Annals of Coloproctology

Original Articles

Colorectal cancer

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 You, Hee Jin Chang, Chang Won Hong, Dae Kyung Sohn, Kyung Su Han, Bun Kim, Byung Chang Kim, Jae Hwan Oh; Ann Coloproctol. 2023;39(6):467-473. Published online April 28, 2023; DOI: https://doi.org/10.3393/ac.2022.00913.0130

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Purpose
Most predictive factors for lymph node metastasis in rectal neuroendocrine tumors (NETs) have been based on local and endoscopic resection. We aimed to evaluate the risk factors for lymph node metastasis in patients who underwent radical resection for rectal NETs and stratify the risk of lymph node metastasis.
Methods
Sixty-four patients who underwent radical resection for rectal NETs between January 2001 and January 2018 were included. We investigated the risk factors of lymph node metastasis using clinicopathologic data. We also performed a risk stratification for lymph node metastases using the number of previously known risk factors. For oncologic outcomes, the 5-year overall survival and recurrence-free survival were evaluated in both groups.
Results
Among the patients who underwent radical surgery, 32 (50.0%) had lymph node metastasis and 32 (50.0%) had non–lymph node metastasis. In the multivariable analysis, only the male sex was identified as a risk factor for lymph node metastasis (odds ratio, 3.695; 95% confidence interval, 1.128–12.105; P=0.031). When there were 2 or more known risk factors, the lymph node metastasis rate was significantly higher than when there were one or no risk factors (odds ratio, 3.667; 95% confidence interval, 1.023–13.143; P=0.046). There was also no statistical difference between the 2 groups in 5-year overall survival (P=0.431) and 5-year recurrence-free survival (P=0.144).
Conclusion
We found that the rate of lymph node metastasis increased significantly when the number of known risk factors is 2 or more.

Citations

Citations to this article as recorded by

Lateral pelvic lymph nodes dissection of rectal neuroendocrine neoplasms: A prospective case-series and literature review
Yueyang Zhang, Yi Yang, Changyuan Gao, Hong Zhao, Haitao Zhou
Surgery.2024;[Epub] CrossRef

Malignant disease,Prognosis

Recurrence after endoscopic resection of small rectal neuroendocrine tumors: a retrospective cohort study: Sukit Pattarajierapan, Supakij Khomvilai; Ann Coloproctol. 2022;38(3):216-222. Published online July 20, 2021; DOI: https://doi.org/10.3393/ac.2021.00017.0002

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Abstract PDF

Purpose
According to the European Neuroendocrine Tumor Society consensus guidelines, rectal neuroendocrine tumors (NETs) up to 10 mm in size and without poor prognostic factors could be safely removed with endoscopic resection, suggesting omitting surveillance colonoscopy after complete resection. However, the benefit of surveillance colonoscopy is still unknown. In this study, we aimed to report the outcomes after endoscopic resection of small rectal NETs using our surveillance protocol.
Methods
This retrospective cohort study included patients who underwent endoscopic resection for rectal NETs sized up to 10 mm from January 2013 to December 2019 at our center. We excluded patients without surveillance colonoscopy and those lost to follow-up. We strictly performed surveillance colonoscopy 1 year after endoscopic resection, and every 2 to 3 years thereafter. The primary outcomes were tumor recurrence and occurrence of metachronous tumors during followup.
Results
Of the 54 patients who underwent endoscopic resection for rectal NETs during the study period, 46 were enrolled in this study. The complete resection rates by endoscopic mucosal resection, precutting endoscopic mucosal resection, and endoscopic submucosal dissection were 92.3% (12 of 13), 100% (21 of 21), and 100% (12 of 12), respectively. There was no local or distant recurrence during the median follow-up of 39 months. However, we found that 8.7% (4 of 46) of patients developed metachronous NETs. All metachronous lesions were treated with precutting endoscopic mucosal resection.
Conclusion
Surveillance colonoscopy is reasonable after endoscopic resection of small rectal NETs for timely detection and treatment of metachronous lesions. However, larger collaborative studies are needed to influence the guidelines.

Citations

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Comparison of the efficacy of endoscopic submucosal dissection and transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors ≤ 2 cm
Rui Jin, Xiaoyin Bai, Tianming Xu, Xi Wu, Qipu Wang, Jingnan Li
Frontiers in Endocrinology.2023;[Epub] CrossRef
Current status of the role of endoscopy in evaluation and management of gastrointestinal and pancreatic neuroendocrine tumors
Zaheer Nabi, Sundeep Lakhtakia, D. Nageshwar Reddy
Indian Journal of Gastroenterology.2023; 42(2): 158. CrossRef

Benign GI diease,Benign diesease & IBD,Complication

High Compliance With Surgical Site Infection (SSI) Prevention Bundle Reduces Incisional SSI After Colorectal Surgery: Varut Lohsiriwat; Ann Coloproctol. 2021;37(3):146-152. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.04.10.2

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Abstract PDF

Purpose
This study aimed to evaluate association between compliance with surgical site infection (SSI) prevention bundle and the development of superficial or deep incisional SSI following colorectal surgery and to evaluate the impact of incisional SSI on surgical outcomes.
Methods
A prospectively collected database of consecutive patients undergoing elective colectomy and/or proctectomy from 2011 to 2019 in a university hospital was reviewed. The association between compliance with Thailand’s SSI Prevention Bundle (10 level-1A interventions) and the incidence of incisional SSI was determined. Surgical outcomes were compared between those with incisional SSI and those without.
Results
This study included 600 patients with a median age of 64 years (range, 18–102 years). Some 126 patients (21.0%) had stoma formation and 52 (8.7%) underwent laparoscopy. The incidence of incisional SSI was 5.5% (n = 33; 32 superficial incisional SSI and 1 deep incisional SSI). Higher compliance with care bundle tended to decrease incisional SSI (P = 0.20). In multivariate analysis, compliance of 70% or more was the only dependent factor for reducing incisional SSI (odds ratio, 0.39; 95% confidence interval, 0.15 to 0.99; P = 0.047). None of individual interventions were significantly associated with a lower probability of incisional SSI. Compared with counterparts, patients with incisional SSI had a 2-day longer length of postoperative stay (6 day vs. 4 day, P < 0.001) but comparable time for gastrointestinal recovery and similar rate of 30-day mortality or readmission.
Conclusion
High compliance with SSI prevention bundle (especially ≥ 70%) reduced incisional SSI after colorectal surgery.

Citations

Citations to this article as recorded by

Surgical Site Infection Prevention Using “Strike Teams”: The Experience of an Academic Colorectal Surgical Department
Buddhi Hatharaliyadda, Michelle Schmitz, Anne Mork, Fauzia Osman, Charles Heise, Nasia Safdar, Aurora Pop-Vicas
Journal for Healthcare Quality.2024; 46(1): 22. CrossRef
Interventions to reduce surgical site infection following elective colorectal surgery: protocol for a systematic review with narrative synthesis and GRADE recommendations
Harry Dean, Ioanna Drami, Amira Shamsiddinova, Eman Alkizwini, James Kinross, Ana Wilson, Phil Tozer, Carolynne Vaizey
Journal of Surgical Protocols and Research Methodologies.2024;[Epub] CrossRef
Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons
Jennifer L. Irani, Traci L. Hedrick, Timothy E. Miller, Lawrence Lee, Emily Steinhagen, Benjamin D. Shogan, Joel E. Goldberg, Daniel L. Feingold, Amy L. Lightner, Ian M. Paquette
Diseases of the Colon & Rectum.2023; 66(1): 15. CrossRef
Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons
Jennifer L. Irani, Traci L. Hedrick, Timothy E. Miller, Lawrence Lee, Emily Steinhagen, Benjamin D. Shogan, Joel E. Goldberg, Daniel L. Feingold, Amy L. Lightner, Ian M. Paquette
Surgical Endoscopy.2023; 37(1): 5. CrossRef
The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review
Varut Lohsiriwat, Romyen Jitmungngan
Medicina.2022; 58(3): 418. CrossRef
Robot-Assisted Colorectal Surgery
Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef

Benign GI diease

The Management of Retained Rectal Foreign Body: Ju Hun Kim, Eunhae Um, Sung Min Jung, Yong Chan Shin, Sung-Won Jung, Jae Il Kim, Tae Gil Heo, Myung Soo Lee, Heungman Jun, Pyong Wha Choi; Ann Coloproctol. 2020;36(5):335-343. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2019.10.03.1

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Abstract PDF

Purpose
Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience.
Methods
We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes.
Results
All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling.
Conclusion
Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.

Citations

Citations to this article as recorded by

Combined laparoscopic and endoscopic method for foreign body removal from descending colon: A case report
Khairunnisa Che Ghazali, Huzairi Yaacob, Ahmad Shanwani Mohamed Sidek
World Journal of Surgical Procedures.2024; 14(1): 1. CrossRef
Minimally invasive techniques as adjuncts in low- versus high-lying retained rectal foreign bodies of autoerotic nature in young men: a tailored management algorithm with two contrasting case reports from India
Shubham Kumar Gupta, Vivek Kumar Katiyar, Sumit Sharma, Shashi Prakash Mishra, Satyanam Kumar Bhartiya
Journal of Trauma and Injury.2024; 37(3): 238. CrossRef
Caring for a patient with a rectal foreign body
Sophia Parsh, Hyun Ah “Esther” Oh, Bridget Parsh
Nursing.2023; 53(9): 11. CrossRef
Proposal of an algorithm for the management of rectally inserted foreign bodies: a surgical single-center experience with review of the literature
Stefan Fritz, Hansjörg Killguss, André Schaudt, Christof M. Sommer, Götz M. Richter, Sebastian Belle, Christoph Reissfelder, Steffan Loff, Jörg Köninger
Langenbeck's Archives of Surgery.2022; 407(6): 2499. CrossRef
Deodorant aerosol spray can in the rectum: a potential fire hazard during surgery
Sivaraman Kumarasamy, Lileswar Kaman, Azhar Ansari, Amarjyoti Hazarika
BMJ Case Reports.2021; 14(5): e241538. CrossRef

Case Report

Pneumatic Colorectal Injury Caused by High Pressure Compressed Air: Jin Young Lee, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Jung Hee Choi; Ann Coloproctol. 2019;35(6):357-360. Published online May 22, 2019; DOI: https://doi.org/10.3393/ac.2018.08.19

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Abstract PDF

The pneumatic colorectal injury caused by high pressure compressed air are rare and can be fatal. Herein, we present a case of 45-year-old male who developed sudden onset of severe abdominal pain after cleaning the dust on his pants with high pressure compressed air gun dust cleaner. Emergent exploratory laparotomy was done which findings are a huge rectal perforation with multiple serosal and subserosal tear in sigmoid to splenic flexure of colon. Anterior resection with left hemicolectomy, and temporary transverse colostomy was performed. Postoperative course was uneventful. Recently, prognosis is generally favorable because of prompt diagnosis and emergent surgical management.

Citations

Citations to this article as recorded by

Laparoscopic Repair of Colorectal Perforations Induced by Compressed Air Pressure: A Case Report
Ibrahim Elnogoomi, Hoorieh Qasemi, Mariam Aylan Alshamsi, Majid Alhammadi, Omar Elnogoomi
Cureus.2024;[Epub] CrossRef
Air Nozzle Injury: Barotrauma Resulted From an Industrial Accident
Ashok N Mhaske, Nishi Gupta, Abhishek Mishra, Shubham Jaiswal, Chirag Dausage, Jyoti Meena, Gourav Goyal
Cureus.2024;[Epub] CrossRef
Emergency laparoscopic resection of the anterior rectum due to rectal trauma secondary to compressed air, case report
Daniel Gómez, Luis F. Cabrera, Mauricio Pedraza, Andres Mendoza-Zuchini, Nicolás Sánchez, Hector W. Cure, Héctor O. Cure Bulicie, Jean A. Pulido
International Journal of Surgery Case Reports.2020; 76: 288. CrossRef

Review

Essential Anatomy of the Anorectum for Colorectal Surgeons Focused on the Gross Anatomy and Histologic Findings: Jong Min Lee, Nam Kyu Kim; Ann Coloproctol. 2018;34(2):59-71. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.12.15

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Abstract PDF

The anorectum is a region with a very complex structure, and surgery for benign or malignant disease of the anorectum is impossible without accurate anatomical knowledge. The conjoined longitudinal muscle consists of smooth muscle from the longitudinal muscle of the rectum and the striate muscle from the levator ani and helps maintain continence; the rectourethralis muscle is connected directly to the conjoined longitudinal muscle at the top of the external anal sphincter. Preserving the rectourethralis muscle without damage to the carvernous nerve or veins passing through it when the abdominoperineal resection is implemented is important. The mesorectal fascia is a multi-layered membrane that surrounds the mesorectum. Because the autonomic nerves also pass between the mesorectal fascia and the parietal fascia, a sharp pelvic dissection must be made along the anatomic fascial plane. With the development of pelvic structure anatomy, we can understand better how we can remove the tumor and the surrounding metastatic lymph nodes without damaging the neural structure. However, because the anorectal anatomy is not yet fully understood, we hope that additional studies of anatomy will enable anorectal surgery to be performed based on complete anatomical knowledge.

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Management of Perianal Fistulizing Crohn’s Disease
Arshdeep Singh, Vandana Midha, Gursimran Singh Kochhar, Bo Shen, Ajit Sood
Inflammatory Bowel Diseases.2024; 30(9): 1579. CrossRef
Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
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Laser hemorrhoidoplasty procedure versus harmonic scalpel hemorrhoidectomy: a comparative study for the treatment of grades III and IV hemorrhoids
Ehab Loutfy, Hatem Elgohary, Mahmoud E. Elkashlan, Mohamed G. Abdelrahman, Wael Omar
The Egyptian Journal of Surgery.2024; 43(2): 572. CrossRef
Anatomic Basis of Rectal Cancer Staging: Clarifying Controversies and Misconceptions
Harmeet Kaur, Helena Gabriel, Muhammad O. Awiwi, Ekta Maheshwari, Camila Lopes Vendrami, Tsuyoshi Konishi, Melissa W. Taggart, Michael Magnetta, Linda C. Kelahan, Sonia Lee
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Kevan J English
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Essential knowledge and technical tips for total mesorectal excision and related procedures for rectal cancer
Min Soo Cho, Hyeon Woo Bae, Nam Kyu Kim
Annals of Coloproctology.2024; 40(4): 384. CrossRef
MRI anatomy of the rectum: key concepts important for rectal cancer staging and treatment planning
Nino Bogveradze, Petur Snaebjornsson, Brechtje A. Grotenhuis, Baukelien van Triest, Max J. Lahaye, Monique Maas, Geerard L. Beets, Regina G. H. Beets-Tan, Doenja M. J. Lambregts
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Jason Llaneras, Caitlyn C. Belza, Samuel Eisenstein, Marek K. Dobke
Biomedicines.2023; 11(2): 537. CrossRef
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Megan Obi, Scott R. Steele
Journal of Gastrointestinal Surgery.2023; 27(6): 1238. CrossRef
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Yoon Kyoo Noh, Jun Lee, Seong Jung Kim
Saudi Journal of Gastroenterology.2023; 29(6): 365. CrossRef
Characteristics, treatment, and outcomes of anal versus rectal squamous cell carcinoma, a retrospective cohort study
Sameh Hany Emile, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Peige Zhou, Victor Strassmann, Steven D. Wexner
Surgery.2023; 174(3): 508. CrossRef
Low Rectal Cancers at Initial Staging MRI
Matthew H. Lee, David H. Kim
RadioGraphics.2023;[Epub] CrossRef
Optimal Surgical techniques for curative resection of the Rectal cancer
Hyeon Woo Bae, Nam Kyu Kim
Formosan Journal of Surgery.2023;[Epub] CrossRef
Robot-assisted anorectal pull-through for anorectal malformations with rectourethral and rectovesical fistula: feasibility and short-term outcome
Xiaopan Chang, Guoqing Cao, Jiarui Pu, Shuai Li, Xi Zhang, Shao-tao Tang
Surgical Endoscopy.2022; 36(3): 1910. CrossRef
Laparoscopic repair of coccygeal hernia with biological mesh following partial coccygectomy
Morgan E. Jones, Matthew Stokes, Satish K. Warrier
ANZ Journal of Surgery.2022; 92(4): 912. CrossRef
HPV-driven anal neoplasia: review and recent developments
Naziheh Assarzadegan, Eugene Brooks, Lysandra Voltaggio
Pathology.2022; 54(2): 184. CrossRef
Anatomy of the vesicovaginal fascia and its relation to branches of the inferior hypogastric plexus
Douglas Stupart, Kylie Pickles, Chris Briggs
Clinical Anatomy.2022;[Epub] CrossRef
Embryology and anatomy of anorectal malformations
Yuichiro Miyake, Geoffrey J. Lane, Atsuyuki Yamataka
Seminars in Pediatric Surgery.2022; 31(6): 151226. CrossRef
A new membrane anatomy-oriented classification of radical surgery for rectal cancer
Jiaqi Wang, Hailong Liu, Ajian Li, Huihong Jiang, Yun Pan, Xin Chen, Lu Yin, Moubin Lin
Gastroenterology Report.2022;[Epub] CrossRef
Essential anatomy for total mesorectal excision and lateral lymph node dissection, in both trans-abdominal and trans-anal perspective
Tak Lit Derek Fung, Yuichiro Tsukada, Masaaki Ito
The Surgeon.2021; 19(6): e462. CrossRef
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Original Article

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

Case Report

A Granular Cell Tumor of the Rectum: A Case Report and Review of the Literature: Seung Yoon Yang, Byung Soh Min, Woo Ram Kim; Ann Coloproctol. 2017;33(6):245-248. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.245

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Abstract PDF

A granular cell tumor (GCT) is an uncommon mesenchymal lesion that rarely occurs in the colon and the rectum. We describe the case of 51-year-old man with a 2-cm-sized rectal GCT 10 cm above the anal verge that was incidentally detected after a screening colonoscopy. Preoperative radiologic studies demonstrated a suspicious submucosal rectal mass with mesorectal fat infiltration, but without circumferential resection margin threatening, extramural vessel invasion, and regional lymph-node enlargement. The tumor was resected by using a transanal endoscopic operation (TEO) without immediate postoperative complications. The final pathology revealed that the tumor consisted of a GCT that had invaded the subserosa with clear margins. It had no other risk factors for malignancy according to Fanburg-Smith criteria. We systematically reviewed the English literature by using PubMed and Google Scholar. This report may be the first documented case in the literature to describe a TEO for a GCT that had invaded the subserosa in the rectum.

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Granular Cell Tumor of the Anal Canal: Case Report and Literature Review
Jorge Arche Prats, Diego García P., Gonzalo Campaña V., Mónica Martínez M.
Journal of Coloproctology.2024;[Epub] CrossRef
Rectal Granular Cell Carcinoma Requiring Abdominoperineal Resection
Michaelia S. Sunderland, Anthony Dakwar, Sowsan Rasheid
The American Surgeon™.2023; 89(4): 1304. CrossRef
Experience of surgical treatment in a granular cell tumor in the qscending colon: a case report
In-Kyeong Kim, Young-Tae Ju, Han-Gil Kim, Jin-Kwon Lee, Dong-Chul Kim, Jae-Myung Kim, Jin Kyu Cho, Ji-Ho Park, Ju-Yeon Kim, Chi-Young Jeong, Soon-Chan Hong, Seung-Jin Kwag
Annals of Coloproctology.2023; 39(3): 275. CrossRef
Granular cell tumour. Case report.
P. Leszczyńska, M. Sobocińska, K. Ustymowicz, W. Romańczyk
Progress in Health Sciences.2023; 13(1): 107. CrossRef
Granular cell tumor of the perineum (clinical case)
R. R. Shakirov, O. Yu. Karpukhin, M. I. Ziganshin, I. S. Raginov
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A case report of rare granular cell tumor of the urinary bladder
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Granular Cell Tumor of the Perianal Region
Marina Pérez-Flecha González, Enrique Revilla Sánchez, Carolina Ibarrola de Andrés, Ramón Gómez Sanz
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Original Article

Clinical Significance of Signet-Ring-Cell Colorectal Cancer as a Prognostic Factor: Sang-Oh Yun, Yong Beom Cho, Woo Yong Lee, Hee Cheol Kim, Seong Hyeon Yun, Yoon Ah Park, Jung Wook Huh; Ann Coloproctol. 2017;33(6):232-238. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.232

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Abstract PDF

Purpose

The aim of this study is to evaluate the prognosis for patients with a signet-ring-cell carcinoma (SRCC) who undergo curative surgery by comparing them to patients with an adenocarcinoma (ADC), excluding a mucinous ADC.

Methods

Between September 1994 and December 2013, 14,110 patients with colorectal cancer underwent surgery and among them, 12,631 patients were enrolled in this study. 71 patients with a SRCC and 12,570 patients with a ADC were identified. We analyzed the disease-free survival and the overall survival rates before and after a 1:2 propensity score matching and evaluated those rates after stage stratification.

Results

The median follow-up durations were 48.5 months for the SRC group and 48.6 months for the ADC group. The disease-free survival rates and the overall survival rates were significantly lower in the SRC group before and after propensity score matching (P < 0.001). After stratification by stage, no differences were observed between the SRC and the ADC groups for the disease-free survival (DFS) and the overall survival (OS) rates for patients with cancer in its early stages (P = 0.913 and P = 0.380 for the DFS and the OS, respectively, in stages 0 and I, and P = 0.223 and P = 0.991 for the DFS and the OS, respectively, in stage II), but those rates were significantly lower in the SRC group for cancer in its later stages (P < 0.001, respectively in stages III and IV).

Conclusion

For cancer in advanced stages, patients with a resectable colorectal SRCC had a poorer prognosis after propensity score matching than those with an ADC did. Therefore, more intensive surveillance and closer observation should be offered to such patients.

Citations

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Case Reports

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Abstract PDF

A colonic mucosa-associated lymphoid-tissue (MALT) lymphoma is relatively rare compared to lymphomas of the stomach or small intestine. We present a case of a MALT lymphoma in the cecum and rectum found during screening colonoscopy. A 54-year-old female, who had undergone right-breast-conserving surgery with axillary dissection due to an invasive ductal carcinoma and a left-breast excisional biopsy due to microcalcification following adjuvant chemoradiation therapy 3 years earlier, was found to have 3-mm-sized smooth elevated lesions in both the cecum and rectum. No pathologic lesion or lymphadenopathy was found at any other site, but chronic gastritis negative for Helicobacter pylori infection was found. The polyps were removed by using an endoscopic biopsy and revealed an extra nodal marginal zone B-cell MALT lymphoma, showing positive for CD3 and CD20 by immunohistochemical staining. The patient underwent close observation without any additional treatment and has shown no evidence of recurrence as of her last visit.

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A primary anorectal malignant melanoma is a rare tumor. Moreover, cases involving a synchronous anorectal melanoma and colon adenocarcinoma are extremely rare. The authors report a case of a synchronous anorectal melanoma and sigmoid adenocarcinoma in an 84-year-old man. The regions of the anorectal melanoma showed melanocytic nevi in the adjacent mucosa of the anal canal and rectum. A dysplastic nevus was also identified in the anal mucosa. This case demonstrates that an anorectal melanoma can arise from pre-existing anorectal melanocytic lesions.

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Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained.

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Transanal evisceration of small bowel in two patients with chronic rectal prolapse: case presentation and literature review
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Abstract PDF

Rhabdoid colonic tumors are very rare lesions with just a few publications describing such neoplasms. Even more unusual for these lesions are their primary rectal locations, with only two brief case reports having been published on that subject to date. We present a case of a composite rhabdoid rectal carcinoma in a 49-year-old male. The tumor behaved very aggressively, with rapid patient demise despite radical surgery and intensive postoperative chemotherapy (FOLFIRI [folinic acid {leucovorin}, fluorouracil {5-fluorouracil}, and irinotecan] and FOLFOX4 [folinic acid {leucovorin}, fluorouraci {5-fluorouracil}, and oxaliplatin]). Pathologic examination was supportive of a rhabdoid carcinoma, with a compatible immunohistochemical profile, demonstrating synchronous expression of vimentin and epithelial markers in the tumor cells. In addition, BRAF V600E gene mutation, together with a wild-type KRAS gene, was identified, and no evidence of microsatellite instability based on MLH1, MSH2, MSH6, and PMS2 immunophenotypes, i.e., no loss of expression for all 4 markers, was observed. Our reported case confirms previously published observations of the clinical aggressiveness and the poor therapeutic response for rhabdoid tumors.

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Abstract PDF

A stercoral perforation of the rectum due to a fecaloma is a rare disease with a high mortality rate. Although multiple case reports of colonic perforations have been published, the data regarding rectal perforations are limited. This case report will highlight one such case of a stercoral rectal perforation that was successfully treated with a laparoscopic operation.

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Abstract PDF

Primary ovarian lymphoma is a rare malignancy whose symptoms or signs are usually nonspecific. In this article, we report a very rare case initially presenting as a rectal submucosal-tumor-like lesion with a defecation disturbance caused by primary ovarian lymphoma with bilateral involvement. A 42-year-old woman visited chungnam national university hospital complaining of persistent defecation disturbance for 6 months. Colonoscopy demonstrated compression of the rectum by an extrinsic mass mimicking a rectal submucosal tumor. Magnetic resonance imaging detected bilateral ovarian tumors, 9.3 cm and 5.4 cm each in diameter, compressing the rectum without enlarged lymph nodes. The diagnosis was established following a bilateral adnexectomy and histological studies of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient was prescribed six cycles of standard CHOP (cyclophosphamide, hydroxydaunorubicin, vincristine, prednisolone) regimen and is presently on treatment.

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