Annals of Coloproctology

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Original Articles

Colorectal cancer

Optimizing lymph node harvest in laparoscopic colorectal cancer: predictors and station-specific lymph node submission solutions: Chun Gao, Sheng Zhang; Ann Coloproctol. 2026;42(2):216-225. Published online April 27, 2026; DOI: https://doi.org/10.3393/ac.2025.01123.0160

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Abstract PDF: Purpose
Adequate lymph node yield is crucial for accurate staging in colorectal cancer. This study aims to analyze clinical factors associated with lymph node retrieval in laparoscopic colorectal cancer surgery and to explore strategies that may enhance yield.
Methods
We conducted a retrospective review of clinical, pathological, and surgical data from patients who underwent laparoscopic colorectal cancer resection between July 2019 and July 2024 at our institution. Patients were stratified by lymph node yield into 2 groups: <12 nodes (reduced yield) and ≥12 nodes (control). Univariate analyses were used to identify factors potentially affecting lymph node yield, and multivariate logistic regression was performed to determine independent risk factors for reduced yield.
Results
A total of 639 patients (305 with rectal cancer and 334 with colon cancer) were included. Univariate analysis identified age (P=0.039), sex (P=0.029), neoadjuvant therapy (P<0.001), tumor location (P<0.001), invasion depth (P<0.001), lymphovascular invasion (P=0.028), and station-specific lymph node submission (P<0.001) as influential factors. Multivariate analysis revealed that preoperative neoadjuvant therapy, tumor location (non–right colon), shallow invasion depth (T1–T2), and lack of station-specific submission independently contributed to reduced lymph node yield (all P<0.05).
Conclusion
This study highlights preoperative neoadjuvant therapy, tumor location, and invasion depth (T stage) as independent factors associated with reduced lymph node yield in laparoscopic colorectal cancer surgery. However, station-specific lymph node submission significantly increases yield and may help address inadequate retrieval. These findings suggest both predictive and interventional strategies to optimize lymph node harvest after surgery.

Colorectal cancer

Margin-driven outcomes prevail over resection planes: multivisceral surgery matches total mesorectal excision in locally advanced rectal cancer: Niyaz Shadmanov, Baris Bakir, Suha Goksel, Oktar Asoglu; Ann Coloproctol. 2026;42(2):226-236. Published online April 27, 2026; DOI: https://doi.org/10.3393/ac.2025.00920.0131

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Abstract PDF: Purpose
This study compared oncologic and perioperative outcomes between patients with locally advanced rectal cancer (LARC) treated with beyond total mesorectal excision (bTME) and those with pathologic stage III disease undergoing TME.
Methods
A retrospective analysis was conducted using prospectively collected data from 580 LARC patients treated with curative-intent surgery over a 23-year period. Patients were categorized as those with clinical T4b tumors who underwent bTME with multivisceral resection (MVR) and those with pathologic stage III tumors treated with TME. Demographic, surgical, pathological, and oncologic outcomes were compared.
Results
Circumferential resection margin (CRM) positivity was similar between the groups (5.3% vs. 3.6%, P=0.467). Postoperative complications occurred more often in the bTME group (28.9% vs. 16.6%, P=0.004), although major complications were comparable (P=0.812). Five-year local recurrence (10.5% vs. 9.3%, P=0.371), distant metastasis (19.7% vs. 21.4%, P=0.140), disease-free survival (64.4% vs. 66.2%, P=0.326), and overall survival (74.8% vs. 75.5%, P=0.464) demonstrated no significant differences. Within the bTME group, 32 patients (42.1%) underwent major MVR and 44 (57.9%) underwent minor MVR. CRM positivity (6.2% vs. 4.5%, P=0.999), local recurrence (12.5% vs. 9.1%, P=0.714), and distant metastasis (25.0% vs. 15.9%, P=0.388) rates were similar. Five-year disease-free survival (61.5% vs. 72.3%, P=0.454) and overall survival (68.5% vs. 74.8%, P=0.609) favored minor MVR, although the differences were not statistically significant.
Conclusion
When negative circumferential margins are achieved, margin-driven bTME resections provide long-term oncologic outcomes comparable to standard TME in high-risk rectal cancer, although they are associated with higher overall complication rates.

Review

Colorectal cancer

Two lives, one fight: navigating rectal cancer in pregnancy with multidisciplinary precision: Supakool Jearanai, Songphol Malakorn; Ann Coloproctol. 2026;42(2):179-184. Published online April 27, 2026; DOI: https://doi.org/10.3393/ac.2025.00843.0120

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Abstract PDF: Rectal cancer during pregnancy represents a clinical paradox in which the instinct to protect new life directly intersects with the urgency to preserve another. With an incidence of approximately 1 in 13,000 pregnancies, this rare condition challenges not only clinical decision-making but also the ethical and emotional dimensions of contemporary medical care. A 32-year-old primigravida at 26 weeks of gestation presented with rectal bleeding and was diagnosed with stage T4bN+M0 rectal adenocarcinoma. Despite the conventional recommendation of pregnancy termination in such circumstances, the patient expressed a strong desire to continue the pregnancy. A multidisciplinary team comprising colorectal surgeons, medical oncologists, radiation oncologists, and maternal-fetal medicine specialists developed a unified and coordinated treatment plan. The patient received neoadjuvant CAPOX (capecitabine [Xeloda] and oxaliplatin) chemotherapy during pregnancy, underwent cesarean delivery at 36 weeks of gestation, and subsequently completed postpartum chemoradiotherapy followed by curative laparoscopic oncologic resection. The child was delivered healthy, and the mother remained disease-free at a 5-year follow-up. This case demonstrates that life-threatening malignancy and ongoing pregnancy can coexist without compromise. Through carefully timed interventions, close cross-specialty collaboration, and respect for patient autonomy, both maternal and fetal outcomes were excellent. Within the evolving landscape of personalized cancer care, this case challenges outdated paradigms and reframes pregnancy not as a contraindication, but as a clinical variable that can be managed with precision and compassion. In addition to this illustrative case, we provide a focused review of the current literature to guide clinicians navigating this rare and complex clinical scenario.

Original Articles

Minimally invasive surgery

Comparative study of robot-assisted surgery for right-sided colon cancer: a propensity score–matched analysis of the hinotori Surgical Robot System and the da Vinci Surgical System: Koji Morohara, Hidetoshi Katsuno, Tomoyoshi Endo, Kenichi Nakamura, Kazuhiro Matsuo, Kazuki Tsujimura, Tetsuya Koide, Takashi Imanaka, Tomohiro Kubo, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise; Ann Coloproctol. 2026;42(2):237-246. Published online April 15, 2026; DOI: https://doi.org/10.3393/ac.2025.01151.0164

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Abstract PDF Supplementary Material

Purpose
The da Vinci Surgical System has led to major advances in robot-assisted colorectal surgery. Following its patent expiration, domestic alternatives such as the hinotori Surgical Robot System have been developed in Japan. However, clinical comparisons between the hinotori and the da Vinci Xi systems remain limited. This study aimed to compare the short-term outcomes of right-sided colon cancer surgeries performed with either system using propensity score matching.
Methods
This retrospective study included 39 patients who underwent da Vinci–assisted surgery and 37 who underwent surgery using the hinotori system. Propensity score matching was performed using 7 covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, clinical T and N categories, and surgeon experience (≥100 prior robotic colorectal surgeries). To assess the robustness of the findings, inverse probability weighting was also applied using the same covariates. Surgical, postoperative, and pathological outcomes were evaluated.
Results
After matching, 27 patients were included in each group. The hinotori group had significantly longer operative and console times (236 minutes vs. 191 minutes, P=0.001; 140 minutes vs. 90 minutes, P<0.001). No significant differences were observed in blood loss, complication rates, length of hospital stay, or lymph node harvest. No conversions or reoperations occurred. One readmission for ileus was noted in the da Vinci group, whereas none occurred in the hinotori group.
Conclusion
Right colectomy assisted by the hinotori system demonstrated short-term outcomes equivalent to those of the da Vinci system, despite a prolonged operative time. Further prospective studies with larger sample sizes and longer follow-up are warranted.

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Beyond the era of monopoly to diversity: new horizons in robotic colorectal cancer surgery
Jeonghee Han
Annals of Coloproctology.2026; 42(2): 149. CrossRef

Colorectal cancer

Effectiveness of primary tumor resection for survival after first-line cetuximab or bevacizumab in KRAS wild-type metastatic colorectal cancer treated with subsequent trifluridine/tipiracil or regorafenib: Yu-Hsun Chen, Chih-Chien Wu, Chien-Chou Su, Pei-Ting Lee, Yi-Chia Su; Ann Coloproctol. 2026;42(1):127-140. Published online February 27, 2026; DOI: https://doi.org/10.3393/ac.2025.00759.0108

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Abstract PDF: Purpose
The optimal sequencing of targeted therapies and the role of primary tumor resection (PTR) in KRAS wild-type metastatic colorectal cancer (mCRC) remain unclear. This study compared survival outcomes in patients treated with first-line cetuximab plus FOLFIRI (folinic acid, 5-fluorouracil, and irinotecan) versus bevacizumab plus FOLFIRI, followed by second-line oxaliplatin-based chemotherapy and later-line trifluridine/tipiracil or regorafenib.
Methods
This retrospective cohort study used Taiwan’s National Health Insurance Research Database and the Taiwan Cancer Registry. Patients diagnosed with mCRC between 2013 and 2019 were included if they received first-line cetuximab or bevacizumab plus FOLFIRI, followed by later-line trifluridine/tipiracil or regorafenib. Patients were stratified by PTR status. Primary endpoints were overall survival and survival during trifluridine/tipiracil or regorafenib treatment. Secondary endpoints included time to treatment discontinuation (TTD) and TTD during trifluridine/tipiracil or regorafenib therapy. Stabilized inverse probability of treatment weighting was used for adjustment.
Results
Among 559 patients, 278 were assigned to the non-PTR group and 281 to the PTR group. In the non-PTR group, the cetuximab cohort demonstrated significantly longer survival during trifluridine/tipiracil or regorafenib therapy (6.2 months vs. 4.9 months; hazard ratio [HR], 0.72) and longer TTD1 (the interval between initiation of first-line therapy and the start of second-line chemotherapy; 11.8 months vs. 9.5 months; HR, 0.67) than the bevacizumab cohort. Survival differences between regimens were less pronounced among patients who underwent PTR.
Conclusion
First-line cetuximab plus FOLFIRI may confer a survival advantage over bevacizumab in patients with KRAS wild-type mCRC without PTR, including during later-line therapy with trifluridine/tipiracil or regorafenib, whereas bevacizumab appears to provide more consistent benefits in those with PTR.

Colorectal cancer

Upfront surgery versus preoperative chemoradiotherapy: a comparative survival analysis for stage II/III resectable rectal cancer: Nattapanee Sukphol, Thitithep Limvorapitak; Ann Coloproctol. 2026;42(1):115-126. Published online February 26, 2026; DOI: https://doi.org/10.3393/ac.2025.00724.0103

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Graphical Abstract Abstract PDF: Purpose
Current international guidelines recommend neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) for locally advanced rectal cancer (LARC). Although nCRT reduces the risk of local recurrence, it has not demonstrated a survival advantage and increases the likelihood of preoperative overtreatment. This study investigated whether upfront TME could be offered without compromising oncologic outcomes.
Methods
From January 2015 to December 2020, patients with stage II/III LARC who underwent either upfront TME or nCRT followed by TME were analyzed using propensity score matching. Long-term survival outcomes were compared between the 2 groups. The primary endpoint was 5-year disease-free survival. Secondary endpoints included 5-year local recurrence-free survival, distant metastasis-free survival, and overall survival.
Results
A total of 348 patients were included, of whom 138 (39.7%) underwent upfront TME. The upfront TME group showed significantly higher 5-year disease-free survival (63.3% vs. 43.9%) and distant metastasis-free survival (88.1% vs. 70.3%). However, after excluding patients with preoperative mesorectal fascia (MRF) involvement, no significant differences were observed in long-term oncologic outcomes. Following 1:1 propensity score matching, 47 patients from each group were compared. Kaplan-Meier survival analysis revealed no significant differences in any endpoints. Cox regression analysis of the matched cohort indicated that preoperative MRF involvement, positive extramural vascular invasion, and tumor deposits were not independent prognostic factors.
Conclusion
Upfront TME may represent a viable treatment option for selected patients with LARC, particularly those without MRF involvement, providing comparable oncologic outcomes to the standard nCRT approach.

Reviews

Colorectal cancer

Gut microbiome in colorectal cancer: recent advances and clinical implications: Jun Yong Han, Min Jung Kim, Ji Won Park, Seung-Yong Jeong; Ann Coloproctol. 2026;42(1):72-85. Published online February 25, 2026; DOI: https://doi.org/10.3393/ac.2026.00010.0001

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Abstract PDF

The gut microbiome is not just a bystander of colorectal carcinogenesis but is an active driver of colorectal cancer (CRC). CRC-associated microbiome contributes in the tumorigenesis through chronic inflammation, formation of toxic metabolite and genotoxins, oncogenic signal activation, immune evasion, and barrier disruption—all reinforcing a tumor microenvironment. In contrast, beneficial microbiome supports the barrier-immune-metabolic axis by maintaining mucosal integrity and balanced immune tone. Despite extensive studies of microbiome-based CRC biomarkers, microbiome-based CRC biomarkers have not been yet ready for routine clinical use due to variation across populations and lack of standardization of key steps such as sampling, analysis, cutoffs, and interpretation. Microbiome-based therapies aim to change the overall intestinal ecosystem rather than simply adding or removing single strains. At present, dietary modulation and prebiotics are considered supportive measures, while probiotics or synbiotics are in preclinical stage. Fecal microbiota transplantation (FMT) still faces important challenges in effectiveness, standardization and safety. By its role in reshaping the tumor–host immune environment, FMT is viewed as a potential option for cancer therapy after further development through well-controlled clinical trials with careful safety monitoring.

Citations

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Over and above what is visible and conventional: development of new territories in colorectal cancer management
In Ja Park
Annals of Coloproctology.2026; 42(1): 1. CrossRef

Colorectal cancer

Fluorescence-guided surgery in colorectal cancer: current evidence, quantitative advances, and future perspectives: Kyung-Ha Lee; Ann Coloproctol. 2026;42(1):58-71. Published online February 25, 2026; DOI: https://doi.org/10.3393/ac.2025.01438.0205

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Abstract PDF

Fluorescence-guided surgery (FGS) has progressed from a qualitative adjunct to a quantitative, data-driven tool in colorectal surgery. Fluorescence-guided angiography for perfusion assessment shows mixed randomized results overall, with signals of benefit in low anterior resection and less-severe leaks; emerging metrics (e.g., time-to-peak, slope, time from the initial fluorescence increase to half of the maximum [T1/2MAX], time ratio [TR]) support objective decision-making. Fluorescence-guided lymphatic mapping can increase D3 yield, whereas consistent oncologic benefit remains uncertain; sentinel lymph node mapping in early colon cancer is feasible but not standard. In advanced rectal cancer, fluorescence may facilitate lateral pelvic node dissection with lower blood loss and selective clearance, though long-term outcomes require confirmation. Tumor-targeted imaging shifts FGS from anatomy to biology, aiding detection of occult disease, characterization of indeterminate lesions after therapy, and therapeutic decision-making for organ preservation. Near-infrared II (NIR-II) agents and hybrid positron emission tomography (PET)/NIR tracers promise deeper penetration and preoperative-to-intraoperative correlation but remain largely preclinical. Platform advances, automated data capture, tumor to background ratio thresholds, and artificial intelligence–assisted analytics are moving FGS toward integrated, reproducible workflows. Priorities include international standardization, prospective trials with long-term endpoints, validated tumor-targeted probes, and digital/robotic integration.

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Citations to this article as recorded by

Over and above what is visible and conventional: development of new territories in colorectal cancer management
In Ja Park
Annals of Coloproctology.2026; 42(1): 1. CrossRef
Strategies to Reduce the Risk of Rectal Stump Leakage After Hartmann's Procedure: A Structured Narrative Review
Mohamed Alkashty, Ehab Kahka, Mafdi Mossaad, Waseem Hameed, Abanoub Saleeb, Ahmed Elshawadia, Mohamed Elgazawey
Cureus.2026;[Epub] CrossRef

Colorectal cancer

Safety and efficacy of chemoprevention for familial adenomatous polyposis: a systematic review and meta-analysis: Francisco Tustumi, Amanda Park, Eric Toshiyuki Nakamura, Thaís Cabral de Melo Viana, Elis Nogara Lisboa, Rodrigo Moisés de Almeida Leite, Sergio Eduardo Alonso Araujo, Pedro Luiz Serrano Usón Jr, Kaique Flávio Xavier Cardoso Filardi; Ann Coloproctol. 2026;42(1):34-46. Published online February 25, 2026; DOI: https://doi.org/10.3393/ac.2025.01018.0145

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Abstract PDF Supplementary Material

Purpose
Familial adenomatous polyposis is a hereditary condition that predisposes individuals to colorectal cancer. This study aimed to evaluate the efficacy and safety of pharmacological therapies for reducing polyp number, burden, and size in individuals with familial adenomatous polyposis.
Methods
A systematic search was conducted in PubMed, Embase, Web of Science, and Cochrane. Randomized trials assessing the effects of pharmacological interventions on polyp number, polyp burden, and polyp size were included, and adverse events were also analyzed.
Results
Sixteen studies (n=985) met the inclusion criteria. The mean participant age was 38±8.3 years, with a mean follow-up of 14.6±15.8 months. Of these studies, 62.5% focused on colorectal polyps, 18.8% on rectal polyps, 18.8% on duodenal polyps, and 12.5% addressed both colorectal and duodenal polyps. Pharmacological interventions were associated with a modest but statistically significant reduction in the number of polyps (Hedges g, −0.57; 95% confidence interval [CI], −1.08 to −0.05) and in average polyp size (Hedges g, −0.26; 95% CI, −0.49 to −0.04). However, no significant reduction in overall polyp burden was observed (Hedges g, −1.07; 95% CI, −2.21 to 0.06). In subgroup analyses, nonselective cyclooxygenase inhibitors produced a large reduction in polyp burden (Hedges g, −2.72; 95% CI, −3.28 to −2.16), while metformin also demonstrated benefit in a single study (Hedges g, −1.06; 95% CI, −1.86 to −0.27). Adverse events were generally infrequent and comparable to placebo. Conclusion: Chemopreventive interventions may reduce polyp number, burden, and size, and they appear to have a favorable safety profile.

Citations

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Advances in chemoprevention of familial adenomatous polyposis
Ruicheng Li, Rong Cao, Jiaqi Kang, Yuwei Li, Xin Lin, Zhao Zhang
Frontiers in Oncology.2026;[Epub] CrossRef

Guideline

Colorectal cancer

The Korean Rectal Cancer Multidisciplinary Committee Clinical Practice Guidelines for Rectal Cancer version 2.0: Hyo Seon Ryu, Hyun Jung Kim, Dong Hyun Kang, Yoo-Kang Kwak, Han Deok Kwak, Yoon-Hye Kwon, Dalyong Kim, Baek-Hui Kim, Jae Hyun Kim, Ji Hun Kim, Jin Won Kim, Tae Hyung Kim, Hae Young Kim, Soo Min Nam, Gyoung Tae Noh, Jun Woo Bong, Nak Song Sung, Seon Hui Shin, Kil-Yong Lee, Sung Chul Lee, Sea-Won Lee, Jung Won Lee, Jong Min Lee, Myung Hoon Ihn, Joo Han Lim, Woong Bae Ji, Dae Hee Pyo, Young Ki Hong, Jung-Myun Kwak, on behalf of the Korean Rectal Cancer Multidisciplinary (KRCM) Committee; Ann Coloproctol. 2026;42(1):4-33. Published online February 24, 2026; DOI: https://doi.org/10.3393/ac.2025.01396.0199

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Abstract PDF Supplementary Material

Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

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Advances in Neoadjuvant Therapy for Colorectal Cancer
达练
Advances in Clinical Medicine.2026; 16(05): 2273. CrossRef

Original Article

Minimally invasive surgery

Interim analysis of short-term outcomes between robotic and laparoscopic surgery for colon cancer: results from the ESSIMIC trial: Marco Milone, Sara Vertaldi, Pietro Anoldo, Simona Borin, Graziano Ceccarelli, Anna D’Amore, Maurizio Degiuli, Paolo Delrio, Uberto Romario Fumagalli, Mario Guerrieri, Michele Manigrasso, Monica Ortenzi, Ugo Pace, Felice Pirozzi, Lucia Puca, Wanda Petz, Rossella Reddavid, Daniela Rega, Fabio Rondelli, Antonio Sciuto, Giovanni Domenico De Palma; Ann Coloproctol. 2026;42(1):86-93. Published online February 23, 2026; DOI: https://doi.org/10.3393/ac.2025.00339.0048

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
This study aimed to determine whether the benefits of robotic surgery can be applied to the treatment of colon cancer by evaluating short-term outcomes of robotic versus laparoscopic colonic resection.
Methods
This interim analysis of an interventional multicenter randomized trial was conducted to compare outcomes of robotic and laparoscopic colorectal surgery performed between January 2017 and December 2019. The study specifically assessed short-term outcomes in patients undergoing laparoscopic or robotic right or left colectomy for cancer. In addition, all short-term outcomes were evaluated in separate subgroups of right and left colonic resections through prespecified subgroup analyses.
Results
A total of 323 patients were analyzed, of whom 142 underwent robotic-assisted surgery and 181 underwent laparoscopic surgery. Overall, 109 complications (33.7%) occurred in the short-term period, 41 (28.9%) in the robotic group and 68 (37.6%) in the laparoscopic group, with no differences between groups in intraoperative or postoperative complications. However, grade III complications were significantly more frequent in the laparoscopic group, with 17 cases (9.4%) compared to 5 cases (3.5%) in the robotic group. Oncological radicality was similar between groups. Functional recovery after surgery was superior in the robotic group, as reflected by a shorter time to mobilization (17.5±10.2 hours vs. 21.1±11.5 hours). In the right colectomy subgroup, rates of grade III complications (1.9% vs. 11.7%) and lymph nodes retrieved (20.3±10.3 vs. 20.2±6.4) favored robotic surgery. In the left colon cancer subgroup, functional recovery was also improved with robotic surgery (44.3±22.2 hours vs. 61.1±31.1 hours, as measured by the composite recovery outcome).
Conclusion
Robotic surgery is associated with fewer severe complications and improved postoperative recovery following colonic resections. Trial registration: ClinicalTrials.gov identifier: NCT02871960

Citations

Citations to this article as recorded by

Beyond the era of monopoly to diversity: new horizons in robotic colorectal cancer surgery
Jeonghee Han
Annals of Coloproctology.2026; 42(2): 149. CrossRef

Review

Colorectal cancer

Immunotherapy for microsatellite-stable colorectal cancer: overcoming resistance and exploring novel therapeutic strategies: Sun Young Kim; Ann Coloproctol. 2026;42(1):47-57. Published online February 19, 2026; DOI: https://doi.org/10.3393/ac.2025.01354.0193

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Abstract PDF

Microsatellite-stable (MSS) colorectal cancer (CRC), comprising 85% to 95% of all CRC cases, represents a significant therapeutic challenge in the era of cancer immunotherapy. Unlike microsatellite instability-high tumors that demonstrate remarkable responses to immune checkpoint inhibitors, MSS CRC exhibits profound resistance due to low tumor mutational burden, minimal T-cell infiltration, and an immunosuppressive tumor microenvironment. This article reviews the current landscape of immunotherapy trials in MSS CRC, including the recently reported STELLAR-303 study, discusses emerging predictive biomarkers such as tumor mutational burden, Immunoscore Immune Checkpoint (Immunoscore-IC), and artificial intelligence-driven tools like Lunit SCOPE, and explores innovative strategies to overcome immune resistance, including next-generation anti–cytotoxic T-lymphocyte–associated protein-4 (anti–CTLA-4) antibodies, programmed cell death-ligand 1 (PD-L1)/interleukin-2 (IL-2) bispecific antibodies, CD47-targeting strategies, vaccines, and chimeric antigen receptor T (CAR-T) cell therapy. Understanding these evolving strategies is critical for advancing precision immunotherapy in this challenging patient population.

Citations

Citations to this article as recorded by

Over and above what is visible and conventional: development of new territories in colorectal cancer management
In Ja Park
Annals of Coloproctology.2026; 42(1): 1. CrossRef
Copper-driven nanoadjuvant reverses immunosuppression in colorectal cancer by orchestrating metabolic dysfunction and innate immune activation
Yaying Zhang, Yichun Huang, Shanshan Liu, Hailong Tian, Qinxia Chang, Tingting Zhang, Fanchen Yan, Qin Ye, Canhua Huang, Na Xie
Chemical Engineering Journal.2026; 540: 177486. CrossRef
Site‐ and age‐dependent associations between Fusobacterium nucleatum and colorectal cancer mortality
Nicole C. Loroña, Scott LaBrie, Claire E. Thomas, Hang Yin, Jeroen R. Huyghe, Conghui Qu, Sushma Thomas, Sosun Nayemi, Hamza Ammar, Orsalem Kahsai, Li Hsu, Keith R. Curtis, Amanda Koehne, Diana G. Redwood, Li Li, Christopher I. Li, Ulrike Peters, Timothy
Cancer.2026;[Epub] CrossRef

Original Articles

Colorectal cancer

Palliative resection versus palliative stenting for intestinal obstruction in patients with metastatic left-sided colonic cancer: a propensity score–matched analysis: Ruby Siu Ting Lau, Sophie Sok Fei Hon, Man Fung Ho, Simon Chu, Dennis CK Ng, Simon SM Ng; Ann Coloproctol. 2025;41(6):528-536. Published online December 29, 2025; DOI: https://doi.org/10.3393/ac.2025.00535.0076

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Abstract PDF: Purpose
Palliative resection and palliative stenting are established options for managing obstruction in patients with metastatic left-sided colonic cancer. This retrospective study investigated the long-term outcomes and survival associated with each treatment modality.
Methods
Patients with left-sided colon cancer complicated by intestinal obstruction and unresectable metastatic lesions were included. Propensity score matching was conducted to balance demographic characteristics. The primary outcome was long-term survival. Secondary outcomes included short-term morbidity, length of hospital stay, clinical success rate, stoma formation rate, and number of readmissions due to tumor-related complications.
Results
Initially, 131 patients who underwent palliative resection or stenting between 2015 and 2022 were included. After propensity score matching, 98 patients remained (49 in each group). Survival was significantly better among patients receiving palliative resection compared to stenting (median, 19.6 months vs. 9.6 months; P=0.003). However, subgroup analysis for patients older than 70 years demonstrated no statistically significant survival benefit (median, 11.5 months vs. 10.2 months; P=0.240). The resection group experienced significantly higher rates of stoma formation and longer postoperative hospital stays. Readmission rates were similar. Cox regression analysis identified low carcinoembryonic antigen levels, tumor resection, chemotherapy, and targeted therapy as independent predictors of longer survival.
Conclusion
For metastatic colon cancer patients presenting with intestinal obstruction, palliative resection may offer a survival advantage. However, this benefit diminishes in patients over 70 years of age. Additionally, resection is associated with a higher rate of stoma formation. Therefore, individualized treatment decisions are warranted when choosing between palliative resection and palliative stenting in metastatic colonic cancer patients.

Anorectal benign disease

New anatomical insight into the muscular structure of the anal canal: revealing Treitz muscle as a directional shift of the internal anal sphincter: Satoru Muro, Kumiko Yamaguchi, Naoko Inoshita, Yasuo Nakajima, Danyo Jennifer Edinam, Akimoto Nimura, Keiichi Akita; Ann Coloproctol. 2025;41(6):501-509. Published online December 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00647.0092

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Abstract PDF

Purpose
Understanding the muscular structure of the anal canal is crucial for the diagnosis and treatment of anorectal diseases. Treitz muscle is a vital yet poorly understood component. It supports the anal venous plexus and contributes to anal cushion formation. However, its anatomical details remain unclear, and various theories suggest different origins for its muscle bundles, which affects our understanding of the pathophysiology of hemorrhoids. In this study, we sought to clarify the origin and localization of Treitz muscle to provide an anatomical foundation for understanding anal function.
Methods
In this descriptive cadaveric study of 11 cadavers, we performed macroscopic examinations and immunohistological analyses on tissues from the anterior, lateral, and posterior walls of the anal canal. The origin and localization of Treitz muscle were qualitatively evaluated.
Results
Treitz muscle is a smooth muscle formed by a directional change in the muscle bundles of the internal anal sphincter, running longitudinally along its surface. A shift in the direction of muscle bundles originating from the internal anal sphincter, giving rise to Treitz muscle, was frequently observed in the anterolateral wall of the anal canal.
Conclusion
In summary, Treitz muscle, a smooth muscle extending from the internal anal sphincter, is considered part of the muscularis propria. Its directional shift was localized to the anterolateral wall, indicating that Treitz muscle is not uniformly distributed around the anal canal. This site-specific localization may influence the risk of hemorrhoids or cancer invasion depending on its anatomical position.

Citations

Citations to this article as recorded by

Histological architecture of the intersphincteric region of the anal canal: implications for the anatomical basis of anal fistula pathways
Satoru Muro, Yasuo Nakajima, Akimoto Nimura, Keiichi Akita
International Journal of Colorectal Disease.2026;[Epub] CrossRef

Complications

Preoperative magnetic resonance imaging–based radiomics nomogram model for predicting postoperative anastomotic leakage in colorectal cancer: Junfeng Yan, Qiushuang Wang, Qiang Li, Jiatong Lu, Qiang Tong; Ann Coloproctol. 2025;41(6):554-564. Published online December 26, 2025; DOI: https://doi.org/10.3393/ac.2025.00689.0098

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Abstract PDF Supplementary Material: Purpose
Anastomotic leakage (AL) is a serious postoperative complication after colorectal cancer surgery, and accurate preoperative prediction remains challenging. This study aimed to develop and validate a magnetic resonance imaging (MRI)–based radiomics nomogram for the preoperative prediction of AL.
Methods
A total of 146 patients with colorectal cancer, including 11 with AL, were retrospectively enrolled and randomly divided into training and validation cohorts at a 7:3 ratio. Clinical variables and preoperative MRI-based radiomic features were analyzed. A clinical model was constructed using logistic regression. Radiomic features were selected using the least absolute shrinkage and selection operator method to develop a radiomics model, from which a radiomic score was calculated. A combined radiomics nomogram integrating the radiomic score and significant clinical factors was subsequently established. Model performance was evaluated using receiver operating characteristic curve analysis in both cohorts.
Results
The clinical model achieved an area under the curve (AUC) of 0.766 in the training cohort and 0.583 in the validation cohort. The radiomics model demonstrated improved discrimination, with AUCs of 0.822 and 0.800, respectively. The combined radiomics nomogram showed the best predictive performance, yielding AUCs of 0.869 in the training cohort and 0.858 in the validation cohort.
Conclusion
The proposed MRI-based radiomics nomogram demonstrates good predictive performance for postoperative anastomotic leakage and may serve as a useful tool for preoperative risk stratification in patients with colorectal cancer.

Complications

Effects of prune consumption on the incidence of low anterior resection syndrome: a randomized controlled trial: Dae Hee Pyo, Jung Kyong Shin, Jung Wook Huh, Hee Cheol Kim, Seong Hyeon Yun, Woo Yong Lee, Yoonah Park, Yong Beom Cho; Ann Coloproctol. 2025;41(6):510-518. Published online December 12, 2025; DOI: https://doi.org/10.3393/ac.2025.00514.0073

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Graphical Abstract Abstract PDF

Purpose
Low anterior resection syndrome (LARS) is common and devastating complication for patients with rectal cancer who have undergone sphincter-sparing surgery. Prunes are a fiber-rich fruit being effective in treating chronic constipation. The aim of this study was to investigate the effect of prune consumption on the incidence of LARS.
Methods
A prospective, double-arm, parallel, nonblinded, randomized controlled trial was conducted from September 2019 to March 2021 at a single tertiary center for patients who underwent low anterior resection. Patients randomized to the prune group consumed prune daily for 2 weeks after surgery, while those in the no-prune group did not. The primary outcome was the incidence of major LARS at 3 weeks after surgery.
Results
A total of 130 patients were randomized and 118 completed the study (81 men, 37 women), including 55 patients (46.6%) in the prune group and 63 patients (53.4%) in the no-prune group. LARS was confirmed in 15 patients (27.3%) in the prune group and 47 patients (74.6%) in the no-prune group (P<0.001). The incidence of major LARS was also significantly lower in the prune group (18.2% vs. 61.9%, P<0.001). Multivariable analysis showed that the level of anastomosis and prune consumption were significantly associated with the incidence of LARS. The prune group had higher emotional scores and lower symptom scores for constipation, sleep disturbance, and loss of appetite in the quality-of-life questionnaire.
Conclusion
Prune consumption significantly reduced the incidence of LARS and improved quality of life after low anterior resection. Trial registration: CRIS identifier: KCT0006085 (registered on September 1, 2019).

Citations

Citations to this article as recorded by

Advances in Diagnosis and Treatment of Low Anterior Resection Syndrome in Chinese and Western Medicine
小琴彭
Advances in Clinical Medicine.2026; 16(02): 2174. CrossRef

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.

Citations

Citations to this article as recorded by

Risk of high-grade infections in colorectal cancer patients treated with anti-EGFR monoclonal antibodies: a meta-analysis of randomized controlled trials
Xueliang Chen, Cui Liu, Hualin Liao
Frontiers in Oncology.2026;[Epub] CrossRef
Molecular Targeting of EGFR, BRAF, and HER2 Signaling in Colorectal Cancer: Contemporary Advances with Panitumumab, Encorafenib, and Tucatinib
Piotr Kawczak, Tomasz Bączek
Journal of Clinical Medicine.2026; 15(6): 2387. CrossRef

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.

Citations

Citations to this article as recorded by

Small bowel metastasis from colorectal cancer in patients with inflammatory bowel disease: a diagnostic challenge
Timothy James Ford, Deloshaan Subhaharan, Sneha John, Pradeep Kakkadasam Ramaswamy
BMJ Case Reports.2026; 19(4): e270330. CrossRef
Development and external validation of a preoperative CT body composition-based model for predicting postoperative metastasis in colorectal cancer: a multicenter retrospective cohort study
Ke Yin, Wenjuan Ba, Rongyu Zhou, Guanyi Liao, Qingling Li, Jinjun Guo
Abdominal Radiology.2026;[Epub] CrossRef

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.

Citations

Citations to this article as recorded by

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

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

Learning curve for robot-assisted rectal resection using the hinotori™ surgical robot system: a risk-adjusted cumulative sum analysis in a surgical team without prior robotic surgery experience
Akiyoshi Ikebata, Koji Okabayashi, Kohei Shigeta, Hiroyuki Hazama, Masayo Ogiri, Jae-Hoon Yoo, Yumi Egashira, Ryusuke Amemiya, Shinichi Tsuwano, Shigeo Hayatsu
Journal of Robotic Surgery.2026;[Epub] CrossRef
Beyond multiport DaVinci®: a closer look at less commonly used robotic systems in resectional colorectal surgery
Rahul Bhome, Subash P Vasudevan
Journal of Robotic Surgery.2026;[Epub] CrossRef
Early Clinical Experience With the Hinotori Robotic Surgical System: Comparable Perioperative Outcomes With the da Vinci Platform in Primary Lung Cancer
Yasuaki Kubouchi, Ryota Yasuda, Yuji Nozaka, Wakako Fujiwara, Shinji Matsui, Yugo Tanaka
Asian Journal of Endoscopic Surgery.2026;[Epub] CrossRef
Global Evolution of Robotic Colorectal Surgery: Lessons from Hong Kong’s Innovation and Implementation
Trevor M. Yeung, Justin N. F. Lam, Rossetti H. Y. Lam, Simon S. Ng
Cancers.2026; 18(8): 1259. CrossRef
Comparative study of robot-assisted surgery for right-sided colon cancer: a propensity score–matched analysis of the hinotori Surgical Robot System and the da Vinci Surgical System
Koji Morohara, Hidetoshi Katsuno, Tomoyoshi Endo, Kenichi Nakamura, Kazuhiro Matsuo, Kazuki Tsujimura, Tetsuya Koide, Takashi Imanaka, Tomohiro Kubo, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise
Annals of Coloproctology.2026; 42(2): 237. CrossRef
Beyond the era of monopoly to diversity: new horizons in robotic colorectal cancer surgery
Jeonghee Han
Annals of Coloproctology.2026; 42(2): 149. CrossRef
Experience with hinotori^TM, the Japan-made Surgical Robotic System, in the Initial 94 Cases of Colorectal Cancer
Takehito Yamamoto, Yoshiro Itatani, Koya Hida, Hiromitsu Kinoshita, Ryosuke Okamura, Masahiro Maeda, Yu Yoshida, Nobuaki Hoshino, Keiko Kasahara, Hisatsugu Maekawa, Ryuhei Aoyama, Kazutaka Obama
Journal of the Anus, Rectum and Colon.2026; 10(2): 213. CrossRef
Robotic-Assisted Surgery for Colorectal Cancer Treatment in 2026: An Updated Narrative Review
Cammarata Roberto, La Vaccara Vincenzo, Catamerò Alberto, Bani Lucrezia, Castagliuolo Pierpaolo, Giordano Federica, Castagna Vittoria, Coppola Roberto, Caputo Damiano
Journal of Clinical Medicine.2026; 15(10): 3714. CrossRef
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.

Citations

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Prognostic significance of integrating pretreatment biopsy-derived Immunoscore and Pan-Immune-Inflammation value in locally advanced rectal cancer after neoadjuvant chemoradiotherapy
Min Joon Kim, Hye Won Lee, Da In Shin, Woon Kyung Jeong, Seong Kyu Baek, Sung Uk Bae
Clinical and Translational Radiation Oncology.2026; 59: 101172. CrossRef
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

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.

Citations

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Expert Review on the Quality of Responses to the Questions of Multiple Myeloma Patients: A Validation Study of the Medical Artificial Intelligence System “Myelobot”
Aleksander Sergeevich Luchinin, O. E. Ochirova, V. G. Potapenko, V. V. Ryabchikova
Clinical Oncohematology.2026; 19(1): 81. CrossRef
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Sayedur Rahman, Md. Tanzib Hosain, Nafiz Fahad, Md. Kishor Morol, Md. Jakir Hossen
Array.2026; 29: 100676. CrossRef
Artificial intelligence in gastroenterology clinical practice: Scoping review of large language model applications
Yigit Yazarkan, Gamze Sonmez, Cem Simsek
International Journal of Medical Informatics.2026; 214: 106413. CrossRef
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Sun Huh
Healthcare Informatics Research.2025; 31(4): 317. CrossRef
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Zilin Qiu, Aimin Jiang, Chang Qi, Wenyi Gan, Lingxuan Zhu, Weiming Mou, Dongqiang Zeng, Mingjia Xiao, Guangdi Chu, Shengkun Peng, Hank Z. H. Wong, Lin Zhang, Hengguo Zhang, Xinpei Deng, Quan Cheng, Bufu Tang, Yaxuan Wang, Jian Zhang, Anqi Lin, Peng Luo
Journal of Translational Medicine.2025;[Epub] CrossRef

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

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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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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.

Citations

Citations to this article as recorded by

Comments on “Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study”
Nabil Mohammad Azmi, Mohd Firdaus Mohd Hayati, Zairul Azwan Mohd Azwan
Annals of Coloproctology.2025; 41(6): 596. CrossRef
In reply to: Comments on "Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study”
Daniela Rega, Carmela Cevone, Paolo Delrio
Annals of Coloproctology.2025; 41(6): 598. CrossRef

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.

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Single-port EDGE SP1000 versus multi-port Da Vinci Xi robot-assisted radical prostatectomy: a comparative analysis of technique and perioperative outcomes
Jialong Zhang, Longxiang Zhou, Hao Li, Hexi Du, Hongzhi Wang, Sheng Tai, Chaozhao Liang
Journal of Robotic Surgery.2026;[Epub] CrossRef
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.

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The role of matrix metalloproteinase 9 in immune-mediated skin diseases
Ke Xu, Min Li, Fengming Hu, Jian Gong, Fangrong Liu, Qiao Liu, Weiwei Wu
Frontiers in Immunology.2026;[Epub] CrossRef
Interplay Between TLR4 and Gelatinases in Tumour Growth and Metastasis
Abdulfattah Al-Kadash, Peter Michael Moyle, Marie-Odile Parat
Cells.2026; 15(9): 822. 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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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.

Citations

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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

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

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Graphical Abstract Abstract PDF

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

Citations

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Total neoadjuvant therapy in rectal cancer: The FOREST protocol, a patient‐centered approach that clusters two cohorts with different outcomes
Hector Guadalajara, Jose Luis Domínguez‐Tristancho, Raquel Fuentes Mateo, Miguel Leon‐Arellano, Raquel Sanz‐Baro, Eleonora Geraldi, Ana Isabel Hormigo‐Sanchez, Víctor Manuel Castellano Megías, Marta Pérez Cobos, Patricia Mellado Miras, Begoña Lopez‐Botet
International Journal of Cancer.2026; 158(3): 697. CrossRef
Organ preservation in rectal cancer: Clinical basis of the watch-and-wait strategy
Rosa M. Jimenez-Rodriguez, Fátima Aguilar-del-Castillo, Felipe Quezada-Diaz, Julio García-Aguilar
Cirugía Española (English Edition).2026; 104(1): 800248. CrossRef
Preservación del órgano en cáncer de recto: fundamentos clínicos de la estrategia watch-and-wait
Rosa M. Jimenez-Rodriguez, Fátima Aguilar-del-Castillo, Felipe Quezada-Diaz, Julio García-Aguilar
Cirugía Española.2026; 104(1): 800248. CrossRef
Pathological Complete Response in Rectal Cancer Patients: A Correlation Between Pathological and Clinical Stage and Oncological Outcome
Ana Grigoraș, Dragoș-Viorel Scripcariu, Ionuț Huțanu, Bogdan Filip, Mihaela-Mădălina Gavrilescu, Maria-Gabriela Aniței, Gheorghe Bălan, Viorel Scripcariu
Cancers.2026; 18(2): 223. CrossRef
Clinical–Pathologic Response Discordance After Neoadjuvant Therapy in Rectal Cancer and Its Prognostic Implications
Aysun Arslantas Erken, Selvi Tabak Dincer
Asia-Pacific Journal of Clinical Oncology.2026;[Epub] CrossRef
The Shifting and Evolving Neoadjuvant Treatments and Surgical Platforms on Oncological Outcomes and Sphincter Preservation in Distal Rectal Cancer: A 23-Year Retrospective Experience
Niyaz Shadmanov, Vusal Aliyev, Barıs Bakır, Suha Goksel, Oktar Asoglu
Journal of Gastrointestinal Cancer.2025;[Epub] CrossRef
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

Guideline

ERAS

The 2024 Korean Enhanced Recovery After Surgery (ERAS) guidelines for colorectal cancer: a secondary publication: Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park, the Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition; Ann Coloproctol. 2025;41(1):3-26. Published online February 20, 2025; DOI: https://doi.org/10.3393/ac.2024.00836.0119

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The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition was established to develop ERAS guidelines tailored to the Korean context. This guideline focuses on creating the most current evidence-based practice guidelines for ERAS purposes, based on systematic reviews. All key questions targeted randomized controlled trials exclusively, and if fewer than 2 were available, studies employing propensity score matching were also included. Recommendations for each key question were marked with strength of recommendation and level of evidence following internal and external review processes by the committee.

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Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Laparoscopic Colorectal Surgery: A Systematic Review and Meta-Analysis
Abdullah M. Alharran, Waleed Bader Alazemi, Saad A. Alajmi, Yousiff A. Bahman, Osamah Alhajri, Ali A. Alenezi, Jarrah J. Alenezi, Duaij Salman Saif
Medicina.2026; 62(1): 92. CrossRef
Clinical impact of acupuncture on post-operative nausea and vomiting (PONV) in enhanced recovery after surgery (ERAS) protocols for patients undergoing colorectal surgery: A case control study
Luisa Ciatti, Piercarlo Ballo, Barbara Berti, Chiara Fricelli, Giulia Ferri, Martina Martinelli, Virginia Manetti, Duccio Conti
Saudi Journal of Anaesthesia.2026; 20(2): 351. CrossRef
ERAS compliance outweighs patient risk in high-risk colon cancer surgery
Jeonghyun Kang
Annals of Surgical Treatment and Research.2026; 110(4): 203. CrossRef
Advances in ERAS to Reduce the Incidence of Chronic Post-Surgical Pain and Persistent Postoperative Opioid Use: A Narrative Review
Zhiyou Peng, Pavan Tankha, Zhiying Feng, Jijun Xu
Journal of Investigative Surgery.2026;[Epub] CrossRef
Efficacy of preoperative immunonutrition in malnourished patients undergoing colorectal cancer surgery: a study protocol for a multicenter randomized clinical trial
Soo Young Lee, Chang Hyun Kim, Gi Won Ha, Soo Yeun Park, In Jun Yang, Jin Soo Kim, Gyung Mo Son, Sung Il Kang, Sung Uk Bae
Trials.2025;[Epub] CrossRef
Oral antibiotics alone for bowel preparation in colorectal surgery: time to rethink tradition?
Soo Young Lee
Annals of Coloproctology.2025; 41(5): 367. CrossRef

Original Article

Colorectal cancer

Comparison of colorectal cancer surgery patients in intensive care between rural and metropolitan hospitals in Australia: a national cohort study: Jessica A. Paynter, Zakary Doherty, Chun Hin Angus Lee, Kirby R. Qin, Janelle Brennan, David Pilcher; Ann Coloproctol. 2025;41(1):68-76. Published online January 24, 2025; DOI: https://doi.org/10.3393/ac.2024.00269.0038

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Purpose
A small proportion of colorectal cancer (CRC) surgical patients will require an admission to an intensive care unit (ICU) within the early postoperative period. This study aimed to compare the characteristics and outcomes of patients admitted to an ICU following CRC surgery per hospital type (metropolitan vs. rural) over a decade in Australia.
Methods
A retrospective cohort analysis was undertaken of all adult patients admitted to a participating Australian ICUs following CRC surgery between January 2011 and December 2021. The primary outcome was in-hospital mortality.
Results
Over the 10-year period, 19,611 patients were treated in 122 metropolitan ICUs and 4,108 patients were treated in 42 rural ICUs. Rural ICUs had a lower proportion of annual admissions following CRC surgery (20 vs. 36, P<0.001). Patients admitted to a rural ICU were more likely to have undergone emergency CRC surgery compared to those admitted to a metropolitan cohort (28.5% vs. 13.8%, P<0.001). There was no difference in in-hospital mortality between metropolitan and rural hospitals (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.73–1.35; P=0.500). There was a general trend for lower mortality in later years of the study with the odds of death in the final year of the study (2021) almost half that of the first study year (OR, 0.52; 95% CI, 0.34–0.80; P=0.003).
Conclusion
There was no difference between in-hospital mortality outcomes for CRC surgical patients requiring ICU admission between metropolitan and rural hospitals. These findings may contribute to discussions regarding rural scope of colorectal practice within Australia and globally.

Citations

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Intensive care unit outcomes and prognostic factors of colorectal cancer
Qian Dong, Rui Xia, Xue-Zhong Xing, Chang-Song Wang, Gang Ma, Hong-Zhi Wang, Biao Zhu, Jiang-Hong Zhao, Dong-Min Zhou, Li Zhang, Ming-Guang Huang, Rong-Xi Quan, Yong Ye, Guo-Xing Zhang, Zheng-Ying Jiang, Bing Huang, Shan-Ling Xu, Yun Xiao, Lin-Lin Zhang,
World Journal of Gastrointestinal Oncology.2025;[Epub] CrossRef

Review

Colorectal cancer

Beyond survival: a comprehensive review of quality of life in rectal cancer patients: Won Beom Jung; Ann Coloproctol. 2024;40(6):527-537. Published online December 20, 2024; DOI: https://doi.org/10.3393/ac.2024.00745.0106

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Abstract PDF

Rectal cancer is one of the most common carcinomas and a leading cause of cancer-related mortality. Although significant advancements have been made in the treatment of rectal cancer, the deterioration of quality of life (QoL) remains a challenging issue. Various tools have been developed to assess QoL, including the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale, the QLQ-C30 and QLQ-CR29 by the European Organization for Research and Treatment of Cancer (EORTC), and the 36-Item Short Form Health Survey (SF-36). Factors such as the lower location of the tumor, radiation therapy, chemoradiotherapy, and chemotherapy are associated with a decline in QoL. Furthermore, anastomotic leakage following rectal cancer resection is an important risk factor affecting QoL. With the development of novel treatment approaches, including neoadjuvant therapies such as chemoradiotherapy and total neoadjuvant therapy, the rate of clinical complete remission has increased, leading to the emergence of organ-preserving strategies. Both local excision and the “watch-and-wait” approach following neoadjuvant therapy improved functional outcomes and QoL. Efforts to improve QoL after rectal cancer surgery are ongoing in surgical techniques for rectal cancer. Since QoL is determined by a complex interplay of factors, including the patient's physical condition, surgical techniques, and psychological and social elements, a comprehensive approach is necessary to understand and enhance it. This review aims to describe the methods for measuring QoL in rectal cancer patients after surgery, the key risk factors involved, and various strategies and efforts to improve QoL outcomes.

Citations

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Quality of Life and Functional Outcomes After Rectal Cancer Surgery: A Comparative Study Applying EORTC QLQ-C30, QLQ-CR29, and LARS Score at 1–6 Months Postoperatively
Floris Cristian Stanculea, Claudiu O. Ungureanu, Octav Ginghina, Razvan A. Stoica, Raul Mihailov, Valerii Lutenco, Valentin T. Grigorean, Mircea Litescu, Niculae Iordache
Healthcare.2026; 14(9): 1203. CrossRef
Watch‑and‑wait in rectal cancer: A critical appraisal of promise, perils and unresolved contours of organ preservation (Review)
Xinqiang Zhu, Beibei Ge, Linchun Wen, Siwei Shan
Oncology Letters.2026; 32(1): 1. CrossRef
Meeting report on the 8th Asian Science Editors’ Conference and Workshop 2024
Eun Jung Park
Science Editing.2025; 12(1): 66. CrossRef
Editorial: Organ preservation for rectal cancer patients
Ionut Negoi, John R. T. Monson, Leonardo Bustamante-Lopez, Zoe Garoufalia, Vito D'Andrea, Sameh Hany Emile
Frontiers in Surgery.2025;[Epub] CrossRef
Sphincter-preserving surgical techniques in low rectal cancer management: A systematic review of contemporary evidence
Song Wang, A-Jian Li, Hui-Hong Jiang, Yin Lin, Hai-Bo Ding
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Non-operative management of locally advanced rectal cancer with an emphasis on outcomes and quality of life: a narrative review
In Ja Park
Ewha Medical Journal.2025; 48(3): e40. CrossRef
Strategies to reduce intestinal toxicity in neoadjuvant management of locally advanced rectal cancer
Hoda Mahdavi, Sahar Dashti, Shima Jafari
Discover Oncology.2025;[Epub] CrossRef

Original Articles

Minimally invasive surgery

Robotic surgery may lead to reduced postoperative inflammatory stress in colon cancer: a propensity score–matched analysis: Eun Ji Park, Gyong Tae Noh, Yong Joon Lee, Min Young Park, Seung Yoon Yang, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Kang Young Lee, Byung Soh Min; Ann Coloproctol. 2024;40(6):594-601. Published online December 6, 2024; DOI: https://doi.org/10.3393/ac.2024.00171.0024

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Abstract PDF Supplementary Material

Purpose
Robot-assisted surgery is readily applied to every type of colorectal surgeries. However, studies showing the safety and feasibility of robotic surgery (RS) have dealt with rectal cancer more than colon cancer. This study aimed to investigate how technical advantages of RS can translate into actual clinical outcomes that represent postoperative systemic response.
Methods
This study retrospectively reviewed consecutive cases in a single tertiary medical center in Korea. Patients with primary colon cancer who underwent curative resection between 2006 and 2012 were included. Propensity score matching was done to adjust baseline patient characteristics (age, sex, body mass index, American Society of Anesthesiologists physical status, tumor profile, pathologic stage, operating surgeon, surgery extent) between open surgery (OS), laparoscopic surgery (LS), and RS groups.
Results
After propensity score matching, there were 66 patients in each group for analysis, and there was no significant differences in baseline patient characteristics. Maximal postoperative leukocyte count was lowest in the RS group and highest in the OS group (P=0.021). Similar results were observed for postoperative neutrophil count (P=0.024). Postoperative prognostic nutritional index was highest in the RS group and lowest in the OS group (P<0.001). The time taken to first flatus and soft diet resumption was longest in the OS group and shortest in the RS group (P=0.001 and P<0.001, respectively). Among all groups, other short-term postoperative outcomes such as hospital stay and complications did not show significant difference, and oncological survival results were similar.
Conclusion
Better postoperative inflammatory indices in the RS group may correlate with their faster recovery of bowel motility and diet resumption compared to LS and OS groups.

Citations

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Laparoscopic surgery should be a viable option for T4 colon cancer: evidence from a propensity score matching analysis
Xiaomei Jiang, Hang Zhou, Zhaoyang Zheng, Xiaodong Wang, Zongguang Zhou, Lie Yang
Updates in Surgery.2026; 78(2): 591. CrossRef
Open, Laparoscopic, and robotic approaches in colorectal surgery: a comprehensive review with focus on colorectal cancer
Farhad Shafiei, Fatemeh Kani, Nargess Porkar, Maede Mirzaee, Fatemeh Heidarzadeh, Mahdi Kolivand, Soheila Behdad, Amir Shokri
Journal of Robotic Surgery.2026;[Epub] CrossRef
Impact of Preoperative Neutrophil Percentage-to-Albumin Ratio (NPAR) on Short-Term Complications and Long-Term Prognosis in Patients Undergoing Robot-Assisted Laparoscopic Radical Surgery for Colorectal Cancer
Jing Wang, Tao Hu, Nanhui Yu
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef
Learning curve for Da Vinci Single-Port robotic colorectal cancer surgery: impact of prior robotic experience
Soo Young Lee, Chang Hyun Kim, Jaram Lee, Hyeung-min Park, Hyeong Rok Kim
Surgical Endoscopy.2026;[Epub] CrossRef
Systemic inflammatory response after robotic versus laparoscopic abdominal surgery: a systematic review and meta-analysis with colorectal cancer subgroup analysis
Taya Keating, C. Drumm, Niall Kennedy, C. Cullinane, E. Condon, M. Fitzgerald, C. Peirce, J. Calvin Coffey, Christina A. Fleming
Journal of Robotic Surgery.2026;[Epub] CrossRef
Übergangsphase zur roboterassistierten Chirurgie beim kolorektalen Karzinom: eine vergleichende konsekutive Kohortenstudie
U. A. Dietz, M. Kalisvaart, S. Maksimovic, R. Frey, M. Ramser, B. M. Erhart, U. Pfefferkorn
Die Chirurgie.2025; 96(11): 942. CrossRef
Comparative clinical efficacy of three surgical modalities for the treatment of malignant tumours of the left hemicolon
Hao Chen, Dong-Ping Han, Jian-Yang Xiong, Zhen-Sheng Li, Teng-Cheng Hu, Zheng-Rong Li, Yi Cao
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Comparison of the perioperative outcomes of robotic vs. open distal pancreatectomy: a meta-analysis of propensity-score-matched studies
Junjie Wang, Yuanjun Liu, Yakun Wu
Frontiers in Surgery.2025;[Epub] CrossRef
Effectiveness of Guardix-SG in Preventing Postoperative Bowel Complications After Radical Cystectomy: A Single-Arm Prospective Observational Study
Jiwoong Yu, Wan Song, Minyong Kang, Hyun Hwan Sung, Hwang Gyun Jeon, Seong Il Seo, Seong Soo Jeon, Byong Chang Jeong
Journal of Urologic Oncology.2025; 23(3): 253. CrossRef

Colorectal cancer

Preventive efficacy of hydrocortisone enema for radiation proctitis in rectal cancer patients undergoing short-course radiotherapy: a phase II randomized placebo-controlled clinical trial: Mohammad Mohammadianpanah, Maryam Tazang, Nam Phong Nguyen, Niloofar Ahmadloo, Shapour Omidvari, Ahmad Mosalaei, Mansour Ansari, Hamid Nasrollahi, Behnam Kadkhodaei, Nezhat Khanjani, Seyed Vahid Hosseini; Ann Coloproctol. 2024;40(5):506-514. Published online October 22, 2024; DOI: https://doi.org/10.3393/ac.2024.00192.0027

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Abstract PDF

Purpose
This study aimed to investigate the efficacy of hydrocortisone enema in preventing radiation proctitis in patients with rectal cancer undergoing short-course radiotherapy (SCRT).
Methods
This phase II randomized controlled trial enrolled patients with newly diagnosed locally advanced rectal cancer (clinically staged T3–4 and/or N1–2M0). Participants received a median of 4 cycles of neoadjuvant chemotherapy (capecitabine plus oxaliplatin) followed by 3-dimensional conformal SCRT (25 Gy in 5 fractions). Patients were randomly assigned to receive either a hydrocortisone enema (n=50) or a placebo (n=51) once daily for 5 consecutive days during SCRT. The primary endpoint was the incidence and severity of acute proctitis.
Results
Of the 111 eligible patients, 101 were included in the study. Baseline characteristics, including sex, age, performance status, and tumor location, were comparable across the treatment arms. None of the patients experienced grade 4 acute gastrointestinal toxicity or had to discontinue treatment due to treatment-related adverse effects. Patients in the hydrocortisone arm experienced significantly less severe proctitis (P<0.001), diarrhea (P=0.023), and rectal pain (P<0.001) than those in the placebo arm. Additionally, the duration of acute gastrointestinal toxicity following SCRT was significantly shorter in patients receiving hydrocortisone (P<0.001).
Conclusion
Hydrocortisone enema was associated with a significant reduction in the severity of proctitis, diarrhea, and rectal pain compared to placebo. Additionally, patients treated with hydrocortisone experienced shorter durations of gastrointestinal toxicity following SCRT. This study highlights the potential benefits of hydrocortisone enema in managing radiation-induced toxicity in rectal cancer patients undergoing radiotherapy.

Citations

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Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef

ERAS

Impact of an Enhanced Recovery After Surgery (ERAS) program on the management of complications after laparoscopic or robotic colectomy for cancer: Victoria Weets, Hélène Meillat, Jacques Emmanuel Saadoun, Marie Dazza, Cécile de Chaisemartin, Bernard Lelong; Ann Coloproctol. 2024;40(5):440-450. Published online September 20, 2024; DOI: https://doi.org/10.3393/ac.2023.00850.0121

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
Enhanced Recovery After Surgery (ERAS) reduces postoperative complications (POCs) after colorectal surgery; however, its impact on the management of POCs remains unclear. This study compared the diagnosis and management of POCs before and after implementing our ERAS protocol after laparoscopic or robotic colectomy for cancer and examined the short- and mid-term oncologic impacts.
Methods
This single-center, retrospective study evaluated all consecutive patients who underwent laparoscopic or robotic colectomy for cancer between 2012 and 2021, focusing on the incidence of POCs within 90 days. We compared outcomes before (standard group) and after (ERAS group) the implementation of our ERAS protocol in January 2016.
Results
Significantly fewer patients in the ERAS group developed POCs (standard vs. ERAS, 136 of 380 patients [35.8%] vs.136 of 660 patients [20.6%]; P<0.01). The ERAS group had a significantly shorter mean total length of stay after POCs (13.1 days vs. 11.4 days, P=0.04), and the rates of life-threatening complications (6.7% vs. 0.7%) and 1-year mortality (7.4% vs. 1.5%) were significantly lower in the ERAS group than in the standard group. Among patients with anastomotic complications, laparoscopic reoperation was significantly more common in the ERAS group than in the standard group (8.3% vs. 75.0%, P<0.01). Among patients with postoperative ileus, the diagnosis and recovery times were significantly shorter in the ERAS group than in the standard group, resulting in a shorter total length of stay (13.5 days vs. 10 days, P<0.01).
Conclusion
The implementation of an ERAS protocol did not eliminate all POCs, but it did accelerate their diagnosis and management and improved patient outcomes.

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The ultrasonographic measure of postoperative day 2 gastric volume may be a useful tool to improve the management of colorectal surgery patients: results of an ancillary study
Aurélien Venara, Anita Paisant, Julien Gillet, Lise Morgado, Emeline Rebmann, Jean-Francois Hamel
International Journal of Colorectal Disease.2026;[Epub] CrossRef
Perioperative impact of enhanced recovery after surgery (ERAS) for minimally invasive colorectal resection: a systematic review and meta-analysis
Kaiming Wen, Haoyang Wu, Bo-Wen Wu
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A cost comparison between patients undergoing robotic colorectal surgery with and without a clinical pathway
Alfonso Valenzuela Hurtado, Onur Bayram, Jörg Kleeff, Johannes Klose, Manuela De Allegri, Ulrich Ronellenfitsch
Cost Effectiveness and Resource Allocation.2026;[Epub] CrossRef
Less is more: simplifying patient-centered cancer care
In Ja Park
Annals of Coloproctology.2025; 41(3): 173. CrossRef
Research Progress on the Application of ERAS Concept in the Perioperative Period of Colorectal Cancer Patients
梦云孙
Advances in Clinical Medicine.2025; 15(08): 1208. CrossRef
Can Surgical Approach and Postoperative Factors Impact Survival in Rectal Cancer? Robotic Versus Laparoscopic Insights
Ahmed Abdelsamad, Seyidali Mirzazada, Karsten Ridwelski, Mohamad Nour Nasif, Florian Gebauer
Cancer Medicine.2025;[Epub] CrossRef
Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
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Colorectal cancer

The impact of short-course total neoadjuvant therapy, long-course chemoradiotherapy, and upfront surgery on the technical difficulty of total mesorectal excision: an observational study with an intraoperative perspective: Cheryl Xi-Zi Chong, Frederick H. Koh, Hui-Lin Tan, Sharmini Su Sivarajah, Jia-Lin Ng, Leonard Ming-Li Ho, Darius Kang-Lie Aw, Wen-Hsin Koo, Shuting Han, Si-Lin Koo, Connie Siew-Poh Yip, Fu-Qiang Wang, Fung-Joon Foo, Winson Jianhong Tan; Ann Coloproctol. 2024;40(5):451-458. Published online September 19, 2024; DOI: https://doi.org/10.3393/ac.2023.00899.0128

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Abstract PDF Supplementary Material

Purpose
Total neoadjuvant therapy (TNT) is becoming the standard of care for locally advanced rectal cancer. However, surgery is deferred for months after completion, which may lead to fibrosis and increased surgical difficulty. The aim of this study was to assess whether TNT (TNT-RAPIDO) is associated with increased difficulty of total mesorectal excision (TME) compared with long-course chemoradiotherapy (LCRT) and upfront surgery.
Methods
Twelve laparoscopic videos of low anterior resection with TME for rectal cancer were prospectively collected from January 2020 to October 2021, with 4 videos in each arm. Seven colorectal surgeons assessed the videos independently, graded the difficulty of TME using a visual analog scale and attempted to identify which category the videos belonged to.
Results
The median age was 67 years, and 10 patients were male. The median interval to surgery from radiotherapy was 13 weeks in the LCRT group and 24 weeks in the TNT-RAPIDO group. There was no significant difference in the visual analog scale for difficulty in TME between the 3 groups (LCRT, 3.2; TNT-RAPIDO, 4.6; upfront, 4.1; P=0.12). A subgroup analysis showed similar difficulty between groups (LCRT 3.2 vs. TNT-RAPIDO 4.6, P=0.05; TNT-RAPIDO 4.6 vs. upfront 4.1, P=0.54). During video assessments, surgeons correctly identified the prior treatment modality in 42% of the cases. TNT-RAPIDO videos had the highest recognition rate (71%), significantly outperforming both LCRT (29%) and upfront surgery (25%, P=0.01).
Conclusion
TNT does not appear to increase the surgical difficulty of TME.

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Left colic artery–preserving radical rectal cancer surgery: a literature review
Xiyin Yang, Yuanshui Sun, Qiang Hu
Frontiers in Surgery.2026;[Epub] CrossRef
Total Neoadjuvant Therapy Versus Conventional Chemoradiotherapy in Rectal Cancer: Impact on Tumor Regression Grade and the Predictive Value of CEA
Aikaterini Sarafi, Aikaterini Leventi, Klaountia Athitaki, Konstantinos Stamou, Ioannis Papaconstantinou, Dimitrios Korkolis
Medicina.2026; 62(1): 226. CrossRef
Laparoscopic Total Meorectal Excision and Systematic Infrarenal Para-aortic Lymph Node En Bloc Resection After Total Neoadjuvant Therapy for Rectal Cancer
Hoyeon Kwon, Soo Yeun Park
Diseases of the Colon & Rectum.2026; 69(3): 458. CrossRef
Prognostic significance of integrating pretreatment biopsy-derived Immunoscore and Pan-Immune-Inflammation value in locally advanced rectal cancer after neoadjuvant chemoradiotherapy
Min Joon Kim, Hye Won Lee, Da In Shin, Woon Kyung Jeong, Seong Kyu Baek, Sung Uk Bae
Clinical and Translational Radiation Oncology.2026; 59: 101172. CrossRef
Non-operative management of locally advanced rectal cancer with an emphasis on outcomes and quality of life: a narrative review
In Ja Park
Ewha Medical Journal.2025; 48(3): e40. CrossRef
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
Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef

Reviews

Colorectal cancer

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

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Abstract PDF

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

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F. E. C. Vande Kerckhove, D. M. J. Creemers, E. Banken, S. H. J. Ketelaers, R. R. J. Coebergh van den Braak, G. A. P. Nieuwenhuijzen, A. E. Verrijssen, A. W. Daniëls-Gooszen, T. R. van Oudheusden, S. G. van Ravensteijn, I. E. G. van Hellemond, H. J. T. Ru
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Y. Lee
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T. Sammour
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Joseph Mathew, Yogesh Kisan Bansod, Nishant Yadav, Janesh Murugan, Kovvuru Bhaskar Reddy, Mufaddal Kazi, Ashwin DeSouza, Avanish Saklani
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D. Castrodá, M. Paniagua, L. Pérez Corbal, L. Otalora, R. Oubiña, A. Parajó
Colorectal Disease.2025;[Epub] CrossRef
Learning curve for lateral lymph node dissection in rectal cancer – a systematic review of literature
D. Kehagias, L. Baldari, E. Cassinotti, L. Boni, C. Lampropoulos, I. Kehagias
Techniques in Coloproctology.2025;[Epub] CrossRef
Pelvic Neuroanatomy in Colorectal Surgery: Advances in Nerve Preservation for Optimized Functional Outcomes
Asim M. Almughamsi, Yasir Hassan Elhassan
Surgeries.2025; 6(4): 94. CrossRef
Targeting lateral pelvic lymph nodes in rectal cancer: response to neoadjuvant therapy and artificial intelligence driven clinical decision support
Ruiqing Liu, Yun Lu, Luca Stocchi
Intelligent Medicine.2025;[Epub] CrossRef
Clinical implications of radiologic criteria and prognostic factors for lateral lymph node metastasis in low rectal cancer
Gyung Mo Son
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From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef

Colorectal cancer

Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision: Daichi Kitaguchi, Masaaki Ito; Ann Coloproctol. 2024;40(4):375-383. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00178.0025

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Abstract PDF

This study aimed to review the historical transition of rectal cancer surgery and recent evidence regarding transanal total mesorectal excision (TaTME). Additionally, it outlined the anatomical landmarks and technical considerations essential for successful TaTME. Anatomical studies and surgical techniques were analyzed to identify key landmarks and procedural steps crucial for TaTME. TaTME offers improved visibility and maneuverability even in the deep and narrow pelvis and is expected to contribute to tumor radical cure rates. By securing the circumferential resection margin and distal margin while preserving pelvic autonomic nerve function, TaTME holds promise for maintaining postoperative urinary and sexual functions. Key anatomical landmarks include the endopelvic fascia posteriorly, the S4-pelvic splanchnic nerve laterally, and the prostate or posterior vaginal wall anteriorly. Selecting the appropriate dissection layer based on tumor depth and ensuring precise incision of the tendinous arch of the pelvic fascia contributes to successful TaTME outcomes. TaTME represents a significant advancement in rectal cancer surgery, offering improved outcomes through meticulous attention to anatomical detail and precise dissection techniques. Understanding the historical context of rectal cancer surgery alongside recent evidence on TaTME is essential for optimizing patient outcomes and expanding the safe implementation of this innovative approach.

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Impact of Two‐Team Surgery on Short‐ and Long‐Term Outcomes of Transanal Total Mesorectal Excision for Rectal Cancer
Nobuaki Hoshino, Koya Hida, Yukinari Tokoro, Kazutaka Obama, Takeru Matsuda, Ichiro Takemasa, Tomonori Akagi, Masafumi Inomata, Shigenori Homma, Nobuki Ichikawa, Yoshihiro Kakeji, Seiichiro Yamamoto, Takeshi Naitoh
Annals of Gastroenterological Surgery.2026; 10(3): 739. CrossRef
Successful Resection of a Large Appendiceal Mucinous Adenocarcinoma with Rectal Invasion Using a Combined Transanal Approach: A Case Report
Ikuma Shioi, Takuya Shiraishi, Yuta Shibasaki, Chika Komine, Takuhisa Okada, Katsuya Osone, Hiroomi Ogawa, Makoto Sakai, Hayato Ikota, Takahiro Shirakura, Ken Shirabe, Hiroshi Saeki
The Japanese Journal of Gastroenterological Surgery.2026; 59(5): 289. CrossRef
From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef
Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef

Original Articles

Colorectal cancer

Colonic stenting: is the bridge to surgery worth its cost? A cost-effectiveness analysis at a single Asian institution: Michelle Shi Qing Khoo, Frederick H. Koh, Sharmini Su Sivarajah, Leonard Ming-Li Ho, Darius Kang-Lie Aw, Cheryl Xi-Zi Chong, Fung Joon Foo, Winson Jianhong Tan; Ann Coloproctol. 2024;40(6):555-563. Published online August 5, 2024; DOI: https://doi.org/10.3393/ac.2023.00738.0105

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Abstract PDF

Purpose
In patients with acute left-sided colonic obstruction, stenting can convert an emergency operation into a semi-elective procedure. However, its use continues to be debated. We performed a cost-effective analysis using our institution’s experiences.
Methods
Endoscopic, surgical, and financial details were prospectively collected for patients who presented with acute colonic obstruction and underwent stenting between 2019 and 2022. Outcomes were defined as technical/clinical success and successful surgical resection. The financial cost of stenting was compared with the expected cost without stenting.
Results
Forty patients were included, with 29 undergoing definitive resection. The most common pathology was primary colon cancer (27 patients, 93%). Endoscopic stenting had high technical (90%) and clinical (83%) success rates, with low rates of complications such as perforation (2 patients, 7%) and migration (0 patients, 0%). As a bridge to surgery, the median procedure time was 226 minutes and the surgical outcomes also showed a low rate of complications (3 patients, 11%), such as anastomotic leakage (0 patients, 0%), intraabdominal abscesses (2 patients, 7%), and 30-day postoperative mortality (0 patients, 0%). The cumulative costs with colonic stenting were $32,900, while the expected costs with emergency surgery, including stoma reversal, were $40,700 (healthcare cost-savings of $7,800 per person). The difference was mainly due to the avoidance of upfront emergency surgery. The incremental cost-effectiveness ratio was 0.81, favoring colonic stenting over upfront emergency surgery.
Conclusion
Colonic stenting as a bridge to surgery is safe and cost-effective for treating left-sided colonic obstruction with high success rates and low complication rates.

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Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly
Khalid Ahmed, Ahmed Dirweesh, Zachary D. Leslie, Yasmin Ali, Nabeel Azeem, Eric Wise, Cyrus Jahansouz, Martin Freeman, Stuart K. Amateau
Techniques and Innovations in Gastrointestinal Endoscopy.2026; 28(1): 250952. CrossRef
Predictors of perforation following colorectal stenting in patients with acute intestinal obstruction
K.I. Seurko, A.N. Kosenkov, E.V. Stolyarchuk, K.I. Seurko, S.A. Grashchenko, D.A. Stribunov
Pirogov Russian Journal of Surgery.2026; (3): 33. CrossRef
Endoscopic Stenting Followed by Laparoscopic Resection in Malignant Colonic Obstruction: Oncological Safety of the Bridge-to-Surgery Approach
Deniz Öçal, Mehmet Torun
Turkish Journal of Colorectal Disease.2026;[Epub] CrossRef
Global Use and Outcomes of Endoscopic Stenting in Acute Malignant Left-Sided Colonic Obstruction: A Secondary Analysis of APOLLO, An International, Prospective Cohort Study

Diseases of the Colon & Rectum.2025; 68(12): 1458. CrossRef

Colorectal cancer

Oncologic outcomes and associated factors of colon cancer patients aged 70 years and older: Byeo Lee Lim, In Ja Park, Jun-Soo Ro, Young Il Kim, Seok-Byung Lim, Chang Sik Yu; Ann Coloproctol. 2025;41(3):198-206. Published online August 5, 2024; DOI: https://doi.org/10.3393/ac.2023.00367.0052

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7 Citations

Abstract PDF Supplementary Material

Purpose
The aim of this study was to examine the prognosis and associated risk factors, including adjuvant chemotherapy (CTx), in elderly patients with colon cancer.
Methods
This retrospective study included patients who underwent radical resection for colon cancer between January 2010 and December 2014 at Asan Medical Center. The effects of stage, risk factors, and chemotherapy on overall survival (OS) and recurrence-free survival (RFS) were compared in patients aged ≥70 and <70 years.
Results
Of 3,313 patients, 933 (28.1%) was aged ≥70 years. Of the 1,921 patients indicated for adjuvant CTx, 1,294 of 1,395 patients (92.8%) aged <70 years and 369 of 526 patients (70.2%) aged ≥70 years received adjuvant CTx. Old age (≥70 years) was independently associated with RFS in overall cohort. Among patients aged ≥70 years indicated for adjuvant CTx, the 5-year OS (81.6% vs. 50.4%, P<0.001) and RFS (82.9% vs. 67.4%, P=0.025) rates were significantly higher in those who did than did not receive adjuvant CTx. Additionally, adjuvant CTx was confirmed as independent risk factor of both OS and RFS in patients aged ≥70 years indicated for adjuvant CTx.
Conclusion
Old age was associated with poor RFS and adjuvant CTx had benefits in OS as well as RFS in elderly patients eligible for adjuvant CTx.

Citations

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Are the long-term oncologic outcomes different between appendiceal cancer and right-sided colon cancer? An exact matching analysis of a 10-year institutional cohort
Gunwoo Lee, Eun Jung Park, Soo Young Oh, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2026; 110(4): 246. CrossRef
Immunological changes and recovery-related factors in older patients with colon cancer: A pilot trial
Byeo Lee Lim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Yousun Ko, Kyung Won Kim, In Ja Park
Journal of Geriatric Oncology.2025; 16(3): 102200. CrossRef
Stage II-III colorectal cancer in geriatric patients: Clinicopathological features and chemotherapy utilization
Yakup Duzkopru, Özlem Doğan
Turkish Journal of Clinics and Laboratory.2025; 16(1): 118. CrossRef
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Peter Hofland
Onco Zine - The International Oncology Network.2025;[Epub] CrossRef
Disease-Free Survival of Patients with Stage II Stroma-Rich Colorectal Adenocarcinomas with Microsatellite Stability
Ángel Romo-Navarro, Juan Ruiz Martín, Irene García-Camacha Gutiérrez, Mariano Amo-Salas, María Recuero Pradillo, César Sánchez-Muñoz, Cristina María Murillo Lázaro, Esperanza Carabias López, Raquel Sánchez Simón, Carlos Quimbayo-Arcila, Yasmina Hernández
International Journal of Molecular Sciences.2025; 26(24): 11795. CrossRef
Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
Gyung Mo Son
Annals of Coloproctology.2024; 40(5): 415. CrossRef
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Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef

Review

Benign bowel disease

Colorectal screening following appendectomy in adult patients: a systematic review: Francesco Esposito, Marco Del Prete, Matilde Magri, Fanny Dufour, Alexandre Cortes; Ann Coloproctol. 2024;40(5):417-423. Published online August 1, 2024; DOI: https://doi.org/10.3393/ac.2023.00528.0075

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4 Citations

Abstract PDF

Purpose
Although the association between appendicitis and colorectal cancer in older patients has received attention, postoperative colorectal screening through endoscopy is not currently recommended. This study conducted a systematic review of the literature on colorectal screening following appendectomy in adult patients.
Methods
A literature search was performed using online databases. Studies reporting colorectal surveillance after appendectomy in adult patients were retrieved for assessment.
Results
Eight articles including a total of 3,995 patients were published between 2013 and 2023. An age of 40 years was the lower threshold in 6 of the 8 articles. Postoperative colorectal screening occurred in 771 patients (19.3%). Endoscopy was performed in 95.2% of cases and computed tomography–colonography in 4.8%. During endoscopic examinations, a lesion was discovered in 184 of 771 patients (24.0%), and an adenomatous polyp was found in 154 of 686 patients (22.5%). The overall cancer rate was 3.9% (30 of 771 patients). The tumor was located in the right-sided colon in 46.7% of the patients, in the cecum in 20.0%, in the rectum in 16.7%, in the left-sided colon in 10.0%, and in the sigmoid colon in 6.7%.
Conclusion
Performing post-appendectomy colorectal screening in patients >40 years of age could allow early detection of an underlying lesion.

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Are the long-term oncologic outcomes different between appendiceal cancer and right-sided colon cancer? An exact matching analysis of a 10-year institutional cohort
Gunwoo Lee, Eun Jung Park, Soo Young Oh, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2026; 110(4): 246. CrossRef
Management of Appendiceal Inflammatory Mass: Nonoperative Treatment, Malignancy Risk, and Surveillance
İlyas Kudaş, Olgun Erdem, Fatih Başak, Zeynep Şevval Aliş, Hüsna Tosun, Yahya Kemal Calışkan, Aylin Acar, Tolga Canbak, Huseyin Kerem Tolan, Kemal Tekeşin
The American Surgeon™.2026;[Epub] CrossRef
An Unusual Culprit Behind Right Lower Quadrant Pain: Cecal Adenocarcinoma Initially Suspected as Appendicitis in an Elderly Female Patient
Michail Angelos Papaoikonomou, Europi Michailidou, Aggeliki Chlorou, Nikolaos Krokos
Cureus.2025;[Epub] CrossRef
Impact of CT‐Detected Appendiceal Fecoliths on Clinical and Histopathological Outcomes in Acute Appendicitis: A Retrospective Cohort Study
Taeyoung Son, Ekua Brenu, Sergei Tsakanov, Lynne Mann
ANZ Journal of Surgery.2025; 95(12): 2550. CrossRef

Original Articles

Colorectal cancer

Obstructing colorectal cancer: a population-based review of colonic stenting in Queensland, Australia: Cian Keogh, Julie Moore, Danica Cossio, Nick Smith, David A. Clark; Ann Coloproctol. 2024;40(3):268-275. Published online June 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00640.0091

3,661 View
181 Download

Abstract PDF: Purpose
Stenting is a useful treatment option for malignant colonic obstruction, but its role remains unclear. This study was designed to establish how stents have been used in Queensland, Australia, and to review outcomes.
Methods
Patients diagnosed with colorectal cancer in Queensland from January 1, 2008, to December 31, 2014, who underwent colonic stent insertion were reviewed. Primary outcomes of 5-year survival, 30-day mortality, and overall length of survival were calculated. The secondary outcomes included patient and tumor factors, and stoma rates.
Results
In total, 319 patients were included, and distant metastases were identified in 183 patients (57.4%). The 30-day mortality rate was 6.6% (n=21), and the 5-year survival was 11.9% (n=38). Median survival was 11 months (interquartile range, 4–27 months). A further operation (hazard ratio [HR], 0.19; P<0.001) and chemotherapy and/or radiotherapy (HR, 0.718; P=0.046) reduced the risk of 5-year mortality. The presence of distant metastases (HR, 2.052; P<0.001) and a comorbidity score of 3 or more (HR, 1.572; P=0.20) increased mortality. Surgery was associated with a reduced risk of mortality even in patients with metastatic disease (HR, 0.14; P<0.001). Twenty-two patients (6.9%) ended the study period with a stoma.
Conclusion
Colorectal stenting was used in Queensland in several diverse scenarios, in both localized and metastatic disease. Surgery had a survival advantage, even in patients with metastatic disease. There was no survival difference according to whether patients were socioeconomically disadvantaged, diagnosed in a major city or not, or treated at private or public hospitals. Stenting proved a valid treatment option with low stoma rates.

Anorectal benign disease

Long-term outcomes of sacral neuromodulation for low anterior resection syndrome after rectal cancer surgery: Mario J. de Miguel Valencia, Gabriel Marin, Ana Acevedo, Ana Hernando, Alfonso Álvarez, Fabiola Oteiza, Mario J. de Miguel Velasco; Ann Coloproctol. 2024;40(3):234-244. Published online June 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00542.0077

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Abstract PDF

Purpose
This study assessed the long-term outcomes and quality of life in patients who underwent sacral neuromodulation (SNM) due to low anterior resection syndrome (LARS).
Methods
This single-center retrospective study, conducted from 2005 to 2021, included 30 patients (21 men; median age, 70 years) who had undergone total mesorectal excision with stoma closure and had no recurrence at inclusion. All patients were diagnosed with LARS refractory to conservative treatment. We evaluated clinical and quality-of-life outcomes after SNM through a stool diary, Wexner score, LARS score, the Fecal Incontinence Quality of Life (FIQL) questionnaire, and EuroQol-5D (EQ-5D) questionnaire.
Results
Peripheral nerve stimulation was successful in all but one patient. Of the 29 patients who underwent percutaneous nerve evaluation, 17 (58.62%) responded well to SNM and received permanent implants. The median follow-up period was 48 months (range, 18–153 months). The number of days per week with fecal incontinence episodes decreased from a median of 7 (range, 2–7) to 0.38 (range, 0–1). The median number of bowel movements recorded in patient diaries fell from 5 (range, 4–12) to 2 (range, 1–6). The median Wexner score decreased from 18 (range, 13–20) to 6 (range, 0–16), while the LARS score declined from 38.5 (range, 37–42) to 19 (range, 4–28). The FIQL and EQ-5D questionnaires demonstrated enhanced quality of life.
Conclusion
SNM may benefit patients diagnosed with LARS following rectal cancer surgery when conservative options have failed, and the treatment outcomes may possess long-term sustainability.

Citations

Citations to this article as recorded by

Advances in Diagnosis and Treatment of Low Anterior Resection Syndrome in Chinese and Western Medicine
小琴彭
Advances in Clinical Medicine.2026; 16(02): 2174. CrossRef
Tertiary lymphoid structures guided opportunities and challenges for immunotherapy in early gastroesophageal junction cancer and low rectal cancer
Qi Zou, Yongjian Zhang, Zhenyu Xian, Zhen Fang, Jizhun Zhang, Liang Shang, Heng Wang, Bang Hu, Zixu Chen
Human Vaccines & Immunotherapeutics.2026;[Epub] CrossRef
Low Anterior Resection Syndrome (LARS): A Contemporary Surgical Review of Incidence, Pathophysiology, Risk Stratification and Functional Outcomes
Supreet Kumar, Vivek Tandon, Deepak Govil
Apollo Medicine.2025;[Epub] CrossRef

Colorectal cancer

Lymphovascular invasion in colorectal cancers: can we predict it preoperatively?: Elbrus Zarbaliyev, Nihan Turhan, Sebahattin Çelik, Mehmet Çağlıkülekçi; Ann Coloproctol. 2024;40(3):245-252. Published online June 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00458.0065

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4 Citations

Abstract PDF

Purpose
This study aimed to investigate preoperative predictors of lymphovascular invasion (LVI), which is a poor prognostic factor usually detected postoperatively in patients with colorectal cancer.
Methods
Results for all patients operated on for colorectal cancer between January 1, 2006, and December 31, 2021, were retrospectively analyzed. Potential preoperative factors and postoperative pathology results were recorded. The patients were categorized as those with LVI and those without LVI. Potential factors that may be associated with LVI were compared between the 2 groups.
Results
The study included 335 patients. The incidence of LVI was 3.11 times higher in patients with ascending colon tumors (odds ratio [OR], 3.11; 95% confidence interval [CI], 1.34–7.23; P=0.008) and 4.28 times higher in those with metastatic tumors (OR, 4.28; 95% CI, 2.18–8.39; P<0.001). Diabetes mellitus was inversely related to LVI in colorectal cancer patients; specifically, LVI was 56% less common in colorectal cancer patients with diabetes mellitus, irrespective of its duration (OR, 0.44; 95% CI, 0.25–0.76; P<0.001).
Conclusion
The presence of preoperative LVI in colorectal cancer patients is difficult to predict. In particular, the effect of the effect of factors such as chronic disease accompanied by microvascular pathologies on LVI is still unclear. Advances in the neoadjuvant treatment of colorectal cancer patients, who are becoming more widespread every day, will encourage the investigation of different methods of preoperatively predicting LVI as a poor prognostic factor in these patients.

Citations

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A prognostic nomogram for colorectal cancer based on ubiquitin-specific protease 21 expression: a retrospective cohort study
Hua Chen, Tianhao Lao, Tong Shen, Yongqiang Wang, Jie Yang
Frontiers in Molecular Biosciences.2026;[Epub] CrossRef
Are the long-term oncologic outcomes different between appendiceal cancer and right-sided colon cancer? An exact matching analysis of a 10-year institutional cohort
Gunwoo Lee, Eun Jung Park, Soo Young Oh, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2026; 110(4): 246. CrossRef
The value of extracellular volume based on spectral CT in lymph node metastasis, perineural invasion, and lymphovascular invasion of colon cancer
Yijie Wang, Jianyao Lu, Yaomin Li, Yaying Yang, Yijun Yu, Zhengyun Sun, Yan Bi, Yuechao Guo, Qiong Zhou, Wenfen Shi, Yamin Li
Abdominal Radiology.2026;[Epub] CrossRef
Immunohistochemical Expression of MLH1, PMS2 and P53 in Colorectal Carcinoma with Clinicopathologic Correlation
Saif Raghad Saleem Alhamadani, Zainab Khalid Shehab Almukhtar
Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ).2025; 9(1): 222. CrossRef

Video

Video clip

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

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

Original Article

Minimally invasive surgery

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

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Graphical Abstract Abstract PDF

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

Citations

Citations to this article as recorded by

Meeting report on the 8th Asian Science Editors’ Conference and Workshop 2024
Eun Jung Park
Science Editing.2025; 12(1): 66. CrossRef
Preoperative Localization, Margins, and Intraoperative Endoscopy in Minimally Invasive Sigmoid Colectomy: A Matched Cohort
Chang-Lin Lin, Feng-Fan Chiang, Ming-Cheng Chen, Chun-Yu Lin, Shang-Chih Huang, Ching-Shiang Lin
Journal of Surgical Research.2025; 315: 847. CrossRef

Review

Colorectal cancer

Postoperative outcomes after prehabilitation for colorectal cancer patients undergoing surgery: a systematic review and meta-analysis of randomized and nonrandomized studies: Ian Jun Yan Wee, Isaac Seow-En, Aik Yong Chok, Eileen Sim, Chee Hoe Koo, Wenjie Lin, Chang Meihuan, Emile Kwong-Wei Tan; Ann Coloproctol. 2024;40(3):191-199. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.01095.0156

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10 Citations

Abstract PDF

Purpose
Prehabilitation (PH) is purported to improve patients’ preoperative functional status. This systematic review and meta-analysis sought to compare short-term postoperative outcomes between patients who underwent a protocolized PH program and the existing standard of care among colorectal cancer patients awaiting surgery.
Methods
A search in MEDLINE/PubMed, the Cochrane Library, Embase, Scopus, and CINAHL was conducted to identify relevant articles. Repetitive and exhaustive combinations of MeSH search terms (“prehabilitation,” “colorectal cancer,” “colon cancer,” and “rectal cancer”) were used to identify randomized and nonrandomized studies comparing PH versus standard of care for colorectal cancer patients awaiting surgery. The primary outcomes included postoperative morbidity, length of hospital stay, and readmission rates.
Results
Seven studies including 1,042 colorectal cancer patients (PH, 382) were included. No significant differences were found in intraoperative outcomes. The postoperative complication rates were comparable between groups (Clavien-Dindo grades I and II: risk ratio, 0.82; 95% confidence interval, 0.62–1.07; P=0.15; Clavien-Dindo grades ≥III: risk ratio, 1.02; 95% confidence interval, 0.72–1.44; P=0.92). There were also no significant differences in length of hospital stay (P=0.21) or the risk of 30-day readmission (P=0.68).
Conclusion
Although PH does not appear to improve short-term postoperative outcomes following colorectal cancer surgery, the quality of evidence is impaired by the limited trials and heterogeneity. Thus, further large-scale trials are warranted to draw definitive conclusions and establish the long-term effects of PH.

Citations

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The effect of myopenia, myosteatosis and visceral obesity on postoperative complications and inflammation in colorectal surgery
S.M.M. Vaes, E.G. Peters, J. Nors, C.H. Back, W.K.G. Leclercq, T.S. de Vries Reilingh, M.D.P. Luyer, B.J.J. Smeets
Clinical Nutrition ESPEN.2026; 72: 102934. CrossRef
Prehabilitation combined with early oral nutrition reduces postoperative complications and hospital stay in older patients undergoing colorectal cancer surgery: A retrospective propensity score‐matched analysis
Yasuhiro Shimamura, Shusaku Honma, Sanae Nakajima, Naomi Akazawa, Yukiko Kobayashi, Wataru Aoi, Masashi Kuwahata
Nutrition in Clinical Practice.2026;[Epub] CrossRef
Identifying Patients with Colorectal Cancer Likely to Benefit from a Trimodal Prehabilitation Prior to Surgery
Nóra Suszták, András Fülöp, Lóránd László Lakatos, Dominic Herovi, Junghyun Cho, Petra Tímár, József Golub, Izabella Mihály, József Tamás Marton, Attila Szijártó, Balázs Bánky
Nutrients.2026; 18(9): 1369. CrossRef
МАЛОІНВАЗИВНІ ТЕХНОЛОГІЇ ПРИ ХІРУРГІЧНОМУ ЛІКУВАННІ РАКУ ТОВСТОЇ КИШКИ ТА ЙОГО УСКЛАДНЕНЬ
А. І. МОЙСЕЄНКО
Шпитальна хірургія. Журнал імені Л. Я. Ковальчука.2026; (1): 118. CrossRef
The inequalities and challenges of prehabilitation before cancer surgery: a narrative review
Hilary Stewart, Sophie Stanley, Xiubin Zhang, Lisa Ashmore, Christopher Gaffney, Jo Rycroft‐Malone, Andrew F. Smith, Laura Wareing, Cliff Shelton
Anaesthesia.2025; 80(S2): 75. CrossRef
Prehabilitation in surgery – an update with a focus on nutrition
Chelsia Gillis, Arved Weimann
Current Opinion in Clinical Nutrition & Metabolic Care.2025; 28(3): 224. CrossRef
The role of exercise-based prehabilitation in enhancing surgical outcomes for patients with digestive system cancers: a meta-analysis
Shasha Xu, Rong Yin, Haiou Zhu, Yin Gong, Jing Zhu, Changxian Li, Qin Xu
BMC Gastroenterology.2025;[Epub] CrossRef
Less is more: simplifying patient-centered cancer care
In Ja Park
Annals of Coloproctology.2025; 41(3): 173. CrossRef
Postoperative Morbidity Is Not Associated with a Worse Mid-Term Quality of Life After Colorectal Surgery for Colorectal Carcinoma
Maximilian Brunner, Theresa Jendrusch, Henriette Golcher, Klaus Weber, Axel Denz, Georg F. Weber, Robert Grützmann, Christian Krautz
Journal of Clinical Medicine.2025; 14(14): 5167. CrossRef
Identifying and optimizing psychosocial frailty in surgical practice
Kurt S. Schultz, Caroline E. Richburg, Emily Y. Park, Ira L. Leeds
Seminars in Colon and Rectal Surgery.2024; 35(4): 101061. CrossRef

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