Annals of Coloproctology

Original Articles

The Impact of the Outcome of Treating a High Anal Fistula by Using a Cutting Seton and Staged Fistulotomy on Saudi Arabian Patients: Bader Hamza Shirah, Hamza Asaad Shirah; Ann Coloproctol. 2018;34(5):234-240. Published online October 10, 2018; DOI: https://doi.org/10.3393/ac.2018.03.23

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Purpose
A cutting seton is used after a partial distal fistulotomy to treat patients with a high exrasphincteric fistula in ano to avoid fecal incontinence and recurrence. In Saudi Arabia, religious practices necessitate complete cleanness, which makes conditions affecting anal continence a major concern to patients affected by an anal fistula. Therefore, we aimed to evaluate the efficiency of the cutting seton in treating a high anal fistula among Saudi Arabians.
Methods
Between January 2005 and December 2014, a prospective study was done for 372 Saudi Arabian patients diagnosed as having a high anal fistula and treated with a cutting seton at Al-Ansar General Hospital, Medina, Saudi Arabia. 0-silk sutures were used. All patients underwent the same preoperative assessment, operative technique, and postoperative follow-up. Weekly, the seton was tightened in outpatient clinics.
Results
Two hundred ninety-eight patients (80.1%) were males and 74 (19.9%) females. The duration of symptoms varied from 3–21 months. The fistula healed completely in 363 patients (97.6%); 58 patients (15.6%) reported some degree of incontinence to flatus, but none to feces. In 9 patients (2.4%) the fistula recurred.
Conclusion
The utilization of the cutting seton method in the treatment of patients with a high anal fistula is highly efficient as it simultaneously drains the abscess, cuts the fistulous tract, and causes fibrosis along the tract. Treatment of a high anal fistula by using a staged fistulotomy with a cutting seton was very rewarding to Saudi Arabian patients who feared anal incontinence for religious reasons and was associated with low postoperative complication and recurrence rates.

Citations

Citations to this article as recorded by

Cutting seton for the treatment of cryptoglandular fistula-in-ano: a systematic review and meta-analysis
J. Khamar, A. Sachdeva, T. McKechnie, Y. Lee, L. Tessier, D. Hong, C. Eskicioglu
Techniques in Coloproctology.2024;[Epub] CrossRef
Evaluation surgical strategies in perianal fistulas treatment: Efficacy draining seton compared to other surgical approaches; a case‐control study
Amir Ghasemlouei, Amirhosein Naseri, Ali Ashjaei, Shahryar Sadeghi, Amir Keshvari
Health Science Reports.2024;[Epub] CrossRef
Assessing the suitability of video-assisted anal fistula treatment for obese patients compared to conventional surgery: a question worth investigating
Xiao-Li Tang, Zi-Yang Xu, Jun Yang, Zhe Yang, Zhi-Gang Wang, Zheng-Yun Zhang, Jing Yao
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Comparative Evaluation Between Cutting of the Intersphincteric Space vs Cutting Seton in High Anal Fistula: A Randomized Controlled Trial
Jiawei Qin, Yanlan Wu, Xueping Zheng, Kunlan Wu, Gongjian Dai, Yanyan Tan, Xu Yang, Yuqing Sun
Journal of the American College of Surgeons.2024; 239(6): 563. CrossRef
Fistulectomy and primary sphincteroplasty in complex anal fistula treatment: a hospital-based long-term follow-up study
Fakhrosadat Anaraki, Mohammad Reza Nikshoar, Arsh Haj Mohamad Ebrahim Ketabforoush, Rojin Chegini, Nasrin Borumandnia, Mehdi Tavallaei
Techniques in Coloproctology.2023; 27(2): 145. CrossRef
Exploring Health-Related Quality of Life in Patients with Anal Fistulas: A Comprehensive Study
Tudor Mateescu, Lazar Fulger, Durganjali Tummala, Aditya Nelluri, Manaswini Kakarla, Lavinia Stelea, Catalin Dumitru, George Noditi, Amadeus Dobrescu, Cristian Paleru, Ana-Olivia Toma
Life.2023; 13(10): 2008. CrossRef
Surgical treatment of anal fistula
A. Ya. Ilkanich, V. V. Darwin, E. A. Krasnov, F. Sh. Aliyev, K. Z. Zubailov
Сибирский научный медицинский журнал.2023; 43(5): 74. CrossRef
Evaluation of the Cutting Seton Technique in Treating High Anal Fistula
Asim M Almughamsi, Mohamed Khaled S Zaky, Abdullatif M Alshanqiti, Ibrahim S Alsaedi, Hamed I Hamed, Tariq E Alharbi, Ali A Elian
Cureus.2023;[Epub] CrossRef
Comparison of loose combined cutting seton and traditional cutting seton for high anal fistula: a meta-analysis
Yi SUN, Chunqiang WANG, Tianye HUANG, Xuebing WANG
Gazzetta Medica Italiana Archivio per le Scienze Mediche.2023;[Epub] CrossRef
Evaluating the Efficacy of Cutting Setons for the Treatment of Anal Fistulas
Miguel E. Gomez, Koianka Trencheva, Matthew Symer, Kelly Garrett, Jeffrey W. Milsom, Parul J. Shukla
Indian Journal of Surgery.2022; 84(5): 961. CrossRef
Advancing standard techniques for treatment of perianal fistula; when tissue engineering meets seton
Hojjatollah Nazari, Zahra Ebrahim Soltani, Reza Akbari Asbagh, Amirsina Sharifi, Abolfazl Badripour, Asieh Heirani Tabasi, Majid Ebrahimi Warkiani, Mohammad Reza Keramati, Behnam Behboodi, Mohammad Sadegh Fazeli, Amir Keshvari, Mojgan Rahimi, Seyed Mohsen
Health Sciences Review.2022; 3: 100026. CrossRef
Treatment of the fistula tract with laser ablation in high anal fistula
Erkan Karacan, Eyüp Murat Yılmaz
Journal of Clinical Medicine of Kazakhstan.2022; 19(6): 43. CrossRef
Influence of the cotton and silastic seton on the distance of the anal sphincter cables after fistulotomy in rats
Ana Laura Sanches Lima, Beatriz Schorro Gianini, Bruna Miranda Santana, Carlos Henrique Marques dos Santos, Doroty Mesquita Dourado, Juliano Seger Falcão, Lucas Bannwart, Sara Jéssica Falcão Câmara
Journal of Coloproctology.2020; 40(01): 056. CrossRef
A Commentary on the article: “Risk factors for recurrence after anal fistula surgery: A meta-analysis”, Int J Surg 2019;69:153–164
F. Karimian
International Journal of Surgery.2019; 71: 79. CrossRef

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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Nan Yao, Wenqiang Li, Jiwei Wang, Hongyuan Chu, Ning Duan, Xinyu Niu, Guoyong Yu, Jun Qu
BMJ Open.2024; 14(2): e076579. CrossRef
Systematic review of risk factors, prognosis, and management of colorectal signet-ring cell carcinoma
Frederiek Nuytens, Vincent Drubay, Clarisse Eveno, Florence Renaud, Guillaume Piessen
World Journal of Gastrointestinal Oncology.2024; 16(5): 2141. CrossRef
Unraveling the complexities of colorectal cancer and its promising therapies – An updated review
Sayan Saha, Shreya Ghosh, Suman Ghosh, Sumit Nandi, Aditi Nayak
International Immunopharmacology.2024; 143: 113325. CrossRef
Case report: Preclinical efficacy of NEDD8 and proteasome inhibitors in patient-derived models of signet ring high-grade mucinous colorectal cancer from a Lynch syndrome patient
Erica Torchiaro, Consalvo Petti, Sabrina Arena, Francesco Sassi, Giorgia Migliardi, Alfredo Mellano, Roberta Porporato, Marco Basiricò, Loretta Gammaitoni, Enrico Berrino, Monica Montone, Giorgio Corti, Giovanni Crisafulli, Caterina Marchiò, Alberto Barde
Frontiers in Oncology.2023;[Epub] CrossRef
Prognosis of Different Histological Types in Patients with Stage II and III Colon Cancer
Yasmeen Z. Qwaider, Naomi M. Sell, Caitlin E. Stafford, Chloe Boudreau, Hiroko Kunitake, Robert N. Goldstone, Rocco Ricciardi, Liliana G. Bordeianou, Christy E. Cauley, David L. Berger
Journal of Gastrointestinal Surgery.2022; 26(2): 476. CrossRef
Tumor budding as a prognostic indicator in colorectal carcinoma: a retrospective study of primary colorectal carcinoma cases in a tertiary care center
Ashini H. Shah, Amisha J. Gami, Neetal H. Desai, Jahnavi S. Gandhi, Priti P. Trivedi
Indian Journal of Surgical Oncology.2022; 13(3): 459. CrossRef
The Association of Microbiome Dysbiosis With Colorectal Cancer
Artem Artemev, Sheetal Naik, Anastasia Pougno, Prasanna Honnavar, Nandan M Shanbhag
Cureus.2022;[Epub] CrossRef
Simple synthesis of WO3 based activated carbon co-doped CuS composites for photocatalytic applications
Tahir Iqbal, Maria Ashraf, Arslan Masood
Inorganic Chemistry Communications.2022; 139: 109322. CrossRef
Predictors of Long-Time Survivors in Nonmetastatic Colorectal Signet Ring Cell Carcinoma: A Large Population-Based Study
Wuguang Zhang, Wenqian Gong, Changhai Wu, Mengting Li, Xiaolong Tu, Stephen Fink
Gastroenterology Research and Practice.2022; 2022: 1. CrossRef
Applications of propensity score matching: a case series of articles published in Annals of Coloproctology
Hwa Jung Kim
Annals of Coloproctology.2022; 38(6): 398. CrossRef
Does signet ring cell carcinoma component signify worse outcomes for patients with colorectal cancer?
Liming Wang, Yasumitsu Hirano, Gregory Heng, Toshimasa Ishii, Hiroka Kondo, Kiyoka Hara, Nao Obara, Masahiro Asari, Takuya Kato, Shigeki Yamaguchi
Asian Journal of Surgery.2021; 44(1): 105. CrossRef
The Impact of Histologic Subtype on Receipt of Adjuvant Chemotherapy and Overall Survival in Stage III Colon Cancer: a Retrospective Cohort Analysis
Benjamin D. Powers, Seth I. Felder, Iman Imanirad, Sophie Dessureault, Sean P. Dineen
Journal of Gastrointestinal Cancer.2021; 52(2): 719. CrossRef
Colorectal adenocarcinomas diagnosed following a negative faecal immunochemical test show high‐risk pathological features in a colon screening programme
Michael J. Steel, Hussam Bukhari, Laura Gentile, Jennifer Telford, David F. Schaeffer
Histopathology.2021; 78(5): 710. CrossRef
Colorectal cancer of the young displays distinct features of aggressive tumor biology: A single-center cohort study
Matteo Mueller, Marcel André Schneider, Barla Deplazes, Daniela Cabalzar-Wondberg, Andreas Rickenbacher, Matthias Turina
World Journal of Gastrointestinal Surgery.2021; 13(2): 164. CrossRef
Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis
Michael G. Fadel, George Malietzis, Vasilis Constantinides, Gianluca Pellino, Paris Tekkis, Christos Kontovounisios
Discover Oncology.2021;[Epub] CrossRef
MRI features of signet ring rectal cancer
Meena Suthar, Akshay D. Baheti, Suman K. Ankathi, Amit Choudhari, Purvi D. Haria, Reena Engineer, Vikas Ostwal, Mukta S. Ramadwar, Ashwin Desouza, Avanish Saklani
Abdominal Radiology.2021; 46(12): 5536. CrossRef
Metastatic patterns and survival outcomes in patients with stage IV colon cancer: A population‐based analysis
Jiwei Wang, Song Li, Yanna Liu, Chunquan Zhang, Honglang Li, Bin Lai
Cancer Medicine.2020; 9(1): 361. CrossRef
Prognostic factors influencing survival in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for isolated colorectal peritoneal metastases: a systematic review and meta‐analysis
V. Narasimhan, S. Tan, J. Kong, T. Pham, M. Michael, R. Ramsay, S. Warrier, A. Heriot
Colorectal Disease.2020; 22(11): 1482. CrossRef
Deconvolution of diffuse gastric cancer and the suppression of CD34 on the BALB/c nude mice model
Seon-Jin Yoon, Jungmin Park, Youngmin Shin, Yuna Choi, Sahng Wook Park, Seok-Gu Kang, Hye Young Son, Yong-Min Huh
BMC Cancer.2020;[Epub] CrossRef
Predictive factors of complete pathological response in patients with locally advanced rectal cancer
Rebekah M. Engel, Karen Oliva, Christine Koulis, Raymond Yap, Paul J. McMurrick
International Journal of Colorectal Disease.2020; 35(9): 1759. CrossRef
Clinicopathological Characteristics and Mutation Spectrum of Colorectal Adenocarcinoma With Mucinous Component in a Chinese Cohort: Comparison With Classical Adenocarcinoma
Jingci Chen, Liangrui Zhou, Jie Gao, Tao Lu, Jing Wang, Huanwen Wu, Zhiyong Liang
Frontiers in Oncology.2020;[Epub] CrossRef
Signet ring cell component in pretreatment biopsy predicts pathological response to preoperative chemoradiotherapy in rectal cancer
Xue Chao, Zixian Wang, Shixun Lu, Yuhua Huang, Shengbing Zang, Peirong Ding, Huizhong Zhang, Jingping Yun
International Journal of Clinical Oncology.2020; 25(9): 1653. CrossRef
Laparoscopic Surgery for Colorectal Cancer in Korea: Nationwide Data from 2013 to 2018
Sun Jin Park, Kil Yeon Lee, Suk-Hwan Lee
Cancer Research and Treatment.2020; 52(3): 938. CrossRef
Outcomes of Definitive Treatment of Signet Ring Cell Carcinoma of the Rectum: Is Minimal Invasive Surgery Detrimental in Signet Ring Rectal Cancers?
S. Raghavan, Deepak Kumar Singh, J. Rohila, A. DeSouza, R. Engineer, A. Ramaswamy, V. Ostwal, A. Saklani
Indian Journal of Surgical Oncology.2020; 11(4): 597. CrossRef
Aggressive Colorectal Cancer in the Young
Blake Read, Patricia Sylla
Clinics in Colon and Rectal Surgery.2020; 33(05): 298. CrossRef
Prognoses of different pathological subtypes of colorectal cancer at different stages: A population-based retrospective cohort study
Xiaoli Wu, Han Lin, Shaotang Li
BMC Gastroenterology.2019;[Epub] CrossRef

Comparative Study of Postoperative Complications in Patients With and Without an Obstruction Who Had Left-Sided Colorectal Cancer and Underwent a Single-Stage Operation After Mechanical Bowel Preparation: Sang Hun Jung, Jae Hwang Kim; Ann Coloproctol. 2014;30(6):251-258. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.251

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Abstract PDF

Purpose

The purpose of this study is to compare postoperative complications for single-stage surgery after mechanical bowel preparation in patients who experienced obstruction and those who did not.

Methods

From 2000 to 2011, 1,224 patients underwent a single-stage operation for left colorectal cancer after bowel preparation. Nonobstruction (NOB) and obstruction (OB) colorectal cancer patients were 1,053 (86.0%) and 171 (14.0%), respectively. Postoperative morbidity and mortality were compared between groups.

Results

The OB group had poor preoperative conditions (age, white blood cell, hemoglobin, albumin level, and advanced tumor stage) compared with the NOB group (P < 0.05). Mean on-table lavage time for the OB group was 17.5 minutes (range, 14-60 minutes). Mean operation time for the OB group was statistically longer than that of the NOB group (OB: 210 minutes; range, 120-480 minutes vs. NOB: 180 minutes; range, 60-420 minutes; P < 0.001). Overall morbidity was similar between groups (NOB: 19.7% vs. OB: 23.4%, P = 0.259). Major morbidity was more common in the OB group than in the NOB group, but the difference was without significance (OB: 11.7% vs. NOB: 7.6%, P = 0.070). Postoperative death occurred in 16 patients (1.3%), and death in the OB group (n = 7) was significantly higher than it was in the NOB group (n = 9) (4.1% vs. 0.9%, P = 0.001). Twelve patients had surgical complications, which were the leading cause of postoperative death: postoperative bleeding in five patients and leakage in seven patients.

Conclusion

Postoperative morbidity for a single-stage operation for obstructive left colorectal cancer is comparable to that for NOB, regardless of poor conditions of the patient.

Citations

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Clinical characteristics and risk factors of post-operative intestinal flora disorder following laparoscopic colonic surgery: A propensity-score-matching analysis
Gan-Bin Li, Chen-Tong Wang, Xiao Zhang, Xiao-Yuan Qiu, Wei-Jie Chen, Jun-Yang Lu, Lai Xu, Bin Wu, Yi Xiao, Guo-Le Lin
World Journal of Gastrointestinal Surgery.2024; 16(5): 1259. CrossRef
Laparoscopic versus open surgery for obese patients with rectal cancer: a retrospective cohort study
Hiroyuki Matsuzaki, Soichiro Ishihara, Kazushige Kawai, Koji Murono, Kensuke Otani, Koji Yasuda, Takeshi Nishikawa, Toshiaki Tanaka, Tomomichi Kiyomatsu, Keisuke Hata, Hiroaki Nozawa, Hironori Yamaguchi, Toshiaki Watanabe
Surgery Today.2017; 47(5): 627. CrossRef
Surgical Treatment of Obstructed Left-Sided Colorectal Cancer Patients
Young Jin Kim
Annals of Coloproctology.2014; 30(6): 245. CrossRef

Oncologic Outcomes of Stage IIIA Colon Cancer for Different Chemotherapeutic Regimens: Yoo Sung Lee, Hee Cheol Kim, Kyung Ook Jung, Yong Beom Cho, Seong Hyeon Yun, Woo Yong Lee, Ho-Kyung Chun; J Korean Soc Coloproctol. 2012;28(5):259-264. Published online October 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.5.259

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Abstract PDF

Purpose

Adjuvant chemotherapy is currently recommended for Stage IIIA colon cancers. This study aimed to elucidate the oncologic outcomes of Stage IIIA colon cancer according to the chemotherapeutic regimen based on a retrospective review.

Methods

From 1995 to 2008, Stage IIIA colon cancer patients were identified from a prospectively maintained database at a single institution. Exclusion criteria were as follows: rectal cancer, another malignancy other than colon cancer, no adjuvant chemotherapy and unknown chemotherapeutic regimen. One hundred thirty-one patients were enrolled in the study, and the clinicopathologic and the oncologic characteristics were analyzed. The number of males was 72, and the number of females was 59; the mean age was 59.5 years (range, 25 to 76 years), and the median follow-up period was 33 months (range, 2 to 127 months).

Results

Of the 131 patients, fluorouracil/leucovorin (FL)/capecitabine chemotherapy was performed in 109 patients, and FOLFOX chemotherapy was performed in 22 patients. When the patients who received FL/capecitabine chemotherapy and the patients who received FOLFOX chemotherapy were compared, there was no significant difference in the clinicopathologic factors between the two groups. The 5-year overall survival and the 5-year disease-free survival were 97.2% and 94.5% in the FL/capecitabine patient group and 95.5% and 90.9% in the FOLFOX patient group, respectively, and no statistically significant differences were noted between the two groups.

Conclusion

Stage IIIA colon cancer showed good oncologic outcomes, and the chemotherapeutic regimen did not seem to affect the oncologic outcome.

Citations

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A New Method for Constructing Macrophage-Associated Predictors of Treatment Efficacy Based on Single-Cell Sequencing Analysis
Jianxiu Lin, Yang Ran, Tengfei Wu, Zishan Wang, Jinjin Zhao, Yun Tian
Journal of Immunotherapy.2024; 47(2): 33. CrossRef
Distinctive oncological features of stage IIIA colorectal cancer: Analysis of prognostic factors for selective adjuvant chemotherapy
Soo Yeun Park, Gyu‐Seog Choi, Jun Seok Park, Hye Jin Kim, Yoshiharu Sakai, Suguru Hasegawa, Toshiaki Watanabe, Seon Hahn Kim
Journal of Surgical Oncology.2015; 111(7): 882. CrossRef

Incidence and Multiplicities of Adenomatous Polyps in TNM Stage I Colorectal Cancer in Korea: Young-Sang Hong, Eun-Joo Jung, Chun-Geun Ryu, Gang-Mi Kim, Su-Ran Kim, Sung-Noh Hong, Dae-Yong Hwang; J Korean Soc Coloproctol. 2012;28(4):213-218. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.213

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Abstract PDF

Purpose

In recent years, the incidence of early-stage colorectal cancer (CRC) has markedly increased in the population within the Republic of Korea. The aim of this study was to evaluate the clinicopathologic features of adenomatous polyps in TNM stage I CRC patients and in the general population.

Methods

Between March 2003 and September 2009, 168 patients with stage I CRC were enrolled in this study. In addition, the records of 4,315 members of the general population without CRC, as determined by colonoscopy during a health check-up, were reviewed.

Results

Of the 168 patients with stage I CRC, 68 (40.5%) had coexisting colorectal adenomatous polyps and of the 4,315 members of the general population, 1,112 (26.0%) had coexisting adenomatous polyps (P = 0.006). The prevalences of adenomatous polyp multiplicity in early CRC and in the general population were 32% and 15%, respectively (P = 0.023). Patients with coexisting adenomatous polyps had a higher frequency of tubulovillous or villous adenomas than members of the general population with polyps (7.5% vs. 2.0%, P = 0.037). Furthermore, a subgroup analysis showed that the occurrence (44% vs. 34%, P = 0.006) and the multiplicity (32% vs. 15%, P = 0.023) of adenomatous polyps were greater for T2 than T1 cancer.

Conclusion

The prevalence and the multiplicity of adenomatous polyps in TNM stage I CRC is higher than it is in the general population. The findings of this study suggest that depth of invasion of early stage CRC affects the prevalence and the number of adenomatous polyps in the remaining colon and rectum.

Citations

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Risk factors of recurrence in TNM stage I colorectal cancer
Jin-Hee Paik, Chun-Geun Ryu, Dae-Yong Hwang
Annals of Surgical Treatment and Research.2023; 104(5): 281. CrossRef

Clinical Impact of Tumor Regression Grade after Preoperative Chemoradiation for Locally Advanced Rectal Cancer: Subset Analyses in Lymph Node Negative Patients: Byung Soh Min, Nam Kyu Kim, Ju Yeon Pyo, Hoguen Kim, Jinsil Seong, Ki Chang Keum, Seung Kook Sohn, Chang Hwan Cho; J Korean Soc Coloproctol. 2011;27(1):31-40. Published online February 28, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.1.31

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Abstract PDF

Background

We investigated the prognostic significance of tumor regression grade (TRG) after preoperative chemoradiation therapy (preop-CRT) for locally advanced rectal cancer especially in the patients without lymph node metastasis.

Methods

One-hundred seventy-eight patients who had cT3/4 tumors were given 5,040 cGy preoperative radiation with 5-fluorouracil/leucovorin chemotherapy. A total mesorectal excision was performed 4-6 weeks after preop-CRT. TRG was defined as follows: grade 1 as no cancer cells remaining; grade 2 as cancer cells outgrown by fibrosis; grade 3 as a minimal presence or absence of regression. The prognostic significance of TRG in comparison with histopathologic staging was analyzed.

Results

Seventeen patients (9.6%) showed TRG1. TRG was found to be significantly associated with cancer-specific survival (CSS; P = 0.001) and local recurrence (P = 0.039) in the univariate study, but not in the multivariate analysis. The ypN stage was the strongest prognostic factor in the multivariate analysis. Subgroup analysis revealed TRG to be an independent prognostic factor for the CSS of ypN0 patients (P = 0.031). TRG had a stronger impact on the CSS of ypN (-) patients (P = 0.002) than on that of ypN (+) patients (P = 0.521). In ypT2N0 and ypT3N0, CSS was better for TRG2 than for TRG3 (P = 0.041, P = 0.048), and in ypN (-) and TRG2 tumors, CSS was better for ypT1-2 than for ypT3-4 (P = 0.034).

Conclusion

TRG was found to be the strongest prognostic factor in patients without lymph node metastasis (ypN0), and different survival was observed according to TRG among patients with a specific histopathologic stage. Thus, TRG may provide an accurate prediction of prognosis and may be used for f tailoring treatment for patients without lymph node metastasis.

Citations

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Tumor Regression Grade as a Prognostic Factor in Metastatic Colon Cancer Following Preoperative Chemotherapy
Yufei Yang, Dakui Luo, Ruoxin Zhang, Sanjun Cai, Qingguo Li, Xinxiang Li
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Prediction of tumor response of rectal cancer cells via 3D cell culture and in�vitro cytotoxicity assay before initiating preoperative chemoradiotherapy
Jeonghyun Kang, Min Park, Jina Kim, Hyuk Hur, Byung Min, Seung Baik, Kang Lee, Nam Kim
Oncology Letters.2019;[Epub] CrossRef
Prognostic significance of tumour regression grade after neoadjuvant chemoradiotherapy for a cohort of patients with locally advanced rectal cancer: an 8‐year retrospective single‐institutional study
L. Xu, S. Cai, T. Xiao, Y. Chen, H. Qiu, B. Wu, G. Lin, X. Sun, J. Lu, W. Zhou, Y. Xiao
Colorectal Disease.2017;[Epub] CrossRef
Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression?
Melanie J. McCoy, Chris Hemmings, Simon Hillery, Cheryl Penter, Max K. Bulsara, Nik Zeps, Cameron F. Platell
ANZ Journal of Surgery.2017;[Epub] CrossRef
Defining response to radiotherapy in rectal cancer using magnetic resonance imaging and histopathological scales
Muhammed R S Siddiqui, Jemma Bhoday, Nicholas J Battersby, Manish Chand, Nicholas P West, Al-Mutaz Abulafi, Paris P Tekkis, Gina Brown
World Journal of Gastroenterology.2016; 22(37): 8414. CrossRef
Interobserver agreement of radiologists assessing the response of rectal cancers to preoperative chemoradiation using the MRI tumour regression grading (mrTRG)
M.R.S. Siddiqui, K.L. Gormly, J. Bhoday, S. Balyansikova, N.J. Battersby, M. Chand, S. Rao, P. Tekkis, A.M. Abulafi, G. Brown
Clinical Radiology.2016; 71(9): 854. CrossRef
Controversies in the pathological assessment of colorectal cancer
Aoife Maguire
World Journal of Gastroenterology.2014; 20(29): 9850. CrossRef
The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer
K. I. Abdul‐Jalil, K. M. Sheehan, J. Kehoe, R. Cummins, A. O'Grady, D. A. McNamara, J. Deasy, O. Breathnach, L. Grogan, B. D. P. O'Neill, C. Faul, I. Parker, E. W. Kay, B. T. Hennessy, P. Gillen
Colorectal Disease.2014;[Epub] CrossRef
Pathological grading of regression: an International Study Group perspective
Runjan Chetty, P Gill, Adrian C Bateman, David K Driman, Dhirendra Govender, Andrew R Bateman, Y J Chua, Godman Greywoode, Christine Hemmings, I Imat, Eleanor Jaynes, Cheok Soon Lee, Michael Locketz, Corwyn Rowsell, Anne Rullier, Stefano Serra, Eva Szentg
Journal of Clinical Pathology.2012; 65(10): 865. CrossRef
Pathological grading of regression following neoadjuvant chemoradiation therapy: the clinical need is now: Table 1
Tom P MacGregor, Tim S Maughan, Ricky A Sharma
Journal of Clinical Pathology.2012; 65(10): 867. CrossRef

Short-Term Outcome of Curative One-Stage Laparoscopic Resection for Obstructive Left-Sided Colon Cancers Followed by Stent Insertion: Comparative Study with Non-Obstructive Left-Sided Colon Cancers.: Kim, Hyun Sil , Kim, Sung Geun , Ahn, Chang Hyuk , Kang, Won Kyung , Lee, Yun Seok , Lee, In Kyu , Kim, Hyung Jin , Lee, Sang Cheol , Cho, Hyeon Min , Park, Jong Kyung , Oh, Seong Taek , Kim, Jun Gi; J Korean Soc Coloproctol. 2009;25(6):417-422.; DOI: https://doi.org/10.3393/jksc.2009.25.6.417

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Abstract PDF: PURPOSE
Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative bowel decompression and bowel preparation. The aim of this study is to evaluate the safety and the feasibility of a one-stage laparoscopic resection for obstructive left-sided colon cancer after stent insertion by comparing the results to those for non-obstructive left-sided colon cancer. METHODS: Between May 2006 and January 2009, a laparoscopic colorectal operation was performed on 18 consecutive patients with obstructive left-sided colon cancer after placement of a self-expandable stent by one colorectal surgeon, and the results were compared retrospectively to those for 43 patients with non-obstructive left-sided colon cancer who had undergone a laparoscopic procedure with the same surgeon. The collected data were the clinicopathologic characteristics, the perioperative complications, the oncologic outcomes, the postoperative recovery results, and the survival rate. RESULTS: The obstructive left-sided colon cancer group had significant benefits in retrieved lymph nodes (18.8+/-5.3 vs. 14.0+/-8.7, P=0.036), and distal resection margin (5.5+/-3.0 cm vs. 3.6+/-2.4 cm, P=0.011). There were no significant differences in other clinicopathological characteristics and oncologic outcomes, including the overall 3-yr survival rate, between the two groups. CONCLUSION: Preoperative stent decompression followed by a laparoscopic colorectal resection is a safe and feasible option for treating obstructive left-sided colon cancer. A further large-scale prospective study should be performed to evaluate the long-term outcome of a one-stage laparoscopic resection using stent insertion in cases of obstructive left-sided colon cancer.

Expression of Alpha-catenin/E-cadherin and Clinical Significance of Metastatic Factors in Stage III Advanced Colon Cancer.: Chae, Seung Hun , Kim, Han Sun , Kim, Jae Man , Lee, Sang Hee , Jo, Sung Ook , Lee, Mi Keung , Jung, Wan Jo , Lee, Ho Jun; J Korean Soc Coloproctol. 2009;25(5):334-339.; DOI: https://doi.org/10.3393/jksc.2009.25.5.334

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Abstract PDF: PURPOSE
Among the cell adhesion molecules, alpha-catenin and E-cadherin play an important part in maintaining normal cell structure. The change in expression of cell adhesion molecules affects the invasion and metastasis of a tumor and the prognosis for patients. In this study, we evaluated the relationship between the expression of cell adhesion molecules and the histopathologic characteristics of stage III colon cancer.
METHODS
The relationship between the immunohistochemical expression of cell adhesion molecules and tumor progression were statistically analyzed in 40 patients with stage III colon cancer.
RESULTS
There were no statistically significant correlations between loss of membranous alpha-catenin and E-cadherin expressions and such variables as histologic differentiation and lymph node disease based on the criteria of the American Joint Committee on Cancer (AJCC). A significant correlation, however, existed between depth of mural invasion and loss of expressions of both alpha-catenin and E-cadherin (P=0.001 and P=0.002, respectively). Expressions of both alpha-catenin and E-cadherin were also significantly decreased in patients showing liver metastases during follow-up (P=0.019 and P=0.015, respectively).
CONCLUSION
Immunohistochemical analyses of alpha-catenin and E-cadherin expressions may be available as predictors for distant metastasis, especially in stage III colon cancer. Such analyses may also help to identify appropriate therapeutic strategies and the need for intensive follow-up in patients with stage III colon cancer.

Treatment Patterns for Colorectal Cancer Patients at the National Cancer Center Korea in 2003.: Kim, Duck Woo , Jeong, Seung Yong , Kim, Dae Yong , Sohn, Dae Kyung , Lim, Seok Byung , Chang, Hee Jin , Jung, Kyung Hae , Jeong, Jun Yong , Choi, Hyo Seong , Park, Jae Gahb; J Korean Soc Coloproctol. 2007;23(4):245-249.; DOI: https://doi.org/10.3393/jksc.2007.23.4.245

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Abstract PDF

PURPOSE
In Korea, colorectal cancer (CRC) is one of the most sharply-increasing malignancies, and the National Colorectal Cancer Screening Program for persons over 50 years of age began in 2004. To determine the effectiveness of the program, comparative data regarding CRCs treated prior to 2004 must be analyzed. The present study assessed CRC status at diagnosis and treatment patterns in 2003.
METHODS
In 2003, 503 patients were newly diagnosed with CRC and were treated at the Center for Colorectal Cancer, National Cancer Center (NCC). Clinical data were retrospectively reviewed.
RESULTS
The 503 patients included 256 colon and 247 rectal cancer patients. Of the 256 colon cancer patients, 5 (2.0%) were diagnosed during screening colonoscopies and were successfully treated using an endoscopic mucosal resection (EMR), and 17 (6.6%) received only palliative chemotherapy because of distant metastases. Forty patients (15.6%) were treated with palliative surgery and chemotherapy, and 194 (75.8%) with curative surgery with or without adjuvant chemotherapy. Of the 247 rectal cancer patients, 9 (3.6%) were treated with an EMR, 20 (8.1%) with palliative chemotherapy with or without radiotherapy, 19 (7.7%) with palliative surgery and chemoradiotherapy, and 199 (80.6%) with curative surgery with or without chemoradiotherapy. Treatment with curative intent was possible in 199 of 256 (77.7%) colon cancer patients and in 208 of 247 (84.2%) rectal cancer patients.
CONCLUSIONS
Only 12.1% of colon and 8.5% of rectal cancer patients were diagnosed early and treated without adjuvant therapies at the NCC in Korea in 2003.

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Lymphovascular Invasion is a Significant Prognosticator in Rectal Cancer Patients Who Receive Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision
Jong Hoon Lee, Hong Seok Jang, Jun-Gi Kim, Hyun Min Cho, Byoung Yong Shim, Seong Taek Oh, Sei-Chul Yoon, Yeon-Sil Kim, Byung Ock Choi, Sung Hwan Kim
Annals of Surgical Oncology.2012; 19(4): 1213. CrossRef
Role of Radiation Therapy as an Adjuvant Treatment in Rectal Cancer Management
Jae Hwan Oh, Dae Yong Kim
Journal of the Korean Society of Coloproctology.2009; 25(4): 273. CrossRef

Trend of Clinicopathologic Characteristics of Colorectal Cancer in Asan Medical Center: a 15-Year Experience.: Choi, Pyong Wha , Jung, Sang Hun , Kim, Jung Rang , Yu, Chang Sik , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2006;22(6):387-395.

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Abstract PDF: PURPOSE
A retrospective study was performed to provide an overview of changes over time by age, stage, tumor location, and surgical therapy of colorectal cancer over the past 15 years.
METHODS
We analyzed the cases 6,314 colorectal cancer patients who underwent surgery at Asan Medical Center between January 1990 and December 2004. The period was divided into three periods: 1990 to 1994, 1995 to 1999, and 2000 to 2004. We analyzed trends over time for stage, resectability, and demographic factors of colorectal cancer over the past 15 years.
RESULTS
The mean age of the patients in the periods from 1990 to 1994, from 1995 to 1999, and from 2000 to 2004 were 57.1 (21~89), 57.4 (14~91), and 58.9 (15~91) years, respectively, showing an increasing tendency over time (P<0.001). The male-to-female ratios were 1.2 : 1, 1.3 : 1, and 1.6 : 1, repectively, and this male preponderance has been more marked in recent years (P=0.003). There was no change in tumor location over time. The ratios of early cancer to advanced cancer were 0.06 : 1, 0.09 : 1, and 0.11 : 1, respecfively, showing an increasing tendency over time (P=0.002). The curative resection rate increased over time (P<0.001). The non-curative resection rate was higher and the non-resected rate was lower in the period 2000 to 2004 than in the period 1990 to 1999 (P<0.001). The ratios of the lowest anterior resection to the abdominoperineal resection were 0.06 : 1, 0.49 : 1, and 1.02 : 1, respectively. With decreasing tendency of abdominoperineal resection, the lowest anterior resection rate has increased gradually over time (P<0.001).
CONCLUSIONS
Etiologic studies are necessary to understand the male preponderance in colorectal cancer, and multi-center studies should be conducted to understand the changing trend of colorectal cancer in Korea.

Safety of a One-stage Operation for an Obstructed Left Colon Carcinoma.: Oh, Soo Youn , Ahn, Eun Jung , Chung, Soon Sup , Lee, Ryung Ah , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 2005;21(4):207-212.

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Abstract PDF: PURPOSE
For a left-sided colonic obstruction, the traditional method of a staged defunctioning colostomy and resection has been performed. Recently, there has been a trend towards a one-stage primary resection and anastomosis. The aim of this study was to assess the safety and the efficacy of a one-stage resection and anastomosis for obstructed left colon cancer.
METHODS
We retrospectively reviewed the records of 29 patients who had been diagnosed as having an obstructed left-sided colon cancer during the period from January 1995 to December 2003 at Ewha Womans University Hospital. We compared two techniques, a one-stage operation (10 cases) and a staged operation (13 cases).
RESULTS
The mean age of the one-stage group was 58.5+/-16.1, and that of the staged operation group was 65.0+/-13.4. Both groups had similar co-morbidities, TNM stages, and tumor locations. In the one-stage operation group, a subtotal colectomy (n=3), a resection and anastomosis with intraoperative lavage (n=5), and a resection and anastomosis following stent insertion (n=2) had been performed. Patients who had undergone a colostomy as the first operation, resection and anastomosis (n=3), and a resection and anastomosis following a defunctioning colostomy (n=10) were included in the staged operation group. The mean postoperative hospital stay showed no significant differences between the two groups. One patient who had undergone a one-stage operation presented with an intestinal partial obstruction five months later. There were no anastomotic leakages, intraabdominal absceses, and wound infections, nor were there any mortalities.
CONCLUSIONS
A one-stage resection and primary anastomosis for obstructed left-sided colon cancer can be done safely without significant morbidity.

The Economic Efficiency of the Single Stage Management of Left Colon Cancer Patient.: Kang, Shin Hwa , Shon, Dae Ho , Kwun, Woo Hyung , Kim, Sang Woon , Shim, Min Chul , Kim, Jae Hwang; J Korean Soc Coloproctol. 2002;18(4):251-256.

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Abstract PDF: PURPOSE
Two-stage management with Hartmann's procedure is the most common procedure used for the treatment of obstructive left colon cancer with or without perforation. However, single-stage procedures have gained popularity recently with reports that show little difference in safety compared to the conventional multi-stage procedures. To evaluate the economic advantage of single stage procedure compare with two stage procedure in emergent left colonic pathology.
METHODS
Eleven patients (SP; single stage procedure) without other accompanying diseases among 15 patients who entered the emergency room and treated by the single stage procedure using the intraoperative irrigation for the left colon obstructions with or without perforation during the period from July of 1999 to November of 2000, were compared in their costs retrospectively with 11 patients (MP; multiple stage procedure) without other accompanying diseases and had final reduction of stoma out of 28 patients treated by Hartman's procedures including the resections of lesions during the period from September 1996 to May 1999 with the same diagnosis. The costs were compared using Mann-Whitney U tests, with data on the costs of overall treatments, operations, anesthesia, admission room, medications, test/evaluations, and managements as well as days of hospital stay, all on the record of accounting department. The relationships of the factors to the total cost of treatment were evaluated using Multi-variant regression analysis, and the pre-operative physiologic status were compared using APACHE III scoring system. The total treatment cost did not include optional treatment costs, uninsured admission room costs, and the costs of colonic irrigator used in the operations for the SP.
RESULTS
There were no significant difference in the age and gender of the two groups as 67 +/-15 years with 6 males for the SP and 6+/-19 years with 7 males for the MP. The preoperative physiologic status of patients, in APACHE III scoring system, were 29.1+/-10.6 in the SP and 26.1+/-8.2 in the MP without any significant difference between the two groups. The average of hospital stay showed a significant difference between two groups as 17.1+/-6.2 (range: 13-25) days for the SP and 31.3 (range: 24-43) days for the MP (p<0.01). The average of total costs showed also a significant difference in two groups as 3,938 687 (range: 3,017-4,974) thousand won for the SP and 7,543 1,851 (range: 5,314-9925) thousand won for the MP (p<0.01). It showed that the SP had roughly 50, 53, 76, 79, and 72% reductions of costs over operations, anesthesia, admission room, medications, tests/evaluations, and managements. The analysis of the overall costs of treatments showed 3,540 thousand won reduction in SP.
CONCLUSIONS
Single stage procedure using intraoperative colonic irrigation technique showed no difference in safety but has an economical advantage over the conventional multiple stage in the management of emergent left colonic obstruction or perforation patients.

Complete Single Stage Management of Left Colon Cancer Obstruction with a New Devices.: Kim, Jae Hwang , Shon, Dae Ho , Cahng, Byung Ik , Chung, Mun Kwan , Shim, Min Chul; J Korean Soc Coloproctol. 2002;18(1):30-36.

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Abstract PDF: Intraoperative antegrade colonic irrigation for single stage procedure in left colon cancer obstruction is a preferred technique recently however, synchronous pathology cannot be detected. A new device that enables easy intraoperative irrigation and colonoscopy before resection of tumor was devised. PURPOSE: To evaluate the efficacy of the new device for single stage procedure in left colon cancer obstruction.
METHODS
The new device (NICI; MITech co., Ltd, Seoul, Korea) consists of a Y-shaped teflon tube of maximum diameter 2.9, 3.5 and 4.1 cm, one proximal end is designed to connect with the dilated colon just proximal to the lesion. Two distal branches are for drainage of fecal matter and for retrograde insertion of irrigation catheter and subsequent colonoscope respectively.
RESULTS
There were 53 patients (27 male, median age 64, range; 28~82) who underwent this procedure. No extraintestinal leaks were encountered. The volume of saline used was 12 (range; 6 to 27) Liters over 14 (range; 9 to 22) minutes. Subsequent colonoscopic examination added 10 (range, 8 to 15) minutes to the entire operation in 28 patients. There were one anastomotic leakage and 2 wound infections, however, there was no operative mortality. On-table colonoscopy resulted in extended resection in 3 cases because of synchronous malignancy in frozen biopsy and found synchronous polyps in 13 of 28 cases.
CONCLUSIONS
The new device enabled safe, simple and time saving single stage surgical management of left colon cancer obstruction. The ability to perform on-table colonoscopy enabled treatment of synchronous bowel pathology.

The Safety of Intraoperative Colonic Irrigation for Single Stage Procedure in Emergency Based Left Colonic Pathology.: Kim, Bum Ryul , Shon, Dae Ho , Jang, Byung Ik , Jung, Moon Kwan , Shim, Min Chul , Kim, Jae Hwang; J Korean Soc Coloproctol. 2001;17(6):309-315.

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Abstract PDF: Staged procedures are preferred to single stage procedures in emergency based left colonic obstruction or perforation because of the safety. PURPOSE: To evaluate whether the single stage procedure in emergency based left colonic pathology is not safe.
METHODS
We compared medical records of single stage procedure (SP, n=22 male; 10, mean age: 60+/-17, range: 26-82 Yrs) with Hartmanns procedure (HP, n=23 male; 13, mean age: 58+/-16, range: 18-90 Yrs) and diverting loop colostomy (DC, n=19, male; 12, mean age: 59+/-19, range: 19-80 Yrs) in these 4 years. All the patients were admitted via emergency room. Intraoperative colonic irrigation method with newly developed irrigation device (MITech co., Ltd, Seoul, Korea) was used for SP. APACHE III scoring system was applied to evaluate the physiologic status of the patients. Preoperative data were compared with the 1st and 3rd postoperative day (POD).
RESULTS
There were no statistically significant differences in patient demographics and preoperative APACHE III scores. The improvement of APACHE III score was significant in SP and DC on the 3rd POD from 29.6+/-20.9 to 22.9+/-10.2 and 25.7+/-13.3 to 21.4+/-14.8 (P<0.05). There was also a significant improvement in DC (25.7+/-13.3 to 21.9+/-12.9, P<0.05) on the 1st POD, however, there was only a tendency of improvement in SP (29.6+/-20.9 to 26.1+/-12.3) without statistical significance. The scores in HP showed no improvement on the 1st and 3rd POD. There were 3 operative mortalities in HP and one in DC.
CONCLUSIONS
Our results suggest that the safety of the single stage procedure with newly developed colonic irrigation device is comparable to palliative decompressive loop colostomy and better than Hartmanns procedure in emergency based left colonic pathology.

Temporary Indwelling of Self-expandable Metal Stent may Obviate the Need of Staged Operation for Malignant Colonic Obstruction.: Kim, Bong Wan , Lee, Kwang Jae , Kim, Jin Hong , Suh, Kwang Wook; J Korean Soc Coloproctol. 2001;17(2):91-96.

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Abstract PDF: PURPOSE
Staged operation employing temporary enterostomy is still the standard treatment of malignant colonic obstruction (MCO). Expandable metal stent has been used for the palliation of unresectable gastrointestinal obstruction. We applied this metal stent technique to the MCO to achieve temporary alleviation of the obstruction so that the bowel preparation and one-stage operation were enabled. In this study we examined the efficacy of temporary indwelling of metal stent to obviate the need of staged operation in the treatment of MCO.
METHODS
From December 1998 to January 2001, 35 MCO patients were treated. Patients had typical symptoms of colonic obstruction such as abdominal pain and distension. When they were admitted, an self-expandable metal stent was introduced under the guide of flexible colonoscopy. For three days, formal bowel preparation (both chemical and mechanical) were followed. With regard to achievement of bowel preparation, postoperative complications and hospital stay, these 35 patients were compared with control group (N=20) of patients who underwent two staged operations for MCO.
RESULTS
The tumor locations were upper rectum (N=10), sigmoid colon (N=22) and left colon (N=3). Metal stent slipped off in one patient. Double contrast barium enema was possible in 34 patients. One stage operation was performed in all patients. Anastomotic complications were not observed in both groups. Intraabdominal abscess requiring reoperation was noted in one patient in each group. Wound infection was noted in 3 (8.6%) stent patients whereas 16 (80%) patients had wound complication in the control group (P<0.05). Mean hospital stay was 12.2 days in stent group and 29.4 days in control group (P<0.05).
CONCLUSIONS
Even though our series is limited in patient number, these data suggested that temporary indwelling of self-expandable metal stent may obviate the need of staged operation in the treatment of MCO.

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