Annals of Coloproctology

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Original Articles

Benign proctology,Rare disease & stoma,Surgical technique

Comparison of blowhole colostomy and loop ostomy for palliation of acute malignant colonic obstruction: Yongjun Park, Dong Uk Choi, Hyung Ook Kim, Yong Bog Kim, Chungki Min, Jung Tack Son, Sung Ryol Lee, Kyung Uk Jung, Hungdai Kim; Ann Coloproctol. 2022;38(4):319-326. Published online March 7, 2022; DOI: https://doi.org/10.3393/ac.2021.00682.0097

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4 Citations

Purpose
Surgery to create a stoma for decompression might be required for unresectable stage IV cancer patients with complete colonic obstruction. The aim of this study was to compare the results of blowhole colostomy with those of loop ostomy.
Methods
Palliative ileostomy or colostomy procedures performed at a single center between January 2011 and October 2020, were analyzed retrospectively. Fifty-nine patients were identified during this period. The demographic characteristics and outcomes between the blowhole colostomy group (n=24) and the loop ostomy group (n=35) were compared.
Results
The median operative time tended to be shorter in the blowhole colostomy group (52.5 minutes; interquartile range [IQR], 43–65) than in the loop ostomy group (60 minutes; IQR, 40–107), but the difference did not reach statistical significance (P=0.162). The median length of hospital stay was significantly shorter with blowhole colostomy (blowhole, 13 days [IQR, 9–23]; loop, 21 days [IQR, 14–37]; P=0.013). Mean cecum diameter was significantly larger in the blowhole group than in the loop group (8.83±1.91 cm vs. 6.78±2.36 cm, P=0.001), and the emergency operation rate was higher in the blowhole group than in the loop group (22 of 24 [91.7%] vs. 23 of 35 [65.7%], P=0.021).
Conclusion
In surgical emergencies, diverting a blowhole colostomy can be safe and effective for palliative management of colonic obstruction in patients with end-stage cancer and might reduce the operative time in emergent situations.

Citations

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Transverse blowhole colostomy versus Hartmann’s for urgent management of large bowel obstruction secondary to diverticular stricture
Hannah R. Liefeld, Kristen L. Coleman, Kelsey Lawrence, James W. Ogilvie
International Journal of Colorectal Disease.2026;[Epub] CrossRef
A Last Resort: Dacron Vascular Graft Prosthesis for Management of a Blowhole Colostomy
Brittney A. Ehrlich, Maria C. Unuvar, Justin M. Orenich, Rebecca L. Hoffman
The American Surgeon™.2025; 91(2): 303. CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef
Stoma-Related Complications: A Single-Center Experience and Literature Review
Zalán Benedek, Loránd Kocsis, Orsolya Bauer, Nicolae Suciu, Sorin Sorlea, Călin Crăciun, Rareș Georgescu, Marius Florin Coroș
Journal of Interdisciplinary Medicine.2022; 7(2): 31. CrossRef

Malignant disease, Functional outcomes

Safety and Efficacy of Single-Port Laparoscopic Ileostomy in Palliative Settings: Seng-Muk Kang, Jung Rae Cho, Heung-Kwon Oh, Eun-Ju Lee, Min Hyun Kim, Duck-Woo Kim, Sung-Bum Kang; Ann Coloproctol. 2020;36(1):17-21. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2019.04.25

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1 Web of Science
2 Citations

Abstract PDF

Purpose
Single-port laparoscopic techniques can be optimized with confined incisions. This approach has an intraoperative advantage of excellent visualization of the correct intestinal segment for exteriorization, along with direct visual control of the extraction to avoid twisting. However, only a few studies have verified the efficacy of the technique. Thus, this study assessed the results of single-port laparoscopic stoma creation for fecal diversion, specifically focusing on feasibility, safety, and efficacy.
Methods
Patients who underwent single-incision enterostomy performed by a single surgeon were included. Data on demographics, indications for and chosen procedure, and operation results were retrospectively collected and analyzed.
Results
Between April 2015 and January 2018, a total of 13 patients (8 males, 5 females) with a mean age of 57.7 years (range, 41–83 years) underwent single-port ileostomy creation. The most common reason for diversion was palliative ileostomy for colon obstruction or fistula from peritoneal malignancy (n = 12), followed by colonic fistula with necrotizing pancreatitis (n = 1). There were no cases of conversion to open or multiport laparoscopic surgery. The mean operative time was 54 minutes (range, 37–118 minutes), and the median length of hospital stay was 8 days (range, 2–211 days). A postoperative complication, aspiration pneumonia, was documented in 1 patient and treated conservatively. The mean duration of bowel movement was 0.7 days (range, 0–4 days). All stomas had good function, and there was no 30-day mortality.
Conclusion
Single-port laparoscopic ileostomy in patients with a palliative setting could be a safe and feasible option for fecal diversion.

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Single port–assisted diverting ileostomy formation for anastomotic leakage after low anterior resection
Kyong-Min Kang, Heung-Kwon Oh, Hong-min Ahn, Hye-Rim Shin, Min-Hyeong Jo, Mi-Jeong Choi, Duck-Woo Kim, Sung-Bum Kang
Journal of Minimally Invasive Surgery.2025; 28(1): 47. CrossRef
Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea
Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2024; 27(1): 14. CrossRef

Case Report

Malignant disease

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

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5 Web of Science
6 Citations

Abstract PDF

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

Citations

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Metastatic sinonasal malignancies of colorectal origin: Case report and comprehensive review of the literature
Andrew J. Rothka, David Goldrich, Jessyka G. Lighthall
Clinical Case Reports.2024;[Epub] CrossRef
Surgical treatment for metastatic colorectal cancer
Eun Jung Park, Seung Hyuk Baik
Journal of the Korean Medical Association.2022; 65(9): 568. CrossRef
Recent Advance in the Surgical Treatment of Metastatic Colorectal Cancer-An English Version
Eun Jung Park, Seung Hyuk Baik
Journal of the Anus, Rectum and Colon.2022; 6(4): 213. CrossRef
A Very Rare Case of Metastases to the Nasal Cavity from Primary Rectal Adenocarcinoma
Nishant Lohia, Harish Sadashiva, Sankalp Singh, Samir Agarwal, Vikas Gupta, Manoj Prashar, Gaurav Trivedi
Clinical Cancer Investigation Journal.2022; 11(4): 1. CrossRef
Major driver mutations are shared between sinonasal intestinal-type adenocarcinoma and the morphologically identical colorectal adenocarcinoma
Sannia Sjöstedt, Ane Yde Schmidt, Filipe Garrett Vieira, Gro Linno Willemoe, Tina Klitmøller Agander, Caroline Olsen, Finn Cilius Nielsen, Christian von Buchwald
Journal of Cancer Research and Clinical Oncology.2021; 147(4): 1019. CrossRef
Rare case of metastatic adenocarcinoma to the maxillary sinus
Apurwa Prasad, Taha Alrifai, Sumathi Vijaya Rangan, Jessica Garcia
BMJ Case Reports.2021; 14(9): e244485. CrossRef

Original Articles

Prognostic Implications of Primary Tumor Resection in Stage IVB Colorectal Cancer in Elderly Patients: Heui-June Ahn, Ho-Suk Oh, Yongchel Ahn, Sang Jin Lee, Hyun Joong Kim, Moon Ho Kim, Dae-Woon Eom, Jae Young Kwak, Myoung Sik Han, Jae Seok Song; Ann Coloproctol. 2014;30(4):175-181. Published online August 26, 2014; DOI: https://doi.org/10.3393/ac.2014.30.4.175

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10 Web of Science
10 Citations

Abstract PDF

Purpose

The aim of this study was to identify prognostic factors in stage IVB colorectal cancer in elderly patients, focusing on the influence of treatment modalities, including palliative chemotherapy and primary tumor resection.

Methods

A cohort of 64 patients aged over 65 years who presented with stage IVB colorectal cancer at the Gangneung Asan Hospital between July 1, 2001, and December 31, 2009, was analyzed. Demographics, tumor location, tumor grade, performance status, levels of carcinoembryonic antigen (CEA), level of aspartate aminotransferase (AST), and distant metastatic site at diagnosis were analyzed. Using the treatment histories, we analyzed the prognostic implications of palliative chemotherapy and surgical resection of the primary tumor retrospectively.

Results

The cohort consisted of 30 male (46.9%) and 34 female patients (53.1%); the median age was 76.5 years. Primary tumor resection was done on 28 patients (43.8%); 36 patients (56.2%) were categorized in the nonresection group. The median survival times were 12.43 months in the resection group and 3.58 months in the nonresection group (P < 0.001). Gender, level of CEA, level of AST, Eastern Cooperative Oncology Group performance status, tumor location, and presence of liver metastasis also showed significant differences in overall survival. On multivariate analysis, male gender, higher level of CEA, higher AST level, and no primary tumor resection were independent poor prognostic factors. In particular, nonresection of the primary tumor was the most potent/poor prognostic factor in the elderly-patient study group (P = 0.001; 95% confidence interval, 2.33 to 21.99; hazard ratio, 7.16).

Conclusion

In stage IVB colorectal cancer in elderly patients, resection of the primary tumor may enhance survival.

Citations

Citations to this article as recorded by

Primary Tumor Resection for Metastatic Colorectal, Gastric and Pancreatic Cancer Patients: In Search of Scientific Evidence to Inform Clinical Practice
Valentina Fanotto, Francesca Salani, Caterina Vivaldi, Mario Scartozzi, Dario Ribero, Marco Puzzoni, Francesco Montagnani, Francesco Leone, Enrico Vasile, Maria Bencivenga, Giovanni De Manzoni, Debora Basile, Lorenzo Fornaro, Gianluca Masi, Giuseppe April
Cancers.2023; 15(3): 900. CrossRef
The association of blood biomarkers with treatment response and adverse health outcomes in older patients with solid tumors: A systematic review
Yara van Holstein, P. Janne E. van den Berkmortel, Stella Trompet, Diana van Heemst, Frederiek van den Bos, Marieke Roemeling-van Rhijn, Nienke A. de Glas, Marian Beekman, P. Eline Slagboom, Johanneke E.A. Portielje, Simon P. Mooijaart, Barbara C. van Mun
Journal of Geriatric Oncology.2023; 14(7): 101567. CrossRef
Survival for patients with metastatic colon cancer underwent cytoreductive colectomy in the era of rapid development of anticancer drugs: A real-world analysis based on updated population dataset of 2004–2018
Guangran Meng, Shengtao Yang, Feixiang Chen
Frontiers in Pharmacology.2022;[Epub] CrossRef
Can the De Ritis Ratio (AST/ALT) be used to predict colon cancer stages?
Saygın ALTINER, Enes CEBECİ, Bedri Burak SUCU, Mert ÇÖL, Ender ERGÜDER, Yılmaz ÜNAL, Salih TUNCAL, Mevlüt Recep PEKCİCİ
Ahi Evran Medical Journal.2022;[Epub] CrossRef
Provisional Clinical Opinions (PCOs) Recommended by the Surgical Treatment Working Group for Vulnerable Elderly Patients in Colorectal Cancer: Clinical Questions with Answers
Junichi Nishimura, Yoshio Yoshida, Chie Tanaka, Keiji Matsuda, Shiro Oka, Kohei Murata, Ju Mizuno, Yoichiro Yoshida
Nippon Daicho Komonbyo Gakkai Zasshi.2021; 74(7): 401. CrossRef
Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment
Dave E. W. van der Kruijssen, Sjoerd G. Elias, Geraldine R. Vink, Karlijn L. van Rooijen, Jorine ‘t Lam-Boer, Linda Mol, Cornelis J. A. Punt, Johannes H. W. de Wilt, Miriam Koopman, Gijs J.D. van Acker, Rahim Altaf, Kees van Arkel, Coen I.M. Baeten, Sandr
JAMA Surgery.2021; 156(12): 1093. CrossRef
Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer: A Systematic Review and Meta‐analysis
Constantinos Simillis, Eliana Kalakouti, Thalia Afxentiou, Christos Kontovounisios, Jason J. Smith, David Cunningham, Michel Adamina, Paris P. Tekkis
World Journal of Surgery.2019; 43(7): 1829. CrossRef
Meta-analysis of outcomes following resection of the primary tumour in patients presenting with metastatic colorectal cancer
U Nitsche, C Stöß, L Stecher, D Wilhelm, H Friess, G O Ceyhan
Journal of British Surgery.2018; 105(7): 784. CrossRef
A systematic analysis highlighting deficiencies in reported outcomes for patients with stage IV colorectal cancer undergoing palliative resection of the primary tumour
Deena P. Harji, Abigail Vallance, Jenny Selgimann, Simon Bach, Faheez Mohamed, Julia Brown, Nicola Fearnhead
European Journal of Surgical Oncology.2018; 44(10): 1469. CrossRef
Paradigm Shift in the Treatment of Elderly Patients With Unresectable Stage IV Colorectal Cancer
Nam Kyu Kim
Annals of Coloproctology.2014; 30(4): 155. CrossRef

Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer: Sung Kang Kim, Chang Ho Lee, Min Ro Lee, Jong Hun Kim; J Korean Soc Coloproctol. 2012;28(1):35-41. Published online February 29, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.1.35

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14 Citations

Abstract PDF

Purpose

The aim of this study was to compare survival in patients that underwent palliative resection treatment versus non-resection for incurable colorectal cancer (ICRC).

Methods

The case records of 201 patients with ICRC between January 2000 and December 2009 were reviewed. Demographics, American Society of Anesthesiologists (ASA) score, carcinoembryonic antigen (CEA) level, the location of the colon cancer, histology, metastasis, treatment options and median survival were analyzed retrospectively. We divided the patients into four groups according to the treatment modalities: resection alone, resection with post-operative chemotherapy, non-resection treatment by chemotherapy alone, and stent or bypass. Median survival times were compared according to each treatment option, and the survival rates were analyzed.

Results

105 patients underwent palliative resection whereas 96 were treated with non-resection modalities. A palliative resection was performed in 44 cases for resection alone and in 61 cases for resection with post-operative chemotherapy. In patients treated with non-resection of the primary tumor, chemotherapy alone was done in 65 cases and stent or bypass in 31 cases. Multivariate analysis showed a median survival of 14 months in patients with palliative resections with post-operative chemotherapy, which was significantly higher than those for chemotherapy alone (8 months), primary tumor resection alone (5 months), and stent or bypass (5 months). Gender, age, ASA score, CEA level, the location of colon cancer, histology and the presence of multiple metastases were not independent factors in association with the median survival rate.

Conclusion

In the treatment of ICRC, palliative resection followed by post-operative chemotherapy shows the most favorable median survival compared to other treatment options.

Citations

Citations to this article as recorded by

Incidence and determinants of mortality among patients with colorectal cancer in oncology centers of Amhara region, Ethiopia, 2024: multicenter retrospective follow up study
Getachew Tesfaw Walle, Tegene Atamenta Kitaw, Seteamlak Adane
BMC Cancer.2025;[Epub] CrossRef
Biopsy sampling during self-expandable metallic stent placement in acute malignant colorectal obstruction: a narrative review
Sigrid Skov Bennedsgaard, Lene Hjerrild Iversen
World Journal of Surgical Oncology.2021;[Epub] CrossRef
National statistics about resection of the primary tumor in asymptomatic patients with Stage IV colorectal cancer and unresectable metastases. Need for improvement in data collection. A systematic review with meta-analysis
Antonio V. Sterpetti, Umberto Costi, Giuseppe D'Ermo
Surgical Oncology.2020; 33: 11. CrossRef
Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer: A Systematic Review and Meta‐analysis
Constantinos Simillis, Eliana Kalakouti, Thalia Afxentiou, Christos Kontovounisios, Jason J. Smith, David Cunningham, Michel Adamina, Paris P. Tekkis
World Journal of Surgery.2019; 43(7): 1829. CrossRef
Long-Chain Noncoding RNAPVT1Gene Polymorphisms Are Associated with the Risk and Prognosis of Colorectal Cancer in the Han Chinese Population
Lei Zhang, Jiehong Mao
Genetic Testing and Molecular Biomarkers.2019; 23(10): 728. CrossRef
Meta-analysis of outcomes following resection of the primary tumour in patients presenting with metastatic colorectal cancer
U Nitsche, C Stöß, L Stecher, D Wilhelm, H Friess, G O Ceyhan
Journal of British Surgery.2018; 105(7): 784. CrossRef
A systematic analysis highlighting deficiencies in reported outcomes for patients with stage IV colorectal cancer undergoing palliative resection of the primary tumour
Deena P. Harji, Abigail Vallance, Jenny Selgimann, Simon Bach, Faheez Mohamed, Julia Brown, Nicola Fearnhead
European Journal of Surgical Oncology.2018; 44(10): 1469. CrossRef
Meta-analysis of oncologic effect of primary tumor resection in patients with unresectable stage IV colorectal cancer in the era of modern systemic chemotherapy
Gi Won Ha, Jong Hun Kim, Min Ro Lee
Annals of Surgical Treatment and Research.2018; 95(2): 64. CrossRef
Prognostic Implications of Primary Tumor Resection in Stage IVB Colorectal Cancer in Elderly Patients
Heui-June Ahn, Ho-Suk Oh, Yongchel Ahn, Sang Jin Lee, Hyun Joong Kim, Moon Ho Kim, Dae-Woon Eom, Jae Young Kwak, Myoung Sik Han, Jae Seok Song
Annals of Coloproctology.2014; 30(4): 175. CrossRef
A Meta-Analysis to Determine the Effect of Primary Tumor Resection for Stage IV Colorectal Cancer with Unresectable Metastases on Patient Survival
Cillian Clancy, John P. Burke, Mitchel Barry, Matthew F. Kalady, J. Calvin Coffey
Annals of Surgical Oncology.2014; 21(12): 3900. CrossRef
Palliative laparoscopic bowel resection in stage IV colorectal cancer patients with unresectable metastasis
Kwan Mo Yang, Seok-Byung Lim, Yong Sik Yoon, Chan Wook Kim, In Ja Park, Chang Sik Yu, Jin Cheon Kim
Korean Journal of Clinical Oncology.2013; 9(2): 134. CrossRef
Recent Advances in the Management of Stage IV Colon Cancer
Rani Kanthan, Jenna-Lynn Senger, Shahid Ahmed, Selliah Kanthan
Journal of Cancer Therapy.2012; 03(06): 1104. CrossRef
Kolonstents als «Bridge to Surgery»
Karl E. Grund, Annette Zipfel
Visceral Medicine.2012; 28(6): 412. CrossRef
Review and Evaluation of Methods Correcting for Population Stratification with a Focus on Underlying Statistical Principles
Hemant K. Tiwari, Jill Barnholtz-Sloan, Nathan Wineinger, Miguel A. Padilla, Laura K. Vaughan, David B. Allison
Human Heredity.2008; 66(2): 67. CrossRef

Review

Colorectal Cancer with Multiple Metastases: Is Palliative Surgery Needed?: Hong-Jo Choi, Jin Yong Shin; J Korean Soc Coloproctol. 2011;27(5):226-230. Published online October 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.5.226

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Abstract PDF

In patients with symptomatic incurable metastatic colorectal cancer (mCRC), the goal of resection of the primary lesion is to palliate cancer-related morbidity, including obstruction, bleeding, or perforation. In patients with asymptomatic primary tumors and incurable metastatic disease, however, the necessity of primary tumor resection is less clear. Although several retrospective analyses suggest survival benefit in patients who undergo resection of the primary tumor, applying this older evidence to modern patients is out of date for several reasons. Modern chemotherapy regimens incorporating the novel cytotoxic agents oxaliplatin and irinotecan, as well as the target agents bevacizumab and cetuximab, have improved median survival from less than 1 year with the only available single-agent 5-fluorouracil until the mid-1990s to over 2 years. In addition to significant prolongation of overall survival, combinations of novel chemotherapeutic and target agents have allowed improved local and distant tumor control, decreasing the likelihood of local tumor-related complications requiring surgical resection. Resection of an asymptomatic primary tumor risks surgical complications and may postpone the administration of chemotherapy that may offer both systemic and local control. In conclusion, the morbidity and the mortality of unnecessary surgery or surgery that does not improve quality of life or survival in patients with mCRC of a limited life expectancy should be carefully evaluated. With the availability of effective combinations of chemotherapy and target agents, systemic therapy for the treatment of life-threatening metastases would be a preferable treatment strategy for unresectable asymptomatic patients with mCRC.

Citations

Citations to this article as recorded by

Palliative laparoscopic bowel resection in stage IV colorectal cancer patients with unresectable metastasis
Kwan Mo Yang, Seok-Byung Lim, Yong Sik Yoon, Chan Wook Kim, In Ja Park, Chang Sik Yu, Jin Cheon Kim
Korean Journal of Clinical Oncology.2013; 9(2): 134. CrossRef

Original Article

Palliative Resection for Incurable Colorectal Cancer.: Kim, Dae Hwan , Baek, Moo Jun , Park, Nae Kyung , Lee, Moon Soo , Song, Ok Pyung; J Korean Soc Coloproctol. 1998;14(1):35-40.

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1 Download

Abstract PDF: Despite a recent trend toward increased screening and public awareness for colorectal cancer, 30% of patients present with incurable disease. This study was designed to identify objective criteria that might help surgeons decide which patients with incurable colorectal cancer will benefit from palliative resection. Among 33 patients considered incurable colorectal cancer, twenty one patients underwent palliative resection and twelve patients had bypass surgery. Incidence of postoperative complication after palliative resection was 61.9%(13 cases), and after bypass surgery was 58.3%(7 cases). Among patients treated by palliative resection, one patient required reoperation for postoperative bleeding. The operative mortality after palliative resection was 19%(4 cases), and after bypass surgery was 25%(3 cases). The median survival was 11.4 months for patients treated by palliative resection, and was 9.7 months for patients treated by bypass surgery. These results show that palliative resection can be done safely and effectively in patients with incurable colorectal cancer. We believe this approach improved the quality of the remaining life in these patients.

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