

Positive cytology of peritoneal fluid was significantly associated with peritoneal recurrence and worse survival in patients undergoing curative surgery for colorectal cancer. Peritoneal cytology might be a useful tool for selecting patients who need intraperitoneal or systemic chemotherapy.

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Risk Factors for Positive Peritoneal Lavage Cytology in Stage I to III Colon Cancer: A Prospective Observational Study
Radha Raman Mondal, Subrata Sahu, Sudip Haldar, Samir Bhattacharyya, Arnab Gupta
Indian Journal of Surgical Oncology.2026; 17(6): 1207. CrossRef
Intraoperative flow cytometry in detecting free carcinoma cells in peritoneal lavage fluid of gastric carcinoma cases
Thulasi Raman Ramalingam, Bharaneedharan Marimuthu, Harsha N. Rasheed, Archana Lakshmanan, Swetha Lakshmi Narla, Lakshman Vaidhyanathan, Ajit Pai
Cytometry Part B: Clinical Cytometry.2025;[Epub] CrossRef
Peritoneal Lavage Cytology Predicts Peritoneal Metastasis and is Associated with Poor Prognosis in Patients with Stage II–III Colorectal Cancer
Dewei Kong, Yingjie Li, Shenyi Yin, Yunfei Tan, Boyang Qu, Lei Huang, Jianzhong Jeff Xi, Aiwen Wu
Annals of Surgical Oncology.2025; 32(13): 9712. CrossRef
Development and validation of a nomogram to predict overall survival in patients with incidental gallbladder cancer: A retrospective cohort study
Zhi-Hua Xie, Xuebing Shi, Ming-Qi Liu, Jinghan Wang, Yong Yu, Ji-Xiang Zhang, Kai-Jian Chu, Wei Li, Rui-Liang Ge, Qing-Bao Cheng, Xiao-Qing Jiang
Frontiers in Oncology.2023;[Epub] CrossRef
Effect of Intraperitoneal Chemotherapy with Regorafenib on IL-6 and TNF-α Levels and Peritoneal Cytology: Experimental Study in Rats with Colorectal Peritoneal Carcinomatosis
Stefanos Bitsianis, Ioannis Mantzoros, Elissavet Anestiadou, Panagiotis Christidis, Christos Chatzakis, Konstantinos Zapsalis, Savvas Symeonidis, Georgios Ntampakis, Kalliopi Domvri, Anastasia Tsakona, Chryssa Bekiari, Orestis Ioannidis, Stamatios Aggelop
Journal of Clinical Medicine.2023; 12(23): 7267. CrossRef
Conventional peritoneal cytology lacks the prognostic significance of detecting local or peritoneal recurrence in colorectal cancer: An Egyptian experience
Mohamed Shalaby, Tarek S El Baradie, Mohamed Salama, Hebat A M Shaaban, Rasha M Allam, Ehab O.A. Hafiz, Mohamed Aly Abdelhamed, Amr Attia
JGH Open.2021; 5(2): 264. CrossRef
Interleukin 10 level in the peritoneal cavity is a prognostic marker for peritoneal recurrence of T4 colorectal cancer
Seung-Yong Jeong, Byeong Geon Jeon, Ji-Eun Kim, Rumi Shin, Hye Seong Ahn, Heejin Jin, Seung Chul Heo
Scientific Reports.2021;[Epub] CrossRef
Risk factors for developing peritoneal metastases after curative surgery for colorectal cancer: A systematic review and meta‐analysis
Yuanxin Zhang, Xiusen Qin, Wenle Chen, Duo Liu, Jian Luo, Huaiming Wang, Hui Wang
Colorectal Disease.2021; 23(11): 2846. CrossRef
Treatment for Peritoneal Metastasis of Patients With Colorectal Cancer
Young Jin Kim, Chang Hyun Kim
Annals of Coloproctology.2021; 37(6): 425. CrossRef
Pathophysiology of colorectal peritoneal carcinomatosis: Role of the peritoneum
Lieselotte Lemoine, Paul Sugarbaker, Kurt Van der Speeten
World Journal of Gastroenterology.2016; 22(34): 7692. CrossRef
The preoperative platelet to lymphocyte ratio is a prognostic marker in patients with stage II colorectal cancer
Tsuyoshi Ozawa, Soichiro Ishihara, Takeshi Nishikawa, Toshiaki Tanaka, Junichiro Tanaka, Tomomichi Kiyomatsu, Keisuke Hata, Kazushige Kawai, Hiroaki Nozawa, Shinsuke Kazama, Hironori Yamaguchi, Eiji Sunami, Joji Kitayama, Toshiaki Watanabe
International Journal of Colorectal Disease.2015; 30(9): 1165. CrossRef
Intraoperative Peritoneal Lavage: Limitations of Current Evidence for Clinical Implementation
Duck-Woo Kim
Annals of Coloproctology.2014; 30(6): 248. CrossRef

Reliability of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Nodal Staging of Colorectal Cancer Patients: Hee Jung Yi, Kyung Sook Hong, Nara Moon, Soon Sup Chung, Ryung-Ah Lee, Kwang Ho Kim; Ann Coloproctol. 2014;30(6):259-265. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.259

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Abstract PDF

Purpose

Lymph-node metastasis is considered as critical prognostic factor in colorectal cancer. A preoperative evaluation of lymph-node metastasis can also help to determine the range of distant lymph node dissection. However, the reliability of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of lymph-node metastasis is not fully known.

Methods

The medical records of 433 patients diagnosed with colorectal cancer were reviewed retrospectively. FDG-PET/CT and CT were performed on all patients. Lymph nodes were classified into regional and distant lymph nodes according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th edition.

Results

The patients included 231 males (53.3%) and 202 females (46.7%), with a mean age of 64.7 ± 19.0 years. For regional lymph nodes, the sensitivity of FDG-PET/CT was lower than that of CT (57.1% vs. 73.5%, P < 0.001). For distant lymph nodes, the sensitivity of FDG-PET/CT was higher than that of CT (64.7% vs. 52.9%, P = 0.012). The sensitivity of FDG-PET/CT for regional lymph nodes was higher in patients with larger primary tumors. The positivity of lymph-node metastasis for FDG-PET/CT was affected by carcinoembryonic antigen levels, tumor location, and cancer stage for regional lymph nodes and by age and cancer stage for distant lymph nodes (P < 0.05).

Conclusion

The sensitivity of FDG-PET/CT for regional lymph-node metastasis was not superior to that of CT. However, FDG-PET/CT provides helpful information for determining surgical plan especially in high risk patients group.

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Ruggeri B. Guimarães, Eduardo O. Pacheco, Serli N. Ueda, Dario A. Tiferes, Fernanda L. Mazzucato, Aley Talans, Ulysses S. Torres, Giuseppe D’Ippolito
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C. Aveline, F. Montravers
EMC - Radiologie et imagerie médicale - Abdominale - Digestive.2024; 42(1): 1. CrossRef
Can Cross-Sectional Imaging Reliably Determine Pathological Staging of Right-Sided Colon Cancers and Select Patients for More Radical Surgery or Neo-Adjuvant Treatment?
Florence Shekleton, Edward Courtney, Adrian Andreou, John Bunni
Cureus.2022;[Epub] CrossRef
Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging
Pier Paolo Mainenti, Arnaldo Stanzione, Salvatore Guarino, Valeria Romeo, Lorenzo Ugga, Federica Romano, Giovanni Storto, Simone Maurea, Arturo Brunetti
World Journal of Gastroenterology.2019; 25(35): 5233. CrossRef
Clinical evaluation of18F-fludeoxyglucose positron emission tomography/CT using point spread function reconstruction for nodal staging of colorectal cancer
Kazuya Kawashima, Kenichi Kato, Makiko Tomabechi, Mikaru Matsuo, Koki Otsuka, Kazuyuki Ishida, Ryuji Nakamura, Shigeru Ehara
The British Journal of Radiology.2016; 89(1063): 20150938. CrossRef
Short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision and central ligation
Ik Yong Kim, Bo Ra Kim, Eun Hee Choi, Young Wan Kim
International Journal of Surgery.2016; 27: 151. CrossRef
Preoperative Staging With Positron Emission Tomography in Patients With Colorectal Cancer
Young Wan Kim, Ik Yong Kim
Annals of Coloproctology.2014; 30(6): 247. CrossRef

Case Reports

TisN0M1 Sigmoid Colon Cancer: A Case Report: Kyung Ha Lee, Jin Su Kim, Kwang Sik Cheon, In Sang Song, Dae Young Kang, Ji Yeon Kim; Ann Coloproctol. 2014;30(3):141-146. Published online June 23, 2014; DOI: https://doi.org/10.3393/ac.2014.30.3.141

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Abstract PDF

Distant metastasis of a colon carcinoma in situ has not yet been reported. We experienced a case of a sigmoid colon carcinoma in situ with common hepatic lymph node metastasis. After the first operation, we diagnosed dual intramucosal adenocarcinomas of the sigmoid colon without any regional lymph node metastasis. After the second operation, a metastatic adenocarcinoma was found in the common hepatic lymph nodes. We suggest that metastasis in cases of a colonic carcinoma in situ is rare, but possible. The parallel progression model of tumors can explain this early metastasis.

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Quo Vadis colorectal intramucosal adenocarcinoma?
Vikram Deshpande, Adrian C Bateman, Munita Bal, Runjan Chetty, Maurice B Loughrey, Jinru Shia, Michael Vieth, Monika Vyas, Yoh Zen
Journal of Clinical Pathology.2026; 79(5): 291. CrossRef
Lymph node metastasis in a patient with carcinoma in situ rectal cancer: A case report
San-Ha Kim, Gi-Bong Chae, Seung-Koo Lee, Seung-Joo Nam
Molecular and Clinical Oncology.2025; 23(4): 1. CrossRef
Potential for Metastasis and Recurrence in Colorectal Carcinoma In Situ: A Retrospective Analysis of 1069 Patients
Seijong Kim, Jung Kyong Shin, Yoonah Park, Jung Wook Huh, Hee Cheol Kim, Seong Hyeon Yun, Woo Yong Lee, Yong Beom Cho
Clinical Colorectal Cancer.2024; 23(3): 245. CrossRef
Rectal intramucosal carcinoma with lymph node metastasis and tumor deposit
Wenhao Chen, Liang Kang, Yan Huang, Zhao Ding
Asian Journal of Surgery.2022; 45(9): 1719. CrossRef
Presacral lymph node recurrence of rectal intramucosal adenocarcinoma after endoscopic mucosal resection: a case report
Taichi Horino, Yukiharu Hiyoshi, Yuji Miyamoto, Naoya Yoshida, Hideo Baba
Surgical Case Reports.2020;[Epub] CrossRef
Recurrence, death risk, and related factors in patients with stage 0 colorectal cancer
Ming-Hao Hsieh, Pei-Tseng Kung, Wen-Yin Kuo, Tao-Wei Ke, Wen-Chen Tsai
Medicine.2020; 99(36): e21688. CrossRef
Recurrence rate of lateral margin-positive cases after en bloc endoscopic submucosal dissection of colorectal neoplasia
Seohyun Lee, Jihun Kim, Jae Seung Soh, Jungho Bae, Sung Wook Hwang, Sang Hyoung Park, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Dong-Hoon Yang
International Journal of Colorectal Disease.2018; 33(6): 735. CrossRef
Unusual Local Recurrence with Distant Metastasis after Successful Endoscopic Submucosal Dissection for Colorectal Mucosal Cancer
Hyo Jeong Lee, Byong Duk Ye, Jeong-Sik Byeon, Jihun Kim, Young Soo Park, Yong Sang Hong, Yong Sik Yoon, Dong-Hoon Yang
Clinical Endoscopy.2017; 50(1): 91. CrossRef
Lymph node pooling: a feasible and efficient method of lymph node molecular staging in colorectal carcinoma
Natalia Rakislova, Carla Montironi, Iban Aldecoa, Eva Fernandez, Josep Antoni Bombi, Mireya Jimeno, Francesc Balaguer, Maria Pellise, Antoni Castells, Miriam Cuatrecasas
Journal of Translational Medicine.2017;[Epub] CrossRef
Inter- and intra-tumor profiling of multi-regional colon cancer and metastasis
Akihiro Kogita, Yasumasa Yoshioka, Kazuko Sakai, Yosuke Togashi, Shunsuke Sogabe, Takuya Nakai, Kiyotaka Okuno, Kazuto Nishio
Biochemical and Biophysical Research Communications.2015; 458(1): 52. CrossRef

Unusual Case of Solitary Perineal Subcutaneous Metastasis From Sigmoid Colon Cancer: Taek-Gu Lee, Sang-Jeon Lee; Ann Coloproctol. 2013;29(1):34-37. Published online February 28, 2013; DOI: https://doi.org/10.3393/ac.2013.29.1.34

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Abstract PDF

Subcutaneous metastasis from colorectal cancer is an unusual presentation. Most perineal subcutaneous metastases are found in extensive involvements of multiorgan metastases or local recurrences of rectal cancer. Subcutaneous metastasis from colon cancer is considered as a distant metastasis with poor prognosis. We report an unusual case of solitary subcutaneous metastasis beneath the perineum without solid organ involvement after a curative anterior resection for sigmoid colon cancer. The patient underwent a perineal resection, and chemotherapy with the FOLFOX (fluorouracil, leucovorin, and oxaliplatin) regimen was instituted. Eight months later, multiple lung metastases were found, and chemotherapy was restarted with the FOLFIRI (fluorouracil, leucovorin, and irinotecan) regimen. However, lung metastases progressed, and new metastases appeared at the adrenal glands, the kidneys and the cerebellum. The patient died 30 months after the diagnosis of perineal subcutaneous metastasis. He lived relatively long in comparison with patients in previous reports.

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Solitary Gluteal Subcutaneous Metastasis after Curative Resection of Cecal Cancer: A Rare Presentation Preceding Systemic Metastasis
Shusaku Hiyama, Ken Imaizumi, Nobuki Ichikawa, Tadashi Yoshida, Yosuke Ohno, Kengo Shibata, Shunji Sano, Honori Okubo, Zenichi Tanei, Shinya Tanaka, Akinobu Taketomi
Surgical Case Reports.2026; 12(1): n/a. CrossRef
Cutaneous metastasis as the first sign of colorectal cancer: a case report
Gyuyeong Kim, Jaeil Chung, Donghui Kim, Kyoohyun Park, Haegwang Shin, Hongsik Lee, Wonjai Hur, Yoosuk Suh
Kosin Medical Journal.2026; 41(2): 164. CrossRef
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T.S. Belysheva, E.E. Zelenova, D.I. Sofronov, G.A. Radjabova, Ya.V. Vishnevskaya, T.T. Valiev
Russian Journal of Clinical Dermatology and Venereology.2024; 23(6): 673. CrossRef
Cutaneous metastasis of rectal adenocarcinoma: a case report and literature review
Vesa Alexandra Alina, Octavian Maghiar, Laura Maghiar, Romina Cuc, Ovidiu Pop, Andrei Pascalau, Monica Boros, Adrian Maghiar
Polish Journal of Pathology.2023; 74(3): 211. CrossRef
Cutaneous metastasis of ascending colon cancer harboring a BRAF V600E mutation
Lianggong Liao, Qian Cheng, Guangsheng Zhu, Feng Pei, Shengwei Ye
Medicine.2020; 99(21): e20026. CrossRef
Late isolated subcutaneous metastasis from colon cancer
Fabio Carboni, Ferdinando Marandino, Mario Valle
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Original Articles

Correlation between Liver Metastases and the Level of PRL-3 mRNA Expression in Patients with Primary Colorectal Cancer: Nam Won Kim, Chong Woo Chu, Tae Sung Ahn, Chang Jin Kim, Dong Jun Jung, Myoung Won Son, Sang Ho Bae, Moon Soo Lee, Chang Ho Kim, Moo Jun Baek; J Korean Soc Coloproctol. 2011;27(5):231-236. Published online October 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.5.231

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Abstract PDF

Purpose

Phosphatase of regenerating liver-3 (PRL-3) has been associated with metastasis promotion. However, clinical applications of this association have not yet been clearly demonstrated. In this study, we evaluated the relation of PRL-3 mRNA level in primary colorectal cancer to the corresponding stage and to other clinicopathologic factors.

Methods

Two hundred forty-five patients with histologically-proven colorectal cancer underwent surgery between January 2004 and December 2006. RNA was extracted and cDNA was prepared by using reverse transcription. Quantification of PRL-3 was done using a real-time polymerase chain reaction.

Results

Eighty-six cases with well-preserved specimens were enrolled: 53 males and 33 females. The mean age was 63.4 years. According to tumour node metastasis (TNM) stage of the American Joint Committee on Cancer (AJCC), stage I was 11 cases, stage II was 38 cases, stage III was 23 cases, and stage IV was 14 cases. Among stage IV cases, one case was combined with liver and lung metastases, and one case was combined with liver metastases and peritoneal dissemination. The remaining stage IV patients were combined with only liver metastases. There was a significant correlation in PRL-3 mRNA expression between primary colorectal cancer and corresponding tumor stage. PRL-3 mRNA expression was increased in the liver metastases cases. Lymphatic and vascular invasion were significantly related with PRL-3 mRNA levels.

Conclusion

Advanced stage prediction may be obtained by measuring the level of PRL-3 mRNA expression in primary colorectal cancer. Especially, the risk of liver metastases may be predicted by measuring the level of PRL-3 mRNA expression in primary colorectal cancer. Further study is required to confirm these preliminary results.

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PRL-3 as a metastasis-associated phosphatase in colorectal cancer: Mechanisms and therapeutic strategies
Sarah J. Greenstein, Charmaine A. Ramlogan-Steel, Ingrid A. Wise, Rebecca J. Wilson, Jason C. Steel
Clinical & Experimental Metastasis.2025;[Epub] CrossRef
Colorectal liver metastasis: molecular mechanism and interventional therapy
Hui Zhou, Zhongtao Liu, Yongxiang Wang, Xiaoyong Wen, Eric H. Amador, Liqin Yuan, Xin Ran, Li Xiong, Yuping Ran, Wei Chen, Yu Wen
Signal Transduction and Targeted Therapy.2022;[Epub] CrossRef
A retrospective cohort study of clinical value of PRL-3 in stage III human colorectal cancer
Chuanyuan Liu, Wu Zhong, Laiyang Xia, Chuanfa Fang, Hongquan Liu, Xiaochun Liu
Medicine.2021; 100(17): e25658. CrossRef
Physiological and oncogenic roles of thePRLphosphatases
Serge Hardy, Elie Kostantin, Teri Hatzihristidis, Yevgen Zolotarov, Noriko Uetani, Michel L. Tremblay
The FEBS Journal.2018; 285(21): 3886. CrossRef
Biomarkers for predicting future metastasis of human gastrointestinal tumors
Lui Ng, Ronnie Tung Ping Poon, Roberta Pang
Cellular and Molecular Life Sciences.2013; 70(19): 3631. CrossRef
Src-Mediated Phosphorylation of the Tyrosine Phosphatase PRL-3 Is Required for PRL-3 Promotion of Rho Activation, Motility and Invasion
James J. Fiordalisi, Brian J. Dewar, Lee M. Graves, James P. Madigan, Adrienne D. Cox, Jung Weon Lee
PLoS ONE.2013; 8(5): e64309. CrossRef

Clinical Characteristics of Colorectal Carcinoid Tumors: J Korean Soc Coloproctol. 2011;27(1):17-20. Published online February 28, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.1.17

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Abstract PDF

Purpose

The carcinoid tumor was recently categorized as a malignant disease due to its possibility of metastasis. This study was aimed to investigate the clinical characteristics and the metastatic rate of colorectal carcinoid tumors.

Methods

Charts were reviewed for 502 patients diagnosed with and treated for colorectal carcinoid tumors between January 2006 and December 2009. The location, size, depth and metastatic status of the tumors were collected.

Results

Including 24 synchronous tumors from 12 patients, 514 carcinoid tumors were removed. Most of them were found in the rectum (97.3%). The male-to-female ratio was 1.38 to 1, and mean age was 50.2 ± 11.4 years. The mean tumor size was 5.8 ± 3.6 mm. Less than 10-mm-sized tumors had a 1.95% lymph node metastatic rate; tumors with sizes from 10 mm to 20 mm and larger than 20 mm had 23.5% and 50% lymph node metastatic rates, respectively. Two cases had distant metastasis; one with a 22-mm-sized tumor metastasized to the liver, and the other with a 20-mm-sized tumor metastasized to the peritoneum. Among 414 patients who completed metastatic studies, 93.8% were classified as stage I, 0.9% as stage II, 4.8% as stage III and 0.5% as stage IV.

Conclusion

Colorectal carcinoid tumors smaller than 10 mm have a low rate of lymph node metastasis, but those sized 10 mm or larger incur significant risk. Further investigation regarding additional risk factors should be done to develop proper treatment guidelines for these tumors.

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O. Radulova-Mauersberger, S. Stelzner, H. Witzigmannn
Der Chirurg.2016; 87(4): 292. CrossRef
Hindgut Neuroendocrine Neoplasia
James D. Smith, Govind Nandakumar
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Rectal carcinoids: a systematic review
Frank D. McDermott, Anna Heeney, Danielle Courtney, Helen Mohan, Des Winter
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Clinicopathological analysis of colorectal carcinoid tumors and patient outcomes
Hung-Hsin Lin, Jen-Kou Lin, Jeng-Kai Jiang, Chun-Chi Lin, Yuan-Tzu Lan, Shung-Haur Yang, Huann-Sheng Wang, Wei-Shone Chen, Tzu-Chen Lin, Wen-Yih Liang, Shih-Ching Chang
World Journal of Surgical Oncology.2014;[Epub] CrossRef
Endoscopic submucosal dissection for colorectal tumors—1,000 colorectal ESD cases: one specialized institute’s experiences
Eun-Jung Lee, Jae Bum Lee, Suk Hee Lee, Do Sun Kim, Doo Han Lee, Doo Seok Lee, Eui Gon Youk
Surgical Endoscopy.2013; 27(1): 31. CrossRef
Factors Associated with Lymph Node Metastasis in Radically Resected Rectal Carcinoids: a Systematic Review and Meta-analysis
Xin Zhou, Haiting Xie, Lingduo Xie, Jing Li, Wei Fu
Journal of Gastrointestinal Surgery.2013; 17(9): 1689. CrossRef
Variable Clinical Classifications and Diagnostic Coding Systems of Colorectal Neuroendocrine Tumor
Byung Chang Kim, Cheol Hee Park, Tae Il Kim, Suck-Ho Lee, Jin-Oh Kim, Hyun Soo Kim, Dong-Hoon Yang, Bora Keum, Sung Pil Hong, Seong-Eun Kim, Hyun Gun Kim, Jeong Eun Shin, Jae Myung Cha, Young Eun Joo, Dong Il Park, Hwang Choi, Kyu Chan Huh, Seung-Jae Myun
Intestinal Research.2013; 11(1): 14. CrossRef

Clinical Usefulness of Preoperative and Postoperative Chest Computed Tomography for Colorectal Cancer: Jeong Hui Lee, Byung Kyu Ahn, Young Soo Nam, Kang Hong Lee; J Korean Soc Coloproctol. 2010;26(5):359-364. Published online October 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.5.359

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Abstract PDF

Purpose

This research sought to identify the utility value of chest computed tomography (CT) when it comes to the diagnosis of lung metastasis in cases of colorectal cancer.

Methods

From September 2004 to January 2008, 266 patients who were treated for colorectal cancer at Department of Surgery, Hanyang University College of Medicine, were divided into two groups: one that underwent preoperative and postoperative periodical chest CT (periodical inspection group, PIG; May 2006 to January 2008, 135 patients) and one that did not undergo periodical chest CT (non-periodical inspection group, NPIG; September 2004 to April 2006, 131 patients) for comparison.

Results

The overall lung metastasis diagnosis rates did not manifest any significant difference. The times to diagnose lung metastasis patients were 6.3 months and 15.7 months for the PIG and the NPIG, respectively (P = 0.022). The size of the metastatic lung nodule was smaller in the PIG than in the NPIG (< 1 cm in 9/9 patients vs. < 1 cm in 6/9 patients in the PIG and the NPIG, respectively; P = 0.02). A solitary lung metastasis was more frequently found in the PIG (5/9 patients) than in the NPIG (1/11 patients) (P = 0.024). During the follow-up period, 100% (2/2 patients) and 60% (3/5 patients) of the patients in the PIG and the NPIG, respectively, with stage III cancer underwent a lung metastasectomy (P = 0.002).

Conclusion

Chest CT enables early diagnosis with a smaller size and a lower number of lung metastases in patients with colorectal cancer. Moreover, pulmonary the rate of the pulmonary resection for selected patients may be improved. However, the contribution of chest CT to increasing the survival rate must be investigated in a prospective randomized study.

Citations

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Development and validation of an artificial intelligence prediction model and a survival risk stratification for lung metastasis in colorectal cancer from highly imbalanced data: A multicenter retrospective study
Weiyuan Zhang, Xu Guan, Shuai Jiao, Guiyu Wang, Xishan Wang
European Journal of Surgical Oncology.2023; 49(12): 107107. CrossRef
CT Morphological Features Integrated With Whole-Lesion Histogram Parameters to Predict Lung Metastasis for Colorectal Cancer Patients With Pulmonary Nodules
TingDan Hu, ShengPing Wang, Xiangyu E, Ye Yuan, Lv Huang, JiaZhou Wang, DeBing Shi, Yuan Li, WeiJun Peng, Tong Tong
Frontiers in Oncology.2019;[Epub] CrossRef

Surgical Resection for Lung Metastases from Colorectal Cancer: Hyung Jin Kim, Bong-Hyeon Kye, Jae Im Lee, Sang Chul Lee, Yoon Suk Lee, In Kyu Lee, Won Kyung Kang, Hyeon-Min Cho, Seok Whan Moon, Seong Taek Oh; J Korean Soc Coloproctol. 2010;26(5):354-358. Published online October 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.5.354

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Abstract PDF

Purpose

The lung is the second most common site of metastasis from colorectal cancer. Of all patients who undergo a curative resection for colorectal cancer, 10% to 15% will develop lung metastasis. As a hepatic resection of colorectal liver metastases results in improved survival, many reports have suggested that a pulmonary resection of a colorectal lung metastasis would also improve survival. The aim of this study was to analyze the postoperative outcomes of and the prognostic factors for a surgical resection of a lung metastasis.

Methods

Between August 1997 and March 2006, 27 patients underwent surgical resections for colorectal lung metastases at Seoul St. Mary's hospital. A retrospective review of patients' characteristics and various tumor factors was performed.

Results

The mean interval between colorectal resection and lung metastasis was 24.0 ± 15.1 months. The overall 3- and 5-year survival rates were 76.5% and 22.2%, respectively. The mean follow-up after pulmonary resection was 39.5 ± 21.6 months (range, 3.3 to 115 months). Except for the existence of hilar-lymph-node metastasis (P < 0.001), no risk factors that we studied were statistically significant. Two patients had hilar-lymph-node metastasis. They survived for only for 3.3- and 11.6-months, respectively.

Conclusion

In our study, we found that a pulmonary resection for metastases from colorectal cancer may improve survival in selected patients.

Citations

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Prognostic factors of para-aortic lymph node metastasis from colorectal cancer in highly selected patients undergoing para-aortic lymph node dissection
Shin Emoto, Yosuke Fukunaga, Manabu Takamatsu, Hiroshi Kawachi, Shuhei Sano, Tetsuro Tominaga, Toshiki Mukai, Tomohiro Yamaguchi, Toshiya Nagasaki, Takashi Akiyoshi, Tsuyoshi Konishi, Satoshi Nagayama, Masashi Ueno
Surgery Today.2024; 54(4): 356. CrossRef
The Determinants of Long-Term Outcomes After Colorectal Cancer Surgery: A Literature Review
Olorungbami K Anifalaje, Charles Ojo, Oluwaseyi T Balogun, Fikayo A Ayodele, Abeeb Azeez, Shirley Gabriels
Cureus.2024;[Epub] CrossRef
Distant Lung Recurrence of Rectal Cancer 20 Years After Primary Surgery
Sreekanthan Gobishangar, Sivakumaran Gobinath, Antony J Thanenthiran, Subramaniyam Bakeerathan
Cureus.2023;[Epub] CrossRef
Pulmonary metastasectomy with lymphadenectomy for colorectal pulmonary metastases: A systematic review
Martijn van Dorp, Jelle Egbert Bousema, Bart Torensma, Christian Dickhoff, Frank Jozef Christiaan van den Broek, Wilhelmina Hendrika Schreurs, Michel Gonzalez, Geert Kazemier, David Jonathan Heineman
European Journal of Surgical Oncology.2022; 48(1): 253. CrossRef
Safety and efficacy of combined resection of colorectal peritoneal and liver metastases
Stephanie Downs-Canner, Yongli Shuai, Lekshmi Ramalingam, James F. Pingpank, Matthew P. Holtzman, Herbert J. Zeh, David L. Bartlett, Haroon A. Choudry
Journal of Surgical Research.2017; 219: 194. CrossRef
CT-guided percutaneous laser ablation of metastatic lung cancer: three cases report and literature review
Qiyu Zhao, Guo Tian, Fen Chen, Liyun Zhong, Tian’an Jiang
Oncotarget.2017; 8(2): 2187. CrossRef
Simultaneous Laparoscopic Resection for Synchronous Pulmonary Metastases of Colorectal Cancers
Byung-Kwon Ahn
Gastroenterology & Hepatology: Open Access.2016;[Epub] CrossRef

Significance of Follow-up in Detection of Pulmonary Metastasis of Colorectal Cancer: Jae Won Shin, Sun Il Lee, Hong Young Moon; J Korean Soc Coloproctol. 2010;26(4):293-297. Published online August 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.4.293

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Abstract PDF

Purpose

This study was performed to evaluate the effectiveness of conventional chest radiography, carcinoembrionic antigen (CEA) level and abdominal computed tomography (CT) or chest CT for early detection of pulmonary metastasis after a curative resection of colorectal cancer.

Methods

We retrospectively reviewed 84 cases of pulmonary metastasis from a group of colorectal cancer patients who had a curative surgical resection from 2000 to 2006 at the Korea University Medical Center.

Results

Stage I tumors were detected in 4 patients, stage II tumors in 18, stage III tumors in 43 and stage IV tumors in 19. The detection rates for pulmonary metastasis were 28.5% by conventional chest radiography, 40.5% by increased CEA level and 28.5% by abdominal CT or chest CT. Among them, fourteen patients underwent a radical pneumonectomy. After detection of pulmonary metastasis, the survival outcome for the patients who underwent a resection of the lung was superior to the survival outcome of the patients who did not undergo a resection of the lung (43.7 months vs. 17.4 months, P = 0.001). For patients who underwent resections of the lung, pulmonary metastasis was detected by conventional chest radiography in 2 (14%) patients, by elevated CEA level in 6 (42%) patients, and by abdominal CT or chest CT in 6 (42%) patients.

Conclusion

Conventional chest radiography is no more useful in detecting early pulmonary metastasis after a curative colorectal surgery than a routine chest CT. Thus, we propose the use of routine chest CT for screening for lung metastasis.

Citations

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Differentiating second primary lung cancer from pulmonary metastasis in patients of single solitary pulmonary lesion with extrapulmonary tumor using multiparametric analysis of FDG PET/CT
Honghong Liu, Xiaolin Meng, Guanyun Wang, Shulin Yao, Yanmei Wang, Ruimin Wang, Tao Wang
Annals of Nuclear Medicine.2025; 39(6): 567. CrossRef
A novel diagnostic model for differentiation of lung metastasis from primary lung cancer in patients with colorectal cancer
Rui Guo, Shi Yan, Fei Wang, Hua Su, Qing Xie, Wei Zhao, Zhi Yang, Nan Li, Jiangyuan Yu
Frontiers in Oncology.2022;[Epub] CrossRef
Simultaneous laparoscopic colorectal resection and pulmonary resection by minithoracotomy: Report of four cases
Tetsuo Tsukahara, Seiichiro Yamamoto, Taihei Oshiro, Shin Fujita, Hiroyuki Sakurai, Shun‐ichi Watanabe
Asian Journal of Endoscopic Surgery.2014; 7(2): 160. CrossRef
Clinical Characteristics of Patients With Solitary Pulmonary Mass After Radical Treatment for Primary Cancers: Pulmonary Metastasis or Second Primary Lung Cancer?
Jun Ge, Hong-Feng Gou, Ye Chen, Ke Cheng, Long-Hao Li, Hang Dong, Feng Gao, Feng Zhao, Hai-Tao Men, Qiu Li, Meng Qiu, Jing-Mei Su, Feng Xu, Feng Bi, Ji-Yan Liu
Cancer Investigation.2013; 31(6): 397. CrossRef

Prognostic Analysis According to N Stage and Circumferential Resection Margin in Patients with Locally Advanced Rectal Cancer.: Sohn, Yong Ki , Shin, Jin Yong , Hong, Kwan Hee; J Korean Soc Coloproctol. 2010;26(3):217-224.; DOI: https://doi.org/10.3393/jksc.2010.26.3.217

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Abstract PDF: PURPOSE
Efforts must be made to clarify the contribution of lymph node metastasis (NM) to adjuvant (chemo) radiotherapy following a curative resection for rectal cancer as the circumferential resection margin (CRM) has increasingly become a more reliable prognosticator for rectal cancer. This study examined the prognostic impact of NM on local recurrence, disease-free survival. and overall survival rates in curatively resected patients with locally advanced rectal cancer.
METHODS
Two hundred two patients with locally advanced rectal cancer curatively resected in Pusan Paik Hospital from January 1995 to December 2003 were enrolled. These patients were divided into three groups according to lymph node (N) disease (N0: node negative, n=79; N1: 1-3 nodes positive, n=70; N2: > or =4 nodes positive, n=53). The potential prognostic factors, for example, T and N stage, preoperative carcinoembryonic antigen (CEA), postoperative (chemo) radiotherapy, operative methods, and several pathologic variables, were assessed among the three groups. The potential clinicopathologic factors were analyzed by using the Kaplan-Meier method, and the prognostic factors were compared in a Cox regression model. Also, we compared the oncologic results of 26 patients with a positive CRM (CMI) with those of the N1 and the N2 subgroups.
RESULTS
N2 patients had an impaired 5-yr local control rate (19.1%) compared with N0 (6.8%) and N1 (11.6%, P=0.029) patients after a median follow up of 60 months (range, 6 to 156 mo). Differences in disease-free and overall survival were also significantly different statistically among the three groups (84.0% and 85.2% for N0; 54.9% and 65.1% for N1; 37.3% and 49.8% for N2; P<0.001 both). The impact of NM on the local recurrence, disease-free survival and overall survival was confirmed in the regression model for the curatively resected patients. There were no significant differences in the recurrence and the survival rates between CMI and N2 stage.
CONCLUSION
NM has an independent prognostic impact on local failure and on disease-free survival and overall survival. Based on these findings, NM should be considered as an indicatior for adjuvant therapy. Although the prognostic impact of CMI is similar to that of N2, a larger prospective study is needed to clarify the prognostic association of CMI and N2.

Outcomes of a Hepatic Resection for Colorectal-Carcinoma Liver Metastases.: Lee, Woo Koung , Kim, Sang Bum , Cho, Eung Ho , Hwang, Dae Yong , Moon, Sun Mi; J Korean Soc Coloproctol. 2010;26(3):204-210.; DOI: https://doi.org/10.3393/jksc.2010.26.3.204

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Abstract PDF

PURPOSE
Recent managements of liver metastasis from colorectal cancer consist of multi-disciplinary treatments. Although hepatic resection is the only curative treatment, for which long-term survival is expected, the recurrence rates is still high. Recently, liver resections, combined with chemotherapy and other additional therapy, have produced promising outcomes. We analyzed the outcomes of hepatic resection for liver metastasis from colorectal cancer.
METHODS
From 1993 to 2007, we performed 116 hepatic resections for the treatment of liver metastasis from colorectal cancer. All patients received adjuvant chemotherapy. We reviewed their medical records and investigated the clinico-pathologic data retrospectively.
RESULTS
One in hospital mortality occurred, and the postoperative morbidity rate was 37.5%, including major complication (11.7%). Five-yr overall survival rate and disease free survival rate were 33.2% and 25.0%, respectively. T stage and postoperative morbidity were independent prognostic factors for survival whereas metachronous metastases and postoperative morbidity were independent prognostic factors for recurrence. During the follow-up periods, 67 recurrences occurred.
CONCLUSION
Hepatic resections for liver metastasis from colorectal cancer were safe and effective. The surgical T stage, complications, and metastasis type (metachronous or synchronous) may determine the results in patients with surgically-curable liver metastasis from colorectal cancer.

Citations

Citations to this article as recorded by

Scoring of prognostic factors that influence long-term survival in patients with hepatic metastasis of colorectal cancer
Sung Woo Ahn, Ahn Soo Na, Jae Do Yang, Hong Pil Hwang, Hee Chul Yu, Baik Hwan Cho
Korean Journal of Hepato-Biliary-Pancreatic Surgery.2011; 15(3): 146. CrossRef

Review

Liver Metastases in Colorectal Cancer.: Lee, Jae Im , Oh, Seong Taek; J Korean Soc Coloproctol. 2009;25(1):63-72.; DOI: https://doi.org/10.3393/jksc.2009.25.1.63

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Abstract PDF: Liver metastases in colorectal cancer are a frequent and lethal complication. Although hepatic resection is an effective treatment for patients with liver metastases in colorectal cancer, only 10-20% of the patients with liver metastases in colorectal cancer are indicated on hepatic resection. However, over the past several decades, liver resection has evolved as a safe and potentially curative treatment for liver metastases in colorectal cancer. Currently the absolute number of patients amenable to resection is large and is growing with better imaging, better surgery, and improvements in systemic therapies to reduce the risk of both intrahepatic and extrahepatic recurrences. The development of active chemotherapy and molecular targeted therapies, together with newer modalities like radiofrequency ablation, have expanded the indications for hepatic resection and improved survival. Also, although initially unresectable, a hepatic resection of colorectal liver metastases after down-sizing by using the above mentioned treatment modalities and chemotherapy can provide a hope for long-term survival that is similar to that of primarily resectable patients. To achieve this objective, for patients with liver metastases, a multidisciplinary team approach has become mandatory, with routine re-evaluation of patients and with adequate timing for each treatment.

Case Report

Skeletal Muscle Metastasis from Colorectal Cancer: Report of a Case.: Choi, Pyong Wha , Kim, Chul Nam , Kim, Han Seong , Lee, Jung Min , Heo, Tae Gil , Park, Je Hoon , Lee, Myung Soo , Chang, Surk Hyo; J Korean Soc Coloproctol. 2008;24(6):492-496.; DOI: https://doi.org/10.3393/jksc.2008.24.6.492

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Metastases from colorectal cancer can occur by either lymphatic or hematogenous spread, and the sites most commonly involved are the liver and lung. Although skeletal muscle comprises a considerable portion of body mass and receives abundant blood supply, it is one of the most unusual sites of metastasis from any malignancies. We report a case of skeletal muscle metastasis from colorectal cancer. An 83-year-old female patient presented with a painful mass in the right posterior thigh. She had already undergone low anterior resection and right lobectomy of liver for rectal cancer with liver metastasis (T2N1M1) about 4 years ago. Although a follow-up computed tomography scan showed a metastatic solitary pulmonary nodule in the left lobe 2 years after the primary operation, she refused further aggressive treatment. Magnetic resonance imaging showed a localized mass in the semimembranosus muscle of the right thigh, and fine-needle aspiration cytology demonstrated clusters of atypical cells compatible with adenocarcinoma. The patient underwent excision of the painful mass located in the right semimembranosus muscle. Histologically, the thigh mass proved to be adenocarcinoma identical to the primary lesion. The patient died of heart failure on the 2nd postoperative day.

Citations

Citations to this article as recorded by

Skeletal muscle metastasis from colorectal adenocarcinoma: A literature review
Nikhil Kulkarni, Ahmed Khalil, Shruti Bodapati
World Journal of Gastrointestinal Surgery.2022; 14(7): 696. CrossRef
Cardiac metastasis from colorectal cancer: A case report
Pyong Wha Choi, Chul Nam Kim, Sun Hee Chang, Woo Ik Chang, Chang Young Kim, Hyun Min Choi
World Journal of Gastroenterology.2009; 15(21): 2675. CrossRef

Clinical Trial

Clinical Significance of Serum Carcinoembryonic Antigen (CEA) Level at Diagnosis of Liver Metastases in Patients with Colorectal Cancer.: Nam, Jung Su , Shin, Jin Yong , Kim, Kyoung Ha , Park, Jeong Ik , Kim, Woon Won , Choi, Chang Soo , Choi, Young Gil , Hong, Kwan Hee; J Korean Soc Coloproctol. 2008;24(6):439-446.; DOI: https://doi.org/10.3393/jksc.2008.24.6.439

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Abstract PDF

PURPOSE
In numerous clinical trials to stratify prognosis of patients with liver metastases (LM) from colorectal cancer (CRC), the clinical value of serum carcinoembryonic antigen (CEA) levels at diagnosis of LM has not been fully investigated in these group. The aim of this study is to explore the relation of CEA to characteristics of LM and to analyze prognostic value of this widely used tool.
METHODS
We retrospectively analyzed clinical data of 143 LM patients who were performed surgical intervention or non-surgical intervention. The cohort was divided into two groups; normal CEA group (NCEAG, <5 ng/ml, n=41) and elevated CEA group (ECEAG, > or =5 ng/ml, n=102). We examined correlation between serum CEA at diagnosis of LM and other clinicopathologic factors and performed univariate and multivariate analyses to determine the clinical impact of this marker on survival.
RESULTS
Compared to ECEAG, the characteristics of LM of NCEAG was associated with unilobar distribution of LM (P=0.003), less metastases (P<0.001), less rate of synchronocity (P=0.008) and more surgical intervention of hepatic deposits (P<0.001). The 5-year survival rate for NCEAG was better than ECEAG (P=0.031). Multivariate analysis revealed that the presence of lymphatic duct invasion, no performance of chemotherapy, bilobar distribution of LM, and treatment of non-surgical intervention had a significant effect on survival. CEA elevation was identified as independently associated with bilobar distribution and non-surgical intervention of LM.
CONCLUSIONS
Although CEA level is not a independent prognostic factor in this study, the clinical characteristics identified in this study and correlation to non surgical intervention of LM may help better patient selection in the management of CRC LM patients.

Citations

Citations to this article as recorded by

Prognostic value of increased postoperative carcinoembryonic antigen in patients with early intestinal anastomosis leakage who underwent right hemicolectomy surgery
Seifollah Rezaei, Naser Masoudi, Mohammad Yasin Karami, Ehsan Sobhanian, Morteza Amestejani, Ali Jafari
Polish Journal of Surgery.2022; 95(1): 24. CrossRef
Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer
Jung Wook Huh, Byung Ryul Oh, Hyeong Rok Kim, Young Jin Kim
Journal of Surgical Oncology.2010; 101(5): 396. CrossRef

Original Articles

IMA-origin Lymph Node Metastasis in Left Colon Cancer.: Lee, Jae Hoon , Jung, Sang Hun , Kim, Hyun Jin , Hwang, Jong Sung , Kim, Jae Hwang , Shim, Min Chul; J Korean Soc Coloproctol. 2008;24(5):380-385.; DOI: https://doi.org/10.3393/jksc.2008.24.5.380

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Abstract PDF: PURPOSE
Although an extended colon resection with high ligation of the inferior mesenteric artery (IMA) generally has been recommended as curative surgery for advanced left colon cancer (LCC), it shows little or no survival advantage over segmental resection with low ligation of IMA. The present study is to determine the risk factors associated with IMA-origin lymph-node (LN) metastasis and to clarify the implication of IMA-origin LN metastasis.
METHODS
We examined the clinicopathological results of 200 cases of LCC. LN dissection was performed as follows: D2 en-bloc resection of the primary tumor, IMA-origin LN dissection, and paraaortic LN dissection.
RESULTS
The incidence of IMA-origin LN metastasis of LCC was 4.5% (9 cases), and all cases involved sigmoid colon cancer. The independent risk factors of IMA-origin LN metastasis were four or more regional LN metastases (hazard ratio: 16.51, 95% confidence interval: 1.60~164.12) and a preoperative CEA level of greater than 6 ng/ml of (hazards ratio: 6.63, 95% confidence interval: 1.06~41.32). The incidence of IMA-origin LN metastasis among stage IIIC patients was 26.7%. Five of the 9 (55.6%) cases of IMA-origin LN metastasis had a concomitant paraaortic LN metastasis.
CONCLUSIONS
The incidence of IMA-origin LN metastasis among patients with LCC was low; however, IMA-origin LN metastasis should be considered as a systemic metastasis.

Clinical Characteristics of Ovarian Metastasis from Colorectal Cancer.: Yun, Chol Hee , Park, Jae Woo , Moon, Sun Mi , Hwang, Dae Young; J Korean Soc Coloproctol. 2008;24(5):367-372.; DOI: https://doi.org/10.3393/jksc.2008.24.5.367

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Abstract PDF

PURPOSE
Treatment of ovarian metastasis from colorectal cancer has been controversial, and only limited data on ovarian metastasis have been reported. We reviewed the clinical features of patients with ovarian metastasis from a colorectal carcinoma.
METHODS
From 1993 to 2002, 568 women were treated for colorectal cancer. Of those, 17 cases were diagnosed as ovarian metastasis. We reviewed the 17 cases retrospectively.
RESULTS
The incidence of ovarian metastasis was 3.0% (17/568). The number of cases involving synchronous ovarian metastasis was 7 (1.2%). Those 7 patients also had another metastasis including ovarian metastasis. Ten cases (1.8%) involved metachronous ovarian metastasis. Of those 10 patients, 8 had ovarian metastasis in combination with other organ metastasis. The median disease-free interval from the diagnosis of the primary colorectal cancer to the diagnosis of ovarian metastasis was 9.8 months, and the median survival after the diagnosis of ovarian metastasis was 17.2 months. The median survival after the diagnosis of ovarian metastasis was 23.4 months in the ovarian- metastasis-only group, compared with 10.1 months in the group with ovarian and other metastasis. The difference in survival between the two groups was statistically significant.
CONCLUSIONS
The incidence of ovarian metastasis from colorectal cancer was low. When such an event occurred, it was frequently associated with widespread disease and resulted in a poor prognosis. However, patients having only ovarian metastasis had a higher survival rate.

Citations

Citations to this article as recorded by

Clinicopathological Characteristics of Ovarian Metastasis from Colorectal Cancer
Youn Si, Jae-Im Lee, Soo-Hong Kim, Ji-Hoon Kim, Hyung Jin Kim, Yoon Suk Lee, Hyun Min Cho, Jun Gi Kim, Seung Tack Oh, In Kyu Lee
Journal of the Korean Surgical Society.2010; 79(4): 287. CrossRef

Curative Resection Following Neoadjuvant Chemotherapy Including a Molecularly Targeted Agent in Patients with Unresectable Colorectal Distant Metastases.: Kim, Jin Soo , Min, Byung Soh , Hur, Hyuk , Kim, Nam Kyu , Choi, Jin Sub , Sohn, Seung Kook , Cho, Chang Hwan , Ahn, Joong Bae , Roh, Jae Kyung; J Korean Soc Coloproctol. 2008;24(3):184-191.; DOI: https://doi.org/10.3393/jksc.2008.24.3.184

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Abstract PDF: PURPOSE
A colorectal carcinoma is the fourth most common malignancy in the world. Unfortunately, only approximately 20% of the liver metastases are resectable at the initial presentation. Neoadjuvant chemotherapy has been used for downsizing in unresectable disease. In addition, the use of newer biologic agents, such as cetuximab and bevacizumab, has much improved responses in patients with unresectable colorectal liver metastases. The aim of this study was to report on patients who had received a curative resection following neoadjuvant chemotherapy including a molecularly targeted agent for unresectable colorectal liver metastases.
METHODS
Following the neoadjuvant chemotherapy using cetuximab plus FOLFIRI (irinotecan and infused fluorouracil plus leucovorin) or bevacizumab plus FOLFOX (oxaliplatin and infused fluorouracil plus leucovorin), 10 patients with initially unresectable colorectal liver metastases underwent a curative surgical resection between September 2005 and June 2007. RESULTS: One patient underwent a right lobectomy, three patients a segmentectomy and five a wedge resection with or without radiofrequency ablation. With a median postoperative follow-up of 14 months (range, 1 to 22 months), five recurrences (50%) occurred. The common toxic effects were grade 2/3 skin toxicity (60%), grade 4 hematologic toxicity (20%), grade 3 gastrointestinal toxicity (10%), and grade 3 neurologic toxicity (10%).
CONCLUSIONS
Our preliminary data suggests that neoadjuvant chemotherapy including a molecularly targeted agent may improve resectability in patients with initially unresectable colorectal liver metastases although a high recurrence rate exists. Randomized prospective studies comparing neoadjuvant chemotherapy including a targeted agent in cases of unresectable colorectal liver metastases are warranted.

Clinical Significance of E-cadherin and beta-catenin Complex Expression in T2 Colorectal Cancer.: Kim, Jin Soo , Ko, Yong Taek , Hur, Hyuk , Min, Byung Soh , Kim, Nam Kyu , Sohn, Seung Kook , Cho, Chang Hwan , Ahn, Choong Bae , Kim, Hoguen; J Korean Soc Coloproctol. 2008;24(2):91-99.; DOI: https://doi.org/10.3393/jksc.2008.24.2.91

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Abstract PDF: PURPOSE
Expression of adhesion molecules is significantly correlated with the invasion and the metastasis of colorectal cancer. The aim of this study is to identify the importance of the expressions of E-cadherin and beta-catenin as a prognostic factor in T2 colorectal cancer. METHODS: Forty-five cases of primary T2 colorectal cancers were selected between February 1997 and February 2000. We evaluated the membranous expressions of E-cadherin and beta-catenin by using immunohistochemisty and analyzed the relationship with various clinicopathologic parameters.
RESULTS
Loss of membranous E-cadherin was significantly associated with histologic differentiation (P=0.023), vascular invasion (P<0.001), lymphatic invasion (P<0.001), and lymph-node metastases (P=0.001). Similar patterns were observed in the expression of beta-catenin. The correlation between the E-cadherin and the beta-catenin expressions was statistically significant (P<0.001). In the multivariate analysis, neither the loss of expression of E-cadherin nor beta-catenin is a risk factor affecting lymph-node metastasis in T2 colorectal cancers. However, there were significant differences in the 5-year disease-free survival rates between the positive (+/-, +) and the negative (-) expression groups of E-cadherin and beta-catenin (P=0.015, 0.03). CONCLUSIONS: This study suggests that loss of membranous expression of E-cadherin and beta-catenin molecules correlates with poor prognostic factors and indicates invasion and metastasis in T2 colorectal cancer, which, therefore, might be predictive of short survival in these patients.

Case Report

Colon Obstruction due to Colonic Metastasis of a Breast Carcinoma.: Kim, Do Hyoung , Lee, In Kyu , Oh, Chang Hyun , Lee, Yoon Suk , Park, Jong Kyung , Park, Woo Chan , Jeon, Hae Myung , Byun, Jae Ho , Park, Gyeoung Sin , Chang, Suk Kyun; J Korean Soc Coloproctol. 2008;24(2):144-147.; DOI: https://doi.org/10.3393/jksc.2008.24.2.144

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Abstract PDF: Breast cancer is a common malignancy in women and metastasizes to the liver, the lung, the brain, and the bone, but metastasis to the colon is rare. We describe a 58-year-old woman with colon metastasis of breast cancer. She was diagnosed with right colon cancer, and during investigation for colon cancer, we found a breast cancer. She received a palliative right hemicolectomy due to obstruction before chemotherapy. The histology of the tissue taken from the right colon was shown to be the same as that of the left breast mass. This is a case of colonic metastasis from breast cancer and we report this case with a review of literature.

Original Articles

PRL-3 Expression in Primary Colorectal Cancer.: Lee, Hee Jae , Chu, Chong Woo , Baek, Moo Jun , Shin, Eung Jin , Kim, Hyung Chul , Cho, Gyu Seok , Song, Ok Pyung , Kim, Hee Kyung , Park, Hyo Jin; J Korean Soc Coloproctol. 2007;23(6):497-502.; DOI: https://doi.org/10.3393/jksc.2007.23.6.497

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Abstract PDF

PURPOSE
Overexpression of the protein tyrosine phosphatase (PRL-3) is elevated in liver metastases derived from colorectal cancer. We examined PRL-3 expression in the primary lesion of colorectal cancer patients and investigated its relation to clinicopathological features.
METHODS
A total of 63 randomly selected patients who underwent surgical resection for colorectal cancer between May 2001 and June 2005 at our hospital were investigated. Formalin-fixed and paraffin-embedded specimens from colorectal cancer patients who underwent surgical resections for primary tumors were collected. The expression of PRL-3 was detected by immunohistochemistry and the relation with age, sex, primary tumor size, tumor cell differentiation, depth of invasion, microscopic lymph node metastases, vascular invasion, numbers of lymph node metastases, postoperative stage, and postoperative survival time were analyzed.
RESULTS
A total of 16 of the 63 colorectal cancer patients were detected with liver metastases during the follow-up periods. Liver resection was performed for those liver metastases patients. Five patients developed lung metastases after liver resection. PRL-3 expression was detected in 46 colorectal cancer patients. Fourteen patients with lymphatic invasion had positive expression of PRL-3 that was significant (P=0.042). The incidence of PRL-3 expression in the T stage was significant (P=0.019). Moreover, PRL-3 expression was closely associated with liver metastases (P=0.048).
CONCLUSIONS
These results indicate that an investigation of PRL-3 expression in primary colorectal cancer lesions may contribute to the detection of occult liver metastases and to a differentiation between postoperative management strategies.

Citations

Citations to this article as recorded by

Correlation between Liver Metastases and the Level of PRL-3 mRNA Expression in Patients with Primary Colorectal Cancer
Nam Won Kim, Chong Woo Chu, Tae Sung Ahn, Chang Jin Kim, Dong Jun Jung, Myoung Won Son, Sang Ho Bae, Moon Soo Lee, Chang Ho Kim, Moo Jun Baek
Journal of the Korean Society of Coloproctology.2011; 27(5): 231. CrossRef
Krukenberg Tumor Confirmed by Surgery during the Follow-up after a Primary Resection of Colorectal Cancer
Won-Ho Choi, Si-Youl Jun
Journal of the Korean Society of Coloproctology.2008; 24(4): 273. CrossRef

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

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

Case Report

Sigmoid Colon Cancer with Metastasis to the Right Spermatic Cord.: Kim, Hyung Jin , Moon, Eun Jung , Kang, Won Kyung , Hong, Seong Hu , Jung, Chan Kwon , Oh, Seong Taek; J Korean Soc Coloproctol. 2007;23(3):203-205.; DOI: https://doi.org/10.3393/jksc.2007.23.3.203

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2 Citations

Abstract PDF

Metastatic tumors involving the spermatic cord are very rare, and the prognosis for such patients is poor. The primary tumors that are frequently metastatic to the spermatic cord are gastric and colon carcinomas. We report a case of a 35-year-old male with a metastatic spermatic cord tumor following a palliative anterior resection for sigmoid colon cancer with peritoneal seeding. The patient complained of a tender mass in a right inguinal lesion. A right orchiectomy was performed, and the pathologic finding was a poorly differentiated adenocarcinoma similar to that of the sigmoid colon cancer.

Citations

Citations to this article as recorded by

Metastatic Spermatic Cord Tumor From Colorectal Cancer
Ji Geon Jang, Hye Yun Jeong, Ki Soo Kim, Mi Jung Park, Jin Sook Lee, Sang Su Kim, Ho Young Kim
Annals of Coloproctology.2015; 31(5): 202. CrossRef
Skeletal Muscle Metastasis from Colorectal Cancer: Report of a Case
Pyong Wha Choi, Chul Nam Kim, Han Seong Kim, Jung Min Lee, Tae Gil Heo, Je Hoon Park, Myung Soo Lee, Surk Hyo Chang
Journal of the Korean Society of Coloproctology.2008; 24(6): 492. CrossRef

Original Articles

Differential Expressions of Genes in Colorectal Cancer with Liver Metastasis by using a cDNA Microarray Chip: A Pilot Study.: Kim, Jae O , Choi, Gyu Seog , Kim, Sang Geol , Chang, Eun Jung , Kim, Woo Ri , Lee, In Taek , Jun, Soo Han , Kim, Mun Kyu , Kim, Jeong Chul; J Korean Soc Coloproctol. 2007;23(2):116-128.; DOI: https://doi.org/10.3393/jksc.2007.23.2.116

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Abstract PDF: PURPOSE
Liver metastasis is the most common type of failure in the treatment of colorectal cancer. The identification of differential expressions of genes in colorectal cancer and liver metastasis is important to differentiate the genetic mechanism of carcinogenesis and liver metastasis from that of a normal mucosa. The aim of this study is to find candidate genes playing roles in liver metastasis of colorectal cancer by using cDNA microarray.
METHODS
We screened a group of genes differentially expressed in a normal mucosa and in cancer and liver metastasis by using a 4.7 K cDNA microarray chip in 8 patients with far advanced colorectal cancer from Jan 2003 to May 2004 at Kyungpook National University Hospital.
RESULTS
A comparison of mRNA expressions of genes in normal mucosa vs. cancer, normal mucosa vs. liver metastasis, and cancer vs. liver metastasis, 76 and 27 known and unknown genes were significantly over-expressed in cancer and liver metastasis, respectively. Also 62 and 26 genes were down- regulated in cancer and liver metastasis. Among those genes, TIMP-1, SRY-box9, Rattus norvegicus fibronectin 1, mitotic check point regulator, etc. were constantly up- regulated in cancer or metastasis, and hsgk, etc. were down-regulated in cancer or liver metastasis. CONSLUSIONS: The cDNA microarray chip technique could be a useful for robust screening of candidate genes involved in carcinogenesis or metastasis of colorectal cancer.

Intraoperative Detection of Liver Metastasis after Preoperative Radiotherapy in Rectal Cancer.: Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2002;18(6):415-418.

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Abstract PDF: PURPOSE
Preoperatvie radiotherapy has many theoretical advantages in contrast to postoperative one such as preventing dissemination of cancer cells during surgery and increasing resectability rate by down-staging, thus more feasibility of preserving anus and improving survival. But there are several adverse effects, too. Distant metastasis can be detected after preoperative radiotherapy. Postoperative complication rate is high. Pathologic stage is changed after preoperative radiationtherapy so that there is difficulty in prediction of prognosis. We reviewed distant metastasis after preoperative radiotherapy and evaluated detection rate of metastasis with computed tomography in rectal cancer.
METHODS
Fifty patients with histologically proven rectal cancer and locally advanced lesions, as determined by physical examination and with no distant metastasis on preoperative computed tomography, entered the trial from 1990 to 1999. Surgery followed 2 to 6 weeks after completion of hyperthermia-chemoradiotherapy (HTCRT). Preoperative stages were determined with computed tomography. Postoperatve stage were determined by pathologic study.
RESULTS
Thirty cases were male. Twenty cases were female. Distance from anal verge to tumor were under 7 cm of 36 cases, over of 14 cases. The median tumor size was 3.3 cm in diameter. The conservation rate of anal sphincter function were 48.0%. In preoperative staging with computed tomography, the number of stage I, II, and III were 4, 11 and 35 cases. none were stage IV. The overall resectability rate was 90.0% (45 of 50 patients). In postoperative staging with pathologic study, the number of stage 0, I, II, and III were 4, 5, 19, and 13 cases. stage IV were 9 cases. Anastomotic leakage were noticed in 2 cases. In stage IV cases, liver metastases were noticed in all cases.
CONCLUSIONS
The preoperative radiotherapy was applied to the 50 patients with rectal cancer. The liver metastases which were detected after preoperative radiotherapy were 9 cases. The false negative value of computed tomography for liver metastasis in rectal cancer was 18.0%. We need more sensitive study for detecting liver metastasis of rectal cancer, especially in scheduled preoperative radiotherapy.

Case Report

Sigmoid Colon Cancer with Isolated Metastasis to the Left Kidney.: Kim, Hyung Jin , Choi, Ho Joong , Kang, Won Kyung , Oh, Soon Nam , Jung, Chan Kwon , Oh, Seong Taek; J Korean Soc Coloproctol. 2006;22(5):346-349.

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Abstract PDF: We report the case of a 63-year-old female with sigmoid colon cancer and isolated metastasis to the left kidney at the time of initial diagnosis. An anterior resection of the sigmoid colon and a left nephrectomy were performed. Three cycles of adjuvant chemotherapy consisting of oxaliplatin, 5-fluorouracil, and leucovorin were given, but two months after the surgery, multiple metastases of the liver were detected on a CT scan. The patient refused further treatment and died 5 months after the discovery of an isolated metastasis. An isolated metastasis to the kidney is very rare in clinical practice. A nephrectomy for kidney metastasis has no effect on survival and quality of life, and a nephrectomy may also compromise the choice of chemotherapy agents that require renal clearance; thus, a careful evaluation of renal function is necessary before a nephrectomy. At present, kidney metastasis should be regarded as an advanced metastatic disease, and aggressive chemotherapy, including target therapy, should prolong survival and improve the quality of life. However, when a synchronous or a metachronous renal tumor is suspected, a nephrectomy should be performed for accurate diagnosis and treatment.

Original Articles

Clinical Significance of Preoperative High Serum CEA Value in Patients with Colorectal Cancer.: Kim, Keon Kug , Yu, Chang Sik , Cho, Young Kyu , Namgung, Hwan , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(5):324-329.

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Abstract PDF: PURPOSE
The preoperative s-CEA level are correlated to the extent of the tumor and distant metastasis in patients with colorectal cancer. This study was performed to analyze patterns of distant metastasis and survival rate according to the levels of preoperative s-CEA and evaluate the significance of chest CT and bone scan as methods of preoperative staging work-up in patients with high s-CEA level (>or=20 ng/ml).
METHODS
A retrospective study was performed on 1,136 colorectal cancer patients who underwent surgery in Asan medical center between 1989 and 1995. These patients were classified into 3 groups according to preoperative s-CEA level (group A: <6; group B: >or=6,<20; group C: >or=20). We scrutinized the patterns of metastasis and compared the survival rates between the groups. Another study was, then, conducted prospectively on the basis of the above results. One hundred and sixty nine patients with s-CEA level (>or=20 ng/ml) were routinely examined by chest CT and bone scan for preoperative metastatic work-up in addition to the conventional work-up. Statistical analysis was performed by chi-squared test, Kaplan-Meier and log-rank test.
RESULTS
The preoperative s-CEA level and the tumor stages were significantly correlated (P=0.009). The distant metastasis rates in group A, B, and C were 22.7% (163/719), 49.1% (115/234), 76.5% (140/183), respectively (P=0.000). Five year survival rate of each group were significantly different in far advanced stage, stage III (0.71 vs. 0.61 vs. 0.51 : P=0.002) and stage IV (0.21 vs. 0.10 vs. 0.05 : P=0.004). In stage I and II, however, we couldn't find statistical differences. Among 169 patients with s-CEA level above 20ng/ml, 52 (30.7%) had liver metastasis. Twenty three patients (13.6%) had lung metastasis. Twenty (11.8%) cases of pulmonary metastasis were found on chest CT scan and 3 cases on chest X-ray or abdominal CT scan. Only 4 (2.4%) cases, however, had bone metastasis on bone scan.
CONCLUSIONS
These results suggest that the high preoperative s-CEA level seemed to be closely correlated with distant metastasis and prognosis. A meticulous preoperative staging work-up including chest CT scan is recommended in patients with high preoperative s-CEA level.

Correlation of beta-catenin and p53 Protein Expression with Clinico-pathologic Characteristics of Colorectal Cancer.: Moon, Kil Min , Park, Young Jin , Kim, Han Seung , Park, Seung Hae , Kim, Ji Il , Kim, Ki Hong , Song, Byung Joo , Lee, Meung Soo , Kim, Chul Nam , Chang, Seok Hyo; J Korean Soc Coloproctol. 2002;18(5):311-316.

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Abstract PDF: PURPOSE
Both the beta-catenin and p53 play a crucial role in the process of colon carcinogenesis. The expression of beta-catenin and/or p53 has been reported to be associated with pathologic features of tumor and prognosis of patients. In addition, several recent studies have suggested a close biological association between p53 expression and nuclear beta-catenin level. We analyzed the pathologic variables and p53 expression according to the intra-nuclear beta-catenin expression in colon cancer to make such assumptions more clear since they are still controversial issues.
METHODS
The expressions of beta-catenin, p53 and Ki-67 protein in colon cancer were determined by immunohistochemical staining. The relationship between these protein expressions and tumor characteristics was statistically analyzed.
RESULTS
The intra-nuclear beta-catenin accumulation was not associated with any of the pathological variables including lymph node metastasis and tumor differentiation, but it was correlated with higher level of Ki-67 proliferation index (P=0.006) and negative staining of p53 (P=0.015). Positive p53 staining was significantly associated with lymph node metastasis (P=0.006), lymphatic invasion (P=0.03) and venous invasion (P=0.02).
CONCLUSION
These results support the suggestion that intra-nuclear accumulation of beta-catenin may regulate the p53 activity in colorectal cancer. In addition, positive staining of p53 may be used as a valuable prognostic indicator since it was strongly associated with lymph node metastasis, lymphatic and venous invasion.

The Risk Factors of Lymph Node Metastasis in Submucosal Invasive Colorectal Cancer.: Choi, Pyong Wha , Yu, Chang Sik , Jang, Se Jin , Kim, Mi Jung , Han, Kyong Rok , Jung, Sang Hun , Yoon, Yong Sik , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2006;22(4):264-270.

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Abstract PDF: PURPOSE
Recent studies have shown a 7~15% lymph node (LN) metastasis rate in submucosal invasive colorectal cancer (SICC). Identification of risk factors for LN metastasis is crucial in the choice of therapeutic modalities for SICC. The present study was performed to assess the possibility of LN metastasis and to determine the risk factors of LN metastasis in SICC.
METHODS
A retrospective study of 168 patients with SICC who underwent a curative resection between June 1989 and December 2004 at Asan Medical Center was conducted. The level of submucosal invasion was classified into upper third (sm1), middle third (sm2), and lower third (sm3) according to the submucosal depth of invasion. The following carcinoma-related variables were assessed: tumor size, tumor location, level of submucosal invasion, cell differentiation, lymphovascular invasion, neural invasion, and tumor cell dissociation (TCD).
RESULTS
The overall LN metastasis rate was 14.3%. According to the level of submucosal invasion, LN metastasis was seen as follows: sm1, n=4 (4.2%), sm2, n= 10 (21.3%), and sm3, n=10 (38.5%) (P=0.039). According to cell differentiation, LN metastasis was observed as follows: well-differentiated, n=4 (4.9%), moderately differentiated, n=19 (22.9%), and poorly differentiated, n=1 (25.0%) (P=0.028). Nineteen of the 66 cases (28.8%) with TCD had significantly higher risk of LN metastasis as did 5 of the 102 cases (4.9%) without TCD (P=0.045). No statistical difference was observed in the risk of LN metastasis with regard to tumor location, tumor size, neural invasion, or lymphovascular invasion.
CONCLUSIONS
Submucosal invasion, cell differentiation, and tumor cell dissociation were significant pathologic predictors of LN metastasis in SICC. As SICC has considerable risk of LN metastasis, local excision should be reserved to highly selective sm1 cancers.

Prevalence of Liver Metastasis of Colorectal Cancer According to Clinical and Histopathologic Characteristics.: Ryu, Dong Won , Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2002;18(4):246-250.

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Abstract PDF: PURPOSE
In Korea, the incidence of colorectal cancer is increasing quickly. The liver metastasis is the most common cause of death. But current diagnosis methods such as CT, MRI, USG have significant false negative rate (up to 15%) especially in micrometastasis. We designed this study to identify the predictive value of liver metastasis of known clinical and histopathologic factors.
METHODS
Retrospectively, we reviewed 248 patients who underwent resection of colorectal cancer between 1997 and 1999. Clinical and histopathologic factors of colorectal cancer with synchronous liver metastasis was compared with those without liver metastasis.
RESULTS
Twenty-nine patients had synchronous liver metastasis. In clinical factors, there was significant difference in liver metastatic rate according to tumors location, and serum carcinoembryonic antigen (CEA). The metastatic rate of right colon was 9.5%, left colon was 27.9%, rectum was 8.0% (P=0.001). The metastatic rate in cases with CEA<5.0 ng/ml was 4.3%, CEA> or =5.0 ng/ml was 18.4% (P=0.001). In histopathologic factors, there was significant difference in liver metastatic rate according to depth of tumor invasion (T-stage), extent of lymph node metastasis (N-stage), venous invasion (9.5 vs 19.3 %, P=0.043), perineural invasion (8.5 vs 19.7 %, P=0.013). The metastatic rate of T1 was 0%, T2 was 3.43%, T3 was 12.3%, T4 was 26.9% (P=0.009). The metastatic rate of N0 was 4.9%, N1 was 15.6%, N2 was 30.3% (P=0.002). But there was no significant difference according to tumor size, histologic differentiation grade, lymphatic invasion. In multi- variant analysis with significant factors, independent factor associated with liver metastasis was N-stage.
CONCLUSIONS
In colorectal cancer, tumor location, CEA, T-stage, N-stage, venous invasion, and perineural invasion of tumor cell had significant relationship with liver metastasis. The most important factor associated with liver metastasis was N-stage. This factors shoud be considered carefully in the planning treatment and follow up in colorectal cancer.

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