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The Surgical Management of Colorectal Cancer

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 21 May 2025 | Viewed by 8712

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Special Issue Editor

Prof. Dr. Gyung-mo Son

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Guest Editor

Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
Interests: colorectal cancer; surgical management; laparoscopic surgery

Special Issue Information

Dear Colleagues,

This Special Issue focuses on the surgical management of colorectal cancer, highlighting critical aspects of surgical development. It aims to present the latest research on colorectal cancer surgery and its practical applications, offering insights that are able to enhance patient care pathways.

In recent years, there have been significant advancements in the field of surgical treatment for colorectal cancer. Minimally invasive approaches, such as laparoscopic, robotic, and single-port surgeries, have gained prominence. Moreover, the utilization of NIR cameras for image-guided surgery has been steadily increasing. The continuous development of surgical equipment and surgical techniques has contributed to the refinement of colorectal cancer surgery.

Of particular note is the potential capacity of these advancements in surgical and imaging technologies to bridge the gap in surgical outcomes attributed to differences in surgeons' experience. This progress has the capacity to empower less-experienced surgeons, enabling them to perform safer procedures and navigate their learning more effectively.

Furthermore, the recent expansion of real-time surgical information analysis through artificial intelligence is ushering in a new era, in which a wealth of information can be seamlessly provided to surgeons during procedures. These breakthroughs in surgical techniques exhibit potential regarding their ability to reduce complications in colorectal cancer surgeries, thus enhancing procedural safety and potentially improving long-term disease-free survival rates for cancer patients.

Prof. Dr. Gyung-mo Son
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

colorectal cancer
surgical management
minimally invasive surgery
laparoscopic surgery
robotic surgery
single port surgery
emergency surgery
image-guided surgery
enhanced recovery after surgery (ERAS)
systemic metastasis in colorectal cancer (involving the liver, lung, peritoneum, etc.)

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Published Papers (6 papers)

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Research

15 pages, 1992 KiB

Open AccessArticle

Effect of Fluorescence Lymph Node Mapping on Improving Diagnostic Values of CT D3 Lymph Node Staging for Right-Sided Colon Cancer

by Gyung Mo Son, Tae Un Kim, Mi Sook Yun, ChangYeop Kim, In Young Lee, Su Bum Park, Dong-Hoon Shin and Gi Won Ha

Cancers 2024, 16(20), 3496; https://doi.org/10.3390/cancers16203496 - 16 Oct 2024

Viewed by 627

Abstract

Background/Objectives: This study evaluated the impact of fluorescence lymph node mapping (FLNM) using indocyanine green (ICG) on the diagnostic accuracy of preoperative computed tomography (CT) in right-sided colon cancer. Methods: A total of 218 patients who underwent laparoscopic right hemicolectomy with D3 lymph node dissection (LND) were analyzed: 86 patients in the FLNM group and 132 in the conventional surgery group. The FLNM technique allowed for enhanced intraoperative visualization of lymph node (LN) and more precise dissection, improving the identification of metastatic LNs. The diagnostic value of preoperative CT staging was assessed in both the FLNM and control groups by calculating the apparent prevalence, true prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value, positive likelihood ratio (PLR), negative likelihood ratio, false positive and false negative proportions, and accuracy. Results: FLNM increased the accuracy of CT staging for detecting D3 LN metastasis in advanced cancer cases, with a higher PPV, PLR, and accuracy. In the FLNM group, the false-positive rate was significantly reduced, and the specificity was higher compared to the control group. Multivariate analysis identified FLNM as an independent factor associated with improved D3 LN metastasis detection. These findings suggest that incorporating FLNM into surgical procedures enhances the diagnostic value of preoperative CT by improving the precision of LND, particularly in patients with advanced colon cancer. Conclusions: The use of FLNM for D3 LND enhances the diagnostic accuracy of cN staging in right-sided colon cancer by improving surgical precision. Full article

(This article belongs to the Special Issue The Surgical Management of Colorectal Cancer)

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12 pages, 773 KiB

Open AccessArticle

Effect of Tumor Regression Grade on Survival and Disease-Free Interval in Patients Operated on for Locally Advanced Rectal Cancer

by Fernando Mendoza-Moreno, Manuel Díez-Alonso, Belén Matías-García, Enrique Ovejero-Merino, Cristina Vera-Mansilla, Ana Quiroga-Valcárcel, Alma Blázquez-Martín, Rubén Jiménez-Martín, Inmaculada Lasa-Unzúe, Miguel A. Ortega, Melchor Alvarez-Mon and Alberto Gutiérrez-Calvo

Cancers 2024, 16(10), 1797; https://doi.org/10.3390/cancers16101797 - 8 May 2024

Viewed by 1475

Abstract

Introduction: Colorectal cancer is the fourth leading cause of cancer-related death in both men and women in our population. In this regard, rectal cancer accounts for more than half of colorectal cancer deaths, and its incidence is expected to increase in the coming years. There have been significant changes in neoadjuvant therapy regimens, with promising results, as demonstrated by the recent RAPIDO and PRODIGE23 studies. Around 40% of patients diagnosed with locally advanced rectal cancer show some degree of response to neoadjuvant treatment, with complete tumor regression observed in up to one in five patients. Materials and Methods: Retrospective observational study. A total of 181 patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by surgery were analyzed. Clinical and pathological data were collected from the patients, including assessment of tumor regression through histopathological studies after surgery. The Mandard tumor regression grading system was used to categorize tumor response into different grades. Results: The results showed a significant association between the degree of tumor regression and several important clinical outcomes. Specifically, patients with higher tumor regression had significantly better disease-free survival than those with less regression (p = 0.004). In addition, tumor regression was also correlated with the incidence of local recurrence (p = 0.018) and distant metastasis (p = 0.032). These associations suggest that tumor responsiveness to neoadjuvant therapy may influence the long-term progression of the disease. Regarding tumor deposits and the presence of lymphadenopathy, these factors were also found to be significantly associated with clinical outcomes. Patients with tumor deposits had a higher incidence of local recurrence (p = 0.025) and distant metastases (p = 0.041), while the presence of lymphadenopathy increased the risk of local recurrence (p = 0.013). These findings highlight the importance of evaluating not only tumor regression but also other pathological markers to predict prognosis and guide clinical management. Conclusions: The degree of tumor regression was not an independent predictor of survival compared to other variables such as nodal stage and presence of tumor deposits. This indicates that while tumor regression is an important factor, other elements also play a crucial role in determining the prognosis of patients with locally advanced rectal cancer. This study provides additional evidence for the importance of tumor regression, tumor deposits, and lymphadenopathy as predictors of clinical outcomes in patients with rectal cancer treated with neoadjuvant chemoradiotherapy. Full article

(This article belongs to the Special Issue The Surgical Management of Colorectal Cancer)

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17 pages, 2285 KiB

Open AccessArticle

Recurrence Patterns and Risk Factors after Curative Resection for Colorectal Cancer: Insights for Postoperative Surveillance Strategies

by Hyo Seon Ryu, Jin Kim, Ye Ryung Park, Eun Hae Cho, Jeong Min Choo, Ji-Seon Kim, Se-Jin Baek and Jung-Myun Kwak

Cancers 2023, 15(24), 5791; https://doi.org/10.3390/cancers15245791 - 10 Dec 2023

Cited by 4 | Viewed by 2397

Abstract

This study aimed to assess recurrence patterns and related risk factors following curative resection of colorectal cancer (CRC). This retrospective observational study was conducted at a tertiary care center, including 2622 patients with stage I–III CRC who underwent curative resection between 2008 and 2018. Hazard rates of recurrence were calculated using a hazard function. The primary outcome was the peak recurrence time after curative resection and secondary outcomes were prognostic factors associated with recurrence. Over a median follow-up period of 53 months, the overall, locoregional and systemic recurrence rates were 8.9%, 0.7%, and 8.5%, respectively. Recurrence rates were significantly higher for rectal cancer (14.9% overall, 4.4% locoregionally, and 12.3% systemically) than for colon cancer (all p < 0.001). The peak recurrence time was 11 months, with variations in hazard rates and curves depending on the tumor location, stage, and risk factors. Patients with AL or CRM involvement exhibited a distinct pattern, with a high hazard rate in the early postoperative period. Understanding these recurrence patterns and risk factors is crucial for establishing effective postoperative surveillance strategies. Our findings suggested that short-interval surveillance should be considered during the first 2 years post-surgery, particularly for high-risk patients who should receive early attention. Full article

(This article belongs to the Special Issue The Surgical Management of Colorectal Cancer)

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13 pages, 2225 KiB

Open AccessArticle

Occult Vertebral Fracture (OVF) in Patients Who Underwent Hepatectomy for Colorectal Liver Metastasis: Strong Association with Oncological Outcomes

by Kenei Furukawa, Koichiro Haruki, Tomohiko Taniai, Mitsuru Yanagaki, Masashi Tsunematsu, Yoshiaki Tanji, Shunta Ishizaki, Yoshihiro Shirai, Shinji Onda and Toru Ikegami

Cancers 2023, 15(23), 5513; https://doi.org/10.3390/cancers15235513 - 22 Nov 2023

Cited by 1 | Viewed by 1171

Abstract

Aim: The impact of occult vertebral fracture (OVF) on oncological outcomes after surgery has not been investigated, although its significance in orthopedics has been much debated recently. We evaluated the prognostic significance of OVF on the long-term outcomes of patients with colorectal liver metastases (CRLM) after hepatectomy. Methods: We included 140 patients with CRLM who underwent hepatectomy. OVF was identified using quantitative measurement and preoperative sagittal computed tomography image reconstruction from the 11th thoracic vertebra to the 5th lumber vertebra. Results: OVF was identified in 48 (34%) of the patients. In multivariate analysis, lymph node metastases (p < 0.01), multiple tumors (p = 0.02), extrahepatic lesions (p < 0.01), OVF (p < 0.01), intraoperative bleeding (p = 0.04), and curability 1 or 2 (p < 0.01) were independent and significant predictors of disease-free survival and extrahepatic lesions (p < 0.01), osteosarcopenia (p = 0.02), and OVF (p < 0.01) were independent and significant predictors of overall survival. A higher age, adjuvant chemotherapy for a primary lesion before metachronous liver metastases, osteopenia, and hypoalbuminemia were independent risk factors for OVF. Conclusions: The evaluation of preoperative OVF is a useful prognostic factor for risk stratification and clinical decision-making for patients with CRLM. Full article

(This article belongs to the Special Issue The Surgical Management of Colorectal Cancer)

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12 pages, 718 KiB

Open AccessArticle

Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach

by Ji-Hyun Seo and In-Ja Park

Cancers 2023, 15(21), 5211; https://doi.org/10.3390/cancers15215211 - 30 Oct 2023

Viewed by 1103

Abstract

The adoption of laparoscopic surgery in the management of serosa-exposed colorectal cancer has raised concerns. This study aimed to investigate whether laparoscopic surgery is associated with an increased risk of postoperative recurrence in patients undergoing resection for serosa-exposed colon cancer. A retrospective analysis was conducted on a cohort of 315 patients who underwent curative resection for pathologically confirmed T4a colon cancer without distant metastases at the Asan Medical Center between 2006 and 2015. Patients were categorized according to the surgical approach method: laparoscopic surgery (MIS group) versus open surgery (Open group). Multivariate analysis was employed to identify risk factors associated with overall survival (OS) and disease-free survival (DFS). The MIS group included 148 patients and the Open group had 167 patients. Of the total cohort, 106 patients (33.7%) experienced recurrence during the follow-up period. Rates, patterns, and time to recurrence were not different between groups. The MIS group (55.8%) showed more peritoneal metastasis compared to the Open group (44.4%) among recurrence sites, but it was not significant (p = 0.85). There was no significant difference in the five-year OS (73.5% vs. 78.4% p = 0.374) or DFS (62.0% vs. 64.6%; p = 0.61) between the Open and MIS groups. Age and the pathologic N stage were independently associated with OS, and the pathologic N stage was the only associated risk factor for DFS. The laparoscopic approach for serosa-exposed colon cancer did not compromise the DFS and OS. This study provides evidence that laparoscopic surgery does not compromise oncologic outcomes of patients with T4a colon cancer although peritoneal seeding is the most common type of disease failure of serosa-exposed colon cancer. Full article

(This article belongs to the Special Issue The Surgical Management of Colorectal Cancer)

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16 pages, 1195 KiB

Open AccessArticle

Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer

by Su Hyeong Park, Hye Seung Woo, In Kyung Hong and Eun Jung Park

Cancers 2023, 15(20), 5098; https://doi.org/10.3390/cancers15205098 - 22 Oct 2023

Cited by 1 | Viewed by 1349

Abstract

Background: The Naples prognostic score (NPS) is a scoring system that reflects a patient’s systemic inflammatory and nutritional status. This study aimed to evaluate whether postoperative NPS is effective in assessing the prognosis of stage II–III colorectal cancer (CRC) patients compared with preoperative NPS. Methods: Between 2005 and 2012, a total of 164 patients diagnosed with stage II–III CRC, who underwent curative resection followed by adjuvant chemotherapy, were divided into two groups: Group 0–1 (NPS = 0–2) and Group 2 (NPS = 3 or 4). Preoperative NPS was calculated based on the results before surgeries, and postoperative NPS was assessed using the results obtained before adjuvant chemotherapy. Results: The overall survival of Group 0–1 was higher than that of Group 2 in both pre- and postoperative NPS assessments. According to the ROC curve analysis, the Area Under the Curve (AUC) ratio for postoperative NPS was 0.64, compared with 0.57 for preoperative NPS, 0.52 for the preoperative neutrophil–lymphocyte ratio (p = 0.032), and 0.51 for the preoperative platelet–lymphocyte ratio (p = 0.027). Conclusions: Postoperative NPS is effective in predicting the prognosis of stage II–III CRC patients who underwent curative resection followed by adjuvant chemotherapy. The use of NPS could be beneficial in evaluating the prognosis of CRC patients after surgeries. Full article

(This article belongs to the Special Issue The Surgical Management of Colorectal Cancer)

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