Annals of Coloproctology

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Original Articles

Colorectal cancer

From regression to machine learning: improving prediction of rectal cancer recurrence: Thanat Tantinam, Ekkarin Supatrakul, Pawit Sutharat, Suwan Sanmee, Kullawat Bhatanaprabhabhan, Boonchai Ngamsirimas, Nataphon Santrakul, Rangsima Thiengthiantham, Punnawat Chandrachamnong, Suradet Buakhrun, Sarawut Ramjan; Ann Coloproctol. 2026;42(3):293-302. Published online June 26, 2026; DOI: https://doi.org/10.3393/ac.2025.01067.0152

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Abstract PDF Supplementary Material: Purpose
Recurrence after curative-intent treatment of rectal cancer remains a major clinical challenge. Conventional regression models may not adequately capture complex clinical interactions, whereas machine learning algorithms may improve predictive accuracy. This study compared regression-based and machine learning models for predicting recurrence using routinely collected clinical data.
Methods
A retrospective cohort of 581 patients with rectal adenocarcinoma treated between 2013 and 2022 at 2 university hospitals in Thailand was analyzed. Seventeen demographic, pathological, and treatment-related features were used to develop logistic regression (LR), random forest (RF), support vector machine, extreme gradient boosting (XGBoost), and light gradient boosting machine (LightGBM) models. Data were split using stratified train-test sampling (80:20). Fivefold cross-validation, calibration, and decision curve analyses were performed. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), average precision (AP), F1 score, sensitivity, specificity, and feature importance.
Results
All models demonstrated moderate discriminative performance. AUC values ranged from 0.626 (LightGBM) to 0.662 (XGBoost), while AP scores ranged from 0.483 (LightGBM) to 0.584 (RF). LR achieved perfect sensitivity (1.000) at the F1-optimized threshold, RF provided the strongest balance between precision and recall, and XGBoost achieved the highest AUC. Key predictors included carcinoembryonic antigen level, nodal status, surgical margin status, tumor grade, lymphovascular invasion, and the number of lymph nodes retrieved.
Conclusion
Machine learning models modestly outperformed regression-based approaches, although their clinical value lies primarily in tailoring model strengths to specific priorities. Selecting LR, RF, or XGBoost according to objectives such as maximizing sensitivity, achieving balanced precision-recall, or enabling risk stratification may enhance recurrence surveillance in rectal cancer.

Anorectal benign disease

Efficacy of escin combined with micronized purified flavonoid fraction in controlling bleeding and preventing recurrence of acute internal hemorrhoids: a randomized controlled trial: Witcha Vipudhamorn, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul, Sunhawit Junrungsee; Ann Coloproctol. 2026;42(3):273-280. Published online June 16, 2026; DOI: https://doi.org/10.3393/ac.2025.01207.0172

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Abstract PDF Supplementary Material: Purpose
Recurrence after initial control of acute internal hemorrhoidal bleeding remains a common and clinically relevant challenge. Escin, a venotonic and anti-inflammatory compound, may augment the therapeutic effects of micronized purified flavonoid fraction (MPFF). This study aimed to evaluate whether the addition of escin to MPFF reduces recurrence of acute internal hemorrhoidal bleeding.
Methods
In this double-blind randomized controlled trial, adults with grade 1 or 2 acute bleeding internal hemorrhoids received MPFF 3,000 mg/day for 7 days in combination with either escin 120 mg/day or a matched placebo. Patients who achieved hemostasis subsequently continued MPFF 1,000 mg/day with escin or placebo for 2 months. The primary endpoint was recurrence within 90 days, defined clinically and confirmed by proctoscopy. Secondary outcomes included time to hemostasis, the Short Health Scale for Hemorrhoids (SHSHD), and safety outcomes.
Results
Among the 108 patients who achieved hemostasis, recurrence occurred in 0% vs. 7.84% at 1 month and 7.02% vs. 23.52% at 3 months in the escin and placebo groups, respectively. Combination therapy was associated with a significantly reduced risk of recurrence (hazard ratio, 3.95; P=0.009). Time to bleeding cessation was shorter in the escin group (median, 2 days vs. 4 days; P<0.001). Improvement in SHSHD scores was greater with escin. No adverse events were observed in either group.
Conclusion
The combination of escin and MPFF reduces recurrence and accelerates symptom resolution in acute internal hemorrhoidal bleeding, with a favorable safety profile. Trial registration: ClinicalTrials.gov identifier: NCT06748014.

Anorectal benign disease

Propensity score–matched comparative study of radiofrequency ablation (with the Rafaelo device) versus hemorrhoidectomy for the treatment of grades II–III internal hemorrhoids: Thanat Tantinam, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul, Kullawat Bhatanaprabhabhan, Boonchai Ngamsirimas, Nataphon Santrakul, Rangsima Thiengthiantham, Punnawat Chandrachamnong; Ann Coloproctol. 2025;41(5):409-416. Published online September 30, 2025; DOI: https://doi.org/10.3393/ac.2025.00458.0065

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3 Web of Science
3 Citations

Abstract PDF

Purpose
Hemorrhoidal disease impacts quality of life, with hemorrhoidectomy being the standard treatment for grades II–III hemorrhoids. Radiofrequency ablation (RFA) using the Rafaelo technique offers a less invasive alternative; however, comparative data remain limited. This study evaluated short-term outcomes following RFA versus conventional hemorrhoidectomy.
Methods
A single-center retrospective cohort study was conducted at a medical university hospital in Thailand, involving patients who underwent either RFA or hemorrhoidectomy between January 2023 and September 2024. Propensity score matching was utilized to minimize selection bias. Primary outcomes were postoperative pain and opioid consumption.
Results
After propensity score matching, 102 patients were analyzed (51 patients in each group). Baseline characteristics were well-balanced between the 2 groups. The RFA group had higher pain scores at 8 hours postoperatively (1 vs. 0, P=0.002) but lower scores at 20 hours (0 vs. 1, P<0.001). Opioid consumption was significantly lower in the RFA group (9.8% vs. 31.4%, P=0.007), with a reduced morphine-equivalent dose (0.7 mg vs. 3.5 mg, P=0.003). Additionally, the RFA group had a shorter operative time (20 minutes vs. 30 minutes, P<0.001) and less intraoperative blood loss (0 mL vs. 5 mL, P<0.001). Hospital stays and complication rates were comparable between groups.
Conclusion
RFA resulted in improved postoperative pain control, reduced opioid use, shorter operative duration, and decreased blood loss compared to hemorrhoidectomy, with similar hospital stay durations and complication rates.

Citations

Citations to this article as recorded by

Radiofrequenzablation bei Hämorrhoidalleiden
Daniel Sterzing, Cristina Caspari
coloproctology.2026; 48(4): 254. CrossRef
Radiofrequency Ablation for Hemorrhoidal Disease
Eremeev Spiridon, Cristian Ichim, Paula Anderco, Ciprian Tanasescu
Life.2026; 16(6): 1025. CrossRef
Radiofrequency ablation for haemorrhoidal disease: a systematic review and meta-analysis of efficacy, safety, and patient-reported outcomes
Indra Sivakumar, Rekha Thiruvengadam, Jeevarathinam Thirumalai, Sreeja Kanna
coloproctology.2026;[Epub] CrossRef

Review Article

Others

Unraveling the enigma of sclerosing encapsulating peritonitis: a comprehensive review: Witcha Vipudhamorn, Tawan Juthasilaparut, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul, Sayanan Chowsilpa, Kraipop Wongwaiyut, Rujee Rattanasathien; Ann Coloproctol. 2025;41(3):175-189. Published online June 18, 2025; DOI: https://doi.org/10.3393/ac.2024.00486.0069

9,907 View
194 Download
1 Web of Science
5 Citations

Abstract PDF

Sclerosing encapsulating peritonitis (SEP) is a rare but serious condition characterized by the progressive formation of a dense fibrous sheath encasing the small bowel within the peritoneal cavity. This review provides a comprehensive overview of the current understanding of SEP, focusing on its etiology, clinical presentation, diagnostic modalities, and management strategies. SEP can be classified into primary and secondary forms, each with distinct etiologies and treatment approaches. Primary SEP typically presents with acute or subacute bowel obstruction symptoms, necessitating surgical intervention to excise the fibrous sheath and relieve the obstruction. Secondary SEP often occurs in patients undergoing peritoneal dialysis, with cessation of dialysis being a key component of management. Medical treatments, including corticosteroids, immunosuppressive agents, and nutritional support, may complement surgical intervention, particularly in cases of secondary SEP. Advanced imaging techniques and personalized medicine approaches show promise in improving diagnostic accuracy and tailoring treatment strategies to individual patients. Future research directions include investigating targeted pharmacological therapies, exploring minimally invasive surgical techniques, and conducting long-term follow-up studies to evaluate treatment efficacy and disease recurrence. Multidisciplinary care teams play a crucial role in the comprehensive management of SEP, emphasizing collaboration among various specialties to optimize patient outcomes.

Citations

Citations to this article as recorded by

From Endometriosis to Encapsulation: A Case Report of Endometriosis Causing Sclerosing Encapsulating Peritonitis
Lexi Frankel, Kristen Stearns, Anna Kuan-Celarier, David Childs, Janelle Moulder, Dan Martin
Case Reports in Obstetrics and Gynecology.2026;[Epub] CrossRef
Caught in a Cocoon: Operative Release of Primary Sclerosing Encapsulating Peritonitis With Endoscopic Management of Early Postoperative Duodenojejunal Intussusception
Chun Pui Joshua Wong, Sajid Malik, Samina Alim , Parth Paskaran, Francesco DiMaggio
Cureus.2026;[Epub] CrossRef
Para-normal-centesis: Percutaneous suction and traction removal of sclerosing peritonitis
Curtis A. Plante, Anant D. Bhave, Bruce J. McClellan, Chelsea I. Majdalany, Molly Feller, Bill S. Majdalany
Radiology Case Reports.2026; 21(9): 3716. CrossRef
Primary sclerosing encapsulating peritonitis with cryptorchidism in an older man: case report and literature review
Yeqing Chen, Zhenxiang Wang, Mingwei Han, Yiwu Liu, Zhengguang Yan, Yiyun Guo, Wei Xie, Hongyu Zhou
Rare Disease and Orphan Drugs Journal.2026;[Epub] CrossRef
Abdominal cocoon syndrome presenting as acute small bowel obstruction: Report of a case
Feige Li, Rongjun Qiao, Xingyu Li, Peidong Wang
Asian Journal of Surgery.2026;[Epub] CrossRef

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