Annals of Coloproctology

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Malignant disease, Prognosis and adjuvant therapy

Long-term Oncologic Outcome of Postoperative Complications After Colorectal Cancer Surgery: Chang Kyu Oh, Jung Wook Huh, You Jin Lee, Moon Suk Choi, Dae Hee Pyo, Sung Chul Lee, Seong Mun Park, Jung Kyong Shin, Yoon Ah Park, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Woo Yong Lee; Ann Coloproctol. 2020;36(4):273-280. Published online November 13, 2019; DOI: https://doi.org/10.3393/ac.2019.10.15

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Purpose
The impact of postoperative complications on long-term oncologic outcome after radical colorectal cancer surgery is controversial. The aim of this study was to examine the risk factors and oncologic outcomes of surgery-related postoperative complication groups.
Methods
From January 2010 to December 2010, 310 patients experienced surgery-related postoperative complications after radical colorectal cancer surgery. These stage I–III patients were classified into 2 subgroups, minor (grades I, II) and major (grades III, IV) complication groups, according to extended Clavien-Dindo classification system criteria. Clinicopathologic differences between the 2 groups were analyzed to identify risk factors for major complications. The diseasefree survival rates of surgery-related postoperative complication groups were also compared.
Results
Minor and major complication groups were stratified with 194 patients (62.6%) and 116 patients (37.4%), respectively. The risk factors influencing the major complication group were pathologic N category and operative method. The prognostic factors associated with disease-free survival were preoperative perforation, perineural invasion, tumor budding, and receiving neoadjuvant therapy. With a median follow-up period of 72.2 months, the 5-year disease-free survival rates were 84.4% in the minor group and 78.5% in the major group, but there was no statistical significance between the minor and major groups (P = 0.392).
Conclusion
Advanced cancer and open surgery were identified as risk factors for increased surgery-related major complications after radical colorectal cancer surgery. However, severity of postoperative complications did not affect disease-free survival from colorectal cancer.

Citations

Citations to this article as recorded by

Mucinous-Type Adenocarcinoma Arising from a Chronic anal Fistula: About 4 Cases
W. Hliwa, H.H. Abakar, S. Sara, A.K. Hassan, Z. Boukhal, F. Z. El Rhaoussi, M. Tahiri, F. Haddad, A. Bellabah, W. Badre
European Journal of Medical and Health Research.2026; 4(1): 178. CrossRef
Oncologic impact of technical difficulties during the early experience with laparoscopic surgery for colorectal cancer: long-term follow-up results of a prospective cohort study
Hong-min Ahn, Tae Gyun Lee, Hye-Rim Shin, Jeehye Lee, In Jun Yang, Jung Wook Suh, Heung-Kwon Oh, Duck-Woo Kim, Sung-Bum Kang
Current Problems in Surgery.2025; 63: 101694. CrossRef
Impact of Preoperative and Intraoperative Factors on Postoperative Outcomes in Patients with Colorectal Cancer: A 10-Year Retrospective Study
Lucian Flavius Herlo, Ioana Golu, Alexandra Herlo, Claudia Raluca Balasa Virzob, Ionescu Alin, Stela Iurciuc, Ionut Eduard Iordache, Luana Alexandrescu, Doina Ecaterina Tofolean, Raluca Dumache
Diseases.2025; 13(1): 16. CrossRef
Surgical management of mucinous adenocarcinoma arising in perianal fistula: A case series
Saeed Derakhshani, Milad Karimian Ghadim, Abolfazl Salari, Mohammadreza Ghahari
Surgery Open Science.2025; 26: 1. CrossRef
Organ/space surgical site infection and long-term outcomes of rectal cancer surgery: retrospective population-based cohort study
Carlota Matallana, Paula Manchon-Walsh, Eloy Espín, Marta Pascual, Sebastiano Biondo, Marta Jiménez-Toscano, Josep Maria Borràs, Josep M Badia, Enric Limón, Luisa Aliste, Rebeca Font, Miguel Pera
BJS Open.2025;[Epub] CrossRef
Accelerated enhanced recovery after colon cancer surgery with discharge within one day after surgery: a systematic review
Misha A. T. Sier, Anke H. C. Gielen, Thaís T. T. Tweed, Noémi C. van Nie, Tim Lubbers, Jan H. M. B. Stoot
BMC Cancer.2024;[Epub] CrossRef
Risk Factors of Postoperative Complication and Hospital Mortality after Colorectal Perforation Surgery
Kensuke Kudou, Shuhei Kajiwara, Takashi Motomura, Takafumi Yukaya, Tomonori Nakanoko, Yosuke Kuroda, Masahiro Okamoto, Tadashi Koga, Yo-Ichi Yamashita
Journal of the Anus, Rectum and Colon.2024; 8(2): 118. CrossRef
Predictive value of POSSUM scoring system for postoperative complications and mortality in elderly patients with colorectal cancer
Qiang Li, Yingjun Lu
Technology and Health Care.2024; 32(6): 4653. CrossRef
Postoperative Complications Result in Poor Oncological Outcomes: What Is the Evidence?
Anjana Wajekar, Sohan Lal Solanki, Juan Cata, Vijaya Gottumukkala
Current Oncology.2024; 31(8): 4632. CrossRef
The role of robotic-assisted surgery in the management of rectal cancer: a systematic review and meta-analysis
Chenxiong Zhang, Hao Tan, Han Xu, Jiaming Ding
International Journal of Surgery.2024; 110(10): 6282. CrossRef
Effect of postoperative complications on 5-year survival following laparoscopic surgery for resectable colorectal cancer: a retrospective study
Jae Eun Lee, Kyeong Eui Kim, Woon Kyung Jeong, Seong Kyu Baek, Sung Uk Bae
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Robotic versus Laparoscopic Total Mesorectal Excision Surgery in Rectal Cancer: Analysis of Medium-Term Oncological Outcomes
Jing-jing Li, Zhi-bo Zhang, Shi-yun Xu, Cheng-ren Zhang, Xiong-fei Yang, Yao-xing Duan
Surgical Innovation.2023; 30(1): 36. CrossRef
Do postoperative infectious complications really affect long‐term survival in colorectal cancer surgery? A multicenter retrospective cohort study
Akihisa Matsuda, Hiroshi Maruyama, Shinji Akagi, Toru Inoue, Kenichiro Uemura, Minako Kobayashi, Hisanori Shiomi, Manabu Watanabe, Hiroki Arai, Yutaka Kojima, Yusuke Mizuuchi, Hajime Yokomizo, Yuji Toiyama, Toru Miyake, Yasuyuki Yokoyama, Kei Ishimaru, Sh
Annals of Gastroenterological Surgery.2023; 7(1): 110. CrossRef
International Society of University Colon and Rectal Surgeons survey of surgeons’ preference on rectal cancer treatment
Audrius Dulskas, Philip F. Caushaj, Domas Grigoravicius, Liu Zheng, Richard Fortunato, Joseph W. Nunoo-Mensah, Narimantas E. Samalavicius
Annals of Coloproctology.2023; 39(4): 307. CrossRef
Effect of serum lactate dehydrogenase-to-albumin ratio (LAR) on the short-term outcomes and long-term prognosis of colorectal cancer after radical surgery
Xin-Peng Shu, Ying-Chun Xiang, Fei Liu, Yong Cheng, Wei Zhang, Dong Peng
BMC Cancer.2023;[Epub] CrossRef
Modified Clavien–Dindo–sink classification system for adolescent idiopathic scoliosis
Ndéye F. Guissé, Joseph D. Stone, Lukas G. Keil, Tracey P. Bastrom, Mark A. Erickson, Burt Yaszay, Patrick J. Cahill, Stefan Parent, Peter G. Gabos, Peter O. Newton, Michael P. Glotzbecker, Michael P. Kelly, Joshua M. Pahys, Nicholas D. Fletcher
Spine Deformity.2022; 10(1): 87. CrossRef
Surgical site infection after laparoscopic resection of colorectal cancer is associated with compromised long-term oncological outcome
Nana Sugamata, Takashi Okuyama, Emiko Takeshita, Haruka Oi, Yuhei Hakozaki, Shunya Miyazaki, Musashi Takada, Takashi Mitsui, Takuji Noro, Hideyuki Yoshitomi, Masatoshi Oya
World Journal of Surgical Oncology.2022;[Epub] CrossRef
Does Preoperative Waiting Time Affect the Short-Term Outcomes and Prognosis of Colorectal Cancer Patients? A Retrospective Study from the West of China
Xiao-Yu Liu, Zi-Wei Li, Bing Kang, Yu-Xi Cheng, Wei Tao, Bin Zhang, Hua Zhang, Zheng-Qiang Wei, Dong Peng, Antonio Giovanni Solimando
Canadian Journal of Gastroenterology and Hepatology.2022; 2022: 1. CrossRef
Surgical safety in the COVID-19 era: present and future considerations
Young Il Kim, In Ja Park
Annals of Surgical Treatment and Research.2022; 102(6): 295. CrossRef
Current status and role of robotic approach in patients with low-lying rectal cancer
Hyo Seon Ryu, Jin Kim
Annals of Surgical Treatment and Research.2022; 103(1): 1. CrossRef
Robotic surgery for colorectal cancer
Sung Uk Bae
Journal of the Korean Medical Association.2022; 65(9): 577. CrossRef
Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
Seung Mi Yeo, Gyung Mo Son
The Ewha Medical Journal.2022;[Epub] CrossRef
Current Status and Future of Robotic Surgery for Colorectal Cancer-An English Version
Sung Uk Bae
Journal of the Anus, Rectum and Colon.2022; 6(4): 221. CrossRef
A propensity score-matched analysis of advanced energy devices and conventional monopolar device for colorectal cancer surgery: comparison of clinical and oncologic outcomes
Woo Jin Song, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Annals of Surgical Treatment and Research.2022; 103(5): 290. CrossRef

Usefulness of Anorectal Manometry for Diagnosing Continence Problems After a Low Anterior Resection: Audrius Dulskas, Narimantas E. Samalavicius; Ann Coloproctol. 2016;32(3):101-104. Published online June 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.3.101

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18 Web of Science
21 Citations

Abstract PDF

Purpose

For several decades, the low anterior resection (LAR) with total mesorectal excision (TME) has been the gold standard for treating patients with rectal cancer. Up to 90% of patients undergoing sphincter-preserving surgery will have changes in bowel habits, so-called 'anterior resection syndrome.' This study examined patients' continence after a LAR for the treatment of rectal cancer.

Methods

This prospective study was performed between September 2014 and August 2015 at the National Cancer Institute and included 30 patients who underwent anorectal manometry preoperatively and at 3 and 4 months after a LAR, but 10 were excluded from further evaluation for various reasons. Wexner score was recorded preoperatively and 4 months after LAR (1 month after ileostomy repair).

Results

Postoperatively, 70% of patients complained of some degree of soiling (incontinence to liquid stool), and 30% experienced urgent defecation. Four months after surgery, these symptoms had somewhat abated. The anal resting pressure and the maximum squeezing pressure did not change significantly. Rectal capacity and compliance were reduced in all patients. The majority of patients demonstrated manometric anorectal changes and clinical anorectal function disorders during the first 4 months after surgery. The Wexner scores and the manometric findings showed no correlation.

Conclusion

Many patients undergoing a LAR with TME for the treatment of rectal cancer experience some degree of incontinence postoperatively. Anorectal manometry may be used as an additional tool for evaluating problems with continence after a LAR. No correlation between the Wexner score and the manometric findings was observed.

Citations

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Impact of timing of ileostomy reversal and anastomotic leakage on bowel function and health-related quality of life following rectal cancer surgery: a cross-sectional study
Ditte Reitz Petersen, Pia Møller Faaborg, Issam Al-Najami, Maja Mi Thygesen, Anna Pilegaard Bjarnesen Mølstrøm, Sören Möller, Mark Bremholm Ellebæk
Surgical Endoscopy.2026;[Epub] CrossRef
Long-term Survival and Functional Outcomes of Laparoscopic Surgery for Clinical Stage I Ultra-low Rectal Cancers Located Within 5 cm of the Anal Verge
Masaaki Ito, Yuichiro Tsukada, Jun Watanabe, Yosuke Fukunaga, Yasumitsu Hirano, Kazuhiro Sakamoto, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshioka, Shinobu Ohnuma,
Annals of Surgery.2025; 281(2): 304. CrossRef
Low Anterior Resection Syndrome (LARS): A Contemporary Surgical Review of Incidence, Pathophysiology, Risk Stratification and Functional Outcomes
Supreet Kumar, Vivek Tandon, Deepak Govil
Apollo Medicine.2025;[Epub] CrossRef
Long term persistence and risk factors for anorectal symptoms following low anterior resection for rectal cancer
E. Koifman, M. Armoni, Y. Gorelik, A. Harbi, Y. Streltsin, S. D. Duek, R. Brun, Y. Mazor
BMC Gastroenterology.2024;[Epub] CrossRef
Effect of neoadjuvant chemoradiation on anorectal function assessed with anorectal manometry: A systematic review and meta-analysis
Pamela Milito, Guglielmo Niccolò Piozzi, Mohammad Iqbal Hussain, Tommaso A. Dragani, Luca Sorrentino, Maurizio Cosimelli, Marcello Guaglio, Luigi Battaglia
Tumori Journal.2024; 110(4): 284. CrossRef
Low anterior resection syndrome
Matthew C. Hernandez, Paul Wong, Kurt Melstrom
Journal of Surgical Oncology.2023; 127(8): 1271. CrossRef
Effects of neoadjuvant radiochemotherapy for anorectal function in locally advanced rectal cancer patients: a study protocol for a prospective, observational, controlled, multicentre study
Jie Shi, Yi-Kan Cheng, Fang He, Jian Zheng, Yun-Long Wang, Xiang-Bo Wan, Hong-Cheng Lin, Xin-Juan Fan
BMC Cancer.2023;[Epub] CrossRef
Should anorectal manometry be routine before stoma reversal in patients after an intersphincteric resection?
Mufaddal Kazi, Bhushan Jajoo, Jitender Rohila, Sayali Dohale, Chaitali Nashikkar, Rajesh Sainani, Prajesh Bhuta, Ashwin Desouza, Avanish Saklani
Colorectal Disease.2023; 25(8): 1638. CrossRef
Optimizing the Utility of Anorectal Manometry for Diagnosis and Therapy: A Roundtable Review and Recommendations
Satish S.C. Rao, Nitin K. Ahuja, Adil E. Bharucha, Darren M. Brenner, William D. Chey, Jill K. Deutsch, David C. Kunkel, Baharak Moshiree, Leila Neshatian, Robert M. Reveille, Gregory S. Sayuk, Jordan M. Shapiro, Eric D. Shah, Kyle Staller, Steven D. Wexn
Clinical Gastroenterology and Hepatology.2023; 21(11): 2727. CrossRef
Clinical impact of the triple‐layered circular stapler for reducing the anastomotic leakage in rectal cancer surgery: Porcine model and multicenter retrospective cohort analysis
Ryota Nakanishi, Yoshiaki Fujimoto, Masahiko Sugiyama, Yuichi Hisamatsu, Tomonori Nakanoko, Koji Ando, Mitsuhiko Ota, Yasue Kimura, Eiji Oki, Tomoharu Yoshizumi
Annals of Gastroenterological Surgery.2022; 6(2): 256. CrossRef
Troubles de la motricité anorectale : troubles fonctionnels de la défécation et incontinence fécale
C. Desprez, V. Bridoux, A.-M. Leroi
Journal de Chirurgie Viscérale.2022; 159(1): S46. CrossRef
Disorders of anorectal motility: Functional defecation disorders and fecal incontinence
C. Desprez, V. Bridoux, A.-M. Leroi
Journal of Visceral Surgery.2022; 159(1): S40. CrossRef
Long-Term Anorectal Manometry Outcomes After Laparoscopic and Transanal Total Mesorectal Excision
Ana López-Sánchez, Antonio Morandeira-Rivas, Carlos Moreno-Sanz, Francisco Javier Cortina-Oliva, Marina Manzanera-Díaz, Jhonny David Gonzales-Aguilar
Journal of Laparoendoscopic & Advanced Surgical Techniques.2021; 31(4): 395. CrossRef
Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study
Bao-Jia Luo, Mei-Chun Zheng, Yang Xia, Zhu Ying, Jian-Hong Peng, Li-Ren Li, Zhi-Zhong Pan, Hui-Ying Qin
European Journal of Oncology Nursing.2021; 55: 102059. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function
S. Kim, M. H. Kim, J. H. Oh, S.‐Y. Jeong, K. J. Park, H.‐K. Oh, D.‐W. Kim, S.‐B. Kang
Colorectal Disease.2020; 22(4): 399. CrossRef
Preoperative incremental maximum squeeze pressure as a predictor of fecal incontinence after very low anterior resection for low rectal cancer
Masatoshi Kochi, Hiroyuki Egi, Tomohiro Adachi, Yuji Takakura, Shoichiro Mukai, Kazuhiro Taguchi, Ikki Nakashima, Yusuke Sumi, Shintaro Akabane, Koki Sato, Hisaaki Yoshinaka, Minoru Hattori, Hideki Ohdan
Surgery Today.2020; 50(5): 516. CrossRef
Manometric assessment of anorectal function after transanal total mesorectal excision
M. X. Bjoern, S. K. Perdawood
Techniques in Coloproctology.2020; 24(3): 231. CrossRef
Assessments of Pudendal Motor and Sensory Nerves in Patients with or without Fecal Incontinence after Low Anterior Resection for Lower Rectal Cancer
Ryouichi Tomita, Sakurai Kenichi, Shigeru Fujisaki
Journal of Cancer Therapy.2020; 11(04): 220. CrossRef
Postoperative Bowel Function After Anal Sphincter-Preserving Rectal Cancer Surgery: Risks Factors, Diagnostic Modalities, and Management
Chris George Cura Pales, Sanghyun An, Jan Paolo Cruz, Kwangmin Kim, Youngwan Kim
Annals of Coloproctology.2019; 35(4): 160. CrossRef
Effectiveness of Pelvic Floor Rehabilitation for Bowel Dysfunction After Intersphincteric Resection for Lower Rectal Cancer
Hideaki Nishigori, Masayuki Ishii, Yujiro Kokado, Kouji Fujimoto, Hiroshi Higashiyama
World Journal of Surgery.2018; 42(10): 3415. CrossRef

Quality of Life After a Low Anterior Resection for Rectal Cancer in Elderly Patients: Verena N.N. Kornmann, Marieke S. Walma, Marnix A.J. de Roos, Djamila Boerma, Henderik L. van Westreenen; Ann Coloproctol. 2016;32(1):27-32. Published online February 29, 2016; DOI: https://doi.org/10.3393/ac.2016.32.1.27

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Abstract PDF

Purpose

Fecal incontinence is a major concern, and its incidence increases with age. Quality of life may decrease due to fecal incontinence after both sphincter-saving surgery and a rectal resection with a permanent stoma. This study investigated quality of life, with regard to fecal incontinency, in elderly patients after rectal-cancer surgery.

Methods

All patients who underwent elective rectal surgery with anastomosis for rectal cancer between December 2008 and June 2012 at two Dutch hospitals were eligible for inclusion. The Wexner and the fecal incontinence quality of life (FIQoL) scores were collected. Young (<70 years of age) and elderly (≥70 years of age) patients were compared.

Results

Seventy-nine patients were included, of whom 19 were elderly patients (24.1%). All diverting stomas that had been placed (n = 60, 75.9%) had been closed at the time of the study. There were no differences in Wexner or FIQoL scores between the young and the elderly patients. Also, there were no differences between patients without a diverting stoma and patients in whom bowel continuity had been restored. Elderly females had significantly worse scores on the FIQoL subscales of coping/behavior (P = 0.043) and depression/self-perception (P = 0.004) than young females. Elderly females scored worse on coping/behavior (P = 0.010) and depression/self-perception (P = 0.036) than elderly males. Young and elderly males had comparable scores.

Conclusion

Quality of life with regard to fecal incontinency is worse in elderly females after sphincter-preserving surgery for rectal cancer. Patients should be informed of this impact, and a definite stoma may be considered in this patient group.

Citations

Citations to this article as recorded by

Bowel dysfunction after minimally invasive sphincter-preserving surgery for rectal cancer: A prospective study of prevalence, associated factors and quality of life
Kuppusamy Senthamizhselvan, RV Chandra Mamidala, Pazhanivel Mohan, Raja Kalayarasan
Journal of Minimal Access Surgery.2026;[Epub] CrossRef
Analyzing quality of life after low anterior resection for rectal cancer
Seyed Mostafa Meshkati Yazd, Reza Shahriarirad, Shayan Almasi, Darioush Naddaffard, Saman Sheikhi, Imana Mosayebi, Kimia Goudarzi, Seyed Mohsen Ahmadi Tafti, Behnam Behboudi, Alireza Kazemeini, Mohammad Reza Keramati
Irish Journal of Medical Science (1971 -).2024; 193(6): 2643. CrossRef
Patient-reported Bowel Function and Bowel-related Quality of Life After Pelvic Radiation for Rectal Adenocarcinoma: The Impact of Radiation Fractionation and Surgical Resection
Michael K. Rooney, Brian De, Kelsey Corrigan, Grace L. Smith, Cullen Taniguchi, Bruce D. Minsky, Ethan B. Ludmir, Eugene J. Koay, Prajnan Das, Albert C. Koong, Oliver Peacock, George Chang, Y. Nancy You, Van K. Morris, Graciela Nogueras-González, Emma B.
Clinical Colorectal Cancer.2023; 22(2): 211. CrossRef
Functional outcomes and local control are acceptable following hand‐sewn colo‐anal anastomoses for rectal cancer: Results of long‐term follow‐up
David Hudson, Fiona Entriken, Rupert Hodder, Michael Warner
ANZ Journal of Surgery.2022; 92(3): 390. CrossRef
Functional Bowel Complaints and the Impact on Quality of Life After Colorectal Cancer Surgery in the Elderly
Stijn H. J. Ketelaers, Maarten van Heinsbergen, Ricardo G. Orsini, F. Jeroen Vogelaar, Joop L. M. Konsten, Grard A. P. Nieuwenhuijzen, Harm J. T. Rutten, Jacobus W. A. Burger, Johanne G. Bloemen
Frontiers in Oncology.2022;[Epub] CrossRef
Symptoms affecting quality of life after sphincter-saving rectal cancer surgery: A systematic review
Jennie Burch, Claire Taylor, Ana Wilson, Christine Norton
European Journal of Oncology Nursing.2021; 52: 101934. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
The Artificial Bowel Sphincter in the Treatment of Fecal Incontinence, Long-term Complications
Aart A. van der Wilt, Stéphanie O. Breukink, Rosel Sturkenboom, Laurents P. Stassen, Cornelius G. Baeten, Jarno Melenhorst
Diseases of the Colon & Rectum.2020; 63(8): 1134. CrossRef
Health-Related Quality of Life in Older Adults with Colorectal Cancer
Evan Lapinsky, Lillian C. Man, Amy R. MacKenzie
Current Oncology Reports.2019;[Epub] CrossRef
Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer: A cross-sectional study
Loris Trenti, Ana Galvez, Sebastiano Biondo, Alejandro Solis, Francesc Vallribera-Valls, Eloy Espin-Basany, Alvaro Garcia-Granero, Esther Kreisler
European Journal of Surgical Oncology.2018; 44(7): 1031. CrossRef
Late assessment of quality of life in patients with rectal carcinoma: comparison between sphincter preservation and definitive colostomy
Mariane Messias Reis Lima Silva, Samuel Aguiar Junior, Juliana de Aguiar Pastore, Érica Maria Monteiro Santos, Fábio de Oliveira Ferreira, Ranyell Matheus S. B. Spencer, Vinicius F. Calsavara, Wilson Toshihiko Nakagawa, Ademar Lopes
International Journal of Colorectal Disease.2018; 33(8): 1039. CrossRef
Chirurgische Therapie des Karzinoms des unteren Rektumdrittels
A. D. Rink
coloproctology.2017; 39(6): 411. CrossRef
Quality of Life After a Low Anterior Resection in Elderly Patients
Byung Chun Kim
Annals of Coloproctology.2016; 32(1): 5. CrossRef

Intraoperative Radiotherapy for Locally Advanced Rectal Cancer: Min Kyu Kang, Myung Se Kim, Jae Hwang Kim; J Korean Soc Coloproctol. 2010;26(4):274-278. Published online August 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.4.274

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Abstract PDF

Purpose

Although intraoperative radiotherapy (IORT) is known to be a method that can reduce local recurrence in locally advanced colorectal cancer, it is not widely used. The aim of this study was to report our experience with IORT for locally advanced rectal cancer.

Methods

From 1991 to 1994, nine patients with locally advanced rectal cancer received IORT. External beam radiotherapy was given postoperatively in five patients and preoperatively in three. Seven patients received chemotherapy. IORT was done with 6-MeV or 9-MeV electrons, and 12 Gy was irradiated at the tumor bed. The median follow-up period was 84 months (range, 15 to 208 months).

Results

The median age of patients was 51 years (range, 42 to 73 years). All patients had advanced clinical T-stage (cT3/4) cancer. The overall and the disease-free survival rates were 66.7% and 66.7% at 5 years, respectively. One patient developed a local recurrence near the anastomosis site, which was out of the IORT field. Four patients died before the last follow-up; three from distant metastasis and one from secondary primary cancer. Adverse effects related to IORT did not occur.

Conclusion

Although the number of patients was small in this study, IORT is thought to be safe and effective in reducing local recurrence in locally advanced rectal cancer. However, the role of IORT should be refined in the era of preoperative radio-chemotherapy followed by total mesorectal excision.

Citations

Citations to this article as recorded by

Laparoscopic abdominoperineal resection with intraoperative radiotherapy for locally advanced low rectal cancer
Matej Skrovina, Renata Soumarova, Miloslav Duda, Roman Bezdek, Jiri Bartos, Adam Wendrinski, Petr Andel, Javed Parvez, Martin Straka, Lukas Adamcik
Biomedical Papers.2014; 158(3): 447. CrossRef
Laparoscopic Resection with Intraoperative Radiotherapy for Local Advanced Rectal Cancer: A Preliminary Case Report
Yimei Jiang, Xiaopin Ji, Shengguang Zhao, Ren Zhao, Yening Jin
Journal of Laparoendoscopic & Advanced Surgical Techniques.2013; 23(3): 267. CrossRef
A review of the logistic role of l‐carnitine in the management of radiation toxicity and radiotherapy side effects
Haseeb Ahmad Khan, Abdullah Saleh Alhomida
Journal of Applied Toxicology.2011; 31(8): 707. CrossRef

Risk Factors and Oncologic Impact of Anastomotic Leakage after Rectal Cancer Surgery.: Jung, Sang Hun , Yu, Chang Sik , Choi, Pyong Wha , Kim, Dae Dong , Hong, Dong Hyun , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2006;22(6):371-379.

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Abstract PDF: PURPOSE
Anastomotic leakage (AL) is a serious and life-threatening complication following rectal cancer surgery. The impact on long-term oncologic outcome in patients with AL is not clear. The aim of this retrospective study was to evaluate the risk factors of AL and its impact on long-term prognosis after rectal cancer surgery.
METHODS
We investigated 1,391 patients who underwent primary resection and anastomosis for rectal cancer between January 1997 and August 2003. Operations were performed as follows: AR (n=164), LAR (n=898), uLAR (n=329). Standard procedures in our clinic were mesorectal excision according to tumor location and autonomic nerve preservation. Median follow-up period was 40.1 months (2~96 months).
RESULTS
AL rate was 2.5% (n=35). Gender (male), age (>60 years) and uLAR were independent risk factors in multivariate analysis (HR: 3.03, 95% CI: 1.18~7.22; HR: 2.42, 95% CI: 1.12~7.83; HR: 2.68, 95% CI: 1.08~7.09, respectively). Local recurrence in the AL group was significantly higher than that in the non-AL group (P<0.05), but there was no significant difference in multivariate analysis (P=0.14). Systemic recurrence between both groups was not statistically different. The 5-year overall survival rate was significantly lower in the AL group than in the non-AL group (55.1% vs 74.1%, P<0.05) and the cancer- specific survival rate was lower in the AL group than in the non-AL group (63.0% vs 78.3%, P=0.05).
CONCLUSIONS
Age, gender, and anastomotic level were risk factors for AL after rectal cancer surgery and anastomotic leakage was associated with a poor survival.

Clinical Characteristics of Inguinal Hernia Following Rectal Cancer Surgery.: Lee, Chang Min , Kim, Hee Cheol , Cho, Young Kyu , Hong, Hyun Kee , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(6):342-345.

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Abstract PDF: PURPOSE
The anatomic and physiologic changes after rectal cancer surgery was suggested to be a cause of inguinal hernia. But, there are only few reported cases about the inguinal hernia following rectal cancer surgery. The aim of this study is to verify risk factors and surgical techniques to prevent inguinal hernia following rectal cancer surgery.
METHODS
Out of 1226 patients who underwent operations at the Department of Surgery, Asan Medical Center, between the period from June 1989 to July 1999, 12 patients who had developed inguinal hernia and their medical records were reviewed retrospectively regarding the clinical characteristics.
RESULTS
The median duration of hernia following rectal cancer surgery was 12 (3-36) months. The median age was 63 (36-74) years with eight of them more than seventh decades of their life. All patients had male sex. Three of them were overweighted. Five cases had hernias on the left side, six on the right, and one case on both side. All patients had indirect inguinal hernia. Three cases had preoperative symptoms of bowel obstruction. The operations for rectal cancer were low anterior resection in eight cases, ultralow anterior resection in three cases, and abdominoperineal resection in one case. The complications in rectal cancer surgery were found in six cases. Six cases had the advanced stage. A postoperative radiation therapy was applied in five cases. Five cases had the coexisting diseases.
CONCLUSIONS
Male sex and old age would be related with occuring inguinal hernia after rectal cancer surgery and, it would be necessary to give a special attention to the patients who have these factors, although the present study could not show the definite correlation between inguinal hernia and rectal cancer surgery due to a small number of cases.

The Effect of Hyaluronate Membrane on Prevention of Adhesion after Rectal Cancer Surgery: a Prospective Study.: Yu, Chang Sik , Kim, Hee Cheol , Park, In Ja , Lee, Kang Hong , Kim, Jin Cheon; J Korean Soc Coloproctol. 2005;21(2):76-81.

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Abstract PDF: PURPOSE
The aim of this study was to evaluate the efficacy of using a Hyaluronate (HA) bioresorbable membrane (SeprafilmTM, Genzyme Corp., Cambridge, MA) to prevent adhesion after rectal cancer surgery.
METHODS
We recruited 362 rectal cancer patients who underwent a curative resection between April 2001 and December 2002. We excluded patients with a previous operation history, a stoma procedure, a multivisceral resection, an extended lymphadenectomy, a total colectomy, or a pouch procedure. An adhesive ileus was defined as a symptomatic, radiological intestinal obstruction without evidence of recurrence.
RESULTS
We placed the HA membrane under the midline incision in 153 patients. There was no difference between the groups regarding demographic findings and clinicopathological findings, including locations of the tumors, surgery performed, AJCC stage, and adjuvant treatment. While only 1 (0.7%) patient of the HA group experienced an adhesive ileus, 13 (6.2%) cases of adhesion were identified in the control group (P=0.008). Every patient, except 1 in the control group, underwent conservative management.
CONCLUSIONS
A Hyaluronate membrane may be effective in preventing an adhesive ileus after rectal cancer surgery. However, a prospective, randomized, double-blind study is needed.

Case Report

Necrotizing Fasciitis of Perineum after Surgery and Radiation Therapy for Rectal Cancer.: Boo, Yoon Jung , Min, Byung Wook , Um, Jun Won , Moon, Hong Young; J Korean Soc Coloproctol. 2004;20(5):333-336.

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Abstract PDF: Necrotizing fasciitis is a rare disease characterized by rapidly progressive soft tissue infection primarily involving the superficial fascia and is associated with significant morbidity and mortality. Necrotizing fasciitis of the genitalia and the perineum, also known as Fournier's gangrene, usually occurs after local trauma, perirectal or perineal infections, and complicated surgery, such as circumcision and herniorraphy. The lack of initial external clinical signs, because the process begins in the deep subcutaneous tissue, make early diagnosis and adequate surgical management difficult. The progression of the disease is often fulminant, and the prognosis hinges on accurate diagnosis and immediate surgical debridement. The present case report documents the rare development of fulminant necrotizing fasciitis associated with a rectal cancer surgery and radiation therapy.

Original Article

Anastomotic Stricture after Colorectal Stapled Anastomosis.: Hong, Hyoun Kee , Jeong, Choon Sik , Lee, Dong Hee , Kim, Hee Cheol , Yu, Chang Sik , Park, Sang Kyu , Kim, Sook Young , Kim, Jin Cheon; J Korean Soc Coloproctol. 2000;16(3):198-203.

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Abstract PDF: INTRODUCTION: Stapled anastomosis in the rectal cancer surgery has been already proven as a safe technique, maintaing secure suture and saving times compared to handsewn anastomosis. With the advancement of stapling device, the incidence of anastomotic leakage has decreased significantly. However, developement of anastomotic stricture has become a major postoperative complication. PURPOSE: An analysis of the clinical features and the predisposing factors of anastomotic stricture was made to identify its pathogenesis and to determine adequate procedure.
METHODS
We analyzed 49 patients (8.1%) with the rectal stricture among 608 patients, undergone stapled anastomosis for the rectal cancer surgery at Asan Medical Center from Jan 1993 to Dec 1998. Rectal stricture was defined when index finger or colonoscope could not pass the anastomotic site (high grade), or could pass with difficulty(low grade). RESULTS: Underlying general diseases, e.g., DM, hypertension and cardiovascular disease was associated more frequently in patients with anastomotic stricture (20.4%) than patients without (10.8%) (P<0.05). The rate of postoperative major complications in patients with stricture was 22.4%, while that of anastomotic leakage was 6.1%. Development of anastomotic stricture was not associated with operative methods, age, anastomosis level, and postoperative radiotherapy. In patients with stricture, 34 patients (69.4%) were asymptomatic, and 15 patients were symptomatic. In treating symptomatic rectal stricture, only five patients performed dilation manually or by the Hegar dilator.
CONCLUSIONS
Rectal stricture after stapled anastomosis might be associated with underlying diseases, and correlated with prolonged sanguinous drainage and ileus. Meticulous management of underlying disease and complete hemostasis during operation appear to be important to reduce the rate of rectal stricture.

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