Purpose This study aimed to compare the wound cosmesis of a single-incision approach on scar assessment after laparoscopic surgery for colon cancer. Methods This study included 32 patients undergoing single-port laparoscopic surgery (SPLS) and 61 patients undergoing multiport laparoscopic surgery (MPLS) for colon cancer at 3 tertiary referral hospitals between September 2011 and December 2019. We modified and applied the Korean version of the Patient and Observer Scar Assessment Scale (POSAS) to assess cosmetic outcomes. To assess the interobserver reliability using intraclass correlation coefficient values for the Observer Scar Assessment Scale (OSAS), the surgeons evaluated 5 images of postoperative scars. Results No significant differences were observed in the time before the return of normal bowel function, time to sips of water and soft diet initiation, length of in-hospital stay, and postoperative complication rate. The SPLS group had a shorter total incision length than the MPLS group. The POSAS favored the SPLS approach, revealing significant differences in the Patient Scar Assessment Scale (PSAS), OSAS, and overall scores. The SPLS approach was an independent factor influencing the POSAS, PSAS, and OSAS scores. Eleven colorectal surgeons had a significantly substantial intraclass coefficient. Conclusion The cosmetic outcomes of SPLS as assessed by the patients and surgeons were superior to those of MPLS in colon cancer. Reducing the number of ports is an independent factor affecting scar assessment by patients and observers.

Single-port laparoscopic surgery (SPLS) improves patient comfort; however, it has limitations, including poor instrument triangulation. The da Vinci® SP system used in single-port robotic surgery (SPRS) addresses these challenges. Most studies on SPRS involve small case series or comparisons with multiport procedures, usually lacking direct comparisons with SPLS for colon cancer. Therefore, this study aimed to evaluate the surgical outcomes of SPRS and compare its short-term results with those of SPLS for colon cancer. This study included patients who underwent SPRS for colon cancer between March 2019 and April 2023 at four tertiary referral centers. Medical records of these patients were reviewed. Eligible patients were aged 19–85 years, with American Society of Anesthesiologists class I or II, and confirmed adenocarcinoma of the ascending or sigmoid colon without distant metastasis. The data obtained were compared with those of the SPLS cohort from the SIngle-port versus MultiPort Laparoscopic surgEry multicenter randomized trial. A matched cohort analysis accounted for baseline differences. Overall, 185 and 179 patients were included in the SPRS and SPLS groups, respectively. After matching, 95 and 86 patients who underwent SPRS and SPLS, respectively, were analyzed with balanced baseline characteristics. SPRS was associated with less blood loss, lower conversion rates, fewer intraoperative complications, and faster recovery, including earlier diet resumption and shorter hospital stays, than SPLS. SPRS provides superior perioperative advantages over SPLS, including reduced blood loss, lower conversion rates, fewer complications, and faster recovery. These findings highlight SPRS as a promising option for minimally invasive colorectal surgery, pending further validation to confirm these benefits and ensure long-term efficacy.

OBJECTIVE To compare short-term perioperative outcomes of single-port laparoscopic surgery (SPLS) and multiport laparoscopic surgery (MPLS) for colon cancer. SUMMARY BACKGROUND DATA Although many studies reported short- and long-term outcomes of SPLS for colon cancer compared with MPLS, few have reported results of randomized controlled trials. METHODS This was a multicenter, prospective, randomized controlled trial with a noninferiority design. It was conducted between August 2011 and June 2017 at 7 sites in Korea. A total of 388 adults (aged 19-85 yrs) with clinical stage I, II, or III adenocarcinoma of the ascending or sigmoid colon were enrolled and randomized. The primary endpoint was 30-day postoperative complication rates. Secondary endpoints were the number of harvested lymph nodes, length of the resection margin, postoperative pain, and time to functional recovery (bowel movement and diet). Patients were followed for 30 days after surgery. RESULTS Among 388 patients, 359 (92.5%) completed the study (SPLS, n = 179; MPLS, n = 180). The 30-day postoperative complication rate was 10.6% in the SPLS group and 13.9% in the MPLS group (95% confidence interval, -10.05 to 3.05 percentage points; P < 0.0001). Total incision length was shorter in the SPLS group than in the MPLS group (4.6 cm vs 7.2 cm, P < 0.001), whereas the length of the specimen extraction site did not differ (4.4 cm vs 4.6 cm, P = 0.249). There were no significant differences between groups for all secondary endpoints and all other outcomes. CONCLUSIONS Even though there was no obvious benefit to SPLS over MPLS when performing colectomy for cancer, our data suggest that SPLS is noninferior to MPLS and can be considered an option in selected patients, when performed by experienced surgeons. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01480128.

In this work we intend to validate the long-term oncologic outcomes for very low rectal cancer over the past 20 years and to determine whether laparoscopic procedures are useful options for very low rectal cancer. A total of 327 patients, who electively underwent laparoscopic rectal cancer surgery for a lesion within 5 cm from the anal verge, were enrolled in this study and their long-term outcomes were reviewed retrospectively. Of 327 patients, 70 patients underwent laparoscopic low anterior resection (LAR), 164 underwent laparoscopic abdominal transanal proctosigmoidocolectomy with coloanal anastomosis (LATA), and 93 underwent laparoscopic abdominoperineal resection (APR). The conversion rate was 1.22% (4/327). The overall postoperative morbidity rate was 26.30% (86/327). The 5-year disease free survival (DFS), 5-year overall survival (OS), and 3-year local recurrence (LR) were 64.3%, 79.7%, and 9.2%, respectively. The CRM involvement was a significant independent factor for DFS (p = 0.018) and OS (p = 0.042) in multivariate analysis. Laparoscopic APR showed poorer 5-year DFS (47.8%), 5-year OS (64.0%), and 3-year LR (17.6%) than laparoscopic LAR (74.1%, 86.4%, 1.9%) and laparoscopic LATA (69.2%, 83.6%, 9.2%). Laparoscopic procedures for very low rectal cancer including LAR, LATA, and APR could be good surgical options in selective patients with very low rectal cancer.

The clinical benefits of single-port laparoscopic surgery (SPLS) in patients with colon cancer patients are unclear because only a few studies have reported on the quality of life (QoL) of such patients. This study aimed to compare the QoL and patient satisfaction between SPLS and multiport laparoscopic surgery (MPLS) in colon cancer. The multicentre randomised controlled SIngle-port versus MultiPort Laparoscopic surgEry (SIMPLE) trial included patients with colon cancer who underwent radical surgery at seven hospitals in South Korea. We performed a pre-planned secondary analysis of the QoL data of 359 patients from that trial. The QoL was surveyed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 preoperatively and at 1, 3, 6, and 12 months postoperatively. Patient satisfaction was measured with a 5-point questionnaire at these postoperative time points. Overall, 145 and 147 patients were included in the SPLS and MPLS groups, respectively. Most QoL domains were similar between the groups. In the subgroup analysis of patients without adjuvant chemotherapy, patients in the SPLS group presented with significantly better global health status (p = 0.017), fatigue (p = 0.047), and pain (p = 0.005) scores and tended to have improved physical (p = 0.055), emotional (p = 0.064), and social (p = 0.081) functioning, with marginal significance at 1 month postoperatively, compared to those in the MPLS group. Patient satisfaction regarding surgery (p = 0.002) and appearance of the abdominal scar (p = 0.002) was significantly higher with SPLS than with MPLS at 12 months postoperatively. Patients who underwent SPLS without adjuvant chemotherapy had better global health status, fatigue status, and pain at 1 month postoperatively; however, these improvements were minimal and temporary. In the near future, the effect of SPLS on postoperative QoL should be confirmed through a randomised controlled trial targeting the QoL in colon cancer patients. ClinicalTrials.gov Identifier: NCT01480128

Background: Prospective data for the effects of FOLFOX chemotherapy on quality of life (QoL) has been limited. The aim of this study is to evaluate the impact of adjuvant FOLFOX chemotherapy on QoL in non-metastatic colon cancer

Background/Aims:The risk of peritoneal seeding following perforation after endoscopic resection in patients with early gastric cancer is unclear. The purpose of this study was to investigate long-term clinical outcomes including peritoneal seeding and overall survival rate following gastric perforation during endoscopic submucosal dissection (ESD).Methods:Between January 2002 and March 2015, 556 patients were diagnosed with early gastric cancer and underwent ESD. Among them, 34 patients (6.1%) experienced gastric perforation during ESD. Clinicopathological data of these patients were reviewed to determine the clinical outcome and evidence of peritoneal seeding.Results:Among 34 patients with perforation, macroperforations occurred during ESD in 17 cases (50%), and microperforation was identified in the remaining 17 cases (50%). All patients except one who underwent emergency surgery due to severe panperitonitis were managed successfully by endoscopic clipping (n=27) or conservative medical treatment (n=6). No evidence of peritoneal seeding after perforation associated with ESD was found in our cohort. Cumulative survival rates did not differ between the perforation and non-perforation groups (p=0.691). Furthermore, mortality was not associated with perforation. In addition, multivariate analysis showed that tumor size and achievement of curative resection were related to cancer recurrence. Perforation was not associated with cancer recurrence and survival.Conclusions:Perforation associated with ESD does not lead to worse clinical outcomes such as peritoneal seeding or cumulative survival rate. Therefore, periodic follow-up might be possible if curative resection was achieved even if perforation occurred during ESD.

Laparoscopic transverse colectomy is technically demanding because of the non-standardized surgical procedure and complicated vascular anatomy. To perform transverse colectomy, both flexures should be mobilized, and lymph node dissection around the middle colic artery should be performed. Several surgical videos have introduced middle colic artery dissection as the first approach with both flexures being subsequently mobilized. Sometimes, however, flexure mobilization can be difficult after lymph node dissection around the middle colic vessels due to an unfamiliar surgical plane, while the direct approach to the middle colic artery is also technically challenging because of anatomical difficulty. Indocyanine green (ICG) is widely used in the surgical field not only for detecting lymph nodes and perfusion but also for clarifying anatomical structures like the vascular and biliary systems. Thus, the authors here detail a laparoscopic transverse colectomy using ICG and both flexure-mobilization first approach.

PURPOSE We intended to identify the oncological outcome for rectal cancer over the past 20 years and whether or not sphincter-preserving surgery is an appropriate approach for low-lying rectal cancer. MATERIALS AND METHODS The oncological outcomes from a total of 418 patients who electively underwent rectal cancer surgery for a lesion located within 8 cm of the anal verge by a single colorectal surgeon were reviewed retrospectively. RESULTS Of 418 patients, 175 patients underwent low anterior resection (LAR), 172 laparoscopic abdominal transanal proctocolectomy with coloanal anastomosis (LATA), and 71 abdominoperineal resection (APR). The factors related to the disease-free survival (DFS) were neoadjuvant chemoradiation (P = .016), pathologic stage (P < .001), circumferential margin involvement (P < .001), and initial (P = .016) and postoperative serum carcinoembryonic antigen level (P < .001). The factors related to the overall survival (OS) were similar with those related to DFS. Compared with DFS, OS, and local recurrence among three surgical techniques, APR was significantly poorer in DFS (P < .001), OS (P < .001), and local recurrence (P = .001), than was LAR or LATA. DISCUSSION The LATA procedure is a technically feasible and oncologically safe surgical option for low-lying rectal cancer. We suggest that LATA may be a good surgical option in selective low-lying rectal cancer patients.

BACKGROUND:The aim of this study was to investigate the learning curves (LCs) of single-port laparoscopic surgery (SPLS) for colon cancer using multidimensional statistical analyses. Although SPLS yields better cosmetic results and comparable short-term outcomes compared to conventional laparoscopic surgery, its technical difficulties make surgeons hesitant to try SPLS. Moreover, the LCs of SPLS for colon cancer are not well delineated.METHODS:Data were collected from patients who underwent SPLS for colon cancer in seven Korean institutions between May 2009 and May 2015. The LCs were analyzed using the moving average method and the cumulative sum control chart (CUSUM) for operation time and surgical failure. Surgical failure was defined as the any conversion, postoperative complications, or less than 12 harvested lymph nodes from surgical specimens.RESULTS:A total of 356 patients were included in this study. Six and three surgeons performed 282 anterior resections (ARs) and 74 right colectomies (RCs), respectively. On the basis of the moving average method and CUSUM for operation time and surgical failure, the LCs for AR were 18, 16, 35, 13, 36, and 13 cases for surgeons A-F, respectively. However, the LCs for RC were 6 and 15 cases for surgeons D and E, respectively, and were ambiguous for one surgeon.CONCLUSIONS:For surgeons experienced in conventional laparoscopic colorectal surgery, the LCs of SPLS for colon cancer ranged from 6 to 36 cases, which is shorter than the LCs reported for conventional laparoscopic surgery.

Single-port laparoscopic surgery (SPLS) was recently introduced as an innovative minimally invasive surgery method. Retrospective studies have revealed the safety and feasibility of SPLS for colon cancer treatment. However, no prospective randomized trials have been performed. The multicenter, randomized SIMPLE (single-port versus multiport laparoscopic surgery) trial aimed to investigate short-term perioperative outcomes of SPLS for colon cancer treatment, compared with multiport laparoscopic surgery (MPLS).

PURPOSE:The purpose of this study was to investigate the prognostic implications of carcinoembryonic antigen (CEA) levels that are inconsistent with Response Evaluation Criteria in Solid Tumor (RECIST) responses in metastatic colorectal cancer patients.MATERIALS AND METHODS:We retrospectively evaluated 360 patients with at least one measurable lesion who received first-line palliative chemotherapy. CEA-response was defined as CEA-complete response (CR; CEA normalization), CEA-partial response (PR; ≥ 50% decrease in CEA levels), CEA-progressive disease (PD; ≥ 50% increase in CEA levels), and CEA-stable disease (SD; non-CR/PR/PD). Overall survival (OS) and progression-free survival (PFS) were evaluated according to CEA-response.RESULTS:In RECIST-PR patients, poorer CEA-response was associated with disease progression at the subsequent evaluation. In RECIST-SD patients, CEA-CR and -PR were associated with lower disease progression rates than CEA-PD at the subsequent evaluation. Correlations between survival outcome and CEA-response in same-category RECIST patients were assessed. In RECIST-PR patients, discordant CEA-response (CEA-PD/SD) was associated with poorer survival than CEA-CR/PR (median OS and PFS, 44.0 and 15.4 [CEA-CR], 28.9 and 12.5 [CEA-PR], 21.0 and 9.8 [CEA-SD], and 13.0 and 7.0 [CEA-PD] months, respectively; all p < 0.001). In RECIST-SD patients, favorable CEA-response produced better survival (median OS and PFS, 26.8 and 21.0 [CEA-CR], 21.0 and 11.0 [CEA-PR], 16.1 and 8.2 [CEA-SD], and 12.2 and 6.0 [CEA-PD] months, respectively; all p < 0.001). RECIST-PD patients with CEA-CR showed longer OS than those with CEA-PD. Multivariate analysis demonstrated that discordant CEA-response is a powerful prognostic factor for RECIST-PR and RECIST-SD patients.CONCLUSION:Among patients of the same RECIST-response categories, CEA-response patterns are significantly prognostic and strongly predictive of subsequent evaluation outcomes.

Purpose: Few studies about laparoscopic surgery for splenic flexure colon cancer have been published. This study aims to compare the short- and long-term outcomes of laparoscopic surgery for splenic flexure colon cancer with those of conventional open surgery.Methods: From January 2004 to December 2010, 51 consecutive patients who underwent curative resection for stages I-III splenic flexure colon cancer were enrolled. Thirty-three patients underwent laparoscopy-assisted colectomy, while 18 patients underwent conventional open colectomy. Short- and long-term outcomes of the 2 groups were compared.Results: There were no differences in baseline characteristics, intra- and postoperative complications. The laparoscopy group showed longer operation time (median [interquartile range, IQR]: 295.0 [255.0-362.5] minutes vs. 180.0 [168.8-206.3] minutes, P < 0.001). In the laparoscopy group, return of bowel function was faster (median [IQR]: 3 [2-4] vs. 4 [3-5], P = 0.007) and postoperative hospital stay was shorter (median [IQR]: 9 [8-11] vs. 10.5 [9-19], P = 0.026). There were no statistically significant differences in overall survival rate (84.3% vs. 76.0%, P = 0.560) or disease-free survival rate (93.8% vs. 74.5%, P = 0.078) between the 2 groups.Conclusion: Laparoscopic surgery for splenic flexure colon cancer has better short-term outcomes than open surgery, as well as acceptable long-term outcomes. Laparoscopic surgery can be a safe and feasible alternative to conventional open surgery for splenic flexure colon cancer.

Objectives. Endoscopic resection (ER) is commonly performed to treat gastric epithelial neoplasms and subepithelial tumors. The aim of this study was to predict the risk factors for surgery after ER-induced perforation. Methods. We retrospectively reviewed the data on patients who received gastric endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) between January 2010 and March 2015. Patients who were confirmed to have perforation were classified into surgery and nonsurgery groups. We aimed to determine the risk factors for surgery in patients who developed iatrogenic gastric perforations. Results. A total of 1183 patients underwent ER. Perforation occurred in 69 (5.8%) patients, and 9 patients (0.8%) required surgery to manage the perforation. In univariate analysis, anterior location of the lesion, a subepithelial lesion, two or more postprocedure pain killers within 24 hrs, and increased heart rate within 24 hrs after the procedure were the factors related to surgery. In logistic regression analysis, the location of the lesion at the anterior wall and using two or more postprocedure pain killers within 24 hrs were risk factors for surgery. Conclusion. Most cases of perforations after ER can be managed conservatively. When a patient requires two or more postprocedure pain killers within 24 hrs and the lesion is located on the anterior wall, early surgery should be considered instead of conservative management.

Sporadic non-ampullary duodenal adenoma is uncommon and found incidentally during endoscopic examinations. Brunner's gland hyperplasia is commonly encountered during endoscopic examinations. Adenomas arising from Brunner's gland hyperplasia originate from the glandular cells, and the surface epithelia are usually intact. Little has been reported on adenomas originating from the surface epithelium that overrides Brunner's gland hyperplasia. Here, we report a case of a sporadic non-ampullary duodenal adenoma overriding the cystic dilatation of Brunner's gland hyperplasia.

Min Ki Kim, Yoon Suk Lee, Hyung-Jin Kim, Suk-Hwan Lee, Jun-Gi Kim, and SIMPLE (SIngle port versus MultiPort trial Laparoscopic surgery) Trial Study Group. J Minim Invasive Surg 2017;20:160-2. https://doi.org/10.7602/jmis.2017.20.4.160

Laparoscopic colectomy procedures and their corresponding difficulty levels may vary depending on the tumor location within the colon, and a laparoscopic complete mesocolic excision (CME) with central vascular ligation (CVL) would require more proficiency than a conventional laparoscopic colectomy. We aimed to report our laparoscopic CME with CVL data and to investigate the clinical outcome differences of laparoscopic CME with CVL by various tumor sub-site locations. Prospectively collected clinical data of consecutive patients who received laparoscopic colectomy for primary colon cancer between April 1995 and December 2010 from single surgeon were retrospectively reviewed. All of the included surgery was performed on the basis of CME with CVL principle with no-touch isolation technique. Data were analyzed and compared among three groups; patients who received right or extended right hemicolectomy (group A, n = 142), transverse colectomy or left or extended left hemicolectomy (group B, n = 59), and sigmoidectomy or anterior resection (group C, n = 210). Female patients were more common in group A (53.5% vs. 37.3% vs. 39.5%, p = 0.020). Other baseline characteristics were comparable. Operative time was shorter in group C than the other groups (309.0 ± 74.7 vs. 324.3 ± 89.1 vs. 280.1 ± 93.1 min, p = 0.000). There was no significant difference among groups in perioperative complication and patient recovery. Five-year overall survival, disease-free survival and local recurrence rate showed no difference for a median follow up period of 73 (1-120) months. In conclusion, laparoscopic tumor-specific CME and CVL for colon cancer can be performed with comparable short- and long-term outcomes regardless of tumor sub-site location except for the operative time.

Aims: GS28 (Golgi SNARE protein, 28 kDa), a member of the soluble N-ethylmaleimide-sensitive factor attachment protein receptors (SNARE) protein family, plays a critical role in mammalian endoplasmic reticulum (ER)-Golgi or intra-Golgi vesicle transport.To date, few researches on the GS28 protein in human cancer tissues have been reported.In this study, we assessed the prognostic value of GS28 in patients with colorectal cancer (CRC). Methods and results:We screened for GS28 expression using immunohistochemistry in 230 surgical CRC specimens.The CRCs were right-sided and left-sided in 28.3% (65/230) and 71.3% (164/230) of patients, respectively.GS28 staining results were available in 214 cases.Among these, there were 26 nuclear predominant cases and 188 non-nuclear predominant cases.Stromal GS28 expression was noted in 152 cases of CRC.GS28 nuclear predominant immunoreactivity was significantly associated with advanced tumour stage (p = 0.045) and marginally associated with perineural invasion (p = 0.064).Decreased GS28 expression in the stromal cells was significantly associated with lymph node metastasis (N stage; p = 0.036).GS28 expression was not associated with epidermal growth factor receptor (EGFR) immunohistochemical positivity or KRAS mutation status.Investigation of the prognostic value of GS28 with Kaplan-Meier analysis revealed a correlation with overall survival (p = 0.004).Cases with GS28 nuclear predominant expression had significantly poorer overall survival than those with a non-nuclear predominant pattern.Conclusions: Taken together, these results indicate that GS28 nuclear predominant expression could serve as a prognostic marker for CRC and may help in identifying aggressive forms of CRC.

We aimed to present the factors associated with lymph node harvest (LNH) and seek whether surgical quality control measures can improve LNH.