Clinical Features and Factors Associated With Surgical Treatment in Patients With Complicated Colonic Diverticulitis

PURPOSE: Colonic diverticulitis is uncommon in Korea, but the incidence is rapidly increasing nowadays. The clinical features and the factors associated with complications of diverticulitis are important for properly treating the disease. METHODS: A retrospective review of the medical records of 225 patients that were prospectively collected between October 2007 and September 2016 was conducted. RESULTS: Diverticulitis was detected mainly in men and women aged 30 to 50 years. Diverticulitis more frequently affected the right colon (n = 194, 86.2%), but age was higher in case of left colonic involvement (42 years vs. 57 years, P < 0.001). Percentages of comorbidities (65.6% vs. 23.8%, P < 0.001), complications (65.6% vs. 6.2%, P < 0.001), and surgical treatment (50.0% vs. 4.1%, P < 0.001) were significantly higher in patients with left colonic diverticulitis. In the multivariate analysis, a risk factor for complicated diverticulitis was left colonic involvement (P < 0.001; relative risk [RR], 47.108; 95% confidence interval [CI], 12.651–175.413). In complicated diverticulitis, age over 50 was the only significant risk factor for surgical treatment (P = 0.024; RR, 19.350; 95% CI, 1.474–254.023). CONCLUSION: In patients over 50 years of age with left colonic diverticulitis, a preventive colectomy should be reconsidered as one of the options for treatment.

Bowel Anastomosis in Single Port Laparoscopic Right Hemicolectomy: Comparison of Functional End to End Anastomosis and Isoperistaltic Side to Side Anastomosis

PURPOSE: Colorectal surgeries by single port laparoscopic surgery (SPLS) are increasing. While recent studies have reported results that are similar with the idea of conventional laparoscopy, SPLS is considered superior to conventional laparoscopy with regard to cosmetic aspects. We investigated the question of whether length of incision and postoperative recovery are different depending on the method of anastomosis in patients who underw ent SPLS right hemicolectomy (RHC). METHODS: Data on patients who underwent SPLS RHC from May 2011 to April 2012 at Samsung Medical Center were retrospectively collected. Among 117 patients, 31 received functional end-to-end anastomosis (FEEA) while 86 received isoperistaltic side-to-side anastomosis (ISSA). RESULTS: Operation time was shorter in FEEA compared to ISSA (152+/-42 vs 172+/-35 min, p=0.01). Neither group required an additional port. Although wound extension for specimen delivery tended to be frequent in loop type specimen after FEEA, the result was statistically insignificant (58.1 vs 43.0%, p=0.15). No difference in wound length was observed (4.4+/-1.0 vs 4.5+/-1.5 cm). Length of stay was longer in ISSA compared to FEEA (6.3+/-2.1 vs 7.9+/-4.3 days, p=0.01), and there was no difference in first gas passage (2.5+/-0.9 vs 2.8+/-0.9 days, p=0.26). Although three patients (9.7%) with FEEA and 19 patients (22.1%) with ISSA had postoperative complications, the difference was insignificant. CONCLUSION: Theoretically, delivery of a tube shaped specimen after ISSA is expected to reduce unnecessary wound extension and possible tumor dissemination compared to loop shape specimen after FEEA. However, results of our study showed no advantage in recovery period and wound length. We suggest that future prospective study might reveal more valuable conclusions on the subject.

Oncologic Outcome after Cessation or Dose Reduction of Capecitabine in Patients with Colon Cancer

PURPOSE: Oral capecitabine has been used as adjuvant therapy for colorectal cancer patients since the 1990s. Patient-initiated cessation or reduced use of capecitabine occurs widely for various reasons, yet the consequences of these actions are unclear. The present study sought to clarify treatment outcomes in such patients. METHODS: The study included 173 patients who had been diagnosed with stage II or III colon cancer according to the pathologic report after radical surgery at Samsung Medical Center from May 2005 to June 2007 and who had received capecitabine as adjuvant therapy. The patients were divided into groups according to whether the dose was reduced (I, dose maintenance; II, dose reduction) or stopped (A, cycle completion; B, cycle cessation). Recurrence and disease-free survival rates between the two groups each were analyzed. RESULTS: Of the 173 patients, 128 (74.6%) experienced complications, most frequently hand-foot syndrome (n = 114). Reduction (n = 35) or cessation (n = 18) of medication was most commonly due to complications. Concerning reduced dosage, both groups displayed no statistically significant differences in recurrence rate and 3-year disease-free survival rate. Concerning discontinued medication use, the cycle completion group showed an improved recurrence rate (P = 0.048) and 3-year disease-free survival rate (P = 0.028). CONCLUSION: The results demonstrate that maintaining compliance with capecitabine as an adjuvant treatment for colon cancer to preventing complications positively affects patient prognosis.