Erratum: Correction of Text and Table in the Article "Establishing a Patient-centered Longitudinal Integrated Clerkship: Early Results from a Single Institution".

This corrects the article on p. e419 in vol. 35, PMID: 33372421.

Establishing a Patient-centered Longitudinal Integrated Clerkship: Early Results from a Single Institution.

BACKGROUND: Longitudinal integrated clerkships (LICs) have been adopted by medical schools to overcome the limitations of traditional block clerkship rotations and to promote continuity of care. In 2018, Seoul National University College of Medicine introduced a patient-centered LIC program as part of a new curriculum in parallel with traditional block rotation clerkships. The purpose of this study was to present the patient-centered LIC program and to investigate its educational effects. METHODS: In 2018 and 2019, a total of 298 third-year medical students participated in the LIC program. We divided the students into groups of eight, which were organized into corresponding discussion classes. Throughout the academic year, students followed up patients by interviewing them at the hospital or reviewing their electric medical records. Discussion classes on set topics were held seven times per year with facilitators and clinical faculites. Students completed a course evaluation questionnaire at the end of the academic year. The questionnaire included 22 items measured on a 5-point scale and two open-ended questions asking about the benefits and limitations of the program. The items covered three domains: student experience, satisfaction, and self-assessment. Final reflective essays were collected as both student assessments and data for qualitative analysis. RESULTS: During the study period, the overall experience of the students improved. We increased the number of faculty members and patients and decreased the number of students in each discussion class. We also provided additional feedback through an e-portfolio. Students' satisfaction changed positively. Compared to the rotational clerkship, students answered that the LIC provided additional help in learning the two core competencies. During the first 2 years of the program, the percentage of students who answered that the program was more helpful than the rotational clerkship increased from 23.7% to 46.4% for continuity of care (P < 0.001), and from 20.5% to 50.7% for patient-centered care (P < 0.001). CONCLUSION: Our patient-centered LIC, in parallel with traditional block rotation clerkships, had a positive effect on students' experience of continuity of care and patient-centered care.

Analysis of interaction between intracellular spermine and transient receptor potential canonical 4 channel: multiple candidate sites of negatively charged amino acids for the inward rectification of transient receptor potential canonical 4.

Transient receptor potential canonical 4 (TRPC4) channel is a nonselective calcium-permeable cation channels. In intestinal smooth muscle cells, TRPC4 currents contribute more than 80% to muscarinic cationic current (mIcat). With its inward-rectifying current-voltage relationship and high calcium permeability, TRPC4 channels permit calcium influx once the channel is opened by muscarinic receptor stimulation. Polyamines are known to inhibit nonselective cation channels that mediate the generation of mIcat. Moreover, it is reported that TRPC4 channels are blocked by the intracellular spermine through electrostatic interaction with glutamate residues (E728, E729). Here, we investigated the correlation between the magnitude of channel inactivation by spermine and the magnitude of channel conductance. We also found additional spermine binding sites in TRPC4. We evaluated channel activity with electrophysiological recordings and revalidated structural significance based on Cryo-EM structure, which was resolved recently. We found that there is no correlation between magnitude of inhibitory action of spermine and magnitude of maximum current of the channel. In intracellular region, TRPC4 attracts spermine at channel periphery by reducing access resistance, and acidic residues contribute to blocking action of intracellular spermine; channel periphery, E649; cytosolic space, D629, D649, and E687.

Deliberate Practice as an Effective Remediation Strategy for Underperforming Medical Students Focused on Clinical Skills: a Prospective Longitudinal Study.

BACKGROUND: It is critical to develop remedial education for underperforming medical students, but little is known about how to create an effective remediation program. Deliberate practice (DP) is a structured and reflective activity that is designed to optimize performance. Here we applied the concept of DP to create remedial education to improve the clinical practices of medical students. We also analyzed the effectiveness of the remediation program. METHODS: Based on the expert performance approach of DP, we designed a 4-week remedial program for clinical performance that included feedback and reflection. There were 74 student participants in this program from 2014 to 2017. Their clinical performance was re-evaluated after completion, and changes in their clinical performance scores were analyzed. RESULTS: Students who completed the remediation program showed significant improvements in clinical performance scores (P < 0.001). Most students found the program to be instructive and helpful for improving their clinical performance. They reported that role play with peers was the most helpful for improving their skills. CONCLUSION: The DP-based remediation program improved the clinical performance of failing medical students. This remediation program should continue to be offered to underperforming students to ensure that medical school graduates are competent.

The impact of visceral adipose tissue amount on the adequacy of lymph node retrieval in colorectal cancer surgery.

BACKGROUND: Obesity is increasing worldwide, potentially influencing surgical outcomes in colorectal cancer (CRC) patients. We analyzed the effects of obesity indexes on lymph node (LN) retrieval in CRC patients. METHOD: We applied obesity indexes of body mass index (BMI) and visceral (VAT) and subcutaneous (SAT) adipose tissue volumes to stage I-III CRC patients. The primary outcome was the effect of these indexes on the number of retrieved LNs (12 > LNs ≥ 12). RESULTS: Among 519 patients, 35.6% had a BMI ≥ 25 kg/m2 . After adjusting for gender, age, tumor location, resected colon length, and local invasion and LN statuses, patients in the highest VAT quartile showed a 5.848 decrease in the number of retrieved LNs, with an odds ratio of 0.483 (95% confidence interval [CI] 0.260-0.8979) for adequate LN retrieval (≥12), compared with those in the lowest quartile (P < 0.001 for both). Analysis of the model predicting LN retrieval revealed VAT as the only obesity index (area under the curve [AUC] = 0.721) providing significant additional predictive power (P = 0.037) to the model including age, gender, staging, tumor location, and resected colon length (AUC = 0.707). CONCLUSION: Increased VAT may cause inadequate LN retrieval in CRC patients. In viscerally obese patients, VAT volumes should be considered when clinically interpreting LN status.

Intracellular spermine blocks TRPC4 channel via electrostatic interaction with C-terminal negative amino acids.

Transient receptor potential canonical (TRPC) 4 channels are calcium-permeable, nonselective cation channels and are widely expressed in mammalian tissue, especially in the GI tract and brain. TRPC4 channels are known to be involved in neurogenic contraction of ileal smooth muscle cells via generating cationic current after muscarinic stimulation (muscarinic cationic current (mIcat)). Polyamines exist in numerous tissues and are believed to be involved in cell proliferation, differentiation, scar formation, wound healing, and carcinogenesis. Besides, physiological polyamines are essential to maintain inward rectification of cardiac potassium channels (Kir2.1). At membrane potentials more positive than equilibrium potential, intracellular polyamines plug the cytosolic surface of the Kir2.1 so that potassium ions cannot pass through the pore. Recently, it was reported that polyamines inhibit not only cardiac potassium channels but also nonselective cation channels that mediate the generation of mIcat. Here, we report that TRPC4, a definite mIcat mediator, is inhibited by intracellular spermine with great extent. The inhibition was specific to TRPC4 and TRPC5 channels but was not effective to TRPC1/4, TRPC1/5, and TRPC3 channels. For this inhibition to occur, we found that glutamates at 728th and 729th position of TRPC4 channels are essential whereby we conclude that spermine blocks the TRPC4 channel with electrostatic interaction between negative amino acids at the C-terminus of the channel.

Prognostic Impact of Changes in Adipose Tissue Areas after Colectomy in Colorectal Cancer Patients.

There have been few studies assessing the changes in the body components of patients after colectomy in colorectal cancer (CRC). The purpose of this study was to verify the trends in the adipose tissue areas of CRC patients before and after surgery and to determine their clinical relevance. Computed tomography (CT)-assessed subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) areas were recorded before and after curative resection in stage I to III CRC patients. Changes in the adipose tissue were assessed by calculating the difference in the adipose tissue area between preoperative CT and the most recent postoperative CT, which is disease-free state. Regarding obesity before surgery, there were no prognostic effect of body mass index (BMI), VAT and SAT, and 47.3% of patients had increases in VAT after colectomy. By multivariate analysis, adjusting sex, age, stage, differentiation, VAT change was the only obesity related factor to predict the prognosis, that patients who had increase in VAT after colectomy had better overall survival (HR, 0.557; 95% CI, 0.317-0.880) and disease-free survival (HR, 0.602; 95% CI, 0.391-0.927). BMI and SAT change had no significant association. In subgroup analysis of stage III CRC patients, VAT change had significance for prognosis only in patients who had adjuvant chemotherapy but not in those who did not receive postoperative chemotherapy. Increase in visceral adipose tissue after surgery is a favorable predictor of prognosis for CRC patients.

Surgical outcomes and prognostic factors of emergency surgery for colonic perforation: would fecal contamination increase morbidity and mortality?

PURPOSE: Complications resulting from colonic perforation are related to secondary peritonitis due to bacterial or fecal contamination. We investigated outcomes of emergency surgery for colonic perforation associated with fecal contamination with regard to early and late postoperative complication rates and mortality rates, and investigated prognostic factors influencing those outcomes. METHODS: A retrospective analysis of prospectively collected data on factors influencing complications and mortality rates was conducted on data from 152 patients who had undergone emergent operations for colonic perforation between January 2005 and December 2011. Patients were categorized into two groups: those with and without gross fecal contamination at the time of operation. RESULTS: Forty-one (26.9 %) patients had gross fecal contamination. Patients who had fetal contamination had a higher Mannheim peritonitis index (31.3 ± 5.1 vs. 21.9 ± 7.2, p < 0.001), higher organ failure rate (53.7 vs. 24.3 %, p = 0.001), and longer operating time (168.8 ± 49.9 vs. 144.8 ± 66.1 min, p = 0.036) than patients without fecal contamination. Early complications (<30 days) occurred more frequently in the fecal contamination group (82.9 vs. 49.5 %, p = 0.001), although late complications (46.2 vs. 39.3 %, p = 0.942) and mortality (17.1 vs. 8.1 %, p = 0.110) did not differ. In multivariate analysis, fecal contamination significantly predicted early complications (odds ratio, 2.78; p = 0.037) but not late complications or mortality. CONCLUSIONS: The frequency of early complications can increase if fecal contamination exists. However, when early complications are well managed, fecal contamination does not significantly influence occurrences late complications or mortality.

Colonoscopic surveillance after colorectal cancer resection: who needs more intensive follow-up?

BACKGROUND/AIMS: Although there are guidelines for colonoscopic surveillance after colorectal cancer (CRC) surgery, the data evaluating the effectiveness of these guidelines are limited. We determined the risk factors for metachronous neoplasia (MN) by performing annual colonoscopy examinations after curative resection. METHODS: We performed annual colonoscopic surveillance on stage I-III CRC patients after curative resection. We stratified the patients based on the advanced neoplasia risk during the surveillance. RESULTS: Advanced MN detected was in 59 (13.1%) of 451 patients. Overall, the cumulative incidence of advanced MN was 17.3% at 5 years. By the multivariate analysis, the risk factors for advanced MN were male gender, age >65, left-sided index cancer and being in the high-risk group. The cumulative incidence of advanced MN was 38.9% at 5 years in the high-risk group. Among the patients who had advanced MN, secondary advanced MN was detected in 13 patients (22.0%) with a subsequent colonoscopy. The 2-year cumulative incidence of secondary advanced MN was 16.9%. Four (0.88%) patients had metachronous CRC during the surveillance and the interval from the index CRC was a median of 58.5 months. CONCLUSIONS: Although the current follow-up guidelines for colonoscopic surveillance after CRC are well established, the high-risk group calls for more meticulous follow-up, which should be continued for a sufficient time.

Electrophysiological and Mechanical Characteristics in Human Ileal Motility: Recordings of Slow Waves Conductions and Contractions, In vitro.

Little human tissue data are available for slow waves and migrating motor complexes, which are the main components of small bowel motility. We investigated the electrophysiological and mechanical characteristics of human ileal motility, in vitro. Ileum was obtained from patients undergoing bowel resection. Electrophysiological microelectrode recordings for membrane potential changes and mechanical tension recordings for contraction from smooth muscle strips and ileal segments were performed. Drugs affecting the enteric nervous system were applied to measure the changes in activity. Slow waves were detected with a frequency of 9~10/min. There were no cross-sectional differences in resting membrane potential (RMP), amplitude or frequency between outer and inner circular muscle (CM), suggesting that electrical activities could be effectively transmitted from outer to inner CM. The presence of the interstitial cell of Cajal (ICC) at the linia septa was verified by immunohistochemistry. Contractions of strips and segments occurred at a frequency of 3~4/min and 1~2/min, respectively. The frequency, amplitude and area under the curve were similar between CM and LM. In segments, contractions of CM were associated with LM, but propagation varied with antegrade and retrograde directions. Atropine, N(W)-oxide-L-arginine, and sodium nitroprusside exhibited different effects on RMP and contractions. There were no cross-sectional differences with regard to the characteristics of slow waves in CM. The frequency of contractions in smooth muscle strips and ileal segments was lower than slow waves. The directions of propagation were diverse, indicating both mixing and transport functions of the ileum.

The outcomes and prognostic factors of surgical treatment for ischemic colitis: what can we do for a better outcome?

BACKGROUND/AIMS: Surgical treatment is mandatory for severe ischemic colitis, but morbidity and mortality are high. We evaluated the outcomes and prognostic factors of surgical treatment for ischemic colitis. METHODOLOGY: Forty-nine consecutive patients (M:F, 26:23, median, 63 years), who underwent surgery for ischemic colitis by single surgeon, had been recruited prospectively and retrospectively analyzed. RESULTS: The causes of ischemia were vascular occlusions in 35 (71.4%). Thirty-seven (75.5%) patients had coexisting chronic medical problems. Emergency operation was performed in 40 (81.6%). Ischemic regions were right colon in 20 (40.8%), left colon in 19 (38.8%), and whole colon in 9 (18.4%). Resection with stoma formation was performed in 29 (59.2%) and primary anastomosis in 19 (38.8%). Postoperative morbidity occurred in 42 (85.7%) and mortality in 22 (44.9%). Univariate analysis showed that abdominal pain with peritoneal irritation signs, systemic inflammatory response, severe systemic hypotension, cardiovascular disease, vasoactive drug, emergency operation, and stoma formation were unfavorably associated with morbidity and/or mortality. Preoperative severe systemic hypotension was the only significant risk factor of mortality in multivariate analysis. CONCLUSIONS: Morbidity and mortality remained high in surgery for ischemic colitis. As preoperative systemic hypotension was the most important, early surgical treatment before the disease being deteriorated is mandatory.

Results of surgical treatment on benign anal diseases in Korean HIV-positive patients.

Perianal diseases are the most common reasons for surgery in HIV-positive patients. This study aimed to evaluate the outcomes of these surgical procedures in Korean patients, focusing on wound healing and postoperative complications. Retrospective analysis was performed on 72 HIV-positive patients who underwent surgery by a single surgeon for benign anal disease between 1998 and 2011. Of these, 68.1% (49/72) of patients received surgery for condyloma acuminata, 19.4% (14/72) for anal fistulas, 6.9% (5/72) for hemorrhoids, and 5.6% (4/72) for perianal abscesses. Patients with condyloma acuminata received surgical excision with electrical coagulation, and all wounds healed completely within 3 months, though 16.3% (8/49) of these patients experienced recurrence. Twelve of the 49 patients (24.5%) who were treated for condyloma acuminata underwent simultaneous operations for concomitant anal fistulas (n = 6), hemorrhoids (n = 4), and perianal abscesses (n = 2). Overall, 3 postoperative complications developed following a total of 94 procedures, and there was no significant increase in complication rate for patients with a low CD4+ T-cell count ( < 200/µL) compared to those with a higher count. The results demonstrate favorable results following perianal surgery in HIV-positive Korean patients.

The effects of eupatilin (stillen®) on motility of human lower gastrointestinal tracts.

Gastrointestinal motility consists of phasic slow-wave contractions and the migrating motor complex (MMC). Eupatilin (Stillen®) has been widely used to treat gastritis and peptic ulcers, and various cytokines and neuropeptides are thought to be involved, which can affect gastrointestinal motility. We performed a study to identify the effects of eupatilin on lower gastrointestinal motility with electromechanical recordings of smooth muscles in the human ileum and colon. Ileum and colon samples were obtained from patients undergoing bowel resection. The tissues were immediately stored in oxygenated Krebs-Ringer's bicarbonate solution, and conventional microelectrode recordings from muscle cells and tension recordings from muscle strips and ileal or colonic segments were performed. Eupatilin was perfused into the tissue chamber, and changes in membrane potentials and contractions were measured. Hyperpolarization of resting membrane potential (RMP) was observed after administration of eupatilin. The amplitude, AUC, and frequency of tension recordings from circular and longitudinal smooth muscle strips and bowel segments of the ileum and colon were significantly decreased after admission of eupatilin. Eupatilin elicited dose-dependent decreases during segmental tension recordings. In conclusion, eupatilin (Stillen®) showed inhibitory effects on the human ileum and colon. We propose that this drug may be useful for treating diseases that increase bowel motility, but further studies are necessary.

Transanal rectosigmoidectomy using a single port in a Swine model.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) and single access surgery are emerging techniques that reduce surgical invasiveness. This study was performed to evaluate the feasibility of NOTES transanal rectosigmoidectomy using a single port in a swine model. METHODS: Ten male pigs were used to conduct 2 studies, 4 for a nonsurvival study and 6 for a survival study. After anesthesia, the rectum was occluded transanally with a purse-string suture, and then a single port was placed. CO(2) gas was insufflated, and full-thickness rectal dissection was extended using laparoscopic instruments as far cephalad as possible. A 5-mm trocar was placed on the abdominal wall for transabdominal laparoscopic view, and then further colonic mobilization was performed using the endoscope through the anus. When the dissection was completed, the specimen was exteriorized and colorectal anastomosis was performed using a circular stapler. In the survival study, necropsies were performed on postoperative day 7. RESULTS: Full-thickness circumferential rectosigmoid mobilization was achieved in all cases. The mean length of resected colon was 10 cm (range = 8-15 cm). No anastomotic defects were noted. All resected rectosigmoid specimens were grossly intact. No mortality or significant postoperative complications was observed in the survival group. On necropsy, a small abscess in the pelvic cavity was noted in 1 case and bladder distention was noted in 3 cases. CONCLUSIONS: NOTES transanal rectosigmoidectomy using the single port is feasible and safe. Further experimental studies are warranted, especially in human cadaver model.

Can the new American Joint Committee on Cancer staging system predict survival in rectal cancer patients treated with curative surgery following preoperative chemoradiotherapy?

BACKGROUND: Although ypStage has been known as a strong prognosticator of recurrence and survival, the detailed interaction of ypT and ypN classification on a survival rate has never been evaluated. METHODS: Between October 2001 and December 2007, in total, 960 patients with locally advanced rectal cancer were enrolled retrospectively at 3 centers. Five-year overall survival (OS) and disease-free survival (DFS) rate were calculated for each ypTN classification. RESULTS: The ypT classification interacted with ypN classification to affect survival in most categories. Patients with ypStage 0 and I cancers showed a >90% 5-year OS (ypStage 0, 96.5%; ypStage I, 92.9%; P = .346) and 5-year DFS (ypStage 0, 90.2%; ypStage I, 90.7%; P = .879). Among ypStage III subgroups, large differences in 5-year OS (ypStage IIIA, 90.1%; ypStage IIIB, 68.3%; ypStage IIIC, 40.5%; P < .001) and 5-year DFS (ypStage IIIA, 74.8%; ypStage IIIB, 55.1%; ypStage IIIC, 12.3%; P < .001) were observed. OS and DFS in patients with ypStage IIIA disease were similar to or greater than those in patients with ypStage IIA or IIB/IIC disease. Four patient risk groups were defined: 1) low (ypT0-isN0, ypT1N0, ypT2N0), 2) intermediate (ypT0-2N1, ypT3N0), 3) moderately high (ypT0-2N2, ypT3N1, ypT4N0), and 4) high risk (ypT3N2, ypT4N1-2). Risk grouping showed a narrower range of survival rate compared with ypStage grouping. CONCLUSIONS: ypStage in rectal cancer, defined according to the 7th edition of the American Joint Committee on Cancer staging system, predicts survival for most ypNT classifications. However, patients with ypStage I rectal cancer have a similar prognosis to those with ypStage 0 cancer, and risk grouping reflects more precise survival outcomes than ypStage.

How to enhance students' learning in a patient-centered longitudinal integrated clerkship: factors associated with students' learning experiences.

PURPOSE: Longitudinal integrated clerkships (LICs) have been introduced in medical schools, as learning relationships with clinical faculty or peers are important components of medical education. The purpose of this study was to investigate the characteristics of student-faculty and student-student interactions in the LIC and to identify other factors related to whether students understood and acquired the program's main outcomes. METHODS: The study was conducted among the 149 third-year students who participated in the LIC in 2019. We divided the students into groups of eight. These groups were organized into corresponding discussion classes, during which students had discussions with clinical faculty members and peers and received feedback. Clinical faculty members and students were matched through an e-portfolio, where records were approved and feedback was given. A course evaluation questionnaire was completed and analysed. RESULTS: A total of 144 valid questionnaires were returned. Logistic regression analysis showed that relevant feedback in discussion classes (adjusted odds ratio [AOR], 5.071; p<0.001), frequency of e-portfolio feedback (AOR, 1.813; p=0.012), and motivation by e-portfolio feedback (AOR, 1.790; p=0.026) predicted a greater likelihood of understanding the continuity of the patient's medical experience. Relevant feedback from faculty members in discussion classes (AOR, 3.455; p<0.001) and frequency of e-portfolio feedback (AOR, 2.232; p<0.001) also predicted a greater likelihood of understanding the concept of patient-centered care. CONCLUSION: Student-faculty interactions, including relevant feedback in discusstion classes, frequency of e-portfolio feedback, and motivation by e-portfolio feedback were found to be important factors in the LIC program.

Impact of COVID-19 on Lifestyle, Personal Attitudes, and Mental Health Among Korean Medical Students: Network Analysis of Associated Patterns.

The current COVID-19 pandemic have affected our daily lifestyle, pressed us with fear of infection, and thereby changed life satisfaction and mental health. The current study investigated influencing cascade of changes during the COVID-19 among the lifestyle, personal attitudes, and life (dis)satisfaction for medical students, using network-based approaches. This cross-sectional survey used self-reports of 454 medical students during June and July of 2020. Depressive mood, anxiety, and intention to drop out of school were observed in 11.9, 18.5, and 38.3% of medical students, respectively. Directed acyclic graph that estimated directional propagation of the COVID-19 in medical students' daily lives initiated from the perception of unexpected event, propagated to nervous and stressed feeling, trouble relaxing, feeling like a failure, and were followed by trouble concentrating, feeling loss of control for situation, and fear of infecting colleagues. These six features were also principal mediators within the intra-individual covariance networks comprised of changed lifestyle, personal attitude, and mental health at COVID-19 pandemic. Psychosocial supports targeting nervousness, trouble relaxing and concentrating, fear of spreading infection to colleagues, feelings of a failure or loss of situational control are required for better mental health of medical students during the COVID-19 pandemic.

Guidelines for accreditation of endoscopy units: quality measures from the Korean Society of Coloproctology.

PURPOSE: Colonoscopy is an effective method of screening for colorectal cancer (CRC), and it can prevent CRC by detection and removal of precancerous lesions. The most important considerations when performing colonoscopy screening are the safety and satisfaction of the patient and the diagnostic accuracy. Accordingly, the Korean Society of Coloproctology (KSCP) herein proposes an optimal level of standard performance to be used in endoscopy units and by individual colonoscopists for screening colonoscopy. These guidelines establish specific criteria for assessment of safety and quality in screening colonoscopy. METHODS: The Colonoscopy Committee of the KSCP commissioned this Position Statement. Expert gastrointestinal surgeons representing the KSCP reviewed the published evidence to identify acceptable quality indicators and indicators that lacked sufficient evidence. RESULTS: The KSCP recommends an optimal standard list for quality control of screening colonoscopy in the following 6 categories: training and competency of the colonoscopist, procedural quality, facilities and equipment, performance indicators and auditable outcomes, disinfection of equipment, and sedation and recovery of the patient. CONCLUSION: The KSCP recommends that endoscopy units performing CRC screening evaluate 6 key performance measures during daily practice.

Tumor Size >5 cm and Harvested LNs <12 Are the Risk Factors for Recurrence in Stage I Colon and Rectal Cancer after Radical Resection.

Recurrence can still occur even after radical resection of stage I colorectal cancer (CRC). This study aimed to identify subgroups with a high risk for recurrence in the stage I CRC. We retrospectively reviewed prospectively collected data of 1952 patients with stage I CRC after radical resection between 2002 and 2017 at our institute. 1398 (colon, 903 (64.6%), rectum, 495 (35.4%)) were eligible for analysis. We analyzed the risk factors for recurrence and survival. During the follow-up period (median: 59 months), 63 (4.6%) had a recurrence. The recurrence rate of rectal cancer was significantly higher than that of colon cancer (8.5% vs. 2.3%). Left-sided tumors, T2, tumor size >5 cm, and lymphovascular invasion were independent risk factors of colon cancer recurrence. Male, preoperative carcinoembryonic antigen (CEA) ≥2.5 ng/mL, and harvested lymph nodes (LNs) <12 were independently associated with recurrence of rectal cancer. Recurrence affected OS (5-year OS: 97.1% vs. 67.6%). Despite curative resection, survival sharply decreased with recurrence. The risk factors for recurrence were different between colon and rectal cancer. Patients with a higher risk for recurrence should be candidates for more aggressive surveillance, even in early-stage CRC.