Histological analysis of explanted implant-bone interface: a case report

Osseointegration has been reported to be a dynamic process in which the alveolar bone comes in direct contact with the implant. Various methods were tried to evaluate degree of osseointegration and the measurement of bone-implant contact (BIC) have been commonly used among them. To properly assess the BIC, only histologic analysis is available. However, few studies evaluated BIC of successfully osseointegrated implants in humans. Thus, this is a unique opportunity when implants should be explanted due to inappropriate positioning of implant, presence of pain or sensory disturbance, or broken screw or fixture. This report presents a case of the implant underwent 3-year functional load and a histologic analysis after the fixture fracture. The histomorphometric analysis revealed 53.1% of BIC measured along the whole implant and 70.9% measured only in subcrestal area, respectively. In the present study, although the implant was fractured, a high degree of BIC was observed.

The Clinical Features and Predictive Risk Factors for Reoperation in Patients With Perianal Crohn Diseases; A Multi-Center Study of a Korean Inflammatory Bowel Disease Study Group

PURPOSE: Perianal lesions are common in Crohn disease, but their clinical course is unpredictable. Nevertheless, predicting the clinical course after surgery for perianal Crohn disease (PCD) is important because repeated operations may decrease patient's quality of life. The aim of this study was to predict the risk of reoperation in patients with PCD. METHODS: From September 1994 to February 2010, 377 patients with PCD were recruited in twelve major tertiary university-affiliated hospitals and two specialized colorectal hospitals in Korea. Data on the patient's demographics, clinical features, and surgical outcomes were analyzed. RESULTS: Among 377 patients, 227 patients were ultimately included in the study. Among the 227 patients, 64 patients underwent at least one reoperation. The median period of reoperation following the first perianal surgery was 94 months. Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively. In multivariate analysis (Cox-regression hazard model), reoperation was significantly correlated with an age of onset less than 20 years (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.07-3.48; P = 0.03), history of abdominal surgery (HR, 1.99; 95% CI, 1.08-3.64; P = 0.03), and the type of surgery. Among types of surgery, fistulotomy or fistulectomy was associated with a decreased incidence of reoperation in comparison with incision and drainage (HR, 0.19; 95% CI, 0.09-0.42; P < 0.001). CONCLUSION: Young age of onset and a history of abdominal surgery were associated with a high risk of reoperation for PCD, and the risk of reoperation were relatively low in fistulotomy or fistulectomy procedures.

A Case of Small Bowel Obstruction Due to a Paracecal Hernia

Internal hernias are rare causes of small bowel obstruction, and one such internal hernia is the paracecal hernia. We report a case of a small bowel obstruction related to a paracecal hernia in which a preoperative diagnosis was made on computed tomography. A laparotomy was performed for definitive diagnosis and treatment. The surgery achieved a good outcome.

Value and Interpretation of Resection Margin after a Colonoscopic Polypectomy for Malignant Polyps

PURPOSE: This study was designed to compare the clinicopathologic findings of an endoscopic polypectomy for malignant polyps with subsequent surgery and to evaluate the appropriateness of the pathologic finding criterion of the resection margin as an indicator for surgery in cases of malignant colorectal polyps. METHODS: We examined the clinicopathologic characteristics, complications and prognoses among the patients who underwent a colonoscopic polypectomy in both our hospitals and at other hospitals from April 2003 and April 2010. These patients were divided into two groups, the group (non-operation group) that only underwent a polypectomy (n = 37) and the group (operation group) that underwent a polypectomy with subsequent surgery (n = 33). RESULTS: There were no differences between two groups in the ratios of the number of men to the number of women, the ages or the comorbidities. In terms of endoscopic findings, we found no differences between the two groups in the locations of the polyps, the sizes of the polyps, or the presence of stalks. However, ulceration of polyps was higher in the non-operation group (51.5% vs. 21.6%; P = 0.009), as was the case with submucosal invasion (75.8% vs. 16.2%; P < 0.005). When an endoscopic polypectomy was performed, incomplete resection margins and specimens with margins involved occurred more frequently in the operation group (93.9% vs. 51.4%; P < 0.005), but no residual tumor was detected in 31 of 33 (93.9%) patients in that group. One pathologist reviewed the specimens of 54 patients (operation group, 19; non-operation group, 36). Six of the 19 polyps (31.6%) in the operation group and fifteen of the 36 polyps (41.7%) in the non-operation group had a margin without cancer cells. CONCLUSION: We may accept the criterion of a safe margin, including a coagulation zone. A multidisciplinary approach has to be developed by surgeons, endoscopists and pathologists based on a discussion of the risk factors for the patient before making a decision on the treatment treatment.

Rectal Lymphogranuloma Venereum in a Man Who Had Sex with Men

We present the case of a 41-yr-old homosexual man who was managed for suspected rectal cancer before lymphogranuloma venereum was clinically diagnosed. At first, he presented with constipation and tenesmus for several days. Upon rectal examination, the mass was palpated at 3 cm from the anal verge. Colonoscopy revealed a tumor of lower rectum, but multiple endoscopic biopsies were unable to reveal the nature of the tumor, so the pathologist just gave the diagnosis of a rectal pseudo-tumor. Positive chlamydial serology was found, and the final diagnosis was made. He was treated for Chlamydia trachomatis with Doxycycline, 100 mg twice daily for 21 days.

Thrombotic Thrombocytopenic Purpura that Developed after Rectal Cancer Surgery

Thrombotic thrombocytopenic purpura (TTP) in the acute postoperative setting is a syndrome that presents with various symptoms such as microangiopathic hemolytic anemia, thrombocytopenia, fever, renal failure, and change of the patient's mental status. Though most of the previous reports of postoperative TTP have been in conjunction with cardiac or vascular surgery, it has also been reported following orthopedic and abdominal surgeries. We present here a case of a 78 year-old female who was diagnosed with rectal cancer and who developed TTP the 2nd day following her cancer surgery. Because the presentation can be confused with other early postoperative complications, TTP should be considered in the differential diagnosis of the patient who develops unexplained anemia and thrombocytopenia following an abdominal surgery. Awareness of this syndrome is essential because starting plasmapheresis early can be life-saving.

The Complications of Stoma Take-down

PURPOSE: The study aimed to investigate the complications accompanying stoma take-down and to elucidate the significant factors associated with complications. METHODS: We recruited 341 patients who underwent stoma take-down in our hospital between January 2000 and December 2005. Data on various complications during this procedure, i.e., wound infection, prolonged ileus, and anastomotic leakage, were collected with respect to patient- and operation-associated parameters. RESULTS: Complications of stoma take-down developed in 72 (21.1%) patients: 53 (20.3%) patients in a loop ileosotmy, 10 (21.3%) patients in a loop colostomy, and 9 (27.3%) patients in a Hartmann colostomy, The overall complication rate was significantly associated with the urgency of the primary operation (elective vs. emergent, 17.8% vs. 29%, P=0.017), and with the operation time ( 80 min, 16.5% vs. 29.3%, P=0.005). Among the complications, ileus developed in 46 (13.5%) patients, wound infection in 17 (5.0%) patients, and anastomotic leakage in 5 (1.5%) patients. Wound infection was related to the type of stoma between a loop ileostomy and a Hartmann colostomy (3.5% vs. 12.1%; P=0.014), but no other factors were associated with other complications. CONCLUSIONS: There were significant differences in overall complications in relation to urgency of the primary operation and the operation time, but there was no statistical difference in complications between a loop ileostomy and a loop colostomy take- down groups. The significance of these factors appears to be reduced with accurate surgical technique and patient care.

Outcomes after a Hepatic Resection for Multiple Hepatic Metastases from Colorectal Cancer

PURPOSE: Surgical resection is still considered as the gold standard in patients with hepatic metastases from colorectal cancer. The impact of the number of hepatic metastases is a controversial issue. We aimed to evaluate the outcomes and the prognostic factors after hepatic resection in multiple hepatic metastases from colorectal cancer. METHODS: Between June 1989 and October 2005, 42 patients underwent hepatic resections for three or more hepatic metastases from colorectal cancer. Disease-free survival analyses were performed on patients grouped as a function of the following factors: age, sex, preoperative serum CEA level, primary tumor site, nodal status, intrahepatic distribution, diameter of the liver lesion, their number, and the resection margin. RESULTS: Of the 42 patients, 29 (69.0%) developed recurrence (16 in the liver alone, 5 in the liver and another distant site, 8 in a distant site alone) during a median follow-up of 24 months. The overall 1-, 2-, and 5-year survival rates were 89.1%, 58.6%, and 31.8%, respectively. The 1-year and 2-year disease-free survival rates were 38.1 and 29.4%, respectively. There was no postoperative mortality and the morbidity rate was 11.9%. The disease-free survival rate was independently associated with the resection margin of the metastatic tumor (P=0.017). The 1-year disease- free survival rates in patients with more than a 5-mm resection margin and with less than a 5-mm resection margin were 72.7%, and 25.8%, respectively. CONCLUSIONS: If technically feasible, an aggressive hepatic resection should be performed for the treatment of multiple hepatic metastases from colorectal cancer. The surgical resection margin may govern the outcomes in patients with surgically curable hepatic metastases from colorectal cancer.

The Role of General Surgeon in Gynecologic Oncology Surgery

PURPOSE: Resection of the bowel or solid organs may be required for pelvic tumor surgery. The present study was performed to assess combined surgical procedures and determine the role of the general surgeon in gynecologic oncology surgery METHODS: We performed a retrospective study of 135 patients with gynecologic malignancy who underwent a combined operation with a general surgeon between January 2000 and December 2005 at Asan Medical Center. The purpose of the combined operation was categorized into 3 groups: a tumor debulking operation, a resolution of intraoperative complications by a gynecologic surgeon, or an intraoperative diagnostic change. RESULTS: The incidence of combined operations for debulking, resolution of intraoperative complications, and intraoperative diagnostic changes were 103 cases (76.3%), 22 cases (16.3%), and 10 cases (7.4%), respectively. Ovarian cancer was the most common gynecologic malignancy (74.1%) and the rate of a combined operation with a general surgeon in ovarian cancer was 18.5% during the time period. Colorectal resection was the most common procedure by a colorectal surgeon (61.5%). Twenty four patients (17.8%) experienced postoperative complications, including ileus, wound infection, pancreas leakage, and stomal necrosis, with no significant differences according to the purpose of combined operation, pathologic diagnosis, or bowel preparation. The rate of a preoperative consultation to a general surgeon by gynecologic surgeons in cases with colorectal or solid organ invasion preoperatively was 53.2%. CONCLUSION: A general surgeon is an important consultant in a debulking operation of gynecologic malignancies, especially ovarian cancer, or treatment of complications. Thorough preoperative evaluation, bowel preparation, and preoperative consultation to a general surgeon is important in gynecologic oncology surgery.

Postoperative Complications and Recurrence in Patients with Crohn's Disease

PURPOSE: This study was performed to assess postoperative complications and recurrence rates and to elucidate the risk factors in Crohn's disease (CD). METHODS: A retrospective review was undertaken for patients who had undergone bowel surgery at Asan Medical Center between October 1991 and June 2006. Symptomatic recurrence was defined as the presence of symptoms related to CD that was subsequently verified by radiologic or endoscopic finding. Surgical recurrence was defined as the need for repeated surgery for enteric CD. RESULTS: There were 160 patients with a mean follow up of 34 months (108 men and 52 women; mean age: 29.7+/-10.9). The most common indication for surgery was a complication of CD, such as intra-abdominal abscess (31.9%), intestinal obstruction (21.9%), and internal fistula (19.4%). Another frequent indication was medical intractability (23.8%). The types of surgical procedures were ileocolic resection (50.0%), small bowel resection (25.0%), total/subtotal colectomy (17.5%), and others. The cumulative symptomatic recurrences were 15.9% and 36.4% at 2 and 5 years, and the cumulative surgical recurrence was 13.6% at 5 years. The cumulative surgical recurrence was higher for stricturing-type CD than for penetrating-type CD (P=0.049). No other significant risk factor for recurrence was found in our study. Twenty patients (12.5%) had postoperative complications, such as intra-abdominal abscess, anastomosis leakage, obstruction, and wound infection. CONCLUSIONS: The postoperative complication and recurrence rates were acceptable. For stricturing-type Crohn's disease surgical recurrence is higher than penetrating type, but long-term follow up is needed to verify the risk factors for recurrence.

Desmoid Tumor in Familial Adenomatous Polyposis (FAP)

PURPOSE: This research was conducted to assess the incidence, clinical characteristics, and treatment outcomes for desmoid tumors in patients with familial adenomatous polyposis (FAP). METHODS: At Medical Center, we recruited 47 patients who had been diagnosed as having intraabdominal or abdominal wall desmoid tumor between Aug. 1995 and Dec. 2005. We compared FAP-associated desmoid tumors with non-FAP-associated desmoid tumors according to clinical characteristics and treatment outcomes. RESULTS: Desmoid tumors developed 12/46 (26.1%) in FAP, 1/14 (7.1%) in attenuated FAP and 34 in non-FAP associated. Unlike non-FAP-associated desmoid tumors, the occurrence of FAP-associated desmoid tumors in tended to be higher in the earlier age groups (< or =40 yrs, 92.3% vs 67.6%, P=0.082) and no sexual predominancy was observed (male:female ratio of 1.2:1 vs a tumor ratio 1:3.9, P=0.033). Intraabdominal-type desmoid tumors associated for the majority of FAP-associated desmoid tumors (92.3% vs 38.2%, P=0.002), and 70% of the desmoid tumors occurred within 3 years after total proctocolectomy. In the treatment of FAP-associated intraabdominal desmoid tumors, surgery was performed in 7 cases (58.3%), and complete resections were done in only 3 cases (25%), with one recurrence. In non-FAP-associated desmoid tumors, complete resection was possible in 10 cases (76.9%), and there was no recurrence (P=0.036). The medical treatment for unresectable or incompletely resectable cases in cases of non-FAP-associated desmoid tumor was good, but for FAP-associated desmoid tumors, the effectiveness was not good, and further investigation was needed. CONCLUSIONS: Intraabdominal desmoid tumors in FAP patients occurred frequently in the early (< or =3 yrs) postoperative period, and the treatment, outcome including surgery and medication, outcome was not good in patients with FAP-associated desmoid tumors.

Risk Factors of Pouch Failure after a Restorative Proctocolectomy

PURPOSE: The aim of this study was to analyze the risk factors of pouch failure after a restorative proctocolectomy. METHODS: A restorative proctocolectomy was performed in 169 patients between November 1989 and May 2007. A retrospective review was done for postoperative complications and follow-up results of pouch failure, and the risk factors of pouch failure were analyzed. Pouch failure was defined as having occurred when a permanent ileostomy was constructed, regardless of pouch removal. The median follow-up was 48 (3~155) months. RESULTS: Among the 169 cases, 86 cases involved ulcerative colitis (UC group), 70 cases involved familial adenomatous polyposis or attenuated adenomatous polyposis coli (FAP group), and the remaining 13 involved hereditary nonpolyposis colorectal cancer or synchronous colon and rectal caner (CRC group). The sex ratios and the incidences of comorbidity were not significantly different between the groups, but the mean ages were. Complications occurred in 61 patients (36.1%): pelvic sepsis (28 cases), pouchitis (23 cases), desmoid tumor (12 cases), wound infection (10 cases), and anastomosis stricture (4 cases). The 5-year cumulative rate of pouch failure was 9.8%. Presence of a desmoid tumor, pelvic sepsis, and anastomosis stricture were risk factors of pouch failure. CONCLUSIONS: The cumulative pouch failure rate after a restorative proctocolectomy was 9.8% for 5 years, and pouch failure was associated with the presence of a desmoid tumor, pelvic sepsis, and anastomosis stricture.

Pathologic Complete Remission after Preoperative Chemoradiation for Rectal Cancer: Analysis of Clinicopathologic Characteristics and Oncologic Outcome

PURPOSE: To assess the clinico-pathologic characteristics associated with pathologic complete remission (pCR) after preoperative chemoradiotherapy (PCRT) for rectal cancer and evaluate predictive factors for pCR and prognostic impact of pCR. METHODS: We analyzed 325 patients who underwent PCRT and surgical resection between September 1999 and September 2006. We have treated 319 patients with PCRT for locally advanced rectal cancer and 6 patients for sphincter-saving procedure. Chemotherapy consisted of either of bolus 5-FU (325 mg/m2/d) or capecitabine (1,650 mg/m2/d) for the duration of radiation and after surgery. Radiation therapy was delivered and surgery was performed 4~6 weeks following the completion of PCRT. We compared pCR patients with non-pCR patients according to the clinico-pathologic characteristics and followed up with a median of 32 (range, 12~91) months. RESULTS: The pCR (n=41, 12.6%) and non-pCR (n=284) groups were comparable in age, sex, location of the tumor, chemotherapy regimen, pre-CRT CEA level except pre-CRT clinical stage (12.2% vs. 0.4% in stage I, P= 0.047). There was no significant difference in genetic characteristics between groups. There was no specific predictive factors for pCR except pre-CRT T category (pCR in T2 (5/8, 62.5%) vs. T3 (33/283, 11.7%) or T4 (3/33, 9.1%), P=0.001). The 3-year disease free survival (DFS) was 100% and 83.6% in the pCR and non-pCR group respectively (P=0.012). There were 5 local and 34 systemic recurrences only in non-pCR group. CONCLUSIONS: Rectal cancer patients with pCR after PCRT have an excellent prognosis and are unlikely to fail locally or systemically because of the effect of stage. However there was no specific predictive factor for pCR except preoperative T category.

The Long-term Oncological Outcome of a Sphincter-saving Resection and an Abdominoperineal Resection for Lower Rectal Cancer

Purpose: The oncological safety of a sphincter-saving resection (SSR) in lower rectal cancer is widely accepted, and both an abdominoperineal resection (APR) and a SSR are used in potentially curative surgery. This retrospective study was performed to compare the long-term oncological outcomes after an APR and a SSR in patients with lower rectal cancer (within 5 cm from the anal verge). Methods: We recruited 441 lower rectal cancer patients who underwent curative resections (APR: 305, SSR: 136) between 1995 and 2000. A total mesorectal excision and autonomic nerve preservation were routinely performed. The median follow- up period was 65 months. Results: Most demographic findings were comparable between the groups; however, the APR groups revealed more advanced pathological characteristics (tumor depth, size, cell differentiation, and metastatic LN number). The local recurrence rates after an APR and a SSR were 12.8% and 7.4%, respectively (P= 0.09). An independent risk factor of local recurrence was LN metastasis only. Distant recurrence was higher in the APR group (26.4%) than in the SSR group (13.2%), but on multivariate analysis the difference was not significant (P=0.17). The 5-year cancer-specific survival rates after an APR and a SSR were 73.2% and 87.6%, respectively (P<0.05). Particularly, there was a significant survival difference for stage III patients (APR: 59.0% vs. SSR: 83.0%, P<0.05). However, an APR was not an independent prognostic factor for cancer-specific survival in the multivariate analysis (P=0.07). Conclusions: An APR per se did not influence local recurrence after a curative resection for lower rectal cancer. The poor cancer-specific survival in the stage III APR group might be attributed to increased distant metastasis due to its more distal location.

The Characteristics of Colorectal Cancer in Patients Older than 80 Years

PURPOSE: The frequency of surgery for elderly Koreans with colorectal cancer has increased because of the current life expectancy rates. The purpose of this study is to identify the characteristics of colorectal cancer in very elderly patients, to determine the optimal treatment decision, and to evaluate the patients prognosis. METHODS: Between 1989~2005, 181 patients (96 men and 85 women, median age 82) over the age of 80 with colorectal cancer underwent surgery at OO hospital, Korea. Medical records with these patients' co-morbidities, symptoms, clinico-pathologic characteristics, complications, survival, and other relevant data were obtained and analyzed retrospectively. RESULTS: The principal clinical symptoms were bleeding (45.3%) and bowel habit change (40.9%). Of these patients, 126 had at least one preoperative co-morbidity, and hypertension (29.3%), and cardiac disease (16.0%) were common. Curative surgery was performed in 82.9% (n=150). Emergency surgery was performed in 6.1% (n=11), and the principal cause was obstruction. The most common location of the colorectal cancer was the rectum (39.8%). There were postoperative complications in 36.4% of the patients, including voiding difficulty (12.2%) and wound infection (9.9%). The thirty-day mortality rate was 0.6% (n=1). A preoperative, low PaO2 level significantly increased the incidence of postoperative complications (P=0.036). The five-year survival rate of the curative resection group was higher than that in the remaining patients (44.3% vs. 38.8%, P<0.001). CONCLUSIONS: Although the preoperative morbidity was high in these very elderly patients, it could be lowered with strict patient management. In addition, these patients showed a relatively good survival rate. Therefore, we believe that major, curative, colorectal surgery should be performed in selected very elderly patients.

Distant Metastasis Identified Immediately after Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

PURPOSE: This study was designed to analyze the clinical characteristics of patients with immediate distant metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer and to help select patients for preoperative chemoradiotherapy. METHODS: Two hundred eight patients, who underwent preoperative chemoradiotherapy for locally advanced rectal cancer, were included. Patients were excluded from the study if they had tumor types other than an adenocarcinoma, prior chemotherapy, radiotherapy, or hereditary nonpolyposis colorectal cancer. The clinicopathological characteristics of patients with distant metastasis immediately after preoperative chemoradioterapy were compared with those of patients without distant metastasis. RESULTS: Distant metastases immediately after preoperative chemoradiotherapy were identified in 15 patients (7.2%). The liver was the most common site of metastasis (8/15), followed by peritoneal seeding (4), the lung (2), bone (1), and the aortocaval lymph node (1). Age, sex, chemotherapy regimen used, and primary tumor response for patients with distant metastases were similar to those for patients without distant metastasis. In patients with immediate distant metastasis, pre-chemoradiotherapy CEA was significantly higher (11.1 vs. 7.4 ng/ml; P= 0.003). CONCLUSIONS: Immediate distant metastasis after preoperative chemoradiotherapy is associated with pre-chemoradiotherapy CEA level. A careful work-up is necessary when pre-chemoradiotherapy CEA is higher than the normal range.

Risk Factors and Oncologic Impact of Anastomotic Leakage after Rectal Cancer Surgery

PURPOSE: Anastomotic leakage (AL) is a serious and life-threatening complication following rectal cancer surgery. The impact on long-term oncologic outcome in patients with AL is not clear. The aim of this retrospective study was to evaluate the risk factors of AL and its impact on long-term prognosis after rectal cancer surgery. METHODS: We investigated 1,391 patients who underwent primary resection and anastomosis for rectal cancer between January 1997 and August 2003. Operations were performed as follows: AR (n=164), LAR (n=898), uLAR (n=329). Standard procedures in our clinic were mesorectal excision according to tumor location and autonomic nerve preservation. Median follow-up period was 40.1 months (2~96 months). RESULTS: AL rate was 2.5% (n=35). Gender (male), age (>60 years) and uLAR were independent risk factors in multivariate analysis (HR: 3.03, 95% CI: 1.18~7.22; HR: 2.42, 95% CI: 1.12~7.83; HR: 2.68, 95% CI: 1.08~7.09, respectively). Local recurrence in the AL group was significantly higher than that in the non-AL group (P<0.05), but there was no significant difference in multivariate analysis (P=0.14). Systemic recurrence between both groups was not statistically different. The 5-year overall survival rate was significantly lower in the AL group than in the non-AL group (55.1% vs 74.1%, P<0.05) and the cancer- specific survival rate was lower in the AL group than in the non-AL group (63.0% vs 78.3%, P=0.05). CONCLUSIONS: Age, gender, and anastomotic level were risk factors for AL after rectal cancer surgery and anastomotic leakage was associated with a poor survival.

Long-term Oncological Outcomes of T1 Rectal Cancer according to the Therapeutic Modalities

PURPOSE: Recent studies have showed a 7~15% lymph node metastasis rate in T1 rectal cancer. Surgical options for T1 rectal cancer are radical resections, local excisions, and local excisions with adjuvant radiotherapy. Outcomes according to the type of surgery are variable. The present study was performed to assess outcomes of T1 rectal cancer according to therapeutic modalities and to provide guidelines for appropriate treatment of T1 rectal cancer. METHODS: A retrospective study of 117 patients with T1 rectal cancer who underwent surgery between June 1989 and December 2002 at Asan Medical Center was conducted. Radical resections, local excisions, and local excisions with adjuvant radiotherapy were performed as therapeutic modalities. Adjuvant radiotherapy after local excision was performed in patients with sm2 or sm3 cancers, lympho-vascular invasion (+), poorly differentiated cancer, and resection margin (+) or because of a patient's refusal to undergo a radical resection. RESULTS: Twenty-five (21.3%) patients were treated by local excision, 14 (12.0%) by adjuvant radiotherapy after local excision, and 78 (66.7%) by radical resection. The distance from the anal verge was significantly longer in the radical resection group than in the local excision group (7.8+/-3.4 vs. 4.9+/-2.1 cm; P<0.001). There was no significant difference by age, sex, or pathologic findings between the three groups. There was one local recurrence in the local excision group, one distant metastasis in the local excision with adjuvant radiotherapy group, and two distant metastases in the radical resection group. The 5-year cancer-specific survival and disease-free survival rates were as follows; local excision group, 94.1 and 95.8%, respectively; local excision with adjuvant radiotherapy group, 100 and 92.8%, respectively; radical resection group, 98.3 and 98.6%, respectively. There were no significant differences in survival between the groups. CONCLUSIONS: Oncological outcomes of T1 rectal cancer patients were comparable among the surgical options. Adjuvant radiotherapy is recommended after local excision in patients with risk factors, such as sm2 or sm3 cancer, poorly differentiated cancer, and positive lympho-vascular invasion.

The Clinicopathologic Factors Affecting the False Negativity of Fine Needle Aspiration Cytology (FNAC) in Breast Cancer

PURPOSE: The aim of this study was to understand the diagnostic false negative outcome of FNAC at the first clinic visit of patients in relation to various clinicopathological factors with the uni- and multivariate analysis. METHODS: From January 1993 to October 2001, the one hundred and twenty-one cases of primary palpable breast cancers which were diagnosed by FNAC were reviewed retrospectively. RESULTS: The ages of the patients varied from 24 to 84 (mean age was 51.3 years). Ten clinicopathological factors correlating with failure or success of FNAC were analyzed. In univariate analysis, statistical significances were observed in palpability (P<0.001), tumor size (P<0.001), histopathologic type (P<0.001), cellular distribution (P=0.002), TNM staging (P=0.042), mammographic findings (P<0.001). On the other hand, other factors such as age, ultrasound findings, extent of tumors, ER status, aspiratiors did not reveal any statistical significance. In multivariate analysis, palpability (P=0.002), histopathologic type (P=0.0457), mammographic findings (P=0.0161) were observed significantly. CONCLUSION: The most important factors for concerning diagnostic failure by FNAC seemed to be summarized into clinically palpability, histopathologic type, mammographic findings, inexperience and number of aspirator were also considered as a factor of diagnostic failure. In rare carcinomas such as lobular carcinoma and DCIS, high false negative rate was identified.