Annals of Coloproctology

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Original Article

Anorectal benign disease

Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study: Antonio Brillantino, Francesca Iacobellis, Luigi Marano, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Claudio Gambardella, Umberto Favetta, Michele Schiano Di Visconte, Luigi Monaco, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Elisa Palladino, Giovanna Frezza, Maria Paola Menna, Paolino Mauro, Stefano Picardi, Mario Massimo Mensorio, Vinicio Mosca, Vincenzo Bottino, Giovanna Ioia, Corrado Rispoli, Marco Di Serafino, Martina Caruso, Roberto Ronza, Barbara Frittoli, Daria Schettini, Luca Stoppino, Franco Iafrate, Giulio Lombardi, Carmine Antropoli, Salvatore Cappabianca, Ludovico Docimo, Roberto Grassi, Alfonso Reginelli; Ann Coloproctol. 2025;41(3):207-220. Published online June 16, 2025; DOI: https://doi.org/10.3393/ac.2024.00675.0096

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Purpose
This study was conducted to evaluate the validity of a new imaging-guided, anatomy-based classification of anorectal fistulas in defining disease severity and predicting surgical outcomes.
Methods
This multicenter, retrospective cohort study analyzed data from patients with perianal fistulas who underwent surgery between 2017 and 2023. All patients underwent preoperative 3-dimensional endoanal ultrasound, with adjunctive magnetic resonance imaging performed if ultrasound indicated a complex fistula. Imaging examinations were retrospectively evaluated to categorize fistulas according to the Garg classification and the newly proposed classification system. The new classification included 6 severity grades based on the characteristics of the primary tract: submucosal, intersphincteric, low transsphincteric, high transsphincteric, multiple, and suprasphincteric/extrasphincteric. Each grade was further subdivided into 3 subtypes (A, B, C) based on the extension of secondary tracts.
Results
When compared with the new classification, the Garg classification demonstrated a slightly lower ability to predict the feasibility of fistulotomy in simple fistulas (94.2% vs 99.1%; Fisher exact test, P=0.006). A strong positive correlation was found between the surgery failure rate and the severity grade of the new classification (Spearman rho, 0.90; P<0.001), whereas the Garg classification showed a nonsignificant positive correlation with surgical failure rate (Spearman rho, 0.90; P=0.08).
Conclusion
The new imaging-guided, anatomy-based classification of anorectal fistulas demonstrates high accuracy in defining disease severity. It represents a valuable tool for preoperative grading of anal fistulas, standardizing the reporting of diagnostic imaging, and improving the communication of findings among healthcare professionals.

Citations

Citations to this article as recorded by

Comparison of the proposed new classification of anal fistulas with the Garg classification
Pankaj Garg, Nicola Clemente, Kaushik Bhattacharya, Sattyadeep Garg
Annals of Coloproctology.2026; 42(1): 145. CrossRef
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

Review

Benign diesease & IBD,Rare disease & stoma

Prolapse of intestinal stoma: Kotaro Maeda; Ann Coloproctol. 2022;38(5):335-342. Published online October 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00465.0066

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12 Citations

Abstract PDF

Stoma prolapse can usually be managed conservatively by stoma care nurses. However, surgical management is considered when complications make traditional care difficult and/or stoma prolapse affects normal bowel function and induces incarceration. If the stoma functions as a fecal diversion, the prolapse is resolved by stoma reversal. Loop stoma prolapse reportedly occurs when increased intraabdominal pressure induces stoma prolapse by pushing the stoma up between the abdominal wall and the intestine, particularly in cases of redundant or mobile colon. Therefore, stoma prolapse repair aims to prevent or eliminate the space between the abdominal wall and the intestine, as well as the redundant or mobile intestine. Accordingly, surgical repair methods for stoma prolapse are classified into 3 types: methods to fix the intestine, methods to shorten the intestine, and methods to eliminate the space between the stoma and the abdominal wall around the stoma orifice. Additionally, the following surgical techniques at the time of stoma creation are reported to be effective in preventing stoma prolapse: an avoidance of excessive fascia incision, fixation of the stoma to the abdominal wall, an appropriate selection of the intestinal site for the stoma orifice to minimize the redundant intestine, and the use of an extraperitoneal route for stoma creation.

Citations

Citations to this article as recorded by

Stapler-assisted extracorporeal revision for non-reducible prolapse of the efferent limb of a loop colostomy in advanced pelvic malignancy
Grace El Nabbout, Zein Maher Daher, Kelly J Manahan, John P Geisler
Journal of Surgical Case Reports.2026;[Epub] CrossRef
Comprehensive nursing management for an older patient with diarrhoea and risk of dehydration
Tiago Horta Reis da Silva
Gastrointestinal Nursing.2025; 23(2): 89. CrossRef
Incarcerated trans-stomal herniation resembling a stomal prolapse – a case report
N Shaikh, RV Blanco, M Vente, R Ebrahim
South African Journal of Surgery.2025; 63(1): 31. CrossRef
Non-Operative Considerations in Relation to Parastomal Hernia
Z. Malaibari, M. W. Christoffersen, M. Krogsgaard, N. A. Henriksen, K. Andresen, F. Helgstrand, R. Aldemyati, J. Rosenberg
Journal of Abdominal Wall Surgery.2025;[Epub] CrossRef
Stoma Complications
Aaron J. Dawes, John V. Gahagan
Clinics in Colon and Rectal Surgery.2024; 37(06): 387. CrossRef
Management of the Difficult Stoma
Clay Merritt, Paola Maldonado
Surgical Clinics of North America.2024; 104(3): 579. CrossRef
Ileostomy: Early and Late Complications
Francisco Duarte Cerqueira Gomes Girão Santos, Laura Elisabete Ribeiro Barbosa, João Paulo Meireles de Araújo Teixeira
Journal of Coloproctology.2024; 44(01): e80. CrossRef
Risk factors for stoma prolapse after laparoscopic loop colostomy
Yusuke Takashima, Hitoshi Hino, Akio Shiomi, Hiroyasu Kagawa, Shoichi Manabe, Yusuke Yamaoka, Chikara Maeda, Shunsuke Kasai, Yusuke Tanaka
Surgical Endoscopy.2024; 38(5): 2834. CrossRef
Linear stapler refashioning technique for irreducible stomal prolapse—A video vignette
Rajesh S. Shinde, Deep Mashru, Murali V
Colorectal Disease.2024; 26(7): 1483. CrossRef
Stomal Prolapse Due to Sidedness of Transverse Loop Colostomy: A Retrospective Cohort Study
Takuya Yano, Masanori Yoshimitsu, Chiyomi Ishibashi, Atsuko Nishibara, Kanyu Nakano, Hitoshi Idani, Masazumi Okajima
Journal of the Anus, Rectum and Colon.2023; 7(4): 258. CrossRef
Intestinal Stomas—Current Practice and Challenges: An Institutional Review
Isam Mazin Juma, Tabarak Qassim, Mirza Faraz Saeed, Aya Qassim, Sana Al-Rawi, Sabrina Al-Salmi, Mustafa Thaer Salman, Ibrahim Al-Saadi, Abdulaziz Almutawea, Eman Aljahmi, Mohamed Khalid Fadhul
Euroasian journal of hepato-gastroenterology.2023; 13(2): 115. CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef

Original Articles

Benign proctology

A New Classification for Hemorrhoidal Disease: The Creation of the “BPRST” Staging and Its Application in Clinical Practice: Carlos Walter Sobrado Júnior, Carlos de Almeida Obregon, Afonso Henrique da Silva e Sousa Júnior, Lucas Faraco Sobrado, Sérgio Carlos Nahas, Ivan Cecconello; Ann Coloproctol. 2020;36(4):249-255. Published online June 1, 2020; DOI: https://doi.org/10.3393/ac.2020.02.06

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16 Web of Science
18 Citations

Abstract PDF

Purpose
Present an updated classification for symptomatic hemorrhoids, which not only guides the treatment of internal hemorrhoids but also the treatment of external components. In addition, this new classification includes new treatment alternatives created over the last few years.
Methods
Throughout the past 7 years, the authors developed a method to classify patients with symptomatic hemorrhoids. This study, besides presenting this classification proposal, also retrospectively analyzed 149 consecutive patients treated between March 2011 and November 2013 and aimed to evaluate the association between the management adopted with Goligher classification and our proposed BPRST classification.
Results
Both classifications had a statistically significant association with the adopted management strategies. However, the BPRST classification tended to have fewer management discrepancies when each stage of disease was individually analyzed.
Conclusion
Although there is much disagreement about how the classification of hemorrhoidal disease should be updated, it is accepted that some kind of revision is needed. The BPRST method showed a strong association with the management that should be adopted for each stage of the disease. Further studies are needed for its validation, but the current results are encouraging.

Citations

Citations to this article as recorded by

Integrative management of Grade IV and III hemorrhoids using leech therapy followed by finger-guided hemorrhoidal artery ligation and laser-assisted hemorrhoidopexy: A clinical case presentation
Arushi Bansal, Awadhesh Kumar Pandey, K. T. Aadithyaraj, Vyasadeva Mahanta, Yogesh Badwe
Journal of Ayurveda Case Reports.2026; 9(2): 134. CrossRef
Percepción y conocimiento de la enfermedad hemorroidal en los profesionales sanitarios en España
M. Frías Vargas, N. Fontanillas Gamilla, I. Rivera Panizo, D. Fuertes Domínguez, C. Granja Ortega, J.F. Peiró Morant
Medicina de Familia. SEMERGEN.2025; 51(3): 102393. CrossRef
Clinical evidence and rationale of topical nifedipine and lidocaine ointment in the treatment of anal fissure and hemorrhoidal disease
Gaetano GALLO, Mario TROMPETTO
Minerva Surgery.2025;[Epub] CrossRef
Real-world use of polidocanol foam sclerotherapy for hemorrhoidal disease: insights from an international survey and systematic review with clinical practice recommendations
Gaetano Gallo, Ugo Grossi, Veronica De Simone, Arcangelo Picciariello, Elia Diaco, Pin Fan, Hongbo He, Jun Li, Hongcheng Lin, Marco La Torre, Rita Laforgia, Pierluigi Lobascio, Hui Ma, Francesco Pata, Roberto Perinotti, Vincent De Parades, Mauro Pozzo, Al
Updates in Surgery.2025; 77(5): 1439. CrossRef
Surgical outcomes of modified Ferguson hemorrhoidectomy for grade IV hemorrhoidal disease
Ahmet Cihangir Emral, Gökay Çetinkaya, Merter Gülen, Bahadır Ege
Anatolian Current Medical Journal.2025; 7(5): 652. CrossRef
Propensity score–matched comparative study of radiofrequency ablation (with the Rafaelo device) versus hemorrhoidectomy for the treatment of grades II–III internal hemorrhoids
Thanat Tantinam, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul, Kullawat Bhatanaprabhabhan, Boonchai Ngamsirimas, Nataphon Santrakul, Rangsima Thiengthiantham, Punnawat Chandrachamnong
Annals of Coloproctology.2025; 41(5): 409. CrossRef
Clinical evidence and rationale of mesoglycan to treat chronic venous disease and hemorrhoidal disease: a narrative review
Gaetano Gallo, Arcangelo Picciariello, Antonella Tufano, Giuseppe Camporese
Updates in Surgery.2024; 76(2): 423. CrossRef
The role of flavonoids in the pharmacological treatment of haemorrhoids
SS Singh, MA Strydom, M Balmith, C Megaw, MJ Nell
South African General Practitioner.2024; 5(1): 36. CrossRef
Timing and Modality of Hemorrhoidal Prolapse Impact on Patients’ Quality of Life
Carlo Ratto, Angelo Parello, Angelo Alessandro Marra, Paola Campennì, Veronica De Simone, Francesco Litta
Journal of Clinical Medicine.2024; 13(13): 3946. CrossRef
Topical Lidocaine or Lidocaine/Diltiazem Ointment Following Rubber Band Ligation of Hemorrhoids: A Prospective 3-Armed Randomized Controlled Trial
Allan M.F. Kwok, Stephen R. Smith, Jie Zhao, Rosemary Carroll, Lucy Leigh, Brian Draganic
Diseases of the Colon & Rectum.2023; 66(8): 1110. CrossRef
Time to change? Present and prospects of hemorrhoidal classification
Ling Wang, Jiachun Ni, Changcheng Hou, Di Wu, Li Sun, Qiong Jiang, Zengjin Cai, Wenbin Fan
Frontiers in Medicine.2023;[Epub] CrossRef
Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults
Yun Soo Hong, Kyung Uk Jung, Sanjay Rampal, Di Zhao, Eliseo Guallar, Seungho Ryu, Yoosoo Chang, Hyung Ook Kim, Hungdai Kim, Ho-Kyung Chun, Chong Il Sohn, Hocheol Shin, Juhee Cho
Scientific Reports.2022;[Epub] CrossRef
Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
Varen Zhi Zheng Tan, Ern-wei Peck, Sharmini S. Sivarajah, Winson J. Tan, Leonard M. L. Ho, Jia-Lin Ng, Cheryl Chong, Darius Aw, Franky Mainza, Fung-Joon Foo, Frederick H. Koh
International Journal of Colorectal Disease.2022; 37(8): 1759. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef
Milligan–Morgan hemorrhoidectomy vs. hemorrhoid artery ligation and recto-anal repair: a comparative study
Dimitrios Symeonidis, Michail Spyridakis, Dimitrios Zacharoulis, George Tzovaras, Athina A. Samara, Alexandros Valaroutsos, Alexandros Diamantis, Konstantinos Tepetes
BMC Surgery.2022;[Epub] CrossRef
Management of Stage 3 Haemorrhoids with Homoeopathy – A case report
Jyothi Vijaykumar, Dhanya Deepak Bhat
Journal of Integrated Standardized Homoeopathy.2022; 5: 107. CrossRef
The novel BPRST classification for hemorrhoidal disease: A cohort study and an algorithm for treatment
Carlos Walter Sobrado, Carlos de Almeida Obregon, Lucas Faraco Sobrado, Lucas Morales Bassi, José Américo Bacchi Hora, Afonso Henrique Silva e Sousa Júnior, Sergio Carlos Nahas, Ivan Cecconello
Annals of Medicine and Surgery.2021; 61: 97. CrossRef
Evaluation Of Anti-inflammatory Mediated Anti-hemorrhoidal Activity of Lawsonia inermis on Croton Oil Induced Hemorrhoidal Rats
Sai Krishna Nallajerla, Suhasin Ganta
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry.2021; 21(1): 62. CrossRef

The Characteristics of Crohn's Disease in Korea According to the Montreal Classification.: Kim, Beom , Park, Soon Do , Choi, Sung Il , Lee, Suk Hwan , Lee, Kil Yeon; J Korean Soc Coloproctol. 2009;25(5):300-305.; DOI: https://doi.org/10.3393/jksc.2009.25.5.300

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Abstract PDF

PURPOSE
Crohn's disease is an inflammatory bowel disease with various symptoms and progressions. For effective identification of various causes and follow up of patients, we used the Vienna Classification from 1998, but we started applying the Montreal Classification in 2005. In this study, our aim was to identify the clinical characteristics of Korean patients with Crohn's disease by using the Montreal Classification.
METHODS
A retrospective study was carried out among 111 patients who were evaluated at KyungHee Medical Center from March 1986 through February 2008 as having Crohn's disease.
RESULTS
The male-to-female ratio was 1.8:1, and the average age was 27.2+/-9.6 yr. Abdominal pain was the major symptom, and extraintestinal manifestations were seen in 16 cases. Of the Crohn's disease patients, 25.2% were initially misdiagnosed as having tuberculosis. Concerning age at diagnosis, A2 (patients 17 to 40 yr of age) was the largest group. The most common disease location was the ileocolon (L3), and a combined upper gastrointestinal lesion (L4) was most commonly seen in L3. The most common disease behaviors were nonstricturing and nonpenetrating (B1), and although perianal lesions were most common in B1, there were no statistical correlations (P=0.061). Surgical treatments were performed in 46 cases, especially in cases involving complex disease (stricturing&penetrating) (P<0.005) and ileal disease (L1) (P=0.024).
CONCLUSION
According to the Montreal Classification of Korean Crohn's disease patients, a more stable manifestation was seen in the group with lower age at diagnosis. Perianal lesions did not have any correlation with the form in which the disease manifested itself. Complex disease and ileal disease required a surgical procedure the most.

Citations

Citations to this article as recorded by

Clinical features of Crohn's disease in Korean patients residing in Busan and Gyeongnam
Eun Ji Lee, Tae Oh Kim, Geun Am Song, Jong hun Lee, Hyung Wook Kim, Sam Ryong Jee, Seun Ja Park, Hyun Jin Kim, Jong Ha Park
Intestinal Research.2016; 14(1): 30. CrossRef
A Case Study of a Soyangin Patient with Crohn's Disease who Reported Symptomatic Improvement after Being Treated with Dojeokgangki-tang
Mi-Suk Lee, Mim-Woo Hwang, Yun-Hee Kim
Journal of Sasang Constitutional Medicine.2012; 24(2): 61. CrossRef

Review

Classification of Colorectal Cancer Based on Clinical, Morphological and Molecular Features.: Park, Sunhoo; J Korean Soc Coloproctol. 2008;24(6):497-504.; DOI: https://doi.org/10.3393/jksc.2008.24.6.497

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Abstract PDF: Colorectal cancer (CRC) has been assumed for many years to be a homogenous condition with the vast majority developing within preexisting-adenomas. However, over the last two-decades, it has become clear that CRC evolves through multiple pathways at the genetic and the epigenetic level. Each of these processes is associated with a unique genetic or epigenetic signature identifiable in the tumor cells. The pathway may be defined on the basis of three molecular features: 1) chromosomal instability (CIN), 2) microsatellite instability (MSI), and 3) CpG island methylator phenotype (CIMP). Those molecular pathways are determined at an early evolutionary stage and are fully established within early cancer. Recently, five subgroups were outlined by using morphological findings and associated molecular changes: type 1 (CIN-stable/ MSI-H/CIMP-H), type 2 (CIN-stable/MSI-L or MSS/ CIMP-H), type 3 (CIN-unstable/MSI-L or MSS/CIMP-L), type 4 (CIN-instable/MSS/CIMP-neg), and type 5 (CIN- stable/MSI-H/CIMP-neg). This approach to the classification of CRC should accelerate understanding of causation and will have an impact on clinical management in the areas of both prevention and treatment.

Original Articles

Retrospective Analysis of a Fistula-in-ano: Focus on an Anal-sphincter-preserving Procedure.: Han, Ki Su , Cho, Hyeon Min , Kim, Do Hyoung , Kim, Jun Gi; J Korean Soc Coloproctol. 2007;23(6):403-409.; DOI: https://doi.org/10.3393/jksc.2007.23.6.403

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1 Citations

Abstract PDF

PURPOSE
The results of anal fistula treatments have improved with the development of the anal fistula operative technique. However, there are still complications, such as recurrence and anal incontinence. To this end, the authors classified anal fistulas by using Sumikoshi's classification and performed an anal-sphincter-preserving procedure.
METHODS
We experienced 98 anal fistula cases involving 86 patients who underwent anal fistula operations at The Catholic University of Korea, St. Vincent's Hospital from January 2001 to December 2006. This study was done retrospectively by chart review and telephone questioning. The follow-up period was from 2 to 72 months (mean 29.5, SD: 19.1).
RESULTS
The study showed 0 cases of Type I (0.0%), 49 cases of Type II (50.0%), 46 cases of Type III (46.9%), and 3 cases of Type IV (3.1%) fistulas. Among the 98 fistula-in-ano operations were 27 (27.6%) of fistulotomies and 71 (72.4%) sphincter-preserving procedures (2 cases of coring-out+muscle filling+rectal mucosal advancement flap, 31 cases of coring-out+ muscle closure+rectal mucosal advancement flap, 28 cases of coring-out+cutting seton, and 10 cases of loose seton). After the sphincter-preserving operation, there were 4 cases (4/71, 5.6%) of recurrence. There were no major disorders of the anal sphincter. However, minor disorders of the anal sphincter (6/71, 8.5%, soiling) were found.
CONCLUSIONS
The anal-sphincter-preserving procedure is very effective in preventing recurrence and anal incontinence, but these results are from a retrospective study with a small number of patients and the follow-up period was short. If further cases are collected and continuous follow-up is done, better results can be expected.

Citations

Citations to this article as recorded by

New Techniques for Treating an Anal Fistula
Kee Ho Song
Journal of the Korean Society of Coloproctology.2012; 28(1): 7. CrossRef

Characteristics of Crohn's Disease in Korea according to the Vienna Classification.: Yoon, Eyi Sang , Chang, Yeon Soo , Lee, Kil Yeon , Lee, Suk Hwan , Yoon, Choong , Kim, Hyo Jong; J Korean Soc Coloproctol. 2005;21(5):286-292.

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Abstract PDF: PURPOSE
Crohn's disease (CD) is a chronic inflammatory disease that is difficult to treat due to various complications and frequent recurrences. There have been many studies on the clinical aspects of CD in Western countries; however, there have been few studies in Korea. We performed this study to evaluate the clinical features of CD in Korea and to assess the stability over the course of the disease according to the Vienna classification.
METHODS
We reviewed the medical records of 85 patients diagnosed as having CD in Kyung Hee University Hospital from March 1986 to July 2004.
RESULTS
The male-to-female ratio was 1.9:1, and the mean age at diagnosis was 27.5 years. The most common symptom was abdominal pain (82%). Perianal lesions were observed in 29 cases (34%). Fistula was the most common (26%) lesion. Extraintestinal manifestations were observed in 13 cases (15%). Stomatitis was the most common (7%) lesion. According to the Vienna classification, the group with ages at diagnosis below 40 years (A1) was 88%, and that with ages equal to or above 40 years (A2) was 12%. The location of the disease was classified as terminal ileum (L1)(15%), colon (L2)(32%), ileocolon (L3)(33%), and upper gastrointestinal (L4)(20%). The behavior of disease was classified as nonstricturing nonpenetrating (B1)(41%), stricturing (B2)(14%), and penetrating (B3)(45%). Empirical anti-tuberculous medications were administered in 23 cases (27%) before the CD had been diagnosed.
CONCLUSIONS
There are differences in the locations and behaviors of Crohn's disease between Korea and Western patients. The cause of the difference is uncertain.

Significance of Subclassification of Depressed-Type Early Colorectal Cancer Based on Growth and Development.: Kim, Hyun Shig , Park, Won Kap , Park, Jong Beom , Kang, Yong Won , Lee, Jung Dal , Kim, Kwang Yun; J Korean Soc Coloproctol. 2001;17(4):203-208.

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Abstract PDF: PURPOSE
Recently it became obvious that some early cancers which appeared to be polyp lesions had actually originated from depressed-type lesions. The aim of this study was to clarify both the characteristics of depressed- type early colorectal cancers compared with protruded- or flat-type ones and the significance of a subclassification of depressed-type early cancers.
METHODS
The authors experienced 248 early colorectal cancers from 1996 to 2000. We classified those cancers into protruded, flat, and depressed types based on growth and development. Further, we used Kudo's classification to subclassify the depressed-type cancers into three sub-types, IIc, IIa+IIc, and Is+IIc. We analyzed the 248 cases with emphasis on size, type, sub-type, and submucosal cancer (sm) rate.
RESULTS
The sm rate of the depressed cancers was 81.8% (18/22) and was significantly higher than those of the protruded (30.5%) or the flat (38.5%) types (P<0.05). The sm rate of the depressed lesions not larger than 10 mm was 70% (7/10) and that of the lesions from 11 mm to 20 mm was 91.7% (11/12); there were no depressed cancers larger than 20 mm in diameter. The sm rate of the type IIa+IIc plus type Is+IIc lesions was higher than that of type IIc lesions (93.3%, 14/15 vs. 57.1%, 4/7). Endoscopic resection was done in 74.2% of all early colorectal cancers.
CONCLUSIONS
The sm rate of depressed-type early colorectal cancers was 82%, and no depressed cancers were larger than 20 mm in diameter, suggesting that by the time a depressed-type cancers had become larger than 20 mm in size, it had already progressed into an advanced cancer. Thus, it is very important to detect depressed-type cancers in an early stage. Moreover, it is imperative to differentiate type IIa+IIc and type Is+IIc from polyp lesions and to manage them cautiously because their sm rate is higher than that for type IIc lesions.

Local Pelvic Recurrence after Curative Resection of the Rectal Cancer: Classification and Prognosis.: Park, Jea Kun , Kim, Nam Kyu , Baik, Seung Hyuk , Lee, Kang Young , Sohn, Seung Kook , Cho, Chang Hwan; J Korean Soc Coloproctol. 2005;21(2):82-88.

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Abstract PDF: PURPOSE
The management of local recurrence after curative surgery of the rectal cancer remains difficult clinical problems to surgeons. This study was performed to analyze the outcomes of patients with local pelvic recurrence according to its recurrence type.
METHODS
A total 109 patients with local recurrence were evaluated. Among the 109 patients 62 were local recurrence alone and 47 were both local and systemic recurrence. The recurrence type was classified as Central, Anterior, Posterior, Lateral and Perineal recurrence according to the relation of the tumor location and either intra pelvic organ and/or fixed pelvic structure.
RESULTS
Only 26 (23.9%) of the 109 patients had curative resection and the remaining 83 (76.1%) patients had palliative exploration or nonsurgical procedure. The resectability according to the recurrence type showed that the Central and Anterior type was higher than other type of recurrences (P=0.001). When the primary operation was Abdominoperineal Resection (APR) the resectability was poorer than Low Anterior Resection (LAR) (P=0.0001). When comparing the patients with local recurrence alone, the 5 year survival rate was significantly higher patients treated by curative resection than palliative or non-resection group (P=0.002). Mean follow up period was 44.2+/-30.0 months and mean recurrence time between primary operation and recurrence was 26.0+/-22.7 months.
CONCLUSIONS
Resection for central type of the recurrent is potentially curative, however treatment failure was common when the recurrence invaded fixed pelvic structure. Our data suggest that local pelvic recurrence should be treated with radical resection as can as possible.

Preoperative Staging of Rectal Cancer by CT & MRI.: Shin, Jong Keun , Lee, Sang Mock , Park, Ho Chul , Lee, Kee Hyung , Oh, Soo Myung , Yoon, Choong , Lee, Dong Ho; J Korean Soc Coloproctol. 2000;16(3):177-185.

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Abstract PDF: Accurate staging of rectal cancer preoperatively is important to plan a proper treatment and to predict treatment results. For the preoperative staging of rectal cancer, computed tomography (CT), transrectal ultrasonography (TRUS), and magnetic resonance imaging (MRI) have been used, but the role of them remains controversial. This research was intended to compare and analyze the accuracy of CT and MRI in the preoperative staging of rectal cancer.
METHODS
From January 1998 to June 1999, sixty patients were studied by CT and MRI before their operations for rectal cancer in our institution, but two patients with local excision were excluded in N-staging as objects. The patients who had preoperative irradiation were also excluded in this study. Preoperative staging with CT and MRI were conducted by one radiologist according to 1997's TNM classification based on AJCC. On the results of pathological findings after operation, preoperative staging with CT and MRI were classified into T-staging and N-staging. Accuracy and agreement rate between pathological staging and preoperative staging by CT and MRI were compared and analyzed by Kappa value.
RESULTS
The accuracy of CT was 68 percent in T-staging, and 58 percent in N-staging, MRI showed accuracy of 82 percent in T-staging and 64 percent in N-staging. In the T-staging, the agreement rate between pathological staging and CT staging was 0.54 (95% confidence interval), while the agreement rate was 0.70 in MRI staging, resulting in a higher agreement rate with MRI than with CT. In the N-staging, the agreement rate between pathological staging and CT staging was 0.38, with a relatively lower agreement rate, while the agreement rate was 0.56 in MRI staging. In our study, MRI showed a higher agreement rate than CT.
CONCLUSIONS
In the future, more research should be conducted, but it can be conclued that in preoperative staging for rectal cancer, MRI using body arrayed coil has a better accuracy than CT. Subsequently MRI staging should be considered as a more useful investigation method before operation than CT.

A Retrospective Analysis and Clinical Review of Fistula-in-Ano.: Lee, Yong Jik , Lee, Mi Ok , Kim, Sung Su , Lee, Young Taek , Park, Yong Ki , Choi, Chang Rock; J Korean Soc Coloproctol. 1999;15(4):321-330.

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Abstract PDF: PURPOSE
The results for treatment of fistula-in-ano have much improved, along with the development of anatomical knowledge, classification, and operative techniques, during last several decades. The authors retrospectively reviewed the results for treatment of fistula-in-ano, especially complex fistulas, during the last 11 years.
METHODS
A retrospective study of fistula-in-ano was performed for 229 patients who had been operated on in St. Benedict Hospital between January 1988 and December 1998. Complex fistulas (IIH, III & IV) were analyzed separately.
RESULTS
The most common type was IILs (92 cases, 40.2%), and the most common horseshoe type was IIIBc (5 cases, 2.2%). The average hospital stay was 11.5 days for all fistula-in-ano types, but 15.1 days for complex fistulas. Non-specific inflammation (209 cases, 91.3%) was the most common pathologic finding. Various operative procedures were used : fistulotomy (80 cases, 34.9%), fistulectomy (74 cases, 32.3%), coring out fistulectomy (63 cases, 27.5%), seton technique (11 cases, 4.8%), and muscle-filling technique (1 case, 0.4%). There was no difference in the recurrence rate among the operative types. Various procedures were tried for complex fistulas, but the sphincter-preserving fistulectomy by Takano seemed to have a low recurrence rate and a short postoperative course. However, because of the small number of cases, this difference in recurrence rate and postoperative course was not statistically significant. The overall postoperative complication rate was 7%: anal infection (4 cases, 1.7%), anal bleeding (3 cases, 1.3%), and urinary retention (2 cases, 0.9%).
CONCLUSIONS
The operations for most of the fistulae, IH, IL & IIL, were simple and uneventful. However, the operations for complex fistulae were complicated and more skill was required. We have thought Takano's operation to be a good curative procedure with less postoperative deformity and shortened postoperative course. However this research couldn't prove that with statistical significance, probably because of the insufficient number of patients. If further cases are collected and continuous follow-up is done, then a better result can be expected.

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