Annals of Coloproctology

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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.

Others

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; Ann Coloproctol. 2026;42(3):303-314. Published online June 26, 2026; DOI: https://doi.org/10.3393/ac.2025.01081.0154

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Graphical Abstract Abstract PDF Supplementary Material: Purpose
Anastomotic leakage remains challenging in left-sided colorectal surgery. We previously proposed a 5-grade visual grading system based on marginal vessel bleeding, indicating that good (grades A/B) to moderate (grade C) perfusion generally ensures safe anastomosis. However, borderline perfusion (grade C) carried additional risk, particularly among older patients or those with comorbidities. We refined this system to determine whether selective resection of grade C bowel could improve perfusion and guide ostomy diversion decisions.
Methods
Eighty patients with left-sided colorectal cancer underwent curative-intent surgery. Intraoperatively, both marginal vessel and mucosal bleeding were assessed. Initial perfusion grade-guided decision-making: grades A/B proceeded to anastomosis, whereas for grade C, additional resection was performed to upgrade perfusion. Ostomy diversion was performed for persistent grade C or prophylactically in high-risk patients.
Results
Among 80 patients, 67 (83.8%) had grades A/B and 13 (16.3%) were initial grade C. Additional resection (mean, 4.5 cm) upgraded perfusion to final grade B in 9 patients (69.2%), enabling primary anastomosis. Overall, 12 patients (15.0%) received ostomy: 4 for persistent grade C and 8 for high-risk indications despite adequate final perfusion. All 76 patients with final grade A/B achieved 0% anastomotic leakage and ischemic colitis. Grade C patients had longer operative times (108.8 minutes vs. 86.6 minutes, P=0.003) with additional procedures. Patients requiring diversion were older with more comorbidities.
Conclusion
By actively applying the intraoperative visual grading system to upgrade borderline perfusion, we achieved low postoperative complication rates. This approach provides a simple and practical strategy to support intraoperative clinical judgment and optimize anastomotic safety.

Complications

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; Ann Coloproctol. 2026;42(3):333-344. Published online June 25, 2026; DOI: https://doi.org/10.3393/ac.2025.01011.0144

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Abstract PDF: Purpose
Early detection is the most critical factor in effectively managing complications following routine colorectal surgery. This study aimed to identify the most effective and useful factors related to body composition and inflammation in the selection of high-risk groups for postoperative complications.
Methods
A retrospective review of 109 patients who underwent elective surgery between January 2021 and May 2023 was conducted. Patients were categorized according to the Clavien-Dindo classification into those discharged without complications (grade 0), those with minor complications (grades 1 and 2), and those with major complications (grade 3+). The characteristics of patients without complications and those with minor or major complications were compared.
Results
Twenty patients developed only minor complications. Bowel obstruction at diagnosis and elevated C-reactive protein (CRP) levels at 2 days postoperatively were statistically significant factors. Eleven patients experienced major complications, and a low lymphocyte count at 2 days postoperatively was a significant predictor of complications. Receiver operating characteristic analysis revealed that CRP levels >125.6 mg/L on postoperative day 2 and lymphocyte count <905 cells/µL were associated with a higher likelihood of minor and major complications.
Conclusion
These findings suggest that monitoring inflammatory markers on postoperative day 2 may help identify patients at risk of complications, enabling early intervention. Further prospective studies are warranted to validate these predictive markers and improve surgical outcomes.

Others

Decreased fluorescence latency and plateau intensity ratio as predictive markers of intraoperative hypoperfusion: quantitative indocyanine green perfusion analysis in colorectal cancer surgery: Paulina Daniluk-Marsy, Johannes Castelein, Karol Połom, Luigi Marano, Ronald J. H. Borra; Ann Coloproctol. 2026;42(3):324-332. Published online May 27, 2026; DOI: https://doi.org/10.3393/ac.2025.01298.0185

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Graphical Abstract Abstract PDF: Purpose
Intraoperative hypoperfusion is a major risk factor for postoperative anastomotic complications in colorectal surgery. Although most perfusion assessments emphasize arterial inflow, the roles of latency, sustained fluorescence, and venous outflow remain underexplored. This study aimed to identify quantitative indocyanine green (ICG) fluorescence parameters predictive of intraoperative hypoperfusion.
Methods
Eighty patients who underwent colorectal cancer resection between 2018 and 2022 were analyzed. Intraoperative perfusion was evaluated qualitatively using near-infrared ICG angiography and quantitatively through post hoc analysis of fluorescence time-intensity curves. Associations with hypoperfusion were assessed using group comparisons and receiver operating characteristic (ROC) analysis.
Results
Qualitative evaluation indicated hypoperfusion requiring intraoperative relocation of the anastomotic site in 12 patients (15%), with postoperative leakage in 1 patient (1.2%) despite revision of the anastomosis. Quantitative analysis showed that latency was significantly shorter in hypoperfused cases (5.5 seconds [interquartile range (IQR), 1.0–13.0 seconds] vs. 20.0 seconds [IQR, 6.8–27.0 seconds]; P=0.003), and the plateau intensity ratio (PIR; Fplateau/Fmax) was markedly decreased (0.6 [IQR, 0.6–0.7] vs. 0.8 [IQR, 0.6–0.9]; P=0.045). The ROC analysis demonstrated good diagnostic performance for latency (area under the curve [AUC], 0.76; sensitivity, 33.3% [95% confidence interval (CI), 13.8–60.9]; specificity, 92.8% [95% CI, 84.1–96.9]; positive likelihood ratio, 4.6) and moderate accuracy for PIR (AUC, 0.68; sensitivity, 66.7% [95% CI, 39.1–86.2]; specificity, 68.1% [95% CI, 56.4–77.9]; positive likelihood ratio, 2.1).
Conclusion
Quantitative fluorescence analysis identified latency and PIR as complementary markers of perfusion dynamics. Whereas latency reflects early arterial inflow kinetics, PIR captures outflow characteristics related to microvascular and venous integrity. Combining these metrics may improve intraoperative detection of hypoperfusion and support data-driven decisions regarding anastomotic site selection.

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.

Complications

Guideline-concordant antibiotic prophylaxis on surgical site infection rates following colorectal surgery: real-world data from Thailand: Prapakorn Tanyakul, Varut Lohsiriwat, Pichapat Ngarmskunroongrote, Naddanai Kaewjaidee; Ann Coloproctol. 2026;42(2):208-215. Published online April 17, 2026; DOI: https://doi.org/10.3393/ac.2025.00913.0130

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Abstract PDF: Purpose
Antibiotic prophylaxis (AP) is a key component in preventing surgical site infections (SSIs). The existing gap between clinical guidelines and real-world practice may influence SSI rates. This study aimed to compare SSI rates between patients receiving guideline-concordant AP based on the 2020 Thailand guideline (group A) and those receiving broader-spectrum and/or prolonged prophylaxis (group B).
Methods
We reviewed a database of adult patients who underwent elective colorectal resection between January 2022 and April 2024 at the largest university hospital in Thailand. SSIs were diagnosed using the US Centers for Disease Control and Prevention’s criteria. SSI rates between the 2 groups were compared, and factors associated with SSIs were determined.
Results
This study included 1,584 patients, with an average age of 66 years, and 822 (51.9%) were male. The most common operation was anterior resection (n=470, 29.7%). A total of 1,030 patients (65.0%) underwent open surgery, and 228 patients (14.4%) had stoma formation. There were 405 patients (25.6%) in group A. Overall, SSIs occurred in 104 patients (6.6%): 69 incisional SSIs (4.4%) and 35 organ/space SSIs (2.2%). There was no significant difference in SSI rates between groups (group A vs. group B: 4.7% [95% confidence interval (CI), 2.9%–7.2%] vs. 7.2% [95% CI, 5.8%–8.8%]; P=0.078). Multivariate analysis identified 3 independent predictors of SSIs: hypoalbuminemia (odds ratio [OR], 2.53; 95% CI, 1.54–4.16; P<0.001), obesity (OR, 1.89; 95% CI, 1.08–3.32; P=0.026), and intraoperative blood loss greater than 400 mL (OR, 1.83; 95% CI, 1.06–3.16; P=0.031).
Conclusion
There was no significant difference in SSI rates following colorectal surgery between patients receiving guideline-concordant AP and those receiving broader-spectrum and/or prolonged prophylaxis.

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.

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

Colorectal cancer

Safety and efficacy of chemoprevention for familial adenomatous polyposis: a systematic review and meta-analysis: Francisco Tustumi, Amanda Park, Eric Toshiyuki Nakamura, Thaís Cabral de Melo Viana, Elis Nogara Lisboa, Rodrigo Moisés de Almeida Leite, Sergio Eduardo Alonso Araujo, Pedro Luiz Serrano Usón Jr, Kaique Flávio Xavier Cardoso Filardi; Ann Coloproctol. 2026;42(1):34-46. Published online February 25, 2026; DOI: https://doi.org/10.3393/ac.2025.01018.0145

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1 Web of Science
1 Citations

Abstract PDF Supplementary Material

Purpose
Familial adenomatous polyposis is a hereditary condition that predisposes individuals to colorectal cancer. This study aimed to evaluate the efficacy and safety of pharmacological therapies for reducing polyp number, burden, and size in individuals with familial adenomatous polyposis.
Methods
A systematic search was conducted in PubMed, Embase, Web of Science, and Cochrane. Randomized trials assessing the effects of pharmacological interventions on polyp number, polyp burden, and polyp size were included, and adverse events were also analyzed.
Results
Sixteen studies (n=985) met the inclusion criteria. The mean participant age was 38±8.3 years, with a mean follow-up of 14.6±15.8 months. Of these studies, 62.5% focused on colorectal polyps, 18.8% on rectal polyps, 18.8% on duodenal polyps, and 12.5% addressed both colorectal and duodenal polyps. Pharmacological interventions were associated with a modest but statistically significant reduction in the number of polyps (Hedges g, −0.57; 95% confidence interval [CI], −1.08 to −0.05) and in average polyp size (Hedges g, −0.26; 95% CI, −0.49 to −0.04). However, no significant reduction in overall polyp burden was observed (Hedges g, −1.07; 95% CI, −2.21 to 0.06). In subgroup analyses, nonselective cyclooxygenase inhibitors produced a large reduction in polyp burden (Hedges g, −2.72; 95% CI, −3.28 to −2.16), while metformin also demonstrated benefit in a single study (Hedges g, −1.06; 95% CI, −1.86 to −0.27). Adverse events were generally infrequent and comparable to placebo. Conclusion: Chemopreventive interventions may reduce polyp number, burden, and size, and they appear to have a favorable safety profile.

Citations

Citations to this article as recorded by

Advances in chemoprevention of familial adenomatous polyposis
Ruicheng Li, Rong Cao, Jiaqi Kang, Yuwei Li, Xin Lin, Zhao Zhang
Frontiers in Oncology.2026;[Epub] CrossRef

Colorectal cancer

Immunotherapy for microsatellite-stable colorectal cancer: overcoming resistance and exploring novel therapeutic strategies: Sun Young Kim; Ann Coloproctol. 2026;42(1):47-57. Published online February 19, 2026; DOI: https://doi.org/10.3393/ac.2025.01354.0193

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4 Citations

Abstract PDF

Microsatellite-stable (MSS) colorectal cancer (CRC), comprising 85% to 95% of all CRC cases, represents a significant therapeutic challenge in the era of cancer immunotherapy. Unlike microsatellite instability-high tumors that demonstrate remarkable responses to immune checkpoint inhibitors, MSS CRC exhibits profound resistance due to low tumor mutational burden, minimal T-cell infiltration, and an immunosuppressive tumor microenvironment. This article reviews the current landscape of immunotherapy trials in MSS CRC, including the recently reported STELLAR-303 study, discusses emerging predictive biomarkers such as tumor mutational burden, Immunoscore Immune Checkpoint (Immunoscore-IC), and artificial intelligence-driven tools like Lunit SCOPE, and explores innovative strategies to overcome immune resistance, including next-generation anti–cytotoxic T-lymphocyte–associated protein-4 (anti–CTLA-4) antibodies, programmed cell death-ligand 1 (PD-L1)/interleukin-2 (IL-2) bispecific antibodies, CD47-targeting strategies, vaccines, and chimeric antigen receptor T (CAR-T) cell therapy. Understanding these evolving strategies is critical for advancing precision immunotherapy in this challenging patient population.

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
Copper-driven nanoadjuvant reverses immunosuppression in colorectal cancer by orchestrating metabolic dysfunction and innate immune activation
Yaying Zhang, Yichun Huang, Shanshan Liu, Hailong Tian, Qinxia Chang, Tingting Zhang, Fanchen Yan, Qin Ye, Canhua Huang, Na Xie
Chemical Engineering Journal.2026; 540: 177486. CrossRef
Site‐ and age‐dependent associations between Fusobacterium nucleatum and colorectal cancer mortality
Nicole C. Loroña, Scott LaBrie, Claire E. Thomas, Hang Yin, Jeroen R. Huyghe, Conghui Qu, Sushma Thomas, Sosun Nayemi, Hamza Ammar, Orsalem Kahsai, Li Hsu, Keith R. Curtis, Amanda Koehne, Diana G. Redwood, Li Li, Christopher I. Li, Ulrike Peters, Timothy
Cancer.2026;[Epub] CrossRef
Fusobacterium nucleatum, succinate signaling, and immunotherapy resistance in colorectal cancer: clinical relevance and translational opportunities
Jiaqi Niu, Weitong Sun, Ruiqian Gong, Qingchun Pan
Clinical and Translational Oncology.2026;[Epub] CrossRef

Original Articles

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.

ERAS

Safety and patient’s satisfaction of preoperative carbohydrate drink until 2 hours before colorectal cancer surgery: a single-center, prospective randomized controlled trial: Yun Min Lee, Kyeong Eui Kim, Sung Uk Bae, Seong Kyu Baek, Woon Kyung Jeong; Ann Coloproctol. 2025;41(6):519-527. Published online December 24, 2025; DOI: https://doi.org/10.3393/ac.2025.00521.0074

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Abstract PDF

Purpose
Traditionally, fasting from midnight has been a standard practice in elective surgery for reduce the risk of aspiration. However, Enhanced Recovery After Surgery (ERAS) programs recommend clear fluid intake until 2 hours before anesthesia. This study aimed to evaluate the safety and patient satisfaction of preoperative carbohydrate drink intake until 2 hours before colorectal cancer surgery.
Methods
Sixty patients who underwent colorectal cancer surgery between April 2021 and February 2023 at Keimyung University Dongsan Medical Center were enrolled. This study included 30 patients who fasted from midnight (nothing by mouth [NPO] group) and 30 patients who consumed a high concentration of complex carbohydrate fluids (New Care NO-NPO) until 2 hours before surgery (No-NPO group). Patient satisfaction was assessed using a visual analog scale. Perioperative and postoperative outcomes were compared.
Results
Basic characteristics of patients were similar for the 2 groups. The No-NPO group had a significantly higher patient satisfaction score than the NPO group (3.7 vs. 2.2, P=0.040). Scores of operative difficulty, operation time, blood loss, postoperative recovery parameters, and postoperative complication rates were similar for the 2 groups. Pathological outcomes were also comparable. No mortality occurred in either group.
Conclusion
High-concentration carbohydrate fluid intake until 2 hours before induction of anesthesia could improve patient satisfaction without increasing postoperative complications, demonstrating its safety and feasibility in colorectal cancer surgery. Trial registration CRIS (cris.nih.go.kr) identifier: KCT0011323.

Citations

Citations to this article as recorded by

Consumption of a 12.5% carbohydrate after 8 h of fasting does not delay gastric emptying in healthy volunteers: a single-blind, randomized, non-inferiority trial
Gang Zhang, Xiaoyan Huang, Ji Feng, Wenchao Yin, Fu Yao
Frontiers in Nutrition.2026;[Epub] CrossRef
Functional recovery after abdominal surgery and the emerging role of acupuncture
Qian-Qian Xu, Yan Yu, Yu-Ning Gao
World Journal of Gastrointestinal Surgery.2026;[Epub] CrossRef

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

Citations to this article as recorded by

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.

Colorectal cancer

Prognostic significance of carbohydrate antigen 19-9 (CA19-9) change during immediate postoperative periods in patients with stage I–III colorectal cancer: Wooram Choi, Yongjung Park, Jeonghyun Kang; Ann Coloproctol. 2025;41(5):400-408. Published online October 23, 2025; DOI: https://doi.org/10.3393/ac.2025.00528.0075

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Abstract PDF Supplementary Material

Purpose
Although carbohydrate antigen 19-9 (CA19-9) may exhibit low sensitivity in tumor screening, its prognostic significance has been highlighted. This study assessed the significance of preoperative CA19-9 and early postoperative CA19-9 levels in patients with nonmetastatic colorectal cancer (CRC).
Methods
Patients diagnosed with stage I–III CRC between January 2004 and April 2014 were included. Preoperative CA19-9 was assessed within 2 months of operation, whereas postoperative CA19-9 was measured 4 to 7 days after operation. The optimal cutoff values for preoperative and postoperative CA19-9 were established to maximize the differences in overall survival. Patients were categorized into 3 groups based on the CA19-9 change (CA19-9 trend): group 1, low preoperative CA19-9; group 2, high preoperative and low postoperative CA19-9; and group 3, high preoperative and postoperative CA19-9. The discriminatory powers of all variables were compared using the concordance index.
Results
A total of 816 patients were included. The determined cutoff values for preoperative and postoperative CA19-9 were 18.9 and 21.4 U/mL, respectively. Subgroup dichotomization revealed associations of preoperative CA19-9, postoperative CA19-9, and CA19-9 trend with overall survival in univariable analysis. The CA19-9 trend emerged as an independent prognostic factor in the multivariable analysis (group 1 vs. group 2: hazard ratio, 1.682 [95% confidence interval (CI), 1.043–2.710], P=0.032; group 1 vs. group 3: hazard ratio, 2.882 [95% CI, 1.899–4.371], P<0.001). The concordance index value of the CA19-9 trend (0.636; 95% CI, 0.509–0.682) surpassed those of preoperative and postoperative CA19-9.
Conclusion
The amalgamation of preoperative and postoperative CA19-9 levels demonstrated enhanced prognostic stratification, allowing for a more detailed classification of patients with nonmetastatic CRC.

Citations

Citations to this article as recorded by

Small bowel metastasis from colorectal cancer in patients with inflammatory bowel disease: a diagnostic challenge
Timothy James Ford, Deloshaan Subhaharan, Sneha John, Pradeep Kakkadasam Ramaswamy
BMJ Case Reports.2026; 19(4): e270330. CrossRef
Development and external validation of a preoperative CT body composition-based model for predicting postoperative metastasis in colorectal cancer: a multicenter retrospective cohort study
Ke Yin, Wenjuan Ba, Rongyu Zhou, Guanyi Liao, Qingling Li, Jinjun Guo
Abdominal Radiology.2026;[Epub] CrossRef

Complications

Efficacy and safety of novel alginate-based sealants (SEAL-G and SEAL-G MIST) in reducing anastomotic leakage following colorectal anastomosis: a prospective multicenter study: Moshe Kamar, Fahim Kanani, Antonio Spinelli, David Jayne, Lior Segev, Matt Tutton, Isacco Montroni, Hagit Tulchinsky, Mordechai Shimonov, Ron Lavy, Oded Zmora; Ann Coloproctol. 2025;41(5):424-433. Published online October 23, 2025; DOI: https://doi.org/10.3393/ac.2025.00297.0042

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Abstract PDF Supplementary Material

Purpose
This study aimed to evaluate the efficacy, usability, and safety of the novel alginate-based sealants SEAL-G and SEAL-G MIST in reducing anastomotic leakage after colorectal resection.
Methods
This prospective, multicenter study enrolled 160 patients undergoing elective colonic resection with primary anastomosis at 8 centers. SEAL-G was applied in open procedures (n=33), and SEAL-G MIST was used for minimally invasive procedures (n=127), with both sealants applied circumferentially to the anastomotic site. The primary endpoints included the rate of anastomotic coverage and the incidence of leakage within 30 days, classified according to the International Study Group of Rectal Cancer (ISGRC) criteria.
Results
The overall anastomotic leak rate was 3.1% (5 of 160), with only 1 patient (0.6%) experiencing a grade C leak that required reoperation. Four patients (2.5%) developed grade A or B leaks, all of which were managed conservatively. Complete circumferential sealant coverage was achieved in 93.1% of cases. The overall leak rates were 6.1 percent and 2.4 percent, respectively. However, statistical analysis did not show a significant difference. Mean hospital stay was significantly shorter after laparoscopic surgery compared to open surgery (5.1±2.8 days vs. 8.4±5.5 days, P<0.001).
Conclusion
Alginate-based sealants show promise in reducing the severity of anastomotic leaks and in supporting anastomotic healing, demonstrating high technical success and low complication rates. Trial registration: ClinicalTrials.gov identifier: NCT04532515

Citations

Citations to this article as recorded by

Long-Term Safety and Efficacy of Alginate-Based Serosal Reinforcement (SEAL-G/SEAL-G MIST) Following Colorectal Anastomosis: A Multicenter, Comparative and Retrospective Cohort Study
Fahim Kanani, Antonino Spinelli, Mordechai Shimonov, Husam Zbede, Nouha Hinnawi, Ron Lavy, Oded Zmora, Moshe Kamar
Journal of Clinical Medicine.2026; 15(4): 1448. CrossRef

Complications

Effect of oral antibiotic bowel preparation versus no preparation on surgical site infections in elective colorectal surgery: a randomized trial: Kavyashree Mallesh, Rajendran Theakarajan, Balasubramanian G, Prashant Penumadu, Raja Kalayarasan, Rajkumar Nagarajan; Ann Coloproctol. 2025;41(5):393-399. Published online October 20, 2025; DOI: https://doi.org/10.3393/ac.2025.00633.0090

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Abstract PDF

Purpose
Surgical site infections (SSIs) represent a significant cause of morbidity following colorectal surgery. While mechanical bowel preparation combined with oral antibiotics is known to reduce SSIs, the independent effect of oral antibiotics alone remains unclear. This study compared the efficacy of oral antibiotic bowel preparation (OABP) versus no bowel preparation (NBP) in reducing SSIs among patients undergoing elective colorectal surgery.
Methods
A prospective, randomized, double-blinded trial was performed at a tertiary care center in India. Eighty-six patients scheduled for elective colorectal surgery were randomized to receive either OABP (oral ciprofloxacin and metronidazole) or placebo, in addition to standard intravenous antibiotics. The primary outcome was the rate of SSIs. Secondary outcomes included anastomotic leak, length of hospital stay, overall morbidity, and readmission rates.
Results
Baseline characteristics were comparable between the groups. The incidence of SSI was significantly lower in the OABP group compared to the NBP group (14.0% vs. 41.9%, P<0.01). The severity of infections and postoperative complications was also reduced in the OABP group (P<0.01). Although rates of anastomotic leak, readmission, and reoperation were higher in the NBP group, these differences were not statistically significant. The mean duration of hospital stay was shorter for patients in the OABP group (8.09 days vs. 11.28 days, P<0.01). No adverse effects related to oral antibiotics were observed.
Conclusion
OABP without mechanical cleansing significantly reduces SSIs, postoperative morbidity, and length of hospital stay in elective colorectal surgery. This approach is safe and effective, offering a strategy to improve surgical outcomes.

Citations

Citations to this article as recorded by

Bowel Preparation for Colorectal Surgery: Evolution, Evidence, and Contemporary Practice
Rajendran Theakarajan, Subramanian Ashuvanth, Govindarajan Rajagopalan
Indian Journal of Colo-Rectal Surgery.2026; 9(1): 7. CrossRef
Oral antibiotics alone for bowel preparation in colorectal surgery: time to rethink tradition?
Soo Young Lee
Annals of Coloproctology.2025; 41(5): 367. CrossRef

Review

Translation/basic research

Extracellular vesicles in colorectal cancer: Young Il Kim, Chungyeop Lee, Hakho Lee, In Ja Park; Ann Coloproctol. 2025;41(5):379-392. Published online October 16, 2025; DOI: https://doi.org/10.3393/ac.2025.00745.0106

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Abstract PDF: Colorectal cancer (CRC) remains a major global health issue, with challenges including early detection and recurrence monitoring. While colonoscopy and fecal-based tests are standard screening tools, their limitations have driven interest in less invasive alternatives. Extracellular vesicles (EVs) present in patient liquid biopsy samples have emerged as potential biomarkers and therapeutic tools in CRC. EVs carry molecular cargo, including nucleic acids and proteins, that reflect the status of their cells of origin and can be readily accessed through minimally invasive liquid biopsy. This review outlines the role of EVs in the initiation and progression of CRC, summarizes recent advances in EV isolation techniques, and highlights candidate EV-derived biomarkers for diagnosis, prognosis, and treatment monitoring. By providing an updated synthesis of current research, this review aims to inform future studies and support clinical translation of EV-based approaches in CRC.

Original Articles

Minimally invasive surgery

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; Ann Coloproctol. 2025;41(5):434-442. Published online October 16, 2025; DOI: https://doi.org/10.3393/ac.2025.00227.0032

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Abstract PDF Supplementary Material

Purpose
Laparoscopic low anterior resection for rectal cancer is technically challenging due to the precision required for mesorectal excision. Articulated instruments were developed to improve precision and oncological safety over conventional instruments. This study compares their perioperative outcomes.
Methods
A retrospective cohort study of 432 patients with colorectal cancer who underwent low anterior resection between August 2022 and February 2024 applied propensity score matching to minimize selection bias. Primary endpoints were circumferential resection margin (CRM), distal resection margin (DRM), and harvested lymph nodes count. Secondary outcomes included postoperative complications.
Results
Following propensity score matching, 84 matched pairs were analyzed. Most patients achieved CRM negativity (>1 mm), with CRM ≥10 mm in 67.9% of the articulated group and 59.5% of the conventional group (P=0.613). Median (interquartile range, IQR) lymph nodes harvests were comparable (20 [14–26] vs. 18 [14–22], P=0.147). The articulated group had a significantly longer DRM (30.0 mm [IQR, 18.0–40.0 mm] vs. 24.0 mm [IQR, 12.0–34.2 mm], P=0.008) and the median operation time (111.0 minutes [IQR, 95.8–125.2 minutes] vs. 99.5 minutes [IQR, 72.0–119.8 minutes], P=0.009). Estimated blood loss, open conversion rates, and postoperative complications, including leakage (7.1% vs. 8.3%, P>0.999) and surgical site infections, (15.5% vs. 9.5%, P=0.383), showed no significant differences.
Conclusion
Articulated laparoscopic instruments demonstrated comparable safety and feasibility to conventional instruments but offered no significant clinical or oncological benefits beyond a longer DRM. Larger studies are needed to evaluate their value in laparoscopic rectal surgery.

Citations

Citations to this article as recorded by

Comparative perioperative outcomes of single-port laparoscopic ArtiSential versus da Vinci SP platform for totally extraperitoneal inguinal hernia repair: a multi-institutional, propensity score-matched analysis in Korea
In Kyeong Kim, Moonjin Kim, Ji-Yeon Moon, Ri Na Yoo, Jumyeong Song, Chaedong Lim, Choon Sik Chung, Gwan Cheol Lee, Tae Gyu Kim, Young Sun Choi, Dong Geun Lee, Chul Seung Lee
Journal of Minimally Invasive Surgery.2026; 29(1): 3. CrossRef

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

Citations to this article as recorded by

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

Evaluation of the utility of a nomogram for predicting lymph node metastasis in T1 colorectal cancer in shared decision-making in clinical practice: a survey-based study: Hyeon Seung Kim, Kyung Su Han, Min Wan Lee, Dae Kyung Sohn, Chang Won Hong, Dong Woon Lee, Kiho You, Sung Chan Park, Byung Chang Kim, Bun Kim, Jae Hwan Oh; Ann Coloproctol. 2025;41(4):303-309. Published online August 25, 2025; DOI: https://doi.org/10.3393/ac.2025.00318.0045

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Abstract PDF

Purpose
In 2019, we reported a novel nomogram to predict lymph node metastasis (LNM) in T1 colorectal cancer. Herein, we conducted a survey-based study to evaluate the clinical utility of this nomogram in determining the need for additional surgery after endoscopic resection for high-risk T1 colorectal cancer.
Methods
A survey was conducted among 77 members of the Korean Society of Coloproctology and 25 members of the Korean Society of Gastrointestinal Endoscopy. The survey assessed decision-making regarding additional surgery after endoscopic resection for high-risk T1 colorectal cancer according to various predicted LNM rates (3%, 10%, and 27%) and tumor locations (anal verge [AV] 2, 7, and 25 cm). Additionally, participants provided feedback regarding the reliability, usefulness, and potential adoptability of the prediction model in patient counseling.
Results
Of the 2,314 surveys distributed, 102 responses were analyzed. A trend was observed in which tumors located closer to the anus and associated with a lower predicted risk of LNM were less likely to lead respondents to opt for surgery (e.g., AV 2 cm and 3% of predicted LNM risk, 21.6% opt for surgery vs. AV 25 cm and 27% of predicted LNM risk, 98.0% opt for surgery). Additionally, 94.1% of the respondents reported that the prediction model would be helpful in clinical decision-making and patient counseling.
Conclusion
Our findings suggest that the nomogram is an effective and reliable tool for guiding treatment strategies and enhancing consultations in patients with T1 colorectal cancer.

Citations

Citations to this article as recorded by

Pathological risk stratification after endoscopic resection of T1 colorectal cancer: a comparative analysis of international guidelines
Hyun Tae Lim, Dae Kyung Sohn
Journal of Minimally Invasive Surgery.2026; 29(1): 31. CrossRef

Metastasis or chemotherapy

Effectiveness of oxaliplatin-based second-line therapy following cetuximab+FOLFIRI or bevacizumab+FOLFIRI in KRAS wild-type metastatic colorectal cancer without primary tumor resection: Yi-Chia Su, Chien-Chou Su, Pei-Ting Lee, Chih-Chien Wu; Ann Coloproctol. 2025;41(4):319-329. Published online August 21, 2025; DOI: https://doi.org/10.3393/ac.2025.00087.0012

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Abstract PDF: Purpose
Wild-type unresectable metastatic colorectal cancer (mCRC) poses challenges for treatment optimization. Effective first-line targeted therapies are crucial for improving outcomes, particularly when combined with second-line oxaliplatin-based chemotherapies. This study examined the effects of first-line cetuximab+FOLFIRI versus bevacizumab+FOLFIRI, followed by second-line oxaliplatin-based chemotherapy, on survival among patients with KRAS wild-type mCRC without primary tumor resection (PTR).
Methods
A retrospective analysis of Taiwanese data (2013–2019) included patients with KRAS wild-type unresectable mCRC who received first-line cetuximab+FOLFIRI or bevacizumab+FOLFIRI, followed by second-line oxaliplatin-based chemotherapy. Survival outcomes—overall survival (OS) and time to treatment discontinuation (TTD)—were compared between these regimens using stabilized inverse probability of treatment weighting to adjust for potential confounders, followed by multivariate Cox proportional hazards regression analysis to account for clinical and biological variables.
Results
In patients without PTR, first-line cetuximab+FOLFIRI with second-line oxaliplatin-based chemotherapy significantly improved OS from the start dates of first- and second-line treatment compared to first-line bevacizumab+FOLFIRI with second-line oxaliplatin-based therapy, yielding adjusted hazard ratios (HRs) of 0.60 (95% confidence interval [CI], 0.46–0.78) and 0.56 (95% CI, 0.42–0.73), respectively. No significant difference in TTD was observed (HR, 0.82; 95% CI, 0.65–1.04).
Conclusion
First-line cetuximab+FOLFIRI followed by second-line oxaliplatin-based chemotherapy offers superior OS compared to bevacizumab+FOLFIRI followed by second-line oxaliplatin‑based chemotherapy in KRAS wild-type mCRC without PTR. These findings underscore the importance of personalized treatment sequencing, highlighting the need for further research to optimize mCRC management.

ERAS

The efficacy of mosapride on recovery of intestinal motility after elective colorectal cancer surgery: a randomized controlled trial: Tharin Thampongsa, Bensita Saengsawang, Chairat Supsamutchai, Chumpon Wilasrusmee, Jakrapan Jirasiritham, Puvee Punmeechao, Visarat Palitnonkiat, Napaphat Poprom, Pattawia Choikrua, Pongsasit Singhathas; Ann Coloproctol. 2025;41(3):232-238. Published online June 25, 2025; DOI: https://doi.org/10.3393/ac.2024.00892.0127

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Abstract PDF Supplementary Material

Purpose
Postoperative ileus is the physiologic hypomotility of the gastrointestinal tract that occurs immediately after abdominal surgery. Mosapride citrate is known to enhance gastrointestinal motility. This study aimed to evaluate mosapride’s impact on postoperative ileus and gastrointestinal motility in patients undergoing elective colorectal surgery.
Methods
Forty-four patients with colorectal cancer undergoing surgery at Ramathibodi Hospital between July 2021 and August 2022 were randomly assigned to either a mosapride group or a control group. The mosapride group received 5 mg of mosapride via the enteric route with 50 mL of water 3 times daily, beginning on postoperative day 1, while the control group received 5 mg of a placebo with 50 mL of water on the same schedule. A single investigator, blinded to the treatment assignments in this triple-blind study, evaluated the postoperative time to the first bowel movement and passage of flatus. Secondary outcomes included the time to step diet, length of postoperative hospital stay, and adverse effects.
Results
There were 23 patients in the control group and 21 in the mosapride group. There were no significant differences in baseline patient characteristics between the 2 groups. The mosapride group demonstrated significantly shorter times to the first bowel movement (26 hours vs. 50 hours, P=0.004) and passage of flatus (40 hours vs. 70 hours, P=0.003).
Conclusion
Mosapride significantly improved the recovery of gastrointestinal motility and reduced the length of hospital stay without causing any serious adverse effects in patients undergoing elective colorectal surgery. Trial registration: ClinicalTrials.gov identifier: NCT04905147

Citations

Citations to this article as recorded by

Mosapride versus Metoclopramide in Critically Ill Patients with Enteral Feeding Intolerance: A Randomized, Double-Blinded Comparison
Eman Mohamed Elmokadem, Dina Khaled Abou El Fadl, Ahmed Bassiouny, Amir Hanna Samy, Nouran Omar El Said
Drug Design, Development and Therapy.2026; Volume 20: 1. CrossRef

Colorectal cancer

How appropriately can generative artificial intelligence platforms, including GPT-4, Gemini, Bing, and Wrtn, answer questions about colon cancer in the Korean language?: Sun Huh; Ann Coloproctol. 2025;41(3):190-197. Published online June 25, 2025; DOI: https://doi.org/10.3393/ac.2024.00122.0017

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Abstract PDF Supplementary Material

Purpose
This study aims to assess the performance of 4 generative artificial intelligence (AI) platforms—Gemini (formerly Bard), Bing, GPT-4, and Wrtn—in answering questions about colon cancer in the Korean language. Two main research questions guided this study. First, which AI platform provides the most accurate answers? Second, can these AI-generated answers be reliably used to educate patients and their families about colon cancer?
Methods
Ten questions selected by the author were posed to the 4 generative AI platforms on February 22, 2024. Two colorectal surgeons in Korea, each with over 20 years of clinical experience, independently evaluated the answers provided by these generative AI platforms.
Results
The generative AI platforms scored an average of 5.5 out of 10 points. Wrtn achieved the highest score at 6 points, followed by GPT-4 and Gemini, each with 5.5, and Bing, scoring 5 points. The weighted κ for inter-rater reliability was 0.597 (P<0.001). The generative AI platforms performed well in explaining the occult blood test for cancer screening, keyhole surgery, and dietary recommendations for cancer prevention. However, they demonstrated significant limitations in answering more complex topics, such as estimating survival rates following surgery, choosing targeted therapy after surgery, and accurately reporting the mortality rate due to colon cancer in Korea.
Conclusion
The findings suggest that using these generative AI platforms as educational resources for patients and their families regarding colon cancer is premature. Further training on colorectal diseases is required before these AI platforms can be considered reliable information sources for the general public in Korea.

Citations

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Expert Review on the Quality of Responses to the Questions of Multiple Myeloma Patients: A Validation Study of the Medical Artificial Intelligence System “Myelobot”
Aleksander Sergeevich Luchinin, O. E. Ochirova, V. G. Potapenko, V. V. Ryabchikova
Clinical Oncohematology.2026; 19(1): 81. CrossRef
Agentic artificial intelligence is the future of cancer detection and diagnosis
Sayedur Rahman, Md. Tanzib Hosain, Nafiz Fahad, Md. Kishor Morol, Md. Jakir Hossen
Array.2026; 29: 100676. CrossRef
Artificial intelligence in gastroenterology clinical practice: Scoping review of large language model applications
Yigit Yazarkan, Gamze Sonmez, Cem Simsek
International Journal of Medical Informatics.2026; 214: 106413. CrossRef
Role of Medical Editors in the Age of Generative Artificial Intelligence
Sun Huh
Healthcare Informatics Research.2025; 31(4): 317. CrossRef
Temporal evolution of large language models (LLMs) in oncology
Zilin Qiu, Aimin Jiang, Chang Qi, Wenyi Gan, Lingxuan Zhu, Weiming Mou, Dongqiang Zeng, Mingjia Xiao, Guangdi Chu, Shengkun Peng, Hank Z. H. Wong, Lin Zhang, Hengguo Zhang, Xinpei Deng, Quan Cheng, Bufu Tang, Yaxuan Wang, Jian Zhang, Anqi Lin, Peng Luo
Journal of Translational Medicine.2025;[Epub] 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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Ke Xu, Min Li, Fengming Hu, Jian Gong, Fangrong Liu, Qiao Liu, Weiwei Wu
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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.

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Fu-Shan Xue, Dan-Feng Wang, Xiao-Chun Zheng
International Journal of Surgery.2025; 111(12): 9993. CrossRef

Complications

Bedside endoscopic inspection of colorectal anastomoses in the early postoperative period: a 2-center prospective feasibility study: David J. Nijssen, Roel Hompes, Jurriaan Tuynman, Jimme K. Wiggers, Willem A. Bemelman, Saidah Sahid, James Kinross, Wytze Laméris; Ann Coloproctol. 2025;41(2):127-135. Published online April 14, 2025; DOI: https://doi.org/10.3393/ac.2024.00584.0083

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Abstract PDF

Purpose
Early diagnosis of anastomotic leakage (AL) after colorectal surgery can reduce severe postoperative morbidity and ensure successful treatment. This study evaluated the feasibility of bedside endoscopic inspection of the anastomosis early postoperatively using a point-of-care digital rectoscope.
Methods
This prospective study was conducted at 2 tertiary centers. Patients who underwent minimally invasive or open sphincter-preserving surgery with creation of a colorectal or coloanal anastomosis were included. Data were collected from December 2022 to October 2023. Bedside anastomotic inspections were performed postoperative day (POD) 3 to 5 using a point-of-care digital rectoscope. The primary outcome was feasibility, defined as adequate clinical assessment of the anastomosis during bedside inspection. Secondary outcomes included patient tolerability, efficacy compared to other diagnostic methods, and clinical outcomes during 90 days of follow-up.
Results
In total, 35 patients were included. All bedside anastomotic inspections were carried out successfully. The examination showed complete visibility of the entire anastomosis in 30 patients (85.7%), with minimal discomfort reported by 3 (8.6%). No adverse events were recorded. AL occurred in 6 patients (17.1%), with 3 cases detected during bedside inspections between POD 3 and 5. Two leaks were detected without clinical or biochemical suspicion. Three patients with negative rectoscopy between POD 3 and 5 were later diagnosed with AL: 2 by a computed tomography scan and 1 by a bedside rectoscopy.
Conclusion
Bedside inspection of rectal anastomoses early postoperatively is feasible and tolerable for patients. Routine anastomotic inspections can detect early AL even without clear clinical or biochemical signs.

Citations

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David J. Nijssen, Mark Broekman, Franny Rensink, Gijs Stuart, Ritch T. J. Geitenbeek, Joost Stael, Susan van Dieren, Willem A. Bemelman, Jurriaan Tuynman, Esther C. J. Consten, Roel Hompes, Wytze Laméris, G. J. D. van Acker, T. S. Aukema, H. J. Belgers, F
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Harpreet Kaur Sekhon Inderjit Singh, Holly Harper, Valentin Butnari, Rebecca Beni, Emilio Lozano, Arnold Goede
BMJ Open.2026; 16(6): e119490. CrossRef
Routine Endoscopic Evaluation of Colorectal Anastomoses for Early Detection of Anastomotic Leakage (REAL Study): Protocol for a Multicenter Prospective Study
David J. Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espín-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes
Digestive Surgery.2025; 42(4): 185. CrossRef

Guideline

ERAS

The 2024 Korean Enhanced Recovery After Surgery (ERAS) guidelines for colorectal cancer: a secondary publication: Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park, the Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition; Ann Coloproctol. 2025;41(1):3-26. Published online February 20, 2025; DOI: https://doi.org/10.3393/ac.2024.00836.0119

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Abstract PDF Supplementary Material

The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition was established to develop ERAS guidelines tailored to the Korean context. This guideline focuses on creating the most current evidence-based practice guidelines for ERAS purposes, based on systematic reviews. All key questions targeted randomized controlled trials exclusively, and if fewer than 2 were available, studies employing propensity score matching were also included. Recommendations for each key question were marked with strength of recommendation and level of evidence following internal and external review processes by the committee.

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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
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Efficacy of preoperative immunonutrition in malnourished patients undergoing colorectal cancer surgery: a study protocol for a multicenter randomized clinical trial
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Original Articles

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

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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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

Anorectal benign disease

Proctitis distal to colorectal anastomosis: a retrospective cohort study of an underreported complication after sigmoidectomy: Ajmal Khan, Maziar Nikberg, Kenneth Smedh, Abbas Chabok; Ann Coloproctol. 2024;40(5):498-505. Published online October 22, 2024; DOI: https://doi.org/10.3393/ac.2023.00675.0096

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Abstract PDF: Purpose
Proctitis distal to colorectal anastomosis is rare and infrequently reported. We evaluated the incidence, symptoms, treatment, and potential risk factors associated with this condition.
Methods
We conducted a retrospective population-based cohort study in Västmanland County, Sweden. This investigation included all patients who underwent sigmoidectomy with colorectal anastomosis between 2008 and 2020. We excluded patients without an anastomosis and those with inflammatory bowel disease.
Results
Of the 546 patients identified, 233 fulfilled the inclusion criteria, of whom 26 (11.2%) developed proctitis distal to colorectal anastomosis. The most frequent symptoms included urgency (n=16, 61.5%), increased stool frequency (n=12, 46.2%), and anorectal pain (n=12, 46.2%). Endoscopic balloon dilation was performed in 20 cases (76.9%), with 10 requiring only a single therapeutic procedure. The median number of dilations was 3 (range, 1–8). Multivariable analysis revealed that surgery due to malignancy and emergency surgery were associated with elevated risk of proctitis. A subgroup analysis of patients who underwent surgery due to malignancy indicated that smoking (odds ratio, 3.9; 95% confidence interval, 1.1–14.0) and emergency surgery (odds ratio, 6.5; 95% confidence interval, 1.1–37.1) were also associated with increased proctitis risk.
Conclusion
Proctitis distal to colorectal anastomosis is not uncommon following sigmoidectomy. Patients undergoing emergency surgery or surgery due to malignancy and who had a history of smoking displayed an increased risk of developing proctitis. Due to the paucity of symptoms observed, particularly in patients with a diverting stoma, routine endoscopic rectal examination should be performed during follow-up after sigmoidectomy.

Reviews

Minimally invasive surgery

Robotic colorectal surgery training: Portsmouth perspective: Guglielmo Niccolò Piozzi, Sentilnathan Subramaniam, Diana Ronconi Di Giuseppe, Rauand Duhoky, Jim S. Khan; Ann Coloproctol. 2024;40(4):350-362. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00444.0063

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Abstract PDF

This study aims to discuss the principles and pillars of robotic colorectal surgery training and share the training pathway at Portsmouth Hospitals University NHS Trust. A narrative review is presented to discuss all the relevant and critical steps in robotic surgical training. Robotic training requires a stepwise approach, including theoretical knowledge, case observation, simulation, dry lab, wet lab, tutored programs, proctoring (in person or telementoring), procedure-specific training, and follow-up. Portsmouth Colorectal has an established robotic training model with a safe stepwise approach that has been demonstrated through perioperative and oncological results. Robotic surgery training should enable a trainee to use the robotic platform safely and effectively, minimize errors, and enhance performance with improved outcomes. Portsmouth Colorectal has provided such a stepwise training program since 2015 and continues to promote and augment safe robotic training in its field. Safe and efficient training programs are essential to upholding the optimal standard of care.

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Shih-Feng Huang, Yung-Lin Tan, Chao-Wen Hsu, Hsin-Ping Tseng, Danilo Miskovic, Chih-Chien Wu
International Journal of Colorectal Disease.2026;[Epub] 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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Lorenzo Spirito, Carmine Sciorio, Vittorio Imperatore, Antonio Di Girolamo, Giuseppe Romeo, Riccardo Giannella, Antonio Ruffo, Fabio Esposito, Lorenzo Romano, Paola Coppola, Luigi Napolitano, Antonio D’Ambrosio, Roberta Siciliano, Guido De Sena
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Michael Devine, Carolyn Cullinane, Helen Mohan, Dara O. Kavanagh, Dara O’Keeffe, Barry B. McGuire, Christina A. Fleming
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Engeng Chen, Li Chen, Wei Zhang
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Sarah Englert, Natascha Tschukewitsch, Alexa Wölfl, Christoph Justinger
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R. Smyth, N. Francis, S. Vasudevan
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Anna K. Kieslich, Ruari Jardine, Hussain Ibrahim, Areeg Calvert, Kenneth G. Walker, Kim A. Walker, Angus J. M. Watson
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From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef

Translational/basic research

Tissue engineering and regenerative medicine approaches in colorectal surgery: Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd; Ann Coloproctol. 2024;40(4):336-349. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00437.0062

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Abstract PDF

Tissue engineering and regenerative medicine (TERM) is an emerging field that has provided new therapeutic opportunities by delivering innovative solutions. The development of nontraditional therapies for previously unsolvable diseases and conditions has brought hope and excitement to countless individuals globally. Many regenerative medicine therapies have been developed and delivered to patients clinically. The technology platforms developed in regenerative medicine have been expanded to various medical areas; however, their applications in colorectal surgery remain limited. Applying TERM technologies to engineer biological tissue and organ substitutes may address the current therapeutic challenges and overcome some complications in colorectal surgery, such as inflammatory bowel diseases, short bowel syndrome, and diseases of motility and neuromuscular function. This review provides a comprehensive overview of TERM applications in colorectal surgery, highlighting the current state of the art, including preclinical and clinical studies, current challenges, and future perspectives. This article synthesizes the latest findings, providing a valuable resource for clinicians and researchers aiming to integrate TERM into colorectal surgical practice.

Citations

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Junpei Takashima, Mitsuo Miyazawa, Masayasu Aikawa, Daisuke Fujimoto, Hirotoshi Kobayashi
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Ana Regina Sampaio, Renata Faria Maia, Maria Camilla Ciardulli, Hélder A. Santos, Bruno Sarmento
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From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef

Benign bowel disease

Colorectal screening following appendectomy in adult patients: a systematic review: Francesco Esposito, Marco Del Prete, Matilde Magri, Fanny Dufour, Alexandre Cortes; Ann Coloproctol. 2024;40(5):417-423. Published online August 1, 2024; DOI: https://doi.org/10.3393/ac.2023.00528.0075

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Abstract PDF

Purpose
Although the association between appendicitis and colorectal cancer in older patients has received attention, postoperative colorectal screening through endoscopy is not currently recommended. This study conducted a systematic review of the literature on colorectal screening following appendectomy in adult patients.
Methods
A literature search was performed using online databases. Studies reporting colorectal surveillance after appendectomy in adult patients were retrieved for assessment.
Results
Eight articles including a total of 3,995 patients were published between 2013 and 2023. An age of 40 years was the lower threshold in 6 of the 8 articles. Postoperative colorectal screening occurred in 771 patients (19.3%). Endoscopy was performed in 95.2% of cases and computed tomography–colonography in 4.8%. During endoscopic examinations, a lesion was discovered in 184 of 771 patients (24.0%), and an adenomatous polyp was found in 154 of 686 patients (22.5%). The overall cancer rate was 3.9% (30 of 771 patients). The tumor was located in the right-sided colon in 46.7% of the patients, in the cecum in 20.0%, in the rectum in 16.7%, in the left-sided colon in 10.0%, and in the sigmoid colon in 6.7%.
Conclusion
Performing post-appendectomy colorectal screening in patients >40 years of age could allow early detection of an underlying lesion.

Citations

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Are the long-term oncologic outcomes different between appendiceal cancer and right-sided colon cancer? An exact matching analysis of a 10-year institutional cohort
Gunwoo Lee, Eun Jung Park, Soo Young Oh, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2026; 110(4): 246. CrossRef
Management of Appendiceal Inflammatory Mass: Nonoperative Treatment, Malignancy Risk, and Surveillance
İlyas Kudaş, Olgun Erdem, Fatih Başak, Zeynep Şevval Aliş, Hüsna Tosun, Yahya Kemal Calışkan, Aylin Acar, Tolga Canbak, Huseyin Kerem Tolan, Kemal Tekeşin
The American Surgeon™.2026; 92(9): 2378. CrossRef
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Shuai Wang, Jingbo Lv, Li Wang, Xueyuan Cao
Frontiers in Cellular and Infection Microbiology.2026;[Epub] CrossRef
An Unusual Culprit Behind Right Lower Quadrant Pain: Cecal Adenocarcinoma Initially Suspected as Appendicitis in an Elderly Female Patient
Michail Angelos Papaoikonomou, Europi Michailidou, Aggeliki Chlorou, Nikolaos Krokos
Cureus.2025;[Epub] CrossRef
Impact of CT‐Detected Appendiceal Fecoliths on Clinical and Histopathological Outcomes in Acute Appendicitis: A Retrospective Cohort Study
Taeyoung Son, Ekua Brenu, Sergei Tsakanov, Lynne Mann
ANZ Journal of Surgery.2025; 95(12): 2550. CrossRef

ERAS

Tolerance to and postoperative outcomes with early oral feeding following elective bowel surgery: a systematic review with meta-analysis: Lord Mvoula, Evelyn Irizarry; Ann Coloproctol. 2024;40(6):538-547. Published online July 31, 2024; DOI: https://doi.org/10.3393/ac.2023.00472.0067

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Abstract PDF

Purpose
Advancements in gastrointestinal surgery have directed attention toward optimizing recovery, including through the use of feeding methods that reduce prolonged postoperative hospital stays, complications, and mortality, among other undesirable outcomes. This study’s primary goals were to identify current peer-reviewed literature reporting the postoperative outcomes of elective bowel surgery and to evaluate the clinical evidence of patients’ tolerance to oral feeding following elective bowel surgery.
Methods
An exhaustive literature search was conducted via PubMed and Scopus. The search results were screened for potential articles, and articles were assessed for eligibility based on prespecified eligibility criteria. The data were synthesized, and the results were reported and discussed thematically.
Results
The database search yielded 1,667 articles, from which 18 randomized controlled trials were chosen for inclusion in this study. This study included 874 early oral feeding (EOF) patients, 865 traditional oral feeding patients, and 91 patients whose postoperative care was unspecified. Data synthesis was done, and meta-analyses were conducted. The results showed that EOF patients required a significantly shorter time to tolerate a solid diet and had shorter hospital stays. In addition, bowel function was restored earlier in EOF groups.
Conclusion
The results show good tolerance to EOF, shorter hospitalizations, and faster restoration of bowel function, suggesting that EOF after elective bowel surgery is relatively safe. However, further studies with similar baseline conditions should be conducted to verify these results.

Citations

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An ERAS-Informed Pathway for Emergency Laparoscopic Repair of Gastroduodenal Perforation: A Pragmatic Pilot Randomized Trial
Zhangjun Wei, Rui Shen, Ping Che, Bo Huang
Indian Journal of Surgery.2026;[Epub] CrossRef
Outcomes of patients with cancer receiving early feeding following gastric, small intestinal or colorectal surgery
Thuy Tran, Bach Hoang, Tien Nguyen, Huong Le
World Academy of Sciences Journal.2025; 7(6): 1. CrossRef
Perioperative nutrition practices in gastrointestinal cancer surgery: A nationwide survey among German surgical departments
Rahel Maria Strobel, Katharina Beyer, Johannes Christian Lauscher, Marc Martignoni, Christoph Reißfelder, Tim Vilz, Arved Weimann, Maria Wobith
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef

Original Articles

Colorectal cancer

Obstructing colorectal cancer: a population-based review of colonic stenting in Queensland, Australia: Cian Keogh, Julie Moore, Danica Cossio, Nick Smith, David A. Clark; Ann Coloproctol. 2024;40(3):268-275. Published online June 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00640.0091

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Abstract PDF: Purpose
Stenting is a useful treatment option for malignant colonic obstruction, but its role remains unclear. This study was designed to establish how stents have been used in Queensland, Australia, and to review outcomes.
Methods
Patients diagnosed with colorectal cancer in Queensland from January 1, 2008, to December 31, 2014, who underwent colonic stent insertion were reviewed. Primary outcomes of 5-year survival, 30-day mortality, and overall length of survival were calculated. The secondary outcomes included patient and tumor factors, and stoma rates.
Results
In total, 319 patients were included, and distant metastases were identified in 183 patients (57.4%). The 30-day mortality rate was 6.6% (n=21), and the 5-year survival was 11.9% (n=38). Median survival was 11 months (interquartile range, 4–27 months). A further operation (hazard ratio [HR], 0.19; P<0.001) and chemotherapy and/or radiotherapy (HR, 0.718; P=0.046) reduced the risk of 5-year mortality. The presence of distant metastases (HR, 2.052; P<0.001) and a comorbidity score of 3 or more (HR, 1.572; P=0.20) increased mortality. Surgery was associated with a reduced risk of mortality even in patients with metastatic disease (HR, 0.14; P<0.001). Twenty-two patients (6.9%) ended the study period with a stoma.
Conclusion
Colorectal stenting was used in Queensland in several diverse scenarios, in both localized and metastatic disease. Surgery had a survival advantage, even in patients with metastatic disease. There was no survival difference according to whether patients were socioeconomically disadvantaged, diagnosed in a major city or not, or treated at private or public hospitals. Stenting proved a valid treatment option with low stoma rates.

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.

Citations

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A prognostic nomogram for colorectal cancer based on ubiquitin-specific protease 21 expression: a retrospective cohort study
Hua Chen, Tianhao Lao, Tong Shen, Yongqiang Wang, Jie Yang
Frontiers in Molecular Biosciences.2026;[Epub] CrossRef
Are the long-term oncologic outcomes different between appendiceal cancer and right-sided colon cancer? An exact matching analysis of a 10-year institutional cohort
Gunwoo Lee, Eun Jung Park, Soo Young Oh, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2026; 110(4): 246. CrossRef
The value of extracellular volume based on spectral CT in lymph node metastasis, perineural invasion, and lymphovascular invasion of colon cancer
Yijie Wang, Jianyao Lu, Yaomin Li, Yaying Yang, Yijun Yu, Zhengyun Sun, Yan Bi, Yuechao Guo, Qiong Zhou, Wenfen Shi, Yamin Li
Abdominal Radiology.2026;[Epub] CrossRef
Circulating Amino Acid Network Remodeling Reveals Systemic Metabolic Reprogramming Predictive of Colorectal Cancer Recurrence and Metastasis
Ji‐Yeon Lee, Jumi Kim, Taehan Yoon, So Hyun Kwon, Su Chan Park, Dohyun Chun, Dohyeong Kim, Eun Jung Park, Hyunwoo Kim, Ji Min Lee
Advanced Science.2026;[Epub] CrossRef
Immunohistochemical Expression of MLH1, PMS2 and P53 in Colorectal Carcinoma with Clinicopathologic Correlation
Saif Raghad Saleem Alhamadani, Zainab Khalid Shehab Almukhtar
Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ).2025; 9(1): 222. CrossRef

Reviews

Colorectal cancer

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

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Abstract PDF

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

Citations

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

ERAS

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

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Abstract PDF

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

Citations

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

Original Articles

Colorectal cancer

Comparing the efficacy of combined versus single immune cell adaptive therapy targeting colorectal cancer: Denis Nchang Che, NaHye Lee, Hyo-Jung Lee, Yea-Won Kim, Solongo Battulga, Ha Na Lee, Won-Kook Ham, Hyunah Lee, Mi Young Lee, Dawoon Kim, Haengji Kang, Subin Yun, Jinju Park, Daeyoun David Won, Jong Kyun Lee; Ann Coloproctol. 2024;40(2):121-135. Published online April 22, 2024; DOI: https://doi.org/10.3393/ac.2023.00402.0057

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165 Download
1 Web of Science

Abstract PDF Supplementary Material: Purpose
Colorectal cancer (CRC) is the most frequent cancer with limited therapeutic achievements. Recently, adoptive cellular immunotherapy has been developed as an antitumor therapy. However, its efficacy has not been tested in CRC. This study investigated the ability of an immune cell cocktail of dendritic cells (DCs), T cells, and natural killer (NK) cells to overcome immunological hurdles and improve the therapeutic efficacy of cell therapy for CRC.
Methods
CRC lysate-pulsed monocyte-derived DCs (Mo-DCs), CRC antigen-specifically expanded T cells (CTL), and in vitro-expanded NK cells were cultured from patient peripheral blood mononuclear cells (PBMC). The ability of the combined immune cells to kill autologous tumor cells was investigated by co-culturing the combined immune cells with patient-derived tumor cells.
Results
The Mo-DCs produced expressed T cell co-stimulating molecules like CD80, CD86, human leukocyte antigen (HLA)-DR and HLA-ABC, at high levels and were capable of activating naive T cells. The expanded T cells were predominantly CD8 T cells with high levels of CD8 effector memory cells and low levels of regulatory T cells. The NK cells expressed high levels of activating receptors and were capable of killing other cancer cell lines (K562 and HT29). The immune cell cocktail demonstrated a higher ability to kill autologous tumor cells than single types. An in vivo preclinical study confirmed the safety of the combined immune cell adaptive therapy showing no therapy-related death or general toxicity symptoms.
Conclusion
The results suggested that combined immune cell adaptive therapy could overcome the limited efficacy of cell immunotherapy.

Colorectal cancer

Estimation of risk posed by malignant polyps amongst colorectal surgeons in Australia and New Zealand: Andrew P. Zammit, Ian Brown, John D. Hooper, David A. Clark, Andrew D. Riddell; Ann Coloproctol. 2024;40(2):114-120. Published online March 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00178.0025

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1 Citations

Abstract PDF Supplementary Material

Purpose
The estimation of the risk posed by malignant polyps for residual or lymphatic disease plays a central role. This study investigated colorectal surgeons’ assessment of these risks associated with malignant polyps.
Methods
A cross-sectional questionnaire was electronically administered to colorectal surgeons in Australia and New Zealand in October 2022. The questionnaire contained 17 questions on demographics, when surgeons consider colorectal resection appropriate, and the risk assessment for 5 hypothetical malignant polyps.
Results
The mean risk of residual or lymphatic disease that would prompt surgeons to recommend colonic resection was 5%. However, this increased to a mean risk of 10% if the malignant polyp was located in the rectum, and the only resection option was abdominoperineal resection with end-colostomy. There was high concordance between the estimated risk of residual or lymphatic disease by colorectal surgeons and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines for the 5 hypothetical malignant polyps, with the ACPGBI estimated risk lying within the 95% confidence interval for 4 of the 5 malignant polyps. Nonetheless, 96.6% of surgeons felt that an online risk calculator would improve clinical practice.
Conclusion
Colorectal surgeons in Australia and New Zealand accurately estimated the risk posed by malignant polyps. An online risk calculator may assist in better conveying risk to patients.

Citations

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Management of the Malignant Rectal Polyp—A Narrative Review
Zhen Hao Ang, Shing Wai Wong
Cancers.2025; 17(9): 1464. CrossRef

Technical Note

Can the Heald anal stent help to reduce anastomotic or rectal stump leak in elective and emergency colorectal surgery? A single-center experience: Michael Jones, Brendan Moran, Richard John Heald, John Bunni; Ann Coloproctol. 2024;40(1):82-85. Published online February 26, 2024; DOI: https://doi.org/10.3393/ac.2023.00038.0005

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223 Download
2 Citations

Abstract PDF

Anastomotic and rectal stump leaks are feared complications of colorectal surgery. Diverting stomas are commonly used to protect low rectal anastomoses but can have adverse effects. Studies have reported favorable outcomes for transanal drainage devices instead of diverting stomas. We describe our use of the Heald anal stent and its potential impact in reducing anastomotic or rectal stump leak after elective or emergency colorectal surgery. We performed a single-center retrospective analysis of patients in whom a Heald anal stent had been used to “protect” a colorectal anastomosis or a rectal stump, in an elective or emergency context, for benign and malignant pathology. Intraoperative and postoperative outcomes were reviewed using clinical and radiological records. The Heald anal stent was used in 93 patients over 4 years. Forty-six cases (49%) had a colorectal anastomosis, and 47 (51%) had an end stoma with a rectal stump. No anastomotic or rectal stump leaks were recorded. We recommend the Heald anal stent as a simple and affordable adjunct that may decrease anastomotic and rectal stump leak by reducing intraluminal pressure through drainage of fluid and gas.

Citations

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Techniques in coloproctology - controversies in coloproctology: resection rectopexy is an underutilised procedure in the management of both symptomatic high-grade internal and external rectal prolapse
J. Bunni, E. D. Courtney
Techniques in Coloproctology.2026;[Epub] 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

Colorectal cancer

Is restrictive transfusion sufficient in colorectal cancer surgery? A retrospective study before and during the COVID-19 pandemic in Korea: Hyeon Kyeong Kim, Ho Seung Kim, Gyoung Tae Noh, Jin Hoon Nam, Soon Sup Chung, Kwang Ho Kim, Ryung-Ah Lee; Ann Coloproctol. 2023;39(6):493-501. Published online December 28, 2023; DOI: https://doi.org/10.3393/ac.2023.00437.0062

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
Blood transfusion is one of the most common procedures used to treat anemia in colorectal surgery. Despite controversy regarding the adverse effects of blood products, surgeons have maintained standards for administering blood transfusions. However, this trend was restrictive during the COVID-19 pandemic because of a shortage of blood products. In this study, we conducted an analysis to investigate whether the restriction of blood transfusions affected postoperative surgical outcomes.
Methods
Medical records of 318 patients who underwent surgery for colon and rectal cancer at Ewha Womans University Mokdong Hospital between June 2018 and March 2022 were reviewed retrospectively. The surgical outcomes between the liberal and restrictive transfusion strategies in pre– and post–COVID-19 groups were analyzed.
Results
In univariate analysis, postoperative transfusion was associated with infectious complications (odds ratio [OR], 1.705; 95% confidence interval [CI], 1.015–2.865; P=0.044). However, postoperative transfusion was not an independent risk factor for the development of infectious complications in multivariate analysis (OR, 1.305; 95% CI, 0.749–2.274; P=0.348). In subgroup analysis, there was no significant association between infectious complications and the hemoglobin threshold level for the administration of a transfusion (OR, 1.249; 95% CI, 0.928–1.682; P=0.142).
Conclusion
During colorectal surgery, the decision to perform a blood transfusion is an important step in ensuring favorable surgical outcomes. According to the results of this study, restrictive transfusion is sufficient for favorable surgical outcomes compared with liberal transfusion. Therefore, modification of guidelines is suggested to minimize unnecessary transfusion-related side effects and prevent the overuse of blood products.

Citations

Citations to this article as recorded by

Коррекция анемии без трансфузий эритроцитсодержащих компонентов донорской крови у пациентов с колоректальным раком
Э.А. Мамедов, И.Б. Кумукова, А.В. Сажин
Гематология. Трансфузиология. Восточная Европа.2026; 12(1): 39. CrossRef

Colorectal cancer

Are the width, length, depth, and area of submucosal invasion predictive of lymph node metastasis in pT1 colorectal cancer?: Olga Maynovskaia, Evgeny Rybakov, Stanislav Chernyshov, Evgeniy Khomyakov, Sergey Achkasov; Ann Coloproctol. 2023;39(6):484-492. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00087.0012

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Abstract PDF

Purpose
Submucosa-limited (pathological T1, pT1) colorectal cancers (CRCs) pose a continuing challenge in the choice of treatment options, which range from local excision to radical surgery. The aim of this study was to evaluate the morphometric and morphologic risk factors associated with regional lymph node metastasis (LNM) in pT1 CRC.
Methods
We performed a histological review of patients who underwent oncological resection between 2016 and 2022. Tumor grade, budding, poorly differentiated clusters (PDCs), cancer gland rupture, lymphovascular invasion (LVI), and presence of deep submucosal invasion (DSI), as well as width, length, total area, and area of DSI, were evaluated as potential risk factors for LNM.
Results
A total of 264 cases of colon and rectal carcinomas with invasion into the submucosal layer (pT1) were identified. LNM was found in 46 of the 264 cases (17.4%). All morphometric parameters, as well as DSI (P=0.330), showed no significant association with LNM. High grade adenocarcinoma (P=0.050), budding (P=0.056), and PDCs (P<0.001) were associated with LNM. In the multivariate analysis, LVI presence remained the only significant independent risk factor (odds ratio, 15.7; 95% confidence interval, 8.5–94.9; P<0.001).
Conclusion
The DSI of T1 CRC, as well as other morphometric parameters of submucosal tumor spread, held no predictive value in terms of LNM. LVI was the only independent risk factor of LNM.

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The results of randomized controlled trial comparing effectiveness of transanal endoscopic microsurgery versus endoscopic submucosal dissection
Evgeny Rybakov, Stanislav Chernyshov, Aleksey Likutov, Evgeny Khomiakov, Oleg Yugai, Mikhail Alekseev, Olga Maynovskaia, Mikhail Tarasov, Sergei Achkasov
Surgical Endoscopy.2026; 40(1): 469. CrossRef
Calibrated Absolute Risk of Lymph-Node-Metastasis After Non-curative Endoscopic Resection of pT1 Colorectal Cancer
Jung Kyong Shin, Hee Cheol Kim, Woo Yong Lee, Seong Hyeon Yun, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park
Annals of Surgical Oncology.2026; 33(8): 6956. CrossRef
Risk-based pathology reporting after endoscopic submucosal dissection for early gastrointestinal cancer: international consensus standards
Kareem Khalaf, Huaqi Li, Mai Iwaya, Christine E Orr, Mark Schneider, Yugo Iwaya, Yuhong Yuan, Yutaka Saito, Yuto Shimamura, Helmut Messmann, Jérémie Jacques, Cesare Hassan, Alessandro Repici, Daniel von Renteln, María Pellisé, Shaimaa Elkholy, John T Ande
Gut.2026; : gutjnl-2025-337567. CrossRef
IMMUNOREACT 8: Immune markers of local tumor spread in patients undergoing transanal excision for clinically N0 rectal cancer
Giulia Becherucci, Cesare Ruffolo, Melania Scarpa, Federico Scognamiglio, Astghik Stepanyan, Isacco Maretto, Andromachi Kotsafti, Ottavia De Simoni, Pierluigi Pilati, Boris Franzato, Antonio Scapinello, Francesca Bergamo, Marco Massani, Tommaso Stecca, An
Surgery.2025; 178: 108902. CrossRef
Long-term outcomes and lymph node metastasis following endoscopic resection with additional surgery or primary surgery for T1 colorectal cancer
Pin-Chun Chen, Yi-Kai Kao, Po-Wen Yang, Chia-Hung Chen, Chih-I Chen
Scientific Reports.2025;[Epub] CrossRef
Management strategies for pT1 rectal cancer following local excision: Insights from a national survey by the AIRO gastrointestinal study group
Elena Galofaro, Paola De Franco, Federico Barbaro, Roberta Menghi, Silvia Pecere, Angela Romano, Silvia Di Franco, Rita Marina Niespolo, Mariantonietta Gambacorta, Giuditta Chiloiro
Journal of Radiation Research and Applied Sciences.2025; 18(4): 101955. CrossRef
Problems and prospects of using morphological risk factors for lymph node metastasis in T1 colorectal cancer (review)
O. A. Mainovskaya
Koloproktologia.2025; 24(4): 177. CrossRef

Technical Note

Minimally invasive surgery

Robotic natural orifice specimen extraction surgery (NOSES) for anterior resection: Toan Duc Pham, Tomas Larach, Bushra Othman, Amrish Rajkomar, Alexander G. Heriot, Satish K. Warrier, Philip Smart; Ann Coloproctol. 2023;39(6):526-530. Published online December 19, 2023; DOI: https://doi.org/10.3393/ac.2022.00458.0065

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Abstract PDF Supplementary Material

Minimally invasive colorectal surgery is currently well-accepted, with open techniques being reserved for very difficult cases. Laparoscopic colectomy has been proven to have lower mortality, complication, and ostomy rates; a shorter median length of stay; and lower overall costs when compared to its open counterpart. This trend is seen in both benign and malignant indications. Natural orifice specimen extraction surgery (NOSES) in colorectal surgery was first described in the early 1990s. Three recent meta-analyses comparing transabdominal extraction against NOSES concluded that NOSES was superior in terms of overall postoperative complications, recovery of gastrointestinal function, postoperative pain, aesthetics, and hospital stay. However, NOSES was associated with a longer operative time. Herein, we present our technique of robotic NOSES anterior resection using the da Vinci Xi platform in diverticular disease and sigmoid colon cancers.

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Aimin Jiang, Zhao Tang, Hanzhong Zhang, Jinxin Li, Jialin Meng, Ying Liu, Yu Fang, Juan Lu, Xu Zhang, Le Qu, Anqi Lin, Linhui Wang
Med Research.2025; 1(3): 378. CrossRef
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Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef

Review

Colorectal cancer

Essential anatomy for lateral lymph node dissection: Yuichiro Yokoyama, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Shigenobu Emoto, Hiroyuki Matsuzaki, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Daisuke Hojo, Soichiro Ishihara; Ann Coloproctol. 2023;39(6):457-466. Published online December 8, 2023; DOI: https://doi.org/10.3393/ac.2023.00164.0023

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Abstract PDF

In Western countries, the gold-standard therapeutic strategy for rectal cancer is preoperative chemoradiotherapy (CRT) following total mesorectal excision (TME), without lateral lymph node dissection (LLND). However, preoperative CRT has recently been reported to be insufficient to control lateral lymph node recurrence in cases of enlarged lateral lymph nodes before CRT, and LLND is considered necessary in such cases. We performed a literature review on aspects of pelvic anatomy associated with rectal surgery and LLND, and then combined this information with our experience and knowledge of pelvic anatomy. In this review, drawing upon research using a 3-dimensional anatomical model and actual operative views, we aimed to clarify the essential anatomy for LLND. The LLND procedure was developed in Asian countries and can now be safely performed in terms of functional preservation. Nonetheless, the longer operative time, hemorrhage, and higher complication rates with TME accompanied by LLND than with TME alone indicate that LLND is still a challenging procedure. Laparoscopic or robotic LLND has been shown to be useful and is widely performed; however, without a sufficient understanding of anatomical landmarks, misrecognition of vessels and nerves often occurs. To perform safe and accurate LLND, understanding the landmarks of LLND is essential.

Citations

Citations to this article as recorded by

Colorectal Surgery
John H. Marks, Brandon K. Vu, Sarah Liu, Deborah Nagle
Surgical Clinics of North America.2026;[Epub] CrossRef
Impact of lateral lymph node dissection on urogenital function and surgical outcomes following neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer: a systematic review and meta-analysis
Hao-Zhu Liu, Xiao Bai, Xin-Mao Zhu, Dong-Qiu Dai
Surgical Endoscopy.2026;[Epub] CrossRef
da Vinci robotic-assisted micro-space dissection and autonomic nerve network preservation technique in the total mesorectal excision procedure for rectal cancer: a single-center, retrospective, observational, real-world study
Fanghai Han, Yequan Xie, Guangyu Zhong, Jintao Zeng, Yang Chen, Jianan Tan, Shengning Zhou
Journal of Robotic Surgery.2025;[Epub] CrossRef
Learning curve for lateral lymph node dissection in rectal cancer – a systematic review of literature
D. Kehagias, L. Baldari, E. Cassinotti, L. Boni, C. Lampropoulos, I. Kehagias
Techniques in Coloproctology.2025;[Epub] CrossRef
Deep learning-based vessel and nerve recognition model for lateral lymph node dissection: a retrospective feasibility study
Shoma Sasaki, Daichi Kitaguchi, Tomohiro Noda, Hiroki Matsuzaki, Hiro Hasegawa, Nobuyoshi Takeshita, Masaaki Ito
Langenbeck's Archives of Surgery.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
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
Annals of Coloproctology.2024; 40(4): 363. CrossRef
Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision
Daichi Kitaguchi, Masaaki Ito
Annals of Coloproctology.2024; 40(4): 375. CrossRef

Original Article

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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187 Download
7 Web of Science
8 Citations

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.

Citations

Citations to this article as recorded by

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Enrico Checcucci, Alessandro Veccia, Stefano Puliatti, Pieter De Backer, Pietro Piazza, Karl-Friedrich Kowalewski, Severin Rodler, Mark Taratkin, Ines Rivero Belenchon, Loic Baekelandt, Sabrina De Cillis, Alberto Piana, Ahmed Eissa, Juan Gomez Rivas, Giov
Nature Reviews Urology.2026; 23(1): 50. CrossRef
CONGA: CONscientization GAme for Colon Cancer Literacy in Last-Semester Software Engineering Students
Franklin Parrales-Bravo, Jonatan Guillen-Salabarria, Janio Jadán-Guerrero, Leonel Vasquez-Cevallos
Computers.2026; 15(3): 143. 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
Meeting report on the 8th Asian Science Editors’ Conference and Workshop 2024
Eun Jung Park
Science Editing.2025; 12(1): 66. CrossRef
Toward Diagnosis of Diseases Using Emerging Technologies: A Comprehensive Survey of the State of the Art in Metaverse
Nasim Aslani, Ali Garavand, Riccardo Ortale
International Journal of Intelligent Systems.2025;[Epub] CrossRef
Global perspectives on young-onset colorectal cancer: epidemiology, challenges, and advances
Drew Goldberg, Erica Pettke
Seminars in Colon and Rectal Surgery.2025; 36(3): 101118. CrossRef
#CRCandMe: results of a pre-post quasi-experimental study of a mass media campaign to increase early-onset colorectal cancer awareness in Utah and Wisconsin
Ami E Sedani
American Journal of Cancer Research.2024; 14(8): 3873. CrossRef
Metaverso: perspectivas, possibilidades e limitações
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
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