Laparoscopic Assisted Colectomy Versus Open Colectomy; Retrospective Case-Control Study

PURPOSE: Despite many reports on laparoscopic-assisted colectomies (LAC) over the past decade, the feasibility of their use in both benign and malignant disease of the colon is not clear. The purpose of this study was to evaluate the feasibility and safety of LAC for the treatment of colonic diseases. METHODS: Between April 2000 and August 2002, we attempted a laparoscopic-assisted colectomy in 95 patients (LAC group). We excluded 3 patients who had converted to open surgery. The surgical outcomes were compared with 92 matched patients who underwent conventional open surgery during the same period (open group), focusing on the results of the surgery, postoperative recovery, complications and oncologic clearance. Between the two groups, there were no significant differences in age, Dukes stage, and type of resection. RESULTS: There were 29 benign and 63 malignant diseases. The mean operating time for the LAC group and the open group were 167.9 and 95.1 minutes, respectively (P<0.00). However, the time taken for passing gas (40.4 hours vs 56.7 hours)(P=0.02) and the length of hospital stay (7.9 days vs 8.6 days) (P=0.07) were significantly shorter in the LAC group than in the open group. Nine patients in the LAC group had complications (9.7%): anastomotic site bleeding (4), chyle leakage (3), urinary retention (1), and ileus (1). All were treated conservatively. There were no differences in complication rates between the groups. The average number of harvested lymph nodes was 20.9 (2~64) in the LAC group and 21.5 (4~60) in the open group (P=0.49). The average distal resection margins were 3.7 (2.0~9.0) cm in the LAC group and 3.3 (1.0~5.0) cm in the open group (P=0.21) for an anterior resection and 3.2 (1.0~7.0) cm in the LAC group and 2.3 (0.7~7.0) cm in the open group for a low anterior resection (P=0.48). CONCLUSIONS: This study showed that LAC had an advantage over open surgery in terms of earlier recovery. Oncological clearance (the number of lymph nodes removed and the resection margins) did not differ between the two procedures. Thus, LAC is a feasible technique in the treatment of colon disease with acceptable morbidity. However, long-term data from a randomized trial is needed.

Prognostic Factors Influencing Survival in Ampullary Carcinoma after Radical Resection

PURPOSE: This retrospective study was aimed to determine prognostic factors after radical resection of an ampullary carcinoma. METHODS: Medical records of patients with adenocarcinoma of the ampulla of Vater who had undergone pancreaticoduodenectomy between Dec. 1994 and May 2002 were reviewed. This study included 59 men and 40 women with a mean age of 58.9 years. 62 patients underwent Whipple procedures, 36 patients, pylorus preserving pancreaticoduodenectomy and 1 patient, total pancreatectomy. Actuarial survival rates were calculated using the Kaplan-Meier method. A Cox proportional hazards model was used to test the independent predictors of survival. P<0.05 was considered statistically significant. RESULTS: The overall 5-year survival rate was 45.4% with 3% mortality and 34.3% morbidity. According to the pTNM stage, the 5-year survival rates were 91.7%, 54.3%, 28.5% and 0% at stages I, II, III, and IV (P<0.01), respectively. The patient survival was significantly impaired by the depth of invasion, lymph node metastasis and intraoperative transfusion (P<0.05). In a multivariate analysis, only lymph node metastasis was a statistically independent prognostic factor. CONCLUSION: pTNM stage is a good prognostic indicator for an ampullary carcinoma after pancreaticoduodenectomy and patients with lymph node metastasis should be identified as high risk and considered as candidates for further adjuvant therapy.

Clinical Study of Hepatoblastoma in Children

PURPOSE: By the help of neoadjuvant chemotherapy, resectability and survival rate of hepatoblastoma have improved. To evaluate recent treatment outcome of hepat-oblastoma, pediatric hepatoblastoma in our institute were reviewed. METHODS: The medical records of 11 pediatric hepatoblastoma patients were analysed retrospectively. RESULTS: All but one patient old were under 3 years old at diagnosis (range: 1~150 months). The male to female ratio was 6 : 5. Two patients were treated without neoadjuvant chemotherapy. One of them received right lobectomy for initially resectable tumor. Another one patient received a liver transplant for multiple unresectable tumors and liver cirrhosis. Nine patients received neoadjuvant chemotherapy based on the CCG-823F or CCG-8881A protocol. Two of them showed lung metastasis, but the metastatic nodules were reduced in size and number in one patient, disappeared in another patient after neoadjuvant chemotherapy. The mean tumor size at diagnosis in 9 patients was 10.5 cm (range: 6.4~14 cm). After neoadjuvant chemotherapy, the mean size reduction was 53% (range: 37~67%) in 9 patients. In 8 out of 9 patients (88%) a curative resection was performed after average 4 cycles of neoadjuvant chemotherapy. All the patients were followed for a median duration of 21 months (range: 5~88 months). Nine of all 11 patients are still alive without tumor recurrence. CONCLUSION: Neoadjuvant chemotherapy was able to increase the resectability of an initially unresectable hepatoblastoma and should not be abandoned even with a distant metastasis such as the lung. Liver transplantation is a good back-up for an unresectable hepatoblastoma.