Annals of Coloproctology

Original Articles

Malignant disease, Rectal cancer

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery: Do Hoe Ku, Hyeon Seung Kim, Jin Yong Shin; Ann Coloproctol. 2020;36(5):304-310. Published online November 13, 2019; DOI: https://doi.org/10.3393/ac.2019.10.22

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Purpose
Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS.
Methods
From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared.
Results
The midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively).
Conclusion
In terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.

Citations

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Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea
Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2024; 27(1): 14. CrossRef
An evidence map and synthesis review with meta-analysis on the risk of incisional hernia in colorectal surgery with standard closure
C. Stabilini, M.A. Garcia-Urena, F. Berrevoet, D. Cuccurullo, S. Capoccia Giovannini, M. Dajko, L. Rossi, K. Decaestecker, M. López Cano
Hernia.2022; 26(2): 411. CrossRef
Choice of specimen’s extraction site affects wound morbidity in laparoscopic colorectal cancer surgery
Mahmood Al Dhaheri, Mohanad Ibrahim, Omer Al-Yahri, Ibrahim Amer, Mahwish Khawar, Noof Al-Naimi, Ayman Abdelhafiz Ahmed, Mohamed Abu Nada, Amjad Parvaiz
Langenbeck's Archives of Surgery.2022; 407(8): 3561. CrossRef

Oncologic Outcomes and Risk Factors for Recurrence after Tumor-specific Mesorectal Excision of Rectal Cancer: 782 Cases: Sam Hee Kim, Ki Beom Bae, Jung Min Kim, Jae Ho Shin, Min Sung An, Tae Geun Ha, Sung Mok Ryu, Kwang Hee Kim, Tae Hyeon Kim, Chang Soo Choi, Jin Yong Shin, Minkyung Oh, Seung Hun Baek, Kwan Hee Hong; J Korean Soc Coloproctol. 2012;28(2):100-107. Published online April 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.2.100

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Abstract PDF

Purpose

The aim of this study was to analyze the oncologic outcomes and the risk factors for recurrence after a tumor-specific mesorectal excision (TSME) of resectable rectal cancer in a single institution.

Methods

A total of 782 patients who underwent a TSME for resectable rectal cancer between February 1995 and December 2005 were enrolled retrospectively. Oncologic outcomes included 5-year cancer-specific survival and its affecting factors, as well as risk factors for local and systemic recurrence.

Results

The 5-year cancer-specific survival rate was 77.53% with a mean follow-up period of 61 ± 31 months. The overall local and systemic recurrence rates were 9.2% and 21.1%, respectively. The risk factors for local recurrence were pN stage (P = 0.015), positive distal resection margin, and positive circumferential resection margin (P < 0.001). The risk factors for systemic recurrence were pN stage (P < 0.001) and preoperative carcinoembryonic antigen level (P = 0.005). The prognostic factors for cancer-specific survival were pT stage (P < 0.001), pN stage (P < 0.001), positive distal resection margin (P = 0.005), and positive circumferential resection margin (P = 0.016).

Conclusion

The oncologic outcomes in our institution after a TSME for patients with resectable rectal cancer were similar to those reported in other recent studies, and we established the risk factors that could be crucial for the planning of treatment and follow-up.

Citations

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Comparison of Short-term Surgical Outcomes between a Robotic Colectomy and a Laparoscopic Colectomy during Early Experience: Jin Yong Shin; J Korean Soc Coloproctol. 2012;28(1):19-26. Published online February 29, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.1.19

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Abstract PDF

Purpose

Although robotic surgery was invented to overcome the technical limitations of laparoscopic surgery, the role of a robotic (procto)colectomy (RC) for the treatment of colorectal cancer compared to that of a laparoscopic (procto)colectomy (LC) was not well defined during the initial adoption periods of both procedures. This study aimed to evaluate the efficacy and the safety of a RC for the treatment of colorectal cancer by comparing the authors' initial experiences with both a RC and a LC.

Methods

The first 30 patients treated by using a RC for colorectal cancer from July 2010 to March 2011 were compared with the first 30 patients treated by using a LC for colorectal cancer from December 2006 to June 2007 by the same surgeon. Perioperative variables and short-term outcomes were analyzed. In addition, the 30 RC and the 30 LC cases involved were divided into rectal cancer (n = 17 and n = 12, respectively), left-sided colon cancer (n = 7 and n = 12, respectively) and right-sided colon cancer (n = 6 and n = 6, respectively) for subgroup analyses.

Results

The mean operating times for RC and LC were significantly different at 371.8 and 275.5 minutes, respectively, but other perioperative parameters (rates of open conversion, numbers of retrieved lymph node, estimated blood losses, times to first flatus, maximal pain scores before discharge and postoperative hospital stays) were not significantly different in the two groups. Subgroup analyses showed that the mean operative times for a robotic proctectomy and a laparoscopic proctectomy were 396.5 and 298.8 minutes, respectively (P < 0.000). Postoperative complications occurred in five patients in the RC group and in six patients in the LC group (P = 0.739).

Conclusion

Although the short-term outcomes of a RC during its initial use were better than those of a LC (with the exception of operating time), differences were not found to be significantly different. On the other hand, the longer operation time of a robotic proctectomy compared to that of a laparoscopic proctectomy during the early period may be problematic.

Citations

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Risk Factors of Early Postoperative Small Bowel Obstruction Following a Proctectomy for Rectal Cancer: Jin Yong Shin; J Korean Soc Coloproctol. 2011;27(6):315-321. Published online December 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.6.315

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Abstract PDF

Purpose

Postoperative small bowel obstruction is a common and serious complication following a proctectomy, and early postoperative small bowel obstruction (EPSBO) leads to longer hospital stays, delays chemotherapy in advanced cases, and may be a contributor to mortality. The goal of this study is to identify the risk factors of EPSBO after a proctectomy for rectal cancer, thereby seeking to reduce the incidence of EPSBO.

Methods

Patients (735) who underwent a proctectomy for rectal cancer between March 2005 and February 2010 were entered into this study, and data were collected prospectively. Patients were judged to have EPSBO if, within the first 30 days, they presented symptoms such as nausea, vomiting and abdominal distention lasting for 2 days, and radiologic finding of small bowel obstruction after evidence of return of small bowel motility. The association between EPSBO and patients and surgery-related variables were studied by using univariate and multivariate analyses.

Results

EPSBO developed in 47 cases (6.4%) and was the most frequently occurring complication in the early perioperative period following a proctectomy. The frequency of EPSBO according to operative variables shows that EPSBO developed in 3.0% of the patients who underwent laparoscopic surgery (LS) compared with 8.4% of the patients who underwent open surgery (OS) (P = 0.004). OS (odds ratio [OR], 2.5) and a previous laparotomy (OR, 2.3) were independent risk factors for the development of EPSBO after a proctectomy for rectal cancer.

Conclusion

EPSBO is more likely to occur in patients who undergo OS or who have had a previous laparotomy. LS may be considered as a surgical procedure that can reduce the risk of EPSBO in patients undergoing a proctectomy for rectal cancer.

Citations

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Median and medial umbilical ligament repositioning for prevention of pelviperineal complications following abdominoperineal resection—a case series and novel technique
Anand Thomas, Subi TS, Teena Sleeba, Abhijith Antony, Naveen George
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Li-Qun Cai, Da-Qing Yang, Rong-Jian Wang, He Huang, Yi-Xiong Shi
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Yang Su, Yanqi Li, Wangshuo Yang, Xuelai Luo, Lisheng Chen
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Omental Pedicle Flap Does Not Decrease the Incidence of Bowel Obstruction after Abdominoperineal Resection
Kunal Kochar, Slawomir Marecik, Leela M. Prasad, John Park
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Early Postoperative Small Bowel Obstruction is an Independent Risk Factor for Subsequent Adhesive Small Bowel Obstruction in Patients Undergoing Open Colectomy
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World Journal of Surgery.2014; 38(11): 3007. CrossRef

Prognostic Significance of Lymph Node Ratio in Stage III Rectal Cancer: Jin Yong Shin, Kwan Hee Hong; J Korean Soc Coloproctol. 2011;27(5):252-259. Published online October 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.5.252

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Abstract PDF

Purpose

Although nodal metastasis is the most powerful prognostic factor in rectal cancer, marked heterogeneity exists within stage III rectal cancer. Recent studies of rectal cancer have shown a prognostic superiority of the lymph node ratio (LNR) compared with N stage. The purpose of this study was to investigate the prognostic value of the LNR in the era of the 7th edition of the TNM classification.

Methods

We included 190 patients who underwent a curative resection for rectal cancer with nodal metastasis. The patients were divided into four groups on the basis of statistically calculated cut-off values as 0.21, 0.32, and 0.61.

Results

The LNR was an independent risk factor for overall survival (OS; P = 0.008) and for systemic recurrence-free survival (SRFS; P = 0.002). However, the LNR was not a predictive factor for local recurrence. When the N stage of the sixth TNM staging system was separately analyzed as a covariate, the LNR was also found to be a predictive factor for both OS and SRFS (P = 0.012 and P = 0.004, respectively). A LNR value of 0.21 offered the best cut off to separate patients into two prognostic groups.

Conclusion

The defined cut-off values of the LNR were an independent risk factor for OS and distant metastasis-free survival in patients with rectal cancer, irrespective of the sixth or the seventh version of the TNM classification, and the LNR should be considered as a prognostic variable in any future staging system.

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Prognostic value of lymph node ratio in non-small-cell lung cancer: a meta-analysis
Jian Zhou, Zhangyu Lin, Mengyuan Lyu, Nan Chen, Hu Liao, Zihuai Wang, Jianqi Hao, Chunyi Yan, Lunxu Liu
Japanese Journal of Clinical Oncology.2020; 50(1): 44. CrossRef
Comparison of two novel staging systems with the TNM system in predicting stage III colon cancer survival
Richard Walker, Trevor Wood, Emily LeSouder, Michelle Cleghorn, Manjula Maganti, Andrea MacNeill, Fayez A. Quereshy
Journal of Surgical Oncology.2018; 117(5): 1049. CrossRef
The Prognostic Impact of the Metastatic Lymph Nodes Ratio in Colorectal Cancer
Chi-Hao Zhang, Yan-Yan Li, Qing-Wei Zhang, Alberto Biondi, Valeria Fico, Roberto Persiani, Xiao-Chun Ni, Meng Luo
Frontiers in Oncology.2018;[Epub] CrossRef
Log odds of positive lymph nodes is a superior prognostic indicator in stage III rectal cancer patients: A retrospective analysis of 17,632 patients in the SEER database
Ben Huang, Chen Chen, Mengdong Ni, Shaobo Mo, Guoxiang Cai, Sanjun Cai
International Journal of Surgery.2016; 32: 24. CrossRef
Clinical Significance of the Metastatic Lymph-Node Ratio in Rectal Cancer
Hyoung Chul Park
Annals of Coloproctology.2013; 29(3): 89. CrossRef
Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer
Wafi Attaallah, Omer Gunal, Manuk Manukyan, Gulden Ozden, Cumhur Yegen
Annals of Coloproctology.2013; 29(3): 100. CrossRef
O índice de linfonodos comprometidos como um preditor para a ocorrência de recidivas tumorais no câncer de cólon estádio III
Tiago L. Dedavid e Silva, Daniel C. Damin
Revista do Colégio Brasileiro de Cirurgiões.2013; 40(6): 463. CrossRef

Review

Colorectal Cancer with Multiple Metastases: Is Palliative Surgery Needed?: Hong-Jo Choi, Jin Yong Shin; J Korean Soc Coloproctol. 2011;27(5):226-230. Published online October 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.5.226

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Abstract PDF

In patients with symptomatic incurable metastatic colorectal cancer (mCRC), the goal of resection of the primary lesion is to palliate cancer-related morbidity, including obstruction, bleeding, or perforation. In patients with asymptomatic primary tumors and incurable metastatic disease, however, the necessity of primary tumor resection is less clear. Although several retrospective analyses suggest survival benefit in patients who undergo resection of the primary tumor, applying this older evidence to modern patients is out of date for several reasons. Modern chemotherapy regimens incorporating the novel cytotoxic agents oxaliplatin and irinotecan, as well as the target agents bevacizumab and cetuximab, have improved median survival from less than 1 year with the only available single-agent 5-fluorouracil until the mid-1990s to over 2 years. In addition to significant prolongation of overall survival, combinations of novel chemotherapeutic and target agents have allowed improved local and distant tumor control, decreasing the likelihood of local tumor-related complications requiring surgical resection. Resection of an asymptomatic primary tumor risks surgical complications and may postpone the administration of chemotherapy that may offer both systemic and local control. In conclusion, the morbidity and the mortality of unnecessary surgery or surgery that does not improve quality of life or survival in patients with mCRC of a limited life expectancy should be carefully evaluated. With the availability of effective combinations of chemotherapy and target agents, systemic therapy for the treatment of life-threatening metastases would be a preferable treatment strategy for unresectable asymptomatic patients with mCRC.

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Palliative laparoscopic bowel resection in stage IV colorectal cancer patients with unresectable metastasis
Kwan Mo Yang, Seok-Byung Lim, Yong Sik Yoon, Chan Wook Kim, In Ja Park, Chang Sik Yu, Jin Cheon Kim
Korean Journal of Clinical Oncology.2013; 9(2): 134. CrossRef

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