Annals of Coloproctology

Original Articles

ERAS

Effect of continuous wound infiltration on patients using intravenous patient-controlled analgesia for pain management after reduced-port laparoscopic colorectal surgery: Hyeon Deok Choi, Sung Uk Bae; Ann Coloproctol. 2024;40(6):564-572. Published online November 22, 2024; DOI: https://doi.org/10.3393/ac.2023.00143.0020

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Purpose
Continuous wound infiltration (CWI) has been introduced as a component of multimodal analgesia to counteract the adverse effects of the most frequently used opioids. Advantages of reduced-port laparoscopic surgery (RPLS) include cosmetic benefits and decreased postoperative pain. We aimed to investigate the effect of CWI in patients using intravenous (IV) patient-controlled analgesia (PCA) for pain management after RPLS for colorectal cancer.
Methods
This retrospective study included 25 patients who received both CWI (0.5% ropivacaine infused over 72 hours) and IV PCA (fentanyl citrate) and 52 patients who received IV PCA alone. The primary endpoint was pain scores on postoperative days (PODs) 0, 1, and 2. Univariate and multivariate analyses were conducted to determine the factors affecting the pain score on POD 0.
Results
On POD 0, the mean numeric rating scale score was significantly lower in the CWI group than in the control group (3.2±0.8 vs. 3.7±0.9, P=0.042). However, the scores were comparable between the groups during the rest of the period. Within 24 hours of surgery, the CWI group consumed fewer opioids (0.7±0.9 vs. 1.3±1.1, P=0.018) and more nonsteroidal anti-inflammatory drugs (2.0±1.4 vs. 1.3±1.4, P=0.046) than the control group. Time to removal of IV PCA was significantly longer in the CWI group than in the control group (4.4±1.6 days vs. 3.4±1.0 days, P=0.016).
Conclusion
CWI with ropivacaine and IV PCA was more effective than IV PCA alone in controlling postoperative pain within 24 hours of surgery, and opioid use could be reduced further.

Citations

Citations to this article as recorded by

Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

Minimally invasive surgery

New double-stapling technique without staple-crossing line in laparoscopic low anterior resection: effort to reduce anastomotic leakage: Nam Seok Kim, Ji Hoon Kim, Yoon Suk Lee, In Kyu Lee, Won Kyung Kang; Ann Coloproctol. 2024;40(6):573-579. Published online November 22, 2024; DOI: https://doi.org/10.3393/ac.2022.00409.0058

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Graphical Abstract Abstract PDF: Purpose
This study aimed to demonstrate the safety of new double-stapling technique (nDST), without a crossing line and dog ears, by comparing with conventional DST (cDST) in laparoscopic low anterior resection (LAR).
Methods
We retrospectively reviewed 98 consecutive patients who underwent laparoscopic LAR for rectal cancer from January 2018 to December 2020. The inclusion criterion was an anastomosis level below the peritoneal reflection and 4 cm above the anal verge. In the nDST group, the staple line of the linear cutter was sutured using barbed sutures to shorten the staple line before firing the circular stapler. Therefore, there were no crossing lines after firing the circular stapler. A 2:1 propensity score matching was performed between the cDST and nDST groups.
Results
After propensity score matching, 39 patients were in the cDST group and 20 were in the nDST group. There were no significant differences in patient demographics between the 2 groups. There was no difference in the total operation time between the cDST and nDST groups (124.0±26.2 minutes vs. 125.2±20.3 minutes, P=0.853). Morbidity rates were similar between the 2 groups (9 cases [23.1%] vs. 5 cases [25.0%], P=0.855). There was no significant difference in leakage rate (4 cases [10.3%] vs. 1 case [5.0%], P=0.847) and anastomotic bleeding rate (1 case [2.6%] vs. 3 cases [15.0%], P=0.211).
Conclusion
The nDST to eliminate the crossing line and dog ears in laparoscopic LAR is technically feasible and safe. However, more attention should be paid to anastomotic bleeding in such cases.

Complication

Early warning model to detect anastomotic leakage following colon surgery: a clinical observational study: Pooya Rajabaleyan, Ravish Jootun, Sören Möller, Ulrik Deding, Mark Bremholm Ellebæk, Issam al-Najami, Ian Lindsey; Ann Coloproctol. 2024;40(5):431-439. Published online October 8, 2024; DOI: https://doi.org/10.3393/ac.2023.00745.0106

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Graphical Abstract Abstract PDF

Purpose
We aimed to develop a predictive tool for anastomotic leakage (AL) following colon cancer surgery by combining a clinical early warning score (EWS) with the C-reactive protein (CRP) level.
Methods
The records of 1,855 patients who underwent colon cancer surgery at the Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018, with or without AL, were retrospectively reviewed. EWS and CRP levels were assessed daily from the first postoperative day until discharge. AL was defined as an anastomotic defect observed at reoperation, the presence of feculent fluid in a pelvic drain, or evidence of AL on computed tomography. The tool incorporated postoperative EWS and CRP levels for the accurate early detection of AL.
Results
From postoperative days 3 to 7, the mean CRP level exceeded 200 mg/L in patients with AL and was under 200 mg/L in those without AL (P<0.05). From postoperative days 1 to 5, the mean EWS among patients with leakage exceeded 2, while scores were below 2 among those without leakage (P<0.05). Receiver operating characteristic curve analysis identified postoperative day 3 as the most predictive of early leakage, with cutoff values of 2.4 for EWS and 180 mg/L for CRP; this yielded an area under the curve of 0.87 (sensitivity, 90%; specificity, 70%).
Conclusion
We propose using an EWS of 2.4 and a CRP level of 180 mg/L on postoperative day 3 following colon surgery with anastomosis as threshold values to prompt investigation and treatment of AL.

Citations

Citations to this article as recorded by

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
Predictive Biomarkers for the Early Detection of Anastomotic Leaks in Colorectal Surgeries: A Systematic Review
Wahidullah Dost, Mohammad Qaher Rasully , Mohammad Nazir Zaman, Wahida Dost, Wahida Ali, Sami A Ayobi, Raisa Dost, Jamaluddin Niazi, Kinza Bakht, Asma Iqbal, Syed Faqeer Hussain Bokhari
Cureus.2024;[Epub] 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.

Citations

Citations to this article as recorded by

Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

ERAS

Clinical impact of a multimodal pain management protocol for loop ileostomy reversal: Jeong Sub Kim, Chul Seung Lee, Jung Hoon Bae, Seung Rim Han, Do Sang Lee, In Kyu Lee, Yoon Suk Lee, In Kyeong Kim; Ann Coloproctol. 2024;40(3):210-216. Published online June 19, 2024; DOI: https://doi.org/10.3393/ac.2022.01137.0162

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Purpose
As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy.
Methods
Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B).
Results
Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate.
Conclusion
Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.

Citations

Citations to this article as recorded by

Multimodal analgesia for postoperative pain: pursuing liberation from pain, not redemption
Soo Yeun Park
Annals of Coloproctology.2024; 40(3): 189. CrossRef
Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review
Ji Hyeong Song, Minsung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef
Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

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.

Benign bowel disease

Risk factors of incisional hernia at the umbilical specimen extraction site in patients with laparoscopic colorectal cancer surgery: Masatsugu Hiraki, Toshiya Tanaka, Shinya Azama, Eiji Sadashima, Hirofumi Sato, Shuusuke Miyake, Kenji Kitahara; Ann Coloproctol. 2024;40(2):136-144. Published online June 21, 2022; DOI: https://doi.org/10.3393/ac.2022.00213.0030

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Graphical Abstract Abstract PDF

Purpose
Incisional hernia (IH) is a frequent complication following laparoscopic colorectal surgery. The present study investigated the risk factors for IH after laparoscopic surgery for colorectal cancer.
Methods
A retrospective study was conducted on 202 patients who underwent laparoscopic surgery for colorectal cancer. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with IH.
Results
The overall incidence of IH was 25.7% (52 of 202). The univariate analysis showed that female sex (P=0.004), a high body mass index (P<0.001), noncurrent smoking habit (P=0.043), low level of hemoglobin (P=0.035), high subcutaneous fat area (P<0.001), high visceral fat area (P=0.006), low skeletal muscle area (P=0.001), long distance between the inner edges of the rectus abdominis muscle (P=0.001), long protrusion of the peritoneum at the umbilical site (P<0.001), and lymph node metastasis (P=0.007) were significantly more frequent in the group with IH than in the group without it. The multivariate logistic regression analysis revealed an older age (10-year increments: odds ratio [OR], 1.576; 95% confidence interval [CI], 1.027–2.419; P=0.037), lymph node metastasis (OR, 2.384; 95% CI, 1.132–5.018; P=0.022) and lengthy protrusion of the peritoneum at the umbilical site (10-mm increments: OR, 5.555; 95% CI, 3.058–10.091; P<0.001) were independent risk factors for IH.
Conclusion
Our findings suggest that older age, lymph node metastasis, and lengthy protrusion of the peritoneum at the umbilical site are risk factors for IH after laparoscopic surgery for colorectal cancer. An assessment using these factors before the operation and the implementation of countermeasures might help prevent IH.

Citations

Citations to this article as recorded by

Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study
I. Omar, A. Townsend, O. Hadfield, T. Zaimis, M. Ismaiel, J. Wilson, C. Magee
Hernia.2024; 28(5): 1619. CrossRef
The first case of robotic‐assisted transabdominal retrorectus repair for incisional hernia in Japan
Gen Shimada, Taketo Matsubara, Mariko Sanbonmatsu, Rumi Nakabayashi, Yosuke Miyachi, Takashi Taketa, Akihiro Suzuki, Tadao Yokoi, Toshimi Kaido
Asian Journal of Endoscopic Surgery.2023; 16(2): 305. CrossRef
Mid-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution
Heita Ozawa, Naoyuki Toyota, Junichi Sakamoto, Hiroki Nakanishi, Ryo Nakanishi, Shin Fujita
Surgery Today.2023; 53(8): 992. CrossRef
Impact of non-muscle cutting periumbilical transverse incision on the risk of incisional hernia as compared to midline incision during laparoscopic colon cancer surgery: a study protocol for a multi-centre randomised controlled trial
Soo Yeun Park, Gi Won Ha, Soo Young Lee, Chang Hyun Kim, Gyung Mo Son
Trials.2023;[Epub] CrossRef

Colorectal cancer

Public effect of the 2022 Colorectal Cancer Awareness Campaign delivered through a metaverse platform: Tae-Gyun Lee, Gil-Hyeon Song, Hong-min Ahn, Heung-Kwon Oh, Moonkyoung Byun, Eon Chul Han, Sohyun Kim, Chang Woo Kim, Hye Jin Kim, Samin Hong, Kee-Ho Song, Chan Wook Kim, Yong Beom Cho, on behalf of the Public Relations Committee of the Korean Society of Coloproctology (KSCP); Ann Coloproctol. 2024;40(2):145-153. Published online April 28, 2023; DOI: https://doi.org/10.3393/ac.2023.00122.0017

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Graphical Abstract Abstract PDF

Purpose
The Korean Society of Coloproctology has been conducting Colorectal Cancer Awareness Campaign, also known as the Gold Ribbon Campaign, every September since 2007. The 2022 campaign was held through a metaverse platform targeting the younger age group under the slogan of raising awareness of early-onset colorectal cancer (CRC). This study aimed to analyze the impact of the 2022 campaign on a metaverse platform.
Methods
Anonymized survey data were collected from participants in the metaverse campaign from September 1 to 15, 2022. The satisfaction score of the participants was evaluated by sex, age group, and previous campaign participation status.
Results
During the campaign, 2,770 people visited the metaverse. Among them, 455 people participated in the survey (response rate, 16.4%). Approximately 95% of the participants reported being satisfied with the information provided by the campaign, understood the necessity of undergoing screening for and prevention of early-onset CRC, and were familiar with the structure of the metaverse. The satisfaction score for campaign information tended to decrease as the participants’ age increased. When the participants’ overall level of satisfaction with the metaverse platform was assessed, teenagers scored particularly lower than the other age groups. The satisfaction scores for CRC information provided in the metaverse, as well as the scores for recognizing the seriousness and necessity of screening for early-onset CRC, indicated a high positive tendency (P<0.001).
Conclusion
Most of the 2022 Gold Ribbon Campaign participants were satisfied with the metaverse platform. Medical society should pay attention to increasing participation in and satisfaction with future public campaigns.

Citations

Citations to this article as recorded by

#CRCandMe: results of a pre-post quasi-experimental study of a mass media campaign to increase early-onset colorectal cancer awareness in Utah and Wisconsin
Ami E Sedani
American Journal of Cancer Research.2024; 14(8): 3873. CrossRef
Metaverse in surgery — origins and future potential
Enrico Checcucci, Alessandro Veccia, Stefano Puliatti, Pieter De Backer, Pietro Piazza, Karl-Friedrich Kowalewski, Severin Rodler, Mark Taratkin, Ines Rivero Belenchon, Loic Baekelandt, Sabrina De Cillis, Alberto Piana, Ahmed Eissa, Juan Gomez Rivas, Giov
Nature Reviews Urology.2024;[Epub] CrossRef
Metaverso: perspectivas, possibilidades e limitações
Walter Rodrigues Marques, Maria Neuraildes Gomes Viana, Anderson Boás Viana, Luís Claúdio Azevedo Gomes, Francilene Silva Cruz, Bruna Monique Cunha Rodrigues, Andréa Luísa Frazão Silva, Regeanne Santos Guaianaz, Daiane Leite Chaves Bezerra, Diêgo Jorge Lo
Caderno Pedagógico.2024; 21(13): e12984. CrossRef

Anorectal benign disease

Laser hemorrhoidoplasty in the treatment of symptomatic hemorrhoids: a pilot Australian study: Anshini Jain, Chen Lew, Gamze Aksakal, Richard Hiscock, Naseem Mirbagheri; Ann Coloproctol. 2024;40(1):52-61. Published online May 19, 2022; DOI: https://doi.org/10.3393/ac.2022.00164.0023

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Graphical Abstract Abstract PDF

Purpose
Traditional therapeutic approaches to the surgical management of hemorrhoid disease such as hemorrhoidectomies are plagued with severe postoperative pain and protracted recovery. Our pilot study aims to the laser hemorrhoidoplasty (LH) patients with symptomatic hemorrhoid disease that have failed conservative management for the first time in an Australian population.
Methods
Thirty patients were prospectively enrolled to undergo LH. Postoperative pain, time to return to function, and quality of life (QoL) were determined through the Hemorrhoid Disease Symptom Score and Short Health Scale adapted for hemorrhoidal disease and compared to a historical group of 43 patients who underwent a Milligan-Morgan hemorrhoidectomy by the same surgeon at 3, 6, and 12 months.
Results
The LH group had significantly lower mean predicted pain scores on days 1 and 2 and lower defecation pain scores and lower opioid analgesia use on days 1, 2, 3, and 4. The median time to return to normal function was significantly lower in the LH group (2 days vs. 9 days, P<0.001). Similarly, the median days to return to the workplace was significantly lower in the LH group (6 days vs. 13 days, P=0.007). During long-term follow-up (12 months), hemorrhoid symptoms and all QoL measures were significantly improved, especially among those with grade II to III disease.
Conclusion
This pilot study demonstrates low pain scores with this revivified procedure in an Australian population, indicating possible expansion of the therapeutic options available for this common condition. Further head-to-head studies comparing LH to other hemorrhoid therapies are required to further determine the most efficacious therapeutic approach.

Citations

Citations to this article as recorded by

Best clinical practice recommendations for the management of symptomatic hemorrhoids via laser hemorrhoidoplasty: the LHP recommendations
P. C. Ambe, G. P. Martin-Martin, N. Vasas, I. Piponski, I. H. Roman, J. D. P. Hernandez, H. Ma, H.C. Lin, G. Weyand, L. Mazlan, L. J. García Flórez, K. Wolff, M. Dessily, C. Wang, V. Dobricanin, W. Yang, T. Bruketa, X.D. Zeng, S. Avdicausevic, Z.G. Zhang,
Techniques in Coloproctology.2025;[Epub] CrossRef
Laser hemorrhoidoplasty versus LigaSure™ hemorrhoidectomy versus diathermy hemorrhoidectomy in treatment of grade III and IV Hemorrhoids: A non-randomized prospective trial
Mohammad Ashour Khadr, Walid Galal El Shazly, Mohamed Mazloum Zakria, Ahmed Mohamed Moaz
Surgery Open Digestive Advance.2024; 13: 100129. CrossRef
Comparison of Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy Techniques in the Treatment of Grade 2 and 3 Hemorrhoidal Disease
Adas Cemil, Kesici Ugur, Genc M. Salih, Karadag Merve, Duman M. Guray, Boluk S. Emine
The American Surgeon™.2024; 90(4): 662. CrossRef
Global International Society of University Colon and Rectal Surgeons in collaboration with European Society of Coloproctology audit on office‐based and surgical treatment of haemorrhoidal disease: Study protocol
Audrius Dulskas, Dovile Cerkauskaite, Joseph Nunoo‐Mensah, Richard Fortunato, Gaetano Gallo, Alaa El Hussuna, Varut Lohsiriwat, Tomas Aukstikalnis, Narimantas E. Samalavicius
Colorectal Disease.2024; 26(6): 1266. CrossRef
Ethnomedical knowledge of plants used in alternative medicine to treat hemorrhoidal diseases in Lubumbashi, Haut-Katanga province, Southern Democratic Republic of Congo
Bashige Chiribagula Valentin, Okusa Ndjolo Philippe, Muhona Melman, Manya Mboni Henry, Bakari Amuri Salvius, Lumbu Simbi Jean Baptiste
BMC Complementary Medicine and Therapies.2024;[Epub] CrossRef
Outcomes of laser hemorrhoidoplasty for grade II–IV hemorrhoidal disease in Bangladesh
Md. Saiful Islam, Abhigan B. Shrestha, Faisal Chowdhury, Md. R.K. Ziko
Annals of Medicine & Surgery.2024; 86(11): 6514. CrossRef
The efficacy of laser haemorrhoidoplasty (LHP) in the treatment of symptomatic haemorrhoidal disease: An observational cohort study
Nadim H. P. Boerhave, Rutger J. Klicks, Kemal Dogan
Colorectal Disease.2023; 25(6): 1202. CrossRef
Comparing outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in grade II–III hemorrhoidal disease: a retrospective analysis
Haluk Tümer, Mevlüt Harun Ağca
ANZ Journal of Surgery.2023; 93(7-8): 1885. CrossRef
Comparison of the efficacy of LigaSure and laser for grade 2-3 hemorrhoids
Ali Kemal Taşkin, Bülent Özçetin
Journal of Clinical Medicine of Kazakhstan.2023; 20(4): 33. CrossRef
Laser hemorrhoidoplasty combined with blind hemorrhoidal artery ligation compared to Milligan–Morgan hemorrhoidectomy in patients with second and third degree piles; a prospective randomized study
Amir F. Abdelhamid, Mohamed M. Elsheikh, Osama H. Abdraboh
The Egyptian Journal of Surgery.2023; 42(3): 669. CrossRef
Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis
Hendry Lie, Evelyn Franca Caesarini, Antonius Agung Purnama, Andry Irawan, Taufik Sudirman, Wifanto Saditya Jeo, Bernardus Parish Budiono, Erik Prabowo, M. Iqbal Rivai, Ryanto Karobuana Sitepu
Lasers in Medical Science.2022; 37(9): 3621. CrossRef

Colorectal cancer

Long-term clinical outcomes after high and low ligations with lymph node dissection around the root of the inferior mesenteric artery in patients with rectal cancer: Min Wan Lee, Sung Sil Park, Kiho You, Dong Eun Lee, Dong Woon Lee, Sung Chan Park, Kyung Su Han, Dae Kyung Sohn, Chang Won Hong, Bun Kim, Byung Chang Kim, Hee Jin Chang, Dae Yong Kim, Jae Hwan Oh; Ann Coloproctol. 2024;40(1):62-73. Published online February 26, 2024; DOI: https://doi.org/10.3393/ac.2023.00094.0013

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Graphical Abstract Abstract PDF

Purpose
This study aimed to evaluate the long-term clinical outcomes based on the ligation level of the inferior mesenteric artery (IMA) in patients with rectal cancer.
Methods
This was a retrospective analysis of a prospectively collected database that included all patients who underwent elective low anterior resection for rectal cancer between January 2013 and December 2019. The clinical outcomes included oncological outcomes, postoperative complications, and functional outcomes. The oncological outcomes included overall survival (OS) and relapse-free survival (RFS). The functional outcomes, including defecatory and urogenital functions, were analyzed using the Fecal Incontinence Severity Index, International Prostate Symptom Score, and International Index of Erectile Function questionnaires.
Results
In total, 545 patients were included in the analysis. Of these, 244 patients underwent high ligation (HL), whereas 301 underwent low ligation (LL). The tumor size was larger in the HL group than in the LL group. The number of harvested lymph nodes (LNs) was higher in the HL group than in the LL group. There were no significant differences in complication rates and recurrence patterns between the groups. There were no significant differences in 5-year RFS and OS between the groups. Cox regression analysis revealed that the ligation level (HL vs. LL) was not a significant risk factor for oncological outcomes. Regarding functional outcomes, the LL group showed a significant recovery in defecatory function 1 year postoperatively compared with the HL group.
Conclusion
LL with LNs dissection around the root of the IMA might not affect the oncologic outcomes comparing to HL; however, it has minimal benefit for defecatory function.

Citations

Citations to this article as recorded by

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

Colorectal cancer

Is restrictive transfusion sufficient in colorectal cancer surgery? A retrospective study before and during the COVID-19 pandemic in Korea: Hyeon Kyeong Kim, Ho Seung Kim, Gyoung Tae Noh, Jin Hoon Nam, Soon Sup Chung, Kwang Ho Kim, Ryung-Ah Lee; Ann Coloproctol. 2023;39(6):493-501. Published online December 28, 2023; DOI: https://doi.org/10.3393/ac.2023.00437.0062

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Graphical Abstract Abstract PDF Supplementary Material: Purpose
Blood transfusion is one of the most common procedures used to treat anemia in colorectal surgery. Despite controversy regarding the adverse effects of blood products, surgeons have maintained standards for administering blood transfusions. However, this trend was restrictive during the COVID-19 pandemic because of a shortage of blood products. In this study, we conducted an analysis to investigate whether the restriction of blood transfusions affected postoperative surgical outcomes.
Methods
Medical records of 318 patients who underwent surgery for colon and rectal cancer at Ewha Womans University Mokdong Hospital between June 2018 and March 2022 were reviewed retrospectively. The surgical outcomes between the liberal and restrictive transfusion strategies in pre– and post–COVID-19 groups were analyzed.
Results
In univariate analysis, postoperative transfusion was associated with infectious complications (odds ratio [OR], 1.705; 95% confidence interval [CI], 1.015–2.865; P=0.044). However, postoperative transfusion was not an independent risk factor for the development of infectious complications in multivariate analysis (OR, 1.305; 95% CI, 0.749–2.274; P=0.348). In subgroup analysis, there was no significant association between infectious complications and the hemoglobin threshold level for the administration of a transfusion (OR, 1.249; 95% CI, 0.928–1.682; P=0.142).
Conclusion
During colorectal surgery, the decision to perform a blood transfusion is an important step in ensuring favorable surgical outcomes. According to the results of this study, restrictive transfusion is sufficient for favorable surgical outcomes compared with liberal transfusion. Therefore, modification of guidelines is suggested to minimize unnecessary transfusion-related side effects and prevent the overuse of blood products.

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.

Colorecal cancer

Prognostic significance of lymph node yield on oncologic outcomes according to tumor response after preoperative chemoradiotherapy in rectal cancer patients: Hyo Seon Ryu, In Ja Park, Bo Kyung Ahn, Min Young Park, Min Sung Kim, Young Il Kim, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2023;39(5):410-420. Published online April 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00143.0020

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Purpose
This study aimed to evaluate the predictive value of lymph node yield (LNY) for survival outcomes according to tumor response after preoperative chemoradiotherapy (PCRT) in patients with rectal cancer.
Methods
This study was a retrospective study conducted in a tertiary center. A total of 1,240 patients with clinical stage II or III rectal cancer who underwent curative resection after PCRT between 2007 and 2016 were included. Patients were categorized into the good response group (tumor regression grade [TRG], 0–1) or poor response group (TRG, 2–3). Propensity score matching was performed for age, sex, and pathologic stage between LNY of ≥12 and LNY of <12 within tumor response group. The primary outcome was 5-year disease-free survival (DFS) and overall survival (OS).
Results
LNY and positive lymph nodes were inversely correlated with TRG. In good responders, 5-year DFS and 5-year OS of patients with LNY of <12 were better than those with LNY of ≥12, but there was no statistical significance. In poor responders, the LNY of <12 group had worse survival outcomes than the LNY of ≥12 group, but there was also no statistical significance. LNY of ≥12 was not associated with DFS and OS in multivariate analysis.
Conclusion
LNY of <12 showed contrasting outcomes between the good and poor responders in 5-year DFS and OS. LNY of 12 may not imply adequate oncologic surgery or proper staging in rectal cancer patients treated by PCRT. Furthermore, a decrease in LNY should be comprehended differently according to tumor response.

Citations

Citations to this article as recorded by

Effects of Adjuvant Chemotherapy on Oncologic Outcomes in Patients With Stage ⅡA Rectal Cancer Above the Peritoneal Reflection Who Did Not Undergo Preoperative Chemoradiotherapy
Hyo Seon Ryu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Yong Sang Hong, Tae Won Kim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(4): 392. CrossRef
Artificial Intelligence-Driven Volumetric Analysis of Muscle Mass as a Predictor of Tumor Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer
Minsung Kim, Sang Min Lee, Il Tae Son, Jaewoong Kang, Gyoung Tae Noh, Bo Young Oh
Journal of Clinical Medicine.2024; 13(23): 7018. CrossRef
Multidisciplinary Treatment Strategy for Early Colon Cancer: A Review-An English Version
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 203. CrossRef

Anorectal physioloy

Risk factors associated with low anterior resection syndrome: a cross-sectional study: See Liang Lim, Wan Zainira Wan Zain, Zalina Zahari, Andee Dzulkarnaen Zakaria, Mohd Nizam Md Hashim, Michael Pak-Kai Wong, Zaidi Zakaria, Rosnelifaizur Ramely, Ahmad Shanwani Mohamed Sidek; Ann Coloproctol. 2023;39(5):427-434. Published online June 3, 2022; DOI: https://doi.org/10.3393/ac.2022.00227.0032

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Purpose
Oncological outcomes following rectal cancer surgery have improved significantly over recent decades with lower recurrences and longer overall survival. However, many of the patients experienced low anterior resection syndrome (LARS). This study identified the prevalence and risk factors associated with the development of LARS.
Methods
This cross-sectional study involved patients who were diagnosed with rectal cancer and had undergone sphincter-preserving low anterior resection from January 2011 to December 2020. Upon clinic follow-up, patients were asked to complete an interviewed based questionnaire (LARS score) designed to assess bowel dysfunction after rectal cancer surgery.
Results
Out of 76 patients, 25 patients (32.9%) had major LARS, 10 patients (13.2%) had minor LARS, and 41 patients (53.9%) had no LARS. The height of tumor from anal verge showed an association with the development of major LARS (P=0.039). Those patients with less than 8 cm tumor from anal verge had an increased risk of LARS by 3 times compared to those with 8 cm and above (adjusted odds ratio, 3.11; 95% confidence interval, 1.06–9.13).
Conclusion
Results from our study show that low tumor height was a significant risk factor that has a negative impact on bowel function after surgery. The high prevalence of LARS emphasizes the need for study regarding risk factors and the importance of understanding the pathophysiology of LARS, in order for us to improve patient bowel function and quality of life after rectal cancer surgery.

Citations

Citations to this article as recorded by

Comparative analysis of organ preservation attempt and radical surgery in clinical T2N0 mid to low rectal cancer
Hyeung-min Park, Jaram Lee, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef
Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef
Low anterior resection syndrome: is it predictable?
Dong Hyun Kang
Annals of Coloproctology.2023; 39(5): 373. CrossRef

Colorectal cancer

International Society of University Colon and Rectal Surgeons survey of surgeons’ preference on rectal cancer treatment: Audrius Dulskas, Philip F. Caushaj, Domas Grigoravicius, Liu Zheng, Richard Fortunato, Joseph W. Nunoo-Mensah, Narimantas E. Samalavicius; Ann Coloproctol. 2023;39(4):307-314. Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00255.0036

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Purpose
Rectal cancer treatment has a wide range of possible approaches from radical extirpative surgery to nonoperative watchful waiting following chemoradiotherapy, with or without, additional chemotherapy. Our goal was to assess the personal opinion of active practicing surgeons on rectal cancer treatment if he/she was the patient.
Methods
A panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) selected 10 questions that were included in a questionnaire that included other items including demographics. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in our database and remained open from April 16 to 28, 2020.
Results
One hundred sixty-three specialists completed the survey. The majority of surgeons (n=65, 39.9%) chose the minimally invasive (laparoscopic) surgery for their personal treatment of rectal cancer. For low-lying rectal cancer T1 and T2, the treatment choice was standard chemoradiation+local excision (n=60, 36.8%) followed by local excision±chemoradiotherapy if needed (n=55, 33.7%). In regards to locally advanced low rectal cancer T3 or greater, the preference of the responders was for laparoscopic surgery (n=65, 39.9%). We found a statistically significant relationship between surgeons’ age and their preference for minimally invasive techniques demonstrating an age-based bias on senior surgeons’ inclination toward open approach.
Conclusion
Our survey reveals an age-based preference by surgeons for minimally invasive surgical techniques as well as organ-preserving techniques for personal treatment of treating rectal cancer. Only 1/4 of specialists do adhere to the international guidelines for treating early rectal cancer.

Citations

Citations to this article as recorded by

Performance reporting design in artificial intelligence studies using image-based TNM staging and prognostic parameters in rectal cancer: a systematic review
Minsung Kim, Taeyong Park, Bo Young Oh, Min Jeong Kim, Bum-Joo Cho, Il Tae Son
Annals of Coloproctology.2024; 40(1): 13. CrossRef
Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
Effects of Adjuvant Chemotherapy on Oncologic Outcomes in Patients With Stage ⅡA Rectal Cancer Above the Peritoneal Reflection Who Did Not Undergo Preoperative Chemoradiotherapy
Hyo Seon Ryu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Yong Sang Hong, Tae Won Kim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(4): 392. CrossRef
Comparative analysis of organ preservation attempt and radical surgery in clinical T2N0 mid to low rectal cancer
Hyeung-min Park, Jaram Lee, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef

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