Ji Yeon Mun

Background: Splenic flexure colon cancer (SFCC) is a relatively rare subtype of colon cancer, and the optimal extent of resection and safety of laparoscopic surgery remain controversial. We conducted a multicenter comparative analysis to evaluate the short- and long-term outcomes of laparoscopic segmental left colectomy (LC) for SFCC using laparoscopic anterior resection (AR) as a comparator. Methods: We retrospectively reviewed patients with stage I–III colon cancer involving the distal transverse to sigmoid colon who underwent laparoscopic surgery at four hospitals between March 2004 and December 2020. SFCC was defined as tumors between the distal transverse and proximal descending colon. Outcomes were compared between the AR group (laparoscopic anterior resection for descending to sigmoid colon cancer) and the LC group (laparoscopic segmental left colectomy for SFCC) using propensity score matching. Results: A total of 1889 patients were included in the AR group and 271 in the LC group. The median follow-up was 60 months. After 2:1 propensity score matching, baseline clinicopathologic characteristics were comparable between groups. Operative time was longer in the LC group. Overall complication rates were similar, except for a higher incidence of postoperative ileus in the LC group, while overall 30-day morbidity did not differ. Five-year disease-free survival and overall survival were comparable, with no significant differences in stage-stratified analyses. Conclusions: Laparoscopic segmental left colectomy for SFCC achieved short- and long-term outcomes comparable to laparoscopic anterior resection for descending and sigmoid colon cancer, supporting it as a safe and oncologically feasible option.

In Kyeong Kim, Moonjin Kim, Ji-Yeon Moon, Ri Na Yoo, Jumyeong Song, Chaedong Lim, Choon Sik Chung, Gwan Cheol Lee, Tae Gyu Kim, Young Sun Choi, Dong Geun Lee, Chul Seung Lee. Journal of Minimally Invasive Surgery 2026;29:3-10. https://doi.org/10.7602/jmis.2026.29.1.3

Purpose: The technique for transanal resection of rectal tumors has evolved from conventional methods to minimally invasive approaches. However, the research comparing long-term results between these approaches is limited.Methods: Between 2016 and 2022, a total of 133 patients who underwent transanal excision were analyzed. Patients were classified into 2 groups according to surgical approach: conventional transanal approach (CTA) and minimally invasive transanal approach (MTA). Medical records were analyzed to compare surgical and oncological outcomes between the 2 groups.Results: There were no significant differences observed in patient’s demographics and tumor characteristics, except the MTA group exhibited a statistically longer distance from the anal verge. Although statistical significance was not reached, the MTA group demonstrated a 100% margin-negative rate in contrast to the CTA group, which had worse outcomes for both margin status and fragmentation. Recurrence was observed only in the CTA group containing pT1 rectal cancer and grade 1 neuroendocrine tumor, with negative margins and no fragmentation.Conclusion: The minimally invasive approach did not demonstrate statistical superiority but showed technical feasibility through the absence of margin-positive cases and the use of the clip handle method. Further studies are needed to validate these findings and assess broader applicability.

Mun JY, et al. Ann Surg Treat Res. 2025 Oct;109(4):278-282. https://doi.org/10.4174/astr.2025.109.4.278

Purpose: Preoperative colonoscopic (POC) localization is recommended for patients scheduled for elective laparoscopic colectomy for early colon cancer. Among the various localization method, POC tattooing localization has been widely used. Several dyes have been used for tattooing, but dye has disadvantages, including foreign body reactions. For this reason, we have used autologous blood tattooing for POC localization. This study aimed to evaluate the safety and efficacy of the autologous blood tattooing method.Methods: This study included patients who required POC localization of the colonic neoplasm among the patients who were scheduled for elective colon resection. The indication for localization was early colon cancer (clinically T1 or T2) or colonic neoplasms that could not be resected endoscopically. POC autologous blood tattooing was performed after saline injection, and 2 hemoclips were applied.Results: A total of 45 patients who underwent autologous blood tattooing and laparoscopic colectomy were included in this study. All POC localization sites were visible in the laparoscopic view. POC localization sites showed almost perfect agreement with intraoperative surgical findings. There were no complications like bowel perforation, peritonitis, hemoperitoneum, and mesenteric hematoma.Conclusion: Autologous blood is a safe and effective agent for localizing materials that can replace previous dyes. However, a large prospective case-control study is required for the routine application of this procedure in early colon cancer or colonic neoplasms.

The role of upfront primary tumor resection (PTR) in patients with unresectable metastatic colorectal cancer without severe symptoms remains controversial. We retrospectively analyzed the role of PTR in overall survival (OS) in this population. Among the 205 patients who enrolled, the PTR group (n = 42) showed better performance (p = 0.061), had higher frequencies of right-sided origin (p = 0.058), the T4 stage (p = 0.003), the M1a stage (p = 0.012), and p = 0.002), and received fewer targeted agents (p = 0.011) than the chemotherapy group (n = 163). The PTR group showed a trend for longer OS (20.5 versus 16.0 months, p = 0.064) but was not related to OS in Cox regression multivariate analysis (p = 0.220). The male sex (p = 0.061), a good performance status (p = 0.078), the T3 stage (p = 0.060), the M1a stage (p = 0.042), p = 0.035), an RAS wild tumor (p = 0.054), and the administration of targeted agents (p = 0.037), especially bevacizumab (p = 0.067), seemed to be related to PTR benefits. Upfront PTR could be considered beneficial in some subgroups, but these findings require larger studies to verify.

The role of upfront primary tumor resection (PTR) in patients with unresectable metastatic col-orectal cancer (CRC) without severe symptoms remains controversial. We retrospectively ana-lyzed the role of PTR in overall survival (OS) in different subgroups. Among 331 patients diag-nosed with synchronous metastatic CRC between 2010 and 2020, 223 were analyzed. The PTR group (n = 42) showed better performance (p = 0.038); higher frequencies of right-sided origin (p = 0.014), T4 stage (p = 0.005), M1a stage (p = 0.015), and <2 organ metastases (p = 0.002); and re-ceived fewer targeted agents (p < 0.001) than the chemotherapy group (n = 181). The PTR group showed longer OS (20.5 versus 14.0 months, p = 0.016), but PTR was marginally related to OS in multivariate analysis (p = 0.060). Male sex (p = 0.022), good performance status (p = 0.07), left-sided tumor (p = 0.069), low serum carcinoembryonic antigen level (p = 0.092), T3 stage (p = 0.029), M1a stage (p = 0.025), <2 organ metastases (p = 0.017), and administration of targeted agents, especially bevacizumab (p = 0.024), were related to survival benefit after PTR. Upfront PTR should be considered when selecting patients with favorable prognoses for bevacizumab administration.