Annals of Coloproctology

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Special issue, Malignant disease, Rectal cancer,Colorectal cancer,Epidemiology & etiology

Has the COVID-19 Pandemic Caused Upshifting in Colorectal Cancer Stage?: Ji Ha Lim, Woo Yong Lee, Seong Hyeon Yun, Hee Cheol Kim, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park, Jung Kyong Shin; Ann Coloproctol. 2021;37(4):253-258. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2021.00269.0038

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Purpose
Coronavirus disease 2019 (COVID-19) has affected many parts of daily life and healthcare, including cancer screening and diagnosis. The purpose of this study was to determine whether there was an upshift in the colorectal cancer stage at diagnosis due to delays related to the COVID-19 outbreak.
Methods
From January to June of each year from 2017 to 2020, a total of 3,229 patients who were first diagnosed with colorectal cancer were retrospectively reviewed. Those enrolled from 2017 to 2019 were classified as the ‘pre-COVID’ group, and those enrolled in 2020 were classified as the ‘COVID’ group. The primary outcome was the rate of stage IV disease at the time of diagnosis.
Results
There was no statistically significant difference in the proportion of stage IV patients between the pre-COVID and COVID groups (P=0.19). The median preoperative carcinoembryonic antigen level in the COVID group was higher than in the pre-COVID group in all stages (all P<0.05). In stage I, II patients who underwent radical surgery, the lymphatic invasion was more presented in COVID patients (P=0.009).
Conclusion
We did not find significant stage upshifting in colorectal cancer during the COVID-19 outbreak. However, there were more initially unresectable stage IV colorectal cancer patients with a low conversion rate to resectable status, and more patients had factors related to poor prognosis. These results may become more apparent over time, so it is vital not to neglect cancer screening to not delay the diagnosis during the COVID-19 epidemic.

Citations

Citations to this article as recorded by

The impact of extended invitation intervals on stage distribution of screen‐detected and interval cancer within the Dutch colorectal cancer screening program
Maria‐Alexandra Katsara, Danica van den Berg, Manon C. W. Spaander, Adriana J. van Vuuren, Evelien Dekker, Folkert J. van Kemenade, Iris D. Nagtegaal, Monique E. van Leerdam, Iris Lansdorp‐Vogelaar, Esther Toes‐Zoutendijk
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The COVID-19 pandemic and clinical characteristics of colorectal cancer: a multicenter retrospective study
Yoon Dae Han, Sung Uk Bae, Woo Ram Kim, Dae Ro Lim, Chang Woo Kim
Scientific Reports.2025;[Epub] CrossRef
Impact of the COVID-19 pandemic on the diagnosis, tumor characteristics, and survival outcomes of colorectal cancer: a retrospective cohort study
Enver Yarikkaya, Merve Cin, Sena Ecin-Demezoglu, Beste Noyan-Mod, Mert Mahsuni Sevinc, Yakup Bozkaya, Nevra Dursun-Kepkep
Annals of Saudi Medicine.2025; 45(3): 169. CrossRef
Was there any change in surgical treatment for colorectal cancer during the COVID-19 pandemic?
Yeajin Moon, Seung Hun Lee, Seung Hyun Lee
Kosin Medical Journal.2025; 40(3): 207. CrossRef
The impact of COVID-19 on patients diagnosed with melanoma, breast, and colorectal cancer
Danielle Hanuschak, Mallori DePiero, Melissa DeMoraes, Shamoore Bailly, Muni Rubens, Paul Lindeman, Michael Zinner, Geoffrey Young
The American Journal of Surgery.2024; 229: 36. CrossRef
The global pandemic's second deadly hit: cancer care
Emma Bradley, Magge Deepa
The American Journal of Surgery.2024; 229: 34. CrossRef
Trends in the Stage Distribution of Colorectal Cancer During the COVID-19 Pandemic in Japan: A Nationwide Hospital-claims Data Analysis
Masato Ota, Kohei Taniguchi, Mitsuhiro Asakuma, Sang-Woong Lee, Yuri Ito
Journal of Epidemiology.2024; 34(7): 356. CrossRef
Inadvertent laparoscopic lavage of perforated colon cancer: a systematic review
Mahir Gachabayov, Agon Kajmolli, Luis Quintero, Daniel M. Felsenreich, Dorin E. Popa, Dejan Ignjatovic, Roberto Bergamaschi
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Impact of the Sars-Cov-2 outbreak on the initial clinical presentation of new solid cancer diagnoses: a systematic review and meta-analysis
Simon Marty, Guillaume Lamé, Etienne Guével, Sonia Priou, Gilles Chatellier, Christophe Tournigand, Emmanuelle Kempf
BMC Cancer.2024;[Epub] CrossRef
Measuring the impact of COVID-19 on cancer survival using an interrupted time series analysis
Pascal Lambert, Katie Galloway, Allison Feely, Oliver Bucher, Piotr Czaykowski, Pamela Hebbard, Julian O Kim, Marshall Pitz, Harminder Singh, Maclean Thiessen, Kathleen M Decker
JNCI Cancer Spectrum.2024;[Epub] CrossRef
Decreased Positive Fecal Occult Blood Tests and Delayed Medical Presentation for Colorectal Cancer during the Initial COVID-19 Pandemic Period: A Single-center Experience
Tadataka Takagi, Fumikazu Koyama, Hiroyuki Kuge, Yosuke Iwasa, Takeshi Takei, Tomomi Sadamitsu, Kosuke Fujimoto, Suzuka Harada, Takashi Tamura, Goki Ejiri, Chihiro Yoshikawa, Masayuki Sho
Journal of the Anus, Rectum and Colon.2024; 8(3): 188. CrossRef
Impact of COVID-19 Pandemic on the Clinical and Pathologic Characteristics of Colorectal Cancer: A Retrospective Multicenter Study in South Korea
Jae Hyun Kang, Il Tae Son, Sang Nam Yoon, Jin Soo Ihm, Byung Mo Kang, Jong Kim
Cancer Management and Research.2024; Volume 16: 1131. CrossRef
The COVID-19 pandemic's impact on prostate cancer screening and diagnosis in Korea
Byeong Jin Kang, Kyung Hwan Kim, Hong Koo Ha
Kosin Medical Journal.2023; 38(3): 193. CrossRef
Measuring the impact of the COVID‐19 pandemic on colorectal cancer presentation: a retrospective comparative study
Kirsten Fullard, Daniel Steffens, Michael Solomon, Joo‐Shik Shin, Cherry Koh
ANZ Journal of Surgery.2023; 93(12): 2951. CrossRef
Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
In Ja Park
The Ewha Medical Journal.2023;[Epub] CrossRef
Colorectal Surgery in the COVID-19 Era: A Systematic Review and Meta-Analysis
Nikolaos Pararas, Anastasia Pikouli, Dimitrios Papaconstantinou, Georgios Bagias, Constantinos Nastos, Andreas Pikoulis, Dionysios Dellaportas, Panagis Lykoudis, Emmanouil Pikoulis
Cancers.2022; 14(5): 1229. CrossRef
Short-Term Impact of Temporary Shutdown of a University-Affiliated Hospital on Patients With Colorectal Cancer During the Coronavirus Disease 2019 Pandemic
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Journal of Korean Medical Science.2022;[Epub] 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
The effect of the COVID-19 pandemic on the outcomes of surgically treated colorectal diseases: a retrospective cohort study
Gülten Çiçek Okuyan, Melih Yıldırım
Annals of Surgical Treatment and Research.2022; 103(2): 104. CrossRef
Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic
Sami Akbulut, Abdirahman Sakulen Hargura, Ibrahim Umar Garzali, Ali Aloun, Cemil Colak
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Epidemiology, risk factors, and prevention of colorectal cancer
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
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Epidemiology, Risk Factors, and Prevention of Colorectal Cancer-An English Version
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
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No evidence of delay in colorectal cancer diagnosis during the COVID-19 pandemic in Gwangju and Jeonnam, Korea
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Malignant disease,Prognosis and adjuvant therapy,Colorectal cancer,Biomarker & risk factor

Prognostic Factor and Survival Benefit of Adjuvant Chemotherapy in Stage IIA Colon Cancer: Mok-Won Lee, Jin-Su Kim, Ji-Yeon Kim, Kyung-ha Lee; Ann Coloproctol. 2021;37(1):35-43. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.09.03

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8 Citations

Abstract PDF

Purpose
There is no clear evidence of the benefit of adjuvant chemotherapy (AC) in stage IIA colon cancer. Therefore, we aimed to evaluate the prognostic factors and survival benefit of AC in this disease.
Methods
A retrospective data collection for patients who underwent radical surgery for colon cancer between January 2008 and December 2015 was undertaken. The cohort was divided into the no-AC and AC groups.
Results
We included 227 patients with stage IIA colon cancer in our study cohort, including 67 and 160 patients in the no-AC and AC groups, respectively. The number of retrieved lymph nodes and the presence of tumor complications as obstruction or perforation were independent risk factors for survival. In the no-AC group, there was a significant difference in survival according to the number of retrieved lymph nodes. In the AC group, there were significant differences in survival according to sidedness and preoperative carcinoembryonic antigen (CEA). There was no significant difference in survival between the no-AC and the AC groups.
Conclusion
The number of retrieved lymph nodes and the presence of tumor complications were prognostic factors for stage IIA colon cancer but lymphovascular and perineural invasion were not. Sidedness and preoperative CEA could be used as factors to predict the benefit of adjuvant chemotherapy. Currently, it is believed that there is no benefit of AC for stage IIA colon cancer. Further studies are needed to determine the survival benefit of adjuvant chemotherapy in stage IIA colon cancer.

Citations

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Can clinicopathologic high-risk features in T3N0 colon cancer be reliable prognostic factors?
Hyun Gu Lee, Young IL Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2023; 104(2): 109. CrossRef
Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study
Gyung Mo Son, Mi Sook Yun, In Young Lee, Sun Bin Im, Kyung Hee Kim, Su Bum Park, Tae Un Kim, Dong-Hoon Shin, Armaan M. Nazir, Gi Won Ha
Cancers.2023; 15(20): 4927. CrossRef
Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef
The Prognostic Reliability of Lymphovascular Invasion for Patients with T3N0 Colorectal Cancer in Adjuvant Chemotherapy Decision Making
Hayoung Lee, Seung-Yeon Yoo, In Ja Park, Seung-Mo Hong, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
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Molecular Analyses in Peritoneal Metastasis from Colorectal Cancer: A Review-An English Version
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Adjuvant chemotherapy benefits on patients with elevated carcinoembryonic antigen in stage IIA colon cancer: a SEER-based analysis
Huabin Zhou, Songsheng Wang, Zhai Cai, Enming Qiu, Qianyun Chen, Xi Rao, Shuai Han, Zhou Li
International Journal of Colorectal Disease.2022; 37(12): 2481. CrossRef
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Malignant disease,Prognosis and adjuvant therapy

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

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6 Citations

Abstract PDF

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

Citations

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

Review

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

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383 Download
62 Web of Science
63 Citations

Abstract PDF

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

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Biomaterials.2025; 316: 123020. CrossRef
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Original Articles

Perioperative Serum Carcinoembryonic Antigen Ratio Is a Prognostic Indicator in Patients With Stage II Colorectal Cancer: Jinsun Woo, Jungbin Kim, Inseok Park, Hyunjin Cho, Geumhee Gwak, Keun Ho Yang, Byung-Noe Bae, Ki Hwan Kim; Ann Coloproctol. 2018;34(1):4-10. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.4

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Abstract PDF

Purpose

The aim of this study was to evaluate whether the perioperative carcinoembryonic antigen (CEA) ratio could be used as a determinant for adjuvant therapy after curative surgery in stage II colorectal cancer.

Methods

Data for 119 patients with stage II colorectal cancer who underwent radical surgery between 2010 and 2013 were collected. The perioperative CEA ratio was defined as the postoperative/preoperative serum CEA level, and the patients were grouped according to their perioperative CEA ratios: high ratio (≥0.5) and low ratio (<0.5). Overall survival rates were calculated, and their prognostic significances were analyzed.

Results

The overall survival rates of the high and the low perioperative CEA groups were 68.2% and 86.8%, respectively (P = 0.033). In patients with normal preoperative CEA levels (<5 ng/mL), the high perioperative CEA ratio group showed a worse survival rate than the low perioperative CEA ratio group (71.7% vs. 100.0%, P = 0.007). In patients with high preoperative CEA levels (≥5 ng/mL), the high perioperative CEA ratio group showed a worse survival rate than the low perioperative CEA ratio group (33.3% vs. 75.0%, P = 0.036). In the multivariate analysis, perioperative CEA ratio (P = 0.046), age (P = 0.034), and venous invasion (P = 0.015) were independent prognostic factors for survival.

Conclusion

The perioperative CEA ratio is a prognostic indicator for stage II colorectal cancer. Patients with normal preoperative serum CEA levels might also be considered for adjuvant therapy if their perioperative CEA ratios are higher than 0.5.

Citations

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Tumor regression and immunity in combination therapy with anti-CEA chimeric antigen receptor T cells and anti-CEA-IL2 immunocytokine
Seung E. Cha, Maciej Kujawski, Paul J. Yazaki, Christine Brown, John E. Shively
OncoImmunology.2021;[Epub] CrossRef
Prognostic Impact of Pretreatment Elevated and Normalized Carcinoembryonic Antigen Levels After Neoadjuvant Chemoradiotherapy in Resected Locally Advanced Rectal Cancer Patients
Jianyuan Song, Zhuhong Chen, Daxin Huang, Benhua Xu
Cancer Management and Research.2021; Volume 13: 3713. CrossRef
Association between Primary Perioperative CEA Ratio, Tumor Site, and Overall Survival in Patients with Colorectal Cancer
Thomas A. Odeny, Nicole Farha, Hannah Hildebrandand, Jessica Allen, Wilfred Vazquez, Maximillian Martinez, Ravi Kumar Paluri, Anup Kasi
Journal of Clinical Medicine.2020; 9(12): 3848. CrossRef

Accuracy of Preoperative Local Staging of Primary Colorectal Cancer by Using Computed Tomography: Reappraisal Based on Data Collected at a Highly Organized Cancer Center: Jung Sub So, Chinock Cheong, Seung Yeop Oh, Jei Hee Lee, Young Bae Kim, Kwang Wook Suh; Ann Coloproctol. 2017;33(5):192-196. Published online October 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.5.192

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19 Web of Science
17 Citations

Abstract PDF

Purpose

In patients with colorectal cancer, preoperative staging using various imaging technologies is important for establishing the treatment plan and predicting the prognosis. Although computed tomography (CT) has been used most widely, the versatility of CT accuracy was primarily because of the lack of specialization. In this study, we aimed to identify whether any advancement in abdominal CT accuracy in the prediction of local staging has occurred.

Methods

Between December 2014 and November 2015, patients with colorectal cancer were retrospectively enrolled. All CT findings were retrospectively reported. A total of 285 patients were included, and their retrospectively collected data were retrospectively reviewed, focusing on a comparison between preoperative and postoperative staging.

Results

The overall prediction accuracy of the T stage was 55.1%, with overstaging occurring in 63 (22.1%) and understaging in 65 patients (22.8%). The sensitivity and specificity were 90.0% and 68.4%, respectively. The overall prediction accuracy of the N stage was 54.7%, with overstaging occurring in 89 (31.2%) and understaging in 40 patients (14.1%). The sensitivity and specificity were 71.9% and 63.2%, respectively. The CT accuracies by pathologic stage were 0%, 62.2%, 25.3%, and 81.2% for stages 0 (Tis N0), I, II, and III, respectively.

Conclusion

CT has good sensitivity for detecting colon cancers with tumor invasion beyond the bowel wall. However, detection of nodal involvement using CT is unreliable. In our opinion, abdominal CT alone has limitations in predicting the local staging of colorectal cancer, and additional technologies, such as CT plus positron emission tomography and/or colonography, will improve its accuracy.

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Positron Emission Tomography/Computed Tomography in the Staging of Colon Cancer: Jae Hyung Lee, Min Ro Lee; Ann Coloproctol. 2014;30(1):23-27. Published online February 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.1.23

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Abstract PDF

Purpose
Accurate preoperative staging of colon cancer is essential for providing the optimal treatment strategy and evaluating the expected prognosis. The aim of this study is to assess the value of positron emission tomography/computed tomography (PET/CT) over conventional studies in the staging of colon cancer.
Methods
A total of 266 colon cancer patients diagnosed between January 2008 and December 2010 were assessed with both PET/CT and conventional studies. Discordance with PET/CT and conventional studies were evaluated, and changes in the management strategy were assessed for each stage. Discordant findings were verified by using intraoperative examination, pathology reports, and follow-up imaging studies.
Results
Multidetector computed tomography (MDCT) and PET/CT showed similar accuracy in detecting lymph node metastasis in patients with clinical stage III (36.2% vs. 42%, P = 0.822) and stage IV (60.3% vs. 63.5%, P = 0.509) disease. PET/CT led to a change in management strategy for 1 of 40 patients (2.5%) with clinical stage I, 0 of 25 patients (0%) with stage II, 9 of 138 patients (6.5%) with stage III, and 8 of 63 patients (12.7%) with stage IV disease.
Conclusion
PET/CT changed the management plan in 6.5% of patients with clinical stage III and 12.7% of patients with clinical stage IV colon cancer. Our findings suggest that PET/CT may be considered as a routine staging tool for clinical stage III and IV colon cancers.

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Chahaya Marc Gauci, Tae Jun Kim, Yijun Gao, Dayashan S. Perera
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Individualized Cutoff Value of the Preoperative Carcinoembryonic Antigen Level is Necessary for Optimal Use as a Prognostic Marker: Byeong Geon Jeon, Rumi Shin, Jung Kee Chung, In Mok Jung, Seung Chul Heo; Ann Coloproctol. 2013;29(3):106-114. Published online June 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.3.106

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Abstract PDF

Purpose

Carcinoembryonic antigen (CEA) is an important prognostic marker in colorectal cancer (CRC). However, in some stages, it does not work. We performed this study to find a way in which preoperative CEA could be used as a constant prognostic marker in harmony with the TNM staging system.

Methods

Preoperative CEA levels and recurrences in CRC were surveyed. The distribution of CEA levels and the recurrences in each TNM stage of CRC were analyzed. An optimal cutoff value for each TNM stage was calculated and tested for validity as a prognostic marker within the TNM staging system.

Results

The conventional cutoff value of CEA (5 ng/mL) was an independent prognostic factor on the whole. However, when evaluated in subgroups, it was not a prognostic factor in stage I or stage III of N2. A subgroup analysis according to TNM stage revealed different CEA distributions and recurrence rates corresponding to different CEA ranges. The mean CEA levels were higher in advanced stages. In addition, the recurrence rates of corresponding CEA ranges were higher in advanced stages. Optimal cutoff values from the receiver operating characteristic curves were 7.4, 5.5, and 4.5 ng/mL for TNM stage I, II, and III, respectively. Those for N0, N1, and N2 stages were 5.5, 4.8, and 3.5 ng/mL, respectively. The 5-year disease-free survivals were significantly different according to these cutoff values for each TNM and N stage. The multivariate analysis confirmed the new cutoff values to be more efficient in discriminating the prognosis in the subgroups of the TNM stages.

Conclusion

Individualized cutoff values of the preoperative CEA level are a more practical prognostic marker following and in harmony with the TNM staging system.

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Prognostic value of preoperative carcinoembryogenic antigen: Is it useful in all stages of colorectal cancer?
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Does T3 Subdivision Correlate with Nodal or Distant Metastasis in Colorectal Cancer?: Hong Yeol Yoo, Rumi Shin, Heon-Kyun Ha, Heung-Kwon Oh, Seung-Yong Jeong, Kyu Joo Park, Gyeong Hoon Kang, Woo Ho Kim, Jae-Gahb Park; J Korean Soc Coloproctol. 2012;28(3):160-164. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.160

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Abstract PDF

Purpose

We analyzed the clinical data of T3 colorectal cancer patients to assess whether T3 subdivision correlates with node (N) or metastasis (M) staging and stage-independent factors.

Methods

Five hundred fifty-five patients who underwent surgery for primary colorectal cancer from January 2003 to December 2009 were analyzed for T3 subdivision. T3 subdivision was determined by the depth of invasion beyond the outer border of the proper muscle (T3a, <1 mm; T3b, 1 to 5 mm; T3c, >5 to 15 mm; T3d, >15 mm). We investigated the correlation between T3 subdivision and N, M staging and stage-independent prognostic factors including angiolymphatic invasion (ALI), venous invasion (VI) and perineural invasion (PNI).

Results

The tumors of the 555 patients were subclassified as T3a in 86 patients (15.5%), T3b in 209 patients (37.7%), T3c in 210 patients (37.8%) and T3d in 50 patients (9.0%). The nodal metastasis rates were 39.5% for T3a, 56.5% for T3b, 75.7% for T3c and 74.0% for T3d. The distant metastasis rates were 7.0% for T3a 9.1% for T3b, 27.1% for T3c and 40.0% for T3d. Both N and M staging correlated with T3 subdivision (Spearman's rho = 0.288, 0.276, respectively; P < 0.001). Other stage-independent prognostic factors correlated well with T3 subdivision (Spearman's rho = 0.250, P < 0.001 for ALI; rho = 0.146, P < 0.001 for VI; rho = 0.271, P < 0.001 for PNI).

Conclusion

Subdivision of T3 colorectal cancer correlates with nodal and metastasis staging. Moreover, it correlates with other prognostic factors for colorectal cancer.

Citations

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Facteurs pronostiques : degré d’invasion de la sous-séreuse, distance tumeur-séreuse et invasion de la limitante élastique de la sous-séreuse dans l’adénocarcinome colique
Arnaud Ronfaut, Christophe Attencourt, Jean-Rene Tesson, Charles Sabbagh, Jean-Marc Regimbeau, Denis Chatelain
Annales de Pathologie.2025; 45(2): 176. CrossRef
Do treated rectal tumors appear differently on MRI after chemotherapy versus chemoradiotherapy?
Yu Shen, Yanqiong Wen, Liang Bi, Xuyang Yang, Xiaoling Gong, Xiangbing Deng, Wenjian Meng, Ziqiang Wang
Abdominal Radiology.2023; 49(3): 774. CrossRef
Pathology and Prognosis of Colonic Adenocarcinomas With Intermediate Primary Tumor Stage Between pT2 and pT3
John D. Paulsen, Alexandros D. Polydorides
Archives of Pathology & Laboratory Medicine.2022; 146(5): 591. CrossRef
Prognostic significance of additional histologic features for subclassification of pathological T3 colon cancer
Lorenzo Macchi, Quoc Riccardo Bao, Laura Albertoni, Matteo Fassan, Valentina Chiminazzo, Marco Scarpa, Gaya Spolverato, Salvatore Pucciarelli
International Journal of Clinical Oncology.2022; 27(9): 1428. CrossRef
The value of diffusion kurtosis imaging and intravoxel incoherent motion quantitative parameters in predicting synchronous distant metastasis of rectal cancer
Xue Ding, Danqi Sun, Qiuchen Guo, Yeting Li, Hao Chen, Xiaoxiao Dai, Guohua Fan, Yongyou Wu, Guangqiang Chen, Yonggang Li
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The 2017 Assisi Think Tank Meeting on rectal cancer: A positioning paper
Vincenzo Valentini, Corrie Marijnen, Geerard Beets, Krzysztof Bujko, Berardino De Bari, Andres Cervantes, Giuditta Chiloiro, Claudio Coco, Maria Antonietta Gambacorta, Robert Glynne-Jones, Karin Haustermans, Elisa Meldolesi, Femke Peters, Claus Rödel, Har
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A meta-analysis assessing the survival implications of subclassifying T3 rectal tumours
M.R.S. Siddiqui, C. Simillis, J. Bhoday, N.J. Battersby, J. Mok, S. Rasheed, P. Tekkis, A.M. Abulafi, G. Brown
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Extramural extension as indicator for postoperative adjuvant chemotherapy in Stage IIA (pT3N0) colon cancer
Yoshito Akagi, Kazuo Shirouzu, Tetsushi Kinugasa
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Diagnostic Usefulness of Routinely Performed Preoperative Chest Computed Tomography for Colorectal Cancer.: Hwang, Mi Jin , Jung, Sang Hun , Kim, Jae Hwang , Shim, Min Chul; J Korean Soc Coloproctol. 2010;26(3):211-216.; DOI: https://doi.org/10.3393/jksc.2010.26.3.211

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Abstract PDF

PURPOSE
The most common site of metastases in colorectal cancer (CRC) is the liver, and the second common site is the lung (10-20%). Preoperative staging for CRC is very important. The aim of this study was to assess the usefulness of chest computed tomography (CT) for preoperative staging in CRC.
METHODS
From January 2006 to December 2007, a total of 597 patients with colorectal cancer underwent surgery at our hospital. One hundred fifty of those patients had received chest CT preoperatively. We analyzed the chest radiologic findings from chest x-ray (CXR), abdominal CT, and chest CT.
RESULTS
The detection rate of abnormal lung findings was higher in chest CT than in the other chest radiologic findings (chest PA: 10 [6.6%]; abdominal CT: 19 [12.7%]; chest CT: 48 [32.0%]). On the chest CT, 19 of the 150 (12.7%) patients that had received a chest CT preoperatively were initially suspected of having malignant lesions. Besides two primary lung malignancies (solitary nodules), metastatic lesions were revealed in 5 (3.3%), 11 (7.3%), and 17 (11.3%) patients on CXR, abdominal CT, and chest CT, respectively. Eleven (64.7%) of the patients having metastatic chest CT lesions were also identified on lower lung fields by abdominal CT. Seven also had other metastatic foci (liver and paraaortic LN). Initially, stage IV was identified in 37 (24.7%) and 40 (26.7%) patients in abdominal CT and chest CT, respectively. After one year, 11 of the 150 (7.3%) patients who had received a chest CT had been diagnosed with pulmonary metastasis.
CONCLUSION
Chest computed tomography is the most sensitive method for the diagnosis of pulmonary metastases. However, if the interpretations of abdominal CT and individualized diagnostic methods are accurate, the demand for unnecessary preoperative work-up may be reduced.

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Radiographic staging practices of newly diagnosed colorectal cancer vary according to medical specialty
Karen Ma, Sandeep Nayak, Hong Li, Kateri Evans, Amanda Francescatti, Marc I. Brand, Bruce Orkin, Marisa Hill, James Cameron, Sohrab Mobarhan, Joanne Favuzza, Joshua Melson
Gastrointestinal Endoscopy.2015; 82(3): 497. CrossRef
Should preoperative chest computed tomography be performed in all patients with colorectal cancer?
A. R. Lazzaron, M. V. Vieira, D. C. Damin
Colorectal Disease.2015;[Epub] CrossRef
The diagnostic yield of preoperative staging computed tomography of the thorax in colorectal cancer patients without hepatic metastases
Gabriella Yongue, Alexander Hotouras, Jamie Murphy, Hasan Mukhtar, Chetan Bhan, Christopher L. Chan
European Journal of Gastroenterology & Hepatology.2015; 27(4): 467. CrossRef
Should Preoperative Chest CT Be Recommended to All Colon Cancer Patients?
Hye Young Kim, Soon Jin Lee, Gilsun Lee, Limwha Song, Su-A Kim, Jin Yong Kim, Dong Kyung Chang, Poong-Lyul Rhee, Jae J. Kim, Jong Chul Rhee, Ho-Kyung Chun, Young-Ho Kim
Annals of Surgery.2014; 259(2): 323. CrossRef
Indeterminate Pulmonary Nodules at Colorectal Cancer Staging: A Systematic Review of Predictive Parameters for Malignancy
Andreas Nordholm-Carstensen, Peer A. Wille-Jørgensen, Lars N. Jorgensen, Henrik Harling
Annals of Surgical Oncology.2013; 20(12): 4022. CrossRef
Pulmonary staging in colorectal cancer: a review
C. N. Parnaby, W. Bailey, A. Balasingam, L. Beckert, T. Eglinton, J. Fife, F. A. Frizelle, M. Jeffery, A. J. M. Watson
Colorectal Disease.2012; 14(6): 660. CrossRef

Positron Emission Tomography (PET)-Computed Tomography (CT) for Preoperative Staging of Colorectal Cancers.: Yoo, Joong Jae , Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn , Lee, Seok Mo; J Korean Soc Coloproctol. 2008;24(3):201-206.; DOI: https://doi.org/10.3393/jksc.2008.24.3.201

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Abstract PDF

PURPOSE
The purpose of this study is to evaluate the usefulness of positron emission tomography (PET)-computed tomography (CT) for preoperative tumor staging in cases of colorectal cancer. METHODS: Between July 2006 and September 2007, seventy-six patients with a diagnosis of colorectal cancer (43 males and 33 females; mean age: 60.4+/-10.13 years; range: 34~82 years) selected prospectively were studied for staging by using Chest X-ray, abdominal CT and PET-CT. RESULTS: The sensitivities and the specificities for N-staging were 76.9% and 35.1% for CT, 61.8% and 66.7% for PET-CT, and both procedures showed a relatively low diagnostic accuracy (CT 57.9%, PET-CT 61.8%). In the PET-CT alone, six distant metastatic lesions and four multiple primary malignancies were found. The locations of the distant metastases were the liver, the axillary node, the common iliac node, the subclavicular node, the peritoneum, and the lung. The locations of the multiple primary maligancies in extracolonic sites were 3 in the thyroid and 1 in the nasopharynx. CONCLUSIONS: For N-staging, preoperative PET-CT is no more useful than CT, but PET-CT is required before surgery to find lesions that cannot be found with conventional studies.

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Preoperative Staging With Positron Emission Tomography in Patients With Colorectal Cancer
Young Wan Kim, Ik Yong Kim
Annals of Coloproctology.2014; 30(6): 247. CrossRef
The Usefulness of FDG-PET/CT for the Prediction of Regional Lymph Node Metastases in Colorectal Cancer
Mi Ji Bang, Sang Hun Jung, Jae Hwang Kim, Min Chul Shim
Journal of the Korean Surgical Society.2010; 79(1): 43. CrossRef

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

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

The Effect of Preoperative Concurrent Chemoradiation in Locally Advanced Rectal Cancer.: Cho, Hyeon Min , Kim, Jun Gi , Jung, Hun , Heo, Youn Jung , Won, Yong Sung , Chun, Kyung Hwa , Chin, Hyung Min , Park, Woo Bae , Chun, Chung Soo; J Korean Soc Coloproctol. 2005;21(2):89-99.

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Abstract PDF: PURPOSE
Tumor downstaging from preoperative chemoradiation has been associated with an increased probability of a sphincter-saving procedure and with improved local control and survival rate. We observed the effect and the prognostic value of pathologic tumor downstaging, including complete pathologic response to preoperative concurrent chemoradiation, resectability, sphincter-saving rate, disease- free survival, and overall survival in locally advanced rectal cancer patients.
METHODS
From January 2000 to December 2003, we recruited a total 78 patients with computed tomography stages II and III rectal cancer which was treated by using preoperative concurrent chemoradiation; all patients had a radical resection with total mesorectal excision. Surgical resection was performed 6 to 8 weeks after completing the radiation therapy. The average follow up was 25.40+/-13.64 months.
RESULTS
The number of patients according to CT stage before preoperative chemoradiation was 39 (II) and 39 (III). Tumor downstaging occurred in 51 (65.4%) patients, including 11 (14.1%) patients who had a complete pathologic response. Tumor size, radiation dose, and clinical stage were associated with tumor downstaging in the univariate analysis. None of the clinical or pathologic variables was associated with a complete pathologic response. The overall resectibality was 100%. The number of sphincter-saving procedures were 61 (78.2%). Recurrence occurred in 17 (21.8%) patients: local recurrence in 4 (5.1%) and distant metastasis in 13 (16.7%). None of the patients with a complete pathologic response recurred. Recurrences were 3 (17.6%)/7 (22.6%)/7 (36.8%) for pathologic stages I/II/III. Recurrence was more common among younger patients (P <0.05). Patients in the complete pathologic response group had more favorable disease-free survival compared with other group (yp stage I, II, III) (P=0.026).
CONCLUSION
Preoperative concurrent chemoradiation for locally advanced rectal cancer seems to afford some potential advantages: high tumor response, resectability, and feasible sphincter preservation, and even a complete pathologic response. A complete pathologic response to preoperative chemoradiation is associated with an improved disease-free survival.

Analysis of Criteria for Tumor Response after Preoperative Chemoradiation Therapy for Locally Advanced Rectal Cancer: Correlation between Tumor Volume Reduction and Histopathologic Downstaging.: Kim, Nam Kyu , Pyo, Hong Ryull , Baik, Seung Hyuk , Lee, Kang Young , Sohn, Seung Kook , Cho, Chang Hwan , Rha, Sun Young , Chung, Hyun Chul; J Korean Soc Coloproctol. 2004;20(5):296-302.

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Abstract PDF: PURPOSE
Preoperative chemoradiation treatment (CCRT) for locally advanced rectal cancer has been known to be safe and effective. The aim of study is to find any correlation between tumor volume reduction and histopathologic downstaging in locally advanced rectal cancer by preoperative CCRT.
METHODS
A total of 16 patients of rectal cancer were selected. They had been T3,4 N (+) preoperatively staged by using a transrectal ultrasonography and pelvic MRI. Radiation was given, a total of 5,040 cGy over 5 weeks, and systemic chemotherapy was also given 5 FU 450 mg/m2 and leucovorin 20 mg/m2 concurrently intravenously during the first and the fifth week of CCRT. Surgery was done 4~6 weeks after completion of CCRT. A 3D CT image was obtained with AcQsim PQ 5000 3D (Philips, USA). Tumor volume was measured before and after CCRT.
RESULTS
The type of operative procedures were abdominoperineal resection 7, low anterior resection 5, coloanal anastomosis 3 and Hartmann operation 1. Volume reduction was ranged from 14.6% to 84.4%. Over a 50% tumor volume reductions were in 9 patients (56.2%). Pathologic complete remission was observed in 2 patients (12.5%), who showed 72% and 58.5% tumor volume reductions. Patients showing pT and/or pN downstaging patients (N=9) had a 55.9% tumor reductions (14.6~84.4%), and patients showing no pT and/or pN downstaging (N=7) had 51.8% volume reduction (24.7~79%).
CONCLUSIONS
Preoeperative CCRT has been thought to be able to decrease tumor size and volume and to increase respectability. However, among our 9 patients who showed over 50% tumor volume reductions, 3 patients did not show any T and N downstaging, which is really important for long-term oncologic outcomes.

Accuracy of Preoperative Staging of Rectal Cancer: Comparative Study of Transrectal Ultrasonography and Computerized Tomography.: Cheon, Seung Hui , Lee, Suk Hwan , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 2003;19(5):327-333.

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Abstract PDF: PURPOSE
Preoperative assessment of the depth of invasion in the rectal wall and of lymph node metastases is very important in determining the treatment modality in rectal cancer. The purposes of study were to evaluate the accuracy of transrectal ultrasonography (TRUS) in preoperative staging of rectal cancer and to compare that accuracy with the accuracy for computed tomography (CT).
METHODS
We reviewed 59 patients who were diagnosed as having rectal cancer and who had been staged by using TRUS and CT preoperatively. Ultrasonographic tumor (uT) and nodal (uN) stage and computerized tomographic tumor (cT) and nodal (cN) stage were entered into the database prospectively. The accuracy of each staging was compared with the pathologic staging. The accuracy, the sensitivity, the specificity, the positive predictive value, and the negative predictive value of each diagnostic test were calculated. Chi- square tests were conducted to identify the factors influencing the accuracy.
RESULTS
The accuracies of TRUS and CT in assessing the depth of invasion were 66.1% and 62.5%, respectively. The accuracies of TRUS and CT in assessing the nodal involvement in patients treated with radical surgery were 70.4% and 63.6%, respectively. For detection of fat infiltration, the sensitivities were 97.4% for TRUS and 76.3% for CT. The specificities were 45.0% for TRUS and 55.6% for CT. The sensitivities for detection of lymph node involvement were 59.3% for TRUS and 42.9% for CT. The specificities were 81.5% for TRUS and 85.2% for CT. The gross appearance of the tumor had a significant influence on the assessment of the depth of invasion (P=0.015). In 9 out of 77 patients (11.7%) could not be performed the TRUS examination due to obstruction or the location of the tumor.
CONCLUSIONS
In spite of some limitations, TRUS is considered a very useful tool in the preoperative assessment of the depth of invasion and of the lymph node involvement in rectal cancer. However, CT examination is mandatory to overcome the limitations of TRUS in the preoperative diagnosis of rectal cancers.

Reappraisal of AJCC Staging System in Colorectal Cancer.: Yu, Chang Sik , Kim, Hee Cheol , Ryu, Jang Hak , Kim, Jung Rang , Cho, Young Kyu , Namgung, Whan , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(4):262-267.

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Abstract PDF: PURPOSE
The TNM classification for carcinoma of the colon and the rectum provides more detail than other staging systems. This study was performed to evaluate the effectiveness of AJCC staging system (5th ed., 1997) for the colorectal cancer in predicting prognosis.
METHODS
We analyzed a data base of 1,233 colorectal cancer patients (M:F=673:560) who underwent surgery in Asan Medical Center during July 1989-December 1996. Survival analysis was performed between the stages and the subgroups in same stage by using Kaplan-Meier method and log rank test. Borderline subgroup comparison between the stages was performed, also. Significance was assigned to a P value of <0.05.
RESULTS
Mean age of the patients was 57 (19-90) years old. Median follow-up period was 42 (6-129) months. The number of patients in each stage were 0: 15, I: 152, II: 390, III: 465, IV: 199. The 5 year overall & disease free survival rates of each stage were 100%, 100% (in stage 0), 96.4%, 93.6% (in stage I), 82.7%, 82.2% (in stage II), 59.9%, 55.3% (in stage III), and 7.3%, 24.9% (in stage IV), respectively (P=0.000). Subgroup analysis in stage I (T1N0 vs. T2N0) and II (T3N0 vs. T4N0) revealed no differences. However, in stage III, N1 (n=246) group showed better survival than N2 (n=219) group (70.3%, 65.5% vs. 49.2%, 44.6%: P=0.000). Borderline survival analysis between stage I and II (T2N0 vs. T3N0) was significantly different (96.6%, 95.7% vs 82.7%, 82.3%: P=0.006). However, between stage II and III (T4N0 vs. T1N1), appropriate analysis was impossible due to small number of cases.
CONCLUSIONS
AJCC staging system for colorectal cancer was reliable and effective in predicting prognosis. However, substages are needed in stage III.

Preoperative Staging of Rectal Cancer by CT & MRI.: Shin, Jong Keun , Lee, Sang Mock , Park, Ho Chul , Lee, Kee Hyung , Oh, Soo Myung , Yoon, Choong , Lee, Dong Ho; J Korean Soc Coloproctol. 2000;16(3):177-185.

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Abstract PDF: Accurate staging of rectal cancer preoperatively is important to plan a proper treatment and to predict treatment results. For the preoperative staging of rectal cancer, computed tomography (CT), transrectal ultrasonography (TRUS), and magnetic resonance imaging (MRI) have been used, but the role of them remains controversial. This research was intended to compare and analyze the accuracy of CT and MRI in the preoperative staging of rectal cancer.
METHODS
From January 1998 to June 1999, sixty patients were studied by CT and MRI before their operations for rectal cancer in our institution, but two patients with local excision were excluded in N-staging as objects. The patients who had preoperative irradiation were also excluded in this study. Preoperative staging with CT and MRI were conducted by one radiologist according to 1997's TNM classification based on AJCC. On the results of pathological findings after operation, preoperative staging with CT and MRI were classified into T-staging and N-staging. Accuracy and agreement rate between pathological staging and preoperative staging by CT and MRI were compared and analyzed by Kappa value.
RESULTS
The accuracy of CT was 68 percent in T-staging, and 58 percent in N-staging, MRI showed accuracy of 82 percent in T-staging and 64 percent in N-staging. In the T-staging, the agreement rate between pathological staging and CT staging was 0.54 (95% confidence interval), while the agreement rate was 0.70 in MRI staging, resulting in a higher agreement rate with MRI than with CT. In the N-staging, the agreement rate between pathological staging and CT staging was 0.38, with a relatively lower agreement rate, while the agreement rate was 0.56 in MRI staging. In our study, MRI showed a higher agreement rate than CT.
CONCLUSIONS
In the future, more research should be conducted, but it can be conclued that in preoperative staging for rectal cancer, MRI using body arrayed coil has a better accuracy than CT. Subsequently MRI staging should be considered as a more useful investigation method before operation than CT.

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