Annals of Coloproctology

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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.

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.

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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1 Citations

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

Minimally invasive surgery

Comparative perioperative outcomes of articulated versus conventional straight devices in laparoscopic low anterior resection: a propensity score–matched analysis: Hayoung Lee, Yong Sik Yoon, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim; Ann Coloproctol. 2025;41(5):434-442. Published online October 16, 2025; DOI: https://doi.org/10.3393/ac.2025.00227.0032

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1 Citations

Abstract PDF Supplementary Material

Purpose
Laparoscopic low anterior resection for rectal cancer is technically challenging due to the precision required for mesorectal excision. Articulated instruments were developed to improve precision and oncological safety over conventional instruments. This study compares their perioperative outcomes.
Methods
A retrospective cohort study of 432 patients with colorectal cancer who underwent low anterior resection between August 2022 and February 2024 applied propensity score matching to minimize selection bias. Primary endpoints were circumferential resection margin (CRM), distal resection margin (DRM), and harvested lymph nodes count. Secondary outcomes included postoperative complications.
Results
Following propensity score matching, 84 matched pairs were analyzed. Most patients achieved CRM negativity (>1 mm), with CRM ≥10 mm in 67.9% of the articulated group and 59.5% of the conventional group (P=0.613). Median (interquartile range, IQR) lymph nodes harvests were comparable (20 [14–26] vs. 18 [14–22], P=0.147). The articulated group had a significantly longer DRM (30.0 mm [IQR, 18.0–40.0 mm] vs. 24.0 mm [IQR, 12.0–34.2 mm], P=0.008) and the median operation time (111.0 minutes [IQR, 95.8–125.2 minutes] vs. 99.5 minutes [IQR, 72.0–119.8 minutes], P=0.009). Estimated blood loss, open conversion rates, and postoperative complications, including leakage (7.1% vs. 8.3%, P>0.999) and surgical site infections, (15.5% vs. 9.5%, P=0.383), showed no significant differences.
Conclusion
Articulated laparoscopic instruments demonstrated comparable safety and feasibility to conventional instruments but offered no significant clinical or oncological benefits beyond a longer DRM. Larger studies are needed to evaluate their value in laparoscopic rectal surgery.

Citations

Citations to this article as recorded by

Comparative perioperative outcomes of single-port laparoscopic ArtiSential versus da Vinci SP platform for totally extraperitoneal inguinal hernia repair: a multi-institutional, propensity score-matched analysis in Korea
In Kyeong Kim, Moonjin Kim, Ji-Yeon Moon, Ri Na Yoo, Jumyeong Song, Chaedong Lim, Choon Sik Chung, Gwan Cheol Lee, Tae Gyu Kim, Young Sun Choi, Dong Geun Lee, Chul Seung Lee
Journal of Minimally Invasive Surgery.2026; 29(1): 3. CrossRef

Complications

Prevalence and clinical significance of evacuation disorders in patients with low anterior resection syndrome: Yuko Homma, Toshiki Mimura, Koji Koinuma, Hisanaga Horie, Naohiro Sata; Ann Coloproctol. 2025;41(4):271-278. Published online August 25, 2025; DOI: https://doi.org/10.3393/ac.2024.00934.0133

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Abstract PDF: Purpose
Low anterior resection syndrome (LARS) manifests with evacuation disorder symptoms and continence problems. However, no prior study has focused on evacuation disorders in patients with LARS. This study investigated the prevalence of evacuation disorders and their association with the LARS score.
Methods
This study included patients with defecation per anus at the time of the survey, which was conducted between November 2020 and April 2021. These patients had undergone anus-preserving surgery for rectal tumors between 2014 and 2019 at a tertiary university hospital. The severity of evacuation disorders and LARS was evaluated using the Constipation Scoring System and the LARS score, respectively. The primary endpoint was the prevalence of evacuation disorders, defined as evacuation difficulty, feeling of incomplete evacuation, and abnormally long time on the toilet. The secondary endpoints were the associations between these symptoms and the LARS score.
Results
Of 332 eligible patients, 238 (71.7%) completed the questionnaire. The overall prevalence of evacuation disorders was 48.3%. The rates of feeling incomplete evacuation, evacuation difficulty, and prolonged time on the toilet were 45.6%, 15.5%, and 8.4%, respectively. Patients with minor or major LARS had a significantly higher prevalence of evacuation disorders than those with no LARS, particularly regarding feeling incomplete evacuation.
Conclusion
Evacuation disorders were present in 48.3% of patients following anus-preserving surgery. Greater severity of LARS was associated with a higher prevalence of evacuation disorders, especially a feeling of incomplete evacuation. Patients should be informed about the potential for both evacuation disorders and continence-related symptoms following anus-preserving surgery.

Colonoscopy

Endoscopic treatment of rectal neuroendocrine tumors: a consecutive analysis of multi-institutional data: Jae Won Shin, Eun-Jung Lee, Sung Sil Park, Kyung Su Han, Chang Gyun Kim, Hee Chul Chang, Won Youn Kim, Eui Chul Jeong, Dong Hyun Choi; Ann Coloproctol. 2025;41(3):221-231. Published online June 30, 2025; DOI: https://doi.org/10.3393/ac.2024.00927.0132

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3 Citations

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