Annals of Coloproctology

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Original Articles

Metastasis or chemotherapy

Comparative effectiveness of bevacizumab, cetuximab, and panitumumab for improving outcomes in metastatic colorectal cancer: a propensity overlap weighting analysis: Yi-Chia Su, Chien-Chou Su, Pei-Ting Lee, Chih-Chien Wu; Ann Coloproctol. 2025;41(5):462-472. Published online October 27, 2025; DOI: https://doi.org/10.3393/ac.2025.00059.0008

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Abstract PDF Supplementary Material: Purpose
Metastatic colorectal cancer (mCRC) remains a leading cause of cancer-related mortality despite advancements in targeted therapies. Monoclonal antibody medications—namely, bevacizumab, cetuximab, and panitumumab—are widely used in combination with chemotherapy as first-line treatments for unresectable mCRC in patients harboring wild-type KRAS tumors. However, the comparative effectiveness of these treatments in improving survival outcomes has not been clearly evaluated. This study aimed to directly compare the effectiveness of these 3 targeted therapies on survival outcomes in patients with unresectable mCRC.
Methods
In this retrospective cohort study, we utilized Taiwan’s National Health Insurance Database and Taiwan Cancer Registry to identify patients newly diagnosed with mCRC who were treated with at least 6 cycles of bevacizumab, cetuximab, or panitumumab between 2011 and 2021. Propensity score overlap weighting was applied to adjust for baseline differences, and outcomes were evaluated using Cox proportional hazards models. Additionally, subgroup analyses were performed separately for left- and right-sided tumors.
Results
Among 4,849 patients, treatment with cetuximab and panitumumab was associated with improved overall survival compared to bevacizumab, particularly in patients with left-sided tumors (adjusted hazard ratio, 0.77 and 0.75, respectively). Both cetuximab and panitumumab also showed significantly higher rates of conversion surgery, with panitumumab demonstrating the strongest effect. For right-sided tumors, however, the effectiveness of all 3 agents was limited, and no significant differences were observed in overall survival.
Conclusion
Cetuximab and panitumumab were more effective than bevacizumab at improving survival outcomes and facilitating conversion surgery in left-sided mCRC. These findings highlight the importance of tumor laterality and molecular profiling in guiding therapeutic strategies.

Complications

Muscle loss phenotype predicts poor postoperative outcomes of colorectal cancer in US inpatients: a population-based analysis: Ko-Chao Lee, Sin-Ei Juang, Kuen-Lin Wu, Kung-Chuan Cheng, Ling-Chiao Song, Chien-En Tang, Hong-Hwa Chen, Kuan-Chih Chung; Ann Coloproctol. 2025;41(5):443-452. Published online October 24, 2025; DOI: https://doi.org/10.3393/ac.2025.00129.0018

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Abstract PDF Supplementary Material: Purpose
Muscle loss may lead to reduced therapy tolerance and survival. We aimed to assess whether colorectal cancer (CRC) patients with a muscle loss phenotype experience worse outcomes.
Methods
Data were extracted from the US Nationwide Inpatient Sample for hospitalized patients aged ≥20 years who underwent surgical resection for colorectal cancer (CRC) between 2005 and 2018. CRC and muscle loss phenotypes were identified using validated International Classification of Diseases (ICD) diagnosis and procedure codes. Propensity score matching was performed to balance characteristics. Regression analyses determined associations between muscle loss and in-hospital outcomes.
Results
A total of 209,171 patients were included, with a mean age of 67.9 years; 7.1% exhibited muscle loss phenotype. After matching, 60,295 patients remained in the sample. After adjustment, patients with muscle loss had significantly increased risks of postoperative complications (adjusted odds ratio [aOR], 2.99; 95% confidence interval [CI], 2.85–3.15), unfavorable discharge (aOR, 2.42; 95% CI, 2.30–2.53), prolonged length of stay (aOR, 4.34; 95% CI, 4.13–4.55), and higher total hospital costs (adjusted β, 70.86; 95% CI, 67.11–74.61) compared to patients without muscle loss. When stratified by age (≥65 years), results remained consistent. Among complications, muscle loss phenotype was most strongly associated with shock, sepsis, and respiratory failure.
Conclusion
Muscle loss phenotype among patients with CRC is strongly associated with poor postoperative outcomes, including higher complication rates, longer stays, and increased costs. These findings highlight the importance of preoperative muscle loss assessments and the necessity for targeted interventions.

Colorectal cancer

Prognostic significance of carbohydrate antigen 19-9 (CA19-9) change during immediate postoperative periods in patients with stage I–III colorectal cancer: Wooram Choi, Yongjung Park, Jeonghyun Kang; Ann Coloproctol. 2025;41(5):400-408. Published online October 23, 2025; DOI: https://doi.org/10.3393/ac.2025.00528.0075

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Abstract PDF Supplementary Material: Purpose
Although carbohydrate antigen 19-9 (CA19-9) may exhibit low sensitivity in tumor screening, its prognostic significance has been highlighted. This study assessed the significance of preoperative CA19-9 and early postoperative CA19-9 levels in patients with nonmetastatic colorectal cancer (CRC).
Methods
Patients diagnosed with stage I–III CRC between January 2004 and April 2014 were included. Preoperative CA19-9 was assessed within 2 months of operation, whereas postoperative CA19-9 was measured 4 to 7 days after operation. The optimal cutoff values for preoperative and postoperative CA19-9 were established to maximize the differences in overall survival. Patients were categorized into 3 groups based on the CA19-9 change (CA19-9 trend): group 1, low preoperative CA19-9; group 2, high preoperative and low postoperative CA19-9; and group 3, high preoperative and postoperative CA19-9. The discriminatory powers of all variables were compared using the concordance index.
Results
A total of 816 patients were included. The determined cutoff values for preoperative and postoperative CA19-9 were 18.9 and 21.4 U/mL, respectively. Subgroup dichotomization revealed associations of preoperative CA19-9, postoperative CA19-9, and CA19-9 trend with overall survival in univariable analysis. The CA19-9 trend emerged as an independent prognostic factor in the multivariable analysis (group 1 vs. group 2: hazard ratio, 1.682 [95% confidence interval (CI), 1.043–2.710], P=0.032; group 1 vs. group 3: hazard ratio, 2.882 [95% CI, 1.899–4.371], P<0.001). The concordance index value of the CA19-9 trend (0.636; 95% CI, 0.509–0.682) surpassed those of preoperative and postoperative CA19-9.
Conclusion
The amalgamation of preoperative and postoperative CA19-9 levels demonstrated enhanced prognostic stratification, allowing for a more detailed classification of patients with nonmetastatic CRC.

Review

Translation/basic research

Extracellular vesicles in colorectal cancer: Young Il Kim, Chungyeop Lee, Hakho Lee, In Ja Park; Ann Coloproctol. 2025;41(5):379-392. Published online October 16, 2025; DOI: https://doi.org/10.3393/ac.2025.00745.0106

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Abstract PDF: Colorectal cancer (CRC) remains a major global health issue, with challenges including early detection and recurrence monitoring. While colonoscopy and fecal-based tests are standard screening tools, their limitations have driven interest in less invasive alternatives. Extracellular vesicles (EVs) present in patient liquid biopsy samples have emerged as potential biomarkers and therapeutic tools in CRC. EVs carry molecular cargo, including nucleic acids and proteins, that reflect the status of their cells of origin and can be readily accessed through minimally invasive liquid biopsy. This review outlines the role of EVs in the initiation and progression of CRC, summarizes recent advances in EV isolation techniques, and highlights candidate EV-derived biomarkers for diagnosis, prognosis, and treatment monitoring. By providing an updated synthesis of current research, this review aims to inform future studies and support clinical translation of EV-based approaches in CRC.

Original Articles

Metastasis or chemotherapy

Short-term surgical outcomes following neoadjuvant immunotherapy in mismatch repair-deficient colorectal cancer: initial experience from a tertiary referral center: Ejaz Ahmed Latif, Ayman Abdelhafiz Ahmed, Mahmood Saad Al-Dhaheri, Ammar Aleter, Ali Toffaha, Mohamed Kurer, Tausief Fatima, Amjad Parvaiz, Mohmmad Hosni Abunada; Ann Coloproctol. 2025;41(4):338-345. Published online August 28, 2025; DOI: https://doi.org/10.3393/ac.2025.00381.0054

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Abstract PDF: Purpose
Immunotherapy has demonstrated remarkable efficacy in mismatch repair-deficient (MMR-D) colorectal cancer (CRC). Due to their significant response rates, immune checkpoint inhibitors have emerged as a promising neoadjuvant therapy. However, data regarding short-term surgical outcomes following immunotherapy remain limited. The aim of this study is to evaluate the safety and feasibility of surgical resection after immunotherapy, as well as its short-term clinical outcomes.
Methods
A retrospective review of prospectively collected data was performed at a tertiary referral center from January 2020 to July 2024. Fifteen consecutive patients with MMR-D CRC treated with pembrolizumab were analyzed. The patients’ demographics, tumor characteristics, clinical outcomes, and histopathological responses were assessed.
Results
In total, 15 patients diagnosed with MMR-D locally advanced or metastatic colorectal cancers received neoadjuvant immunotherapy followed by surgery. Of the 15 patients, 11 (73.3%) were male, 12 (80.0%) presented with T3/T4 tumors, and 3 (20.0%) had metastatic disease at diagnosis. The median number of immunotherapy cycles was 5 (range, 3–13). Surgery was performed without any anastomotic leaks or 30-day mortality. The median length of hospital stay was 5 days (range, 3–14 days). All surgical specimens had negative resection margins. Major pathological response was observed in 11 patients (73.3%), including complete response in 8 (53.3%) and near-complete response in 3 (20.0%). The median follow-up was 14 months (range, 1–56 months). One patient developed liver metastasis, which was successfully resected.
Conclusion
Surgical resection of MMR-D CRC following neoadjuvant immunotherapy is safe and associated with low morbidity. Neoadjuvant immunotherapy in MMR-D CRC facilitates high rates of major pathological response.

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.

Minimally invasive surgery

Propensity score–matched comparison of robot-assisted rectal cancer surgery using hinotori and da Vinci: Hidetoshi Katsuno, Koji Morohara, Tomoyoshi Endo, Kenji Kikuchi, Kenichi Nakamura, Kazuhiro Matsuo, Takahiko Higashiguchi, Tetsuya Koide, Hiromi Kanai, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise; Ann Coloproctol. 2025;41(4):310-318. Published online August 25, 2025; DOI: https://doi.org/10.3393/ac.2025.00136.0019

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Graphical Abstract Abstract PDF

Purpose
The hinotori Surgical Robot System (hereafter “hinotori”) is a novel platform for robot-assisted surgery, while the da Vinci Surgical System (“da Vinci”) remains the field standard. This study compared short-term surgical outcomes of rectal cancer surgery between these systems using propensity score–matched analysis.
Methods
A retrospective analysis was conducted of 209 consecutive patients who underwent robot-assisted surgery with the da Vinci and 58 patients with the hinotori system. After 2:1 propensity score matching, 108 da Vinci and 54 hinotori cases were included. Surgical outcomes, including operative time, blood loss, postoperative complications, length of hospital stay, and pathological findings, were compared.
Results
After matching, the baseline demographics were well balanced between groups. The hinotori system was associated with significantly longer operative time (266 minutes vs. 227 minutes, P=0.014) and console time (156 minutes vs. 110 minutes, P=0.001). However, estimated blood loss and postoperative complication rate did not differ significantly. Pathological findings, including the number of lymph nodes retrieved and the incidence of positive surgical margins, were comparable between systems.
Conclusion
In rectal surgery, the hinotori system demonstrates comparable short-term safety outcomes to da Vinci. Despite longer operative times and limited integrated instrumentation, hinotori‐assisted procedures may be feasible in selected patients. Further research should address long-term oncological outcomes and strategies to improve procedural efficiency.

Citations

Citations to this article as recorded by

Racing toward the future of robot-assisted rectal cancer surgery: a comparative study of hinotori and da Vinci
Sung Uk Bae
Annals of Coloproctology.2025; 41(4): 259. CrossRef

Metastasis or chemotherapy

Effectiveness of oxaliplatin-based second-line therapy following cetuximab+FOLFIRI or bevacizumab+FOLFIRI in KRAS wild-type metastatic colorectal cancer without primary tumor resection: Yi-Chia Su, Chien-Chou Su, Pei-Ting Lee, Chih-Chien Wu; Ann Coloproctol. 2025;41(4):319-329. Published online August 21, 2025; DOI: https://doi.org/10.3393/ac.2025.00087.0012

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Abstract PDF: Purpose
Wild-type unresectable metastatic colorectal cancer (mCRC) poses challenges for treatment optimization. Effective first-line targeted therapies are crucial for improving outcomes, particularly when combined with second-line oxaliplatin-based chemotherapies. This study examined the effects of first-line cetuximab+FOLFIRI versus bevacizumab+FOLFIRI, followed by second-line oxaliplatin-based chemotherapy, on survival among patients with KRAS wild-type mCRC without primary tumor resection (PTR).
Methods
A retrospective analysis of Taiwanese data (2013–2019) included patients with KRAS wild-type unresectable mCRC who received first-line cetuximab+FOLFIRI or bevacizumab+FOLFIRI, followed by second-line oxaliplatin-based chemotherapy. Survival outcomes—overall survival (OS) and time to treatment discontinuation (TTD)—were compared between these regimens using stabilized inverse probability of treatment weighting to adjust for potential confounders, followed by multivariate Cox proportional hazards regression analysis to account for clinical and biological variables.
Results
In patients without PTR, first-line cetuximab+FOLFIRI with second-line oxaliplatin-based chemotherapy significantly improved OS from the start dates of first- and second-line treatment compared to first-line bevacizumab+FOLFIRI with second-line oxaliplatin-based therapy, yielding adjusted hazard ratios (HRs) of 0.60 (95% confidence interval [CI], 0.46–0.78) and 0.56 (95% CI, 0.42–0.73), respectively. No significant difference in TTD was observed (HR, 0.82; 95% CI, 0.65–1.04).
Conclusion
First-line cetuximab+FOLFIRI followed by second-line oxaliplatin-based chemotherapy offers superior OS compared to bevacizumab+FOLFIRI followed by second-line oxaliplatin‑based chemotherapy in KRAS wild-type mCRC without PTR. These findings underscore the importance of personalized treatment sequencing, highlighting the need for further research to optimize mCRC management.

Colorectal cancer

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

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

Colorectal cancer

How appropriately can generative artificial intelligence platforms, including GPT-4, Gemini, Bing, and Wrtn, answer questions about colon cancer in the Korean language?: Sun Huh; Ann Coloproctol. 2025;41(3):190-197. Published online June 25, 2025; DOI: https://doi.org/10.3393/ac.2024.00122.0017

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Abstract PDF Supplementary Material: Purpose
This study aims to assess the performance of 4 generative artificial intelligence (AI) platforms—Gemini (formerly Bard), Bing, GPT-4, and Wrtn—in answering questions about colon cancer in the Korean language. Two main research questions guided this study. First, which AI platform provides the most accurate answers? Second, can these AI-generated answers be reliably used to educate patients and their families about colon cancer?
Methods
Ten questions selected by the author were posed to the 4 generative AI platforms on February 22, 2024. Two colorectal surgeons in Korea, each with over 20 years of clinical experience, independently evaluated the answers provided by these generative AI platforms.
Results
The generative AI platforms scored an average of 5.5 out of 10 points. Wrtn achieved the highest score at 6 points, followed by GPT-4 and Gemini, each with 5.5, and Bing, scoring 5 points. The weighted κ for inter-rater reliability was 0.597 (P<0.001). The generative AI platforms performed well in explaining the occult blood test for cancer screening, keyhole surgery, and dietary recommendations for cancer prevention. However, they demonstrated significant limitations in answering more complex topics, such as estimating survival rates following surgery, choosing targeted therapy after surgery, and accurately reporting the mortality rate due to colon cancer in Korea.
Conclusion
The findings suggest that using these generative AI platforms as educational resources for patients and their families regarding colon cancer is premature. Further training on colorectal diseases is required before these AI platforms can be considered reliable information sources for the general public in Korea.

ERAS

Early urinary catheter removal in patients undergoing rectal cancer surgery: a randomized controlled trial on silodosin versus no pharmacological treatment on urinary function in the early postoperative period: Žilvinas Gricius, Justas Kuliavas, Eugenijus Stratilatovas, Bronius Buckus, Audrius Dulskas; Ann Coloproctol. 2025;41(3):239-245. Published online June 20, 2025; DOI: https://doi.org/10.3393/ac.2024.00703.0100

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Abstract PDF

Purpose
This study aimed to evaluate the efficacy of the α1 adrenergic receptor antagonist silodosin in preventing lower urinary tract symptoms after rectal cancer surgery.
Methods
We conducted a 2-arm, double-blind, single-center randomized controlled trial. The study included 150 patients with rectal cancer who underwent radical surgery between 2019 and 2022. On the first postoperative day, the urinary catheter was removed for all patients. Of these, 100 patients were administered silodosin, while 50 patients (control group) receive placebo (glucose tablet). Urinary dysfunction (urinary retention, infection, dysuria) and other complications were monitored.
Results
Among the 150 patients, 84 (56.0%) were male and 66 (44.0%) were female. Surgical procedures included abdominoperineal resection in 33 patients, partial mesorectal excision in 45, and total mesorectal excision in 72. A laparoscopic approach was used in 69 patients, while the remaining 81 underwent open surgery. Urinary tract symptoms developed in 10 patients (6.7%): 7 (7.0%) in the silodosin group and 3 (6.0%) in the control group (P=0.92). In the silodosin group, there was 1 case (1.0%) of urinary retention, 3 cases (3.0%) of urinary tract infection, and 3 cases (3.0%) of dysuria. In the control group, there was 1 case (2.0%) each of urinary retention, urinary tract infection, and dysuria (all P=0.92).
Conclusion
Early urinary catheter removal on the first postoperative day was safe in both groups. The use of the oral α-antagonist silodosin did not provide additional benefits in preventing lower urinary tract symptoms in patients undergoing rectal cancer surgery. Trial registration: ClinicalTrials.gov identifier: NCT03607370

Citations

Citations to this article as recorded by

Less is more: simplifying patient-centered cancer care
In Ja Park
Annals of Coloproctology.2025; 41(3): 173. CrossRef

Complications

Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study: Daniela Rega, Ernesto De Giulio, Raffaele De Luca, Andrea Muratore, Marco Milone, Giuseppe Sica, Paolo Millo, Carmela Cervone, Nicola Cillara, Patrizia Marsanic, Brunella Maria Pirozzi, Valeria Grazia Malagnino, Pietro Anoldo, Marcello Calabrò, Giovanni De Palma, Michele Simone, Paolo Delrio; Ann Coloproctol. 2025;41(4):293-302. Published online June 4, 2025; DOI: https://doi.org/10.3393/ac.2024.00899.0128

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Graphical Abstract Abstract PDF: Purpose
Anastomotic leaks (AL) remain a major complication following right colectomy for colon cancer. This multicenter, prospective, observational study evaluated the efficacy of Glubran 2, a cyanoacrylate-based sealant, in reducing the incidence of AL by reinforcing ileocolic anastomoses.
Methods
The study enrolled 380 patients undergoing right colectomy for colon cancer across 7 Italian hospitals. Glubran 2 was applied to reinforce ileocolic anastomoses. The primary endpoint was a 50% reduction in AL incidence from a baseline of 6.18% within 10 days after surgery. Secondary endpoints included examining the correlation between AL and preexisting risk factors and determining the rate of anastomotic bleeding. Statistical analyses employed binomial tests and logistic regression.
Results
The AL rate was reduced to 1.85% compared to the reference rate of 6.18% (P<0.01). Glubran 2 exhibited a protective effect even in patients with preexisting risk factors such as smoking, diabetes, or prior surgeries; none of these factors was significantly associated with AL (P>0.05). Surgical technique (P=0.687), anastomosis technique (P=0.998), and anastomosis type (P=0.998) did not influence AL rates. Operation time was similar across groups (P=0.613), and anastomotic bleeding occurred in 1.3% of cases, with no association with AL (P=0.989).
Conclusion
Glubran 2 was safely applied to ileocolic anastomoses, significantly reducing AL rates and potentially providing a protective effect even in patients with known risk factors. Its hemostatic and bacteriostatic properties support improved postoperative outcomes, highlighting its potential as an effective adjunct in colorectal surgery. Further studies are warranted to confirm these findings and explore broader applications.

Minimally invasive surgery

Impact of single-port laparoscopic approach on scar assessment by patients and observers: a multicenter retrospective study: Sung Uk Bae, Kyeong Eui Kim, Chang-Woo Kim, Ji-Hoon Kim, Woon Kyung Jeong, Yoon-Suk Lee, Seong Kyu Baek, Suk-Hwan Lee, Jun-Gi Kim; Ann Coloproctol. 2025;41(2):154-161. Published online April 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00563.0080

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Abstract PDF

Purpose
This study aimed to compare the wound cosmesis of a single-incision approach on scar assessment after laparoscopic surgery for colon cancer.
Methods
This study included 32 patients undergoing single-port laparoscopic surgery (SPLS) and 61 patients undergoing multiport laparoscopic surgery (MPLS) for colon cancer at 3 tertiary referral hospitals between September 2011 and December 2019. We modified and applied the Korean version of the Patient and Observer Scar Assessment Scale (POSAS) to assess cosmetic outcomes. To assess the interobserver reliability using intraclass correlation coefficient values for the Observer Scar Assessment Scale (OSAS), the surgeons evaluated 5 images of postoperative scars.
Results
No significant differences were observed in the time before the return of normal bowel function, time to sips of water and soft diet initiation, length of in-hospital stay, and postoperative complication rate. The SPLS group had a shorter total incision length than the MPLS group. The POSAS favored the SPLS approach, revealing significant differences in the Patient Scar Assessment Scale (PSAS), OSAS, and overall scores. The SPLS approach was an independent factor influencing the POSAS, PSAS, and OSAS scores. Eleven colorectal surgeons had a significantly substantial intraclass coefficient.
Conclusion
The cosmetic outcomes of SPLS as assessed by the patients and surgeons were superior to those of MPLS in colon cancer. Reducing the number of ports is an independent factor affecting scar assessment by patients and observers.

Citations

Citations to this article as recorded by

Investigating the Efficacy of Layered Moderate Tension Reduction Suturing in Facial Aesthetic Surgery
Gui H Wang, Jin Y Gang, Yan Li
Cureus.2025;[Epub] CrossRef

CRC

Relationships between MMP-2, MMP-9, and ADAMDEC1 serum and tissue levels in patients with colorectal cancer: Zahra Mozooni, Kiana Khajeh Amiri, Nafiseh Golestani, Alireza Shahmohammadi, Sara Minaeian, Leyla Bahadorizadeh; Ann Coloproctol. 2025;41(2):136-144. Published online April 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00227.0032

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Abstract PDF Supplementary Material: Purpose
Colorectal cancer (CRC) is the most common malignancy of the gastrointestinal system globally. Identifying specific gene expression patterns indicative of early-stage CRC could enable early diagnosis and rapid treatment initiation. Matrix metalloproteinases (MMPs) play crucial roles in extracellular matrix degradation and tissue remodeling. Among them, MMP-2 and MMP-9 have been found to be upregulated in various cancers, including CRC, and are associated with tumor invasion, metastasis, and angiogenesis. In contrast, a disintegrin and metalloproteinase like decysin 1 (ADAMDEC1) is a relatively newly discovered gene with demonstrated involvement in immune response and inflammation. This study investigated serum levels of MMP-2 and MMP-9, along with tissue expression of MMP-2, MMP-9, and ADAMDEC1, and explored potential associations with pathological and clinical factors in patients with CRC.
Methods
This study included 100 patients with CRC and 100 control participants. Tissue and blood samples were collected. Serum MMP-2 and MMP-9 levels were analyzed using the enzyme-linked immunosorbent assay. Quantitative real-time polymerase chain reaction was employed to assess the expression levels of MMP-2, MMP-9, and ADAMDEC1 in CRC tissue samples compared to adjacent control tissue.
Results
The expression levels of MMP-2, MMP-9, and ADAMDEC1 were significantly upregulated in CRC relative to adjacent control tissues. Analysis of clinicopathological features revealed statistically significant differences in the expression levels of MMP-2, MMP-9, and ADAMDEC1 between patients with CRC with and without lymphovascular invasion (P<0.001). Based on receiver operating characteristic curve analysis, these genes represent promising candidate diagnostic biomarkers for CRC.
Conclusion
MMP-2, MMP-9, and ADAMDEC1 levels may serve as potential diagnostic biomarkers for CRC.

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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