Annals of Coloproctology

Review

Malignant disease,Prognosis and adjuvant therapy,Colorectal cancer,Surgical technique

Treatment for Peritoneal Metastasis of Patients With Colorectal Cancer: Young Jin Kim, Chang Hyun Kim; Ann Coloproctol. 2021;37(6):425-433. Published online December 22, 2021; DOI: https://doi.org/10.3393/ac.2021.00920.0131

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From the perspective of survival outcomes, the cancer survival of colorectal cancer (CRC) in the whole stage has improved. Peritoneal metastasis (PM) is found in approximately 8% to 15% of patients with CRC, with a poorer prognosis than that associated with other sites of metastases. Randomized controlled trials and up-to-date meta-analyses provide firm evidence that cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) could significantly improve overall survival compared with systemic chemotherapy alone in selected patients with CRC-PM. Practical guidelines recommend that the management of CRC-PM should be led by a multidisciplinary team carried out in experienced centers and consider CRS plus HIPEC for selected patients. In this review, we aim to provide the latest results of land mark studies and an overview of recent insights with regard to the management of CRC-PM.

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Molecular characterization of Pseudomyxoma peritonei with single-cell and bulk RNA sequencing
Ye Jin Ha, Seong-Hwan Park, Seon-Kyu Kim, Ka Hee Tak, Jeong-Hwan Kim, Chan Wook Kim, Yong Sik Yoon, Seon-Young Kim, Jong Lyul Lee
Scientific Data.2025;[Epub] CrossRef
Discovery of WEE1 Kinase Inhibitors with Potent Activity against Patient-Derived, Metastatic Colorectal Cancer Organoids
Joel L. Syphers, Josephine A. Wright, Shen Liu, Yi Sing Gee, Fan Gao, Ramesh Mudududdla, Da Qing Che, Aeson Chang, Erica K. Sloan, Vignesh Narasimhan, Alexander Heriot, Robert G. Ramsay, Rebekah de Nys, Tharindie N. Silva, Laura Vrbanac, Tarik Sammour, Ma
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CILP2 is a potential biomarker for the prediction and therapeutic target of peritoneal metastases in colorectal cancer
Ye Jin Ha, Seong-Hwan Park, Ka Hee Tak, Jong Lyul Lee, Chan Wook Kim, Jeong-Hwan Kim, Seon-Young Kim, Seon-Kyu Kim, Yong Sik Yoon
Scientific Reports.2024;[Epub] CrossRef
Comparison of EPIC Versus HIPEC in the Treatment of Colorectal Peritoneal Metastases and Appendix Tumors Using Inverse Probability of Treatment Weighting
Min Hye Jeong, Su Jin Kang, Soo Yeun Park, Sang Gyu Kwak, An Na Seo, Suehyun Park, Jun Seok Park, Hye Jin Kim, Gyu-Seog Choi
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Albumin Leakage Level during Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Is Associated with Major Complications
Hyun-Chang Kim, Dong Woo Han, Eun Jung Park, Yeon Hwa Hong, Young Song
Cancers.2024; 16(16): 2874. CrossRef
Inflammatory and nutritional markers in colorectal cancer: Implications for prognosis and treatment
Mesut Tez
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Analgesic effects of combined transversus abdominis plane block and intramuscular electrical stimulation in patients undergoing cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy: a randomized controlled trial
Hyun-Chang Kim, Jinyoung Park, Jinyoung Oh, Minjae Kim, Eun Jung Park, Seung Hyuk Baik, Young Song
International Journal of Surgery.2023; 109(5): 1199. CrossRef
Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach
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Improving nanochemoimmunotherapy efficacy by boosting “eat-me” signaling and downregulating “don't-eat-me” signaling with Ganoderma lucidum polysaccharide-based drug delivery
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Journal of Materials Chemistry B.2023; 11(48): 11562. CrossRef
Effect of Intraperitoneal Chemotherapy with Regorafenib on IL-6 and TNF-α Levels and Peritoneal Cytology: Experimental Study in Rats with Colorectal Peritoneal Carcinomatosis
Stefanos Bitsianis, Ioannis Mantzoros, Elissavet Anestiadou, Panagiotis Christidis, Christos Chatzakis, Konstantinos Zapsalis, Savvas Symeonidis, Georgios Ntampakis, Kalliopi Domvri, Anastasia Tsakona, Chryssa Bekiari, Orestis Ioannidis, Stamatios Aggelop
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Hyo Seon Ryu, Jin Kim, Ye Ryung Park, Eun Hae Cho, Jeong Min Choo, Ji-Seon Kim, Se-Jin Baek, Jung-Myun Kwak
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Youngbae Jeon, Eun Jung Park
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The Ewha Medical Journal.2023;[Epub] 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
The Onset of In-Vivo Dehydration in Gas -Based Intraperitoneal Hyperthermia and Its Cytotoxic Effects on Colon Cancer Cells
Agata Diakun, Tanja Khosrawipour, Agata Mikolajczyk-Martinez, Jakub Nicpoń, Zdzisław Kiełbowicz, Przemysław Prządka, Bartłomiej Liszka, Wojciech Kielan, Kacper Zielinski, Pawel Migdal, Hien Lau, Shiri Li, Veria Khosrawipour
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Patients with Metachronous Peritoneal Metastatic Mucinous Colorectal Adenocarcinoma Benefit More from Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) than Their Synchronous Counterparts
Zoltan Herold, Miklos Acs, Attila Marcell Szasz, Katalin Olasz, Jana Hussong, Max Mayr, Magdolna Dank, Pompiliu Piso
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ASO Author Reflections: Is it Correct to Use 5% Dextrose Solution as a Carrier Fluid for Oxaliplatin-based HIPEC?
Eun Jung Park, Sung-Joo Hwang, Seung Hyuk Baik
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Pharmacologic Effects of Oxaliplatin Instability in Chloride-Containing Carrier Fluids on the Hyperthermic Intraperitoneal Chemotherapy to Treat Colorectal Cancer In Vitro and In Vivo
Eun Jung Park, Junhyun Ahn, Sharif Md Abuzar, Kyung Su Park, Sung-Joo Hwang, Seung Hyuk Baik
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Benign multicystic mesothelioma of appendiceal origin treated by hyperthermic intraperitoneal chemotherapy: A case report
Suk Jun Lee, Ji Hae Nahm, Jeonghyun Kang, Seung Hyuk Baik, Eun Jung Park
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Molecular analyses of peritoneal metastasis from colorectal cancer
Chang Hyun Kim
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Surgical treatment for metastatic colorectal cancer
Eun Jung Park, Seung Hyuk Baik
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In Ja Park
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Eun Jung Park, Seung Hyuk Baik
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Chang Hyun Kim
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Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
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In Ja Park
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Original Articles

Oncologic Outcomes of Postoperative Chemoradiotherapy Versus Chemotherapy Alone in Stage II and III Upper Rectal Cancer: Ji Eun Yoon, Soo Young Lee, Han Duk Kwak, Seung Seop Yeom, Chang Hyun Kim, Jae Kyun Joo, Hyeong Rok Kim, Young Jin Kim; Ann Coloproctol. 2019;35(3):137-143. Published online June 30, 2019; DOI: https://doi.org/10.3393/ac.2018.09.28

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Abstract PDF

Purpose
The aim of this study was to assess oncological outcomes of postoperative radiotherapy plus chemotherapy (CRT) versus chemotherapy alone (CTx) in stage II or III upper rectal cancer patients who underwent curative surgery.
Methods
We retrospectively reviewed 263 consecutive patients with pathologic stage II or III upper rectal cancer who underwent primary curative resection with postoperative CRT or CTx from January 2008 to December 2014 at Chonnam National University Hwasun Hospital. Multivariate and propensity score matching analyses were used to reduce selection bias.
Results
Median follow-up was 48.1 months for the entire cohort and 53.5 months for the matched cohort. In subgroup analysis of the propensity score matched cohort, the 3-year local recurrence-free survival was 94.1% (95% confidence interval [CI], 87.8%–100%) in the CRT group and 90.1% (95% CI, 82.8%–97.9%) in the CTx group (P = 0.370). No significant difference in disease-free survival was observed according to treatment type. On multivariate analysis, circumferential resection margin involvement (hazard ratio [HR], 2.386; 95% CI, 1.190–7.599; P = 0.032), N stage (HR, 6.262; 95% CI, 1.843–21.278, P = 0.003), and T stage (HR, 5.896, 95% CI, 1.298–6.780, P = 0.021) were identified as independent risk factors for local recurrence of tumors of the upper rectum.
Conclusion
Omission of radiotherapy in an adjuvant treatment setting may not jeopardize oncologic outcomes in stages II and III upper rectal cancer.

Citations

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Is radiotherapy necessary for upper rectal cancer underwent curative resection? A retrospective study of 363 patients
Zhiwei Ma, Jumei Zhou, Ke Liu, Sisi Chen, Qinghui Wu, Lin Peng, Wei Zhao, Suyu Zhu
Radiation Oncology.2024;[Epub] CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplement
Sean J. Langenfeld, Bradley R. Davis, Jon D. Vogel, Jennifer S. Davids, Larissa K.F. Temple, Kyle G. Cologne, Samantha Hendren, Steven Hunt, Julio Garcia Aguilar, Daniel L. Feingold, Amy L. Lightner, Ian M. Paquette
Diseases of the Colon & Rectum.2023;[Epub] CrossRef
Which Definition of Upper Rectal Cancer Is Optimal in Selecting Stage II or III Rectal Cancer Patients to Avoid Postoperative Adjuvant Radiation?
Xian Hua Gao, Bai Zhi Zhai, Juan Li, Jean Luc Tshibangu Kabemba, Hai Feng Gong, Chen Guang Bai, Ming Lu Liu, Shao Ting Zhang, Fu Shen, Lian Jie Liu, Wei Zhang
Frontiers in Oncology.2021;[Epub] CrossRef
Role of adjuvant (chemo)radiotherapy for resected extrahepatic cholangiocarcinoma: a meta-analysis
Xin-qi Shi, Jing-yu Zhang, Hua Tian, Ling-na Tang, Ai-lin Li
Journal of Zhejiang University-SCIENCE B.2020; 21(7): 549. CrossRef

Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy: Chang Hyun Kim, Seung-Seop Yeom, Hand-Duk Kwak, Soo Young Lee, Jae Kyun Ju, Young Jin Kim, Hyeong Rok Kim; Ann Coloproctol. 2019;35(2):72-82. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2019.04.22

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Abstract PDF

Purpose
Treatment after failure of circumferential resection margin (CRM) conversion after preoperative chemoradiotherapy (pCRT) for locally advanced rectal cancer (LARC) has not been evaluated well. We conducted a single‐center, retrospective analysis to fill this information gap.
Methods
From 2008 to 2016, we included 112 patients who had predictive CRM involvement on baseline magnetic resonance imaging (MRI) and who underwent surgery following pCRT for LARC. Baseline and posttreatment radiologic and clinical factors were analyzed.
Results
Of 493 patients with LARC, 112 had CRM involvement by baseline MRI (mrCRM). In 40 patients (35.7%), mrCRM involvement was converted as negative posttreatment CRM (ymrCRM−). Multivariate analysis showed the risk factors for persistent CRM involvement (ymrCRM+) after pCRT were extramural venous invasion (mrEMVI+) (P = 0.030) and lower tumor location (P = 0.007). In addition, persistent CRM involvement after pCRT was an independent risk factor for predicting pathologic CRM involvement. The Cox proportional hazard model showed baseline positive mrEMVI remained significant for disease-free survival (DFS) (P < 0.001). On posttreatment MRI, abdominoperineal resection (P = 0.031), intersphincteric resection (P = 0.006), and persistent CRM involvement (P = 0.001) remained significant for local recurrence-free survival. With regard to DFS, persistent CRM involvement (P = 0.048) and positive EMVI on posttreatment MRI (ymrEMVI) (P = 0.014) were significant. In the patient subgroup with persistent CRM involvement, 5-year DFS in patients with mrEMVI and ymrEMVI was 29.8% and 21.2%, respectively.
Conclusion
Patients who fail to convert to negative CRM have extremely poor oncologic outcomes. Lower tumor height and negative mrEMVI status were good responders to ymrCRM conversion. Our results suggest that these patients require a more intensive treatment modality.

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Post‐diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta‐analysis
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International Journal of Cancer.2024; 155(3): 400. CrossRef
A Review of Neoadjuvant Therapy and the Watch-and-Wait Protocol in Rectal Cancer: Current Evidence and Future Directions
Iulian M Slavu, Octavian Munteanu, Florin Filipoiu, Raluca Tulin, Anca Monica Macovei Oprescu , Ileana Dima, Iulian A Dogaru, Adrian Tulin
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A Predictive Model to Evaluate Pathologic Complete Response in Rectal Adenocarcinoma
Shuiwang Qing, Lei Gu, Tingting Du, Xiaolan Yin, Ke-jia Zhang, Huo-jun Zhang
Technology in Cancer Research & Treatment.2023;[Epub] CrossRef
Oncologic Outcomes Associated With MRI-detected Extramural Venous Invasion (mrEMVI) in Rectal Cancer
François Rouleau Fournier, Mohammad Ali K. Motamedi, Carl J. Brown, Terry Phang, Manoj J. Raval, Cameron J. Hague, Ahmer A. Karimuddin
Annals of Surgery.2022; 275(2): 303. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
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Are oncological long-term outcomes equal after laproscopic completed and converted laparoscopic converted rectal resection for cancer?
M. Finochi, B. Menahem, G. Lebreton, J. Lubrano, Y. Eid, A. Alves
Techniques in Coloproctology.2021; 25(1): 91. CrossRef
Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?
Philippe Rouanet, Michel Rivoire, Sophie Gourgou, Bernard Lelong, Eric Rullier, Merhdad Jafari, Laurent Mineur, Marc Pocard, Jean Luc Faucheron, François Dravet, Denis Pezet, Jean Michel Fabre, Laurent Bresler, Jacques Balosso, Christophe Taoum, Claire Le
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The prognostic value of MRI-detected extramural vascular invasion (mrEMVI) for rectal cancer patients treated with neoadjuvant therapy: a meta-analysis
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European Radiology.2021; 31(12): 8827. CrossRef
Predictors of Positive Circumferential Resection Margin in Rectal Cancer: A Current Audit of the National Cancer Database
Hillary L. Simon, Thais Reif de Paula, Magda M. Profeta da Luz, Ravi P. Kiran, Deborah S. Keller
Diseases of the Colon & Rectum.2021; 64(9): 1096. CrossRef
MRI-detected extramural venous invasion of rectal cancer: Multimodality performance and implications at baseline imaging and after neoadjuvant therapy
Akitoshi Inoue, Shannon P. Sheedy, Jay P. Heiken, Payam Mohammadinejad, Rondell P. Graham, Hee Eun Lee, Scott R. Kelley, Stephanie L. Hansel, David H. Bruining, Jeff L. Fidler, Joel G. Fletcher
Insights into Imaging.2021;[Epub] CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Surgical Treatment of Low-Lying Rectal Cancer: Updates
Cristopher Varela, Nam Kyu Kim
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Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
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Reconsideration of the Safety of Laparoscopic Rectal Surgery for Cancer
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Video

Reduced-Port Laparoscopic Surgery for Patients With Proximal Transverse Colon Cancer With Situs Inversus Totalis: A Case Report: Seung-Seop Yeom, Kyung Hwan Kim, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim, Young Jin Kim; Ann Coloproctol. 2018;34(6):322-325. Published online December 31, 2018; DOI: https://doi.org/10.3393/ac.2018.05.29.1

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Abstract PDF Supplementary Material

Situs inversus is a rare hereditary disorder in which various anomalies have been reported with internal rotation abnormalities. This case involved an 85-year-old woman who had been diagnosed with transverse colon cancer and who underwent reduced-port laparoscopic surgery. All intra-abdominal organs were reversed left to right and right to left. The aberrant midcolic artery was identified during surgery. The total surgery time was 170 minutes, and the patient lost 20 mL of blood. The patient was discharged on the 8th postoperative day without complications.

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Review

The Future Medical Science and Colorectal Surgeons: Young Jin Kim; Ann Coloproctol. 2017;33(6):207-209. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.207

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Abstract PDF

Future medical technology breakthroughs will build from the incredible progress made in computers, biotechnology, and nanotechnology and from the information learned from the human genome. With such technology and information, computer-aided diagnoses, organ replacement, gene therapy, personalized drugs, and even age reversal will become possible. True 3-dimensional system technology will enable surgeons to envision key clinical features and will help them in planning complex surgery. Surgeons will enter surgical instructions in a virtual space from a remote medical center, order a medical robot to perform the operation, and review the operation in real time on a monitor. Surgeons will be better than artificial intelligence or automated robots when surgeons (or we) love patients and ask questions for a better future. The purpose of this paper is looking at the future medical science and the changes of colorectal surgeons.

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Editorials

Colorectal Cancer Surgery in Elderly Patients: Young Jin Kim; Ann Coloproctol. 2017;33(4):121-122. Published online August 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.4.121

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Feasibility of robotic surgery in elderly patients with rectal cancer: a meta-analysis
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Does a surgical access for rectal cancer in older patients affect postoperative morbidity and oncological safety?
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Extralevator Abdominoperineal Resection in the Prone Position: Young Jin Kim; Ann Coloproctol. 2016;32(1):1-2. Published online February 29, 2016; DOI: https://doi.org/10.3393/ac.2016.32.1.1

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Extralevator abdominoperineal excision for advanced low rectal cancer: Where to go
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Surgical Treatment of Obstructed Left-Sided Colorectal Cancer Patients: Young Jin Kim; Ann Coloproctol. 2014;30(6):245-246. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.245

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Acute obstructing left-sided colonic lesions: Role of preoperative endoscopic colonic stent insertion
Wael Al-shelfa, MohamadS Marie, Ahmed Hashem, Shymaa Yahia, Salah Mansour, Salina Saddick, Amr Ibrahim
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Serum Carcinoembryonic Antigen for Recurrence in Colorectal Cancer Patients: Young Jin Kim; Ann Coloproctol. 2013;29(4):137-137. Published online August 29, 2013; DOI: https://doi.org/10.3393/ac.2013.29.4.137

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Significance of Secreted Protein Acidic and Rich in Cysteine Expression in Colorectal Carcinoma: Young Jin Kim; Ann Coloproctol. 2013;29(3):87-88. Published online June 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.3.87

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Original Article

Clinical Significance of Serial Serum Carcinoembryonic Antigen Values for Treating Rectal Cancer with Preoperative Chemoradiotherapy: Young Jae Ryu, Chang Hyun Kim, Hun Jin Kim, Hyo Kang, Sang Woo Lim, Jung Wook Huh, Jae Kyun Ju, Young Jin Kim, Hyeong Rok Kim; J Korean Soc Coloproctol. 2012;28(4):205-212. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.205

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Abstract PDF

Purpose

Preoperative chemoradiotherapy is now widely accepted to treat rectal cancer; however, the prognosis for rectal cancer patients during and after chemoradiotherapy must be determined. The aim of this study was to evaluate the serial serum carcinoembryonic antigen (s-CEA) samples in patients with rectal cancer who underwent radical surgery after concurrent chemoradiotherapy (CRT).

Methods

This study evaluated 236 patients with rectal cancer who received preoperative CRT followed by curative surgery between June 2005 and June 2010. We measured the patient's s-CEA levels pre-CRT, post-CRT and post-surgery. Patients were classified into four groups according to their s-CEA concentrations (group 1, high, high, high; group 2, high, high, normal; group 3, high, normal, normal; group 4, normal, normal, normal). We analyzed the clinicopathologic factors and the outcomes among these groups.

Results

Of the 236 patients, 12 were in group 1, 31 were in group 2, 67 were in group 3, and 126 were in group 4. The 3-year disease-free survival rate in group 1 was poorer than those in group 3 (P = 0.007) and group 4 (P < 0.001). In a univariate analysis, type of surgery, clinical N stage, pathologic T or N stage, lymphovascular invasion, perineural invasion, and CEA group were prognostic factors. A multivariate analysis revealed that type of surgery, pathologic T stage, and lymphovascular invasion were independent prognostic factors; however, no statistical significance was associated with the CEA group.

Conclusion

High pre-CRT, post-CRT, and post-surgery s-CEA levels in patients with rectal cancer were associated with high rates of systemic recurrence and poor survival. Therefore, patients with sustained high s-CEA levels during CRT require careful monitoring after surgery.

Citations

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Editorials

Risk Factors for Repeat Abdominal Surgery in Patients with Crohn's Disease: Young Jin Kim; J Korean Soc Coloproctol. 2012;28(4):175-175. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.175

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What is a Reasonable Screening Test for Colorectal Cancer: Young Jin Kim; J Korean Soc Coloproctol. 2010;26(6):375-375. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.375

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Original Article

Clinical Significance of Tumor Regression Grade in Rectal Cancer with Preoperative Chemoradiotherapy: Young Joo Park, Byung Ryul Oh, Sang Woo Lim, Jung Wook Huh, Jae Kyun Joo, Young Jin Kim, Hyeong Rok Kim; J Korean Soc Coloproctol. 2010;26(4):279-286. Published online August 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.4.279

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Abstract PDF

Purpose

Neoadjuvant chemoradiotherapy applied to the locally advanced rectal cancer reduces local recurrence and improves survival. We assessed tumor regression grade (TRG) and its influence on survival in rectal cancer patients treated with chemoradiotherapy followed by surgical resection.

Methods

We studied 108 patients that were seen at our hospital between August 2004 and December 2008. Patients received preoperative chemoradiotherapy consisting of 5-fluorouracil and leucovorin by continous infusion during the first and fifth week, delivered with concurrent pelvic radiation of 50.4 Gy, followed by radical surgery at 6-8 weeks. The TRG was determined by the amount of fibrosis in the tumor embedding area and was divided into 5 grades based on the relative amount of fibrosis. We analyzed all preoperative clinicopathologic factors, postoperative pathologic stages, TRG and prognosis, retrospectively.

Results

Downstaging of rectal cancer through neoadjuvant chemoradiotherapy occurred in 64 (59%) patients. The numbers of total regressions (TRG4), good regressions (TRG3), moderate regressions (TRG2), minor regressions (TRG1), and no regression (TRG0) were 19 (18%), 65 (60%), 17 (16%), 6 (5%), and 1 (1%) respectively. The TRG was inversely correlated with perineural invasion and lymphovascular invasion (P = 0.008, P = 0.032). The local recurrence rate declined as the tumor regression grade increased (P = 0.032). The 19 patients with TRG4 had a better three-year disease free survival than the 89 patients with TRG0-3 (P = 0.034). The 16 patients with pathologic complete remission (pCR) had a better three-year disease free survival than the 92 patients with non-pCR (P = 0.025).

Conclusion

Higher TRG after preoperative chemoradiotherapy for rectal cancer closely correlates with better survival and low local recurrence. The TRG is considered to be a significant prognostic factor.

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