Annals of Coloproctology

Volume 35(1); February 2019

Editorial

Anastomotic Sinus Developed From Leakage in Rectal Cancer Resection: When Can We Reverse the Defunctioning Stoma?: Chang Hyun Kim; Ann Coloproctol. 2019;35(1):1-2. Published online February 28, 2019; DOI: https://doi.org/10.3393/ac.2018.12.28

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Chronische Anastomoseninsuffizienz nach tiefer Rektumresektion – ein ungelöstes Problem?
Peter Kienle, Jörn Richard Magdeburg
Der Chirurg.2021; 92(7): 605. CrossRef

Review

How to Achieve a Higher Pathologic Complete Response in Patients With Locally Advanced Rectal Cancer Who Receive Preoperative Chemoradiation Therapy: Suk-Hwan Lee; Ann Coloproctol. 2019;35(1):3-8. Published online February 28, 2019; DOI: https://doi.org/10.3393/ac.2019.02.17

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The current standard of care for treating patients with locally advanced rectal cancer includes preoperative chemoradiation therapy (PCRT) followed by a total mesorectal excision and postoperative adjuvant chemotherapy. A subset of these patients has achieved a pathologic complete response (pCR) and they have shown improved disease-free and overall survival compared to non-pCR patients. Thus, many efforts have been made to achieve a higher pCR through PCRT. In this review, results from various ongoing and recently completed clinical trials that are being or have been conducted with an aim to improve tumor response by modifying therapy will be discussed.

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Predictors of Pathologic Response After Total Neoadjuvant Therapy in Patients With Rectal Adenocarcinoma: A National Cancer Database Analysis
David M McDermott, Sarah A Singh, Paul B Renz, Shaakir Hasan, Josh Weir
Cureus.2021;[Epub] CrossRef
Can Pretreatment Blood Biomarkers Predict Pathological Response to Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer?
Marina Morais, Telma Fonseca, Raquel Machado-Neves, Mrinalini Honavar, Ana Rita Coelho, Joanne Lopes, Elisabete Barbosa, Emanuel Guerreiro, Silvestre Carneiro
Future Oncology.2021; 17(35): 4947. CrossRef
Pretreatment Blood Biomarkers Predict Pathologic Responses to Neo-Crt in Patients with Locally Advanced Rectal Cancer
Aijie Li, Kewen He, Dong Guo, Chao Liu, Duoying Wang, Xiangkui Mu, Jinming Yu
Future Oncology.2019; 15(28): 3233. CrossRef

Original Articles

Effect of Hyperoxygenation During Surgery on Surgical Site Infection in Colorectal Surgery: Mina Alvandipour, Farzad Mokhtari-Esbuie, Afshin Gholipour Baradari, Abolfazl Firouzian, Mehdi Rezaie; Ann Coloproctol. 2019;35(1):9-14. Published online February 28, 2019; DOI: https://doi.org/10.3393/ac.2018.01.16

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Purpose
Despite the use of different surgical methods, surgical site infection is still an important cause of mortality and morbidity in patients and imposes a considerable cost on the healthcare system. Administration of supplemental oxygen during surgery has been reported to reduce surgical site infection (SSI); however, that result is still controversial. This study was performed to evaluate the effect of hyperoxygenation during colorectal surgery on the incidence of wound infection.
Methods
This study was a prospective double-blind case-control study. The main aim of the study was to evaluate the effect of hyperoxygenation during colorectal surgery on the incidence of SSI. Also, secondary outcomes, such as atelectasis, pneumonia, respiratory failure, length of hospital stay, and required hospitalization in the intensive care unit were evaluated.
Results
SSI was recorded in 2 patients (2 of 40, 5%) in the hyperoxygenation group (FiO2 80%) and 6 patients (6 of 40, 15%) in the control group (FiO2 30%) (P < 0.05). Time of hospitalization was 6 ± 6.4 days in the hyperoxygenation group and 9.2 ± 2.4 days in the control group (P < 0.05).
Conclusion
This study showed a positive effect of hyperoxygenation in reducing SSI in colorectal surgery, especially surgery in an emergency setting. When the low risk, low cost, and effectiveness of this method in patients undergoing a laparotomy are considered, it is recommended for all patients undergoing colorectal surgery.

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Risk Factors for Postoperative Infections Following Appendectomy of Complicated Appendicitis: A Meta-analysis and Retrospective Single-institutional Study
Katherine Cironi, Aaron L. Albuck, Bryant McLafferty, Alison K. Mortemore, Christina McCarthy, Mohammad Hussein, Peter P. Issa, Tyler Metz, Marcela Herrera, Eman Toraih, Sharven Taghavi, Emad Kandil, Jacquelyn Turner
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(1): 20. CrossRef
Vermeidung postoperativer Wundinfektionen
Pernilla V. Conrad, Thomas Becker, Julius Pochhammer, Axel Kramer
Im OP.2024; 14(05): 236. CrossRef
Updated meta-analysis on intraoperative inspired fraction of oxygen and the risk of surgical site infection in adults undergoing general and regional anesthesia
Yoann El Maleh, Charlotte Fasquel, Christophe Quesnel, Marc Garnier
Scientific Reports.2023;[Epub] CrossRef
Vermeidung postoperativer Wundinfektionen
Pernilla V. Stropnicky, Thomas Becker, Julius Pochhammer, Axel Kramer
Allgemein- und Viszeralchirurgie up2date.2023; 17(04): 301. CrossRef
The effect of high perioperative inspiratory oxygen fraction for abdominal surgery on surgical site infection: a systematic review and meta-analysis
Jae Hee Kuh, Woo-Seok Jung, Leerang Lim, Hae Kyung Yoo, Jae-Woo Ju, Ho-Jin Lee, Won Ho Kim
Scientific Reports.2023;[Epub] CrossRef
Differences in clinical and cost-effectiveness between cefmetazole and flomoxef for the prevention of surgical site infection in elective colorectal surgery: A single-center, retrospective cohort study
Yuya Urano, Shunichi Saito, Takafumi Machimoto, Yukio Tsugihashi, Hiroyasu Ishimaru, Hiroyuki Akebo, Ryuichi Sada
Journal of Infection and Chemotherapy.2022; 28(4): 510. CrossRef
Does Higher Intraoperative Fraction of Inspired Oxygen Improve Complication Rates Following Implant-Based Breast Reconstruction?
Mallory A Rowley, Kometh Thawanyarat, Jennifer K Shah, Lawrence Cai, Elizabeth Turner, Oscar J Manrique, Brian Thornton, Rahim Nazerali
Aesthetic Surgery Journal Open Forum.2022;[Epub] CrossRef
Fraction of inspired oxygen during general anesthesia for non‐cardiac surgery: Systematic review and meta‐analysis
Maria Høybye, Peter C. Lind, Mathias J. Holmberg, Maria Bolther, Marie K. Jessen, Mikael F. Vallentin, Frederik B. Hansen, Johanne M. Holst, Andreas Magnussen, Niklas S. Hansen, Cecilie M. Johannsen, Johannes Enevoldsen, Thomas H. Jensen, Lara L. Roessler
Acta Anaesthesiologica Scandinavica.2022; 66(8): 923. CrossRef
Intraoperative respiratory and hemodynamic strategies for reducing nausea, vomiting, and pain after surgery: Systematic review and meta‐analysis
Johanne M. Holst, Maibritt P. Klitholm, Jeppe Henriksen, Mikael F. Vallentin, Marie K. Jessen, Maria Bolther, Mathias J. Holmberg, Maria Høybye, Peter Carøe Lind, Asger Granfeldt, Lars W. Andersen
Acta Anaesthesiologica Scandinavica.2022; 66(9): 1051. CrossRef
Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement
Gearóid Mc Geehan, Itoro M. Edelduok, Magda Bucholc, Angus Watson, Zsolt Bodnar, Alison Johnston, Michael Sugrue
Life.2021; 11(2): 138. CrossRef

Does the Different Locations of Colon Cancer Affect the Oncologic Outcome? A Propensity-Score Matched Analysis: Kwan Mo Yang, In Ja Park, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seok-Byung Lim, Na Young Kim, Shinae Hong, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2019;35(1):15-23. Published online February 28, 2019; DOI: https://doi.org/10.3393/ac.2018.07.25

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Purpose
We evaluate the prognostic value of primary tumor location for oncologic outcomes in patients with colon cancer (CC).
Methods
CC patients treated with curative surgery between 2009 and 2012 were classified into 2 groups: right-sided colon cancer (RCC) and left-sided colon cancer (LCC). Recurrence-free survival (RFS) and overall survival (OS) were examined based on tumor stage. Propensity scores were created using eight variables (age, sex, T stage, N stage, histologic grade, presence of lymphovascular invasion/perineural invasion, and microsatellite instability status).
Results
Overall, 2,329 patients were identified. The 5-year RFSs for RCC and LCC patients were 89.7% and 88.4% (P = 0.328), respectively, and their 5-year OSs were 90.9% and 93.4% (P = 0.062). Multivariate survival analyses were carried out by using the Cox regression proportional hazard model. In the unadjusted analysis, a marginal increase in overall mortality was seen in RCC patients (hazard ratio [HR], 1.297; 95% confidence interval [CI], 0.987–1.704, P = 0.062); however, after multivariable adjustment, similar OSs were observed in those patients (HR, 1.219; 95% CI, 0.91–1.633; P = 0.183). After propensity-score matching with a total of 1,560 patients, no significant difference was identified (P = 0.183). A slightly worse OS was seen for stage III RCC patients (HR, 1.561; 95% CI, 0.967–2.522; P = 0.068) than for stage III LCC patients. The 5-year OSs for patients with stage III RCC and stage III LCC were 85.5% and 90.5%, respectively (P = 0.133).
Conclusion
Although the results are inconclusive, tumor location tended to be associated with OS in CC patients with lymph node metastasis, but it was not related to oncologic outcome.

Citations

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Prognostic value of primary tumor location in colorectal cancer: an updated meta-analysis
Hanieh Gholamalizadeh, Nima Zafari, Mahla Velayati, Hamid Fiuji, Mina Maftooh, Elnaz Ghorbani, Seyed Mahdi Hassanian, Majid Khazaei, Gordon A. Ferns, Elham Nazari, Amir Avan
Clinical and Experimental Medicine.2023; 23(8): 4369. CrossRef
Inhibition of CXCR4 and CXCR7 Is Protective in Acute Peritoneal Inflammation
Kristian-Christos Ngamsri, Christoph Jans, Rizki A. Putri, Katharina Schindler, Jutta Gamper-Tsigaras, Claudia Eggstein, David Köhler, Franziska M. Konrad
Frontiers in Immunology.2020;[Epub] CrossRef
Left colon as a novel high-risk factor for postoperative recurrence of stage II colon cancer
Liming Wang, Yasumitsu Hirano, Toshimasa Ishii, Hiroka Kondo, Kiyoka Hara, Nao Obara, Shigeki Yamaguchi
World Journal of Surgical Oncology.2020;[Epub] CrossRef

Variation in the Height of Rectal Cancers According to the Diagnostic Modalities: Seung-Seop Yeom, In Ja Park, Dong-Hoon Yang, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seok-Byung Lim, Sung Ho Park, Hwa Jung Kim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2019;35(1):24-29. Published online February 28, 2019; DOI: https://doi.org/10.3393/ac.2018.07.31

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Purpose
Although the height of a rectal tumor above the anal verge (tumor height) partly determines the treatment strategy, no practical standard exists for reporting this. We aimed to demonstrate the differences in tumor height according to the diagnostic modality used for its measurement.
Methods
We identified 100 patients with rectal cancers located within 15 cm of the anal verge who had recorded tumor heights measured by using magnetic resonance imaging (MRI), colonoscopy, and digital rectal examination (DRE). Tumor height measured by using MRI was compared with those measured by using DRE and colonoscopy to assess reporting inconsistencies. Factors associated with differences in tumor height among the modalities were also evaluated.
Results
The mean tumor heights were 77.8 ± 3.3, 52.9 ± 2.3, and 68.9 ± 3.1 mm when measured by using MRI, DRE, and colonoscopy, respectively (P < 0.001). Agreement among the 3 modalities in terms of tumor sublocation within the rectum was found in only 39% of the patients. In the univariate and the multivariate analyses, clinical stage showed a possible association with concordance among modalities, but age, sex, and luminal location of the tumor were not associated with differences among modalities.
Conclusion
The heights of rectal cancer differed according to the diagnostic modality. Tumor height has implications for rectal cancer’s surgical planning and for interpreting comparative studies. Hence, a consensus is needed for measuring and reporting tumor height.

Citations

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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;[Epub] CrossRef
Interrater Agreement of Height Assessment by Rigid Proctoscopy/ Rectoscopy for Rectal Carcinoma
Matthias J. Kraemer, Sarkhan Nabiyev, Silvia E. Kraemer, Stephanie Schipmann
Diseases of the Colon & Rectum.2024;[Epub] CrossRef
Chinese national clinical practice guidelines on prevention, diagnosis and treatment of early colorectal cancer
Jingnan Li, Hongwei Yao, Yun Lu, Shutian Zhang, Zhongtao Zhang
Chinese Medical Journal.2024; 137(17): 2017. CrossRef
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
Comparison of flexible endoscopy and magnetic resonance imaging in determining the tumor height in rectal cancer
Mohammed H. Basendowah, Mohammed A. Ezzat, Aseel H. Khayyat, Eyad Saleh A. Alamri, Turki A. Madani, Anas H. Alzahrani, Rana Y. Bokhary, Arwa O. Badeeb, Hussam A. Hijazi
Cancer Reports.2023;[Epub] CrossRef
Measuring Rectal Cancer Tumor Height: Concordance Between Clinical Examination and MRI
Shannon M. Navarro, Shuai Chen, Linda M. Farkas
Diseases of the Colon & Rectum.2022; 65(4): 497. CrossRef
How do they measure up: Assessing the height of rectal cancer with digital rectal exam, endoscopy, and MRI,,
Jordan Wlodarczyk, Kshitij Gaur, Nicholas Serniak, Kevin Mertz, Jason Muri, Sarah Koller, Sang W. Lee, Kyle G. Cologne
Surgery in Practice and Science.2022; 10: 100096. CrossRef
Measurement of rectal tumor height from the anal verge on MRI: a comparison of internal versus external anal sphincter
David D. B. Bates, James L. Fuqua, Junting Zheng, Marinela Capanu, Jennifer S. Golia Pernicka, Sidra Javed-Tayyab, Viktoriya Paroder, Iva Petkovska, Marc J. Gollub
Abdominal Radiology.2021; 46(3): 867. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef

Anastomotic Sinus That Developed From Leakage After a Rectal Cancer Resection: Should We Wait for Closure of the Stoma Until the Complete Resolution of the Sinus?: Chris Tae-Young Chung, Se-Jin Baek, Jung-Myun Kwak, Jin Kim, Seon-Hahn Kim; Ann Coloproctol. 2019;35(1):30-35. Published online January 25, 2019; DOI: https://doi.org/10.3393/ac.2018.08.13

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Purpose
The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus.
Methods
The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus.
Results
Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture.
Conclusion
Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.

Citations

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Management of Low-Rectal Anastomotic Sinus With Transanal Minimally Invasive Septotomy
Nirvana B. Saraswat, Scott A. Brill, William E. Wise
The American Surgeon.2023; 89(2): 322. CrossRef
The management of asymptomatic radiological anastomotic leakage following anterior resection
Mohamed Rabie, Laura Parry, Iannish Sadien, Sandeep Kapur, Adam Stearns, Irshad Shaikh
ANZ Journal of Surgery.2022; 92(4): 801. CrossRef
Chronische Anastomoseninsuffizienz nach tiefer Rektumresektion – ein ungelöstes Problem?
Peter Kienle, Jörn Richard Magdeburg
Der Chirurg.2021; 92(7): 605. CrossRef
Response to Dioscoridi et al.
G. I. Popivanov, V. M. Mutafchiyski, R. Cirocchi, S. D. Chipeva, V. V. Vasilev, K. T. Kjossev, M. S. Tabakov
Colorectal Disease.2020; 22(7): 841. CrossRef
Anastomotic Sinus Developed From Leakage in Rectal Cancer Resection: When Can We Reverse the Defunctioning Stoma?
Chang Hyun Kim
Annals of Coloproctology.2019; 35(1): 1. CrossRef

Cancer-Associated Fibroblasts and Desmoplastic Reactions Related to Cancer Invasiveness in Patients With Colorectal Cancer: Nari Shin, Gyung Mo Son, Dong-Hoon Shin, Myeong-Sook Kwon, Byung-Soo Park, Hyun-Sung Kim, Dongryeol Ryu, Chi-Dug Kang; Ann Coloproctol. 2019;35(1):36-46. Published online February 28, 2019; DOI: https://doi.org/10.3393/ac.2018.09.10

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Abstract PDF

Purpose
We evaluated the relationship of cancer-associated fibroblasts (CAFs) and desmoplastic reactions with cancer invasiveness and long-term outcomes in patients with colorectal cancer (CRC).
Methods
Histologic evaluation of mature CAFs and desmoplasia was performed by observing the collagen fiber structure and fibroblast cytomorphology in the intratumoral stroma and invasive front of CRC tissues. Cancer-cell invasiveness was evaluated using lymphatic invasion, vascular invasion, perineural invasion, tumor budding, and tumor growth patterns. Overall survival and systemic recurrence were analyzed. A network analysis was performed between CAF maturation, desmoplastic reaction, and cancer invasiveness.
Results
The proportions of mature CAFs in the intratumoral stroma and the invasive front were 57.6% and 60.3%, respectively. Epidermal growth factor receptor (EGFR) overexpression was significantly higher in the mature CAFs in the invasive front as compared to immature CAFs. Lymphatic invasion increased as the number of mature fibroblasts in the intratumoral stroma increased. Tumor budding was observed in almost half of both mature and immature stroma samples and occurred more frequently in infiltrating tumors. On network analysis, well-connected islands were identified that was associated with EGFR overexpression, CAF maturation, and infiltrating tumor growth patterns leading to tumor budding.
Conclusion
The maturity of CAFs and desmoplastic reactions were associated with cancer invasion. However, the cytomorphologic characteristics of CAFs were insufficient as an independent prognostic factor for patients with CRC.

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Cancers.2024; 16(5): 923. CrossRef
Simultaneous Expression of CD70 and POSTN in Cancer-Associated Fibroblasts Predicts Worse Survival of Colorectal Cancer Patients
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Case Report

Anal Adenocarcinoma Can Masquerade as Chronic Anal Fistula in Asians: Faith Qi-Hui Leong, Dedrick Kok Hong Chan, Ker-Kan Tan; Ann Coloproctol. 2019;35(1):47-49. Published online December 3, 2018; DOI: https://doi.org/10.3393/ac.2018.03.15

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Abstract PDF

Purpose
Perianal adenocarcinoma arising from a chronic anorectal fistula is a rare condition for which the natural history and optimal management are not well established. For that reason, we conducted a retrospective analysis of 5 consecutive patients with a perianal adenocarcinoma arising from a chronic anorectal fistula managed at our institution from January 2014 to December 2015.
Methods
The patients were identified from a prospectively collected colorectal cancer database that included all patients managed for colorectal cancer at our institution.
Results
The median age at diagnosis was 64 years (range, 55–72 years). Magnetic resonance imaging (MRI) was the initial investigation for all patients and showed a hyperintense T2-weighted image. One patient underwent an abdominoperineal resection following neoadjuvant chemoradiotherapy and remained disease free during the 12-month follow-up. Three patients received neoadjuvant therapy with intent for surgery, but did not undergo surgery due to either worsening health or metastatic spread. One patient declined intervention. The median overall survival was 10.5 months (range, 2–19 months).
Conclusion
A high index of suspicion is required to make a clinical diagnosis of an anal adenocarcinoma arising from a chronic fistula. Histologic diagnosis must be achieved to confirm the diagnosis. Multimodal therapy with neoadjuvant chemoradiotherapy followed by abdominoperineal resection is the treatment of choice.

Citations

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