Annals of Coloproctology

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Minimally invasive surgery

Robotic versus laparoscopic surgery for mid and low rectal cancer: a propensity score–matched analysis of short-term outcomes and costs: Aaron Seah Wei Ming, Isaac Seow-En, Koo Chee Hoe, Lionel Raphael Chen Hui, Yvonne Ng Ying Ru, Ngo Nye Thane, Ivan Tan En-Howe, Rachel Lee Shi Yi, Emile Kwong Wei Tan; Ann Coloproctol. 2026;42(3):355-363. Published online June 16, 2026; DOI: https://doi.org/10.3393/ac.2025.01508.0215

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Purpose
Robotic and laparoscopic approaches to rectal cancer surgery yield comparable short-term outcomes; however, comparative inpatient costs, particularly when stratified by tumor level, remain insufficiently characterized. This study compared short-term clinical and pathological outcomes, as well as index hospitalization costs, for minimally invasive surgery in patients with mid and low rectal cancer.
Methods
All consecutive patients with mid (5–10 cm from the anal verge) and low (<5 cm from the anal verge) rectal cancer who underwent elective minimally invasive surgery between January 2018 and December 2023 were identified. One-to-one propensity score matching was performed using the following covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, tumor level, receipt of neoadjuvant therapy, and presence of a defunctioning stoma. Outcomes and cost components were compared overall and stratified by tumor level.
Results
After matching, 282 patients were included (laparoscopic surgery, n=141; robotic surgery, n=141). Median operative time was longer in the robotic group (368 minutes vs. 325 minutes, P=0.007), whereas the median postoperative length of stay was similar between groups (6.0 days vs. 6.0 days, P=0.255). Rates of conversion to open surgery, anastomotic leak, 30-day mortality, and 30-day readmission did not differ significantly. Histopathological indicators of resection quality, including lymph node yield, margin clearance, and completeness of total mesorectal excision, were comparable. Mean index hospitalization cost was higher in the robotic group (SGD 37,436 vs. SGD 31,724; difference, SGD 5,713; P=0.008), with a greater difference observed in mid rectal cancer (SGD 8,606; P=0.008) than in low rectal cancer (SGD 1,811; P=0.465).
Conclusion
Robotic and laparoscopic surgery yielded comparable short-term clinical and pathological outcomes. Although costs were higher with robotic surgery, the cost differential was smaller for low rectal cancer, identifying this subgroup as a priority for prospective evaluation of clinical and economic value.

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Comment On: “Robotic versus laparoscopic surgery for mid and low rectal cancer: a propensity score–matched analysis of short-term outcomes and costs”
Zhibin Liu, Linfeng Liu, Xueqing Yao
Updates in Surgery.2026;[Epub] CrossRef

Anorectal benign disease

Cryotherapy reduces pain post-hemorrhoidectomy (CYPHER): a randomized, controlled, superiority trial of intra-anal ice after surgery for grade III hemorrhoids: Isaac Seow-En, Lionel Raphael Hui Chen, Yun Zhao, Yvonne Ying-Ru Ng, Emile Kwong-Wei Tan; Ann Coloproctol. 2025;41(6):537-544. Published online December 24, 2025; DOI: https://doi.org/10.3393/ac.2025.00549.0078

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Abstract PDF Supplementary Material

Purpose
We aimed to determine whether intra-anal cryotherapy reduces postoperative pain in patients undergoing hemorrhoidectomy.
Methods
This randomized controlled trial was conducted from January 2023 to August 2024. Patients with symptomatic grade III hemorrhoids were randomized 1:1 to receive either 1 minute of intra-anal cryotherapy or standard postoperative care. Because cryotherapy was applied before reversal of general anesthesia, patients were blinded to treatment allocation. The primary outcome was pain at rest on postoperative day (POD) 1. Secondary outcomes included pain after defecation, time to return to work or non-work activities, 30-day complications, and compliance with analgesia. Pain was measured using the visual analog scale.
Results
A total of 50 patients were randomized (25 per group). All 50 were included in the analysis. Baseline clinicodemographic characteristics were comparable between groups. The primary outcome, POD 1 pain at rest, did not demonstrate superiority of cryotherapy compared with standard care (median 3.0 vs. 4.0, P=0.062). However, the POD 1 pain score after defecation was significantly lower with cryotherapy than without (3.0 vs. 4.0, P=0.046). On POD 2, median pain scores at rest and after defecation were both significantly lower in the cryotherapy cohort (at rest: 2.0 vs. 4.0, P=0.043; after defecation: 2.0 vs. 5.0, P=0.001).
Conclusion
Intra-anal cryotherapy significantly reduces pain after defecation in the early postoperative period following surgery for grade III hemorrhoids. Its therapeutic efficacy, ease of application, and safety support consideration for routine use. Trial registration ClinicalTrials.gov identifier: NCT06005727

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Evidence‐Based Strategies for Post‐Hemorrhoidectomy Pain Management: A Systematic Review
Mina Alvandipour, Asal Khodabakhsh
Surgical Practice.2026;[Epub] CrossRef

Reviews

Colorectal cancer

Postoperative outcomes after prehabilitation for colorectal cancer patients undergoing surgery: a systematic review and meta-analysis of randomized and nonrandomized studies: Ian Jun Yan Wee, Isaac Seow-En, Aik Yong Chok, Eileen Sim, Chee Hoe Koo, Wenjie Lin, Chang Meihuan, Emile Kwong-Wei Tan; Ann Coloproctol. 2024;40(3):191-199. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.01095.0156

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Abstract PDF

Purpose
Prehabilitation (PH) is purported to improve patients’ preoperative functional status. This systematic review and meta-analysis sought to compare short-term postoperative outcomes between patients who underwent a protocolized PH program and the existing standard of care among colorectal cancer patients awaiting surgery.
Methods
A search in MEDLINE/PubMed, the Cochrane Library, Embase, Scopus, and CINAHL was conducted to identify relevant articles. Repetitive and exhaustive combinations of MeSH search terms (“prehabilitation,” “colorectal cancer,” “colon cancer,” and “rectal cancer”) were used to identify randomized and nonrandomized studies comparing PH versus standard of care for colorectal cancer patients awaiting surgery. The primary outcomes included postoperative morbidity, length of hospital stay, and readmission rates.
Results
Seven studies including 1,042 colorectal cancer patients (PH, 382) were included. No significant differences were found in intraoperative outcomes. The postoperative complication rates were comparable between groups (Clavien-Dindo grades I and II: risk ratio, 0.82; 95% confidence interval, 0.62–1.07; P=0.15; Clavien-Dindo grades ≥III: risk ratio, 1.02; 95% confidence interval, 0.72–1.44; P=0.92). There were also no significant differences in length of hospital stay (P=0.21) or the risk of 30-day readmission (P=0.68).
Conclusion
Although PH does not appear to improve short-term postoperative outcomes following colorectal cancer surgery, the quality of evidence is impaired by the limited trials and heterogeneity. Thus, further large-scale trials are warranted to draw definitive conclusions and establish the long-term effects of PH.

Citations

Citations to this article as recorded by

The effect of myopenia, myosteatosis and visceral obesity on postoperative complications and inflammation in colorectal surgery
S.M.M. Vaes, E.G. Peters, J. Nors, C.H. Back, W.K.G. Leclercq, T.S. de Vries Reilingh, M.D.P. Luyer, B.J.J. Smeets
Clinical Nutrition ESPEN.2026; 72: 102934. CrossRef
Prehabilitation combined with early oral nutrition reduces postoperative complications and hospital stay in older patients undergoing colorectal cancer surgery: A retrospective propensity score‐matched analysis
Yasuhiro Shimamura, Shusaku Honma, Sanae Nakajima, Naomi Akazawa, Yukiko Kobayashi, Wataru Aoi, Masashi Kuwahata
Nutrition in Clinical Practice.2026;[Epub] CrossRef
Identifying Patients with Colorectal Cancer Likely to Benefit from a Trimodal Prehabilitation Prior to Surgery
Nóra Suszták, András Fülöp, Lóránd László Lakatos, Dominic Herovi, Junghyun Cho, Petra Tímár, József Golub, Izabella Mihály, József Tamás Marton, Attila Szijártó, Balázs Bánky
Nutrients.2026; 18(9): 1369. CrossRef
МАЛОІНВАЗИВНІ ТЕХНОЛОГІЇ ПРИ ХІРУРГІЧНОМУ ЛІКУВАННІ РАКУ ТОВСТОЇ КИШКИ ТА ЙОГО УСКЛАДНЕНЬ
А. І. МОЙСЕЄНКО
Шпитальна хірургія. Журнал імені Л. Я. Ковальчука.2026; (1): 118. CrossRef
Comparative effectiveness of preoperative prehabilitation modalities for postoperative recovery in colorectal cancer: A systematic review and network meta-analysis
Xin Xiang, Qingxin Chen, Yang Yu
Journal of Gastrointestinal Surgery.2026; 30(9): 102481. CrossRef
Prehabilitation in Colorectal Cancer Surgery: A Narrative Review of Current Evidence and Clinical Perspectives
Dorota Zierkiewicz, Stanisław Manulik, Anna Chudiak, Dorota Krówczyńska, Wojciech Homola, Piotr Pobrotyn, Janecka Wioletta, Mariola Głowacka, Małgorzata Paprocka-Borowicz, Mariusz Chabowski
Nutrients.2026; 18(15): 2457. CrossRef
The inequalities and challenges of prehabilitation before cancer surgery: a narrative review
Hilary Stewart, Sophie Stanley, Xiubin Zhang, Lisa Ashmore, Christopher Gaffney, Jo Rycroft‐Malone, Andrew F. Smith, Laura Wareing, Cliff Shelton
Anaesthesia.2025; 80(S2): 75. CrossRef
Prehabilitation in surgery – an update with a focus on nutrition
Chelsia Gillis, Arved Weimann
Current Opinion in Clinical Nutrition & Metabolic Care.2025; 28(3): 224. CrossRef
The role of exercise-based prehabilitation in enhancing surgical outcomes for patients with digestive system cancers: a meta-analysis
Shasha Xu, Rong Yin, Haiou Zhu, Yin Gong, Jing Zhu, Changxian Li, Qin Xu
BMC Gastroenterology.2025;[Epub] CrossRef
Less is more: simplifying patient-centered cancer care
In Ja Park
Annals of Coloproctology.2025; 41(3): 173. CrossRef
Postoperative Morbidity Is Not Associated with a Worse Mid-Term Quality of Life After Colorectal Surgery for Colorectal Carcinoma
Maximilian Brunner, Theresa Jendrusch, Henriette Golcher, Klaus Weber, Axel Denz, Georg F. Weber, Robert Grützmann, Christian Krautz
Journal of Clinical Medicine.2025; 14(14): 5167. CrossRef
Identifying and optimizing psychosocial frailty in surgical practice
Kurt S. Schultz, Caroline E. Richburg, Emily Y. Park, Ira L. Leeds
Seminars in Colon and Rectal Surgery.2024; 35(4): 101061. CrossRef

ERAS

Venous thromboembolism among Asian populations with localized colorectal cancer undergoing curative resection: is pharmacological thromboprophylaxis required? A systematic review and meta-analysis: Shih Jia Janice Tan, Emile Kwong-Wei Tan, Yvonne Ying Ru Ng, Rehena Sultana, John Carson Allen, Isaac Seow-En, Ronnie Mathew, Aik Yong Chok; Ann Coloproctol. 2024;40(3):200-209. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.01046.0149

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Abstract PDF

Purpose
We compared the incidence of venous thromboembolism (VTE) among Asian populations with localized colorectal cancer undergoing curative resection with and without the use of pharmacological thromboprophylaxis (PTP).
Methods
A comprehensive literature search was undertaken to identify relevant studies published from January 1, 1980 to February 28, 2022. The inclusion criteria were patients who underwent primary tumor resection for localized nonmetastatic colorectal cancer; an Asian population or studies conducted in an Asian country; randomized controlled trials, case-control studies, or cohort studies; and the incidence of symptomatic VTE, deep vein thrombosis, and/or pulmonary embolism as the primary study outcomes. Data were pooled using a random-effects model. This study was registered in PROSPERO on October 11, 2020 (No. CRD42020206793).
Results
Seven studies (2 randomized controlled trials and 5 observational cohort studies) were included, encompassing 5,302 patients. The overall incidence of VTE was 1.4%. The use of PTP did not significantly reduce overall VTE incidence: 1.1% (95% confidence interval [CI], 0%–3.1%) versus 1.9% (95% CI, 0.3%–4.4%; P = 0.55). Similarly, PTP was not associated with significantly lower rates of symptomatic VTE, proximal deep vein thrombosis, or pulmonary embolism.
Conclusion
The benefit of PTP in reducing VTE incidence among Asian patients undergoing curative resection for localized colorectal cancer has not been clearly established. The decision to administer PTP should be evaluated on a case-bycase basis and with consideration of associated bleeding risks.

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Effectiveness and Safety of Long-Term Venous Thromboembolism Prophylaxis After Colorectal Cancer Surgery: A Retrospective Study
Ying Zhang, Xiaozhu Zhou, Yi Wu, Shicai Chen, Xiangli Cui, Ying Zhao
Drugs - Real World Outcomes.2025; 12(3): 479. CrossRef
Machine learning-based risk prediction of postoperative deep vein thrombosis in Chinese patients undergoing gastrointestinal surgery
Likui Huang, Lihua Gong, Jun Chen, Xiaojing Chen, Bicha Yao, Zhengrong Wang, Shuwei Weng
Frontiers in Cardiovascular Medicine.2025;[Epub] CrossRef

Colorectal cancer

Survival outcomes of salvage surgery in the watch-and-wait approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis: Wenjie Lin, Ian Jun Yan Wee, Isaac Seow-En, Aik Yong Chok, Emile Kwong-Wei Tan; Ann Coloproctol. 2023;39(6):447-456. Published online December 28, 2023; DOI: https://doi.org/10.3393/ac.2022.01221.0174

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Purpose
This systematic review and meta-analysis compared the outcomes of the watch-and-wait (WW) approach versus radical surgery (RS) in rectal cancers with clinical complete response (cCR) after neoadjuvant chemoradiotherapy.
Methods
This study followed the PRISMA guidelines. Major databases were searched to identify relevant articles. WW and RS were compared through meta-analyses of pooled proportions. Primary outcomes included overall survival (OS), disease-free survival (DFS), local recurrence, and distant metastasis rates. Pooled salvage surgery rates and outcomes were also collected. The Newcastle-Ottawa scale was employed to assess the risk of bias.
Results
Eleven studies including 1,112 rectal cancer patients showing cCR after neoadjuvant chemoradiation were included. Of these patients, 378 were treated nonoperatively with WW, 663 underwent RS, and 71 underwent local excision. The 2-year OS (risk ratio [RR], 0.95; P = 0.94), 5-year OS (RR, 2.59; P = 0.25), and distant metastasis rates (RR, 1.05; P = 0.80) showed no significant differences between WW and RS. Local recurrence was more frequent in the WW group (RR, 6.93; P < 0.001), and 78.4% of patients later underwent salvage surgery (R0 resection rate, 97.5%). The 2-year DFS (RR, 1.58; P = 0.05) and 5-year DFS (RR, 2.07; P = 0.02) were higher among RS cases. However, after adjustment for R0 salvage surgery, DFS showed no significant between-group difference (RR, 0.82; P = 0.41).
Conclusion
Local recurrence rates are higher for WW than RS, but complete salvage surgery is often possible with similar long-term outcomes. WW is a viable strategy for rectal cancer with cCR after neoadjuvant chemoradiation, but further research is required to improve patient selection.

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Current and Future Strategies versus Tradeoffs in Maximizing the Treatment Response in Rectal Cancer: A Focus on MSI-H Disease
FNU Anamika, Nicholas Hornstein, Mirac Ajredini, John R. T. Monson
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Rectal mucinous adenocarcinoma mimicking prostatic urothelial carcinoma: A diagnostic and therapeutic challenge
Anna Homeniuk, Rongrong Ge
Urology Case Reports.2026; 67: 103481. CrossRef
Mucinous rectal adenocarcinoma and neoadjuvant therapy: Implications for surgical practice
Alberto Patriti, Francesco Graziano, Rita Chiari
World Journal of Gastrointestinal Surgery.2026;[Epub] CrossRef
The Evolving Role of Organ Preservation in Locally Advanced Rectal Cancer
Megan Delisle, Kilian G.M. Brown, Kelly Sanders, J. Joshua Smith
Seminars in Colon and Rectal Surgery.2026; : 101170. CrossRef
Organ preservation in rectal cancer following clinical complete response after short-course radiotherapy-based total neoadjuvant therapy
Carlos G. Morales, Erik Manriquez-Alegria, Valentina Duran, Maite Gonzalez, Gonzalo Carvajal, Pamela Briones, Felipe Mena, Martin Quintana, Richard Castillo, Angelo Fulle, Manuel Cabreras, Rodrigo Kusanovich, Nicole Caire, Javier Retamales, Patricia Garcí
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Watch‐and‐Wait Approach Following Neoadjuvant Chemo‐Radiotherapy for Locally Advanced Rectal Cancer: A Retrospective Single‐Center Cohort Study
Georgi Kalev, Sylvia Buettner, Tianzuo Zhan, Ralf‐Dieter Hofheinz, Judit Boda‐Heggemann, Christoph Reissfelder, Steffen Seyfried, Georgi Vassilev, Julia Hardt
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Phase 2, Multicenter, Open-label, Nonrandomized Study of Neoadjuvant Chemotherapy Liposomal Irinotecan With 5-Fluorouracil, Leucovorin, and Oxaliplatin, Followed by Chemoradiotherapy in Patients With Rectal Cancer in a Watch-and-Wait Program
César Muñoz, María-C. Riesco Martinez, Lisardo Ugidos, Pilar García-Alfonso, Rafael Alvarez-Gallego, Paloma Peinado, Carmen Toledano, Luka Mihic-Góngora, Justo Gabriel Ortega Anselmi, Enrique Sanz Garcia, Emilio Vicente, Yolanda Quijano, Hipólito J. Durán
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Horia-Dan Lișcu, Nicolae Verga, Dimitrie-Ionuț Atasiei, Andreea-Teodora Ilie, Maria Vrabie, Laura Roșu, Alexandra Poștaru, Stefania Glăvan, Adriana Lucaș, Maria Dinulescu, Andreea Delea, Andreea-Iuliana Ionescu
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A management of patients achieving clinical complete response after neoadjuvant therapy and perspectives: on locally advanced rectal cancer
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Frontiers in Oncology.2025;[Epub] CrossRef
ACCORD study: a national multi‐centre study of the watch and wait approach in patients with rectal cancer in Aotearoa New Zealand

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Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis: Ian Jun Yan Wee, Chee Hoe Koo, Isaac Seow-En, Yvonne Ying Ru Ng, Wenjie Lin, Emile John Kwong-Wei Tan; Ann Coloproctol. 2023;39(1):3-10. Published online January 3, 2023; DOI: https://doi.org/10.3393/ac.2022.00598.0085

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Abstract PDF Supplementary Material

Purpose
This study compared the short- and long-term clinical outcomes of laser hemorrhoidoplasty (LH) vs. conventional hemorrhoidectomy (CH) in patients with grade II/III hemorrhoids.
Methods
PubMed/Medline and the Cochrane Library were searched for randomized and nonrandomized studies comparing LH against CH in grade II/III hemorrhoids. The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities.
Results
Nine studies totaling 661 patients (LH, 336 and CH, 325) were included. The LH group had shorter operative time (P<0.001) and less intraoperative blood loss (P<0.001). Postoperative pain was lower in the LH group, with lower postoperative day 1 (mean difference [MD], –2.09; 95% confidence interval [CI], –3.44 to –0.75; P=0.002) and postoperative day 7 (MD, –3.94; 95% CI, –6.36 to –1.52; P=0.001) visual analogue scores and use of analgesia (risk ratio [RR], 0.59; 95% CI, 0.42–0.81; P=0.001). The risk of postoperative bleeding was also lower in the LH group (RR, 0.18; 95% CI, 0.12– 0.28; P<0.001), with a quicker return to work or daily activities (P=0.002). The 12-month risks of bleeding (P>0.999) and prolapse (P=0.240), and the likelihood of complete resolution at 12 months, were similar (P=0.240).
Conclusion
LH offers more favorable short-term clinical outcomes than CH, with reduced morbidity and pain and earlier return to work or daily activities. Medium-term symptom recurrence at 12 months was similar. Our results should be verified in future well-designed trials with larger samples.

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Comments on “Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis”
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