Annals of Coloproctology

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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.

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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7 Web of Science
8 Citations

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

Citations to this article as recorded by

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
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
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.2025;[Epub] CrossRef

Enhancing the Enhanced Recovery Program in Colorectal Surgery - Use of Extended-Release Epidural Morphine (DepoDur®): Rajeev Peravali, Rachael Brock, Elizabeth Bright, Patricia Mills, Dawn Petty, Justin Alberts; Ann Coloproctol. 2014;30(4):186-191. Published online August 26, 2014; DOI: https://doi.org/10.3393/ac.2014.30.4.186

6,027 View
34 Download
12 Web of Science
12 Citations

Abstract PDF

Purpose

DepoDur® is a single-dose extended-release morphine injection into the epidural space. It is not commonly used, but has many advantages over traditional analgesic regimens. We analyzed a number of these advantages in our case series in the context of the colorectal enhanced recovery program (ERP) and aimed to show that the ERP could be further enhanced by using DepoDur®.

Methods

We conducted a prospective audit of all patients undergoing open and laparoscopic colorectal procedures where DepoDur® was used between July 2010 and April 2012. Validated pain scores were used, and primary outcome measures were resting and dynamic pain, mobilization, and need for additional analgesia.

Results

Two hundred eighty patients were included in the case series. Good pain control was seen at 24 and 48 hours. Eighty-one percent of the patients required simple analgesia alone at 24 hours, and 62% required simple analgesia (paracetamol +/- nonsteroidal anti-inflammatory drugs) alone at 48 hours. Only a minority required additional oramorph and patient-controlled analgesia at 24 and 48 hours (19% at 24 hours and 38% at 48 hours). Seventy-nine percent of the patients were mobilized at 24 hours, and 88% of the patients were mobilized at 48 hours.

Conclusion

DepoDur® is an effective alternative to conventional pain management techniques and may have a role in further enhancing the ERP.

Citations

Citations to this article as recorded by

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Journal of Nanobiotechnology.2022;[Epub] CrossRef
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Anshul Sharma, Keshav Dhiman, Anshul Sharma, Kamya Goyal, Vinay Pandit, M. S. Ashawat, Shammy Jindal
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Pooria Nakhaei, Ria Margiana, Dmitry O. Bokov, Walid Kamal Abdelbasset, Mohammad Amin Jadidi Kouhbanani, Rajender S. Varma, Faroogh Marofi, Mostafa Jarahian, Nasrin Beheshtkhoo
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Richard J. Bodnar
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Protocol for a multicentre, prospective, observational cohort study of variation in practice in perioperative analgesic strategies in elective laparoscopic colorectal surgery: the LapCoGesic Study
Phillippa Burnell, Rachael Coates, Steven Dixon, Lucy Grant, Matthew Grey, Ben Griffiths, Mike Jones, Anantha Madhavan, Iain McCallum, Ross McClean, Karen Naru, Lydia Newton, Paul O'Loughlin, Fadlo Shaban, Anisha Sukha, Sameer Somnath, Syed Shumon, Deena
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Epidural Injection of Extended-Release Morphine During Colorectal Surgery
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