Annals of Coloproctology

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Original Articles

Colorectal cancer

Impact of the timing of additional surgery after noncurative endoscopic resection of early colorectal cancer on perioperative and oncological outcomes: a single-center retrospective cohort study: Shuhua Zhuo, Yijuan Liu, Kaiyan Wei, Jiantao Zheng, Lin Zhang; Ann Coloproctol. 2026;42(3):345-354. Published online June 26, 2026; DOI: https://doi.org/10.3393/ac.2025.01319.0188

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Abstract PDF Supplementary Material: Purpose
For early colorectal cancer (CRC) following noncurative endoscopic resection, additional curative surgery is the standard of care, but the optimal timing remains unclear. This study investigated the effect of the interval between procedures on surgical complexity, complications, and oncological outcomes.
Methods
This retrospective study included 112 patients with early CRC who underwent additional laparoscopic surgery after noncurative endoscopic resection between August 2019 and August 2024. Clinical and pathological data were collected, with primary endpoints focused on surgical difficulty (operative duration and intraoperative blood loss). Statistical analyses were performed using multivariate analysis of variance, logistic regression, and receiver operating characteristic curve analysis.
Results
The interval between procedures was not significantly associated with surgical difficulty or lymph node metastasis (P>0.05). Multivariate analysis did not identify an optimal timing point for surgery. However, a longer waiting time was independently associated with an increased risk of residual tumor (odds ratio, 1.09; 95% confidence interval, 1.03–1.16; P=0.004). Furthermore, lymphovascular invasion and elevated preoperative carcinoembryonic antigen levels were identified as independent predictors of lymph node metastasis. A higher preoperative lymphocyte ratio was associated with an increased risk of postoperative intra-abdominal infection (r=0.243, P=0.010).
Conclusion
In the era of laparoscopic surgery, the timing of additional surgery does not appear to be the primary determinant of surgical difficulty in CRC. Clinical decision-making should prioritize high-risk pathological features, such as lymphovascular invasion, rather than rigid adherence to a predetermined waiting period. Strategically delaying surgery may facilitate the selection of patients without residual disease, thereby helping to avoid unnecessary procedures.

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.

Colorectal cancer

Optimizing lymph node harvest in laparoscopic colorectal cancer: predictors and station-specific lymph node submission solutions: Chun Gao, Sheng Zhang; Ann Coloproctol. 2026;42(2):216-225. Published online April 27, 2026; DOI: https://doi.org/10.3393/ac.2025.01123.0160

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Abstract PDF: Purpose
Adequate lymph node yield is crucial for accurate staging in colorectal cancer. This study aims to analyze clinical factors associated with lymph node retrieval in laparoscopic colorectal cancer surgery and to explore strategies that may enhance yield.
Methods
We conducted a retrospective review of clinical, pathological, and surgical data from patients who underwent laparoscopic colorectal cancer resection between July 2019 and July 2024 at our institution. Patients were stratified by lymph node yield into 2 groups: <12 nodes (reduced yield) and ≥12 nodes (control). Univariate analyses were used to identify factors potentially affecting lymph node yield, and multivariate logistic regression was performed to determine independent risk factors for reduced yield.
Results
A total of 639 patients (305 with rectal cancer and 334 with colon cancer) were included. Univariate analysis identified age (P=0.039), sex (P=0.029), neoadjuvant therapy (P<0.001), tumor location (P<0.001), invasion depth (P<0.001), lymphovascular invasion (P=0.028), and station-specific lymph node submission (P<0.001) as influential factors. Multivariate analysis revealed that preoperative neoadjuvant therapy, tumor location (non–right colon), shallow invasion depth (T1–T2), and lack of station-specific submission independently contributed to reduced lymph node yield (all P<0.05).
Conclusion
This study highlights preoperative neoadjuvant therapy, tumor location, and invasion depth (T stage) as independent factors associated with reduced lymph node yield in laparoscopic colorectal cancer surgery. However, station-specific lymph node submission significantly increases yield and may help address inadequate retrieval. These findings suggest both predictive and interventional strategies to optimize lymph node harvest after surgery.

Review

Colorectal cancer

Two lives, one fight: navigating rectal cancer in pregnancy with multidisciplinary precision: Supakool Jearanai, Songphol Malakorn; Ann Coloproctol. 2026;42(2):179-184. Published online April 27, 2026; DOI: https://doi.org/10.3393/ac.2025.00843.0120

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Abstract PDF: Rectal cancer during pregnancy represents a clinical paradox in which the instinct to protect new life directly intersects with the urgency to preserve another. With an incidence of approximately 1 in 13,000 pregnancies, this rare condition challenges not only clinical decision-making but also the ethical and emotional dimensions of contemporary medical care. A 32-year-old primigravida at 26 weeks of gestation presented with rectal bleeding and was diagnosed with stage T4bN+M0 rectal adenocarcinoma. Despite the conventional recommendation of pregnancy termination in such circumstances, the patient expressed a strong desire to continue the pregnancy. A multidisciplinary team comprising colorectal surgeons, medical oncologists, radiation oncologists, and maternal-fetal medicine specialists developed a unified and coordinated treatment plan. The patient received neoadjuvant CAPOX (capecitabine [Xeloda] and oxaliplatin) chemotherapy during pregnancy, underwent cesarean delivery at 36 weeks of gestation, and subsequently completed postpartum chemoradiotherapy followed by curative laparoscopic oncologic resection. The child was delivered healthy, and the mother remained disease-free at a 5-year follow-up. This case demonstrates that life-threatening malignancy and ongoing pregnancy can coexist without compromise. Through carefully timed interventions, close cross-specialty collaboration, and respect for patient autonomy, both maternal and fetal outcomes were excellent. Within the evolving landscape of personalized cancer care, this case challenges outdated paradigms and reframes pregnancy not as a contraindication, but as a clinical variable that can be managed with precision and compassion. In addition to this illustrative case, we provide a focused review of the current literature to guide clinicians navigating this rare and complex clinical scenario.

Original Articles

Minimally invasive surgery

Comparative study of robot-assisted surgery for right-sided colon cancer: a propensity score–matched analysis of the hinotori Surgical Robot System and the da Vinci Surgical System: Koji Morohara, Hidetoshi Katsuno, Tomoyoshi Endo, Kenichi Nakamura, Kazuhiro Matsuo, Kazuki Tsujimura, Tetsuya Koide, Takashi Imanaka, Tomohiro Kubo, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise; Ann Coloproctol. 2026;42(2):237-246. Published online April 15, 2026; DOI: https://doi.org/10.3393/ac.2025.01151.0164

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Abstract PDF Supplementary Material

Purpose
The da Vinci Surgical System has led to major advances in robot-assisted colorectal surgery. Following its patent expiration, domestic alternatives such as the hinotori Surgical Robot System have been developed in Japan. However, clinical comparisons between the hinotori and the da Vinci Xi systems remain limited. This study aimed to compare the short-term outcomes of right-sided colon cancer surgeries performed with either system using propensity score matching.
Methods
This retrospective study included 39 patients who underwent da Vinci–assisted surgery and 37 who underwent surgery using the hinotori system. Propensity score matching was performed using 7 covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, clinical T and N categories, and surgeon experience (≥100 prior robotic colorectal surgeries). To assess the robustness of the findings, inverse probability weighting was also applied using the same covariates. Surgical, postoperative, and pathological outcomes were evaluated.
Results
After matching, 27 patients were included in each group. The hinotori group had significantly longer operative and console times (236 minutes vs. 191 minutes, P=0.001; 140 minutes vs. 90 minutes, P<0.001). No significant differences were observed in blood loss, complication rates, length of hospital stay, or lymph node harvest. No conversions or reoperations occurred. One readmission for ileus was noted in the da Vinci group, whereas none occurred in the hinotori group.
Conclusion
Right colectomy assisted by the hinotori system demonstrated short-term outcomes equivalent to those of the da Vinci system, despite a prolonged operative time. Further prospective studies with larger sample sizes and longer follow-up are warranted.

Citations

Citations to this article as recorded by

Beyond the era of monopoly to diversity: new horizons in robotic colorectal cancer surgery
Jeonghee Han
Annals of Coloproctology.2026; 42(2): 149. CrossRef

Colorectal cancer

Effectiveness of primary tumor resection for survival after first-line cetuximab or bevacizumab in KRAS wild-type metastatic colorectal cancer treated with subsequent trifluridine/tipiracil or regorafenib: Yu-Hsun Chen, Chih-Chien Wu, Chien-Chou Su, Pei-Ting Lee, Yi-Chia Su; Ann Coloproctol. 2026;42(1):127-140. Published online February 27, 2026; DOI: https://doi.org/10.3393/ac.2025.00759.0108

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Abstract PDF: Purpose
The optimal sequencing of targeted therapies and the role of primary tumor resection (PTR) in KRAS wild-type metastatic colorectal cancer (mCRC) remain unclear. This study compared survival outcomes in patients treated with first-line cetuximab plus FOLFIRI (folinic acid, 5-fluorouracil, and irinotecan) versus bevacizumab plus FOLFIRI, followed by second-line oxaliplatin-based chemotherapy and later-line trifluridine/tipiracil or regorafenib.
Methods
This retrospective cohort study used Taiwan’s National Health Insurance Research Database and the Taiwan Cancer Registry. Patients diagnosed with mCRC between 2013 and 2019 were included if they received first-line cetuximab or bevacizumab plus FOLFIRI, followed by later-line trifluridine/tipiracil or regorafenib. Patients were stratified by PTR status. Primary endpoints were overall survival and survival during trifluridine/tipiracil or regorafenib treatment. Secondary endpoints included time to treatment discontinuation (TTD) and TTD during trifluridine/tipiracil or regorafenib therapy. Stabilized inverse probability of treatment weighting was used for adjustment.
Results
Among 559 patients, 278 were assigned to the non-PTR group and 281 to the PTR group. In the non-PTR group, the cetuximab cohort demonstrated significantly longer survival during trifluridine/tipiracil or regorafenib therapy (6.2 months vs. 4.9 months; hazard ratio [HR], 0.72) and longer TTD1 (the interval between initiation of first-line therapy and the start of second-line chemotherapy; 11.8 months vs. 9.5 months; HR, 0.67) than the bevacizumab cohort. Survival differences between regimens were less pronounced among patients who underwent PTR.
Conclusion
First-line cetuximab plus FOLFIRI may confer a survival advantage over bevacizumab in patients with KRAS wild-type mCRC without PTR, including during later-line therapy with trifluridine/tipiracil or regorafenib, whereas bevacizumab appears to provide more consistent benefits in those with PTR.

Complications

Comparative outcomes of early and late rectourethral fistula: insights from a multicentric retrospective study on multidisciplinary management strategies: Pauline Jeannot, Edouard Roussel, Alexandre Dutoit, Maxime Collard, Niki Christou, Jérémie H. Lefevre, Amine Souadka, Alves Arnaud, Antonio Castaldi, Martin Bertrand, Nicolas Michot, Benjamin Faivre d’Arcier, Jean Jacques Tuech, Franck Bruyère, Urs Giger-Pabst, Mehdi Ouaïssi, for the French Research Group of Rectal Cancer Surgery (GRECCAR); Ann Coloproctol. 2026;42(1):103-114. Published online February 27, 2026; DOI: https://doi.org/10.3393/ac.2025.00696.0099

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Abstract PDF: Purpose
The objective of this study was to evaluate the natural history of early and late rectourethral fistulas (RUFs) and to determine the long-term outcomes of a multidisciplinary management approach.
Methods
A multicenter retrospective study was performed on patients with RUF who were treated by a combined colorectal and urological team. Early RUF (ERUF) was defined as occurring within 31 days after surgery, while late RUF (LRUF) was defined as occurring thereafter. Surgical procedures and the surgeons involved were recorded, in addition to clinical assessments, radiological findings, and oncological assessments.
Results
A total of 72 patients diagnosed with RUF were treated between January 1, 2010, and June 2023. Patients were divided into ERUF (n=37) and LRUF (n=35) groups. After conservative management, comparisons of success rates for graciloplasty, York-Mason, and delayed coloanal anastomosis as second and third treatments showed higher rates for graciloplasty in ERUF than in LRUF (83% vs. 40%, P=0.034; 71% vs. 33%, P=0.500; and 60% vs. 40%, P>0.999, respectively). The ERUF group demonstrated significantly higher cure rates after the second treatment (83.8% vs. 40.0%, P<0.001). At final follow-up, complete healing was significantly more frequent in ERUF than in LRUF (83.8% vs. 42.9%, P<0.005). Definitive digestive and urinary diversion rates were lower in ERUF (13.5% vs. 48.5%, P=0.001; and 13.5% vs. 25.7%, P=0.240, respectively).
Conclusion
These findings suggest that 30% of patients required a definitive colostomy, with a significantly higher proportion observed in the LRUF group. Moreover, repeated surgical procedures in the LRUF group were frequently unsuccessful.

Colorectal cancer

Upfront surgery versus preoperative chemoradiotherapy: a comparative survival analysis for stage II/III resectable rectal cancer: Nattapanee Sukphol, Thitithep Limvorapitak; Ann Coloproctol. 2026;42(1):115-126. Published online February 26, 2026; DOI: https://doi.org/10.3393/ac.2025.00724.0103

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Graphical Abstract Abstract PDF: Purpose
Current international guidelines recommend neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) for locally advanced rectal cancer (LARC). Although nCRT reduces the risk of local recurrence, it has not demonstrated a survival advantage and increases the likelihood of preoperative overtreatment. This study investigated whether upfront TME could be offered without compromising oncologic outcomes.
Methods
From January 2015 to December 2020, patients with stage II/III LARC who underwent either upfront TME or nCRT followed by TME were analyzed using propensity score matching. Long-term survival outcomes were compared between the 2 groups. The primary endpoint was 5-year disease-free survival. Secondary endpoints included 5-year local recurrence-free survival, distant metastasis-free survival, and overall survival.
Results
A total of 348 patients were included, of whom 138 (39.7%) underwent upfront TME. The upfront TME group showed significantly higher 5-year disease-free survival (63.3% vs. 43.9%) and distant metastasis-free survival (88.1% vs. 70.3%). However, after excluding patients with preoperative mesorectal fascia (MRF) involvement, no significant differences were observed in long-term oncologic outcomes. Following 1:1 propensity score matching, 47 patients from each group were compared. Kaplan-Meier survival analysis revealed no significant differences in any endpoints. Cox regression analysis of the matched cohort indicated that preoperative MRF involvement, positive extramural vascular invasion, and tumor deposits were not independent prognostic factors.
Conclusion
Upfront TME may represent a viable treatment option for selected patients with LARC, particularly those without MRF involvement, providing comparable oncologic outcomes to the standard nCRT approach.

Survival impact of radiotherapy for patients with de novo metastatic rectal cancer: Harvey Yu-Li Su, Yun-Hsuan Lin, Ko-Chao Lee, Yueh-Ming Lin, Chun-Chieh Huang, Eng-Yen Huang, Tai-Jan Chiu, Shih-Yu Huang, Chia-Che Wu, Chang-Ting Lin, Ming-Chun Kuo, Kai-Lung Tsai; Ann Coloproctol. 2026;42(1):94-102. Published online February 26, 2026; DOI: https://doi.org/10.3393/ac.2025.00605.0086

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Abstract PDF: Purpose
Metastatic rectal cancer (mRC) is a highly lethal and complex disease that demands a multidisciplinary treatment approach. However, the clinical effectiveness of radiotherapy (RT) for de novo mRC remains controversial and uncertain.
Methods
This retrospective cohort study examined medical records from Kaohsiung Chang Gung Memorial Hospital for patients with histologically confirmed de novo mRC diagnosed between January 2015 and December 2020. All patients received standard systemic therapy and radical surgery when feasible. The primary outcome, overall survival (OS), was assessed using the Kaplan-Meier method. Multivariable analysis was performed using a Cox regression model.
Results
Among 271 patients included in the analysis, 117 received RT and 154 did not. The median OS was significantly longer in the RT group compared with the non-RT group (27.8 months vs. 21.9 months; P=0.046). Multivariate analysis identified several independent predictors of OS: age ≥65 years (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.26–2.27; P=0.001), primary tumor resection (HR, 2.62; 95% CI, 1.90–3.61; P<0.001), M1b or M1c disease (HR, 1.97; 95% CI, 1.44–2.69; P<0.001), and receipt of RT (HR, 1.41; 95% CI, 1.02–1.94; P=0.036).
Conclusion
RT significantly improves OS in patients with mRC, underscoring its role in treatment strategies. These findings support its inclusion in therapeutic protocols and highlight the need for larger, multicenter trials to confirm and extend these results.

Reviews

Colorectal cancer

Gut microbiome in colorectal cancer: recent advances and clinical implications: Jun Yong Han, Min Jung Kim, Ji Won Park, Seung-Yong Jeong; Ann Coloproctol. 2026;42(1):72-85. Published online February 25, 2026; DOI: https://doi.org/10.3393/ac.2026.00010.0001

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Abstract PDF

The gut microbiome is not just a bystander of colorectal carcinogenesis but is an active driver of colorectal cancer (CRC). CRC-associated microbiome contributes in the tumorigenesis through chronic inflammation, formation of toxic metabolite and genotoxins, oncogenic signal activation, immune evasion, and barrier disruption—all reinforcing a tumor microenvironment. In contrast, beneficial microbiome supports the barrier-immune-metabolic axis by maintaining mucosal integrity and balanced immune tone. Despite extensive studies of microbiome-based CRC biomarkers, microbiome-based CRC biomarkers have not been yet ready for routine clinical use due to variation across populations and lack of standardization of key steps such as sampling, analysis, cutoffs, and interpretation. Microbiome-based therapies aim to change the overall intestinal ecosystem rather than simply adding or removing single strains. At present, dietary modulation and prebiotics are considered supportive measures, while probiotics or synbiotics are in preclinical stage. Fecal microbiota transplantation (FMT) still faces important challenges in effectiveness, standardization and safety. By its role in reshaping the tumor–host immune environment, FMT is viewed as a potential option for cancer therapy after further development through well-controlled clinical trials with careful safety monitoring.

Citations

Citations to this article as recorded by

Over and above what is visible and conventional: development of new territories in colorectal cancer management
In Ja Park
Annals of Coloproctology.2026; 42(1): 1. CrossRef
The diet-microbiota-inflammation axis and colorectal cancer
Konstantinos Kossenas, Christos Damaskos, Nikolaos Garmpis
Frontiers in Oncology.2026;[Epub] CrossRef
Microbiome-Shaped Metastatic Niches in Colorectal Cancer: Organ-Specific Patterns, Immune-Metabolic Mechanisms, and Therapeutic Translation
Maochen Luo, Zhuotao Lin, Jiaxin Deng, Yun Zhong, Hui Wang, Qin Liu, Keli Yang
Microorganisms.2026; 14(8): 1649. CrossRef

Colorectal cancer

Fluorescence-guided surgery in colorectal cancer: current evidence, quantitative advances, and future perspectives: Kyung-Ha Lee; Ann Coloproctol. 2026;42(1):58-71. Published online February 25, 2026; DOI: https://doi.org/10.3393/ac.2025.01438.0205

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2 Citations

Abstract PDF

Fluorescence-guided surgery (FGS) has progressed from a qualitative adjunct to a quantitative, data-driven tool in colorectal surgery. Fluorescence-guided angiography for perfusion assessment shows mixed randomized results overall, with signals of benefit in low anterior resection and less-severe leaks; emerging metrics (e.g., time-to-peak, slope, time from the initial fluorescence increase to half of the maximum [T1/2MAX], time ratio [TR]) support objective decision-making. Fluorescence-guided lymphatic mapping can increase D3 yield, whereas consistent oncologic benefit remains uncertain; sentinel lymph node mapping in early colon cancer is feasible but not standard. In advanced rectal cancer, fluorescence may facilitate lateral pelvic node dissection with lower blood loss and selective clearance, though long-term outcomes require confirmation. Tumor-targeted imaging shifts FGS from anatomy to biology, aiding detection of occult disease, characterization of indeterminate lesions after therapy, and therapeutic decision-making for organ preservation. Near-infrared II (NIR-II) agents and hybrid positron emission tomography (PET)/NIR tracers promise deeper penetration and preoperative-to-intraoperative correlation but remain largely preclinical. Platform advances, automated data capture, tumor to background ratio thresholds, and artificial intelligence–assisted analytics are moving FGS toward integrated, reproducible workflows. Priorities include international standardization, prospective trials with long-term endpoints, validated tumor-targeted probes, and digital/robotic integration.

Citations

Citations to this article as recorded by

Over and above what is visible and conventional: development of new territories in colorectal cancer management
In Ja Park
Annals of Coloproctology.2026; 42(1): 1. CrossRef
Strategies to Reduce the Risk of Rectal Stump Leakage After Hartmann's Procedure: A Structured Narrative Review
Mohamed Alkashty, Ehab Kahka, Mafdi Mossaad, Waseem Hameed, Abanoub Saleeb, Ahmed Elshawadia, Mohamed Elgazawey
Cureus.2026;[Epub] CrossRef

Original Articles

Minimally invasive surgery

Interim analysis of short-term outcomes between robotic and laparoscopic surgery for colon cancer: results from the ESSIMIC trial: Marco Milone, Sara Vertaldi, Pietro Anoldo, Simona Borin, Graziano Ceccarelli, Anna D’Amore, Maurizio Degiuli, Paolo Delrio, Uberto Romario Fumagalli, Mario Guerrieri, Michele Manigrasso, Monica Ortenzi, Ugo Pace, Felice Pirozzi, Lucia Puca, Wanda Petz, Rossella Reddavid, Daniela Rega, Fabio Rondelli, Antonio Sciuto, Giovanni Domenico De Palma; Ann Coloproctol. 2026;42(1):86-93. Published online February 23, 2026; DOI: https://doi.org/10.3393/ac.2025.00339.0048

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2 Citations

Graphical Abstract Abstract PDF Supplementary Material

Purpose
This study aimed to determine whether the benefits of robotic surgery can be applied to the treatment of colon cancer by evaluating short-term outcomes of robotic versus laparoscopic colonic resection.
Methods
This interim analysis of an interventional multicenter randomized trial was conducted to compare outcomes of robotic and laparoscopic colorectal surgery performed between January 2017 and December 2019. The study specifically assessed short-term outcomes in patients undergoing laparoscopic or robotic right or left colectomy for cancer. In addition, all short-term outcomes were evaluated in separate subgroups of right and left colonic resections through prespecified subgroup analyses.
Results
A total of 323 patients were analyzed, of whom 142 underwent robotic-assisted surgery and 181 underwent laparoscopic surgery. Overall, 109 complications (33.7%) occurred in the short-term period, 41 (28.9%) in the robotic group and 68 (37.6%) in the laparoscopic group, with no differences between groups in intraoperative or postoperative complications. However, grade III complications were significantly more frequent in the laparoscopic group, with 17 cases (9.4%) compared to 5 cases (3.5%) in the robotic group. Oncological radicality was similar between groups. Functional recovery after surgery was superior in the robotic group, as reflected by a shorter time to mobilization (17.5±10.2 hours vs. 21.1±11.5 hours). In the right colectomy subgroup, rates of grade III complications (1.9% vs. 11.7%) and lymph nodes retrieved (20.3±10.3 vs. 20.2±6.4) favored robotic surgery. In the left colon cancer subgroup, functional recovery was also improved with robotic surgery (44.3±22.2 hours vs. 61.1±31.1 hours, as measured by the composite recovery outcome).
Conclusion
Robotic surgery is associated with fewer severe complications and improved postoperative recovery following colonic resections. Trial registration: ClinicalTrials.gov identifier: NCT02871960

Citations

Citations to this article as recorded by

Beyond the era of monopoly to diversity: new horizons in robotic colorectal cancer surgery
Jeonghee Han
Annals of Coloproctology.2026; 42(2): 149. CrossRef
Economic Reporting and Conflicts of Interest in Randomized Trials Comparing Robot-Assisted With Laparoscopic Colorectal Surgery: A Meta-Epidemiological Systematic Review
Sang-ji Choi, Gibong Chae
Surgery.2026; : 110509. CrossRef

Colorectal cancer

Predictors of lateral lymph node metastasis and prognostic factors in patients with low rectal cancer who underwent lateral lymph node dissection without preoperative treatment: Riki Ohno, Haruka Oi, Soichiro Natsume, Kazuki Kawasaki, Yuichiro Yoshioka, Nao Kakizawa, Junko Kishikawa, Toshiya Nagasaki; Ann Coloproctol. 2025;41(6):545-553. Published online December 29, 2025; DOI: https://doi.org/10.3393/ac.2025.00675.0096

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Abstract PDF

Purpose
This study aimed to identify predictors of lateral lymph node metastasis (LLNM) and assess prognostic factors in patients with locally advanced low rectal cancer (LALRC), with the goal of informing optimal treatment strategies for LALRC.
Methods
We retrospectively analyzed clinicopathological data from patients with LALRC who underwent lateral lymph node dissection without preoperative treatment between 2014 and 2023. The radiological criterion for LLNM was a short-axis diameter of ≥6 mm on magnetic resonance imaging (MRI).
Results
Of 163 patients, 27 (16.6%) had pathological LLNM (pLLNM). Among 130 patients preoperatively classified as LLNM-negative, 5 (3.8%) were found to have pLLNM. Univariate and multivariate analyses showed that meeting the radiological LLNM criterion independently predicted pLLNM (odds ratio, 53.000; P<0.001). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this criterion were 90.2%, 81.5%, 91.9%, 66.7%, and 96.2%, respectively. In multivariate analyses, pLLNM was an independent risk factor for 3‑year relapse‑free survival. MRI‑detected extramural vascular invasion (mrEMVI) was independently associated with 3‑year relapse‑free survival, local recurrence‑free survival, and distant recurrence‑free survival.
Conclusion
These radiological criteria may help clinicians develop personalized treatment plans for patients with LALRC. The high negative predictive value and specificity of LLNM assessment can assist in avoiding overtreatment in appropriate patients. Further evaluation is needed to define optimal management for mrEMVI‑positive cases.

Citations

Citations to this article as recorded by

Clinical implications of radiologic criteria and prognostic factors for lateral lymph node metastasis in low rectal cancer
Gyung Mo Son
Annals of Coloproctology.2025; 41(6): 489. CrossRef

Colorectal cancer

Palliative resection versus palliative stenting for intestinal obstruction in patients with metastatic left-sided colonic cancer: a propensity score–matched analysis: Ruby Siu Ting Lau, Sophie Sok Fei Hon, Man Fung Ho, Simon Chu, Dennis CK Ng, Simon SM Ng; Ann Coloproctol. 2025;41(6):528-536. Published online December 29, 2025; DOI: https://doi.org/10.3393/ac.2025.00535.0076

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Abstract PDF: Purpose
Palliative resection and palliative stenting are established options for managing obstruction in patients with metastatic left-sided colonic cancer. This retrospective study investigated the long-term outcomes and survival associated with each treatment modality.
Methods
Patients with left-sided colon cancer complicated by intestinal obstruction and unresectable metastatic lesions were included. Propensity score matching was conducted to balance demographic characteristics. The primary outcome was long-term survival. Secondary outcomes included short-term morbidity, length of hospital stay, clinical success rate, stoma formation rate, and number of readmissions due to tumor-related complications.
Results
Initially, 131 patients who underwent palliative resection or stenting between 2015 and 2022 were included. After propensity score matching, 98 patients remained (49 in each group). Survival was significantly better among patients receiving palliative resection compared to stenting (median, 19.6 months vs. 9.6 months; P=0.003). However, subgroup analysis for patients older than 70 years demonstrated no statistically significant survival benefit (median, 11.5 months vs. 10.2 months; P=0.240). The resection group experienced significantly higher rates of stoma formation and longer postoperative hospital stays. Readmission rates were similar. Cox regression analysis identified low carcinoembryonic antigen levels, tumor resection, chemotherapy, and targeted therapy as independent predictors of longer survival.
Conclusion
For metastatic colon cancer patients presenting with intestinal obstruction, palliative resection may offer a survival advantage. However, this benefit diminishes in patients over 70 years of age. Additionally, resection is associated with a higher rate of stoma formation. Therefore, individualized treatment decisions are warranted when choosing between palliative resection and palliative stenting in metastatic colonic cancer patients.

Anorectal benign disease

New anatomical insight into the muscular structure of the anal canal: revealing Treitz muscle as a directional shift of the internal anal sphincter: Satoru Muro, Kumiko Yamaguchi, Naoko Inoshita, Yasuo Nakajima, Danyo Jennifer Edinam, Akimoto Nimura, Keiichi Akita; Ann Coloproctol. 2025;41(6):501-509. Published online December 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00647.0092

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Abstract PDF

Purpose
Understanding the muscular structure of the anal canal is crucial for the diagnosis and treatment of anorectal diseases. Treitz muscle is a vital yet poorly understood component. It supports the anal venous plexus and contributes to anal cushion formation. However, its anatomical details remain unclear, and various theories suggest different origins for its muscle bundles, which affects our understanding of the pathophysiology of hemorrhoids. In this study, we sought to clarify the origin and localization of Treitz muscle to provide an anatomical foundation for understanding anal function.
Methods
In this descriptive cadaveric study of 11 cadavers, we performed macroscopic examinations and immunohistological analyses on tissues from the anterior, lateral, and posterior walls of the anal canal. The origin and localization of Treitz muscle were qualitatively evaluated.
Results
Treitz muscle is a smooth muscle formed by a directional change in the muscle bundles of the internal anal sphincter, running longitudinally along its surface. A shift in the direction of muscle bundles originating from the internal anal sphincter, giving rise to Treitz muscle, was frequently observed in the anterolateral wall of the anal canal.
Conclusion
In summary, Treitz muscle, a smooth muscle extending from the internal anal sphincter, is considered part of the muscularis propria. Its directional shift was localized to the anterolateral wall, indicating that Treitz muscle is not uniformly distributed around the anal canal. This site-specific localization may influence the risk of hemorrhoids or cancer invasion depending on its anatomical position.

Citations

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Histological architecture of the intersphincteric region of the anal canal: implications for the anatomical basis of anal fistula pathways
Satoru Muro, Yasuo Nakajima, Akimoto Nimura, Keiichi Akita
International Journal of Colorectal Disease.2026;[Epub] CrossRef

Complications

Preoperative magnetic resonance imaging–based radiomics nomogram model for predicting postoperative anastomotic leakage in colorectal cancer: Junfeng Yan, Qiushuang Wang, Qiang Li, Jiatong Lu, Qiang Tong; Ann Coloproctol. 2025;41(6):554-564. Published online December 26, 2025; DOI: https://doi.org/10.3393/ac.2025.00689.0098

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Abstract PDF Supplementary Material: Purpose
Anastomotic leakage (AL) is a serious postoperative complication after colorectal cancer surgery, and accurate preoperative prediction remains challenging. This study aimed to develop and validate a magnetic resonance imaging (MRI)–based radiomics nomogram for the preoperative prediction of AL.
Methods
A total of 146 patients with colorectal cancer, including 11 with AL, were retrospectively enrolled and randomly divided into training and validation cohorts at a 7:3 ratio. Clinical variables and preoperative MRI-based radiomic features were analyzed. A clinical model was constructed using logistic regression. Radiomic features were selected using the least absolute shrinkage and selection operator method to develop a radiomics model, from which a radiomic score was calculated. A combined radiomics nomogram integrating the radiomic score and significant clinical factors was subsequently established. Model performance was evaluated using receiver operating characteristic curve analysis in both cohorts.
Results
The clinical model achieved an area under the curve (AUC) of 0.766 in the training cohort and 0.583 in the validation cohort. The radiomics model demonstrated improved discrimination, with AUCs of 0.822 and 0.800, respectively. The combined radiomics nomogram showed the best predictive performance, yielding AUCs of 0.869 in the training cohort and 0.858 in the validation cohort.
Conclusion
The proposed MRI-based radiomics nomogram demonstrates good predictive performance for postoperative anastomotic leakage and may serve as a useful tool for preoperative risk stratification in patients with colorectal cancer.

Metastasis or chemotherapy

Comparative effectiveness of bevacizumab, cetuximab, and panitumumab for improving outcomes in metastatic colorectal cancer: a propensity overlap weighting analysis: Yi-Chia Su, Chien-Chou Su, Pei-Ting Lee, Chih-Chien Wu; Ann Coloproctol. 2025;41(5):462-472. Published online October 27, 2025; DOI: https://doi.org/10.3393/ac.2025.00059.0008

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Purpose
Metastatic colorectal cancer (mCRC) remains a leading cause of cancer-related mortality despite advancements in targeted therapies. Monoclonal antibody medications—namely, bevacizumab, cetuximab, and panitumumab—are widely used in combination with chemotherapy as first-line treatments for unresectable mCRC in patients harboring wild-type KRAS tumors. However, the comparative effectiveness of these treatments in improving survival outcomes has not been clearly evaluated. This study aimed to directly compare the effectiveness of these 3 targeted therapies on survival outcomes in patients with unresectable mCRC.
Methods
In this retrospective cohort study, we utilized Taiwan’s National Health Insurance Database and Taiwan Cancer Registry to identify patients newly diagnosed with mCRC who were treated with at least 6 cycles of bevacizumab, cetuximab, or panitumumab between 2011 and 2021. Propensity score overlap weighting was applied to adjust for baseline differences, and outcomes were evaluated using Cox proportional hazards models. Additionally, subgroup analyses were performed separately for left- and right-sided tumors.
Results
Among 4,849 patients, treatment with cetuximab and panitumumab was associated with improved overall survival compared to bevacizumab, particularly in patients with left-sided tumors (adjusted hazard ratio, 0.77 and 0.75, respectively). Both cetuximab and panitumumab also showed significantly higher rates of conversion surgery, with panitumumab demonstrating the strongest effect. For right-sided tumors, however, the effectiveness of all 3 agents was limited, and no significant differences were observed in overall survival.
Conclusion
Cetuximab and panitumumab were more effective than bevacizumab at improving survival outcomes and facilitating conversion surgery in left-sided mCRC. These findings highlight the importance of tumor laterality and molecular profiling in guiding therapeutic strategies.

Citations

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Risk of high-grade infections in colorectal cancer patients treated with anti-EGFR monoclonal antibodies: a meta-analysis of randomized controlled trials
Xueliang Chen, Cui Liu, Hualin Liao
Frontiers in Oncology.2026;[Epub] CrossRef
Molecular Targeting of EGFR, BRAF, and HER2 Signaling in Colorectal Cancer: Contemporary Advances with Panitumumab, Encorafenib, and Tucatinib
Piotr Kawczak, Tomasz Bączek
Journal of Clinical Medicine.2026; 15(6): 2387. CrossRef
Colorectal cancer liver metastasis: immunosuppressive microenvironment, signaling pathways, and emerging therapeutic strategies
Hanlin Yang, Shaoxian Wu, Lujun Chen
Frontiers in Immunology.2026;[Epub] CrossRef

Complications

Muscle loss phenotype predicts poor postoperative outcomes of colorectal cancer in US inpatients: a population-based analysis: Ko-Chao Lee, Sin-Ei Juang, Kuen-Lin Wu, Kung-Chuan Cheng, Ling-Chiao Song, Chien-En Tang, Hong-Hwa Chen, Kuan-Chih Chung; Ann Coloproctol. 2025;41(5):443-452. Published online October 24, 2025; DOI: https://doi.org/10.3393/ac.2025.00129.0018

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Abstract PDF Supplementary Material: Purpose
Muscle loss may lead to reduced therapy tolerance and survival. We aimed to assess whether colorectal cancer (CRC) patients with a muscle loss phenotype experience worse outcomes.
Methods
Data were extracted from the US Nationwide Inpatient Sample for hospitalized patients aged ≥20 years who underwent surgical resection for colorectal cancer (CRC) between 2005 and 2018. CRC and muscle loss phenotypes were identified using validated International Classification of Diseases (ICD) diagnosis and procedure codes. Propensity score matching was performed to balance characteristics. Regression analyses determined associations between muscle loss and in-hospital outcomes.
Results
A total of 209,171 patients were included, with a mean age of 67.9 years; 7.1% exhibited muscle loss phenotype. After matching, 60,295 patients remained in the sample. After adjustment, patients with muscle loss had significantly increased risks of postoperative complications (adjusted odds ratio [aOR], 2.99; 95% confidence interval [CI], 2.85–3.15), unfavorable discharge (aOR, 2.42; 95% CI, 2.30–2.53), prolonged length of stay (aOR, 4.34; 95% CI, 4.13–4.55), and higher total hospital costs (adjusted β, 70.86; 95% CI, 67.11–74.61) compared to patients without muscle loss. When stratified by age (≥65 years), results remained consistent. Among complications, muscle loss phenotype was most strongly associated with shock, sepsis, and respiratory failure.
Conclusion
Muscle loss phenotype among patients with CRC is strongly associated with poor postoperative outcomes, including higher complication rates, longer stays, and increased costs. These findings highlight the importance of preoperative muscle loss assessments and the necessity for targeted interventions.

Metastasis or chemotherapy

Short-term surgical outcomes following neoadjuvant immunotherapy in mismatch repair-deficient colorectal cancer: initial experience from a tertiary referral center: Ejaz Ahmed Latif, Ayman Abdelhafiz Ahmed, Mahmood Saad Al-Dhaheri, Ammar Aleter, Ali Toffaha, Mohamed Kurer, Tausief Fatima, Amjad Parvaiz, Mohmmad Hosni Abunada; Ann Coloproctol. 2025;41(4):338-345. Published online August 28, 2025; DOI: https://doi.org/10.3393/ac.2025.00381.0054

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Abstract PDF

Purpose
Immunotherapy has demonstrated remarkable efficacy in mismatch repair-deficient (MMR-D) colorectal cancer (CRC). Due to their significant response rates, immune checkpoint inhibitors have emerged as a promising neoadjuvant therapy. However, data regarding short-term surgical outcomes following immunotherapy remain limited. The aim of this study is to evaluate the safety and feasibility of surgical resection after immunotherapy, as well as its short-term clinical outcomes.
Methods
A retrospective review of prospectively collected data was performed at a tertiary referral center from January 2020 to July 2024. Fifteen consecutive patients with MMR-D CRC treated with pembrolizumab were analyzed. The patients’ demographics, tumor characteristics, clinical outcomes, and histopathological responses were assessed.
Results
In total, 15 patients diagnosed with MMR-D locally advanced or metastatic colorectal cancers received neoadjuvant immunotherapy followed by surgery. Of the 15 patients, 11 (73.3%) were male, 12 (80.0%) presented with T3/T4 tumors, and 3 (20.0%) had metastatic disease at diagnosis. The median number of immunotherapy cycles was 5 (range, 3–13). Surgery was performed without any anastomotic leaks or 30-day mortality. The median length of hospital stay was 5 days (range, 3–14 days). All surgical specimens had negative resection margins. Major pathological response was observed in 11 patients (73.3%), including complete response in 8 (53.3%) and near-complete response in 3 (20.0%). The median follow-up was 14 months (range, 1–56 months). One patient developed liver metastasis, which was successfully resected.
Conclusion
Surgical resection of MMR-D CRC following neoadjuvant immunotherapy is safe and associated with low morbidity. Neoadjuvant immunotherapy in MMR-D CRC facilitates high rates of major pathological response.

Citations

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Neoadjuvant Chemotherapy in Resectable Colon Cancer: Evidence, Controversies, and an Implementation Roadmap for 2026
Lorenzo Dottorini, Matteo Viti, Marcella Arru, Francesca Senzani, Fausto Petrelli
Annals of Surgical Oncology.2026;[Epub] CrossRef

Colorectal cancer

Effects of clinical information on the treatment decisions for good responders to neoadjuvant chemoradiotherapy among rectal cancer patients: Eon Bin Kim, In Ja Park, Hwa Jung Kim, Jong Keon Jang, Seong Ho Park, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu; Ann Coloproctol. 2025;41(5):473-482. Published online July 10, 2025; DOI: https://doi.org/10.3393/ac.2024.00276.0039

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Abstract PDF Supplementary Material

Purpose
The decision for treatment after neoadjuvant chemoradiotherapy (nCRT) in rectal cancer is intricately linked to tumor response and clinical parameters. This study was designed to elucidate determinants influencing treatment decisions for good responders to nCRT, while concurrently evaluating the ramifications of modifications in magnetic resonance imaging (MRI) tumor response evaluation protocols.
Methods
A survey was constructed with 5 cases of good responder after nCRT based on the magnetic resonance–based tumor regression grade (mrTRG) criteria. A total of 35 colorectal surgeons in Korea participated in the survey via email, and they were introduced to 2 discrete MRI-based tumor response evaluation methodologies: the conventional mrTRG and an emergent complete response (CR)/non-CR classification system. Surgeons were directed to select between total mesorectal excision, local excision, or a watch and wait strategy.
Results
Treatment decisions varied significantly (P<0.01), as gradually more clinical information was provided with mrTRG. The paradigm shift from mrTRG to CR/non-CR evaluation criterion instigated the highest alteration in decision (P<0.01). Even comparing with other sets of information, decision change with different tumor response assessment (i.e., mrTRG vs. CR/non-CR) was statistically significant (P<0.01). Three particular cases consistently displayed a declining predilection for total mesorectal excision, favoring a more pronounced inclination towards watch and wait strategy or local excision. Nonetheless, the magnitude of these decisional shifts oscillated depending on the specific endoscopic imagery present.
Conclusion
Our current findings underscore the significant role of tumor response assessment methods in shaping treatment decisions for rectal cancer patients who respond well to nCRT. This highlights the need for clear and accurate tools to interpret MRI results.

Citations

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Prognostic significance of integrating pretreatment biopsy-derived Immunoscore and Pan-Immune-Inflammation value in locally advanced rectal cancer after neoadjuvant chemoradiotherapy
Min Joon Kim, Hye Won Lee, Da In Shin, Woon Kyung Jeong, Seong Kyu Baek, Sung Uk Bae
Clinical and Translational Radiation Oncology.2026; 59: 101172. CrossRef
Oncologic outcomes of colorectal cancer during the coronavirus pandemic: a multicenter retrospective study
Chungyeop Lee, In Ja Park, Ju Yeon Choi, Woo Yong Lee, Dae Hee Pyo, Hyo Seon Ryu, Jin Kim, Jun Seok Park, Yoon Suk Lee, Jung Hoon Bae, Gyung Mo Son, Chang Hyun Kim, Eun Jung Park
International Journal of Surgery.2026;[Epub] CrossRef
Clinical implications of radiologic criteria and prognostic factors for lateral lymph node metastasis in low rectal cancer
Gyung Mo Son
Annals of Coloproctology.2025; 41(6): 489. CrossRef

ERAS

Early urinary catheter removal in patients undergoing rectal cancer surgery: a randomized controlled trial on silodosin versus no pharmacological treatment on urinary function in the early postoperative period: Žilvinas Gricius, Justas Kuliavas, Eugenijus Stratilatovas, Bronius Buckus, Audrius Dulskas; Ann Coloproctol. 2025;41(3):239-245. Published online June 20, 2025; DOI: https://doi.org/10.3393/ac.2024.00703.0100

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Abstract PDF

Purpose
This study aimed to evaluate the efficacy of the α1 adrenergic receptor antagonist silodosin in preventing lower urinary tract symptoms after rectal cancer surgery.
Methods
We conducted a 2-arm, double-blind, single-center randomized controlled trial. The study included 150 patients with rectal cancer who underwent radical surgery between 2019 and 2022. On the first postoperative day, the urinary catheter was removed for all patients. Of these, 100 patients were administered silodosin, while 50 patients (control group) receive placebo (glucose tablet). Urinary dysfunction (urinary retention, infection, dysuria) and other complications were monitored.
Results
Among the 150 patients, 84 (56.0%) were male and 66 (44.0%) were female. Surgical procedures included abdominoperineal resection in 33 patients, partial mesorectal excision in 45, and total mesorectal excision in 72. A laparoscopic approach was used in 69 patients, while the remaining 81 underwent open surgery. Urinary tract symptoms developed in 10 patients (6.7%): 7 (7.0%) in the silodosin group and 3 (6.0%) in the control group (P=0.92). In the silodosin group, there was 1 case (1.0%) of urinary retention, 3 cases (3.0%) of urinary tract infection, and 3 cases (3.0%) of dysuria. In the control group, there was 1 case (2.0%) each of urinary retention, urinary tract infection, and dysuria (all P=0.92).
Conclusion
Early urinary catheter removal on the first postoperative day was safe in both groups. The use of the oral α-antagonist silodosin did not provide additional benefits in preventing lower urinary tract symptoms in patients undergoing rectal cancer surgery. Trial registration: ClinicalTrials.gov identifier: NCT03607370

Citations

Citations to this article as recorded by

Less is more: simplifying patient-centered cancer care
In Ja Park
Annals of Coloproctology.2025; 41(3): 173. CrossRef

CRC

Relationships between MMP-2, MMP-9, and ADAMDEC1 serum and tissue levels in patients with colorectal cancer: Zahra Mozooni, Kiana Khajeh Amiri, Nafiseh Golestani, Alireza Shahmohammadi, Sara Minaeian, Leyla Bahadorizadeh; Ann Coloproctol. 2025;41(2):136-144. Published online April 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00227.0032

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Abstract PDF Supplementary Material

Purpose
Colorectal cancer (CRC) is the most common malignancy of the gastrointestinal system globally. Identifying specific gene expression patterns indicative of early-stage CRC could enable early diagnosis and rapid treatment initiation. Matrix metalloproteinases (MMPs) play crucial roles in extracellular matrix degradation and tissue remodeling. Among them, MMP-2 and MMP-9 have been found to be upregulated in various cancers, including CRC, and are associated with tumor invasion, metastasis, and angiogenesis. In contrast, a disintegrin and metalloproteinase like decysin 1 (ADAMDEC1) is a relatively newly discovered gene with demonstrated involvement in immune response and inflammation. This study investigated serum levels of MMP-2 and MMP-9, along with tissue expression of MMP-2, MMP-9, and ADAMDEC1, and explored potential associations with pathological and clinical factors in patients with CRC.
Methods
This study included 100 patients with CRC and 100 control participants. Tissue and blood samples were collected. Serum MMP-2 and MMP-9 levels were analyzed using the enzyme-linked immunosorbent assay. Quantitative real-time polymerase chain reaction was employed to assess the expression levels of MMP-2, MMP-9, and ADAMDEC1 in CRC tissue samples compared to adjacent control tissue.
Results
The expression levels of MMP-2, MMP-9, and ADAMDEC1 were significantly upregulated in CRC relative to adjacent control tissues. Analysis of clinicopathological features revealed statistically significant differences in the expression levels of MMP-2, MMP-9, and ADAMDEC1 between patients with CRC with and without lymphovascular invasion (P<0.001). Based on receiver operating characteristic curve analysis, these genes represent promising candidate diagnostic biomarkers for CRC.
Conclusion
MMP-2, MMP-9, and ADAMDEC1 levels may serve as potential diagnostic biomarkers for CRC.

Citations

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The role of matrix metalloproteinase 9 in immune-mediated skin diseases
Ke Xu, Min Li, Fengming Hu, Jian Gong, Fangrong Liu, Qiao Liu, Weiwei Wu
Frontiers in Immunology.2026;[Epub] CrossRef
Interplay Between TLR4 and Gelatinases in Tumour Growth and Metastasis
Abdulfattah Al-Kadash, Peter Michael Moyle, Marie-Odile Parat
Cells.2026; 15(9): 822. CrossRef

CRC

Impact of iron-deficiency anemia on short-term outcomes after resection of colorectal cancer liver metastasis: a US National (Nationwide) Inpatient Sample (NIS) analysis: Ko-Chao Lee, Yu-Li Su, Kuen-Lin Wu, Kung-Chuan Cheng, Ling-Chiao Song, Chien-En Tang, Hong-Hwa Chen, Kuan-Chih Chung; Ann Coloproctol. 2025;41(2):119-126. Published online April 24, 2025; DOI: https://doi.org/10.3393/ac.2024.00591.0084

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Abstract PDF Supplementary Material

Purpose
Colorectal cancer (CRC) often spreads to the liver, necessitating surgical treatment for CRC liver metastasis (CRLM). Iron-deficiency anemia is common in CRC patients and is associated with fatigue and weakness. This study investigated the effects of iron-deficiency anemia on the outcomes of surgical resection of CRLM.
Methods
This population-based, retrospective study evaluated data from adults ≥20 years old with CRLM who underwent hepatic resection. All patient data were extracted from the 2005–2018 US National (Nationwide) Inpatient Sample (NIS) database. The outcome measures were in-hospital outcomes including 30-day mortality, unfavorable discharge, and prolonged length of hospital stay (LOS), and short-term complications such as bleeding and infection. Associations between iron-deficiency anemia and outcomes were determined using logistic regression analysis.
Results
Data from 7,749 patients (representing 37,923 persons in the United States after weighting) were analyzed. Multivariable analysis revealed that iron-deficiency anemia was significantly associated with an increased risk of prolonged LOS (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 2.30–3.30), unfavorable discharge (aOR, 2.42; 95% CI, 1.83–3.19), bleeding (aOR, 5.05; 95% CI, 2.92–8.74), sepsis (aOR, 1.60; 95% CI, 1.04–2.46), pneumonia (aOR, 2.54; 95% CI, 1.72–3.74), and acute kidney injury (aOR, 1.71; 95% CI, 1.24–2.35). Subgroup analyses revealed consistent associations between iron-deficiency anemia and prolonged LOS across age, sex, and obesity status categories.
Conclusion
In patients undergoing hepatic resection for CRLM, iron-deficiency anemia is an independent risk factor for prolonged LOS, unfavorable discharge, and several critical postoperative complications. These findings underscore the need for proactive anemia management to optimize surgical outcomes.

Citations

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A commentary on “Individualized blood pressure regulation and acute kidney injury in older patients having major abdominal surgery: a pilot randomized trial”
Fu-Shan Xue, Dan-Feng Wang, Xiao-Chun Zheng
International Journal of Surgery.2025; 111(12): 9993. CrossRef

Colorectal cancer

Is clinical complete response as accurate as pathological complete response in patients with mid-low locally advanced rectal cancer?: Niyaz Shadmanov, Vusal Aliyev, Guglielmo Niccolò Piozzi, Barıs Bakır, Suha Goksel, Oktar Asoglu; Ann Coloproctol. 2025;41(1):57-67. Published online February 28, 2025; DOI: https://doi.org/10.3393/ac.2024.00339.0048

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Graphical Abstract Abstract PDF

Purpose
The standard treatment for locally advanced rectal cancer involves neoadjuvant chemoradiation followed by total mesorectal excision surgery. A subset of patients achieves pathologic complete response (pCR), representing the optimal treatment outcome. This study compares the long-term oncological outcomes of patients who achieved pCR with those who attained clinical complete response (cCR) after total neoadjuvant therapy, managed using a watch-and-wait approach.
Methods
This study retrospectively evaluated patients with mid-low locally advanced rectal cancer who underwent neoadjuvant treatment from January 1, 2005, to May 1, 2023. The pCR and cCR groups were compared based on demographic, clinical, histopathological, and long-term survival outcomes.
Results
The median follow-up times were 54 months (range, 7–83 months) for the cCR group (n=73), 96 months (range, 7–215 months) for the pCR group (n=63), and 72 months (range, 4–212 months) for the pathological incomplete clinical response (pICR) group (n=627). In the cCR group, 15 patients (20.5%) experienced local regrowth, and 5 (6.8%) developed distant metastasis (DM). The pCR group had no cases of local recurrence, but 3 patients (4.8%) developed DM. Among the pICR patients, 58 (9.2%) experienced local recurrence, and 92 (14.6%) had DM. Five-year disease-free survival rates were 90.0% for cCR, 92.0% for pCR, and 69.5% for pICR (P=0.022). Five-year overall survival rates were 93.1% for cCR, 92.0% for pCR, and 78.1% for pICR. There were no significant differences in outcomes between the cCR and pCR groups (P=0.810); however, the pICR group exhibited poorer outcomes (P=0.002).
Conclusion
This study shows no significant long-term oncological differences between patients who exhibited cCR and those who experienced pCR.

Citations

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Total neoadjuvant therapy in rectal cancer: The FOREST protocol, a patient‐centered approach that clusters two cohorts with different outcomes
Hector Guadalajara, Jose Luis Domínguez‐Tristancho, Raquel Fuentes Mateo, Miguel Leon‐Arellano, Raquel Sanz‐Baro, Eleonora Geraldi, Ana Isabel Hormigo‐Sanchez, Víctor Manuel Castellano Megías, Marta Pérez Cobos, Patricia Mellado Miras, Begoña Lopez‐Botet
International Journal of Cancer.2026; 158(3): 697. CrossRef
Organ preservation in rectal cancer: Clinical basis of the watch-and-wait strategy
Rosa M. Jimenez-Rodriguez, Fátima Aguilar-del-Castillo, Felipe Quezada-Diaz, Julio García-Aguilar
Cirugía Española (English Edition).2026; 104(1): 800248. CrossRef
Preservación del órgano en cáncer de recto: fundamentos clínicos de la estrategia watch-and-wait
Rosa M. Jimenez-Rodriguez, Fátima Aguilar-del-Castillo, Felipe Quezada-Diaz, Julio García-Aguilar
Cirugía Española.2026; 104(1): 800248. CrossRef
Pathological Complete Response in Rectal Cancer Patients: A Correlation Between Pathological and Clinical Stage and Oncological Outcome
Ana Grigoraș, Dragoș-Viorel Scripcariu, Ionuț Huțanu, Bogdan Filip, Mihaela-Mădălina Gavrilescu, Maria-Gabriela Aniței, Gheorghe Bălan, Viorel Scripcariu
Cancers.2026; 18(2): 223. CrossRef
Clinical–Pathologic Response Discordance After Neoadjuvant Therapy in Rectal Cancer and Its Prognostic Implications
Aysun Arslantas Erken, Selvi Tabak Dincer
Asia-Pacific Journal of Clinical Oncology.2026;[Epub] CrossRef
Metformin as a Neoadjuvant to Chemotherapy in Locally Advanced and Metastatic Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Nada G. Hamam, Mahmoud Samir, Nereen A. Almosilhy, Mohamad Mahmoud Whdan, Omar A. Mohamed, Mohamed Mohsen Helal
Clinical Breast Cancer.2026; 26(9): 1. CrossRef
The Shifting and Evolving Neoadjuvant Treatments and Surgical Platforms on Oncological Outcomes and Sphincter Preservation in Distal Rectal Cancer: A 23-Year Retrospective Experience
Niyaz Shadmanov, Vusal Aliyev, Barıs Bakır, Suha Goksel, Oktar Asoglu
Journal of Gastrointestinal Cancer.2025;[Epub] CrossRef
Clinical implications of radiologic criteria and prognostic factors for lateral lymph node metastasis in low rectal cancer
Gyung Mo Son
Annals of Coloproctology.2025; 41(6): 489. CrossRef

Translational/basic research

The effect of tumor resection on intestinal microbiota dysbiosis in patients with right-sided colon cancer: Aldhimas Marthsyal Pratikna, M. Iqbal Rivai, Rini Suswita, Andani Eka Putra, Irwan Abdul Rachman, Avit Suchitra; Ann Coloproctol. 2025;41(1):47-56. Published online February 26, 2025; DOI: https://doi.org/10.3393/ac.2024.00346.0049

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Graphical Abstract Abstract PDF

Purpose
This study aimed to determine the effect of tumor resection on dysbiosis of the intestinal microbiota in patients with right-sided colon cancer.
Methods
This study utilized a longitudinal design to explore the outcomes of patients diagnosed with right-sided colon cancer who underwent surgical resection at Dr. M. Djamil General Hospital from July to December 2023. We excluded patients with a documented history of comorbidities, specifically those affecting the digestive system. To compare the microbiota (genus and phylum) between patients with right-sided colon cancer and the control group, we conducted bivariate analyses using the independent t-test or Mann-Whitney test. Furthermore, we employed the dependent t-test or Wilcoxon test to assess changes in the dysbiosis of the microbiota (genus and phylum) before and after resection. A P-value of <0.05 was considered statistically significant.
Results
This study included a total of 21 patients diagnosed with right-sided colon cancer. In the control group, Bacteroidetes constituted the highest proportion of intestinal microbiota, accounting for 56.34%. Prior to tumor resection, the intestinal microbiota of patients exhibited Proteobacteria as the predominant phylum, representing 52.97%. Following tumor resection, Bacteroidetes remained the most prevalent, comprising 50.9% of the intestinal microbiota. Significant variations in the levels of Proteobacteria, Verrucomicrobia, and Cyanobacteria/Chloroplast were observed in the intestinal microbiota of patients with right-sided colorectal cancer before and after tumor excision (all P=0.001).
Conclusion
The microbiome of patients with right-sided colorectal cancer differed significantly from that of the control group. However, following tumor resection, the microbiome composition of these patients became more similar to that observed in the control group.

Citations

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Dynamics of the microbiota in right-sided colon cancer patients: pre- and post-tumor resection
Youn Young Park
Annals of Coloproctology.2025; 41(1): 1. CrossRef
大腸癌周術期におけるONSのエビデンスと意義
岳史山田, 明久松田, 圭上原, 寛吉田
The Japanese Journal of SURGICAL METABOLISM and NUTRITION.2025; 59(4): 96. CrossRef

Colorectal cancer

Comparison of colorectal cancer surgery patients in intensive care between rural and metropolitan hospitals in Australia: a national cohort study: Jessica A. Paynter, Zakary Doherty, Chun Hin Angus Lee, Kirby R. Qin, Janelle Brennan, David Pilcher; Ann Coloproctol. 2025;41(1):68-76. Published online January 24, 2025; DOI: https://doi.org/10.3393/ac.2024.00269.0038

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Abstract PDF Supplementary Material

Purpose
A small proportion of colorectal cancer (CRC) surgical patients will require an admission to an intensive care unit (ICU) within the early postoperative period. This study aimed to compare the characteristics and outcomes of patients admitted to an ICU following CRC surgery per hospital type (metropolitan vs. rural) over a decade in Australia.
Methods
A retrospective cohort analysis was undertaken of all adult patients admitted to a participating Australian ICUs following CRC surgery between January 2011 and December 2021. The primary outcome was in-hospital mortality.
Results
Over the 10-year period, 19,611 patients were treated in 122 metropolitan ICUs and 4,108 patients were treated in 42 rural ICUs. Rural ICUs had a lower proportion of annual admissions following CRC surgery (20 vs. 36, P<0.001). Patients admitted to a rural ICU were more likely to have undergone emergency CRC surgery compared to those admitted to a metropolitan cohort (28.5% vs. 13.8%, P<0.001). There was no difference in in-hospital mortality between metropolitan and rural hospitals (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.73–1.35; P=0.500). There was a general trend for lower mortality in later years of the study with the odds of death in the final year of the study (2021) almost half that of the first study year (OR, 0.52; 95% CI, 0.34–0.80; P=0.003).
Conclusion
There was no difference between in-hospital mortality outcomes for CRC surgical patients requiring ICU admission between metropolitan and rural hospitals. These findings may contribute to discussions regarding rural scope of colorectal practice within Australia and globally.

Citations

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Impact of geographical location on ICU outcomes in adults: a scoping review
Jacob Zand, Nattaya Raykateeraroj, Je Min Suh, Carl Reyneke, Anoop N Koshy, Benjamin Cailes, Dong-Kyu Lee, Laurence Weinberg
BMJ Open.2026; 16(7): e114956. CrossRef
Intensive care unit outcomes and prognostic factors of colorectal cancer
Qian Dong, Rui Xia, Xue-Zhong Xing, Chang-Song Wang, Gang Ma, Hong-Zhi Wang, Biao Zhu, Jiang-Hong Zhao, Dong-Min Zhou, Li Zhang, Ming-Guang Huang, Rong-Xi Quan, Yong Ye, Guo-Xing Zhang, Zheng-Ying Jiang, Bing Huang, Shan-Ling Xu, Yun Xiao, Lin-Lin Zhang,
World Journal of Gastrointestinal Oncology.2025;[Epub] CrossRef

Minimally invasive surgery

Robotic surgery may lead to reduced postoperative inflammatory stress in colon cancer: a propensity score–matched analysis: Eun Ji Park, Gyong Tae Noh, Yong Joon Lee, Min Young Park, Seung Yoon Yang, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Kang Young Lee, Byung Soh Min; Ann Coloproctol. 2024;40(6):594-601. Published online December 6, 2024; DOI: https://doi.org/10.3393/ac.2024.00171.0024

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Abstract PDF Supplementary Material

Purpose
Robot-assisted surgery is readily applied to every type of colorectal surgeries. However, studies showing the safety and feasibility of robotic surgery (RS) have dealt with rectal cancer more than colon cancer. This study aimed to investigate how technical advantages of RS can translate into actual clinical outcomes that represent postoperative systemic response.
Methods
This study retrospectively reviewed consecutive cases in a single tertiary medical center in Korea. Patients with primary colon cancer who underwent curative resection between 2006 and 2012 were included. Propensity score matching was done to adjust baseline patient characteristics (age, sex, body mass index, American Society of Anesthesiologists physical status, tumor profile, pathologic stage, operating surgeon, surgery extent) between open surgery (OS), laparoscopic surgery (LS), and RS groups.
Results
After propensity score matching, there were 66 patients in each group for analysis, and there was no significant differences in baseline patient characteristics. Maximal postoperative leukocyte count was lowest in the RS group and highest in the OS group (P=0.021). Similar results were observed for postoperative neutrophil count (P=0.024). Postoperative prognostic nutritional index was highest in the RS group and lowest in the OS group (P<0.001). The time taken to first flatus and soft diet resumption was longest in the OS group and shortest in the RS group (P=0.001 and P<0.001, respectively). Among all groups, other short-term postoperative outcomes such as hospital stay and complications did not show significant difference, and oncological survival results were similar.
Conclusion
Better postoperative inflammatory indices in the RS group may correlate with their faster recovery of bowel motility and diet resumption compared to LS and OS groups.

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Laparoscopic surgery should be a viable option for T4 colon cancer: evidence from a propensity score matching analysis
Xiaomei Jiang, Hang Zhou, Zhaoyang Zheng, Xiaodong Wang, Zongguang Zhou, Lie Yang
Updates in Surgery.2026; 78(2): 591. CrossRef
Open, Laparoscopic, and robotic approaches in colorectal surgery: a comprehensive review with focus on colorectal cancer
Farhad Shafiei, Fatemeh Kani, Nargess Porkar, Maede Mirzaee, Fatemeh Heidarzadeh, Mahdi Kolivand, Soheila Behdad, Amir Shokri
Journal of Robotic Surgery.2026;[Epub] CrossRef
Impact of Preoperative Neutrophil Percentage-to-Albumin Ratio (NPAR) on Short-Term Complications and Long-Term Prognosis in Patients Undergoing Robot-Assisted Laparoscopic Radical Surgery for Colorectal Cancer
Jing Wang, Tao Hu, Nanhui Yu
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef
Learning curve for Da Vinci Single-Port robotic colorectal cancer surgery: impact of prior robotic experience
Soo Young Lee, Chang Hyun Kim, Jaram Lee, Hyeung-min Park, Hyeong Rok Kim
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Systemic inflammatory response after robotic versus laparoscopic abdominal surgery: a systematic review and meta-analysis with colorectal cancer subgroup analysis
Taya Keating, C. Drumm, Niall Kennedy, C. Cullinane, E. Condon, M. Fitzgerald, C. Peirce, J. Calvin Coffey, Christina A. Fleming
Journal of Robotic Surgery.2026;[Epub] CrossRef
Short-term outcomes of robotic versus laparoscopic surgery for colon cancer: A multicenter propensity score-matched study
Tetsuro Tominaga, Shintaro Hashimoto, Toshio Shiraishi, Koki Wakata, Masato Nishimuta, Masaki Utsugi, Hidetoshi Fukuoka, Mitsutoshi Ishii, Keisuke Noda, Kaido Oishi, Koya Taguchi, Shosaburo Oyama, Ayano Inao, Takashi Nonaka, Keitaro Matsumoto
Surgery Today.2026;[Epub] CrossRef
Übergangsphase zur roboterassistierten Chirurgie beim kolorektalen Karzinom: eine vergleichende konsekutive Kohortenstudie
U. A. Dietz, M. Kalisvaart, S. Maksimovic, R. Frey, M. Ramser, B. M. Erhart, U. Pfefferkorn
Die Chirurgie.2025; 96(11): 942. CrossRef
Comparative clinical efficacy of three surgical modalities for the treatment of malignant tumours of the left hemicolon
Hao Chen, Dong-Ping Han, Jian-Yang Xiong, Zhen-Sheng Li, Teng-Cheng Hu, Zheng-Rong Li, Yi Cao
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Comparison of the perioperative outcomes of robotic vs. open distal pancreatectomy: a meta-analysis of propensity-score-matched studies
Junjie Wang, Yuanjun Liu, Yakun Wu
Frontiers in Surgery.2025;[Epub] CrossRef
Effectiveness of Guardix-SG in Preventing Postoperative Bowel Complications After Radical Cystectomy: A Single-Arm Prospective Observational Study
Jiwoong Yu, Wan Song, Minyong Kang, Hyun Hwan Sung, Hwang Gyun Jeon, Seong Il Seo, Seong Soo Jeon, Byong Chang Jeong
Journal of Urologic Oncology.2025; 23(3): 253. CrossRef

Minimally invasive surgery

New double-stapling technique without staple-crossing line in laparoscopic low anterior resection: effort to reduce anastomotic leakage: Nam Seok Kim, Ji Hoon Kim, Yoon Suk Lee, In Kyu Lee, Won Kyung Kang; Ann Coloproctol. 2024;40(6):573-579. Published online November 22, 2024; DOI: https://doi.org/10.3393/ac.2022.00409.0058

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Graphical Abstract Abstract PDF

Purpose
This study aimed to demonstrate the safety of new double-stapling technique (nDST), without a crossing line and dog ears, by comparing with conventional DST (cDST) in laparoscopic low anterior resection (LAR).
Methods
We retrospectively reviewed 98 consecutive patients who underwent laparoscopic LAR for rectal cancer from January 2018 to December 2020. The inclusion criterion was an anastomosis level below the peritoneal reflection and 4 cm above the anal verge. In the nDST group, the staple line of the linear cutter was sutured using barbed sutures to shorten the staple line before firing the circular stapler. Therefore, there were no crossing lines after firing the circular stapler. A 2:1 propensity score matching was performed between the cDST and nDST groups.
Results
After propensity score matching, 39 patients were in the cDST group and 20 were in the nDST group. There were no significant differences in patient demographics between the 2 groups. There was no difference in the total operation time between the cDST and nDST groups (124.0±26.2 minutes vs. 125.2±20.3 minutes, P=0.853). Morbidity rates were similar between the 2 groups (9 cases [23.1%] vs. 5 cases [25.0%], P=0.855). There was no significant difference in leakage rate (4 cases [10.3%] vs. 1 case [5.0%], P=0.847) and anastomotic bleeding rate (1 case [2.6%] vs. 3 cases [15.0%], P=0.211).
Conclusion
The nDST to eliminate the crossing line and dog ears in laparoscopic LAR is technically feasible and safe. However, more attention should be paid to anastomotic bleeding in such cases.

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Impact of circular stapler size on anastomotic complications after low colorectal anastomosis: a systematic review and meta-analysis
Maria C. STYLIANDI, Sascha VAGHIRI, Alireza PANDKHAHI, Alireza GHAFOURIANSAMEDANIMASHHAD, Irina DAVLETOVA, Ali M. KARIMI, Ali ALIPOURIANI, Andrea ALEXANDER, Hermann KESSLER, Wolfram T. KNOEFEL, Dimitrios PRASSAS
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Sentilnathan Subramaniam, Michele Carvello, Jin-Jiun Mah, Davide Cuneo, Giorgia Gualtieri, Antonino Spinelli
Clinics in Colon and Rectal Surgery.2026;[Epub] CrossRef
Retrospective Analysis Study of Modified Bacon Procedure and Double Stapling Technique in Low Rectal Cancer Surgery
Xiaojun Tian, Tao Jiang, Yuehua Lei, Chen Zhang
The American Surgeon™.2026;[Epub] CrossRef
The robotic intracorporeal single-stapled anastomosis (RiSSA) technique in robotic left-sided colorectal resection: a technical note
Chih-Chien Wu, Yung-Lin Tan, Chao-Wen Hsu, Hsin-Ping Tseng, Danilo Miskovic, Shih-Feng Huang
Annals of Coloproctology.2025; 41(4): 357. CrossRef
Comparative perioperative outcomes of articulated versus conventional straight devices in laparoscopic low anterior resection: a propensity score–matched analysis
Hayoung Lee, Yong Sik Yoon, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim
Annals of Coloproctology.2025; 41(5): 434. CrossRef

Colorectal cancer

Preventive efficacy of hydrocortisone enema for radiation proctitis in rectal cancer patients undergoing short-course radiotherapy: a phase II randomized placebo-controlled clinical trial: Mohammad Mohammadianpanah, Maryam Tazang, Nam Phong Nguyen, Niloofar Ahmadloo, Shapour Omidvari, Ahmad Mosalaei, Mansour Ansari, Hamid Nasrollahi, Behnam Kadkhodaei, Nezhat Khanjani, Seyed Vahid Hosseini; Ann Coloproctol. 2024;40(5):506-514. Published online October 22, 2024; DOI: https://doi.org/10.3393/ac.2024.00192.0027

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Abstract PDF

Purpose
This study aimed to investigate the efficacy of hydrocortisone enema in preventing radiation proctitis in patients with rectal cancer undergoing short-course radiotherapy (SCRT).
Methods
This phase II randomized controlled trial enrolled patients with newly diagnosed locally advanced rectal cancer (clinically staged T3–4 and/or N1–2M0). Participants received a median of 4 cycles of neoadjuvant chemotherapy (capecitabine plus oxaliplatin) followed by 3-dimensional conformal SCRT (25 Gy in 5 fractions). Patients were randomly assigned to receive either a hydrocortisone enema (n=50) or a placebo (n=51) once daily for 5 consecutive days during SCRT. The primary endpoint was the incidence and severity of acute proctitis.
Results
Of the 111 eligible patients, 101 were included in the study. Baseline characteristics, including sex, age, performance status, and tumor location, were comparable across the treatment arms. None of the patients experienced grade 4 acute gastrointestinal toxicity or had to discontinue treatment due to treatment-related adverse effects. Patients in the hydrocortisone arm experienced significantly less severe proctitis (P<0.001), diarrhea (P=0.023), and rectal pain (P<0.001) than those in the placebo arm. Additionally, the duration of acute gastrointestinal toxicity following SCRT was significantly shorter in patients receiving hydrocortisone (P<0.001).
Conclusion
Hydrocortisone enema was associated with a significant reduction in the severity of proctitis, diarrhea, and rectal pain compared to placebo. Additionally, patients treated with hydrocortisone experienced shorter durations of gastrointestinal toxicity following SCRT. This study highlights the potential benefits of hydrocortisone enema in managing radiation-induced toxicity in rectal cancer patients undergoing radiotherapy.

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Fatmanur Tuğcu-Demiröz, Sinem Saar, Ayşegül Yıldız, Emine Yıldırım, Recep Uyar, Yağmur Turgut-Birer, Begüm Yurdakok-Dikmen, Füsun Acartürk
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Cancers.2024; 16(24): 4280. CrossRef

Complication

Early warning model to detect anastomotic leakage following colon surgery: a clinical observational study: Pooya Rajabaleyan, Ravish Jootun, Sören Möller, Ulrik Deding, Mark Bremholm Ellebæk, Issam al-Najami, Ian Lindsey; Ann Coloproctol. 2024;40(5):431-439. Published online October 8, 2024; DOI: https://doi.org/10.3393/ac.2023.00745.0106

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Graphical Abstract Abstract PDF

Purpose
We aimed to develop a predictive tool for anastomotic leakage (AL) following colon cancer surgery by combining a clinical early warning score (EWS) with the C-reactive protein (CRP) level.
Methods
The records of 1,855 patients who underwent colon cancer surgery at the Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018, with or without AL, were retrospectively reviewed. EWS and CRP levels were assessed daily from the first postoperative day until discharge. AL was defined as an anastomotic defect observed at reoperation, the presence of feculent fluid in a pelvic drain, or evidence of AL on computed tomography. The tool incorporated postoperative EWS and CRP levels for the accurate early detection of AL.
Results
From postoperative days 3 to 7, the mean CRP level exceeded 200 mg/L in patients with AL and was under 200 mg/L in those without AL (P<0.05). From postoperative days 1 to 5, the mean EWS among patients with leakage exceeded 2, while scores were below 2 among those without leakage (P<0.05). Receiver operating characteristic curve analysis identified postoperative day 3 as the most predictive of early leakage, with cutoff values of 2.4 for EWS and 180 mg/L for CRP; this yielded an area under the curve of 0.87 (sensitivity, 90%; specificity, 70%).
Conclusion
We propose using an EWS of 2.4 and a CRP level of 180 mg/L on postoperative day 3 following colon surgery with anastomosis as threshold values to prompt investigation and treatment of AL.

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The Clinical Presentation of Anastomotic Leakage Compared Between CRS-HIPEC and Conventional Colorectal Surgery
M. Cats, L. G. Magermans, E. C. E. Wassenaar, A. A. W. van Geloven, M. J. Wiezer, J. D. J. Plate, D. Boerma
Annals of Surgical Oncology.2026; 33(2): 1706. CrossRef
Anastomotic leak in colorectal surgery: Current evidence on risk, diagnosis, preventive measures and management
Ali Akbar Shah, Gevorg Manoukian, Omar Yasin, Amy Jacob, Timothy M. Kopah, Jas Simran Gill, Ruthel Rose, Bashayer Khaled Alharbi, Sana Zafar
Surgical Practice.2026;[Epub] CrossRef
Unplanned intensive care unit admission after elective colon cancer resection: population-based registry study
Sofia Dahlberg, Tomas Vedin, Ingvar Syk, Emma Larsson, Niklas Nielsen, Henrik Bergenfeldt
BJS Open.2026;[Epub] CrossRef
Late Anastomotic Leakage After Rectal Cancer Surgery: Incidence and Differential Risk Factors
Hyeon Kyeong Kim, In Ja Park, Jae Cheol Kang, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim
Diseases of the Colon & Rectum.2026; 69(4): 565. CrossRef
Risk factor analysis and nomogram model development for anastomotic leakage following laparoscopic radical colorectal cancer surgery
Zi-Hong He, Yang-Yang Zhou, Ruo-Nan Zhang, Yu-Shen He, Yan-Hong Jin, Fu-Hao Tian
World Journal of Surgical Oncology.2026;[Epub] CrossRef
Enhancing anastomosis safety with intraoperative perfusion assessment: a visual grading system for tailoring resection and ostomy formation in sigmoid colon and rectal cancer surgery
Soo Young Oh, Seok-Byung Lim, Eu-Tteum Choi, Min Hyun Kim, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, In Ja Park, Chang Sik Yu
Annals of Coloproctology.2026; 42(3): 303. CrossRef
Prevention and management of anastomotic leakage after colorectal resection: evolving trends among Italian surgeons. A SICCR survey
Renato Costi, Alfredo Annicchiarico, Antonio Amato, Cristina Folliero, Claudio Guerci, Alessandro Facchinetti, Filippo Montali, Adolfo Petrina, Agnese Dezi, Agostino Falcone, Agostino Fernicola, Alba Oliva, Alberto Buonanno, Alberto Porcu, Alberto Servent
Updates in Surgery.2026;[Epub] CrossRef
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Cameron I. Wells, Wal Baraza, Greg O'Grady, Ian P. Bissett
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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
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Wahidullah Dost, Mohammad Qaher Rasully , Mohammad Nazir Zaman, Wahida Dost, Wahida Ali, Sami A Ayobi, Raisa Dost, Jamaluddin Niazi, Kinza Bakht, Asma Iqbal, Syed Faqeer Hussain Bokhari
Cureus.2024;[Epub] CrossRef

ERAS

Impact of an Enhanced Recovery After Surgery (ERAS) program on the management of complications after laparoscopic or robotic colectomy for cancer: Victoria Weets, Hélène Meillat, Jacques Emmanuel Saadoun, Marie Dazza, Cécile de Chaisemartin, Bernard Lelong; Ann Coloproctol. 2024;40(5):440-450. Published online September 20, 2024; DOI: https://doi.org/10.3393/ac.2023.00850.0121

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
Enhanced Recovery After Surgery (ERAS) reduces postoperative complications (POCs) after colorectal surgery; however, its impact on the management of POCs remains unclear. This study compared the diagnosis and management of POCs before and after implementing our ERAS protocol after laparoscopic or robotic colectomy for cancer and examined the short- and mid-term oncologic impacts.
Methods
This single-center, retrospective study evaluated all consecutive patients who underwent laparoscopic or robotic colectomy for cancer between 2012 and 2021, focusing on the incidence of POCs within 90 days. We compared outcomes before (standard group) and after (ERAS group) the implementation of our ERAS protocol in January 2016.
Results
Significantly fewer patients in the ERAS group developed POCs (standard vs. ERAS, 136 of 380 patients [35.8%] vs.136 of 660 patients [20.6%]; P<0.01). The ERAS group had a significantly shorter mean total length of stay after POCs (13.1 days vs. 11.4 days, P=0.04), and the rates of life-threatening complications (6.7% vs. 0.7%) and 1-year mortality (7.4% vs. 1.5%) were significantly lower in the ERAS group than in the standard group. Among patients with anastomotic complications, laparoscopic reoperation was significantly more common in the ERAS group than in the standard group (8.3% vs. 75.0%, P<0.01). Among patients with postoperative ileus, the diagnosis and recovery times were significantly shorter in the ERAS group than in the standard group, resulting in a shorter total length of stay (13.5 days vs. 10 days, P<0.01).
Conclusion
The implementation of an ERAS protocol did not eliminate all POCs, but it did accelerate their diagnosis and management and improved patient outcomes.

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The ultrasonographic measure of postoperative day 2 gastric volume may be a useful tool to improve the management of colorectal surgery patients: results of an ancillary study
Aurélien Venara, Anita Paisant, Julien Gillet, Lise Morgado, Emeline Rebmann, Jean-Francois Hamel
International Journal of Colorectal Disease.2026;[Epub] CrossRef
Perioperative impact of enhanced recovery after surgery (ERAS) for minimally invasive colorectal resection: a systematic review and meta-analysis
Kaiming Wen, Haoyang Wu, Bo-Wen Wu
Journal of Robotic Surgery.2026;[Epub] CrossRef
A cost comparison between patients undergoing robotic colorectal surgery with and without a clinical pathway
Alfonso Valenzuela Hurtado, Onur Bayram, Jörg Kleeff, Johannes Klose, Manuela De Allegri, Ulrich Ronellenfitsch
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Lymphopenia and C-reactive protein elevation on postoperative day 2 are independent risk factors for occurrence of major and minor complications in elective colorectal cancer surgery
Minsuh Park, Kyung Jong Kim, Young-hun Kim
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In Ja Park
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Ahmed Abdelsamad, Seyidali Mirzazada, Karsten Ridwelski, Mohamad Nour Nasif, Florian Gebauer
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Colorectal cancer

The impact of short-course total neoadjuvant therapy, long-course chemoradiotherapy, and upfront surgery on the technical difficulty of total mesorectal excision: an observational study with an intraoperative perspective: Cheryl Xi-Zi Chong, Frederick H. Koh, Hui-Lin Tan, Sharmini Su Sivarajah, Jia-Lin Ng, Leonard Ming-Li Ho, Darius Kang-Lie Aw, Wen-Hsin Koo, Shuting Han, Si-Lin Koo, Connie Siew-Poh Yip, Fu-Qiang Wang, Fung-Joon Foo, Winson Jianhong Tan; Ann Coloproctol. 2024;40(5):451-458. Published online September 19, 2024; DOI: https://doi.org/10.3393/ac.2023.00899.0128

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Purpose
Total neoadjuvant therapy (TNT) is becoming the standard of care for locally advanced rectal cancer. However, surgery is deferred for months after completion, which may lead to fibrosis and increased surgical difficulty. The aim of this study was to assess whether TNT (TNT-RAPIDO) is associated with increased difficulty of total mesorectal excision (TME) compared with long-course chemoradiotherapy (LCRT) and upfront surgery.
Methods
Twelve laparoscopic videos of low anterior resection with TME for rectal cancer were prospectively collected from January 2020 to October 2021, with 4 videos in each arm. Seven colorectal surgeons assessed the videos independently, graded the difficulty of TME using a visual analog scale and attempted to identify which category the videos belonged to.
Results
The median age was 67 years, and 10 patients were male. The median interval to surgery from radiotherapy was 13 weeks in the LCRT group and 24 weeks in the TNT-RAPIDO group. There was no significant difference in the visual analog scale for difficulty in TME between the 3 groups (LCRT, 3.2; TNT-RAPIDO, 4.6; upfront, 4.1; P=0.12). A subgroup analysis showed similar difficulty between groups (LCRT 3.2 vs. TNT-RAPIDO 4.6, P=0.05; TNT-RAPIDO 4.6 vs. upfront 4.1, P=0.54). During video assessments, surgeons correctly identified the prior treatment modality in 42% of the cases. TNT-RAPIDO videos had the highest recognition rate (71%), significantly outperforming both LCRT (29%) and upfront surgery (25%, P=0.01).
Conclusion
TNT does not appear to increase the surgical difficulty of TME.

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Xiyin Yang, Yuanshui Sun, Qiang Hu
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Aikaterini Sarafi, Aikaterini Leventi, Klaountia Athitaki, Konstantinos Stamou, Ioannis Papaconstantinou, Dimitrios Korkolis
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In Ja Park
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Clinical implications of radiologic criteria and prognostic factors for lateral lymph node metastasis in low rectal cancer
Gyung Mo Son
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Cancers.2024; 16(24): 4280. CrossRef

Reviews

Colorectal cancer

The role of lateral pelvic lymph node dissection in advanced rectal cancer: a review of current evidence and outcomes: Gyu-Seog Choi, Hye Jin Kim; Ann Coloproctol. 2024;40(4):363-374. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00521.0074

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Abstract PDF

Metastatic lateral pelvic lymph nodes (LPNs) in rectal cancer significantly impact the prognosis and treatment strategies. Western practices emphasize neoadjuvant chemoradiotherapy (CRT), whereas Eastern approaches often rely on LPN dissection (LPND). This review examines the evolving role of LPND in the context of modern treatments, including total neoadjuvant therapy (TNT), and the impact of CRT on the management of clinically suspicious LPNs. We comprehensively reviewed the key literature comparing the outcomes of LPND versus preoperative CRT for rectal cancer, focusing on recent advancements and ongoing debates. Key studies, including the JCOG0212 trial and recent multicenter trials, were analyzed to assess the efficacy of LPND, particularly in conjunction with preoperative CRT or TNT. Current evidence indicates that LPND can reduce local recurrence rates compared to total mesorectal excision alone in patients not receiving radiation therapy. However, the benefit of LPND in the context of neoadjuvant CRT is influenced by the size and pretreatment characteristics of LPNs. While CRT can effectively control smaller metastatic LPNs, larger or clinically suspicious LPNs may require LPND for optimal outcomes. Advances in surgical techniques, such as robotic-assisted LPND, offer potential benefits but also present challenges and complications. The role of TNT in controlling metastatic LPNs and improving patient outcomes is emerging but remains underexplored. The decision to perform LPND should be individualized based on patient-specific factors, including LPN size, response to neoadjuvant treatment, and surgeon expertise. Future research should focus on optimizing treatment protocols and further evaluating the role of TNT in managing metastatic LPNs.

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Blas Flor-Lorente, Mario Javier de Miguel Valencia
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Blas Flor-Lorente, Mario J. de Miguel-Valencia
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Cancer-associated fibroblasts enhance colorectal cancer lymphatic metastasis via CLEC11A/LGR5-mediated WNT pathway activation
Chuhan Zhang, Teng Pan, Yuyuan Zhang, Yushuai Wu, Anning Zuo, Shutong Liu, Yuhao Ba, Benyu Liu, Shuaixi Yang, Yukang Chen, Hui Xu, Peng Luo, Quan Cheng, Siyuan Weng, Long Liu, Xing Zhou, Jingyuan Ning, Xinwei Han, Jinhai Deng, Zaoqu Liu
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D. Kehagias, L. Baldari, E. Cassinotti, L. Boni, C. Lampropoulos, I. Kehagias
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Asim M. Almughamsi, Yasir Hassan Elhassan
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Gyung Mo Son
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Colorectal cancer

Essential knowledge and technical tips for total mesorectal excision and related procedures for rectal cancer: Min Soo Cho, Hyeon Woo Bae, Nam Kyu Kim; Ann Coloproctol. 2024;40(4):384-411. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00388.0055

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Abstract PDF

Total mesorectal excision (TME) has greatly improved rectal cancer surgery outcomes by reducing local recurrence and enhancing patient survival. This review outlines essential knowledge and techniques for performing TME. TME emphasizes the complete resection of the mesorectum along embryologic planes to minimize recurrence. Key anatomical insights include understanding the rectal proper fascia, Denonvilliers fascia, rectosacral fascia, and the pelvic autonomic nerves. Technical tips cover a step-by-step approach to pelvic dissection, the Gate approach, and tailored excision of Denonvilliers fascia, focusing on preserving pelvic autonomic nerves and ensuring negative circumferential resection margins. In Korea, TME has led to significant improvements in local recurrence rates and survival with well-adopted multidisciplinary approaches. Surgical techniques of TME have been optimized and standardized over several decades in Korea, and minimally invasive surgery for TME has been rapidly and successfully adopted. The review emphasizes the need for continuous research on tumor biology and precise surgical techniques to further improve rectal cancer management. The ultimate goal of TME is to achieve curative resection and function preservation, thereby enhancing the patient’s quality of life. Accurate TME, multidisciplinary-based neoadjuvant therapy, refined sphincter-preserving techniques, and ongoing tumor research are essential for optimal treatment outcomes.

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Original Article

Colorectal cancer

Lymphovascular invasion in colorectal cancers: can we predict it preoperatively?: Elbrus Zarbaliyev, Nihan Turhan, Sebahattin Çelik, Mehmet Çağlıkülekçi; Ann Coloproctol. 2024;40(3):245-252. Published online June 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00458.0065

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Abstract PDF

Purpose
This study aimed to investigate preoperative predictors of lymphovascular invasion (LVI), which is a poor prognostic factor usually detected postoperatively in patients with colorectal cancer.
Methods
Results for all patients operated on for colorectal cancer between January 1, 2006, and December 31, 2021, were retrospectively analyzed. Potential preoperative factors and postoperative pathology results were recorded. The patients were categorized as those with LVI and those without LVI. Potential factors that may be associated with LVI were compared between the 2 groups.
Results
The study included 335 patients. The incidence of LVI was 3.11 times higher in patients with ascending colon tumors (odds ratio [OR], 3.11; 95% confidence interval [CI], 1.34–7.23; P=0.008) and 4.28 times higher in those with metastatic tumors (OR, 4.28; 95% CI, 2.18–8.39; P<0.001). Diabetes mellitus was inversely related to LVI in colorectal cancer patients; specifically, LVI was 56% less common in colorectal cancer patients with diabetes mellitus, irrespective of its duration (OR, 0.44; 95% CI, 0.25–0.76; P<0.001).
Conclusion
The presence of preoperative LVI in colorectal cancer patients is difficult to predict. In particular, the effect of the effect of factors such as chronic disease accompanied by microvascular pathologies on LVI is still unclear. Advances in the neoadjuvant treatment of colorectal cancer patients, who are becoming more widespread every day, will encourage the investigation of different methods of preoperatively predicting LVI as a poor prognostic factor in these patients.

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Review

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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Abstract PDF Supplementary Material

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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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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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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Watch and wait in early onset rectal cancer patients: A review of the literature
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Original Articles

Colorectal cancer

Impact of consolidation chemotherapy in poor responders to neoadjuvant radiation therapy: magnetic resonance imaging–based clinical-radiological correlation in high-risk rectal cancers: Swapnil Patel, Suman Ankathi, Purvi Haria, Mufaddal Kazi, Ashwin L. Desouza, Avanish Saklani; Ann Coloproctol. 2023;39(6):474-483. Published online December 21, 2023; DOI: https://doi.org/10.3393/ac.2023.00080.0011

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Abstract PDF

Purpose
The current study was conducted to examine the role of consolidation chemotherapy after neoadjuvant radiation therapy (NART) in decreasing the involvement of the mesorectal fascia (MRF) in high-risk locally advanced rectal cancers (LARCs).
Methods
In total, 46 patients who received consolidation chemotherapy after NART due to persistent MRF involvement were identified from a database. A team of 2 radiologists, blinded to the clinical data, studied sequential magnetic resonance imaging (MRI) scans to assess the tumor response and then predict a surgical plan. This prediction was then correlated with the actual procedure conducted as well as histopathological details to assess the impact of consolidation chemotherapy.
Results
The comparison of MRI-based parameters of sequential images showed significant downstaging of T2 signal intensity, tumor height, MRF involvement, diffusion restriction, and N category between sequential MRIs (P < 0.05). However, clinically relevant downstaging (standardized mean difference, > 0.3) was observed for only T2 signal intensity and diffusion restriction on diffusion-weighted imaging. No clinically relevant changes occurred in the remaining parameters; thus, no change was noted in the extent of surgery predicted by MRI. Weak agreement (Cohen κ coefficient, 0.375) and correlation (Spearman rank coefficient, 0.231) were found between MRI-predicted surgery and the actual procedure performed. The comparison of MRI-based and pathological tumor response grading also showed a poor correlation.
Conclusion
Evidence is lacking regarding the use of consolidation chemotherapy in reducing MRF involvement in LARCs. The benefit of additional chemotherapy after NART in decreasing the extent of planned surgery by reducing margin involvement requires prospective research.

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Tan Jih Huei, Emile John Tan Kwong Wei
Annals of Coloproctology.2026; 42(2): 256. CrossRef
Survival benefit of adjuvant chemotherapy in high-risk patients with colon cancer regardless of microsatellite instability
Sung Uk Bae, Jong Lyul Lee, Chun-Seok Yang, Eun Jung Park, Soo Yeun Park, Chang Woo Kim, Woong Bae Ji, Gyung Mo Son, Yoon Dae Han, So Hyun Kim, Min Sung Kim, Youn Young Park, Kyung Ha Lee, Chang Hyun Kim, Gi Won Ha, JaeIm Lee, Kyeong Eui Kim, Woon Kyung J
European Journal of Surgical Oncology.2025; 51(6): 109674. CrossRef
Non-operative management of locally advanced rectal cancer with an emphasis on outcomes and quality of life: a narrative review
In Ja Park
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The conundrum of total neoadjuvant therapy in rectal cancer
Devesh S. Ballal, Tejas P. Vispute, Avanish P. Saklani
Colorectal Disease.2024; 26(5): 1068. CrossRef

Colorectal cancer

Public effect of the 2022 Colorectal Cancer Awareness Campaign delivered through a metaverse platform: Tae-Gyun Lee, Gil-Hyeon Song, Hong-min Ahn, Heung-Kwon Oh, Moonkyoung Byun, Eon Chul Han, Sohyun Kim, Chang Woo Kim, Hye Jin Kim, Samin Hong, Kee-Ho Song, Chan Wook Kim, Yong Beom Cho, on behalf of the Public Relations Committee of the Korean Society of Coloproctology (KSCP); Ann Coloproctol. 2024;40(2):145-153. Published online April 28, 2023; DOI: https://doi.org/10.3393/ac.2023.00122.0017

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Graphical Abstract Abstract PDF

Purpose
The Korean Society of Coloproctology has been conducting Colorectal Cancer Awareness Campaign, also known as the Gold Ribbon Campaign, every September since 2007. The 2022 campaign was held through a metaverse platform targeting the younger age group under the slogan of raising awareness of early-onset colorectal cancer (CRC). This study aimed to analyze the impact of the 2022 campaign on a metaverse platform.
Methods
Anonymized survey data were collected from participants in the metaverse campaign from September 1 to 15, 2022. The satisfaction score of the participants was evaluated by sex, age group, and previous campaign participation status.
Results
During the campaign, 2,770 people visited the metaverse. Among them, 455 people participated in the survey (response rate, 16.4%). Approximately 95% of the participants reported being satisfied with the information provided by the campaign, understood the necessity of undergoing screening for and prevention of early-onset CRC, and were familiar with the structure of the metaverse. The satisfaction score for campaign information tended to decrease as the participants’ age increased. When the participants’ overall level of satisfaction with the metaverse platform was assessed, teenagers scored particularly lower than the other age groups. The satisfaction scores for CRC information provided in the metaverse, as well as the scores for recognizing the seriousness and necessity of screening for early-onset CRC, indicated a high positive tendency (P<0.001).
Conclusion
Most of the 2022 Gold Ribbon Campaign participants were satisfied with the metaverse platform. Medical society should pay attention to increasing participation in and satisfaction with future public campaigns.

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Drew Goldberg, Erica Pettke
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Walter Rodrigues Marques, Maria Neuraildes Gomes Viana, Anderson Boás Viana, Luís Claúdio Azevedo Gomes, Francilene Silva Cruz, Bruna Monique Cunha Rodrigues, Andréa Luísa Frazão Silva, Regeanne Santos Guaianaz, Daiane Leite Chaves Bezerra, Diêgo Jorge Lo
Caderno Pedagógico.2024; 21(13): e12984. CrossRef

Case Report

Colorectal cancer

Neuroendocrine carcinoma associated with chronic ulcerative colitis: a case report and review of the literature: Yumi Yokota, Hiroyuki Anzai, Yuzo Nagai, Hirofumi Sonoda, Takahide Shinagawa, Yuichiro Yoshioka, Shinya Abe, Yuichiro Yokoyama, Hiroyuki Matsuzaki, Shigenobu Emoto, Koji Murono, Kazuhito Sasaki, Hiroaki Nozawa, Tetsuo Ushiku, Soichiro Ishihara; Ann Coloproctol. 2024;40(Suppl 1):S32-S37. Published online April 19, 2023; DOI: https://doi.org/10.3393/ac.2022.00801.0114

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Abstract PDF

Adenocarcinoma is a common histological type of ulcerative colitis-associated cancer (UCAC), whereas neuroendocrine carcinoma (NEC) is extremely rare. UCAC is generally diagnosed at an advanced stage, even with regular surveillance colonoscopy. A 41-year-old man with a 17-year history of UC began receiving surveillance colonoscopy at the age of 37 years; 2 years later, dysplasia was detected in the sigmoid colon, and he underwent colonoscopy every 3 to 6 months. Approximately 1.5 years thereafter, a flat adenocarcinoma lesion occurred in the rectum. Flat lesions with high-grade dysplasia were found in the sigmoid colon and surrounding area. The patient underwent laparoscopic total proctocolectomy and ileal pouch-anal anastomosis with ileostomy. Adenocarcinoma was diagnosed in the sigmoid colon and NEC in the rectum. One year postoperation, recurrence or metastasis was not evident. Regular surveillance colonoscopy is important in patients with long-term UC. A histological examination of UCAC might demonstrate NEC.

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Depressed lesion detected during surveillance colonoscopy in a patient with ulcerative colitis
Keijiro Numa, Kazuki Kakimoto, Noboru Mizuta, Naohiko Kinoshita, Kei Nakazawa, Ryoji Koshiba, Yuki Hirata, Ken Kawakami, Takako Miyazaki, Shiro Nakamura, Hiroki Nishikawa
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Original Articles

Stoma

Benefits and risks of diverting stoma creation during rectal cancer surgery: Masaya Kawai, Kazuhiro Sakamoto, Kumpei Honjo, Yu Okazawa, Rina Takahashi, Shingo Kawano, Shinya Munakata, Kiichi Sugimoto, Shun Ishiyama, Makoto Takahashi, Yutaka Kojima, Yuichi Tomiki; Ann Coloproctol. 2024;40(5):467-473. Published online December 5, 2022; DOI: https://doi.org/10.3393/ac.2022.00353.0050

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11 Citations

Abstract PDF

Purpose
A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer.
Methods
We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared.
Results
The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group.
Conclusion
Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

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Yi Cao, Ahao Wu, Zhouqiao Wu, Su Yan, Changqing Jing, Fenglin Liu, Jian Zhang, Lu Zang, Hankun Hao, Yong Li, Lin Fan, Pin Liang, Bin Wu, Jiaming Zhu, Zhaojian Niu, Linghua Zhu, Wu Song, Jun You, Qingwen Zeng, Jiafu Ji, Ziyu Li, Zhengrong Li
International Journal of Surgery.2026; 112(4): 9680. CrossRef
Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer
Hirotaka Momose, Makoto Takahashi, Masaya Kawai, Kiichi Sugimoto, Hiromitsu Takahashi, Shunsuke Motegi, Kumpei Honjo, Yu Okazawa, Rina Takahashi, Shun Ishiyama, Yuichi Tomiki, Kazuhiro Sakamoto
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Jian-xin Gan, Hai-peng Liu, Kang Chen
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Makoto Takahashi, Kazuhiro Sakamoto, Yuichiro Tsukada, Shingo Kawano, Jun Watanabe, Yosuke Fukunaga, Yasumitsu Hirano, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshi
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Yuegang Li, Gang Hu, Jinzhu Zhang, Wenlong Qiu, Shiwen Mei, Xishan Wang, Jianqiang Tang
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Gyung Mo Son
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Chaoyang Wang, Xiaolong Li, Hao Lin, Jiahua Ju, Haibao Zhang, Yongjiang Yu
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef

Colorectal cancer

Validation of the Vietnamese version of the low anterior resection syndrome score questionnaire: Tuong-Anh Mai-Phan, Vu Quang Pham; Ann Coloproctol. 2024;40(6):588-593. Published online November 25, 2022; DOI: https://doi.org/10.3393/ac.2022.00514.0073

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Abstract PDF Supplementary Material

Purpose
The aim of this study was to validate the low anterior resection syndrome (LARS) score questionnaire in the Vietnamese language among Vietnamese patients who underwent sphincter-preserving surgery for rectal cancer.
Methods
The LARS score questionnaire was translated from English into Vietnamese and then back-translated as recommended internationally. From January 2018 to December 2020, 93 patients who underwent sphincter-preserving surgery completed the Vietnamese version of the LARS score questionnaire together with an anchored question assessing the influence of bowel function on quality of life. To validate test-retest reliability, patients were requested to answer the LARS score questionnaire twice.
Results
Ninety-three patients completed the LARS score questionnaire, of whom 89 responded twice. The patients who responded twice were included in the analysis of test-retest reliability. Fifty-eight patients had a “major” LARS score. The LARS score was able to discriminate between patients who were obese and those who were not (P<0.001) and between the LAR and AR procedures (P<0.001). Age and sex were not associated with higher LARS scores (P=0.975). There was a perfect fit between the quality of life category question and the LARS score in 56.2% of cases, and a moderate fit was found in 42.7% of cases, showing reasonable convergent validity. The test-retest reliability of 89 patients showed a high intraclass correlation coefficient.
Conclusion
The Vietnamese version of the LARS score questionnaire is a valid tool for measuring LARS.

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Longitudinal evolution of low anterior resection syndrome in ultra-low rectal cancer: A trend analysis of a propensity-matched cohort
Han-Shuo Wang, Yu-Xin Lin, Si-Rui Xu, Li-Ya Wang, Xiao-Dong Wang, Ming-Jun Huang
World Journal of Gastroenterology.2026;[Epub] CrossRef
Major Low Anterior Resection Syndrome (LARS) and Quality of Life in Patients With Low Rectal Cancer: A Preoperative Survey Using LARS Score and European Organisation for Research and Treatment of Cancer’s 30-Item Core Quality of Life Questionnaire
Ly Huu Phu, Ho Tat Bang, Nguyen Viet Binh, Hoang Danh Tan, Ung Van Viet, Nguyen Trung Tin
Cureus.2023;[Epub] CrossRef

Malignant disease,Epidemiology & etiology

Colorectal cancer mortality trends in the era of cancer survivorship in Korea: 2000–2020: Min Hyun Kim, Sanghee Park, Nari Yi, Bobae Kang, In Ja Park; Ann Coloproctol. 2022;38(5):343-352. Published online October 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00535.0076

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
Korea has implemented an early screening for colorectal cancer since 2004. However, it is not known whether this has translated into improved survival over the years.
Methods
We acquired colorectal cancer mortality data from the Cause of Death Statistics in Korea from 2000 to 2020. We characterized the data into year of death, cancer-specific loci, and age group. We analyzed age-standardized mortality rates (ASMR) according to year of death, age group, and primary location to find trends in colorectal cancer mortality over a 20-year period.
Results
The crude mortality rate of colorectal cancer increased from 8.78 per 100,000 in 2000 to 17.27 per 100,000 in 2020. The second decade was slower in increments compared to the first decade. ASMR showed a decrease over the second decade after an initial increase in the first decade. The decrease was primarily from the lowering of ASMR for rectosigmoid cancers. Age group analysis showed a lowering of ASMR mainly in the 45–59-year, 60–74-year, and ≥ 75-year age groups; however, 0–29-year and 30–44-year age groups showed generally unchanged ASMR over the total period.
Conclusion
After a brief incline of age-specific mortality of colorectal cancers during the early 2000s, colorectal cancer mortality has gradually been decreasing in the past decade. This was mainly due to decreased mortalities in rectosigmoid colon cancers especially in the age groups that were the target of early screening.

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Clinical profile, treatment patterns, and early outcomes of colorectal cancer at Kassala Police Hospital, Eastern Sudan: a 10-year retrospective cohort study
Abdel Latif Khalifa Elnaim, Salma Salah Hassan Mohamed Ali, Rawah Suliman Mohamed Ahmed, Ismail Sagap
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Predominance of Peritoneal Metastasis in the Recurrence Pattern of T4 Colorectal Cancer: A Retrospective Cohort Study
Jin Gi Chang, In Ja Park, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seok-Byung Lim
Annals of Surgical Oncology.2026;[Epub] CrossRef
Gochujang attenuates colorectal cancer by promoting colonic SCFA utilization and GPCR expression despite limited recovery of microbial diversity
Jin Young Baek, Ji-Woo Kim, Do-Youn Jeong, Seungyong Hwang, Dallas R. Donohoe, Anna Han
Journal of Functional Foods.2026; 143: 107417. CrossRef
Translational Validation of a Novel Multi-Locus ctDNA Methylation Assay for Early Detection and Stratification of Colorectal Cancer: An Exploratory Prospective, Case-Control Study
Hayoung Lee, Jae Cheol Kang, In Ja Park, Gwang-un Kim, Hwi Hyun, Na Young Min, Sungwon Jeon, Byoung-Chul Kim
International Journal of Molecular Sciences.2026; 27(13): 5738. CrossRef
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ALK Elnaim, MPK Wong, I Sagap
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Association between relative dose intensity of adjuvant chemotherapy and survival outcomes in patients aged ≥ 70 years with high-risk stage II and stage III colon cancer
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Chungyeop Lee, In Ja Park
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In-Hospital Mortality and Associated Factors among Colorectal Cancer Patients in Germany
Karel Kostev, Sarah Krieg, Andreas Krieg, Tom Luedde, Sven H. Loosen, Christoph Roderburg
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Effect of Fluorescence Lymph Node Mapping on Improving Diagnostic Values of CT D3 Lymph Node Staging for Right-Sided Colon Cancer
Gyung Mo Son, Tae Un Kim, Mi Sook Yun, ChangYeop Kim, In Young Lee, Su Bum Park, Dong-Hoon Shin, Gi Won Ha
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Gochujang suppresses cell survival and changes reactive oxygen species metabolism in colorectal cancer cells
Eun-Bi Seo, So-Min Oh, Anna Han
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Gyung Mo Son, Sang-Ho Park, Nam Su Kim, Mi Sook Yun, In Young Lee, Myeong-Sook Kwon, Tae Kyun Kim, Eun Hwa Lee, Eun Jung Hwang, Kwang-Ryul Baek
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Won Beom Jung
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Clinical implication of tissue carcinoembryonic antigen expression in association with serum carcinoembryonic antigen in colorectal cancer
Abdulmohsin Fawzi Aldilaijan, Young Il Kim, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jihun Kim, Jun-Soo Ro, Jin Cheon Kim
Scientific Reports.2023;[Epub] CrossRef
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Xiangqing Ren, Tian Huang, Xiaolong Tang, Qian Ma, Ya Zheng, Zenan Hu, Yuping Wang, Yongning Zhou
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Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
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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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Jeonghee Han
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Hyun Gu Lee
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Colorectal cancer

International Society of University Colon and Rectal Surgeons survey of surgeons’ preference on rectal cancer treatment: Audrius Dulskas, Philip F. Caushaj, Domas Grigoravicius, Liu Zheng, Richard Fortunato, Joseph W. Nunoo-Mensah, Narimantas E. Samalavicius; Ann Coloproctol. 2023;39(4):307-314. Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00255.0036

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
Rectal cancer treatment has a wide range of possible approaches from radical extirpative surgery to nonoperative watchful waiting following chemoradiotherapy, with or without, additional chemotherapy. Our goal was to assess the personal opinion of active practicing surgeons on rectal cancer treatment if he/she was the patient.
Methods
A panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) selected 10 questions that were included in a questionnaire that included other items including demographics. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in our database and remained open from April 16 to 28, 2020.
Results
One hundred sixty-three specialists completed the survey. The majority of surgeons (n=65, 39.9%) chose the minimally invasive (laparoscopic) surgery for their personal treatment of rectal cancer. For low-lying rectal cancer T1 and T2, the treatment choice was standard chemoradiation+local excision (n=60, 36.8%) followed by local excision±chemoradiotherapy if needed (n=55, 33.7%). In regards to locally advanced low rectal cancer T3 or greater, the preference of the responders was for laparoscopic surgery (n=65, 39.9%). We found a statistically significant relationship between surgeons’ age and their preference for minimally invasive techniques demonstrating an age-based bias on senior surgeons’ inclination toward open approach.
Conclusion
Our survey reveals an age-based preference by surgeons for minimally invasive surgical techniques as well as organ-preserving techniques for personal treatment of treating rectal cancer. Only 1/4 of specialists do adhere to the international guidelines for treating early rectal cancer.

Citations

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Non-operative management of locally advanced rectal cancer with an emphasis on outcomes and quality of life: a narrative review
In Ja Park
Ewha Medical Journal.2025; 48(3): e40. 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
Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
Effects of Adjuvant Chemotherapy on Oncologic Outcomes in Patients With Stage ⅡA Rectal Cancer Above the Peritoneal Reflection Who Did Not Undergo Preoperative Chemoradiotherapy
Hyo Seon Ryu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Yong Sang Hong, Tae Won Kim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(4): 392. 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
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. 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

Colorectal cancer

Short- and long-term outcomes of subtotal/total colectomy in the management of obstructive left colon cancer: Jung Tak Son, Yong Bog Kim, Hyung Ook Kim, Chungki Min, Yongjun Park, Sung Ryol Lee, Kyung Uk Jung, Hungdai Kim; Ann Coloproctol. 2023;39(3):260-266. Published online May 25, 2022; DOI: https://doi.org/10.3393/ac.2022.00101.0014

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Abstract PDF

Purpose
Surgical management of obstructive left colon cancer (OLCC) is still a matter of debate. The classic Hartmann procedure (HP) has a disadvantage that requires a second major operation. Subtotal colectomy/total abdominal colectomy (STC/TC) with ileosigmoid or ileorectal anastomosis is proposed as an alternative procedure to avoid stoma and anastomotic leakage. However, doubts about morbidity and functional outcome and lack of long-term outcomes have made surgeons hesitate to perform this procedure. Therefore, this trial was designed to provide data for morbidity, functional outcomes, and long-term outcomes of STC/TC.
Methods
This study retrospectively analyzed consecutive cases of OLCC that were treated by STC/TC between January 2000 and November 2020 at a single tertiary referral center. Perioperative outcomes and long-term outcomes of STC/TC were analyzed.
Results
Twenty-five descending colon cancer (45.5%) and 30 sigmoid colon cancer cases (54.5%) were enrolled in this study. Postoperative complications occurred in 12 patients. The majority complication was postoperative ileus (10 of 12). Anastomotic leakage and perioperative mortality were not observed. At 6 to 12 weeks after the surgery, the median frequency of defecation was twice per day (interquartile range, 1–3 times per day). Eight patients (14.5%) required medication during this period, but only 3 of 8 patients required medication after 1 year. The 3-year disease-free survival was 72.7% and 3-year overall survival was 86.7%.
Conclusion
The risk of anastomotic leakage is low after STC/TC. Functional and long-term outcomes are also acceptable. Therefore, STC/TC for OLCC is a safe, 1-stage procedure that does not require diverting stoma.

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Endoscopic Stenting Followed by Laparoscopic Resection in Malignant Colonic Obstruction: Oncological Safety of the Bridge-to-Surgery Approach
Deniz Öçal, Mehmet Torun
Turkish Journal of Colorectal Disease.2026;[Epub] CrossRef
Stoma-free subtotal and total colectomy for obstructed left-sided colon cancer: safety, functional outcomes, and oncological results
Mustafa Kuşak, Mustafa Gün, Serdar Şenol
Journal of Medicine and Palliative Care.2026; 7(3): 580. CrossRef
Controversial issues of colon stenting in case of tumor obstructive intestinal obstruction: surgical and oncological aspects
S.A. Aliyev, E.S. Aliyev, T.K. Aliyev
Endoscopic Surgery.2025; 31(2): 65. CrossRef
The Safety of Primary Anastomosis Without Protective Stoma in Emergency Left Colon Surgery: A Meta-Analysis
Zhiyan Wang, Wentao Sheng, Senjie Dai, Xuanzhou Li, Guojian Lin, Xiaohong Kang
Journal of Investigative Surgery.2025;[Epub] CrossRef
Ileus After Colectomy in the Modern Era: A Population-Based Analysis
Grace M. Crouch, Samantha Hendren, Kara K. Brockhaus, Wenjing Weng, Jami L. Boyd, Cheryl Rocker, Robert K. Cleary
Diseases of the Colon & Rectum.2025; 68(8): 1001. CrossRef
Influence of the type of anatomic resection on anastomotic leak after surgery for colon cancer
Suat Chin Ng, Andrew McCombie, Frank Frizelle, Tim Eglinton
ANZ Journal of Surgery.2024; 94(3): 424. CrossRef
Complete Obstruction, a Real Risk Factor: A Comprehensive Study on Obstruction in Stage IIA Colon Cancer With Propensity Score Matching Analysis
Soo Young Oh, Chan Wook Kim, Seonok Kim, Min Hyun Kim, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(2): 135. CrossRef
Can we use colon stenting in accelerated recovery programs for surgical treatment colon cancer complicated by obstructive intestinal obstruction? A literature review
Saday A. Aliyev, Emil S. Aliyev
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An investigation into tumor regression grade as a parameter for locally advanced rectal cancer and 5-year overall survival rate: Supparerk Laohawiriyakamol, Wongsakorn Chaochankit, Worawit Wanichsuwan, Kanet Kanjanapradit, Teeranan Laohawiriyakamol; Ann Coloproctol. 2023;39(1):59-70. Published online March 18, 2022; DOI: https://doi.org/10.3393/ac.2021.01011.0144

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Abstract PDF

Purpose
The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiation (nCRT) followed by surgery. Several parameters are associated with patient survival in LARC. One of these parameters is tumor regression grade (TRG); however, the significance of TRG remains controversial. In this study, we aimed to examine the correlations of TRG with 5-year overall (OS) and relapse-free survival (RFS) and identify other factors that influence the survival rates in LARC after nCRT followed by surgery.
Methods
This retrospective study included 104 patients diagnosed with LARC who underwent nCRT followed by surgery at Songklanagarind Hospital from January 2010 to December 2015. All patients received fluoropyrimidine-based chemotherapy at a total dose of 45.0 to 50.4 Gy in 25 daily fractions. Tumor response was evaluated using the 5-tier Mandard TRG classification. TRG was categorized into good (TRG 1–2) and poor (TRG 3–5) responses.
Results
TRG (classified by either the 5-tier classification system or the 2-group classification system) was not correlated with 5-year OS or RFS. The 5-year OS rates were 80.0%, 54.5%, 80.8%, and 67.4% in patients with TRG 1, 2, 3, and 4, respectively (P=0.22). Poorly differentiated rectal cancer and systemic metastasis were associated with poor 5-year OS. Intraoperative tumor perforation, poor differentiation, and perineural invasion were correlated with inferior 5-year RFS.
Conclusion
TRG was probably not associated with either 5-year OS or RFS; however, poor differentiation and systemic metastasis were strongly associated with poor 5-year OS.

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Impact of Hemoglobin Levels on Treatment Response and Survival in Locally Advanced Rectal Cancer: A Retrospective Cohort Study
Seyed Kazem Mirinezhad, Mohammad Mohammadzadeh, Amir Ghasemi Jangjoo
Journal of Research in Clinical Medicine.2026; 14: 34681. CrossRef
Is Mandard tumor regression grade scoring sufficient for locally advanced rectal cancer?
Buket Şahin Çelik, Aslı Geçgel, Erdem Göker
Medical Science and Discovery.2025; 12(1): 1. CrossRef
Risk score model for predicting local control and survival in patients with rectal cancer treated with neoadjuvant chemoradiotherapy
Tuba Kurt Catal, Günay Can, İsmai̇l Demi̇rel, Sefi̇ka Ergen, Di̇dem Öksüz
Oncology Letters.2025; 29(5): 1. CrossRef
Evaluation of pre-treatment F-18 FDG PET/CT according to Mandard classification in locally advanced rectal cancer patients undergoing neoadjuvant chemoradiotherapy
Feray Aras, Murtaza Parvizi, Olcay Ak Nalbant, Volkan Ozkol, Engin Kut
BMC Cancer.2025;[Epub] CrossRef
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Ömer Atmış, Hanife Seda Mavili
OSMANGAZİ JOURNAL OF MEDICINE.2025; 47(6): 975. CrossRef
Radiopathological Correlation in Locally Advanced Rectal Cancer After Neoadjuvant Treatment
Mario Martín-Sánchez, Pedro Villarejo Campos, Víctor Domínguez-Prieto, Eva Ruiz-Hispán, Begoña López-Botet Zulueta, Carlos Pastor, Miguel León-Arellano, Héctor Guadalajara, Damián García-Olmo, Siyuan Qian-Zhang
Cancers.2025; 17(24): 3937. 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
Risk-factors for locally advanced rectal cancer relapse after neoadjuvant chemoradiotherapy: A single center experience
Dragana Stupar, Saša Jungić, Zdenka Gojković, Jelena Berendika, Živojin Janičić
Medicine.2023; 102(44): e35519. CrossRef

Malignant disease,Colorectal cancer,Epidemiology & etiology

Clinicopathologic characteristics of early-onset colorectal cancer: Kui Seon Park, Young Ki Hong, Yoon Jung Choi, Jung Gu Kang; Ann Coloproctol. 2022;38(5):362-369. Published online March 11, 2022; DOI: https://doi.org/10.3393/ac.2021.00976.0139

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Abstract PDF

Purpose
The aim of this study was to analysis of the clinicopathological characteristics and prognosis of colorectal cancer (CRC) under the age of 50 years.
Methods
Between January 2009 and December 2018, 1,126 primary CRC patients were included from National Health Insurance Service Ilsan Hospital. The patients were divided into group 1 (n=111, ≤50 years) and group 2 (n=1,015, >50 years). The clinicopathologic features and prognostic outcomes were compared. In addition, to analyze whether there were any differences of those characteristics in 3 groups, patients aged under 50 years were divided into their 20s, 30s, and 40s.
Results
Group 1 had a slightly higher distribution in the left colon and rectum, lower T stage I and higher T stage IV rate, and a significantly higher distribution in stage N2 than group 2 (30.6%:16.3%, P<0.001). Poor histological differentiation of tumors was significantly high in group 1 (P=0.003). The 5-year survival rate for those in their 30s (69.2%) and 40s (91.6%) was higher than those in their 20s who died immediately after surgery (P<0.001). The 5-year disease-free survival rate was also confirmed to be meaningful for each age group, with 0% in their 20s, 53.8% in their 30s, 79.2% in their 40s (P<0.001).
Conclusion
Although the age was not an independent prognostic factor for overall survival in this study, the early onset group of CRCs is more advanced at the time of diagnosis and has a more aggressive histologic type.

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A Clinicopathologic, Molecular, and Prognostic Comparison Between Early- and Late-Onset Colorectal Cancer in Korea: A Single-Center Retrospective Cohort Study
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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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Abstract PDF

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.

Citations

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Original Article

Malignant disease, Rectal cancer,Prognosis and adjuvant therapy,Colorectal cancer

Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review: Min Chul Kim, Jae Hwan Oh; Ann Coloproctol. 2021;37(6):382-394. Published online December 22, 2021; DOI: https://doi.org/10.3393/ac.2021.00913.0130

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Abstract PDF Supplementary Material

Purpose
We aimed to evaluate the surgicopathological outcomes of lateral pelvic lymph node dissection (LPLD) and long-term oncological outcomes of selective LPLD after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer and compare them to those of total mesorectal excision (TME) alone based on pretreatment magnetic resonance imaging (MRI).
Methods
We compared the TME-alone group (2001–2009, n=102) with the TME with LPLD group (2011–2016, n=69), both groups having lateral lymph nodes (LLNs) of ≥5 mm in short axis diameter. The surgicopathological outcomes were analyzed retrospectively. Oncological outcomes were analyzed using the Kaplan-Meier method.
Results
The rates of overall postoperative 30-day morbidity (42.0% vs. 26.5%, P=0.095) and urinary retention (13.7% vs. 10.1%, P=0.484) were not significantly different between the LPLD and TME-alone groups, respectively. Pathologically proven LLN metastasis was identified in 24 (34.8%) LPLD cases after nCRT. The LPLD group showed a lower 5-year local recurrence (LR) rate (27.9% vs. 4.6%, P<0.001) and better recurrence-free survival (RFS) (59.6% vs. 78.2%, P=0.008) than those of the TME-alone group, while the 5-year overall survival was not significantly different between the 2 groups (76.2% vs. 86.5%, P=0.094).
Conclusion
This study suggests that LPLD is a safe and feasible procedure. The oncological outcomes suggest that selective LPLD improves LR and RFS in patients with clinically suspicious LLNs on pretreatment MRI. Considering that lateral nodal disease is not common, a multicenter large-scale study is necessary.

Citations

Citations to this article as recorded by

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Review

Malignant disease, Rectal cancer ,Functional outcomes,Colorectal cancer,Minimally invasive surgery

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; Ann Coloproctol. 2021;37(6):351-367. Published online November 17, 2021; DOI: https://doi.org/10.3393/ac.2021.00836.0119

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236 Download
50 Web of Science
52 Citations

Abstract PDF

Intersphincteric resection (ISR) is the ultimate anus-sparing technique for low rectal cancer and is considered an oncologically safe alternative to abdominoperineal resection. The application of the robotic approach to ISR (RISR) has been described by few specialized surgical teams with several differences regarding approach and technique. This review aims to discuss the technical aspects of RISR by evaluating point by point each surgical controversy. Moreover, a systematic review was performed to report the perioperative, oncological, and functional outcomes of RISR. Postoperative morbidities after RISR are acceptable. RISR allows adequate surgical margins and adequate oncological outcomes. RISR may result in severe bowel and genitourinary dysfunction affecting the quality of life in a portion of patients.

Citations

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Original Article

Malignant disease,Prognosis and adjuvant therapy,Colorectal cancer,Epidemiology & etiology

Characteristics and outcomes of colorectal cancer surgery by age in a tertiary center in Korea: a retrospective review: Tae-Hoon Lee, Jeong Min Choo, Jeong Sub Kim, Seon Hui Shin, Ji-Seon Kim, Se-Jin Baek, Jung-Myun Kwak, Jin Kim, Seon-Hahn Kim; Ann Coloproctol. 2022;38(3):244-252. Published online November 4, 2021; DOI: https://doi.org/10.3393/ac.2021.00619.0088

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Graphical Abstract Abstract PDF

Purpose
Colorectal cancer (CRC) occurs in all age groups, and the application of treatment may vary according to age. The study was designed to identify the characteristics of CRC by age.
Methods
A total of 4,326 patients undergoing primary resection for CRC from September 2006 to July 2019 were reviewed. Patient and tumor characteristics, operative and postoperative data, and oncologic outcome were compared
Results
Patients aged 60 to 69 years comprised the largest age group (29.7%), followed by those aged 50 to 59 and 70 to 79 (24.5% and 23.9%, respectively). Rectal cancer was common in all age groups, but right-sided colon cancer tended to be more frequent in older patients. In very elderly patients, there were significant numbers of emergency surgeries, and the frequencies of open surgery and permanent stoma were greater. In contrast, total abdominal colectomy or total proctocolectomy was performed frequently in patients in their teens and twenties. The elderly patients showed more advanced tumor stages and postoperative ileus. The incidence of adjuvant treatment was low in elderly patients, who also had shorter follow-up periods. Overall survival was reduced in older patients with stages 0 to 3 CRC (P<0.001), but disease-free survival did not differ by age (P=0.391).
Conclusion
CRC screening at an earlier age than is currently undertaken may be necessary in Korea. In addition, improved surgical and oncological outcomes can be achieved through active treatment of the growing number of elderly CRC patients.

Citations

Citations to this article as recorded by

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Oncologic outcomes of surgically treated colorectal cancer in octogenarians: a comparative study using inverse probability of treatment weighting (IPTW)
Soo Young Oh, Jung Yun Park, Kwan Mo Yang, Seong-A Jeong, Yong Jae Kwon, Yun Tae Jung, Chung Hyeun Ma, Keong Won Yun, Kwang Hyun Yoon, Jae Young Kwak, Chang Sik Yu
BMC Gastroenterology.2025;[Epub] CrossRef
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
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Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
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Min Ki Kim
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Surgical Techniques for Transanal Local Excision for Early Rectal Cancer
Gyoung Tae Noh
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Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
In Ja Park
The Ewha Medical Journal.2023;[Epub] CrossRef
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Gyung Mo Son
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