Annals of Coloproctology

Original Articles

Oncologic outcomes and associated factors of colon cancer patients aged 70 years and older: Byeo Lee Lim, In Ja Park, Jun-Soo Ro, Young Il Kim, Seok-Byung Lim, Chang Sik Yu; Received June 7, 2023 Accepted September 11, 2023 Published online August 5, 2024; DOI: https://doi.org/10.3393/ac.2023.00367.0052 [Epub ahead of print]

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Purpose
The aim of this study was to examine the prognosis and associated risk factors, including adjuvant chemotherapy (CTx), in elderly patients with colon cancer.
Methods
This retrospective study included patients who underwent radical resection for colon cancer between January 2010 and December 2014 at Asan Medical Center. The effects of stage, risk factors, and chemotherapy on overall survival (OS) and recurrence-free survival (RFS) were compared in patients aged ≥70 and <70 years.
Results
Of 3,313 patients, 933 (28.1%) was aged ≥70 years. Of the 1,921 patients indicated for adjuvant CTx, 1,294 of 1,395 patients (92.8%) aged <70 years and 369 of 526 patients (70.2%) aged ≥70 years received adjuvant CTx. Old age (≥70 years) was independently associated with RFS in overall cohort. Among patients aged ≥70 years indicated for adjuvant CTx, the 5-year OS (81.6% vs. 50.4%, P<0.001) and RFS (82.9% vs. 67.4%, P=0.025) rates were significantly higher in those who did than did not receive adjuvant CTx. Additionally, adjuvant CTx was confirmed as independent risk factor of both OS and RFS in patients aged ≥70 years indicated for adjuvant CTx.
Conclusion
Old age was associated with poor RFS and adjuvant CTx had benefits in OS as well as RFS in elderly patients eligible for adjuvant CTx.

Citations

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Immunological changes and recovery-related factors in older patients with colon cancer: A pilot trial
Byeo Lee Lim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Yousun Ko, Kyung Won Kim, In Ja Park
Journal of Geriatric Oncology.2025; 16(3): 102200. CrossRef
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
Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef

Colorectal cancer

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

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Abstract PDF

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

Citations

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

Colorectal cancer

Efficacy of preoperative chemoradiotherapy in patients with cT2N0 distal rectal cancer: Min Young Park, Chang Sik Yu, Tae Won Kim, Jong Hoon Kim, Jin-hong Park, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2023;39(3):250-259. Published online April 4, 2022; DOI: https://doi.org/10.3393/ac.2022.00066.0009

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
This study was designed to determine the feasibility of preoperative chemoradiotherapy (PCRT) in patients with clinical T2N0 distal rectal cancer.
Methods
Patients who underwent surgery for clinical T2N0 distal rectal cancer between January 2008 and December 2016 were included. Patients were divided into PCRT and non-PCRT groups. Non-PCRT patients underwent radical resection or local excision (LE) according to the surgeon’s decision, and PCRT patients underwent surgery according to the response to PCRT. Patients received 50.0 to 50.4 gray of preoperative radiotherapy with concurrent chemotherapy.
Results
Of 127 patients enrolled, 46 underwent PCRT and 81 did not. The mean distance of lesions from the anal verge was lower in the PCRT group (P=0.004). The most frequent operation was transanal excision and ultralow anterior resection in the PCRT and non-PCRT groups, respectively. Of the 46 patients who underwent PCRT, 21 (45.7%) achieved pathologic complete response, including 15 of the 24 (62.5%) who underwent LE. Rectal sparing rate was significantly higher in the PCRT group (11.1% vs. 52.2%, P<0.001). There were no significant differences in 3- and 5-year overall survival and recurrence-free survival regardless of PCRT or surgical procedures.
Conclusion
PCRT in clinical T2N0 distal rectal cancer patients increased the rectal sparing rate via LE and showed acceptable oncologic outcomes. PCRT may be a feasible therapeutic option to avoid abdominoperineal resection in clinical T2N0 distal rectal cancer.

Citations

Citations to this article as recorded by

Lymph node metastasis following chemoradiotherapy in advanced rectal cancer: ypT2-focused analyses of total mesorectal excision specimens
A. N. Singhi, T.-G. Lee, H.-M. Ahn, H.-R. Shin, M. J. Choi, M. H. Jo, H.-K. Oh, D.-W. Kim, S.-B. Kang
Techniques in Coloproctology.2025;[Epub] CrossRef
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
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
Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. 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

Malignant disease,Colorectal cancer,Benign diesease & IBD,Biomarker & risk factor

Molecular characterization of dysplasia-initiated colorectal cancer with assessing matched tumor and dysplasia samples: Sungwon Jung, Jong Lyul Lee, Tae Won Kim, Jongmin Lee, Yong Sik Yoon, Kil Yeon Lee, Ki-hwan Song, Chang Sik Yu, Yong Beom Cho; Ann Coloproctol. 2022;38(1):72-81. Published online November 17, 2021; DOI: https://doi.org/10.3393/ac.2021.00290.0041

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Abstract PDF

Purpose
Ulcerative colitis (UC) is known to have an association with the increased risk of colorectal cancer (CRC), and UC-associated CRC does not follow the typical progress pattern of adenoma-carcinoma. The aim of this study is to investigate molecular characteristics of UC-associated CRC and further our understanding of the association between UC and CRC.
Methods
From 5 patients with UC-associated CRC, matched normal, dysplasia, and tumor specimens were obtained from formalin-fixed paraffin-embedded (FFPE) samples for analysis. Genomic DNA was extracted and whole exome sequencing was conducted to identify somatic variations in dysplasia and tumor samples. Statistical analysis was performed to identify somatic variations with significantly higher frequencies in dysplasia-initiated tumors, and their relevant functions were investigated.
Results
Total of 104 tumor mutation genes were identified with higher mutation frequencies in dysplasia-initiated tumors. Four of the 5 dysplasia-initiated tumors (80.0%) have TP53 mutations with frequent stop-gain mutations that were originated from matched dysplasia. APC and KRAS are known to be frequently mutated in general CRC, while none of the 5 patients have APC or KRAS mutation in their dysplasia and tumor samples. Glycoproteins including mucins were also frequently mutated in dysplasia-initiated tumors.
Conclusion
UC-associated CRC tumors have distinct mutational characteristics compared to typical adenoma-carcinoma tumors and may have different cancer-driving molecular mechanisms that are initiated from earlier dysplasia status.

Citations

Citations to this article as recorded by

Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef
Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus R0 resection for resectable colorectal cancer with peritoneal metastases and low peritoneal cancer index scores: A collaborative observational study from Korea and Japan
Daichi Kitaguchi, Eun Jung Park, Seung Hyuk Baik, Shoma Sasaki, Yuichiro Tsukada, Masaaki Ito
International Journal of Surgery.2023;[Epub] CrossRef

Malignant disease, Rectal cancer,Colorectal cancer,Epidemiology & etiology

Clinicopathological Characteristics and Surgical Outcomes of Crohn Disease-Associated Colorectal Malignancy: Yoo Na Lee, Jong Lyul Lee, Chang Sik Yu, Jong Beom Kim, Seok-Byung Lim, In Ja Park, Young Sik Yoon, Chan Wook Kim, Suk-Kyun Yang, Byong Duk Ye, Sang Hyoung Park, Jin Cheon Kim; Ann Coloproctol. 2021;37(2):101-108. Published online April 30, 2021; DOI: https://doi.org/10.3393/ac.2020.11.02

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Abstract PDF Supplementary Material

Purpose
Carcinoma arising from Crohn disease (CD) is rare, and there is no clear guidance on how to properly screen for at-risk patients and choose appropriate care. This study aimed to evaluate the clinicopathological characteristics, treatment, and oncologic outcomes of CD patients diagnosed with colorectal cancer (CRC).
Methods
Using medical records, we retrospectively enrolled a single-center cohort of 823 patients who underwent abdominal surgery for CD between January 2006 and December 2015. CD-associated CRC patients included those with adenocarcinoma, lymphoma, or neuroendocrine tumors of the colon and rectum.
Results
Nineteen patients (2.3%) underwent abdominal surgery to treat CD-associated CRC. The mean duration of CD in the CD-associated CRC group was significantly longer than that in the benign CD group (124.7 ± 77.7 months vs. 68.9 ± 60.2 months, P = 0.006). The CD-associated CRC group included a higher proportion of patients with a history of perianal disease (73.7% vs. 50.2%, P = 0.035) and colonic location (47.4% vs. 6.5%, P = 0.001). Among 19 CD-associated CRC patients, 17 (89.5%) were diagnosed with adenocarcinoma, and of the 17 cases, 15 (88.2%) were rectal adenocarcinoma. On multivariable analyses for developing CRC, only colonic location was a risk factor (relative risk, 7.735; 95% confidence interval, 2.862–20.903; P = 0.001).
Conclusion
Colorectal malignancy is rare among CD patients, even among patients who undergo abdominal surgery. Rectal adenocarcinoma accounted for most of the CRC, and colonic location was a risk factor for developing CRC.

Citations

Citations to this article as recorded by

Perianal Fistulizing Crohn’s Disease–Associated Anorectal and Fistula Cancers: Systematic Review and Expert Consensus
Serre-Yu Wong, Cathy Rowan, Elvira Diaz Brockmans, Cindy C.Y. Law, Elisabeth Giselbrecht, Celina Ang, Sergey Khaitov, David Sachar, Alexandros D. Polydorides, Leon Shin-han Winata, Bram Verstockt, Antonino Spinelli, David T. Rubin, Parakkal Deepak, Dermot
Clinical Gastroenterology and Hepatology.2024;[Epub] CrossRef
Reduced expression of alanyl aminopeptidase is a robust biomarker of non‐familial adenomatous polyposis and non‐hereditary nonpolyposis colorectal cancer syndrome early‐onset colorectal cancer
Ye Jin Ha, Yun Jae Shin, Ka Hee Tak, Jong Lyul Park, Jeong Hwan Kim, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seon Young Kim, Jin Cheon Kim
Cancer Medicine.2023; 12(8): 10091. CrossRef
Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef
Pretreatment inflammatory markers predicting treatment outcomes in colorectal cancer
Sanghyun An, Hongjin Shim, Kwangmin Kim, Bora Kim, Hui-Jae Bang, Hyejin Do, Hyang-Rae Lee, Youngwan Kim
Annals of Coloproctology.2022; 38(2): 97. CrossRef

Review

Benign GI diease, Inflammatory bowel disease,Benign diesease & IBD

Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View: Jong Lyul Lee, Yong Sik Yoon, Chang Sik Yu; Ann Coloproctol. 2021;37(1):5-15. Published online February 28, 2021; DOI: https://doi.org/10.3393/ac.2021.02.08

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Abstract PDF

Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence.

Citations

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Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study
Tamer A. A. M. Habeeb, Massimo Chiaretti, Igor A. Kryvoruchko, Antonio Pesce, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A. M. Adam, Mohamed A. Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H. Alsayed, Esmail Tharwat Kamel Awad, M
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Insights into treatment of complex Crohn's perianal fistulas
Gregor Norčič, Nataša Smrekar, Srđan Marković, Goran Barišić, Gediminas Kiudelis, Henrikas Paužas, Tamás Molnár, Attila Szijarto, Zuzana Šerclová, Tina Roblek, Viktor Uršič, Ian White
BMC Proceedings.2024;[Epub] CrossRef
Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study
In Seob Jeong, Sung Hwan Hwang, Hye Mi Yu, Hyeonseok Jeong
Annals of Coloproctology.2024; 40(2): 169. CrossRef
Management of Perianal Fistulas Associated with Crohn Disease
Kay Greveson, Ola Haj, Ailsa Hart, Parnia Geransar, Oded Zmora
Gastroenterology Nursing.2024; 47(6): 428. CrossRef
Real-World Long-Term Persistence and Surgical Procedure-Free Period Among Bio-naïve Patients with Crohn’s Disease and Fistula Initiated on Ustekinumab
Maryia Zhdanava, Sumesh Kachroo, Porpong Boonmak, Sabree Burbage, Aditi Shah, Patrick Lefebvre, Caroline Kerner, Dominic Pilon
Advances in Therapy.2024; 41(10): 3922. CrossRef
Efficacy and Safety of Upadacitinib for Perianal Fistulizing Crohn’s Disease: A Post Hoc Analysis of 3 Phase 3 Trials
Jean-Frédéric Colombel, Ana P. Lacerda, Peter M. Irving, Remo Panaccione, Walter Reinisch, Florian Rieder, Adam Steinlauf, David Schwartz, Tian Feng, Elena Dubcenco, Samuel I. Anyanwu, F. Stephen Laroux, Colla Cunneen, Nick Powell
Clinical Gastroenterology and Hepatology.2024;[Epub] CrossRef
Optimizing Treatment Outcomes in Crohn’s Disease: A Comprehensive Systematic Review and Meta-Analysis of Regenerative Therapies with Emphasis on Platelet-Rich Plasma
Marcia Carolina Mazzaro, Ana Emília Carvalho de Paula, Livia Bitencourt Pascoal, Livia Moreira Genaro, Isabela Machado Pereira, Bruno Lima Rodrigues, Priscilla de Sene Portel Oliveira, Raquel Franco Leal
Pharmaceuticals.2024; 17(11): 1519. CrossRef
Clinical Characteristics That Led to Diagnosis of Crohn’s Disease After Anal Fistula Surgery in Patients Aged 10–19 Years: A Single Center, Retrospective Study
Ah Young Kang, Ki-Yun Lim, Keehoon Hyun, Heecheol Chang
Advances in Pediatric Surgery.2024; 30(2): 64. CrossRef
Three‐dimensional modelling as a novel interactive tool for preoperative planning for complex perianal fistulas in Crohn's disease
Sebastián Jeri‐McFarlane, Álvaro García‐Granero, Aina Ochogavía‐Seguí, Gianluca Pellino, Anaí Oseira‐Reigosa, Alejandro Gil‐Catalan, Leandro Brogi, Daniel Ginard‐Vicens, Margarita Gamundi‐Cuesta, Francisco Xavier Gonzalez‐Argente
Colorectal Disease.2023; 25(6): 1279. CrossRef
Risk of anorectal cancer in patients with Crohn's disease and perianal fistula: a nationwide Danish cohort study
Alaa El‐Hussuna, Camilla Engel Lemser, Aske Thorn Iversen, Kristine Højgaard Allin, Tine Jess
Colorectal Disease.2023; 25(7): 1453. CrossRef
The Impact of Crohn’s Perianal Fistula on Quality of Life: Results of an International Patient Survey
Antonino Spinelli, Henit Yanai, Paolo Girardi, Slobodan Milicevic, Michele Carvello, Annalisa Maroli, Luisa Avedano
Crohn's & Colitis 360.2023;[Epub] CrossRef
A Prospective, Single-Arm Study to Evaluate the Safety and Efficacy of RD2-Ver.02, an Autologous Blood Clot, in the Treatment of Anal Fistula
Edward Ram, Yaniv Zager, Dan Carter, Olga Saukhat, Roi Anteby, Ido Nachmany, Nir Horesh
Diseases of the Colon & Rectum.2023;[Epub] CrossRef
Crohn disease
Elizabeth F. Snyder, Stephanie Davis, Kristina Aldrich, Manjakkollai Veerabagu, Tiziana Larussa, Ludovico Abenavoli, Luigi Boccuto
The Nurse Practitioner.2021; 46(12): 22. CrossRef

Original Articles

Malignant disease, Rectal cancer,Prognosis and adjuvant therapy

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

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Abstract PDF

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

Citations

Citations to this article as recorded by

Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Update on Diagnosis and Treatment of Colorectal Cancer
Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
The watch-and-wait strategy versus radical resection for rectal cancer patients with a good response (≤ycT2) after neoadjuvant chemoradiotherapy
Chungyeop Lee, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Annals of Surgical Treatment and Research.2022; 103(6): 350. CrossRef
Optimal Postoperative Surveillance Strategies for Colorectal Cancer: A Retrospective Observational Study
Min-Young Park, In-Ja Park, Hyo-Seon Ryu, Jay Jung, Min-Sung Kim, Seok-Byung Lim, Chang-Sik Yu, Jin-Cheon Kim
Cancers.2021; 13(14): 3502. CrossRef
Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(19): 4823. CrossRef
Shifting Treatment Strategies to Prevent Early Relapse of Locally Advanced Rectal Cancer After Preoperative Chemoradiotherapy
Eun Jung Park
Annals of Coloproctology.2020; 36(6): 357. CrossRef

Benign GI diease, Inflammatory bowel disease

Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease: Joon Suk Moon, Jong Lyul Lee, Chang Sik Yu, Seok-Byung Lim, In Ja Park, Yong Sik Yoon, Chan Wook Kim, Suk-Kyun Yang, Byong Duk Ye, Sang Hyoung Park, Hassan Abdullah Alsaleem, Jin Cheon Kim; Ann Coloproctol. 2020;36(4):243-248. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.10.16.1

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Abstract PDF

Purpose
Upper gastrointestinal (GI) tract involvement in Crohn disease (CD) is rare and effectiveness of surgical treatment is limited. The aim of this study was to evaluate characteristics and surgical outcomes of upper GI CD.
Methods
Medical records of 811 patients who underwent intestinal surgery for CD between January 2006 and December 2015 at a single institution were reviewed. Upper GI CD was defined by involvement of the stomach to the fourth portion of duodenum, with or without concomitant small/large bowel CD involvement according to a modification of the Montreal classification.
Results
We identified 24 patients (21 males, 3 females) who underwent surgery for upper GI CD. The mean age at diagnosis was 27 ± 12 years, the mean age at surgery was 33 ± 11 years, and the mean duration of CD was 73.6 ± 56.6 months. Fifteen patients (62.5%) had history of previous perianal surgery. Ten patients (41.7%) had duodenal or gastric stricture and 14 patients (58.3%) had penetrating fistula; patients with fistula were significantly more likely to develop complications (57.1% vs. 20.0%, P = 0.035). One patient with stricture had surgical recurrence. In seven patients with fistula, fistula was related to previous anastomosis. Patients with fistula had significantly longer hospital stays than those with stricture (16 days vs. 11 days, P = 0.01).
Conclusion
Upper GI CD is rare among CD types (2.96%). In patients with upper GI CD, penetrating fistula was associated with longer hospital stay and more complications.

Citations

Citations to this article as recorded by

Update S2k-Guideline Helicobacter pylori and gastroduodenal ulcer disease of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS)
Wolfgang Fischbach, Jan Bornschein, Jörg C. Hoffmann, Sibylle Koletzko, Alexander Link, Lukas Macke, Peter Malfertheiner, Kerstin Schütte, Dieter-Michael Selgrad, Sebastian Suerbaum, Christian Schulz
Zeitschrift für Gastroenterologie.2024; 62(02): 261. CrossRef
Aktualisierte S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – Juli 2022 – AWMF-Registernummer: 021–001

Zeitschrift für Gastroenterologie.2023; 61(05): 544. CrossRef
A systematic review and meta‐analysis of prevalence and clinical features of upper gastrointestinal (UGI) tract Crohn's disease in adults compared to non‐UGI types
Babak Tamizifar, Peyman Adibi, Maryam Hadipour, Vahid Mohamadi
JGH Open.2023; 7(5): 325. CrossRef
Upper gastrointestinal tract involvement of Crohn disease: clinical implications in children and adolescents
Eun Sil Kim, Mi Jin Kim
Clinical and Experimental Pediatrics.2022; 65(1): 21. CrossRef
Profiling non-coding RNA levels with clinical classifiers in pediatric Crohn’s disease
Ranjit Pelia, Suresh Venkateswaran, Jason D. Matthews, Yael Haberman, David J. Cutler, Jeffrey S. Hyams, Lee A. Denson, Subra Kugathasan
BMC Medical Genomics.2021;[Epub] CrossRef
Surgical Treatment of Upper Gastrointestinal Tract Crohn Disease: A Long Way to Go to Identify the Optimal Method
Soo Yeun Park
Annals of Coloproctology.2020; 36(4): 207. CrossRef

Benign GI diease, Inflammatory bowel disease

Short-term Outcomes of Elective 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea: Does Laparoscopy Have Benefits?: Jun Woo Bong, Yong Sik Yoon, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2020;36(1):41-47. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2019.03.29

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Abstract PDF

Purpose
This study aimed to compare the short-term outcomes of the open and laparoscopic approaches to 2-stage restorative proctocolectomy (RPC) for Korean patients with ulcerative colitis (UC).
Methods
We retrospectively analyzed the medical records of 73 patients with UC who underwent elective RPC between 2009 and 2016. Patient characteristics, operative details, and postoperative complications within 30 days were compared between the open and laparoscopic groups.
Results
There were 26 cases (36%) in the laparoscopic group, which had a lower mean body mass index (P = 0.025), faster mean time to recovery of bowel function (P = 0.004), less intraoperative blood loss (P = 0.004), and less pain on the first and seventh postoperative days (P = 0.029 and P = 0.027, respectively) compared to open group. There were no deaths, and the overall complication rate was 43.8%. There was no between-group difference in the overall complication rate; however, postoperative ileus was more frequent in the open group (27.7% vs. 7.7%, P = 0.043). Current smoking (odds ratio [OR], 44.4; P = 0.003) and open surgery (OR, 5.4; P = 0.014) were the independent risk factors for postoperative complications after RPC.
Conclusion
Laparoscopic RPC was associated with acceptable morbidity and faster recovery than the open approach. The laparoscopic approach is a feasible and safe option for surgical treatment for UC in selective cases.

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Original article

Defunctioning Protective Stoma Can Reduce the Rate of Anastomotic Leakage after Low Anterior Resection in Rectal Cancer Patients: Byoung Chul Lee, Seok-Byung Lim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Chang Sik Yu, Jin Cheon Kim; Received October 22, 2019 Accepted November 19, 2019 Published online January 16, 2020; DOI: https://doi.org/10.3393/ac.2019.11.19.1

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Abstract PDF

PURPOSE
This study aimed to identify risk factors for anastomotic leakage and to evaluate the impact of protective stoma on the rate of anastomotic leakage and subsequent management.
METHODS
This retrospective study analyzed data from 4,282 patients who underwent low anterior resection between 2007 and 2014. Among these, 1,367 (31.9%) underwent surgery to create protective diverting stoma and 232 (5.4%) experienced anastomotic leakage. At 6-month timepoints, data were evaluated to identify any correlation between the presence of diverting stoma and the incidence of anastomotic leakage. In addition, clinicopathological parameters were investigated to identify risk factors for anastomotic leakage.
RESULTS
Diverting stomas significantly reduced the rate of anastomotic leakage [HR 0.334, 95% CI 0.212

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Original Articles

Sensitivity of Various Evaluating Modalities for Predicting a Pathologic Complete Response After Preoperative Chemoradiation Therapy for Locally Advanced Rectal Cancer: Sungwoo Jung, Anuj Parajuli, Chang Sik Yu, Seong Ho Park, Jong Seok Lee, Ah Young Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2019;35(5):275-281. Published online October 31, 2019; DOI: https://doi.org/10.3393/ac.2019.01.07

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Abstract PDF

Purpose
We investigated the sensitivity of various evaluating modalities in predicting a pathologic complete response (pCR) after preoperative chemoradiation therapy (PCRT) for locally advanced rectal cancer (LARC).
Methods
From a population of 2,247 LARC patients who underwent PCRT followed by surgery at Asan Medical Center, Seoul, Korea from January 2007 to June 2016, we retrospectively analyzed 313 patients (14.1%) who showed a pCR after surgery. Transrectal ultrasound (TRUS), high-resolution magnetic resonance imaging (MRI), abdominopelvic computed tomography (AP-CT), and endoscopy were performed within 2 weeks prior to surgery.
Results
Of the 313 patients analyzed, 256 (81.8%) had a pCR after radical surgery and 57 (18.2%) showed total regression after local excision. Preoperative TRUS, MRI, and AP-CT were performed in 283, 305, and 139 patients, respectively. Among these 3 groups, a prediction of a pCR of the primary tumor was made in 41 (14.5%), 51 (16.7%), and 27 patients (19.4%), respectively, before surgery. A prediction of a clinical N0 stage was made in 204 patients (88.3%) using TRUS, 130 (52.2%) using MRI, and 78 (65.5%) using AP-CT. Of the 211 patients who underwent endoscopy, 87 (41.2%) had a mention of clinical CR in their records. A prediction of a pathologic CR was made for 124 patients (39.6%) through at least one diagnostic modality.
Conclusion
The various evaluation methods for predicting a pCR after PCRT show a predictive sensitivity of 0.15–0.41 for primary tumors and 0.52–0.88 for lymph nodes. Endoscopy is a relatively superior modality for predicting the pCR of the primary tumor of LARC patients.

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Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(19): 4823. CrossRef
Predicting Neoadjuvant Chemoradiotherapy Response in Locally Advanced Rectal Cancer Using Tumor-Infiltrating Lymphocytes Density
Yao Xu, Xiaoying Lou, Yanting Liang, Shenyan Zhang, Shangqing Yang, Qicong Chen, Zeyan Xu, Minning Zhao, Zhenhui Li, Ke Zhao, Zaiyi Liu
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A Nine-Gene Signature for Predicting the Response to Preoperative Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer
In Ja Park, Yun Suk Yu, Bilal Mustafa, Jin Young Park, Yong Bae Seo, Gun-Do Kim, Jinpyo Kim, Chang Min Kim, Hyun Deok Noh, Seung-Mo Hong, Yeon Wook Kim, Mi-Ju Kim, Adnan Ahmad Ansari, Luigi Buonaguro, Sung-Min Ahn, Chang-Sik Yu
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Long-term Transanal Excision Outcomes in Patients With T1 Rectal Cancer: Comparative Analysis of Radical Resection: Yunghuyn Hwang, Yong Sik Yoon, Jun Woo Bong, Hye Yun Choi, In Ho Song, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2019;35(4):194-201. Published online August 31, 2019; DOI: https://doi.org/10.3393/ac.2018.10.18.2

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Abstract PDF

Purpose
Transanal excision (TAE) is an alternative surgical procedure for early rectal cancer. This study compared long-term TAE outcomes, in terms of survival and local recurrence (LR), with total mesorectal excision (TME) in patients with pathologically confirmed T1 rectal cancer.
Methods
T1 rectal adenocarcinoma patients who underwent surgery from 1990 to 2011 were retrospectively reviewed. Patients that were suspected to have preoperative lymph node metastasis were excluded. Demographics, recurrence, and survival were analyzed based on TAE and TME surgery.
Results
Of 268 individuals, 61 patients (26%) underwent TAE, which was characterized by proximity to the anus, submucosal invasion depth, and lesion infiltration, compared with TME patients (P < 0.001–0.033). During a median follow-up of 10.4 years, 12 patients had systemic and/or LR. Ten-year cancer-specific survival in the TAE and TME groups was not significantly different (98% vs. 100%). However, the 10-year LR rate in the TAE group was greater than that of TME group (10% vs. 0%, P < 0.001). Although 5 of the 6 TAE patients with LR underwent salvage surgery, one of the patients eventually died. The TAE surgical procedure (hazard ratio, 19.066; P = 0.007) was the only independent risk factor for LR.
Conclusion
Although long-term survival after TAE was comparable to that after TME, TAE had a greater recurrence risk than TME. Thus, TAE should only be considered as an alternative surgical option for early rectal cancer in selected patients.

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Local resection in rectal cancer: When, who and how?
Jesus Badia-Closa, Juan Pablo Campana, Gustavo Leandro Rossi, Xavier Serra-Aracil
Cirugía Española (English Edition).2025;[Epub] CrossRef
Short- and long-term outcomes of local excision with adjuvant radiotherapy in high-risk T1 rectal cancer patients
Abdullah Al-Sawat, Jung Hoon Bae, Hyun Ho Kim, Chul Seung Lee, Seung Rim Han, Yoon Suk Lee, Hyeon-Min Cho, Hong Seok Jang, In Kyu Lee
Annals of Surgical Treatment and Research.2022; 102(1): 36. CrossRef
The Role of Transanal Endoscopic Surgery for Early Rectal Cancer
Natalie F. Berger, Patricia Sylla
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Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
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Early-rectal Cancer Treatment: A Decision-tree Making Based on Systematic Review and Meta-analysis
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Cirugía Española (English Edition).2021; 99(2): 89. CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surveillance and Survivorship Care of Patients After Curative Treatment of Colon and Rectal Cancer
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I-Li Lai, Jeng-Fu You, Yih-Jong Chern, Wen-Sy Tsai, Jy-Ming Chiang, Pao-Shiu Hsieh, Hsin-Yuan Hung, Yu-Jen Hsu
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Moon Suk Choi, Jung Wook Huh, Jung Kyong Shin, Yoon Ah Park, Yong Beom Cho, Hee Cheol Kim, Seong Hyeon Yun, Woo Yong Lee
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O. A. Maynovskaya, E. G. Rybakov, S. V. Chernyshov, Yu. A. Shelygin, S. I. Achkasov
Koloproktologia.2021; 20(4): 22. CrossRef
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Cristopher Varela, Nam Kyu Kim
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Konstantinos Perivoliotis, Ioannis Baloyiannis, Chamaidi Sarakatsianou, George Tzovaras
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Taesung Ahn
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I-Li Lai, Jeng-Fu You, Yih-Jong Chern, Wen-Sy Tsai, Jy-Ming Chiang, Pao-Shiu Hsieh, Hsin-Yuan Hung, Chien-Yuh Yeh, Sum-Fu Chiang, Cheng-Chou Lai, Rei-Ping Tang, Jinn-Shiun Chen, Yu-Jen Hsu
World Journal of Surgical Oncology.2019;[Epub] CrossRef

Oncologic Outcomes of Organ Preserving Approaches in Patients With Rectal Cancer Treated With Preoperative Chemoradiotherapy: In Ja Park, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2019;35(2):65-71. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2019.03.17

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Abstract PDF

Purpose
We evaluated the oncologic outcomes of organ-preserving strategies in patients with rectal cancer treated with preoperative chemoradiotherapy (PCRT).
Methods
Between January 2008 and January 2013, 74 patients who underwent wait-and-watch (WW) (n = 42) and local excision (LE) (n = 32) were enrolled. Organ-preserving strategies were determined based on a combination of magnetic resonance imaging, sigmoidoscopy, and physical examination 4–6 weeks after completion of PCRT. The rectum sparing rate, 5-year recurrence-free survival (RFS), and overall survival (OS) were evaluated.
Results
The rectum was more frequently spared in the LE (100% vs. 87.5%, P = 0.018) at last follow-up. Recurrence occurred in 9 (28.1%) WW and 7 (16.7%) LE (P = 0.169). In the WW, 7 patients had only luminal regrowth and 2 had combined lung metastasis. In the LE, 2 (4.8%) had local recurrence only, 4 patients had distant metastasis, and 1 patient had local and distant metastasis. Among 13 patients who indicated salvage surgery (WW, n = 7; LE, n = 11), all in the WW received but all of LE refused salvage surgery (P = 0.048). The 5-year OS and 5-year RFS in overall patients was 92.7% and 76.9%, respectively, and were not different between WW and LE (P = 0.725, P = 0.129).
Conclusion
WW and LE were comparable in terms of 5-year OS and RFS. In the LE group, salvage treatment was performed much less among indicated patients. Therefore, methods to improve the oncologic outcomes of patients indicated for salvage treatment should be considered before local excision.

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Kaibo Ouyang, Zifeng Yang, Yuesheng Yang, Zejian Lyu, Junjiang Wang, Yong Li
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Precision and Future Medicine.2022; 6(1): 32. CrossRef
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The watch-and-wait strategy versus radical resection for rectal cancer patients with a good response (≤ycT2) after neoadjuvant chemoradiotherapy
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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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Abstract PDF

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.

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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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