Annals of Coloproctology

Review

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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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.

Citations

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Who is a candidate at the initial presentation? Prediction of positive lateral lymph node and survival after dissection
Y. Lee
Techniques in Coloproctology.2025;[Epub] CrossRef
The oncologic benefits of lateral lymph node dissection after neoadjuvant therapy – local control or survival?
T. Sammour
Techniques in Coloproctology.2025;[Epub] CrossRef
Laparoscopic Versus Robotic Lateral Pelvic Lymph Node Dissection in Locally‐Advanced Rectal Cancer: A Cohort Study Comparing Perioperative Morbidity and Short‐Term Oncological Outcomes
Joseph Mathew, Yogesh Kisan Bansod, Nishant Yadav, Janesh Murugan, Kovvuru Bhaskar Reddy, Mufaddal Kazi, Ashwin DeSouza, Avanish Saklani
Cancer Reports.2025;[Epub] 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

Original Articles

Translational/basic research

Exfoliate cancer cell analysis in rectal cancer surgery: comparison of laparoscopic and transanal total mesorectal excision, a pilot study: Kiho You, Jung-Ah Hwang, Dae Kyung Sohn, Dong Woon Lee, Sung Sil Park, Kyung Su Han, Chang Won Hong, Bun Kim, Byung Chang Kim, Sung Chan Park, Jae Hwan Oh; Ann Coloproctol. 2023;39(6):502-512. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00479.0068

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Graphical Abstract Abstract PDF Supplementary Material: Purpose
Minimally invasive surgery (MIS) is currently the standard treatment for rectal cancer. However, its limitations include complications and incomplete total mesorectal resection (TME) due to anatomical features and technical difficulties. Transanal TME (TaTME) has been practiced since 2010 to improve this, but there is a risk of local recurrence and intra-abdominal contamination. We aimed to analyze samples obtained through lavage to compare laparoscopic TME (LapTME) and TaTME.
Methods
From June 2020 to January 2021, 20 patients with rectal cancer undergoing MIS were consecutively and prospectively recruited. Samples were collected at the start of surgery, immediately after TME, and after irrigation. The samples were analyzed for carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20) through a quantitative real-time polymerase chain reaction. The primary outcome was to compare the detected amounts of CEA and CK20 immediately after TME between the surgical methods.
Results
Among the 20 patients, 13 underwent LapTME and 7 underwent TaTME. Tumor location was lower in TaTME (7.3 cm vs. 4.6 cm, P=0.012), and negative mesorectal fascia (MRF) was more in LapTME (76.9% vs. 28.6%, P=0.044). CEA and CK20 levels were high in 3 patients (42.9%) only in TaTME. There was 1 case of T4 with incomplete purse-string suture and 1 case of positive MRF with dissection failure. All patients were followed up for an average of 32.5 months without local recurrence.
Conclusion
CEA and CK20 levels were high only in TaTME and were related to tumor factors or intraoperative events. However, whether the detection amount is clinically related to local recurrence remains unclear.

Colorectal cancer

Partial mesorectal excision can be a primary option for middle rectal cancer: a propensity score–matched retrospective analysis: Ee Jin Kim, Chan Wook Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2024;40(3):253-267. Published online March 31, 2023; DOI: https://doi.org/10.3393/ac.2022.00689.0098

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Abstract PDF

Purpose
Although partial mesorectal excision (PME) and total mesorectal excision (TME) is primarily indicated for the upper and lower rectal cancer, respectively, few studies have evaluated whether PME or TME is more optimal for middle rectal cancer.
Methods
This study included 671 patients with middle and upper rectal cancer who underwent robot-assisted PME or TME. The 2 groups were optimized by propensity score matching of sex, age, clinical stage, tumor location, and neoadjuvant treatment.
Results
Complete mesorectal excision was achieved in 617 of 671 patients (92.0%), without showing a difference between the PME and TME groups. Local recurrence rate (5.3% vs. 4.3%, P>0.999) and systemic recurrence rate (8.5% vs. 16.0%, P=0.181) also did not differ between the 2 groups, in patients with middle and upper rectal cancer. The 5-year disease-free survival (81.4% vs. 74.0%, P=0.537) and overall survival (88.0% vs. 81.1%, P=0.847) also did not differ between the PME and TME groups, confined to middle rectal cancer. Moreover, 5-year recurrence and survival rates were not affected by distal resection margins of 2 cm (P=0.112) to 4 cm (P>0.999), regardless of pathological stages. Postoperative complication rate was higher in the TME than in the PME group (21.4% vs. 14.5%, P=0.027). Incontinence was independently associated with TME (odds ratio [OR], 2.009; 95% confidence interval, 1.015–3.975; P=0.045), along with older age (OR, 4.366, P<0.001) and prolonged operation time (OR, 2.196; P=0.500).
Conclusion
PME can be primarily recommended for patients with middle rectal cancer with lower margin of >5 cm from the anal verge.

Citations

Citations to this article as recorded by

Review of definition and treatment of upper rectal cancer
Elias Karam, Fabien Fredon, Yassine Eid, Olivier Muller, Marie Besson, Nicolas Michot, Urs Giger-Pabst, Arnaud Alves, Mehdi Ouaissi
Surgical Oncology.2024; 57: 102145. CrossRef
Tumour-specific mesorectal excision for rectal cancer: Systematic review and meta-analysis of oncological and functional outcomes
Fabio Carbone, Wanda Petz, Simona Borin, Emilio Bertani, Stefano de Pascale, Maria Giulia Zampino, Uberto Fumagalli Romario
European Journal of Surgical Oncology.2023; 49(11): 107069. CrossRef

Colorectal cancer

Recurrence following transanal total mesorectal excision for rectal cancer: a monocentric retrospective series of technically difficult cases: Jonathan Frigault, Geneviève Morin, Sébastien Drolet, Philippe Bouchard, Alexandre Bouchard, Thanh-Quan Philips Ngo, François Letarte; Ann Coloproctol. 2023;39(4):332-341. Published online November 14, 2022; DOI: https://doi.org/10.3393/ac.2022.00178.0025

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Abstract PDF: Purpose
Transanal total mesorectal excision (TaTME) has been proposed to overcome surgical difficulties encountered during rectal resection, especially for patients having high body mass index or low rectal cancer. The aim of this study was to evaluate oncologic outcomes following TaTME.
Methods
This retrospective study included all consecutive patients with rectal cancer who had a TaTME from 2013 to 2019. The main outcome was the incidence of locoregional recurrence by the end of the follow-up period.
Results
Among a total of 81 patients, 96.3% were male, and their mean age was 63±9 years. The mean body mass index was 30.3±5.7 kg/m2, and the median distance from tumor to anal verge was 5.0 cm (interquartile range [IQR], 4.0–6.0 cm). Most patients had a low anterior resection performed (n=80, 98.8%) with a diverting ileostomy (n=64, 79.0%). Distal and circumferential resection margins were positive in 2.5% and 6.2% of patients, respectively. Total mesorectal excision was complete or near complete in 95.1% of patients. A successful resection was achieved in 72 patients (88.9%). After a median follow-up of 27.5 months (IQR, 16.7–48.1 months), 4 patients (4.9%) experienced locoregional recurrence. Anastomotic leaks were observed in 21 patients (25.9%). At the end of the follow-up, 69 patients (85.2%) were stoma-free.
Conclusion
TaTME was associated with acceptable oncological outcomes, including low locoregional recurrence rates in selected patients with low rectal cancer. Although associated with a high incidence of postoperative morbidities, the use of TaTME enabled a high rate of successful sphincter-saving procedures in selected patients who posed a technical challenge.

Anorectal benign disease

Garg scoring system to predict long-term healing in cryptoglandular anal fistulas: a prospective validation study: Sushil Dawka, Vipul D. Yagnik, Baljit Kaur, Geetha R. Menon, Pankaj Garg; Ann Coloproctol. 2024;40(5):490-497. Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00346.0049

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Abstract PDF

Purpose
Complex anal fistulas can recur after clinical healing, even after a long interval which leads to significant anxiety. Also, ascertaining the efficacy of any new treatment procedure becomes difficult and takes several years. We prospectively analyzed the validity of Garg scoring system (GSS) to predict long-term fistula healing.
Methods
In patients operated for cryptoglandular anal fistulas, magnetic resonance imaging was performed preoperatively and at 3 months postoperatively to assess fistula healing. Scores as per the GSS were calculated for each patient at 3 months postoperatively and correlated with long-term healing to check the accuracy of the scoring system.
Results
Fifty-seven patients were enrolled, but 50 were finally included (7 were excluded). These 50 patients (age, 41.2±12.4 years; 46 men) were followed up for 12 to 20 months (median, 17 months). Forty-seven patients (94.0%) had complex fistulas, 28 (56.0%) had recurrent fistulas, 48 (96.0%) had multiple tracts, 20 (40.0%) had horseshoe tracts, 15 (32.0%) had associated abscesses, 5 (10.0%) were suprasphincteric, and 8 (16.0%) were supralevator fistulas. The GSS could accurately predict long-term healing (high positive predictive value, 31 of 31 [100%]) but was not very accurate in predicting nonhealing (negative predictive value, 15 of 19 [78.9%]). The sensitivity in predicting healing was 31 of 35 (88.6%).
Conclusion
GSS accurately predicts long-term fistula with a high positive predictive value (100%) but is less accurate in predicting nonhealing. This scoring system can help allay anxiety in patients and facilitate the early validation of innovative procedures for anal fistulas.

Citations

Citations to this article as recorded by

Recent Advances in the Understanding and Management of Anal Fistula from India
Vipul D. Yagnik, Sandeep Kumar, Anshul Thakur, Kaushik Bhattacharya, Sushil Dawka, Pankaj Garg
Indian Journal of Surgery.2024; 86(6): 1105. CrossRef
Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas
Pankaj Garg, Laxmikant Ladukar, Vipul Yagnik, Kaushik Bhattacharya, Gurleen Kaur
Clinical and Experimental Gastroenterology.2024; Volume 17: 97. CrossRef
Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Annals of Coloproctology.2024; 40(4): 321. CrossRef
Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review
Alireza Teymouri, Amir Keshvari, Ali Ashjaei, Seyed Mohsen Ahmadi Tafti, Faeze Salahshour, Faezeh Khorasanizadeh, Amirhosein Naseri
Health Science Reports.2023;[Epub] CrossRef
Pankaj Garg: A Community Doctor to a Master Innovator to a Global Icon
David N. Armstrong, Iwona Sudoł-Szopińska, Vincent de Parades, Francesco Litta, Manuel Limbert, Khaw C. W. James
Global Journal of Medical, Pharmaceutical, and Biomedical Update.2023; 18: 16. CrossRef

Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain: Zahra Abdulla Isa Yusuf Hasan, Bayan Mohamed, Rawaa AlSayegh, Raed AlMarzooq; Ann Coloproctol. 2023;39(1):27-31. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2020.00962.0137

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Abstract PDF

Purpose
Perianal fistula is one of the most common anorectal diseases in adult patients, especially men. A relationship between pyogenic perianal abscess and fistula formation is established in multiple domains. This is the first exploration of such association among patients in the country as no related study has been published in Bahrain. We expect this study to be a foundation for future protocols and evidence-based practice.
Methods
A retrospective study was conducted in Salmaniya Medical Complex of Bahrain. A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018. Data were collected from the electronic files database used in Salmaniya Medical Complex (iSeha) as well as phone calls to the patients. Collected data were analyzed using statistical software.
Results
The most predominant presentation of perianal abscess was pain. Over 50% of abscesses were classified as perianal (56.9%) and among those, left-sided abscesses were more common, followed by right-, posterior-, and anterior-sited, respectively. No recurrence of abscess was recorded among 80% of patients. A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage. Posterior fistulas were the most common, followed by anterior and left-sided fistulas.
Conclusion
The incidence of anal fistula in Bahrain after perianal abscess was 33.9%. Most of the patients who developed a fistula following pyogenic abscess drainage were males and above the age of 40 years. The most common site for fistula was posterior.

Citations

Citations to this article as recorded by

Risk factors for perianal abscess recurrence after incision and drainage: a review of the literature
Kheira Gabsi
International Surgery Journal.2025; 12(2): 255. CrossRef
Anal Cryptoglandular Suppuration
Oladapo Akinmoladun, Quinton M. Hatch
Surgical Clinics of North America.2024; 104(3): 491. CrossRef
Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence
Shan-Zhong Chen, Kui-Jun Sun, Yi-Fan Gu, Hong-Yuan Zhao, Dong Wang, Yun-Fang Shi, Ren-Jie Shi
World Journal of Gastrointestinal Surgery.2024; 16(11): 3425. CrossRef
Research Progress on Diagnosis and Surgical Treatment of Perianal Deep Space Abscess
永罡秦
Advances in Clinical Medicine.2023; 13(01): 180. CrossRef

Case Report

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

Late Recurrence in a Rectal Cancer Patient Who Underwent Preoperative Chemoradiotherapy Followed by Local Excision: A Case Report: Jin Soo Han, Seok-Byung Lim, Jin-hong Park, Yong Sang Hong; Ann Coloproctol. 2021;37(Suppl 1):S24-S27. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2020.00073.0010

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Abstract PDF

Some patients who have undergone preoperative chemoradiotherapy (CRT) following surgery have been diagnosed with late recurrence more than 5 years after treatment, raising questions about the possible benefit extending surveillance beyond the recommended 5 years. In 2011, a 71-year-old male patient was diagnosed with T3N+ low-lying rectal cancer located 3 cm from the anal verge before undergoing long-course preoperative CRT. After CRT, the patient was reexamined and diagnosed with ycT1–2N0 lesion, so local excision (LE) was performed. The patient underwent intensive surveillance for up to 5 years, and no evidence of recurrence was found. At 74 months after surgery, the patient was hospitalized for a hematochezia, and local recurrence at the excision site and peritoneal seeding nodules were identified. Considering the late recurrence in this patient, it might be necessary to long-term follow-up beyond 5 years in patients with preoperative CRT followed by LE.

Citations

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Coccygodynia in a Long-Term Cancer Survivor Diagnosed with Metastatic Cancer: A Case Report
Jung Hyun Park, Seong Jin Park, Dulee Kim, Jae Hoo Park, So Young Kwon
Medicina.2024; 60(8): 1365. CrossRef

Original Articles

Malignant disease,Prognosis

Recurrence after endoscopic resection of small rectal neuroendocrine tumors: a retrospective cohort study: Sukit Pattarajierapan, Supakij Khomvilai; Ann Coloproctol. 2022;38(3):216-222. Published online July 20, 2021; DOI: https://doi.org/10.3393/ac.2021.00017.0002

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Abstract PDF

Purpose
According to the European Neuroendocrine Tumor Society consensus guidelines, rectal neuroendocrine tumors (NETs) up to 10 mm in size and without poor prognostic factors could be safely removed with endoscopic resection, suggesting omitting surveillance colonoscopy after complete resection. However, the benefit of surveillance colonoscopy is still unknown. In this study, we aimed to report the outcomes after endoscopic resection of small rectal NETs using our surveillance protocol.
Methods
This retrospective cohort study included patients who underwent endoscopic resection for rectal NETs sized up to 10 mm from January 2013 to December 2019 at our center. We excluded patients without surveillance colonoscopy and those lost to follow-up. We strictly performed surveillance colonoscopy 1 year after endoscopic resection, and every 2 to 3 years thereafter. The primary outcomes were tumor recurrence and occurrence of metachronous tumors during followup.
Results
Of the 54 patients who underwent endoscopic resection for rectal NETs during the study period, 46 were enrolled in this study. The complete resection rates by endoscopic mucosal resection, precutting endoscopic mucosal resection, and endoscopic submucosal dissection were 92.3% (12 of 13), 100% (21 of 21), and 100% (12 of 12), respectively. There was no local or distant recurrence during the median follow-up of 39 months. However, we found that 8.7% (4 of 46) of patients developed metachronous NETs. All metachronous lesions were treated with precutting endoscopic mucosal resection.
Conclusion
Surveillance colonoscopy is reasonable after endoscopic resection of small rectal NETs for timely detection and treatment of metachronous lesions. However, larger collaborative studies are needed to influence the guidelines.

Citations

Citations to this article as recorded by

Comparison of the efficacy of endoscopic submucosal dissection and transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors ≤ 2 cm
Rui Jin, Xiaoyin Bai, Tianming Xu, Xi Wu, Qipu Wang, Jingnan Li
Frontiers in Endocrinology.2023;[Epub] CrossRef
Current status of the role of endoscopy in evaluation and management of gastrointestinal and pancreatic neuroendocrine tumors
Zaheer Nabi, Sundeep Lakhtakia, D. Nageshwar Reddy
Indian Journal of Gastroenterology.2023; 42(2): 158. CrossRef

Malignant disease,Prognosis and adjuvant therapy,Colorectal cancer

Comparison of the oncological outcomes of stenting as a bridge to surgery and surgery alone in stages II to III obstructive colorectal cancer: a retrospective study: Hiroaki Uehara, Toshiyuki Yamazaki, Akira Iwaya, Hitoshi Kameyama, Masaru Komatsu, Motoharu Hirai; Ann Coloproctol. 2022;38(3):235-243. Published online July 13, 2021; DOI: https://doi.org/10.3393/ac.2020.01067.0152

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Graphical Abstract Abstract PDF

Purpose
We evaluated the oncological outcomes of bridge to surgery (BTS) using stent compared with surgery alone for obstructive colorectal cancer.
Methods
Consecutive patients who underwent curative resection for stages II to III obstructive colorectal cancer at our institution from January 2009 to March 2020, were registered retrospectively and divided into 43 patients in the BTS group and 65 patients in the surgery alone group. We compared the surgical and oncological outcomes between the 2 groups.
Results
Stent-related perforation did not occur. One patient in whom the stent placement was unsuccessful underwent emergency surgery with poor decompression (clinical success rate, 97.7%). The pathological characteristics were not significantly different between the groups. The following surgical outcomes in the BTS group were superior to those in the surgery alone group; nonemergency surgery (P<0.001), surgical approach (P=0.006), and length of hospital stay (P=0.020). The median follow-up time was 44.9 months (range, 1.1–126.5 months). The 3-year relapse-free survival rates were 68.4% and 58.2% (P=0.411), and the overall survival rates were 78.3% and 88.2% (P=0.255) in the surgery alone and BTS groups, respectively. The 3-year locoregional recurrence rates were 10.2% and 8.0% (P=0.948), and distant metastatic recurrence rates were 13.3% and 30.4% (P=0.035) in the surgery alone and BTS groups, respectively.
Conclusion
This study revealed that BTS with stent may be associated with a higher frequency of distant metastatic recurrence. Stent for stages II to III obstructive colorectal cancer potentially worsens oncological outcomes.

Citations

Citations to this article as recorded by

Complete Obstruction, a Real Risk Factor: A Comprehensive Study on Obstruction in Stage IIA Colon Cancer With Propensity Score Matching Analysis
Soo Young Oh, Chan Wook Kim, Seonok Kim, Min Hyun Kim, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(2): 135. CrossRef
Can we use colon stenting in accelerated recovery programs for surgical treatment colon cancer complicated by obstructive intestinal obstruction? A literature review
Saday A. Aliyev, Emil S. Aliyev
Russian Journal of Oncology.2024; 29(2): 130. CrossRef
Oncologic impact of colonic stents for obstructive left-sided colon cancer
Hideyuki Suzuki, Shingo Tsujinaka, Yoshihiro Sato, Tomoya Miura, Chikashi Shibata
World Journal of Clinical Oncology.2023; 14(1): 1. CrossRef
5-year oncological outcomes in left-sided malignant colonic obstruction: stent as bridge to surgery
Noura S Alhassan, Sulaiman A AlShammari, Razan N AlRabah, Amirah M AlZahrani, Maha-Hamadien Abdulla, Thamer A Bin Traiki, Ahmad M Zubaidi, Omar A Al-Obeed, Khayal A Alkhayal
BMC Gastroenterology.2023;[Epub] CrossRef
Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef
Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach
Ji-Hyun Seo, In-Ja Park
Cancers.2023; 15(21): 5211. CrossRef
Recurrence Patterns and Risk Factors after Curative Resection for Colorectal Cancer: Insights for Postoperative Surveillance Strategies
Hyo Seon Ryu, Jin Kim, Ye Ryung Park, Eun Hae Cho, Jeong Min Choo, Ji-Seon Kim, Se-Jin Baek, Jung-Myun Kwak
Cancers.2023; 15(24): 5791. CrossRef
Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction: A review of the literature after 2020
Margherita Binetti, Augusto Lauro, Valeria Tonini
World Journal of Clinical Oncology.2022; 13(12): 957. CrossRef

Benign proctology,Complication,Biomarker & risk factor

Longer prolapsed rectum length increases recurrence risk after Delorme’s procedure: Taro Tanabe, Emi Yamaguchi, Takuya Nakada, Risa Nishio, Kinya Okamoto, Tetsuo Yamana; Ann Coloproctol. 2022;38(4):314-318. Published online July 13, 2021; DOI: https://doi.org/10.3393/ac.2020.01032.0147

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Abstract PDF

Purpose
Risk factors for recurrence of rectal prolapse after surgery remain unclear. Delorme’s procedure is often selected for relatively small-sized rectal prolapse, but there are few reports discussing the association between prolapsed rectum length and prolapse recurrence after Delorme’s procedure. We hypothesized that patients with longer rectal prolapses are at a higher risk of recurrence after Delorme’s procedure.
Methods
The study population comprised patients with rectal prolapse who underwent Delorme’s procedure between January 2014 and December 2019 at Tokyo Yamate Medical Center. We extracted data on patient age, sex, body mass index, previous history of anal surgery, previous history of surgery for rectal prolapse, and length of prolapse, to identify risk factors for prolapse recurrence.
Results
Altogether, 96 patients were eligible for analysis. The median length of the prolapsed rectum was 3.0 cm (range, 1.0–6.6 cm). Twenty-four patients (25.0%) experienced recurrence after Delorme’s procedure after a median of 7.5 months (interquartile range, 3.2–20.9 months). Multivariate analysis revealed that longer prolapsed rectum length increased the risk of recurrence after Delorme’s procedure (hazard ratio, 6.28; 95% confidence interval, 1.83–21.50; P<0.001).
Conclusion
The length of the prolapsed rectum should be measured before Delorme’s procedure for rectal prolapse, because length is associated with a risk of recurrence after the surgery.

Citations

Citations to this article as recorded by

Surgical approaches for complete rectal prolapse
Long Wu, Huan Wu, Song Mu, Xiao-Yun Li, Yun-Huan Zhen, Hai-Yang Li
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Tratamiento quirúrgico del prolapso rectal completo del adulto
C. Korkmaz, G. Meurette
EMC - Técnicas Quirúrgicas - Aparato Digestivo.2024; 40(1): 1. CrossRef
Trattamento chirurgico del prolasso rettale completo dell’adulto
C. Korkmaz, G. Meurette
EMC - Tecniche Chirurgiche Addominale.2024; 30(1): 1. CrossRef
The Predictive Risk Factor of Postoperative Recurrence Following Altemeier's and Delorme's Procedures for Full-thickness Rectal Prolapse: An Analysis of 127 Japanese Patients in a Single Institution
Yasuyuki Miura, Kimihiko Funahashi, Akiharu Kurihara, Satoru Kagami, Takayuki Suzuki, Kimihiko Yoshida, Mitsunori Ushigome, Tomoaki Kaneko
Journal of the Anus, Rectum and Colon.2024; 8(3): 171. CrossRef
Modified Altemeier Procedure as Management for Incarcerated Rectal Prolapse in a Young Healthy Male Patient: A Case Report and Literature Review
Leenah Abdulgader, Ebtesam Al-Najjar, Bayan Khasawneh, Abdullah Esmail
Medicina.2024; 60(11): 1872. CrossRef
Traitement chirurgical du prolapsus rectal complet de l’adulte
C. Korkmaz, G. Meurette
EMC - Techniques chirurgicales - Appareil digestif.2023; 40(4): 1. CrossRef

Malignant disease, Rectal cancer,Prognosis and adjuvant therapy

Beware of Early Relapse in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy: Seul Gi Oh, In Ja Park, Ji-hyun Seo, Young Il Kim, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2020;36(6):382-389. Published online June 17, 2020; DOI: https://doi.org/10.3393/ac.2020.06.11

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Abstract PDF

Purpose
Recurrence patterns in rectal cancer patients treated with preoperative chemoradiotherapy (PCRT) are needed to evaluate for establishing tailored surveillance protocol.
Methods
This study included 2,215 patients with locally-advanced mid and low rectal cancer treated with radical resection between January 2005 and December 2012. Recurrence was evaluated according to receipt of PCRT; PCRT group (n = 1,258) and no-PCRT group (n = 957). Early recurrence occurred within 1 year of surgery and late recurrence after 3 years. The median follow-up duration was 65.7 ± 29 months.
Results
The overall recurrence rate was similar between the PCRT and no-PCRT group (25.8% vs. 24.9%, P = 0.622). The most common initial recurrence site was the lungs in both groups (50.6% vs. 49.6%, P = 0.864), followed by the liver, which was more common in the no-PCRT group (22.5% vs. 33.6%, P = 0.004). Most of the recurrence occurred within 3 years after surgery in both groups (85.3% vs. 85.8%, P = 0.862). Early recurrence was more common in the PCRT group than in the no-PCRT group (43.1% vs. 32.4%, P = 0.020). Recurrence within the first 6 months after surgery was significantly higher in the PCRT group than in the no-PCRT group (18.8% vs. 7.6%, P = 0.003). Lung (n = 27, 44.3%) and liver (n = 22, 36.1%) were the frequent the first relapsed site within 6 months after surgery in PCRT group.
Conclusion
Early recurrence within the first 1 year after surgery was more common in patients treated with PCRT. This difference would be considered for surveillance protocols and need to be evaluated in further studies.

Citations

Citations to this article as recorded by

Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Update on Diagnosis and Treatment of Colorectal Cancer
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Case Report

Benign proctology

Combined Fistulotomy and Contralateral Anal Internal Sphincterotomy for Recurrent and Complex Anal Fistula to Prevent Recurrence: Adeodatus Yuda Handaya, Aditya Rifqi Fauzi; Ann Coloproctol. 2020;36(2):122-127. Published online March 17, 2020; DOI: https://doi.org/10.3393/ac.2018.11.19

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3 Citations

Abstract PDF

The ideal intervention in the treatment of perianal fistula prevents the onset of infection to speed healing and prevent fistula recurrence while maintaining the function of the anal sphincter. Currently, there is no consensus on the best recommended surgical technique for perianal fistula management. Several studies have shown that fistulotomy was an easy and safe procedure for treatment of perianal fistula. Lateral internal sphincterotomy is the usual procedure performed on an anal fissure to decrease the anal sphincter tone. This study reports a combination of fistulotomy and contralateral internal sphincterotomy procedures for recurrent and complex perianal fistula to prevent recurrence. Here, we report 5 cases of recurrent and complex perianal fistula. The combination of fistulotomy and contralateral internal sphincterotomy is a relatively easy and safe procedure for complex perianal fistulae. In our cases, we found neither recurrence nor postoperative anal incontinence.

Citations

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Review

A Review of the Role of Carcinoembryonic Antigen in Clinical Practice: Claire Hall, Louise Clarke, Atanu Pal, Pamela Buchwald, Tim Eglinton, Chris Wakeman, Frank Frizelle; Ann Coloproctol. 2019;35(6):294-305. Published online December 31, 2019; DOI: https://doi.org/10.3393/ac.2019.11.13

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463 Download
139 Web of Science
131 Citations

Abstract PDF

Carcinoembryonic antigen (CEA) is not normally produced in significant quantities after birth but is elevated in colorectal cancer. The aim of this review was to define the current role of CEA and how best to investigate patients with elevated CEA levels. A systematic review of CEA was performed, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified from PubMed, Cochrane library, and controlled trials registers. We identified 2,712 papers of which 34 were relevant. Analysis of these papers found higher preoperative CEA levels were associated with advanced or metastatic disease and thus poorer prognosis. Postoperatively, failure of CEA to return to normal was found to be indicative of residual or recurrent disease. However, measurement of CEA levels alone was not sufficient to improve survival rates. Two algorithms are proposed to guide investigation of patients with elevated CEA: one for patients with elevated CEA after CRC resection, and another for patients with de novo elevated CEA. CEA measurement has an important role in the investigation, management and follow-up of patients with colorectal cancer.

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Original Articles

Malignant disease, Prognosis and adjuvant therapy

Long-term Oncologic Outcome of Postoperative Complications After Colorectal Cancer Surgery: Chang Kyu Oh, Jung Wook Huh, You Jin Lee, Moon Suk Choi, Dae Hee Pyo, Sung Chul Lee, Seong Mun Park, Jung Kyong Shin, Yoon Ah Park, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Woo Yong Lee; Ann Coloproctol. 2020;36(4):273-280. Published online November 13, 2019; DOI: https://doi.org/10.3393/ac.2019.10.15

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Abstract PDF

Purpose
The impact of postoperative complications on long-term oncologic outcome after radical colorectal cancer surgery is controversial. The aim of this study was to examine the risk factors and oncologic outcomes of surgery-related postoperative complication groups.
Methods
From January 2010 to December 2010, 310 patients experienced surgery-related postoperative complications after radical colorectal cancer surgery. These stage I–III patients were classified into 2 subgroups, minor (grades I, II) and major (grades III, IV) complication groups, according to extended Clavien-Dindo classification system criteria. Clinicopathologic differences between the 2 groups were analyzed to identify risk factors for major complications. The diseasefree survival rates of surgery-related postoperative complication groups were also compared.
Results
Minor and major complication groups were stratified with 194 patients (62.6%) and 116 patients (37.4%), respectively. The risk factors influencing the major complication group were pathologic N category and operative method. The prognostic factors associated with disease-free survival were preoperative perforation, perineural invasion, tumor budding, and receiving neoadjuvant therapy. With a median follow-up period of 72.2 months, the 5-year disease-free survival rates were 84.4% in the minor group and 78.5% in the major group, but there was no statistical significance between the minor and major groups (P = 0.392).
Conclusion
Advanced cancer and open surgery were identified as risk factors for increased surgery-related major complications after radical colorectal cancer surgery. However, severity of postoperative complications did not affect disease-free survival from colorectal cancer.

Citations

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Oncologic Outcomes of Postoperative Chemoradiotherapy Versus Chemotherapy Alone in Stage II and III Upper Rectal Cancer: Ji Eun Yoon, Soo Young Lee, Han Duk Kwak, Seung Seop Yeom, Chang Hyun Kim, Jae Kyun Joo, Hyeong Rok Kim, Young Jin Kim; Ann Coloproctol. 2019;35(3):137-143. Published online June 30, 2019; DOI: https://doi.org/10.3393/ac.2018.09.28

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106 Download
4 Web of Science
4 Citations

Abstract PDF

Purpose
The aim of this study was to assess oncological outcomes of postoperative radiotherapy plus chemotherapy (CRT) versus chemotherapy alone (CTx) in stage II or III upper rectal cancer patients who underwent curative surgery.
Methods
We retrospectively reviewed 263 consecutive patients with pathologic stage II or III upper rectal cancer who underwent primary curative resection with postoperative CRT or CTx from January 2008 to December 2014 at Chonnam National University Hwasun Hospital. Multivariate and propensity score matching analyses were used to reduce selection bias.
Results
Median follow-up was 48.1 months for the entire cohort and 53.5 months for the matched cohort. In subgroup analysis of the propensity score matched cohort, the 3-year local recurrence-free survival was 94.1% (95% confidence interval [CI], 87.8%–100%) in the CRT group and 90.1% (95% CI, 82.8%–97.9%) in the CTx group (P = 0.370). No significant difference in disease-free survival was observed according to treatment type. On multivariate analysis, circumferential resection margin involvement (hazard ratio [HR], 2.386; 95% CI, 1.190–7.599; P = 0.032), N stage (HR, 6.262; 95% CI, 1.843–21.278, P = 0.003), and T stage (HR, 5.896, 95% CI, 1.298–6.780, P = 0.021) were identified as independent risk factors for local recurrence of tumors of the upper rectum.
Conclusion
Omission of radiotherapy in an adjuvant treatment setting may not jeopardize oncologic outcomes in stages II and III upper rectal cancer.

Citations

Citations to this article as recorded by

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