Annals of Coloproctology

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Original Articles

Colorectal cancer

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

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

Citations

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

Colorectal cancer

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.

Videos

Video clip

Cranial-first approach for laparoscopic extended right hemicolectomy: Kyong-Min Kang, Heung-Kwon Oh, Hong-Min Ahn, Tae-Gyun Lee, Hye-Rim Shin, Mi-Jeong Choi, Duck-Woo Kim, Sung-Bum Kang; Ann Coloproctol. 2024;40(3):282-284. Published online June 19, 2024; DOI: https://doi.org/10.3393/ac.2023.00661.0094

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Abstract PDF Supplementary Material: Complete mesocolic excision and central vascular ligation with D3 lymphadenectomy are important surgical principles for improving oncological outcomes in colon cancer. The cranial-first approach is a colonic mobilization–first approach to radical right hemicolectomy, which has several advantages, including early feasibility assessment, safe dissection from surrounding organs, preestablished inferior margin of lymph node dissection, and revelation of the tangible anatomy of the tributaries of the gastrocolic trunk. This video demonstrates the cranial-first approach to radical right hemicolectomy in a 66-year-old man with locally advanced cecal cancer.

Tips and tricks for robotic lateral pelvic node dissection: James Chi-Yong Ngu, Nan-Zun Teo; Ann Coloproctol. 2023;39(6):531-531. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00766.0109

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Abstract PDF Supplementary Material: Lateral pelvic node dissection can be challenging. In addition to detailed anatomical knowledge of the pelvic side wall, surgeons also need to be proficient in performing fine dissection within the confines of this limited operative field. While the incorporation of robotics can facilitate the safe completion of this technically demanding procedure, this is nonetheless dependent on the way the robotic system is used. This video aims to demonstrate several tips and tricks for performing robotic lateral pelvic node dissection.

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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293 Download
6 Web of Science
6 Citations

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

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 Articles

Minimally invasive surgery

A comparative study of the pathological outcomes of robot-assisted versus open surgery for rectal cancer: René Reyes, Csaba Kindler, Kenneth Smedh, Catarina Tiselius; Ann Coloproctol. 2024;40(2):154-160. Published online December 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00332.0047

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2 Web of Science
3 Citations

Abstract PDF

Purpose
The use of robot-assisted surgery for rectal cancer is increasing, but the pathological outcomes have not been fully clarified. We compared the surgical and pathological outcomes between robot-assisted and open surgery in specimens from patients operated on for rectal cancer.
Methods
All patients who underwent resection for rectal cancer from 2016 to 2018 were included (n=137). Specimens were divided into 3 sections to analyze the pathology of the lymph nodes.
Results
The total specimen lengths were shorter in the robot-assisted group than in the open surgery group (mean±standard deviation: 29.1±8.6 cm vs. 33.8±9.9 cm, P=0.004) because of a shorter proximal resection margin (21.7±8.7 cm vs. 26.4±10.6 cm, P=0.006). The number of recruited lymph nodes (35.8±21.8 vs. 39.6±16.5, P=0.604) and arterial vessel length (8.84±2.6 cm vs. 8.78±2.4 cm, P=0.891) did not differ significantly between the 2 surgical approaches. Lymph node metastases were found in 33 of 137 samples (24.1%), but the numbers did not differ significantly between the procedures. Among these 33 cases, metastatic lymph nodes were located in the mesorectum (75.8%), in the sigmoid colon mesentery (33.3%), and at the arterial ligation site of the inferior mesenteric artery (12.1%). The circumferential resection margin and the proportion of complete mesorectal fascia were comparable between the groups.
Conclusion
There were no significant differences between the 2 surgical approaches regarding arterial vessel length, recruitment of lymph node metastases, and resection margins.

Citations

Citations to this article as recorded by

Robotic Surgery for Rectal Cancer Treatment: Clinical Outcomes and Quality of Life. Comparison of Surgical Methods
Raminta Akelaitytė, Justas Žilinskas
Lietuvos chirurgija.2025; 24(3): 184. CrossRef
Can robotic surgery lead the way in the treatment of rectal cancer?
Jeonghee Han
Annals of Coloproctology.2024; 40(2): 87. CrossRef
Comparative analysis of short-term outcomes and oncological results between robotic-assisted and laparoscopic surgery for rectal cancer by multiple surgeon implementation: a propensity score-matched analysis
E. Barzola, L. Cornejo, N. Gómez, A. Pigem, D. Julià, N. Ortega, O. Delisau, K. A. Bobb, R. Farrés, P. Planellas
Journal of Robotic Surgery.2023; 17(6): 3013. CrossRef

Colorecal cancer

Prognostic significance of lymph node yield on oncologic outcomes according to tumor response after preoperative chemoradiotherapy in rectal cancer patients: Hyo Seon Ryu, In Ja Park, Bo Kyung Ahn, Min Young Park, Min Sung Kim, Young Il Kim, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2023;39(5):410-420. Published online April 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00143.0020

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6 Web of Science
5 Citations

Graphical Abstract Abstract PDF

Purpose
This study aimed to evaluate the predictive value of lymph node yield (LNY) for survival outcomes according to tumor response after preoperative chemoradiotherapy (PCRT) in patients with rectal cancer.
Methods
This study was a retrospective study conducted in a tertiary center. A total of 1,240 patients with clinical stage II or III rectal cancer who underwent curative resection after PCRT between 2007 and 2016 were included. Patients were categorized into the good response group (tumor regression grade [TRG], 0–1) or poor response group (TRG, 2–3). Propensity score matching was performed for age, sex, and pathologic stage between LNY of ≥12 and LNY of <12 within tumor response group. The primary outcome was 5-year disease-free survival (DFS) and overall survival (OS).
Results
LNY and positive lymph nodes were inversely correlated with TRG. In good responders, 5-year DFS and 5-year OS of patients with LNY of <12 were better than those with LNY of ≥12, but there was no statistical significance. In poor responders, the LNY of <12 group had worse survival outcomes than the LNY of ≥12 group, but there was also no statistical significance. LNY of ≥12 was not associated with DFS and OS in multivariate analysis.
Conclusion
LNY of <12 showed contrasting outcomes between the good and poor responders in 5-year DFS and OS. LNY of 12 may not imply adequate oncologic surgery or proper staging in rectal cancer patients treated by PCRT. Furthermore, a decrease in LNY should be comprehended differently according to tumor response.

Citations

Citations to this article as recorded by

Breaking Myths: Comparable Outcomes in Lymph Node Analysis Across Surgical Methods
Salvatore Pezzino, Tonia Luca, Mariacarla Castorina, Giulia Fuccio Sanzà, Gaetano Magro, Stefano Puleo, Ornella Coco, Sergio Castorina
Cancers.2025; 17(8): 1312. CrossRef
A predictive nomogram for assessing the likelihood of retrieving 12 lymph nodes after rectal cancer surgery: a single-center study
Jian Ma, Runyang Hao, Shuai Jiao, Qingmin Chen, Baohong Yang, Xu Guan, Jiale Li, Xinxuan Zhao, Yu Huo, Qingxia Xu, Haiyi Liu, Wen Su, Xishan Wang
Frontiers in Oncology.2025;[Epub] CrossRef
Effects of Adjuvant Chemotherapy on Oncologic Outcomes in Patients With Stage ⅡA Rectal Cancer Above the Peritoneal Reflection Who Did Not Undergo Preoperative Chemoradiotherapy
Hyo Seon Ryu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Yong Sang Hong, Tae Won Kim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(4): 392. CrossRef
Artificial Intelligence-Driven Volumetric Analysis of Muscle Mass as a Predictor of Tumor Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer
Minsung Kim, Sang Min Lee, Il Tae Son, Jaewoong Kang, Gyoung Tae Noh, Bo Young Oh
Journal of Clinical Medicine.2024; 13(23): 7018. CrossRef
Multidisciplinary Treatment Strategy for Early Colon Cancer: A Review-An English Version
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 203. CrossRef

Case Report

Rare disease & stoma

A small, low-grade rectal neuroendocrine tumor with lateral pelvic lymph node metastasis: a case report: Seonhui Shin, Young-In Maeng, Seyun Jung, Chun-Seok Yang; Ann Coloproctol. 2022;38(4):327-331. Published online March 7, 2022; DOI: https://doi.org/10.3393/ac.2021.00899.0128

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7 Web of Science
8 Citations

Abstract PDF

Rectal neuroendocrine tumors (NETs) are typically small lesions that are confined to the submucosa and have favorable behavior at the time of diagnosis. Local endoscopic or surgical resection is recommended because lymph node metastasis is very rare. In this report, we present the case of a 36-year-old male presenting with an incidentally found rectal mass during screening colonoscopy. Pathologic examination of the primary tumor revealed a 9-mm grade 1 NET with submucosal invasion and no significant aggressive factors except for central ulceration. However, radiologic studies revealed a suspected 2.6-cm mesorectal lymph node metastasis and multiple left internal iliac lymph node metastases. We performed laparoscopic intersphincteric resection with left lateral pelvic lymph node dissection. The final pathologic report revealed a metastatic lymph node with low grade, low mitotic count, and low Ki-67 index. We describe an overview of lymph node metastasis of rectal NETs focusing on lateral pelvic lymph node metastasis.

Citations

Citations to this article as recorded by

Risk factors for and prognostic impact of lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: a single-center retrospective analysis of 214 cases with radical resection
Tsubasa Sakurai, Y. Hiyoshi, N. Daitoku, S. Matsui, T. Mukai, T. Nagasaki, T. Yamaguchi, T. Akiyoshi, H. Kawachi, Y. Fukunaga
Surgery Today.2025; 55(2): 144. CrossRef
Construction and evaluation of the prediction model for advanced disease in well-differentiated colorectal neuroendocrine neoplasms less than 2 cm in diameter
Hongda Yin, Yanan Chen, Wei Zhao, Fuqiang Zhao, Zhijun Huang, Aimin Yue, Zhijie Wang
Heliyon.2025; 11(1): e41197. CrossRef
Primary small rectal neuroendocrine tumor with pelvic lateral lymph nodes metastasis: A case report and review of literature
Lihong Li, Ziyue Chen, Dajian Zhu, Qianbao Lv, Tianpeng Zhang, Jinsong Lai
International Journal of Surgery Case Reports.2025; 127: 110963. CrossRef
Risk factors for lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: a systematic review and meta-analysis
Ziyue Chen, Dajian Zhu
Frontiers in Oncology.2025;[Epub] CrossRef
Endoscopic treatment of rectal neuroendocrine tumors: a consecutive analysis of multi-institutional data
Jae Won Shin, Eun-Jung Lee, Sung Sil Park, Kyung Su Han, Chang Gyun Kim, Hee Chul Chang, Won Youn Kim, Eui Chul Jeong, Dong Hyun Choi
Annals of Coloproctology.2025; 41(3): 221. CrossRef
Successfully Resected Isolated Lateral Lymph Node Recurrence in a Patient with T1 Lower Rectal Cancer: Case Report and Literature Review
Kazuma Rifu, Koji Koinuma, Hisanaga Horie, Katsusuke Mori, Daishi Naoi, Mineyuki Tojo, Yuko Homma, Satoshi Murahashi, Atsushi Kihara, Toshiki Mimura, Joji Kitayama, Naohiro Sata
Journal of the Anus, Rectum and Colon.2024; 8(3): 259. CrossRef
Clinical application of endoscopic ultrasonography in the management of rectal neuroendocrine tumors
Soo-Young Na, Seong Jung Kim, Hyoun Woo Kang
International Journal of Gastrointestinal Intervention.2023; 12(3): 105. CrossRef
Multiple rectal neuroendocrine tumors: An analysis of 15 cases and literature review
Shu Pang, Ye Zong, Kun Zhang, Haiying Zhao, Yongjun Wang, Junxiong Wang, Chuntao Liu, Yongdong Wu, Peng Li
Frontiers in Oncology.2022;[Epub] CrossRef

Review

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

Surgical Treatment of Low-Lying Rectal Cancer: Updates: Cristopher Varela, Nam Kyu Kim; Ann Coloproctol. 2021;37(6):395-424. Published online December 22, 2021; DOI: https://doi.org/10.3393/ac.2021.00927.0132

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53 Web of Science
59 Citations

Abstract PDF

Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

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Original Article

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

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

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Abstract PDF Supplementary Material

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

Citations

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Reviews

Malignant disease,Prognosis and adjuvant therapy,Colorectal cancer,Minimally invasive surgery,Surgical technique

Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?: Gyung Mo Son, In Young Lee, Yoon Suk Lee, Bong-Hyeon Kye, Hyeon-Min Cho, Je-Ho Jang, Chang-Nam Kim, Kil Yeon Lee, Suk-Hwan Lee, Jun-Gi Kim, On behalf of The Korean Laparoscopic Colorectal Surgery Study Group; Ann Coloproctol. 2021;37(6):434-444. Published online December 8, 2021; DOI: https://doi.org/10.3393/ac.2021.00955.0136

10,032 View
301 Download
21 Web of Science
24 Citations

Abstract PDF

Colon cancer treatment is on the way to evolution over several decades. The minimally invasive surgery has improved postoperative short-term outcomes. Adjuvant chemotherapy has prolonged the survival of advanced colon cancer patients. Hohenberger proposed the noble concept of complete mesocolic excision (CME) which consists of 3 components: plane surgery, sufficient longitudinal bowel resection, and central vascular ligation (CVL). Mesocolic plane surgery shares the same surgical principle of total mesorectal excision, which is maintaining the intact mesothelial envelope. However, there remain debates about the extent of bowel resection and the level of CVL for maximizing lymph node dissection. There is no solid clinical evidence for the oncological necessity and benefit of extended radical dissection in right hemicolectomy. CME with CVL based on open surgery has been adopted in laparoscopic surgery. So, it is also necessary to look at how the CME could be transformed and successfully implanted in the laparoscopic era. Recent rapid advances in surgical technology and cancer biology are preparing for fundamental changes in cancer surgery. In this study, we reviewed the history, oncological necessity, and compatibility of CME for the right hemicolectomy in the laparoscopic era and outline the new perspectives on the evolution of cancer surgery.

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G. Anania, M. Chiozza, A. Campagnaro, F. Bagolini, G. Resta, D. Azzolina, G. Silecchia, R. Cirocchi, A. Agrusa, D. Cuccurullo, M. Guerrieri, V. Adamo, M. Ammendola, P. Angelini, M. Annecchiarico, G. Aprea, F. Autori, G. Baldazzi, A. Balla, G. Baronio, G.
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Christoph Holmer
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Malignant disease, Rectal cancer,Colorectal cancer

Extended lymphadenectomy in locally advanced rectal cancers: a systematic review: Balaji Mahendran, Supriya Balasubramanya, Simone Sebastiani, Sebastian Smolarek; Ann Coloproctol. 2022;38(1):3-12. Published online November 17, 2021; DOI: https://doi.org/10.3393/ac.2021.00703.0100

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Abstract PDF

Purpose
The surgical treatment of advanced low rectal cancer remains controversial. Extended lymphadenectomy (EL) is the preferred option in the East, especially in Japan, while neoadjuvant radiotherapy is the treatment of choice in the West. This review was undertaken to review available evidence supporting each of the therapies.
Methods
All studies looking at EL were included in this review. A comprehensive search was conducted as per PRISMA guidelines. Primary outcome was defined as 5-year overall survival, with secondary outcomes including 3-year overall survival, 3- and 5-year disease-free survival, length of operation, and number of complications.
Results
Thirty-one studies met the inclusion criteria. There was no significant publication bias. There was statistically significant difference in 5-year survival for patient who underwent EL (odds ratio, 1.34; 95 confidence interval, 0.09–0.5; P=0.006). There were no differences noted in secondary outcomes except for length of the operations.
Conclusion
There is evidence supporting EL in rectal cancer; however, it is difficult to interpret and not easily transferable to a Western population. Further research is necessary on this important topic.

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Original Articles

Preoperative endoscopic tattoo marking improves lymph node retrieval in laparoscopic rectal resection: a retrospective cohort study: Kouki Imaoka, Takuya Yano, Masanori Yoshimitsu, Sotaro Fukuhara, Ko Oshita, Kanyu Nakano, Masaki Kunihiro, Hitoshi Idani, Masazumi Okajima; Ann Coloproctol. 2023;39(2):115-122. Published online September 16, 2021; DOI: https://doi.org/10.3393/ac.2021.00458.0065

7,541 View
178 Download
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6 Citations

Graphical Abstract Abstract PDF

Purpose
Harvesting at least 12 lymph nodes (LNs) is recommended for adequate tumor staging in colon surgery. Although preoperative endoscopic tattooing has been used for primary localization of tumors, its impact on LN retrieval in colorectal surgery remains controversial. We aimed to investigate the relationship between preoperative tattooing and LN retrieval after laparoscopic rectal resection.
Methods
We reviewed the records of 92 patients with rectal cancer who underwent laparoscopic resection from January 1, 2018 to December 31, 2019. Patients were categorized into 2 groups according to whether preoperative endoscopic tattooing was performed. The rate of adequate LN retrieval (≥12) was compared.
Results
The tattooed and non-tattooed groups comprised 49 and 43 patients, respectively. In the tattooed and non-tattooed groups, the rates of adequate LN retrieval were 75.5% and 55.8%, respectively (P=0.046). Univariate analysis revealed that female sex, tattooing, LN metastasis status, pathological pathological stage (p-stage), and LN dissection were predictive factors for adequate LN retrieval. In the multivariate analysis, female sex (odds ratio [OR], 3.34; 95% confidence interval [CI], 1.15–9.73; P=0.027), tattooing (OR, 2.87; 95% CI, 1.03–7.94; P=0.043), and p-stage (OR, 3.34; 95% CI, 1.04–10.75; P=0.043) were independent predictive factors for adequate LN retrieval after surgery.
Conclusion
This study revealed that preoperative endoscopic tattooing was statistically significantly associated with adequate LN retrieval in patients with rectal cancer who underwent laparoscopic rectal resection. Preoperative endoscopic tattooing should be considered to improve disease assessment and avoid stage migration.

Citations

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Cancers.2023; 15(20): 4927. CrossRef
Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis
Qianqian Liu, Min Huang, Jing Yang, Mengyuan Jiang, Ziru Zhao, Haitong Zhao, Tingting He, Yuping Bai, Rui Zhang, Min Zhang
BMJ Open.2023; 13(12): e072244. CrossRef

Influence of colonic mesenteric area on the number of lymph node retrieval for colon cancer: a prospective cohort study: Nadir Adnan Hacım, Ahmet Akbaş, Yigit Ulgen, Talar Vartanoglu Aktokmakyan, Serhat Meric, Merve Tokocin, Onder Karabay, Yuksel Altinel; Ann Coloproctol. 2023;39(1):77-84. Published online September 16, 2021; DOI: https://doi.org/10.3393/ac.2021.00444.0063

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Abstract PDF

Purpose
The minimum harvested 12 lymph nodes (LNs) is regarded as the limit for accurate staging of nodal status in colorectal cancer patients. Besides the association of the lengths of resected intestinal segments and vascular pedicles, the mesocolic mesenteric area’s impact on LN count has not been studied. We aimed to evaluate the associations between metric variables, including the mesocolic mesentery area on the nodal harvest.
Methods
All consecutive patients who underwent elective colectomy with a curative intention for colon adenocarcinoma were prospectively included. The metric variables included the lengths of resected intestinal segments, vascular pedicle, and colonic mesenteric area. The variables influencing the LN count and the correlation between the total LN count and the specimens’ relevant metric measurements were analyzed.
Results
There were 46 patients with a median age of 64 years. The median count for total LNs was 22, and the LN positivity was 59.2%. There was an inadequate LN yield (<12) in 3 patients (6.1%). No significant associations were found between the adequacy of nodal harvest and the demographic, clinical, and tumoral features (P>0.05). There were significant positive correlations between total LN number and length of vascular pedicle and mesenteric area (r=0.576, P<0.001 and r=0.566, P<0.001).
Conclusion
The length of the vascular pedicle and mesenteric area were significantly correlated with total LN counts. Although there was no significant impact on the length of resected segments, the colonic mesenteric area can be used alone as a measure for the assessment of the nodal yield in colon cancer.

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Deep learning model for predicting lymph node metastasis around rectal cancer based on rectal tumor core area and mesangial imaging features
Lili Guo, Kuang Fu, Wenjia Wang, Li Zhou, Lu Chen, Miaomiao Jiang
BMC Medical Imaging.2025;[Epub] CrossRef
Effect of Fluorescence Lymph Node Mapping on Improving Diagnostic Values of CT D3 Lymph Node Staging for Right-Sided Colon Cancer
Gyung Mo Son, Tae Un Kim, Mi Sook Yun, ChangYeop Kim, In Young Lee, Su Bum Park, Dong-Hoon Shin, Gi Won Ha
Cancers.2024; 16(20): 3496. CrossRef
Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study
Gyung Mo Son, Mi Sook Yun, In Young Lee, Sun Bin Im, Kyung Hee Kim, Su Bum Park, Tae Un Kim, Dong-Hoon Shin, Armaan M. Nazir, Gi Won Ha
Cancers.2023; 15(20): 4927. CrossRef
The Relationship Between the Resected Colon Length and the Number of Lymph Nodes in Colorectal Cancer: A Retrospective Cohort Study
Ulaş Karabay, Latif Yılmaz, Alper Aytekin, Aziz Bulut
European Journal of Therapeutics.2023; 29(4): 731. CrossRef
Multidisciplinary Treatment Strategy for Early Colon Cancer: A Review-An English Version
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 203. CrossRef
Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?
Gyung Mo Son, In Young Lee, Yoon Suk Lee, Bong-Hyeon Kye, Hyeon-Min Cho, Je-Ho Jang, Chang-Nam Kim, Kil Yeon Lee, Suk-Hwan Lee, Jun-Gi Kim
Annals of Coloproctology.2021; 37(6): 434. CrossRef

Video

Malignant disease, Rectal cancer,Minimally invasive surgery,Surgical technique

Standardized Step-by-step Technique Using Surgical Landmarks in Robotic Lateral Pelvic Lymph Node Dissection: Jung Hoon Bae, Wooree Koh, Hyun Ho Kim, Yoon Suk Lee; Ann Coloproctol. 2021;37(1):58-60. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.05

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Abstract PDF Supplementary Material

We aimed to show that a standardized step-by-step robotic approach using surgical landmarks could make lateral pelvic lymph node dissection (LPND) less complicated. We performed robot-assisted LPND consisting of 4 steps using surgical landmarks. The first step is a dissection of uretero-hypogastric fascia, which envelopes the ureter and the hypogastric nerve. The second step is a dissection of the medial side of the external iliac vein located at the lateral border of the obturator lymph nodes (LNs) group. The third step is a dissection of the vesico-hypogastric fascia, which is at the medial border of the obturator LNs group. The final step is a dissection of the internal iliac artery until the Alcock’s canal. Indocyanine green was injected just before surgery around the dentate line to identify the lateral pelvic LNs. Standardization using a robotic approach for LPND guided by surgical landmarks allows a safer and more effective surgery.

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The first video comparison of lateral pelvic lymph node dissection in rectal cancer: Laparoscopic approach using articulating instruments (ArtiSential) versus robotic Xi platform—A video vignette
In Kyeong Kim, Jung Hoon Bae, In Kyu Lee, Yoon Suk Lee
Colorectal Disease.2025;[Epub] CrossRef
MRI-based scoring systems for selective lateral lymph node dissection in locally advanced low rectal cancer after neoadjuvant chemoradiotherapy
Min Jeong Cho, Kyunghwa Han, Hye Jung Shin, Woong Sub Koom, Kang Young Lee, Joo Hee Kim, Joon Seok Lim
European Radiology.2025; 35(8): 4967. CrossRef
Short- and long-term outcomes of robot-assisted versus laparoscopic lateral lymph node dissection for rectal cancer
Daichi Kitaguchi, Tsuyoshi Enomoto, Kinji Furuya, Shuntaro Tsukamoto, Tatsuya Oda
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Is lateral pelvic lymph node dissection necessary for good responder to neoadjuvant chemoradiation in locally advanced rectal cancer?
Jung Hoon Bae, Jumyung Song, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
Surgical Oncology.2025; 61: 102249. CrossRef
Was there any change in surgical treatment for colorectal cancer during the COVID-19 pandemic?
Yeajin Moon, Seung Hun Lee, Seung Hyun Lee
Kosin Medical Journal.2025; 40(3): 207. CrossRef
The use of indocyanine green for lateral lymph node dissection in rectal cancer—preliminary data from an emerging procedure: a systematic review of the literature
D. Kehagias, C. Lampropoulos, A. Bellou, I. Kehagias
Techniques in Coloproctology.2024;[Epub] CrossRef
Japanese expert consensus on the standardization of robot‐assisted pelvic lymph node dissection in urological surgery: Extent of pelvic lymph node and surgical technique
Shuichi Morizane, Jun Miki, Masaki Shimbo, Toru Kanno, Noriyoshi Miura, Yuta Yamada, Takeshi Yamasaki, Takashi Saika, Atsushi Takenaka
International Journal of Urology.2024; 31(12): 1300. CrossRef
Simplified approach to the medial internal iliac region using a uretero‐hypogastric nerve fascia development procedure for extended pelvic lymph node dissection during robot‐assisted radical prostatectomy for high‐risk prostate cancer
Masaki Shimbo, Takehiro Ohyama, Fumiyasu Endo, Kenji Komatsu, Yoko Kyono, Masayuki Sano, Kazutaka Narimoto, Kazunori Hattori
International Journal of Urology.2023; 30(2): 190. CrossRef
Lateral Lymph Node Size and Tumor Distance From Anal Verge Accurately Predict Positive Lateral Pelvic Lymph Nodes in Rectal Cancer: A Multi-Institutional Retrospective Cohort Study
Jung Hoon Bae, Jumyung Song, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
Diseases of the Colon & Rectum.2023; 66(6): 785. CrossRef
Robotic Lateral Pelvic Lymph Node Dissection Could Harvest More Lateral Pelvic Lymph Nodes over Laparoscopic Approach for Mid-to-Low Rectal Cancer: A Multi-Institutional Retrospective Cohort Study
Jung Hoon Bae, Jumyung Song, Ri Na Yoo, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
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In Ja Park
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Young Il Kim
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Enhanced recovery after surgery: importance of compliance audits
Jung Hoon Bae
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Original Articles

Malignant disease,Prognosis and adjuvant therapy

Identification of Risk Factors Associated With Stage III Disease in Nonmetastatic Colon Cancer: Results From a Prospective National Cohort Study: Jakob Lykke, Ole Roikjaer, Per Jess, Jacob Rosenberg, On behalf of the Danish Colorectal Cancer Group; Ann Coloproctol. 2020;36(5):316-322. Published online February 18, 2020; DOI: https://doi.org/10.3393/ac.2019.03.03

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Abstract PDF

Purpose
This study aimed to identify possible patient- and tumor-related factors associated with risk of TNM stage III disease in nonmetastatic colon cancer.
Methods
The associations between stage III disease and age, sex, lymph node yield, pathological tumor (pT) stage, tumor subsite, type of surgery, and priority of surgery were assessed in a nationwide cohort of 13,766 patients treated with curative resection of colon cancer. Each level of age, lymph node yield, and pT stage was compared to the preceding level.
Results
Age, lymph node yield, pT stage, tumor subsite, and priority of surgery were associated with stage III disease. Odds ratios (95% confidence interval [CI]) were as follows: age < 65/65–75 years: 1.28 (95% CI, 1.15–1.43) and 65–75/ > 75 years: 1.22 (95% CI, 1.13–1.32); lymph node yield 0–5/6–11: 0.60 (95% CI, 0.50–0.72), lymph node yield 6–11/12–17: 0.84 (95% CI, 0.76–0.93), and lymph node yield 12–17/ ≥ 18: 0.97 (95% CI, 0.89–1.05); pT1/pT2: 0.74 (95% CI, 0.57–0.95), pT2/pT3: 0.35 (95% CI, 0.30–0.40), and pT3/pT4: 0.49 (95% CI, 0.47–0.54). Only tumors of the transverse colon were independently associated with lower risk of stage III disease than tumors in the sigmoid colon (sigmoid colon: 1, transverse colon: 0.84 [95% CI, 0.73–0.96]; elective surgery: 1, acute surgery: 1.43 [95% CI, 1.29–1.60]).
Conclusion
In this study, stage III disease in colon cancer was significantly associated with age, lymph node yield, pT stage, tumor subsite, and priority of surgery but was not associated with right-sided location compared with stage I and II cancers.

Citations

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Optimized workup of lymph nodes in regard to UICC classification of colorectal carcinoma
Moritz Rust, Nabih Farkouh, Piet Beusker, Ali Eissing‐Al‐Mukahal, Clara Böker, Julian Mall, Ludwig Wilkens
Histopathology.2026;[Epub] CrossRef
Association of the pathomics-collagen signature with lymph node metastasis in colorectal cancer: a retrospective multicenter study
Wei Jiang, Huaiming Wang, Xiaoyu Dong, Yandong Zhao, Chenyan Long, Dexin Chen, Botao Yan, Jiaxin Cheng, Zexi Lin, Shuangmu Zhuo, Hui Wang, Jun Yan
Journal of Translational Medicine.2024;[Epub] CrossRef
Can clinicopathologic high-risk features in T3N0 colon cancer be reliable prognostic factors?
Hyun Gu Lee, Young IL Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2023; 104(2): 109. CrossRef
Deep learning-based pathology signature could reveal lymph node status and act as a novel prognostic marker across multiple cancer types
Siteng Chen, Jinxi Xiang, Xiyue Wang, Jun Zhang, Sen Yang, Wei Yang, Junhua Zheng, Xiao Han
British Journal of Cancer.2023; 129(1): 46. CrossRef
Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study
Gyung Mo Son, Mi Sook Yun, In Young Lee, Sun Bin Im, Kyung Hee Kim, Su Bum Park, Tae Un Kim, Dong-Hoon Shin, Armaan M. Nazir, Gi Won Ha
Cancers.2023; 15(20): 4927. CrossRef
Deep learning can predict lymph node status directly from histology in colorectal cancer
Lennard Kiehl, Sara Kuntz, Julia Höhn, Tanja Jutzi, Eva Krieghoff-Henning, Jakob N. Kather, Tim Holland-Letz, Annette Kopp-Schneider, Jenny Chang-Claude, Alexander Brobeil, Christof von Kalle, Stefan Fröhling, Elizabeth Alwers, Hermann Brenner, Michael Ho
European Journal of Cancer.2021; 157: 464. CrossRef

Sentinel Lymph Node Analysis in Colorectal Cancer Patients Using One-Step Nucleic Acid Amplification in Combination With Fluorescence and Indocyanine Green: Francesco Esposito, Adele Noviello, Nicola Moles, Enrico Coppola Bottazzi, Mario Baiamonte, Ina Macaione, Umberto Ferbo, Maria Lepore, Antonio Miro, Francesco Crafa; Ann Coloproctol. 2019;35(4):174-180. Published online August 31, 2019; DOI: https://doi.org/10.3393/ac.2018.07.21.1

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Abstract PDF

Purpose
Analysis of the sentinel lymph node (SLN) in colorectal cancer (CRC) patients was proposed for more accurate staging and tailored lymphadenectomy. The aim of this study was to assess the ability to predict lymph node (LN) involvement through analysis of the SLN with a one-step nucleic acid (OSNA) technique in combination with peritumoral injection of indocyanine green (ICG) and near-infrared (NIR) lymphangiography in CRC patients.
Methods
A total of 34 patients were enrolled. Overall, 51 LNs were analyzed with OSNA. LNs of 17 patients (50%) were examined simultaneously with hematoxylin and eosin (H&E) and OSNA.
Results
SLN analysis of 17 patients examined with H&E and OSNA revealed that OSNA had a higher sensitivity (1 vs. 0.55), higher negative predictive value (1 vs. 0.66) and higher accuracy (100% vs. 76.4%) in predicting LN involvement. Overall, OSNA showed a sensitivity of 0.69, specificity of 1, accuracy of 88.2%, and stage migration of 8.8%. Compared to those who were OSNA (−), OSNA (+) patients had a greater number of LN metastases (4.8 vs. 0.16, P = 0.04), higher G3 rate (44.4% vs. 4%, P = 0.01), more advanced stage of disease (stage III: 77.8% vs. 16%; P = 0.00) and were more rapidly subjected to adjuvant chemotherapy (39.1 days vs. 50.2 days, P = 0.01).
Conclusion
SLN analysis with OSNA in combination with ICG-NIR lymphangiography is feasible and can detect LN involvement in CRC patients. Furthermore, it allows for more accurate staging reducing the delay between surgery and adjuvant chemotherapy.

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Ke Li, Min Meng, Weiwei Zhang, Junyi Li, Yiting Wang, Changhui Zhou
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World Journal of Gastroenterology.2023; 29(24): 3883. CrossRef
Role of one-step nucleic acid amplification in colorectal cancer lymph node metastases detection
Francesco Crafa, Serafino Vanella, Onofrio A Catalano, Kelsey L Pomykala, Mario Baiamonte
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The advantage of one‐step nucleic acid amplification for the diagnosis of lymph node metastasis in colorectal cancer patients
Yukiharu Hiyoshi, Takashi Akiyoshi, Yosuke Fukunaga
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The evolving role of one-step nucleic acid amplification (OSNA) for the intra-operative detection of lymph node metastases: A diagnostic accuracy meta-analysis
Anastasios Tranoulis, Dimitra Georgiou, Jason Yap, Stephen Attard-Montalto, Jeremy Twigg, Ahmed Elattar, Kavita Singh, Janos Balega, Sean Kehoe
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Reviews

Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives: Hye Jin Kim, Gyu–Seog Choi; Ann Coloproctol. 2019;35(3):109-117. Published online June 30, 2019; DOI: https://doi.org/10.3393/ac.2019.06.12

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Abstract PDF

Lymph node metastasis is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Lymph node status based on examination of a resected specimen is a key element of the current staging system and is also a crucial factor to determine use of adjuvant chemotherapy after surgical resection. However, the current tumor-node-metastasis (TNM) staging system only incorporates the number of metastatic lymph nodes in the N category. Numerous attempts have been made to supplement this simplified N staging including lymph node ratio, distribution of metastatic lymph nodes, tumor deposits, or extracapsular invasion. In addition, several attempts have been made to identify more specific prognostic factors in resected colorectal specimens than lymph node status. In this review, we will discuss controversies in lymph node staging and factors that may influence survival beyond lymph node status.

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Lateral Lymph Node Dissection With the Focus on Indications, Functional Outcomes, and Minimally Invasive Surgery: Min Jung Kim, Jae Hwan Oh; Ann Coloproctol. 2018;34(5):229-233. Published online October 31, 2018; DOI: https://doi.org/10.3393/ac.2018.10.26

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Abstract PDF

The lateral lymph node dissection (LLND) is still a subject of great debate as to the appropriate treatment for patients with mid to low advanced rectal cancer. The guidelines of the Japanese Society for Cancer of the Colon and Rectum recommend a LLND for patients with T3/4 rectal cancer below the peritoneal reflection. However, in most Western countries, a routine LLND is not recommended unless a node or nodes are clinically suspicious for metastasis. Even after preoperative chemoradiotherapy (CRT), an 8% to 12% lateral pelvic recurrence was noted. The size of the lateral lymph node and responsiveness to preoperative CRT should be the main factors for selecting appropriate patients to undergo a LLND. In addition, from the recent literature, a laparoscopic LLND is safe and oncologically feasible and might have some advantages in short-term outcomes.

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Diseases of the Colon & Rectum.2024; 67(6): e360. CrossRef
Laparoscopic Extraperitoneal Approach for Lateral Pelvic Node Dissection in Rectal Cancer: Techniques and Short-Term Outcomes
Ji-Seon Kim, Jin Kim, Se-Jin Baek, Hyunmi Park, Jung-Myun Kwak, Seon-Hahn Kim
Surgical Innovation.2023; 30(1): 13. CrossRef
Lateral pelvic sentinel lymph node biopsy using indocyanine green fluorescence navigation: can it be a powerful supplement tool for predicting the status of lateral pelvic lymph nodes in advanced lower rectal cancer
Hao Su, Zheng Xu, Mandula Bao, Shou Luo, Jianwei Liang, Wei Pei, Xu Guan, Zheng Liu, Zheng Jiang, Mingguang Zhang, Zhixun Zhao, Weisen Jin, Haitao Zhou
Surgical Endoscopy.2023; 37(5): 4088. CrossRef
Anatomical Validation of Internal Iliac Vessels Assessed by Three-dimensional Angiographic Analysis
Yuya Takenaka, Naohito Beppu, Masaki Otani, Kazuma Ito, Ayako Imada, Takaaki Matsubara, Jihyung Song, Kei Kimura, Kozo Kataoka, Motoi Uchino, Hiroki Ikeuchi, Masataka Ikeda
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Indocyanine green dye and its application in gastrointestinal surgery: The future is bright green
Zavier Yongxuan Lim, Swetha Mohan, Sunder Balasubramaniam, Saleem Ahmed, Caroline Ching Hsia Siew, Vishal G Shelat
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Original Articles

Distribution of Lymph Nodes in Stage III Patients With Mid and Low Rectal Cancer: Preliminary Study: Sohyun Kim; Ann Coloproctol. 2018;34(1):42-46. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.42

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Abstract PDF

Purpose

Most patients with rectal cancer undergo a total mesorectal excision and a partial resection of the sigmoid colon to improve oncologic outcomes. The aim of this study was to assess the distribution of lymph nodes (LNs) in rectal cancer.

Methods

The records of 54 patients with mid and low rectal cancer between April 2015 and March 2017 were reviewed, and 49 patients were enrolled in this study. All harvested LNs were analyzed according to the harvested area: the mesorectum area (MA), the vascular pedicle area (VA), and the sigmoid area (SA).

Results

Finally, 865 LNs were harvested from all patients, and of these, 71 (8.2%) showed metastases. In stage III patients, 343 LNs were harvested, and of these, 52 (15.2%) showed metastases. Significant differences were found in the total numbers of harvested LNs by area (P < 0.001) and in the numbers of harvested positive LNs by area (P < 0.001). In stage III patients, LNs from the MA were more frequently to be positive than were those from the VA (P < 0.001) or the SA (P < 0.001).

Conclusion

LN metastasis in the SA was rare. Therefore, resecting the mesorectum and the vascular pedicle may be more important than resecting the sigmoid mesentery due to concerns about LN metastases.

Citations

Citations to this article as recorded by

Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review
Min Chul Kim, Jae Hwan Oh
Annals of Coloproctology.2021; 37(6): 382. CrossRef

Reliability of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Nodal Staging of Colorectal Cancer Patients: Hee Jung Yi, Kyung Sook Hong, Nara Moon, Soon Sup Chung, Ryung-Ah Lee, Kwang Ho Kim; Ann Coloproctol. 2014;30(6):259-265. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.259

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Abstract PDF

Purpose

Lymph-node metastasis is considered as critical prognostic factor in colorectal cancer. A preoperative evaluation of lymph-node metastasis can also help to determine the range of distant lymph node dissection. However, the reliability of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of lymph-node metastasis is not fully known.

Methods

The medical records of 433 patients diagnosed with colorectal cancer were reviewed retrospectively. FDG-PET/CT and CT were performed on all patients. Lymph nodes were classified into regional and distant lymph nodes according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th edition.

Results

The patients included 231 males (53.3%) and 202 females (46.7%), with a mean age of 64.7 ± 19.0 years. For regional lymph nodes, the sensitivity of FDG-PET/CT was lower than that of CT (57.1% vs. 73.5%, P < 0.001). For distant lymph nodes, the sensitivity of FDG-PET/CT was higher than that of CT (64.7% vs. 52.9%, P = 0.012). The sensitivity of FDG-PET/CT for regional lymph nodes was higher in patients with larger primary tumors. The positivity of lymph-node metastasis for FDG-PET/CT was affected by carcinoembryonic antigen levels, tumor location, and cancer stage for regional lymph nodes and by age and cancer stage for distant lymph nodes (P < 0.05).

Conclusion

The sensitivity of FDG-PET/CT for regional lymph-node metastasis was not superior to that of CT. However, FDG-PET/CT provides helpful information for determining surgical plan especially in high risk patients group.

Citations

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Ruggeri B. Guimarães, Eduardo O. Pacheco, Serli N. Ueda, Dario A. Tiferes, Fernanda L. Mazzucato, Aley Talans, Ulysses S. Torres, Giuseppe D’Ippolito
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C. Aveline, F. Montravers
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Florence Shekleton, Edward Courtney, Adrian Andreou, John Bunni
Cureus.2022;[Epub] CrossRef
Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging
Pier Paolo Mainenti, Arnaldo Stanzione, Salvatore Guarino, Valeria Romeo, Lorenzo Ugga, Federica Romano, Giovanni Storto, Simone Maurea, Arturo Brunetti
World Journal of Gastroenterology.2019; 25(35): 5233. CrossRef
Clinical evaluation of18F-fludeoxyglucose positron emission tomography/CT using point spread function reconstruction for nodal staging of colorectal cancer
Kazuya Kawashima, Kenichi Kato, Makiko Tomabechi, Mikaru Matsuo, Koki Otsuka, Kazuyuki Ishida, Ryuji Nakamura, Shigeru Ehara
The British Journal of Radiology.2016; 89(1063): 20150938. CrossRef
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Ik Yong Kim, Bo Ra Kim, Eun Hee Choi, Young Wan Kim
International Journal of Surgery.2016; 27: 151. CrossRef
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Young Wan Kim, Ik Yong Kim
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Case Report

Surgical Management of Unicentric Castleman's Disease in the Abdomen: Min-Sang Kim, Jae-Kyun Ju, Young Kim; Ann Coloproctol. 2014;30(2):97-100. Published online April 25, 2014; DOI: https://doi.org/10.3393/ac.2014.30.2.97

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Abstract PDF

Castleman's disease (CD) is a rare lymphoproliferative disorder that can involve single or multiple lymph nodes in the body. Especially, the localized form of CD is known to be well-controlled by using a surgical resection. On occasion, the surgeon may confront an abdominal and retroperitoneal mass of unknown origin. Thus, we present this case in which we treated a 16-year-old female patient for CD and investigated how to evaluate and manage the situation from the standpoint of CD. Also, we give a review of the pathology, clinical manifestation, diagnosis, and treatment of CD.

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Marco Paulli, Giuseppe Neri, Francesca Antoci, Edoardo D’Este, Marco Minetto, Federico Carpi, Martina La Fauci, Marcello Gambacorta, Marco Lucioni, Luca Arcaini
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Castleman's disease
Himanshu Srivastava, DulgantiSantosh Reddy, ShreyasN Shah, Vandana Shah
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Castleman’s Disease: A Unicentric Case of Abdominal Origin and Literature Review
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Original Articles

Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer: Wafi Attaallah, Omer Gunal, Manuk Manukyan, Gulden Ozden, Cumhur Yegen; Ann Coloproctol. 2013;29(3):100-105. Published online June 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.3.100

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Abstract PDF

Purpose

Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer.

Methods

A retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival.

Results

According to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ≥ 0.15 (P = 0.02). In stratified and multivariate analyses adjusted for age, gender, histology and tumor status, a higher LNR was independently associated with worse DFS.

Conclusion

This study showed the prognostic significance of ratio-based staging for rectal cancer and may help in developing better staging systems. LNR 0.15 (15%) was shown to be a cutoff point for determining survival and prognosis in rectal cancer cases.

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Clinical Significance of the Metastatic Lymph-Node Ratio in Rectal Cancer
Hyoung Chul Park
Annals of Coloproctology.2013; 29(3): 89. CrossRef

Initial Clinical Experience with Robotic Lateral Pelvic Lymph Node Dissection for Advanced Rectal Cancer: Ju-A Park, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park; J Korean Soc Coloproctol. 2012;28(5):265-270. Published online October 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.5.265

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Abstract PDF

Purpose

This study was conducted to evaluate the technical feasibility and safety of robotic extended lateral pelvic lymph node dissection (LPLD) in patients with advanced low rectal cancer.

Methods

A review of a prospectively-collected database at Kyungpook National University Medical Center from January 2011 to November revealed a series of 8 consecutive robotic LPLD cases with a preoperative diagnosis of lateral node metastasis. Data regarding patient demographics, operating time, perioperative blood loss, surgical morbidity, lateral lymph node status, and functional outcome were analyzed.

Results

In all eight patients, the procedures were completed without conversion to open surgery. The mean operative time of extended pelvic node dissection was 38 minutes (range, 20 to 51 minutes), the mean number of lateral lymph nodes harvested was 4.1 (range, 1 to 13), and 3 patients (38%) were found to have lymph node metastases. Postoperative mortality and morbidity were 0% and 25%, respectively, but, there was no LPLD-related morbidity. The mean hospital stay was 7.5 days (range, 5 to 12 days).

Conclusion

Robotic LPLD is safe and feasible, with the advantage of being a minimally invasive approach. Further large-scale studies comparing robotic and conventional surgery with long-term follow-up evaluation are needed to confirm these findings.

Citations

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Xiajuan Xue, Shuijie Lin, Qunzhang Zeng, Yincong Guo
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Robot-assisted lateral pelvic lymph node dissection in patients with advanced rectal cancer: a single-center experience of 65 cases
Eon Bin Kim, Yong Sik Yoon, Min Hyun Kim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
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Naradha Lokuhetty, José Tomás Larach, Amrish K. S. Rajkomar, Helen Mohan, Peadar S. Waters, Alexander G. Heriot, Satish K. Warrier
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S. H. Song, G.-S. Choi, H. J. Kim, J. S. Park, S. Y. Park, S.-M. Lee, J. A. Choi, H. A. Seok
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Clinical Significance of Lymph Node Ratio in Stage III Colorectal Cancer: Yo Han Park, Jae Im Lee, Jong Kyung Park, Hang Ju Jo, Won Kyung Kang, Chang Hyeok An; J Korean Soc Coloproctol. 2011;27(5):260-265. Published online October 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.5.260

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Abstract PDF

Purpose

Recent literature has shown that lymph node ratio is superior to the absolute number of metastatic lymph nodes in predicting the prognosis in several malignances other than colorectal cancer. The aim of this study was to evaluate the prognostic significance of the lymph node ratio (LNR) in patients with stage III colorectal cancer.

Methods

We included 186 stage III colorectal cancer patients who underwent a curative resection over a 10-year period in one hospital. The cutoff point of LNR was chosen as 0.07 because there was significant survival difference at that LNR. The Kaplan-Meier and the Cox proportional hazard models were used to evaluate the prognostic effect according to LNR.

Results

There was statistically significant longer overall survival in the group of LNR > 0.07 than in the group of LNR ≤ 7 (P = 0.008). Especially, there was a survival difference for the N1 patients group (LN < 4) according to LNR (5-year survival of N1 patients was lower in the group of LNR > 0.07, P = 0.025), but there was no survival difference for the N2 group (4 ≥ LN) according to LNR. The multivariate analysis showed that the LNR is an independent prognostic factor.

Conclusions

LNR can be considered as a more accurate and potent modality for prognostic stratifications in patients with stage III colorectal cancer.

Citations

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The prognostic performance of the log odds of positive lymph nodes in patients with esophageal squamous cell carcinoma: A population study of the US SEER database and a Chinese single‐institution cohort
Hongdian Zhang, Wanyi Xiao, Peng Ren, Kai Zhu, Ran Jia, Yueyang Yang, Lei Gong, Zhentao Yu, Peng Tang
Cancer Medicine.2021; 10(17): 6149. CrossRef
Lymph Node Ratio and Liver Metachronous Metastases in Colorectal Cancer
Giovanni Li Destri, Giuseppe Privitera, Gaetano La Greca, Roberto Scilletta, Antonio Pesce, Teresa Rosanna Portale, Erminia Conti, Stefano Puleo
International Surgery.2021; 105(1-3): 122. CrossRef
Rectal cancers with microscopic circumferential resection margin involvement (R1 resections): Survivals, patterns of recurrence, and prognostic factors
Gianpiero Gravante, David Hemingway, James Andrew Stephenson, David Sharpe, Ahmed Osman, Melissa Haines, Vafa Pirjamali, Roberto Sorge, Justin Ming Yeung, Michael Norwood, Andrew Miller, Kirsten Boyle
Journal of Surgical Oncology.2016; 114(5): 642. CrossRef
Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer
Wafi Attaallah, Omer Gunal, Manuk Manukyan, Gulden Ozden, Cumhur Yegen
Annals of Coloproctology.2013; 29(3): 100. CrossRef
Prognostic Value of Total Lymph Node Identified and Ratio of Lymph Nodes in Resected Colorectal Cancer
Leila Ghahramani, Leila Moaddabshoar, Samira Razzaghi, Sayed Hasan Hamedi, Saeedeh Pourahmad, Mohammad Mohammadianpanah
Annals of Colorectal Research.2013; 1(3): 81. CrossRef
Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation
Jamal Jafari Nadoshan, Ramesh Omranipour, Omid Beiki, Kazem Zendedel, Abbas Alibakhshi, Habibollah Mahmoodzadeh
Asian Pacific Journal of Cancer Prevention.2013; 14(6): 3769. CrossRef
Proposal of a New Classification for Stage III Colorectal Cancer Based on the Number and Ratio of Metastatic Lymph Nodes
Li‐Ping Wang, Hong‐Yan Wang, Rui Cao, Cong Zhu, Xiong‐Zhi Wu
World Journal of Surgery.2013; 37(5): 1094. CrossRef
An appraisal of lymph node ratio in colon and rectal cancer: not one size fits all
M. Medani, Niall Kelly, George Samaha, G. Duff, Vourneen Healy, Elizabeth Mulcahy, Eoghan Condon, David Waldron, Jean Saunders, J. Calvin Coffey
International Journal of Colorectal Disease.2013; 28(10): 1377. CrossRef

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

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Abstract PDF

Purpose

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

Methods

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

Results

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

Conclusion

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

Citations

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

The Feasibility of an Ex-vivo Sentinel Lymph Mapping Using Preoperative Radioisotope Injection in Cases of Extraperitoneal Rectal Cancer: Jun Seok Park, Gyu-Seog Choi, Hye Jin Kim, Soo Yeon Park, Yun Jung Park, Sang-Woo Lee, Ziguang Xu, Han Ik Bae; J Korean Soc Coloproctol. 2011;27(2):83-89. Published online April 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.2.83

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Abstract PDF

Purpose

The purpose of this research was to evaluate the feasibility of sentinel lymph node (SLN) mapping involving transanal injection with an ex-vivo mapping in patients with rectal cancer.

Methods

Between April 2007 and December 2009, 20 consecutive patients with T1-3, N0-1 clinical stage rectal cancer preoperatively underwent a SLN procedure using submucosal ^99mTc-phytate injection. All the patients underwent a total mesorectal excision. After the standard surgical resection, all specimens were identified on lymphoscintigraphy, and bench work was done to pick up the sentinel node basin. All the lymph nodes (non-SLNs and SLNs) were examined using conventional hematoxylin and eosin staining and immunohistochemistry with anti-cytokeratin antibodies.

Results

SLNs were identified from 19 of 20 patients with rectal cancer. The total number of sentinel nodes retrieved from the surgical specimens was 29, and the mean number per patient was 1.6 (range, 0 to 4). In three patients, the SLN was the only positive lymph node. There was one false-negative case with a sensitivity of 88.8% and two upstaged cases (20.0%). The SLN samples from rectal cancer are mainly localized in the pararectal region, but aberrant nodes receive direct drainage from the rectal cancer. On planar lymphoscintigraphy, 15.7% of all patients had aberrant lymphatic drainage to the sigmoid mesenteric or sigmoid lymph node station.

Conclusion

In conclusion, the intraoperative transanal injection for ex-vivo SLN navigation is a safe, feasible surgical modality in patients with rectal cancer. Large studies are warranted to determine the clinical significance of the SLN concept and micrometastasis in rectal cancer.

Citations

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Comparing the efficacy of routine H&E staining and cytokeratin immunohistochemical staining in detection of micro-metastasis on serial sections of dye-mapped sentinel lymph nodes in colorectal carcinoma
Mohammad Hossein Sanei, Seid Abbas Tabatabie, Seid Mozafar Hashemi, Ali Cherei, Parvin Mahzouni, Behnam Sanei
Advanced Biomedical Research.2016;[Epub] CrossRef
In vivo lymph node mapping and pattern of metastasis spread in locally advanced mid/low rectal cancer after neoadjuvant chemoradiotherapy
E. Farinella, L. Viganò, M. C. Fava, M. Mineccia, F. Bertolino, L. Capussotti
International Journal of Colorectal Disease.2013; 28(11): 1523. CrossRef
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Magyar Sebészet.2012; 65(3): 129. CrossRef

Impact on Prognosis of Lymph Node Micrometastasis and Isolated Tumor Cells in Stage II Colorectal Cancer: Tai Young Oh, Sun Mi Moon, Ui Sup Shin, Hyang Ran Lee, Sun Hoo Park; J Korean Soc Coloproctol. 2011;27(2):71-77. Published online April 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.2.71

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12 Citations

Abstract PDF

Purpose

Even though the importance of micrometastases (MMS) and isolated tumor cells (ITC) has been brought up by many physicians, its impact on the prognosis in stage II colorectal cancer is uncertain. In this research, we tried to investigate the clinical features of MMS and ITC and to prove any correlation with prognosis.

Methods

The research pool was 124 colorectal cancer patients who underwent a curative resection from April 2005 to November 2009. A total of 2,379 lymph nodes (LNs) were examined, and all retrieved LNs were evaluated by immunohistochemical staining with anti-cytokeratin antibody panel. Clinicopathologic parameters and survival rates were compared based on the presence of MMS or ITC and on the micrometastatic lymph node ratio (mmLNR), which is defined as the number of micrometastatic LNs divided by the number of retrieved LNs.

Results

Out of 124 patients (26.6%) 33 were found to have MMS or ITC. There were no significant differences in clinicopathologic features, such as gender, tumor location and size, depth of invasion, histologic grade, except for age (P = 0.04). The three-year disease-free survival rate for the MMS or ITC positive group was 85.7%, and that for MMS and ITC negative group was 92.8% (P = 0.209). The three-year disease-free survival rate for the mmLNR > 0.25 group was 73.3%, and that for the mmLNR ≤ 0.25 group was 92.9% (P = 0.03).

Conclusion

The presence of MMS or ITC was not closely correlated to the prognosis. However, mmLNR is thought to be a valuable marker of prognosis in cases of stage II colorectal cancer.

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Lymph Node Micrometastasis Cannot be Considered as Positive Lymph Node in Nonmetastatic Colorectal Cancer
Kwang Dae Hong, Jun Won Um, Byung Wook Min, Woong-Bae Ji, Jung-Woo Choi, Young-Sik Kim
The American Surgeon™.2017; 83(2): 127. CrossRef
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Bruno Märkl, C. Herbst, C. Cacchi, T. Schaller, I. Krammer, G. Schenkirsch, A. Probst, H. Spatz
International Journal of Colorectal Disease.2013; 28(7): 977. CrossRef
Molecular Detection of Tumor Cells in Regional Lymph Nodes Is Associated With Disease Recurrence and Poor Survival in Node-Negative Colorectal Cancer: A Systematic Review and Meta-Analysis
Nuh N. Rahbari, Ulrich Bork, Edith Motschall, Kristian Thorlund, Markus W. Büchler, Moritz Koch, Jürgen Weitz
Journal of Clinical Oncology.2012; 30(1): 60. CrossRef
Prognostic Significance of EpCAM-Positive Disseminated Tumor Cells in Rectal Cancer Patients With Stage I Disease
Sameer Dhayat, Sorina Sorescu, Daniel Vallböhmer, Sebastian Kraus, Stephan Ernst Baldus, Alexander Rehders, Feride Kröpil, Andreas Krieg, Wolfram Trudo Knoefel, Nikolas Hendrik Stoecklein
American Journal of Surgical Pathology.2012; 36(12): 1809. CrossRef
Prognostic Signifi cance of the Lymph Node Ratio Regarding Recurrence and Survival in Rectal Cancer Patients Treated with Postoperative Chemoradiotherapy
Ji-Yoon Kim, Su-Mi Chung, Byung-Ock Choi, In-Kyu Lee, Chang-Hyeok An, Jong-Man Won, Mi-Ryeong Ryu
Gut and Liver.2012; 6(2): 203. CrossRef

Clinical Characteristics of Colorectal Carcinoid Tumors: J Korean Soc Coloproctol. 2011;27(1):17-20. Published online February 28, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.1.17

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Abstract PDF

Purpose

The carcinoid tumor was recently categorized as a malignant disease due to its possibility of metastasis. This study was aimed to investigate the clinical characteristics and the metastatic rate of colorectal carcinoid tumors.

Methods

Charts were reviewed for 502 patients diagnosed with and treated for colorectal carcinoid tumors between January 2006 and December 2009. The location, size, depth and metastatic status of the tumors were collected.

Results

Including 24 synchronous tumors from 12 patients, 514 carcinoid tumors were removed. Most of them were found in the rectum (97.3%). The male-to-female ratio was 1.38 to 1, and mean age was 50.2 ± 11.4 years. The mean tumor size was 5.8 ± 3.6 mm. Less than 10-mm-sized tumors had a 1.95% lymph node metastatic rate; tumors with sizes from 10 mm to 20 mm and larger than 20 mm had 23.5% and 50% lymph node metastatic rates, respectively. Two cases had distant metastasis; one with a 22-mm-sized tumor metastasized to the liver, and the other with a 20-mm-sized tumor metastasized to the peritoneum. Among 414 patients who completed metastatic studies, 93.8% were classified as stage I, 0.9% as stage II, 4.8% as stage III and 0.5% as stage IV.

Conclusion

Colorectal carcinoid tumors smaller than 10 mm have a low rate of lymph node metastasis, but those sized 10 mm or larger incur significant risk. Further investigation regarding additional risk factors should be done to develop proper treatment guidelines for these tumors.

Citations

Citations to this article as recorded by

Endoscopic treatment of rectal neuroendocrine tumors: a consecutive analysis of multi-institutional data
Jae Won Shin, Eun-Jung Lee, Sung Sil Park, Kyung Su Han, Chang Gyun Kim, Hee Chul Chang, Won Youn Kim, Eui Chul Jeong, Dong Hyun Choi
Annals of Coloproctology.2025; 41(3): 221. CrossRef
Clinical outcomes and risk factors associated with poor prognosis after endoscopic resection of 10–20 mm rectal neuroendocrine tumors: a multicenter, retrospective study of 10-year experience
Ja Jun Goo, Dong Hoon Baek, Hyung Wook Kim, Hong Sub Lee, Jong Yoon Lee, Su Bum Park, Geun Am Song, Sang Heon Lee, Jong Hoon Lee
Surgical Endoscopy.2023; 37(7): 5196. CrossRef
Stratification of rate of lymph node metastasis according to risk factors and oncologic outcomes in patients who underwent radical resection for rectal neuroendocrine tumors
Myung Jae Jin, Sung Sil Park, Dong-Eun Lee, Sung Chan Park, Dong Woon Lee, Kiho Yu, Hee Jin Chang, Chang Won Hong, Dae Kyung Sohn, Kyung Su Han, Bun Kim, Byung Chang Kim, Jae Hwan Oh
Annals of Coloproctology.2023; 39(6): 467. CrossRef
Risk factors of lymph node metastasis in rectal neuroendocrine tumors*
Donghong Liang, Zhennan Niu, Xiaofang Sun, Changjuan Meng, Zhuang Liu
Oncology and Translational Medicine.2022; 8(4): 186. CrossRef
Risk of lymph node metastasis after endoscopic treatment for rectal NETs 10 mm or less
Yutaka Inada, Naohisa Yoshida, Kohei Fukumoto, Ryohei Hirose, Ken Inoue, Osamu Dohi, Takaaki Murakami, Kiyoshi Ogiso, Akira Tomie, Munehiro Kugai, Hiroyuki Yoriki, Yoshikazu Inagaki, Daisuke Hasegawa, Kotaro Okuda, Takashi Okuda, Yukiko Morinaga, Mitsuo K
International Journal of Colorectal Disease.2021; 36(3): 559. CrossRef
Grade G2 Rectal Neuroendocrine Tumor Is Much More Invasive Compared With G1 Tumor
Yi-Wei Li, Yi-Ping He, Fang-Qi Liu, Jun-Jie Peng, San-Jun Cai, Ye Xu, Ming-He Wang
Frontiers in Oncology.2021;[Epub] CrossRef
Nodal metastases in small rectal neuroendocrine tumours
Sarah O’Neill, Amyn Haji, Suzanne Ryan, Dominique Clement, Konstantinos Sarras, Bu Hayee, Nicola Mulholland, John K. Ramage, Rajaventhan Srirajaskanthan
Colorectal Disease.2021; 23(12): 3173. CrossRef
Analysis of Risk Factors of Lymph Node Metastasis in Rectal Neuroendocrine Neoplasms Using Multicenter Data
Gengzhou Wei, Xingyu Feng, Wei Wang, Yu Zhang, Yujie Zeng, Minhu Chen, Ye Chen, Jie Chen, Zhiwei Zhou, Yong Li
Future Oncology.2018; 14(18): 1817. CrossRef
Predictive Factors for Lymph Node Metastasis and Prognostic Factors for Survival in Rectal Neuroendocrine Tumors
Beonghoon Sohn, Yoomin Kwon, Seung-Bum Ryoo, Inho Song, Yoon-Hye Kwon, Dong Woon Lee, Sang Hui Moon, Ji Won Park, Seung-Yong Jeong, Kyu Joo Park
Journal of Gastrointestinal Surgery.2017; 21(12): 2066. CrossRef
The Clinicopathologic Features and Treatment of 607 Hindgut Neuroendocrine Tumor (NET) Patients at a Single Institution
Seung Tae Kim, Sang Yun Ha, Jeeyun Lee, Sung No Hong, Dong Kyung Chang, Young Ho Kim, Yoon Ah Park, Jung Wook Huh, Yong Beom Cho, Seong Hyeon Yun, Woo Yong Lee, Hee Cheol Kim, Young Suk Park
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Comparison of Endoscopic Mucosal Resection With Circumferential Incision and Endoscopic Submucosal Dissection for Rectal Carcinoid Tumor
Ru Chen, Xiang Liu, Siyu Sun, Sheng Wang, Nan Ge, Guoxin Wang, Jintao Guo
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2016; 26(3): e56. CrossRef
Nonlinear optical microscopy for label-free detection of gastrointestinal neuroendocrine tumors
Lianhuang Li, Liwei Jiang, Zhifen Chen, Deyong Kang, Zhenrong Yang, Xing Liu, Weizhong Jiang, Shuangmu Zhuo, Guoxian Guan, Yongjian Zhou, Jianxin Chen
Lasers in Medical Science.2016; 31(7): 1285. CrossRef
Rektale neuroendokrine Tumoren: chirurgische Therapie
O. Radulova-Mauersberger, S. Stelzner, H. Witzigmannn
Der Chirurg.2016; 87(4): 292. CrossRef
Hindgut Neuroendocrine Neoplasia
James D. Smith, Govind Nandakumar
Indian Journal of Surgical Oncology.2016; 7(1): 73. CrossRef
Are Small Rectal Neuroendocrine Tumors Safe?
Jae Ho Choi, Jae Myung Cha
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Rectal carcinoids: a systematic review
Frank D. McDermott, Anna Heeney, Danielle Courtney, Helen Mohan, Des Winter
Surgical Endoscopy.2014; 28(7): 2020. CrossRef
Clinicopathological analysis of colorectal carcinoid tumors and patient outcomes
Hung-Hsin Lin, Jen-Kou Lin, Jeng-Kai Jiang, Chun-Chi Lin, Yuan-Tzu Lan, Shung-Haur Yang, Huann-Sheng Wang, Wei-Shone Chen, Tzu-Chen Lin, Wen-Yih Liang, Shih-Ching Chang
World Journal of Surgical Oncology.2014;[Epub] CrossRef
Endoscopic submucosal dissection for colorectal tumors—1,000 colorectal ESD cases: one specialized institute’s experiences
Eun-Jung Lee, Jae Bum Lee, Suk Hee Lee, Do Sun Kim, Doo Han Lee, Doo Seok Lee, Eui Gon Youk
Surgical Endoscopy.2013; 27(1): 31. CrossRef
Factors Associated with Lymph Node Metastasis in Radically Resected Rectal Carcinoids: a Systematic Review and Meta-analysis
Xin Zhou, Haiting Xie, Lingduo Xie, Jing Li, Wei Fu
Journal of Gastrointestinal Surgery.2013; 17(9): 1689. CrossRef
Variable Clinical Classifications and Diagnostic Coding Systems of Colorectal Neuroendocrine Tumor
Byung Chang Kim, Cheol Hee Park, Tae Il Kim, Suck-Ho Lee, Jin-Oh Kim, Hyun Soo Kim, Dong-Hoon Yang, Bora Keum, Sung Pil Hong, Seong-Eun Kim, Hyun Gun Kim, Jeong Eun Shin, Jae Myung Cha, Young Eun Joo, Dong Il Park, Hwang Choi, Kyu Chan Huh, Seung-Jae Myun
Intestinal Research.2013; 11(1): 14. CrossRef

Prognostic Analysis According to N Stage and Circumferential Resection Margin in Patients with Locally Advanced Rectal Cancer.: Sohn, Yong Ki , Shin, Jin Yong , Hong, Kwan Hee; J Korean Soc Coloproctol. 2010;26(3):217-224.; DOI: https://doi.org/10.3393/jksc.2010.26.3.217

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Efforts must be made to clarify the contribution of lymph node metastasis (NM) to adjuvant (chemo) radiotherapy following a curative resection for rectal cancer as the circumferential resection margin (CRM) has increasingly become a more reliable prognosticator for rectal cancer. This study examined the prognostic impact of NM on local recurrence, disease-free survival. and overall survival rates in curatively resected patients with locally advanced rectal cancer.
METHODS
Two hundred two patients with locally advanced rectal cancer curatively resected in Pusan Paik Hospital from January 1995 to December 2003 were enrolled. These patients were divided into three groups according to lymph node (N) disease (N0: node negative, n=79; N1: 1-3 nodes positive, n=70; N2: > or =4 nodes positive, n=53). The potential prognostic factors, for example, T and N stage, preoperative carcinoembryonic antigen (CEA), postoperative (chemo) radiotherapy, operative methods, and several pathologic variables, were assessed among the three groups. The potential clinicopathologic factors were analyzed by using the Kaplan-Meier method, and the prognostic factors were compared in a Cox regression model. Also, we compared the oncologic results of 26 patients with a positive CRM (CMI) with those of the N1 and the N2 subgroups.
RESULTS
N2 patients had an impaired 5-yr local control rate (19.1%) compared with N0 (6.8%) and N1 (11.6%, P=0.029) patients after a median follow up of 60 months (range, 6 to 156 mo). Differences in disease-free and overall survival were also significantly different statistically among the three groups (84.0% and 85.2% for N0; 54.9% and 65.1% for N1; 37.3% and 49.8% for N2; P<0.001 both). The impact of NM on the local recurrence, disease-free survival and overall survival was confirmed in the regression model for the curatively resected patients. There were no significant differences in the recurrence and the survival rates between CMI and N2 stage.
CONCLUSION
NM has an independent prognostic impact on local failure and on disease-free survival and overall survival. Based on these findings, NM should be considered as an indicatior for adjuvant therapy. Although the prognostic impact of CMI is similar to that of N2, a larger prospective study is needed to clarify the prognostic association of CMI and N2.

Oncologic Impact of Extracapsular Invasion of Nodal Metastasis in Patients with Stage III Rectal Cancer.: Li, Ki Yoon , Shin, Jin Yong , Oh, Sang Hoon , Hong, Kwan Hee; J Korean Soc Coloproctol. 2009;25(3):186-192.; DOI: https://doi.org/10.3393/jksc.2009.25.3.186

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Abstract PDF: PURPOSE
Extracapsular invasion (ECI) of nodal metastasis is reported to be a prognosticator of colorectal cancer. However, limited knowledge exists about the prognostic value of ECI in stage III rectal cancer.
METHODS
From January 1996 to June 2004, 202 stage III rectal cancer patients who underwent surgery were enrolled in this study. The patients were divided into two groups according to ECI (patients with ECI, ECIP, n=122; patients without ECI, ECIN, n=80). The potential prognostic factors were compared in a Cox model.
RESULTS
Of 916 positive nodes examined, ECI was seen in 46.7% of the positive nodes. The univariate comparison between the two groups revealed the five-year results after a median follow-up of 48.0 mo. The local control rate of ECIP did not show a significant difference from that of ECIN (77.0% vs. 85.4%, P=0.550). The disease-free survival rate and the overall survival rate differed for the two groups, with rates of 44.1% and 50.0% for ECIP and 70.4% and 63.2% for ECIN (P<0.001, P=0.049, respectively). The impact of ECI on the disease-free survival was confirmed in a Cox model. In a subgroup analysis, no significant differences in the recurrence and the survival rates were seen between the N1 ECIP and the N2 ECIN subgroups.
CONCLUSION
Although ECI is not a risk factor for survival and local relapse, ECI is a prognosticator of overall recurrence. Based on these findings, more aggressive adjuvant treatment seems to be needed for decreasing the overall recurrence in stage III rectal cancer with ECI.

IMA-origin Lymph Node Metastasis in Left Colon Cancer.: Lee, Jae Hoon , Jung, Sang Hun , Kim, Hyun Jin , Hwang, Jong Sung , Kim, Jae Hwang , Shim, Min Chul; J Korean Soc Coloproctol. 2008;24(5):380-385.; DOI: https://doi.org/10.3393/jksc.2008.24.5.380

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Abstract PDF: PURPOSE
Although an extended colon resection with high ligation of the inferior mesenteric artery (IMA) generally has been recommended as curative surgery for advanced left colon cancer (LCC), it shows little or no survival advantage over segmental resection with low ligation of IMA. The present study is to determine the risk factors associated with IMA-origin lymph-node (LN) metastasis and to clarify the implication of IMA-origin LN metastasis.
METHODS
We examined the clinicopathological results of 200 cases of LCC. LN dissection was performed as follows: D2 en-bloc resection of the primary tumor, IMA-origin LN dissection, and paraaortic LN dissection.
RESULTS
The incidence of IMA-origin LN metastasis of LCC was 4.5% (9 cases), and all cases involved sigmoid colon cancer. The independent risk factors of IMA-origin LN metastasis were four or more regional LN metastases (hazard ratio: 16.51, 95% confidence interval: 1.60~164.12) and a preoperative CEA level of greater than 6 ng/ml of (hazards ratio: 6.63, 95% confidence interval: 1.06~41.32). The incidence of IMA-origin LN metastasis among stage IIIC patients was 26.7%. Five of the 9 (55.6%) cases of IMA-origin LN metastasis had a concomitant paraaortic LN metastasis.
CONCLUSIONS
The incidence of IMA-origin LN metastasis among patients with LCC was low; however, IMA-origin LN metastasis should be considered as a systemic metastasis.

Clinical Significance of E-cadherin and beta-catenin Complex Expression in T2 Colorectal Cancer.: Kim, Jin Soo , Ko, Yong Taek , Hur, Hyuk , Min, Byung Soh , Kim, Nam Kyu , Sohn, Seung Kook , Cho, Chang Hwan , Ahn, Choong Bae , Kim, Hoguen; J Korean Soc Coloproctol. 2008;24(2):91-99.; DOI: https://doi.org/10.3393/jksc.2008.24.2.91

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Abstract PDF: PURPOSE
Expression of adhesion molecules is significantly correlated with the invasion and the metastasis of colorectal cancer. The aim of this study is to identify the importance of the expressions of E-cadherin and beta-catenin as a prognostic factor in T2 colorectal cancer. METHODS: Forty-five cases of primary T2 colorectal cancers were selected between February 1997 and February 2000. We evaluated the membranous expressions of E-cadherin and beta-catenin by using immunohistochemisty and analyzed the relationship with various clinicopathologic parameters.
RESULTS
Loss of membranous E-cadherin was significantly associated with histologic differentiation (P=0.023), vascular invasion (P<0.001), lymphatic invasion (P<0.001), and lymph-node metastases (P=0.001). Similar patterns were observed in the expression of beta-catenin. The correlation between the E-cadherin and the beta-catenin expressions was statistically significant (P<0.001). In the multivariate analysis, neither the loss of expression of E-cadherin nor beta-catenin is a risk factor affecting lymph-node metastasis in T2 colorectal cancers. However, there were significant differences in the 5-year disease-free survival rates between the positive (+/-, +) and the negative (-) expression groups of E-cadherin and beta-catenin (P=0.015, 0.03). CONCLUSIONS: This study suggests that loss of membranous expression of E-cadherin and beta-catenin molecules correlates with poor prognostic factors and indicates invasion and metastasis in T2 colorectal cancer, which, therefore, might be predictive of short survival in these patients.

Ex-vivo Sentinel Lymph-node Mapping in Colorectal Cancer.: Kim, Hyung Jin , Lee, In Kyu , Lee, Yoon Suk , Kang, Won Kyung , Ahn, Chang Hyeok , Oh, Seong Taek; J Korean Soc Coloproctol. 2008;24(1):39-44.; DOI: https://doi.org/10.3393/jksc.2008.24.1.39

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Abstract PDF: PURPOSE
The presence of lymph-node metastases is one of the most important prognostic factors for patients with a colorectal carcinoma. The sentinel lymph node is the first lymph node that receives afferent lymphatic drainage from a primary tumor, and thus has the highest risk of harboring metastatic disease. METHODS: Twenty-eight patients with an adenocarcinoma of the colon or the rectum were investigated. After resection of the specimen in standard oncologic fashion, the specimen was dissected longitudinally along the antimesenteric border, and methylene blue was injected around the tumor submucosally. After 5 minutes, the mesentery was meticulously examined, and blue-stained lymphatics and lymph nodes were carefully dissected and harvested. RESULTS: Sentinel lymph nodes were identified in all cases. The average number of sentinel nodes identified was 3 (range, 1~6), and the average number of lymph nodes retrieved was 20.8 (range, 6~42). Of the fifteen patients (53.6%) identified to be positive for lymph-node metastasis 10 showed nonsentinel nodal metastasis without sentinel nodal involvement. No additional isolated tumor cells were found by immunohistochemical staining in 13 patients who had no lymph-node metastasis on conventional pathologic examination. CONCLUSIONS: In colorectal cancer, the sentinel-lymph-node sampling method is easy and can be performed for the purpose of finding lymph nodes easily. However, applying the sentinel-lymph-node sampling method for the purpose of minimizing lymph node dissection, as in breast cancer, is not recommended because of the high probability of missing metastasis.

The Prognostic Significance of Tumor Budding, Tumor Nodules, and Lymph Node Extracapsular Extension in Stage III Colorectal Cancer Patients.: Kim, Seong Ah , Shin, Ok Ran , Kim, Hyong Ran , Cho, Hang Ju , Seo, Hak Jun , Kim, Kee Hwan , Kim, Ji Il , An, Chang Hyeok , Oh, Seung Tack , Kim, Jeong Soo; J Korean Soc Coloproctol. 2007;23(6):460-476.; DOI: https://doi.org/10.3393/jksc.2007.23.6.460

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Abstract PDF

PURPOSE
The prognosis of advanced colorectal cancer patients may be different even for the same TNM staging. The characteristic features of tumors, such as tumor budding, tumor nodules, and extracapsular extension (ECE) of lymph nodes, can influence the disease progression and the outcome for patients. Tumor budding occurs what at the invasion front of colorectal adenocarcinomas, tumor cells, singly or in small aggregates, become detached from the neoplastic glands, and it can be divided it into two groups, low grade (0~16 foci in a field) and high grade (17 or more foci in a field). A tumor nodule is histologically identified within the fatty tissue or the detached fatty tissue around the dissected lymph nodes, or is a place picked up as lymph nodes from resected specimens which contain no lymph node components. ECE is defined as a tumor extension beyond the node capsule. The aims of this study were to evaluate the clinical significance of tumor budding, tumor nodules, and ECE of lymph nodes as prognostic factors in Stage III colorectal cancer patients.
METHODS
We analyzed the disease-free and overall 5-year survival rates and recurrence rates in 94 Stage-III colorectal cancer patients according to tumor the budding intensity, the tumor nodules, and the lymph node ECE status.
RESULTS
Of the entire group, the 5-year disease-free and overall survival rates were 49%, and 50%, respectively. The 5-year disease-free and overall survival rates were higher in the low-grade tumor budding group than in the high-grade group (58% vs 33%, P=0.045, 61% vs 39%, P=0.003). The 5-year disease-free and overall survival rates in patients with tumor nodules were lower than those in patients without one (44% vs 69%, P=0.086, 47% vs 77%, P=0.018). The recurrence rate was also higher in the group with tumor nodules than without one (80% vs 52%, P=0.045). The 5-year disease-free and overall survival rates were higher in the ECE negative group than in the positive one (68% vs 37%, P=0.018, 75% vs 42%, P=0.001). The recurrence rate was also higher in the ECE positive group than in the negative group (78% vs 46%, P=0.008). The existence of ECE and tumor nodule were strongly related to systemic recurrence (P=0.006, P=0.033), but not to the local recurrence (P=0.777, P=0.611). Considering the analysis of the recurrence pattern by N stage classification, there is no statistical difference in the N2 patient group, but there was in the existence of ECE and tumor nodule were strongly related to the systemic recurrence in N1 group (P=0.019, P=0.028). These three factors were scored according to the existence, and the score range was divided into two prognostic groups, high risk group (> or =2) and low risk group (<2). The high risk group was significantly associated with systemic recurrence (P= 0.004) rather than recurrence (P=0.865), and these score value were only significant in the N1 patient group (P=0.007) rather than in the N2 group (P=0.927). The high risk group also showed poor overall survival rate compared with the low risk one in only the N1 group (P=0.002), but nof in the N2 group (P=0.193). On multivariate analysis, UICC stage and ECE were two significant factors for tumor recurrence and the 5-year disease-free survival rate.
CONCLUSIONS
These data showed that even if similar lymph node metastasis existed in advanced colorectal cancer patients, there was a different 5-year disease-free survival rate and overall survival rate according to the tumor budding, tumor nodule, and ECE status. On multivariate analysis, UICC stage and ECE were two significant factors for the tumor recurrence and the 5-year disease-free survival rate. Our results suggest that tumor budding, tumor nodule, and ECE of lymph node are excellent parameters to provide a confident prediction of clinical outcome.

Citations

Citations to this article as recorded by

Tumor Budding and Survival After Potentially Curative Resection of Node-Positive Colon Cancer
Joanne Sy, Caroline L.-S. Fung, Owen F. Dent, Pierre H. Chapuis, Les Bokey, Charles Chan
Diseases of the Colon & Rectum.2010; 53(3): 301. CrossRef
The Relatioships Between Tumor-related Gene Expression and Tumor Budding, Tumor Nodule and Lymph Node Extracapsular Extension in Colorectal Cancer
Hyun Jong Kang, Hang Joo Cho, Gi Chang Kang, Kee Hwan Kim, Won Kyung Kang, Ji Il Kim, Jong Kyung Park, Seungtack Oh, Jeong Soo Kim, Chang Hyeok An
Journal of the Korean Society of Coloproctology.2009; 25(1): 1. CrossRef

Effect on the Local Recurrence and the Survival of Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection in Rectal Cancer.: Choi, Byung Gwan , Kim, Hyung Soo , Seo, Kyeong Won , Ju, Jae Kyoon , Ryu, Seong Yeob , Park, Young Kyu , Kim, Hyeong Rok , Kim, Dong Yi , Kim, Young Jin; J Korean Soc Coloproctol. 2007;23(1):46-52.; DOI: https://doi.org/10.3393/jksc.2007.23.1.46

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Abstract PDF: PURPOSE
One of the most common sites of recurrence after a curative resection of rectal cancer is the pelvis, and local control is a major goal of surgical treatment. The advantages of lateral pelvic lymph node dissection are regarded as questionable because lateral pelvic lymph node metastasis does not occur so frequently and because a lateral lymphadenectomy has a negative influence on the postoperative quality of life. The aim of this study was to clarify if lateral pelvic lymph node dissection (LPLD) conferred any benefit.
METHODS
A total of 769 patients who underwent curative surgery for rectal cancer between 1981 and 2005 at the Department of Surgery, OOO Hospital, were reviewed retrospectively. One hundred ninety-three of these patients underwent a lateral pelvic lymph node dissection, and 576 patients had a total mesorectal excision with high ligation of the IMA.
RESULTS
There was no difference in pathological characteristics between the two groups. Patients who underwent a lateral pelvic lymph node dissection had no statistically significant difference in terms of the 5-year survival rate at stage II and III (64% vs 65% at stage II, P=0.391; 49% vs 47% at stage III, P=0.815).
CONCLUSIONS
A lateral pelvic lymph node dissection has no advantage as part of a standard operation for rectal cancer. A total mesorectal excision alone has good local control and survival compared with a lateral pelvic lymph node dissection.

The Significance of CD44v Expression in the Pelvic LateralLymph Node in Distal Rectal Cancer.: Bae, Ok Suk; J Korean Soc Coloproctol. 1999;15(2):93-97.

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Abstract PDF: PURPOSE
The CD44 has been known a lymph node homing receptor on circulating lymphocytes. CD44 spliced variants have been found to be overexpressed in human cancers and metastatic cancers. The variant CD44v 6-7 in particular has been suggested to have a potential role in tumor metastasis. It has been reported that histopathological examination could occaisionally miss lymph node micrometastasis. PURPOSE: The aim of this study was to investigate the role of CD44v in metastasis of rectal carcinoma to the pelvic lateral lymph nodes around the obturator nerve, obturator vessel and superior vesical artery.
METHODS
Thirty pelvic lateral lymph nodes reported normal histopathologically from 22 patients with rectal carcinomas, 22 rectal carcinomas and their corresponding colonic mucosas. We have used RT-PCR for the detection of CD44 gene products (CD44v and CD44 v6-7) in samples.
RESULTS
The expression rates of CD44v were 2/22 (9%) for normal colonic mucosa, 20/22 (90%) for cancer tissues, and 4/30 (13.3%) for pelvic lateral lymph nodes. The rates of CD44v6-7 were also 2/22 (9%) for normal colonic mucosa 20/22 (90%) for cancer tissues, but 7/30 (23.3%) for pelvic lateral lymph nodes.
CONCLUSIONS
The analysis of CD44v might be useful for determination of pelvic lateral lymph nodes metastasis, but it should not be used as a metastatic marker in general for rectal cancer patients.

Correlation of beta-catenin and p53 Protein Expression with Clinico-pathologic Characteristics of Colorectal Cancer.: Moon, Kil Min , Park, Young Jin , Kim, Han Seung , Park, Seung Hae , Kim, Ji Il , Kim, Ki Hong , Song, Byung Joo , Lee, Meung Soo , Kim, Chul Nam , Chang, Seok Hyo; J Korean Soc Coloproctol. 2002;18(5):311-316.

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Abstract PDF: PURPOSE
Both the beta-catenin and p53 play a crucial role in the process of colon carcinogenesis. The expression of beta-catenin and/or p53 has been reported to be associated with pathologic features of tumor and prognosis of patients. In addition, several recent studies have suggested a close biological association between p53 expression and nuclear beta-catenin level. We analyzed the pathologic variables and p53 expression according to the intra-nuclear beta-catenin expression in colon cancer to make such assumptions more clear since they are still controversial issues.
METHODS
The expressions of beta-catenin, p53 and Ki-67 protein in colon cancer were determined by immunohistochemical staining. The relationship between these protein expressions and tumor characteristics was statistically analyzed.
RESULTS
The intra-nuclear beta-catenin accumulation was not associated with any of the pathological variables including lymph node metastasis and tumor differentiation, but it was correlated with higher level of Ki-67 proliferation index (P=0.006) and negative staining of p53 (P=0.015). Positive p53 staining was significantly associated with lymph node metastasis (P=0.006), lymphatic invasion (P=0.03) and venous invasion (P=0.02).
CONCLUSION
These results support the suggestion that intra-nuclear accumulation of beta-catenin may regulate the p53 activity in colorectal cancer. In addition, positive staining of p53 may be used as a valuable prognostic indicator since it was strongly associated with lymph node metastasis, lymphatic and venous invasion.

The Risk Factors of Lymph Node Metastasis in Submucosal Invasive Colorectal Cancer.: Choi, Pyong Wha , Yu, Chang Sik , Jang, Se Jin , Kim, Mi Jung , Han, Kyong Rok , Jung, Sang Hun , Yoon, Yong Sik , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2006;22(4):264-270.

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Abstract PDF: PURPOSE
Recent studies have shown a 7~15% lymph node (LN) metastasis rate in submucosal invasive colorectal cancer (SICC). Identification of risk factors for LN metastasis is crucial in the choice of therapeutic modalities for SICC. The present study was performed to assess the possibility of LN metastasis and to determine the risk factors of LN metastasis in SICC.
METHODS
A retrospective study of 168 patients with SICC who underwent a curative resection between June 1989 and December 2004 at Asan Medical Center was conducted. The level of submucosal invasion was classified into upper third (sm1), middle third (sm2), and lower third (sm3) according to the submucosal depth of invasion. The following carcinoma-related variables were assessed: tumor size, tumor location, level of submucosal invasion, cell differentiation, lymphovascular invasion, neural invasion, and tumor cell dissociation (TCD).
RESULTS
The overall LN metastasis rate was 14.3%. According to the level of submucosal invasion, LN metastasis was seen as follows: sm1, n=4 (4.2%), sm2, n= 10 (21.3%), and sm3, n=10 (38.5%) (P=0.039). According to cell differentiation, LN metastasis was observed as follows: well-differentiated, n=4 (4.9%), moderately differentiated, n=19 (22.9%), and poorly differentiated, n=1 (25.0%) (P=0.028). Nineteen of the 66 cases (28.8%) with TCD had significantly higher risk of LN metastasis as did 5 of the 102 cases (4.9%) without TCD (P=0.045). No statistical difference was observed in the risk of LN metastasis with regard to tumor location, tumor size, neural invasion, or lymphovascular invasion.
CONCLUSIONS
Submucosal invasion, cell differentiation, and tumor cell dissociation were significant pathologic predictors of LN metastasis in SICC. As SICC has considerable risk of LN metastasis, local excision should be reserved to highly selective sm1 cancers.

Prevalence of Liver Metastasis of Colorectal Cancer According to Clinical and Histopathologic Characteristics.: Ryu, Dong Won , Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2002;18(4):246-250.

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Abstract PDF: PURPOSE
In Korea, the incidence of colorectal cancer is increasing quickly. The liver metastasis is the most common cause of death. But current diagnosis methods such as CT, MRI, USG have significant false negative rate (up to 15%) especially in micrometastasis. We designed this study to identify the predictive value of liver metastasis of known clinical and histopathologic factors.
METHODS
Retrospectively, we reviewed 248 patients who underwent resection of colorectal cancer between 1997 and 1999. Clinical and histopathologic factors of colorectal cancer with synchronous liver metastasis was compared with those without liver metastasis.
RESULTS
Twenty-nine patients had synchronous liver metastasis. In clinical factors, there was significant difference in liver metastatic rate according to tumors location, and serum carcinoembryonic antigen (CEA). The metastatic rate of right colon was 9.5%, left colon was 27.9%, rectum was 8.0% (P=0.001). The metastatic rate in cases with CEA<5.0 ng/ml was 4.3%, CEA> or =5.0 ng/ml was 18.4% (P=0.001). In histopathologic factors, there was significant difference in liver metastatic rate according to depth of tumor invasion (T-stage), extent of lymph node metastasis (N-stage), venous invasion (9.5 vs 19.3 %, P=0.043), perineural invasion (8.5 vs 19.7 %, P=0.013). The metastatic rate of T1 was 0%, T2 was 3.43%, T3 was 12.3%, T4 was 26.9% (P=0.009). The metastatic rate of N0 was 4.9%, N1 was 15.6%, N2 was 30.3% (P=0.002). But there was no significant difference according to tumor size, histologic differentiation grade, lymphatic invasion. In multi- variant analysis with significant factors, independent factor associated with liver metastasis was N-stage.
CONCLUSIONS
In colorectal cancer, tumor location, CEA, T-stage, N-stage, venous invasion, and perineural invasion of tumor cell had significant relationship with liver metastasis. The most important factor associated with liver metastasis was N-stage. This factors shoud be considered carefully in the planning treatment and follow up in colorectal cancer.

Statistical Evaluation of Number of Lymph Node in Dukes C Colorectal Carcinoma.: Kim, Jong Hyun , Jung, Bong Wha; J Korean Soc Coloproctol. 1998;14(3):413-418.

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Abstract PDF: PURPOSE
Colorectal surgery, there are many important prognostic factors---depth of invasion, lymph node metastasis and distant metastasis. In there, the involvement of the lymph nodes by metastatic colorectal carcinoma may depends on several factors such as the sex, the age of the patient, tumor site and size, the symptomatic duration of the disease, tumor cell differentiation, and operating methods. In that point of view, we want to know how many lymph nodes are dissected for enough to determine statistically considerated Dukes C stage.
METHODS
We had studied 128 operation cases of colorectal adenocarcinoma from our hospital admission during the period of May, 1988 to October, 1997 to determine to provide an accurate assessment of the presence of nodal metastases. Patients status, tumor site and size, symptomatic duration of disease, tumor cell differentiation, and operating methods of 128 cases were analyzed. We calculated the probability to find at least one positive node in Dukes C, by binomial distribution from SPSS (version 7.5).
RESULTS
Eighty-three specimens (65%) were classified as Dukes B. Forty-five specimen (35%) had lymph node metastases (Dukes C) with a mean of 4.1+/-4.1 positive lymph nodes per specimen. The mean total number of lymph nodes identified per specimen was 11.6+/-7.4 (range 1~41), Dukes B was 10.9+/-7.1 (range 1~29) and Dukes C was 12.8+/-7.9 (range 3~41). Applying Students t-test to compare two independent average means, the result was the absence of significant differences in the number of nodes for the specimens defined as Dukes B and Dukes C, sex, age, symptom duration, and operationmethods whereas significant differences did exist for the specimen depending on the tumor differentiation, tumor size, and location. Poorly differentiation cancer was more prominent meaning than well or moderately differentiation in Dukes B (p<0.05). In stage Dukes C, if tumor size was below 2cm it was differences in other sizes (p<0.05). In tumor location, if tumor sited ascending colon was more prominent than sigmoid and rectum (p<0.05). According to our result, minimum 6 lymph nodes per specimen were optimal Dukes C staging assessment.
CONCLUSION
The minimum 6 lymph nodes provided an accurate assessment of the presence of nodal metastases (95 percent confidence interval) in Dukes C stage.

Predicting Lymph Node Metastasis in Patients with Advanced Rectal Cancer: A Prospective Study for the Characteristics of Lymph Node Metastasis of Mesorectum and Extra-Mesorectum.: Shim, Kang Sup , Kim, Kwang Ho , Yoon, Dae Kun , Kim, Ki Hyun , Kim, Sung Phill , Lee, Kun Young , Choi, Eun Chang , Sung, Sun Hee , Han, Woon Sup , Pa, Eung Bum; J Korean Soc Coloproctol. 1998;14(3):399-412.

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Abstract PDF: It is very important to tallow that pelvic lymphadenectomy associated with proctectomy must be based on the principle of oncologic surgery and encompass all predictable pathways of extension of rectal cancer for curative surgical resection. We investigated the characteristis of lymph node metastasis in patients with rectal cancer prospectively. 108 consecutive patients with rectal cancer underwent curative surgical resection were enrolled in this study. Rectal cancers were divided into two groups, upper and mid-lower. Upper rectal cancer was defined as the tumor above the peritoneal reflexion. Lymph nodes were stratified as mesorectum, distal mesorectum (defined as distal part more than 2 cm from the lower margin of the tumor), intemal iliac, common iliac, presacral, superior rectal artery, inferior mesenteric artery, paraaortic lymph node. Average number of sampled nodes in these groups 18.5+/-10.7, 3.6+/-3, 2.3+/-3, 1.8+/-1.3, 4 +/-4.1, 1.6+/-2, 3.1+/-3.2, 5.4+/-4.7 respectively. 60 of all patients showed positive lymph node. The over all percentages of patients with positive lymph node was 53% in mesorectum, 12% in distal mesorectum, 8% in intemal iliac, 4.5% in common iliac, 4.5% in presacral, 10% in superior rectal artery, 6.5% in inferior mesenteric artery, 4% in paraaortic lymph node. The over all percentages of patients with positive lymph nodes in each group were 60% (27/45), 9% (4/45), 6.5% (3/45),2% (1/45), 2% (1/45), 13% (6/45), 11% (5/45), 1% (1/45) respectively in upper rectal cancer, 49% (31/63), 14% (9/63), 9.5% (6/63), 6% (4/63), 6% (4/63), 8% (5/63),3% (2/63),5% (3/63) respectively in mid-lower rectal cancer. There were skip metastasis in 3 patients with upper rectal cancer, 2 patients with mid-lower rectal cancer. Age, depth of invasion, tumor size, tumor differentiation among clinicopathologic factors were predictive factors of lymph node metastasis to mesorectum. Risk factors of metastasis to extra-mesorectal lymph node were younger age (<40), poorly differentiation, larger tumor size (>5.0 cm), involved circimferential (>50%), and positive CA 19-9 (>37 U/ml). These results suggest that more careful upward lymphadenectomy must be carried out especially in upper rectal cancer and also careful lateral dissection in selected patients and more generous excision of distal mesorectum especially in mid-lower rectal cancer is needed for curative resection according to clinicopathologic factors.

Pattern of Recurrences and Metastases according to Regional Lymph Node Metastasis of Colorectal Cancer.: Park, In Ja , Kim, Hee Cheol , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2006;22(1):47-53.

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Abstract PDF: PURPOSE
We aimed to verify the pattern of recurrences or metastases of primary colorectal cancer according to regional lymph node metastasis and to use it for follow up.
METHODS
A study was undertaken of 537 stage II and III patients who had undergone a resection of colorectal cancer between July 1989 and December 2002 and who had been identified as having a recurrence during follow up and of 439 stage IV patients who had undergone a resection of the primary tumor during the same period and who could be evaluated for regional lymph node status. Patients were classified into two groups according to regional lymph node status: no lymph node metastasis (214) and lymph node metastasis (762). Univariate and multivariate (Cox's model) analyses of recurrence were employed to identify differences. Statistical significance was assigned to a P value of <0.05.
RESULTS
In the lymph-node-metastasis group, female, poorly differentiated, and infiltrating type cancer were dominant. The patterns of recurrence were hematogenous in 729 cases (74.7%), local recurrence in 101 cases (10.3%), peritoneal seeding in 107 cases (11.0%), and lymph node recurrence in 116 cases (11.9%). Hematogenous metastasis was the most common type of metastasis or recurrence in both groups. Compared with the no-lymph-node-metastasis group, the rates of lymph node recurrence (P<0.01) and local recurrence (P=0.02) were much higher in the were more frequent lymph-node-metastasis group. Local recurrence was frequent in rectal cancer, and the location of the primary tumor greatly influenced on local recurrence. Therefore, lymph node recurrence was strongly influenced by regional lymph node metastasis.
CONCLUSIONS
The pattern of recurrence differed according to the characteristics of the primary tumor. Especially, in the lymph-node-metastasis group, lymph node and local recurrences were more common than they were in the no-lymph-node-metastasis group. Therefore, lymph node metastasis should be considered for follow up.

Occurrence and Prognostic Implications of Lymph Node Micrometastases in Patients with Dukes' B Colorectal Carcinoma.: Choi, Yun Young , Choi, Hong Jo , Jung, Ghap Joong , Kim, Sang Soon , Hong, Sook Hee; J Korean Soc Coloproctol. 2001;17(3):141-147.

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Abstract PDF: PURPOSE
Whereas lymph node metastases in colorectal carcinoma are important prognostic factor, the prognostic relevance of occult tumor cells in lymph nodes has not been elucidated yet. Aims of this study were to assess the incidence of micrometastases of lymph nodes in patients with Dukes' B colorectal carcinoma and to investigate the correlation between nodal micrometastases and malignant potential to determine whether micrometastases of lymph nodes have prognostic significance, using an anti-cytokeratin immunohistochemical technique.
METHODS
To evaluate the incidence of lymph node micrometastases in patients with Dukes' B colorectal carcinoma, 1160 lymph nodes taken from 65 patients (17.9 per case) were assessed by immunohistochemical technique using a monoclonal anti-human cytokeratin (MNF 116). Clinicopathologic parameters and survival rate were compared between patients with and without micrometastases.
RESULTS
The incidence of nodal involvement by tumor cells in 65 patients with Dukes' B colorectal carcinoma (41 colon, 22 rectum, 2 synchronous cancer) was 30.8% (20 cases) and nodal positivity 3.2% (33/1423 nodes) by the immunostaining. No correlations were observed between the incidence of cytokeratin positivity and various clinicopathologic parameters, including preoperative CEA level, tumor site and size, histologic differentiation, pT stage, vascular invasion and lymphatic invasion and rate of recurrence. There was no difference in five-year survival estimated by Kaplan-Meier lifetable method between the micrometastases negative and positive groups (94.8% and 94.1%, respectively).
CONCLUSIONS
The presence of nodal micrometastases detected by anti-cytokeratin immunohistochemistry is an interesting phenomenon but clinically seems to be of little prognostic value in patients with Dukes' B colorectal carcinoma. Thus, this immunostaining technique does not offer a significant benefit over conventional pathologic staging using hematoxylin-eosin staining.

Impact of the Number of Lymph Nodes Retrieved on Reliability of Nodal Staging of Stage II Colorectal Carcinomas.: Lee, Tae Mu , Choi, Hong Jo , Park, Ki Jae , Kim, Jung Min , Roh, Young Hoon , Roh, Mee Sook; J Korean Soc Coloproctol. 2005;21(3):167-173.

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Abstract PDF: PURPOSE
The variety of outcomes in patients with stage II colorectal carcinomas might be due to understaging caused by an inadequate number of lymph nodes (LNs) being examined. The aim of this study was to determine if any number of examined LNs reflects a reliable node-negative staging for colorectal carcinomas (CRCs).
METHODS
Data on 241 patients (132 males) who underwent potentially curative resections for pT3 and pT4 CRC were reviewed. The patients ranged in age from 21 to 87 (mean: 58.2) years with a median follow-up of 43 (range: 7~96) months. The relationship between the number of LNs harvested and both the 5-year disease-free survival (DFS) and the overall survival (OS) rates were assessed for stage II CRCs.
RESULTS
A median of 15 LNs (range: 3~104) was harvested per tumor specimen, and lymph-node metastases were present in 107 cases (44.4%). The proportion of lymph-node metastases increased as a function of the number of LNs harvested (P=0.0002; 95% confidence interval, 0.3333~0.8138). The number of LNs revealed to be the best number for dividing stage II patients into subgroups with different DFS and OS rates was ten. The 5-year DFS and OS rates of the 48 patients (35.8%) with nine or fewer LNs harvested were 68.6% and 76.8%, respectively, whereas those of the 86 patients (64.2%) with ten or more LNs harvested were 87.2% and 91.9%, respectively (DFS, P=0.0082; OS, P=0.0303). Moreover, there were no statistical differences between the node-negative patients with nine or fewer LNs harvested and the 67 stage III patients with N1 in respect to the DFS (68.6% vs. 56.7%; P= 0.2031) and the OS (76.8% vs. 68.3%; P=0.2772) rates.
CONCLUSIONS
This study suggests that examining a greater number of lymph nodes increases the likelihood of accurate nodal staging and that a minimum of ten LNs per surgical specimen should be harvested and examined to label a pT3 or pT4 CRC as node-negative.

The Relationship of Depth of Penetration and Tumor Size to the Number of.: Hong, Dong Hwan , Kim, Heung Dae , Shin, Jun Ho , Han, Won Kon , Pae, Won Kil; J Korean Soc Coloproctol. 1997;13(3):343-352.

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Abstract PDF: We examined the interrelationships of depth of penetration, tumor size, and the number of positive lymph nodes in Dukes'c colorectal cancer. This report contains a retrospective study of 256 cases of colorectal cancer that underwent treatment from Jan. 1985 to Dec. 1994 at the Department of Surgery, Kangbuk Samsung Hospital. The most of the patients were on the 6th decades and male to female ratio was 1.27 : 1. By modified Astler-Coller classification, there were stage Cl 29 cases(11.3%), C2 227 cases(88.7%). Eighty patients with colon cancer(31.4%) and 176 patients with carcinoma of the rectum(68.6%) were available for analysis. Utilizing cumulative frequency distributions of tumor size, depth of invasion and the number of positive lymph nodes, comparisons were carried out among three factors. The results indicate that there was no correlation between the longest diameter of the tumor and other two factors but the number of positive lymph node was closely related to depth of invasion. In conclusion, the number of positive lymph node and depth of invasion are very important prognostic factor. But tumor size as a single factor does not correlated with prognosis in Dukes' C colorectal cancer.

Clinicopathologic Features of Colorectal Cancer with Liver Metastases.: Choi, Sun Keun , Jeon, Yong Sun , Bae, Sun Young , Kwak, Min Keun , Hur, Yoon Seok , Lee, Keon Young , Kim, Sei Joong , Cho, Young Up , Ahn, Seung Ik , Hong, Kee Chun , Shin, Seok Hwan , Kim, Kyung Rae , Woo, Ze Hong; J Korean Soc Coloproctol. 2004;20(4):211-217.

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Abstract PDF: PURPOSE
The aim of this study was to clarify the clinicopathologic features in colorectal cancer with liver metastases and to evaluate their clinical significance.
METHODS
From August 1996 to April 2002, 545 patients, who underwent radical surgery for primary colorectal cancers, were analyzed retrospectively.
RESULTS
Colorectal cancers with and without synchronous liver metastases at the time of the surgery were 36 and 509 cases, respectively. Of the 509 cases without metastases, 34 cases had metachronous liver metastases by April 2002, but the others did not. Serosal, vascular, perineural, and lymph node invasions, as well as increased preoperative CEA levels, were more frequently observed in those with synchronous liver metastases than it was in those without metastases (P<0.05). According to multivariate analyses, lymph node invasion was statistically significant as an independent variable in those with synchronous metastases (P=0.009). Serosal, vascular, and lymph node invasions, increased preoperative CEA levels, DNA ploidy, and positive lateral resection margins were more frequently observed in those with metachronous liver metastases than it was in those without metastases (P<0.05). According to multivariate analyses, vascular invasion was statistically significant in those with metachronous metastases (P=0.015).
CONCLUSIONS
Lymph node and vascular invasions appear to be significant determinants for synchronous and metachronous liver metastases in colorectal cancers. Therefore, close observation and careful postoperative follow-up is needed for such patients.

Clinical Significance of Occult Micrometastases in Colorectal Cancer.: Lee, Suk Hwan , Kim, Tae Young , Kim, Yoon Wha , Koh, Suck Hwan , Yoon, Choong , Oh, Soo Myung , Lee, Kee Hyung; J Korean Soc Coloproctol. 2000;16(2):78-86.

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Abstract PDF: BACKGROUND
One of the most important prognostic factors in colorectal cancer is lymph node metastasis, which predicts a reduced survival time. Although lymph node metastases were not detected by a conventional hematoxylin-eosin stain technique, 20 to 30 percent of patients fail long-term survival on account of a local or systemic recurrence. Recurrent disease in these patients is believed to develop from occult tumor in lymph nodes. PURPOSE: The authors have conducted an immunohistochemical study with two different antibodies against cytokeratin to identify occult micrometastases in lymph nodes which were diagnosed as tumor negative by conventional histopathology.
METHODS
Paraffin blocks of sixty-five patients with colorectal cancer (T2/3, N0, M0) after a curative resection between January 1991 and December 1993 at Kyung-Hee University Hospital were stained with avidin-biotin-peroxidase complex technique using two monoclonal antibodies (anti-cytokeratin AE1/AE3 and anti-cytokeratin No. 20, DAKO, Hamburg, Germany). To assess the clinical correlation between micrometastasis in lymph node and patients survial, 5-year disease-free survival rates were calculated by Kaplan-Meier method and the significance of the differences was estimated by the log-rank test. P values <0.05 were taken to be significant.
RESULTS
Of the sixty-five patients with 1133 lymph nodes, tumor cells detected by anti-cytokeratin AE1/AE3 and anti-cytokeratin No. 20, were 2.4 percent (27/1133) and 3.4 percent (38/1133), respectively. Micrometastases were detected in twenty-six patients (40.0 percent). The histologic stage of four cytokeratin positive cases was upstaged from T2, N0, M0 to T2, N1/2, M0, and twenty-two of T3, N0, M0 to T3, N1/2, M0. Cytokeratin-positive cases showed statistically significant recurrence rate (42.3 percent) compared to that of cytokeratin -negative cases (17.9 percent)(x2 test, p=0.032). With the median follow-up of 62 months, 5-year disease-free survival rates of the micrometastses negative and positive cases were 81.7 percent and 61.3 percent, respectively (p=0.0438).
CONCLUSIONS
In conclusion, immunohistochemical technique to identify the occult micrometastases in lymph nodes overlooked in conventional histopathology is a useful staging method to anticipate a recurrence and a prognosis more precisely.

Is Laparoscopic Procedure Adequate for Colorectal Cancer Surgery?.: Kim, Jae Hwang , Huh, Jin Myeung , Yoon, Sung Su , Kim, Sang Woon , Shim, Min chul , Kwun, Koing Bo; J Korean Soc Coloproctol. 1999;15(5):434-442.

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Abstract PDF: PURPOSE
To evaluate the possibility that laparoscopic procedure could perform surgeries keeping the principle of oncologic surgery.
METHODS
From July 1993 to June 1996, thrity patients undergone laparoscopic assisted colon and rectal resections (LR) for malignant disease at Yeungman university hospital. Margins of resection and lymph nodes (LNs) recovered were compared with those of thirty stage matched open resection cases (OR, n=30) retrospectively. There was no operative mortality in both group. Operative techniques used in LR vs OR were colectomy, 5:6; anterior resection, 6:5; low anterior resection, 11:12 and abdominoperineal resection, 8:7. Parameters were analgesic use, duration of postoperative ileus, operative time, hospital stay, margins of rescetion, lymph node yield (LNs), and recurrence.
RESULTS
Patients who underwent LR had less pain, a shorter period of postoperative ileus and hospital stay than patients who underwent OR. But, the length of operative time was greater for patients undergoing LR. Mean lymph node yield in the laparoscopic group was 16 compared with 18.1 in the open group (P=0.560). Average margins of resection in LR vs OR were 13.9 cm vs 14.1 cm proximally (P=0.823), 3.6 cm vs 5.2 cm distally (P=0.498). In no case did the margins contain tumor. There was no statistical significance in dissected LNs and the length of both resection margins in both groups. Recurrence was similar in both groups.
CONCLUSIONS
In this study, there is no evidence that laparoscopic technique is inadequate in following the cancer surgery principle.

Clinical Analysis of T4 Colorectal Cancer with Adhesion to Adjacent Organs.: Cho, Mun Hyeong , Joo, Jai Kyun , Ryu, Seong Yeob , Kim, Hyeong Rok , Kim, Dong Yi , Kim, Young Jin; J Korean Soc Coloproctol. 2003;19(5):290-298.

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Abstract PDF: PURPOSE
A colorectal cancer (CRC) is defined as T4 when the tumor directly invades other organs or structures and/or perforates the visceral peritoneum. The purpose of this study was to evaluate the results of a surgical approach and to determine the significant prognostic factors for tumor resectability and survival in patients with advanced T4 CRC.
METHODS
A total of 61 patients with T4 CRC with adjacent organ adhesion, who received multivisceral resections at Chonnam University Hospital, Korea, between Jan. 1990 and Dec. 2001, were analyzed retrospectively.
RESULTS
Cancer invasion to contiguous organs was present in 51 (83.6%) of the 61 patients who received a multivisceral resection and was absent in 10 (16.4%). Postoperative rates of complications and death were 22.9% and 4.9%, respectively, in the 61 patients. Lymph-node (LN) metastases were presented in 25 patients (41.0%). The 5-year survival rate (5 YSR) was 22.2% in patients with LN metastases, but was significantly higher (66.7%) in patients without LN metastases. The 5 YSRs for the 61 patients according to the AJCC cancer stage (TNM classification) were as follows: stage II (66.7%), stage III (46.4%), and stage IV (0%).
CONCLUSIONS
T4 CRC without distant metastases requires multivisceral en-bloc resection of any organ or structure to which the primary tumor is adhered. The presence of LN metastases at the time of surgery is one of the significant factors with a poor prognosis in T4 CRC.

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