Annals of Coloproctology

Volume 40(1); February 2024

Editorial

To go high, or to go low: the never-ending debate of inferior mesenteric artery ligation: HyungJoo Baik; Ann Coloproctol. 2024;40(1):1-2. Published online February 8, 2024; DOI: https://doi.org/10.3393/ac.2024.00094.0013

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Reviews

Benign bowel disease

Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery: Jingting Wu, Hannah Chi, Shawn Kok, Jason M.W. Chua, Xi-Xiao Huang, Shipin Zhang, Shimin Mah, Li-Xin Foo, Hui-Yee Peh, Hui-Bing Lee, Phoebe Tay, Cherie Tong, Jasmine Ladlad, Cheryl H.M. Tan, Nathanelle Khoo, Darius Aw, Cheryl X.Z. Chong, Leonard M.L. Ho, Sharmini S. Sivarajah, Jialin Ng, Winson J.H. Tan, Fung-Joon Foo, Bin-Tean Teh, Frederick H. Koh; Ann Coloproctol. 2024;40(1):3-12. Published online March 31, 2023; DOI: https://doi.org/10.3393/ac.2022.01207.0172

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11 Citations

Abstract PDF

Sarcopenia, which is characterized by progressive and generalized loss of skeletal muscle mass and strength, has been well described to be associated with numerous poor postoperative outcomes, such as increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care, decreased functional outcome, and poorer oncological outcomes in cancer surgery. Multimodal prehabilitation, as a concept that involves boosting and optimizing the preoperative condition of a patient prior to the upcoming stressors of a surgical procedure, has the purported benefits of reversing the effects of sarcopenia, shortening hospitalization, improving the rate of return to bowel activity, reducing the costs of hospitalization, and improving quality of life. This review aims to present the current literature surrounding the concept of sarcopenia, its implications pertaining to colorectal cancer and surgery, a summary of studied multimodal prehabilitation interventions, and potential future advances in the management of sarcopenia.

Citations

Citations to this article as recorded by

Preoperative Management of the Adult Oncology Patient
Shannon M. Popovich, Thomas R. Vetter
Anesthesiology Clinics.2024; 42(1): 145. CrossRef
The potential use of perioperative rectus femoris ultrasonography in guiding prehabilitation strategies
W.R. Martis
Journal of Clinical Anesthesia.2024; 92: 111302. CrossRef
Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef
Differences in Functional Capacity between Oncologic and Non-Oncologic Populations: Reference Values
Egoitz Mojas, Aitor Santisteban, Iker Muñoz-Pérez, Arkaitz Larrinaga-Undabarrena, Maria Soledad Arietaleanizbeaskoa, Nere Mendizabal-Gallastegui, Gonzalo Grandes, Jon Cacicedo, Xabier Río
Healthcare.2024; 12(3): 318. CrossRef
The use of technology in cancer prehabilitation: a systematic review
San San Tay, Fuquan Zhang, Edmund Jin Rui Neo
Frontiers in Oncology.2024;[Epub] CrossRef
Sarcopenia as a Preoperative Risk Stratification Tool among Older Adults with Inflammatory Bowel Disease

Advances in Geriatric Medicine and Research.2024;[Epub] CrossRef
Analysis of effect of colonoscopy combined with laparoscopy in the treatment of colorectal tumors
Deyu Zhao, Xun Sun, Xun Guo, Wang Jianfeng
Technology and Health Care.2024; 32(4): 2115. CrossRef
Diagnosing Sarcopenia with AI-Aided Ultrasound (DINOSAUR)—A Pilot Study
Vanessa Yik, Shawn Shi Xian Kok, Esther Chean, Yi-En Lam, Wei-Tian Chua, Winson Jianhong Tan, Fung Joon Foo, Jia Lin Ng, Sharmini Sivarajah Su, Cheryl Xi-Zi Chong, Darius Kang-Lie Aw, Nathanelle Ann Xiaolian Khoo, Paul E. Wischmeyer, Jeroen Molinger, Stev
Nutrients.2024; 16(16): 2768. CrossRef
The relation between preoperative radiological sarcopenia and postoperative recovery of physical activity in older surgical cancer patients; an explorative study
S. Hendriks, M.G. Huisman, L. Weerink, L.T. Jonker, B.C. van Munster, J.J. de Haan, G.H. de Bock, B.L. van Leeuwen
The Journal of nutrition, health and aging.2024; 28(10): 100345. CrossRef
Get Fit: Muscle Health for Crohn’s Disease Surgical Outcome Optimization
Sara Massironi, Pierpaolo Sileri, Silvio Danese
Inflammatory Bowel Diseases.2023;[Epub] CrossRef
Recommendations on the use of prehabilitation, i.e. comprehensive preparation of the patient for surgery
Tomasz Banasiewicz, Jarosław Kobiela, Jarosław Cwaliński, Piotr Spychalski, Patrycja Przybylska, Karolina Kornacka, Dagmara Bogdanowska-Charkiewicz, Magdalena Leyk-Kolańczak, Maciej Borejsza-Wysocki, Dominika Batycka-Stachnik, Rafał Drwiła
Polish Journal of Surgery.2023; 95(4): 62. CrossRef

Colorectal cancer

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; Ann Coloproctol. 2024;40(1):13-26. Published online February 28, 2024; DOI: https://doi.org/10.3393/ac.2023.00892.0127

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3 Citations

Abstract PDF

Purpose
The integration of artificial intelligence (AI) and magnetic resonance imaging in rectal cancer has the potential to enhance diagnostic accuracy by identifying subtle patterns and aiding tumor delineation and lymph node assessment. According to our systematic review focusing on convolutional neural networks, AI-driven tumor staging and the prediction of treatment response facilitate tailored treatment strategies for patients with rectal cancer.
Methods
This paper summarizes the current landscape of AI in the imaging field of rectal cancer, emphasizing the performance reporting design based on the quality of the dataset, model performance, and external validation.
Results
AI-driven tumor segmentation has demonstrated promising results using various convolutional neural network models. AI-based predictions of staging and treatment response have exhibited potential as auxiliary tools for personalized treatment strategies. Some studies have indicated superior performance than conventional models in predicting microsatellite instability and KRAS status, offering noninvasive and cost-effective alternatives for identifying genetic mutations.
Conclusion
Image-based AI studies for rectal cancer have shown acceptable diagnostic performance but face several challenges, including limited dataset sizes with standardized data, the need for multicenter studies, and the absence of oncologic relevance and external validation for clinical implantation. Overcoming these pitfalls and hurdles is essential for the feasible integration of AI models in clinical settings for rectal cancer, warranting further research.

Citations

Citations to this article as recorded by

L’intelligence artificielle pourrait-elle aider le chirurgien digestif dans la prise en charge du cancer du rectum ?
Arnaud Alves, Karem Slim
Journal de Chirurgie Viscérale.2024; 161(4): 253. CrossRef
Can artificial intelligence help a digestive surgeon in management of rectal cancer?
Arnaud Alves, Karem Slim
Journal of Visceral Surgery.2024; 161(4): 231. CrossRef
Artificial intelligence for the colorectal surgeon in 2024 – A narrative review of Prevalence, Policies, and (needed) Protections
Kurt S. Schultz, Michelle L. Hughes, Warqaa M. Akram, Anne K. Mongiu
Seminars in Colon and Rectal Surgery.2024; 35(3): 101037. CrossRef

Original Articles

Colorectal cancer

Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study: Ahmad Sakr, Seung Yoon Yang, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim; Ann Coloproctol. 2024;40(1):27-35. Published online February 28, 2024; DOI: https://doi.org/10.3393/ac.2022.01067.0152

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Abstract PDF: Purpose
Despite advances in neoadjuvant chemoradiotherapy and anal sphincter-preserving surgery for rectal cancer, bowel dysfunction is still unavoidable and negatively affects patients’ quality of life. In this longitudinal study, we aimed to investigate the changes in bowel function with follow-up time and the effect of neoadjuvant chemoradiotherapy on bowel function following low anterior resection for rectal cancer.
Methods
In this study, 171 patients with upper or middle rectal cancer who underwent low anterior resection between 2012 and 2018 were included. Bowel function was assessed longitudinally with Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner scores every 6 months after restoration of bowel continuity. Patients with at least 2 follow-up visits were included.
Results
Overall, 100 patients received neoadjuvant chemoradiotherapy. Urgency, soilage, and fecal incontinence were noted within 24 months in the patients treated with neoadjuvant chemoradiotherapy. After 2 years of follow-up, significant bowel dysfunction and fecal incontinence were observed in the neoadjuvant chemoradiotherapy group. Low tumor level and neoadjuvant chemoradiotherapy were associated with delayed bowel dysfunction.
Conclusion
Neoadjuvant chemoradiotherapy in combination with low tumor level was significantly associated with delayed bowel dysfunction even after 2 years of follow-up. Therefore, careful selection and discussion with patients are paramount.

Benign bowel disease

Development of a home health care service platform for ostomy patient management: Seongwoo Yang, Ji Won Park, Hyuk Hur, Min Jung Kim, Seung-Yong Jeong, Kyounghoon Park, Ik Yong Kim; Ann Coloproctol. 2024;40(1):36-43. Published online November 21, 2022; DOI: https://doi.org/10.3393/ac.2022.00360.0051

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1 Citations

Abstract PDF

Purpose
The use of an ostomy for urination and defecation leads to reduced quality of life. Although many ostomy management strategies are needed, such strategies are often implemented by patients. Thus, there is a need for a home health care service platform that can be used in ostomy patient management.
Methods
We developed an ostomy patient management platform by identifying the needs of patients and medical staff through the Chronic Care Ostomy Self-Management Training Program in the United States and from studies conducted in Korea.
Results
The platform encompassed physical management, psychological management, maintenance of social function, spiritual stability, and home medical care. These components were implemented through monitoring, self-care guidance, and a community platform. For the monitoring function, patients entered their health status in a mobile application (app); the medical staff at the affiliated hospital then monitored the stoma status through a web interface.
Conclusion
Our platform allows medical staff to monitor ostomy patients through a web interface and help such patients to fully manage their ostomy at home using an app. We expect that the continued development of patient-oriented functions in our app will allow ostomy patients to experience quality-of-life improvements.

Citations

Citations to this article as recorded by

Lebensqualität von Stomapatienten
Michael S. Kasparek
coloproctology.2023; 45(4): 242. CrossRef

Minimally invasive surgery

Learning curve for single-port robot-assisted colectomy: Moon Suk Choi, Seong Hyeon Yun, Sung Chul Lee, Jung Kyong Shin, Yoon Ah Park, Jungwook Huh, Yong Beom Cho, Hee Cheol Kim, Woo Yong Lee; Ann Coloproctol. 2024;40(1):44-51. Published online December 20, 2022; DOI: https://doi.org/10.3393/ac.2022.00745.0106

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2 Citations

Abstract PDF

Purpose
Since the introduction of robotic surgery, robots for colorectal cancer have replaced laparoscopic surgery, and a single-port robot (SPR) platform has been launched and is being used to treat patients. We analyzed the learning curve and initial complications of using an SPR platform in colorectal cancer surgery.
Methods
We reviewed 39 patients who underwent SPR colectomy from April to October 2019. All surgeries were performed by the same surgeon using an SPR device. A learning curve was generated using the cumulative sum methodology to assess changes in total operation time, docking time, and surgeon console time. We grouped the patients into 3 groups according to the time period: the first 11 were phase 1, the next 11 were phase 2, and the last 17 were phase 3.
Results
The mean age of the patients was 61.28±13.03 years, and they had a mean body mass index of 23.79±2.86 kg/m2. Among the patients, 23 (59.0%) were male, and 16 (41.0%) were female. The average operation time was 186.59±51.30 minutes, the average surgeon console time was 95.49±35.33 minutes, and the average docking time (time from skin incision to robot docking) was 14.87±10.38 minutes. The surgeon console time differed significantly among the different phases (P<0.001). Complications occurred in 8 patients: 2 ileus, 2 postoperation hemoglobin changes, 3 urinary retentions, and 1 complicated fluid collection.
Conclusion
In our experience, the learning curve for SPR colectomy was achieved after the 18th case.

Citations

Citations to this article as recorded by

Da Vinci single-port robotic system current application and future perspective in general surgery: A scoping review
Francesco Celotto, Niccolò Ramacciotti, Alberto Mangano, Giacomo Danieli, Federico Pinto, Paula Lopez, Alvaro Ducas, Jessica Cassiani, Luca Morelli, Gaya Spolverato, Francesco Maria Bianco
Surgical Endoscopy.2024; 38(9): 4814. CrossRef
Wristed articulated instrumentation for single‐incision plus one‐port laparoscopic surgery for obstructed sigmoid colon cancer—A video vignette
Sung Uk Bae
Colorectal Disease.2024; 26(9): 1782. 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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6 Web of Science
8 Citations

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

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
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.

Technical Notes

Transanal opening of the intersphincteric space (TROPIS): a novel procedure on the horizon to effectively manage high complex anal fistulas: Pankaj Garg, Anvesha Mongia; Ann Coloproctol. 2024;40(1):74-81. Published online October 24, 2023; DOI: https://doi.org/10.3393/ac.2022.01263.0180

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Abstract PDF

Anal fistulas, especially complex and high fistulas, are difficult to manage. The transanal opening of the intersphincteric space (TROPIS) procedure was first described in 2017, and a high success rate of over 90% was reported in high complex fistulas. Since then, more studies and even a meta-analysis have corroborated the high efficacy of this procedure in high fistulas. Conventionally, the main focus was to close the internal (primary) opening for the fistula to heal. However, most complex fistulas have a component of the fistula tract in the intersphincteric plane. This component is like an abscess (sepsis) in a closed space (2 muscle layers). It is a well-known fact that in the presence of sepsis, healing by secondary intention leads to better results than attempting to heal by primary intention. Therefore, TROPIS is the first procedure in which, instead of closing the internal opening, the opening is widened by laying open the fistula tract in the intersphincteric plane so that healing can occur by secondary intention. Although the drainage of high intersphincteric abscesses through the transanal route was described 5 decades ago, the routine utilization of TROPIS for the definitive management of high complex fistulas was first described in 2017. The external anal sphincter (EAS) is completely spared in TROPIS, as the fistula tract on either side of the EAS is managed separately—inner (medial) to the EAS by laying open the intersphincteric space and outer (lateral) to the EAS by curettage or excision.

Citations

Citations to this article as recorded by

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
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef

Can the Heald anal stent help to reduce anastomotic or rectal stump leak in elective and emergency colorectal surgery? A single-center experience: Michael Jones, Brendan Moran, Richard John Heald, John Bunni; Ann Coloproctol. 2024;40(1):82-85. Published online February 26, 2024; DOI: https://doi.org/10.3393/ac.2023.00038.0005

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Abstract PDF: Anastomotic and rectal stump leaks are feared complications of colorectal surgery. Diverting stomas are commonly used to protect low rectal anastomoses but can have adverse effects. Studies have reported favorable outcomes for transanal drainage devices instead of diverting stomas. We describe our use of the Heald anal stent and its potential impact in reducing anastomotic or rectal stump leak after elective or emergency colorectal surgery. We performed a single-center retrospective analysis of patients in whom a Heald anal stent had been used to “protect” a colorectal anastomosis or a rectal stump, in an elective or emergency context, for benign and malignant pathology. Intraoperative and postoperative outcomes were reviewed using clinical and radiological records. The Heald anal stent was used in 93 patients over 4 years. Forty-six cases (49%) had a colorectal anastomosis, and 47 (51%) had an end stoma with a rectal stump. No anastomotic or rectal stump leaks were recorded. We recommend the Heald anal stent as a simple and affordable adjunct that may decrease anastomotic and rectal stump leak by reducing intraluminal pressure through drainage of fluid and gas.

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